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Nutrition Causal Analysis Thatta and Dadu District, Sindh Province By ACF

In 2010, Pakistan was hit by the worst floods in living memory. 18 million people were affected, with more than 1,500 dying, and 14 million were in need of direct assistance. The National Nutrition Survey revealed that 38% of households in Sindh are food insecure with moderate hunger and 16.8% with severe hunger. In lower Sindh, Global Acute Malnutrition (GAM) rates were critically high (above WHO emergency thresholds of 15%) even before floods hit the province. FAN survey in October/November 2010 showed that 23% of children in northern Sindh and 21% of children in southern Sindh were acutely malnourished which indicates a critical nutrition situation. ACF intervention areas are located in Thatta and Dadu District of Southern Sindh Province. To develop its understanding of the nutrition situation in the intervention areas and its underlying causal factors, ACF carried out a Nutrition Causal Analysis (NCA) study in its PEFSA and CIDA/EU intervention areas based on a draft methodology developed by ACF France and the results of field tests in Bangladesh, Zimbabwe and South Sudan. Malnutrition is one of the most important health and welfare problems among infants and young children in Sindh Province, resulting in serious health and economic consequences for both the individual and the family. Based on these and other related findings, this study arrives at the following conclusions to improve children nutritional status in the areas.  In total 787 children aged between 6 and 59 months were surveyed and the prevalence of global acute malnutrition was estimated at 12.2 % (10.1-14.7 95% C.I.), with the prevalence of severe acute malnutrition estimated at 3.4 % (2.4 -4.9 95% C.I.). Although the magnitude of wasting decreases in comparison with earlier surveys, the overall nutritional status of children under five years is classified as serious considering the presence of aggravating factors such as poor child care practices, high levels of childhood morbidity and acute water shortage.  Overall, this study has unveiled knowledge on appropriate feeding practice such as importance of colostrum and frequent and more breastfeeding during and after child illness and access to adequate potable water are the principal risk factors that brought short-term nutritional deprivation (wasting) among under-five children in the study area  A range of socio-economic, health and child care and feeding practices were found to influence the nutritional status of children in the area.  Lack of alternative income source at household level negatively affect the nutritional status of children  Breastfeeding is universal in the area. But continuous and frequenct breastfeeding during and after illness is not well practiced.  Inappropriate child feeding practices such as late introduction of complementary foods and failure to feed children more often (poor child May 2012 ACF –Pakistan - Nutrition Causal Analysis Report Page 9 of 119 dietary diversity) are conspicuous threats to the nutritional status of children in the area  Lack of knowledge on duration of exclusive breastfeeding, signs of malnutrition and prevention of diarrhea significantly contribute to high incidence of wasting among under-five children in the survey area.  In most cases, as the types of food offered to children are of poor quality (mostly cereal sources) which are deficient in quality protein is also other area of concern that can exacerbate the existing childhood malnutrition and needs the due attention.  Incidence of illness such as fever, whooping cough and diarrhea are significantly detrimental to short-term nutritional status (wasting) of children in the study area.  This study led to the realization that poor household hygiene and sanitation practices such not using soap/ashes and non-treatment of drinking water are some of the areas of concern that needs appropriate intervention as these factors have significantly affect the nutrition status of children.  The health and nutrition education activity was inadequate to address the issue of malnutrition in the districts. In general based on the survey results, this study led to the conclusion that an integrated multisectoral approach is required by non-governmental groups, community and government to increase efforts to improve nutrition, health and food insecurity problems of the study communities. Nutrition education and awareness creation on appropriate feeding practice through community-based nutrition programs, promotion of hygiene and environmental sanitation, access to adequate potable water, income generating activities and sound development strategies and policies on off farm activities are critical to accelerate improvement in children nutritional status in the area. The following are specific recommendations:- 1. Based on the anthropometric findings there is a need to strengthen the therapeutic and supplementary feeding programme in place 2. Support initiatives that enhance the own production of nutritious food and increase the resilience through the diversification of income, like alternative income generating opportunities within the province 3. Strengthen water, sanitation and hygiene (WASH) programming. 4. There is an urgent need to strengthen linkages amongst the various ACF programmes affecting nutrition. May 2012 ACF –Pakistan - Nutrition Causal Analysis Report Page 10 of 119 5. Strengthen the capacity of the health system through technical, logistical and financial support to implement the nutrition programme. 6. Promotion of family planning programme. 7. Enhancing dietary diversification:. 8. Provision of sustained nutrition education. 9. Strengthen advocacy, social mobilization and program communication. 10. Strengthen nutrition information system. 11. Improving the nutritional status of mother’s.
Key findings: 
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Assessment Questionnaire: 
Publicly Available
Assessment Data: 
Publicly Available
Assessment Date(s): 
01 Jan 2012 to 31 May 2012

Level of Representation

District / Province / Locality / County
Report completed
Unit(s) of Measurement: 
Collection Method(s): 
Population Type(s): 
Children under 5
Leading/Coordinating Organization(s): 
Action against Hunger
Participating Organization(s): 
Action against Hunger
Other location: