Surviving against the odds
How UNICEF’s Nutrition programme aided a young widow's only child in overcoming severe malnutrition
Sujawal, Sindh: “Everyone kept telling me, ‘She is not going to survive, you should prepare for her death,” shares a teary-eyed Farzana, holding her only child, Shabira in her arms as she squirms and wiggles out of her grasp and starts crawling. At 16 months, unlike most children her age, Shabira does not yet walk or stand on her own, but she looks healthy and is certainly hungry.
“It was a miracle that she not only survived, but is active and happy,” says Farzana.
Soon after her marriage, in 2022 Farzana became pregnant. However, tragedy struck during her eighth month of pregnancy when she unexpectedly became a young widow. Grief-stricken and unwanted by her in-laws, Farzana made the difficult decision to return to her childhood home, seeking solace with her mother and older brother.
“The days felt long. I felt alone and so sad without my husband, and constantly worried about the future of my unborn child,” she adds.
Her brother, Ayub, who works on a farm, was struggling to provide for his mother and sister. She felt like a burden. In her grief, during the most crucial part of her pregnancy, Farzana herself became sick and weak.
"I found it hard to prioritize my own health," she admits. "My mind was consumed by grief, and the frightening prospect of raising my child alone weighed heavily on me."
Shabira was born weak, and unfortunately, she did not receive appropriate breastfeeding, which is critical, since breastfeeding helps prevent malnutrition in all its forms. Shabira’s health was fragile, and she became a constant source of concern for her family as she cried incessantly, day and night, in the months that followed.
The family could not understand what was wrong with her and why she was constantly sick and growing weaker by the day.
“She was practically skin and bones and we could not afford to have her checked or admitted to the local hospital, which is also quite far away,” says her uncle, Ayub.
Farzana reveals that even after Shabira's birth, she often found herself lost in thoughts. This distraction might have led to her struggling to feed her baby at regular intervals.
Despite being ready for the introduction of healthy semi solid meals to complement breastfeeding, Shabira continued to experience irregular feeding over the next few months. Her food intake remained limited. By the time she was eight months old, Shabira had become severely malnourished.
In July 2023, a team supported by UNICEF arrived in the village of 200 families to initiate community-based nutrition interventions.
Led by Umbreen, the Nutrition Assistant, and her colleagues, the team began conducting monthly visits to Farzana's village. During these visits, they organized awareness sessions focusing on the advantages of exclusive breastfeeding, establishing healthy feeding routines for mothers and infants, and facilitating support groups for both mothers and fathers, involving community leaders.
Farzana brought 10-month-old Shabira to the team for a check-up. Following protocol, Umbreen conducted a mid-upper arm circumference (MUAC) measurement and found it to be a concerning 9 cm, well below the normal range. This confirmed that Shabira was suffering from severe acute malnutrition (SAM).
Shabira was prescribed a two-month treatment of ready-to-use therapeutic food (RUTF), which is rich in essential micronutrients and vitamins necessary for the recovery of children under five suffering from SAM. In addition to the RUTF, Farzana was advised to continue breastfeeding and include an age-appropriate amount of solid food for Shabira to keep her full.
“Many women claim they are exclusively breastfeeding, but upon further pressing we often learn that they are supplementing with improper feed like tea, unpasteurized buffalo milk, or impure water,” says Umbreen.
Umbreen also observed that Farzana appeared unwell herself. She advised Farzana to adopt healthy eating habits, recommending a diet rich in milk, vegetables, fruits, and rice to ensure she also receives proper nutrition.
"We counsel mothers on the importance of diverse, nutritious foods for both themselves and their children," explains Umbreen. "In essence, we are addressing the nutritional needs of two individuals affected by malnutrition."
Within two months, by her first birthday, Shabira had made a remarkable recovery. Her MUAC had increased to 11.5 cm. Farzana shares that Shabira loved the taste of the RUTF and it has helped her develop a good appetite, unlike before.
Four months later, Shabira is a lively and active baby. She has transitioned to solid foods and particularly enjoys meals of potatoes with roti and fish.
Acute malnutrition remains a persistent but often overlooked crisis in Pakistan, with rates far surpassing global thresholds. It is a significant contributor to child mortality, accounting for over 50% of such cases. Shockingly, one in five children under the age of five suffers from acute malnutrition, even prior to the 2022 floods and COVID19 pandemic in Pakistan. Sindh stands out as one of the worst-affected provinces, grappling with high rates of malnutrition among mothers, adolescent girls and children.
Thanks to generous funding and support from USAID, UNICEF Pakistan has been able to provide crucial assistance in nutrition and other child survival interventions. This support has been instrumental in efforts to prevent, detect early, and manage wasting, with a focus on treating severe acute malnutrition across six districts in the provinces of Sindh and Balochistan.
This funding has enabled UNICEF to train health workers, like Umbreen, in screening and treating malnutrition in children, pregnant, and breastfeeding women. Also, it has facilitated the procurement, storage, and transportation of over 35,000 cartons of RUTF, enabling the treatment of children with SAM, and enhanced community engagement to educate on detecting, treatment, and prevention of malnutrition.
From October 2022 to December 2023, well over 400,000 children in Sindh (more than half of them girls) between the ages of six months and five years were screened for their nutritional status. Almost 39,000 of those with severe acute malnutrition were treated with RUTF.
“I didn’t think she would survive. After her treatment and recovery, I can finally breathe a sigh of relief,” says Farzana with a soft smile.
