Knowledge is power in the fight against malnutrition in Afghanistan

Fatima, 35, participated in training to help prevent and treat malnutrition with her daughter Elnaz

Afghanistan cannot meet Millennium Development Goal of reducing the child mortality rate by 50 per cent by 2015 and 75 per cent 2020 without focusing on preventable deaths, such as malnutrition. The prospects for young children in Afghanistan remain grim as one child in 10 does not live to celebrate their fifth birthday.

Inadequate infant and young child feeding practices are a major cause of malnutrition. To this end, World Vision Afghanistan has started a programme called Positive Device Hearth (PDH), a global health initiative to prevent and treat malnutrition, in three high-risk malnutrition districts of Herat in order to save the life of thousands of Afghan children who are suffering from malnutrition.

Fatima, 35, loves to talk about children’s health and nutrition. She has seven children, giving her a wealth of information and experiences to draw from. Because her husband is a daily worker and their economic situation is not so good, Zahra, their youngest child, at 2 years old, will be their last.

“I know that I have a lot of babies,” says Fatima with a smile. “My mother-in-law loved to have many grandchildren, so I had to obey her,” she recalls.

Fatima and her husband might have continued to have more children had they not received important information about the dangers that could bring for their children. “Since I and my husband understood about dangerous and risks of pregnancy through awareness session conducted by World Vision, we promised to each other that Zahra will be our last baby,” she says with a laugh.

“My mother-in-law received my sixth child, Elnza, in [our] home about five years ago. I didn’t feed Elnaz with my breast milk for two days, the same I did for my older children,” remembers Fatima. “My mother-in-law told me, ‘your milk is dirty and [you] should throw away. It as is harmful for baby’.”

Confronting false information

In 2013 a lot of attention has been given around the world to the importance of breast-feeding. But, in Afghanistan many people still hold on to wrong beliefs and misconceptions. Here, Mothers do not give colostrum to their babies. They believe it is dirty and infected. Instead, they give their babies a mixture of sugar and water from a bottle and animal oil, using a spoon. These women truly believe this is the best thing for their babies. This tradition can cause lasting damage, sometimes babies can forget how to breastfeed if he bottle feeds during these early days.

“My mother-in-law gave Elnaz mixture of powdered candy and animal oil,” says Fatima. “I didn’t have any information about importance of breast feeding, so for me it didn’t matter. It was even pleasant for me because others fed my baby and I could rest and sleep…Poor Elnaz and my older babies, I don’t know how their sensitive [bodies] tolerated those things,” she says.

Elnaz was one of those babies who, because of these traditions, never really learned how to nurse. “I remember after one week when I wanted to give Elnaz my milk, she didn’t accept my breast any more so I had to feed her by powdered milk. I fed her by artificial milk for four months, but as our economic condition wasn’t good, my husband said that I couldn’t buy powdered milk anymore. So, I had to fed her with food which we were eating every day,” she remembers.

“Day-by-day Elnaz grew up, but not like a normal child,” remembers Fatima. “She started walking and speaking later than others. She even looked weak, thinner and most of the time was sick.

“One day a group from World Vision came to our village and told people about starting [the] PDH program in the village. All the people welcomed and couldn’t wait for it.”

Positive Deviance Hearth is World Vision’s community-based approach that started its work in 2010 to address malnutrition with three inextricably linked goals: prevent malnutrition among the community; treat malnourished children, and enable families to sustain the rehabilitation of these children.

World Vision Afghanistan equipped target areas for PDH session with the necessary materials, such as: scales, fuel, and equipment for measurement of height. Then World Vision PDH supervisors conducted a 12-day training for mothers of malnourished babies between the ages of 6 months and 5 years. The supervisors teach mothers about personal hygiene as well as how to prepare nutritious and economical foods by increasing the mother’s knowledge of food categories, the importance of exclusive breastfeeding, hand washing, complementary feeding and cooking local foods.

Since start of the project, 715 malnourished children have been rehabilitated from malnutrition in remote areas of Afghanistan.

“I was very happy when the women came to my house and weighed Elnaz,” says Fatima. “They said they would help feeding her. Then I went to the house of one of my neighbors every day for 10 days. We cooked together for the children. Everybody brought a child and little bit of food from home,” Fatima says.

“On Day 12, the PDH supervisor weighed Elnaz. I could not believe it. Elnaz’s weight had been increased and it meant my daughter was [finally] healthy. [Today], when my relatives come to my house for visiting, they ask me how Elnaz gained weight and I explain about PDH to them. They want to participate in this training also. Sometimes, I advise them about cooking food for their children.”

“If I tell the truth, before I didn’t pay particular attention to my children’s food. I had beans, vegetables, and carrots in the home, but didn’t know about importance of these foods. Since I participated in the PDH session, instead of feeding Elnaz with inefficacious snake, sugar, tea, and dry bread I am cooking delicious food which I learnt from the PHD session,” says Fatima. “Since I participated in PDH session, I try to cook useful foods for my family. So, in addition of Elnza, Zahra, my older children and even my husband and I are benefiting from cooking of cheap and useful food,” she adds

“God blesses you and PDH supervisor for this important work,” says Fatima as she raises her hand and prays for the World Vision staff.