Nine-year-old Pramila Chepang from Benighat-Rorang Rural Municipality weighs just 13 kilograms, which indicates that the girl has been suffering from a severe form of malnutrition.

According to the World Health Organisation, a 9 year-old girl should weigh at least 28.12 kg. Her weight shows the girl is not getting a sufficient diet or has other serious health issues, doctors say.

“We immediately referred the girl to the Kanti Children's Hospital for treatment,” Shankar Duwadi, health coordinator at the rural municipality, told the Post over the phone from Dhading. “The girl could not even go to school, as she was bedridden and her health condition was severe.”

Issues of malnutrition are not new in the Chepang community of Dhading and Chitwan, and some districts of the Karnali Province. And the problem has been escalating throughout the country of late.

A recent report on hunger also paints a bleak picture of Nepal's hunger level. The country ranks 81st out of 121 countries in the 2022 Global Hunger Index, with a score of 19.1, which indicates that the country is at the borderline between moderate and serious levels of hunger.

A GHI score of less than 10 is considered a low hunger level, a score between 10 and 19.9 is moderate, 20 to 34.9 is serious, 35 to 49.9 is alarming, and over 50 is extremely alarming.

“There is a little improvement compared to the past, but there is no reason to cheer, as we are still at a high risk of serious hunger problems,” said Dr Atul Upadhyay, a nutrition expert. “Many people in the country have not been getting adequate nutritious food.”

The hunger report by the Concern Worldwide of Ireland Welthungerhilfe was prepared based on three equally weighted indicators—inadequate food supply, which leads to undernourishment problems, child undernutrition, which leads to wasting and stunting in children, and child mortality rate.

Nepal made significant progress in reducing stunting among children under five. Stunting decreased from 57 percent in 2001 to 32 percent in 2019, according to the Multiple Indicator Cluster Surveys (MICS 2019).

The report showed that 12 percent of children under five suffer from wasting, which is the major indicator for mapping GHI scores.

Only 10 percent of children under five were suffering from waste, according to the Nepal Demographic Health Survey 2016.

Wasting or low weight for a particular height is an undernutrition condition, which is a strong predictor of mortality among children under five, according to the UN health agency. Wasting in children is associated with a higher risk of death if not treated properly, according to it.

Officials at the Ministry of Health and Population and nutrition experts attribute the problems of nutrition, especially food security, for escalating quickly throughout the country. They say that multiple factors including the Covid-19 pandemic, which rendered thousands of people jobless, growing inflation triggered by the protracted Ukraine-Russia war, and climate change are to blame for the deterioration of the problems. As politicians both in the government and the opposition are busy in election campaigns, they have no time to address these issues, making the situation worse.

Many people in the Tarai region, who used to sell surplus grains, have been forced to buy foodstuff due to extreme weather events—dry spells in monsoon and flooding at the time of harvest.

Of late, unseasonal and extreme precipitation becomes the new normal, and thousands of people face the risk of hunger.

“My husband is in India, and all ready-to-harvest food crops have been inundated by a recent flood,” said Pratima Thapa, a local of Narainapur Rural Municipality-4 Banke district. “We have to purchase foodstuff this year.”

Districts of Tarai region are considered the country’s food basket. But a study carried out in 2019-2020 in two districts of eastern Tarai—Saptari and Udayapur—showed a high prevalence of acute forms of malnutrition.

Around 18 percent of children under five years of age were found to be affected by waste against the 12 percent national average.

Experts say that nutrition has a direct link with the overall development of the country.

Malnutrition affects the physical as well as mental growth of children, which ultimately affects the country’s economic health, according to them.

“We have to admit that immediate intervention measures are needed to address the existing problems of nutrition,” said Dr Kiran Rupakheti, chief of the Public-Private Partnership section at the National Planning Commission.

“Problems will escalate if we fail to address the problems at the earliest. What we should not forget is that problems now are not limited to any particular area but could be in many places in the country.”

Rupakheti concedes that a high prevalence of wasting means children of the said age group are not getting enough nutritious foods and poor water and sanitation conditions and other factors are also responsible for the problems.

Experts say malnutrition is not only a problem of not getting enough to eat but also of the lack of nutritious food, of lack of knowledge to use locally available food, and growing junk food consumption among children.

Nepal also has an international obligation to improve the condition of malnourished children.

The country needs to reduce stunting to 15 percent from the existing 32 percent by 2030 in order to meet the United Nations-backed Sustainable Development Goals (SDGs) targets, wasting to 4 percent from the current 12 percent, underweight to 10 percent from the existing 27 percent and anaemia to 10 percent from over 52 percent in 2016.

SDGs, a follow-up on the Millennium Development Goals (MDGs), aims at ending poverty and hunger and all forms of inequality in the world by 2030, and Nepal has committed to meeting the goals.

UNICEF warned in January that Nepal’s significant progress in the nutrition of mothers and children was at risk due to current inequalities and the pandemic.

UNICEF recommended a multisystem approach involving food, health, water and sanitation, education, and social protection systems to improve the health of Nepali children.

The UN agency also urged the government and other partner agencies to better children’s health by improving access to nutritious, safe, affordable, and sustainable diets throughout childhood, adolescence and years of childbearing.

“Progress toward the SDG targets on stunting and wasting is not advancing at the speed, scale, or equity required,” concedes Lila Bikram Thapa, chief of the Nutrition Section under the Family Welfare Division. “Only the agency under the Health Ministry cannot address these problems.”