1. A.   Background/Context

The latest acute malnutrition (AMN) analysis by the Integrated Food Security Phase Classification (IPC) has found that 2.14 million children in parts of Pakistan are suffering acute malnutrition. The analysis conducted in 32 districts of Baluchistan, Khyber Pakhtunkhwa and Sindh provinces indicates that 23 districts are classified in IPC AMN Phase 4 (Critical), five districts in IPC AMN Phase 3 (Serious) and four districts in IPC AMN Phase 2 (Alert).[1] In the case of the IPC acute malnutrition analysis, Khuzdar, Matiari, Sukkur, Kohistan Lower and Nowshera are classified in IPC AMN Phase 3 (Serious). Upper Dir, Swat, Malakand and Charsadda are in IPC AMN Phase 2 (Alert). The remaining districts (Jafferabad, Kachhi, Kalat, Kharan, Killa Abdullah, Kila Saifullah, Loralai, Naseerabad, Nushki, Pishin, Quetta, Washuk, Dadu, Jacobabad, Jamshoro, Khairpur, Mirpur Khas, Naushehro Feroz, Kambar Shahdadkot, Sanghar, Tharparkar, Thatta and Umerkot) are classified in more severe conditions, IPC AMN Phase 4 (Critical).

In Sajawal, 14.7% of children are moderately wasted, while 4.5% are severely wasted due to lack of nutritious food, lack of access to healthcare, maternal malnutrition, and limited access to safe drinking water amongst many other factors. Furthermore, the average distance in district Sajawal for hospital/Dispensary is 12 Km which is challenging because of the poor transportation infrastructure and the fact that emergency medical services are limited, which hinders access to timely medical treatment [2]. In the district, Sujawal 25 OTP sites are operational and are delivering services to the SAM children with an overall coverage gap of 63%. The primary contributing factors contributing to acute malnutrition encompass a range of challenges, including inadequate quality and quantity of food, heightened food insecurity, insufficient sanitation coverage, elevated rates of diarrhea, acute respiratory infections (ARIs), and fever, as well as suboptimal health-seeking behaviour. Furthermore, concerns arise from low to medium levels of exclusive breastfeeding, early childbearing, low birth weight, and a prevalence of malnutrition among pregnant and lactating women (PLWs) in various districts. The amount of malnutrition in women is higher in Sindh, mainly due to cultural barriers and gender inequality; this manifests in unequal distribution of food within households, with men and boys receiving larger portions or more nutritious meals while women and girls are left with leftovers or less nutritious food, also traditional agricultural practices that don't allow women to work alongside men to help provide for their families as well as hindrance of involvement in decision making in general, this lack of autonomy as well as lack of access contributes to malnutrition of women and girls as women are unable to prioritize their own nutritional needs and their children’s. Addressing these barriers requires challenging patriarchal values and promoting gender equality to ensure equitable access to nutrition and healthcare for all individuals.

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