Arbun Khatun, a resident of Jagarnathpur Rural Municipality-4 in Parsa district, took her ailing son Jafar Hussein to Narayani Hospital in Birgunj on January 20. The hospital referred the one-year-old, who had pneumonia, to the Nutrition Rehabilitation Home as he was also found to be suffering from severe malnutrition.

The malnourished baby was immediately admitted to the NRH set up on the hospital premises. The boy should have a body weight above 8.2 kg for his age but he was just 6 kg. He is getting treatment at the nutrition home now. Hussein is now 10 kg and looks healthy.

“My mother-in-law instructed me not to feed any solid foods until the boy is one-and-a-half years old. So I just fed him milk. Here, at the nutrition home, I came to know that the child should be given solid foods gradually after six months of age,” Khatun explained the reasons behind her son’s malnutrition.

Hussein is from an impoverished Muslim community. The family members are uneducated. Khatun’s husband is currently in Gorkha for work. “I was not aware of the nutrition that children need. Nobody told me about it either,” rued Khatun.

Hussein’s is just a case in point. Malnutrition is a serious health challenge in Parsa and other seven districts of Madhes Province, mainly due to poverty and a lack of awareness among guardians. Malnutrition is rampant in children from poor communities and Dalit settlements in the province.

“Many children, mainly six to 23 months old, have malnutrition in Madhesh. The main reason is a lack of awareness among the guardians. They are unaware of the nutritious food required for the overall growth of children,” said Sarita Yadav, chief at the nutrition rehabilitation home.

“Some guardians don’t even know the children should have solid foods after six months. As a result, the children are deprived of nourishing foods and suffer from malnutrition,” she added.

According to Yadav, many people in Madhesh do not take their wards to health institutions unless they fall seriously ill from malnutrition. She said people generally offer packaged foods like noodles and biscuits to their kids. According to her, even the guardians who can afford proper nutrition do not provide milk, yoghurt, egg and meat to their children.

Nutrition Rehabilitation Home in Narayani Hospital was established in 2006 to provide treatment, mainly to the malnourished children from Parsa, Bara, Rautahat and Sarlahi districts. Currently five children are getting care at the 10-bed nutrition rehabilitation facility.

As per the data with the home, a total of 175 malnourished children were admitted there in the fiscal year 2023-24. Among them, 11 were below six months, 101 between six and 23 months, while 49 were between 24 months and 59 months and 14 above 60 months.

Similarly, 57 children suffering from malnutrition were admitted to the rehabilitation home in the first six months of the current fiscal year. Five of them were below six months, 37 between six and 23 months, 14 were between 24 months and 59 months and one above 60 months.

Madhesh Province, which is known as the country’s food basket, ironically faces the problem of malnutrition. According to the World Health Organisation, malnutrition includes undernutrition—stunting, wasting and underweight—inadequate vitamins or minerals, overweight, obesity and resulting diet-related non-communicable diseases.

The National Demographic and Health Survey carried out in 2022 shows that stunted children number the highest in Karnali Province at 36 percent, while it is 29 percent in Madhesh, and the lowest in Bagmati at 18 percent. Wasting is highest in Lumbini Province at 16 percent, followed by Madhesh Province at 10 percent.

Overall, 25 percent of children under five across the country are stunted (short for their age), eight percent are wasted (thin for their height), 19 percent are underweight (thin for their age) and one percent are overweight (too heavy for their height).

Dr Shailesh Thakur, a paediatrician at Narayani Hospital, said malnutrition among children is a serious health problem in Madhesh. “The percentage of malnutrition is high in Madhesh mainly due to poverty and a lack of awareness among the guardians,” he added.

“Junk food is another reason behind the alarming state of malnutrition in Madhesh.”