In a bid to address the problem of malnutrition in children under five, the Ministry of Health and Population has started imparting training to nurses and paramedics serving in Lumbini, Karnali, and Sudurpaschim provinces.

Officials hope that a week-long training programme will help lessen the existing problems of malnutrition in those provinces.

“Imparting training to combat malnutrition in small children is our nationwide programme, which we have started from Lumbini, Karnali and Sudurpaschim provinces,” said Lila Bikram Thapa, chief of Nutrition Section at the Family Welfare Division under the Department of Health Services. “Along with imparting training to health workers, we will also launch an awareness drive to improve exclusive breastfeeding practices.”

Malnutrition is considered a silent health crisis in Nepal. The country has made significant progress in reducing stunting among children under five, which decreased from 57 percent in 2001 to 25 percent in 2022, according to the Nepal Demographic and Health Survey-2022.

The report showed some improvement in the country’s overall nutrition status, but progress is not the same in all provinces.

More than 16 percent of the children under five years in Lumbini Province are found to be suffering from wasting—the most immediate, visible, and life-threatening form of malnutrition.

Wasting, a debilitating disease that causes muscle and fat tissues to waste away among children under five, decreased from 11 percent in 2001 to eight percent in 2022.

Wasting or low weight for one’s height in children, if not treated properly and on time, is associated with a higher mortality risk, according to the World Health Organisation.

The report shows that exclusive breastfeeding has been continuously declining, from 70 percent in 2011 to 56 percent last year. Health officials said that studies show that more educated and well-off mothers are less likely to exclusively breastfeed their babies.

According to the report, the proportion of children who are bottle-fed rises with increasing mothers’ education, from 12 percent among those whose mothers have no education to 49 percent among those whose mothers have more than a secondary education. Use of a bottle with a nipple is the highest in the highest wealth quintile at 46 percent and lowest in the lowest quintile at 11 percent.

Likewise, the proportion of children who are bottle-fed is higher in urban areas, 26 percent, than in rural areas, 15 percent. The use of a bottle with a nipple is lowest in Karnali Province at 11 percent, in Madhesh Province at 12 percent, and the highest in Bagmati Province at 43 percent.

Exclusive breastfeeding is the highest in Sudurpaschim and Karnali provinces—74 percent each—and the lowest in Lumbini Province—36 percent.

“We have allocated the nutrition budget to launch a nationwide awareness drive about the importance of exclusive breastfeeding in the upcoming fiscal year,” said Thapa. “We have also designated a nutrition focal person at every local unit who is tasked to discourage practices of promoting replacement feeding.”

The report also showed that bottle-feeding practices started in health facilities. It showed that 22 percent of children born in a health facility receive mixed milk feeding (breast milk and fresh, packaged, or powdered animal milk or infant formula), as compared with 12 percent of those born at home.

Bottle feeding is not recommended, as the nipple on a feeding bottle is susceptible to contamination and increases the risk of diseases among children, according to the World Health Organisation.

Health ministry officials hoped that training for nurses and paramedics would help lessen bottle-feeding practices in health facilities.

Doctors say breastfeeding should continue for the first two years or beyond, as breast milk lowers children’s risk of illness, promotes their recovery during illness, and remains an important source of nutrients for healthy growth and development.

According to them, longer durations of breastfeeding have many health benefits for women, including reduced risks of certain breast and ovarian cancers and diabetes.

Nepal had committed to increasing the exclusive breastfeeding rate to more than 90 percent by 2030, but the rate declined from 70 percent in 2011 to 66 percent in 2016 and to 56 percent in 2022.