Kopila BK, aged 21, of ward 3 in Darma Rural Municipality of Salyan district, gave birth to a baby girl two years ago. The newborn weighed just 1.7 kg. The health workers advised the BK family to take the infant to Nepalgunj immediately for treatment. But the family members could not manage the funds.

The underweight newborn is two years old and still weighs only 3.5kg. She is currently receiving treatment for malnutrition at Bheri Hospital in Nepalgunj. “My wife did not get proper care during or after pregnancy. Our daughter often falls ill and shows no improvement in her health despite receiving good care at the hospital,” said Madan BK, Kopila’s husband “The child is still struggling against malnutrition.”

Tripura BK, a 29-year-old woman from Darma-8, gave birth to three children. One of her daughters died six months after birth due to pneumonia. Her six-year-old son is thin for his age and has a swollen belly. He has issues with his speech. Tripura’s daughter aged 5, is only 4.5 kg.

Tripura’s family is financially weak. Her husband went to India a few months ago for work. “The food grains we store are hardly enough for three months. I have to struggle hard to manage food for myself and my children,” said Tripura. “There is no way I can give them nutritious food.”

The District Health Office (DHO) and the local units in Salyan launched various programmes and spent a good amount of budget to control malnutrition in the last fiscal year of 2021-22. According to the DHO, it spent around Rs4 million in the last fiscal year while each local unit spent between Rs 2-5 million to combat malnutrition. However, malnutrition cases in the district are yet to be contained.

According to the data at the DHO, a total of 242 children suffered from severe acute malnutrition and moderate acute malnutrition in the fiscal year 2019-20. The number of malnourished children was the same in 2020-21. As many as 258 children suffered from severe acute malnutrition and moderate acute malnutrition in the fiscal year 2021-22. Likewise, 221 children are suffering from malnutrition in the district in the current fiscal year of 2022-23.

“Poverty, lack of balanced diet, giving birth at an early age, lack of public health awareness among people and lack of awareness among mothers about the importance of breastfeeding are the major problems behind the unchecked malnutrition cases in Salyan,” said Dr Pooja Acharya, chief at the DHP in Salyan. According to Acharya, the district does not have a treatment facility for children suffering from severe acute malnutrition. The malnourished children are taken to Birendranagar, Nepalgunj or other towns and cities.

“Nursing mothers are compelled to work in the fields due to poverty. As a result they are unable to breastfeed their children on a regular basis,” said Acharya.

Malnutrition is a serious health challenge in Salyan and other districts of the Karnali Province. Malnutrition, according to experts, is taking its toll in Karnali due to food scarcity and a shortage of nutritious foods.

According to the National Census 2021, there are around 311,000 children below five years of age in Karnali. Karnali Provincial Health Directorate says 37.4 percent of children in Karnali are underweight, 48 percent are stunted and 17.6 percent are suffering from wasting. A study conducted by Unicef last year shows that only around 30 percent of children between 6 to 23 months in Karnali get nutritious food.

According to the Karnali Provincial Health Directorate, a total of 152 infants died in the province in the current fiscal year so far. Fifty-two infants died in Surkhet while 21 died in Salyan and Jumla each, 16 in Jajarkot, 11 each in Dailekh and Rukum (West), nine in Kalikot, eight in Dolpa and three in Mugu.

“Among the infants who died in the current fiscal year in Karnali, most died due to malnutrition. Malnutrition is a serious health crisis in Karnali Province,” said Mana Kumari Gurung, a senior nursing officer at the directorate.

As many as 199 infants died in the last fiscal year of 2021-22 in Karnali, the country’s largest and remotest province.

The Multiple Indicator Survey-2019 showed that the prevalence of wasting among children in Karnali Province was 17.6, the highest in the country followed by Koshi Province (14.3 percent), Sudurpaschim Province (14.1 percent), Madhesh Province (13.9 percent ), Lumbini Province (13.7 percent), Gandaki Province (8 percent) and Bagmati Province (4.7 percent).

Lack of proper health care for women during pregnancy, according to health experts, is also a leading cause of malnutrition among children. “If the mothers are malnourished they generally give birth to underweight infants who are prone to malnutrition. The women get malnourished as they do not get nutritious foods during pregnancy and in the postpartum period. They cannot breastfeed their children well which ultimately causes malnutrition,” said Nabaraj KC, a senior paediatrician at Karnali Province Hospital in Bairendranagar. KC estimates that around 40 percent of mothers suffer from malnutrition in Karnali.

Mina Shahi, 21, of Soru Rural Municipality-5 in Mugu gave birth to a baby weighing 1.8 kg a year ago. The newborn died after one and half months as Mina and her family members did not seek treatment for the abnormalities in the infant. “We thought that child would gradually grow. I knew that I suffered from malnutrition only after the baby died,” said Mina.

Nutrition Rehabilitation Home in Birendranagar is often overwhelmed with malnourished children and mothers. “We have just 11 beds. Eleven children are currently receiving treatment with their mothers,” said Prabha Singh, in-charge at the home. According to her, children from almost all districts of Karnali Province are brought to the home for treatment.