Features

Surkhet

A small thatched, doorless hut surrounded by timbers is in a broken-down condition. Blankets and clothes are scattered everywhere. 22-year-old Manju Nepali of Chaukune Rural Municipality-7 Sanneghari, lives alone in the hut. 

Manju got married at the age of 18. Her 18 months eldest son weighs 5 kilograms. Youngest daughter who is 6 months old weighs only 3 kilograms. Both of her children are suffering from malnutrition.  

Last November, after her husband got married for the second time and went to India, she got disoriented. The remaining three members of the family also work in India. 

There is no irrigation in the little land. She says, “farming would have been possible depending on rainwater but there is nobody to assist in planting the crops.” She has been barely keeping her children alive with the leftover food provided by relatives and neighbours. Manju’s son has been malnourished for a year.  

Last August she became pregnant for the second time. During that time, she reached hospital to save the life of her son, Dilip. Upon observing signs of malnutrition in Dilip, the health post referred them to the Nutrition Rehabilitation Home for further treatment. 

In the Rehabilitation Home, Manju and her son Dilip, both of them received treatment. Manju mentioned that the baby also showed good growth and development. She gave birth to a baby girl, Sangita on 6th December in the rehabilitation home.  

36% of children below 5 years of age have issues such as stunting, underweight and wasting in Karnali. 40% of the children under 5 are anaemic. These issues share some connections to child-marriage.  

In the Rehabilitation home, the health of Manju’s newborn baby and her son, Dilip’s was improving.  Upon returning from the rehabilitation home after few months on 10th February, both of her children became victims of malnutrition again. Currently both children are malnourished due to poor nutrition. The mother’s health is also deteriorating.  

At the age of 18 she got married and gave birth to her first child. She mentioned that her second child was born before her first child received proper care. She regrets getting married at an early age.  

19-year-old Niruta Oli of Toribari, Gurvakot Municipality-6, got married at the age of 16. 15 months back she gave birth to a baby girl. When her daughter was taken to the health post in Mehalkuna in the month of November, it was found that her weight was only seven kilograms. Afterward, upon diagnosing malnutrition, the health post referred her to the Nutrition Rehabilitation Home in Birendranagar. 

During her stay of about two months at the rehabilitation home, her daughter’s health improved through the provided treatment. Upon returning home, the situation remained unchanged. She mentioned that if they diagnosed malnutrition, it was more convenient to receive treatment locally rather than being referred to the Nutrition Rehabilitation Home. She added, “After returning from the Nutrition Rehabilitation Home, the health condition of my child has reverted back to the same state.” 

Kalpana Bohora, a 17-year-old residing in Barahtal Rural Municipality-7, reached the health post of Lamakhali with her 12-month-old son. When examined, her son weighed only five kilograms. Subsequently, the health worker referred them to the Nutrition Rehabilitation Home for further treatment. 

According to Kalpana, it would be convenient if the local government wrote a recommendation letter and sent the malnourished children directly to the Nutrition Rehabilitation Home established within the municipality instead of referring her to Birendranagar. 

Local levels limited to referrals 

Apart from the remote municipalities in Karnali, even the local government of Birendranagar Municipality, which is also the capital of the province, recommends cases for the Nutrition Rehabilitation Home. 

As of now, there is no Nutrition Rehabilitation Home within any municipality of Karnali Province. Some municipalities are working with pregnant women by conducting the program ‘Mayor, Deputy Mayor and Ward Chairman’ to distribute one-carat eggs. 

Yashoda Acharya, a resident of Birendranagar Municipality-13 believes that if the Nutrition Rehabilitation Home is brought into operation by the municipality, it would facilitate the treatment of malnourished mothers and the children. She mentioned that even though he resides in municipality of the capital of the province, there is lack of available services and facilities related to nutrition. 

There are Nutrition Rehabilitation Homes in three districts of Karnali Province. The Nutrition Rehabilitation Homes operating under the Provincial Hospital in Surkhet with 11 beds, under the Karnali Institute of Health Sciences in Jumla with 11 beds, and under the District Hospital in Dailekh with 5 beds. 

It is more convenient to arrange for treatment locally rather than referring the case to at the Nutrition Rehabilitation Home at another location. After returning from the Nutrition Rehabilitation Home, the child’s health condition has reverted back to its previous state. 

The Nutrition Division under the Ministry of Health and Population provides some support for the Nutrition Rehabilitation Homes. The arrangements for other management aspects are facilitated through internal sources of the hospital, as mentioned by Prabha Singh, the manager of Nutrition Rehabilitation Home in Surkhet.
According to Singh, malnourished children from all eight districts, except Jumla and Dailekh, come to the Nutrition Rehabilitation Home for treatment. 

Singh said, “Managing the 11-bed hospital dedicated to the treatment of malnourished children can sometimes be challenging. We coordinate with the municipality and health organizations to receive referrals, and after conducting assessments and providing treatment for a specific period, we send the children back home. If such homes are established at the local level, it would be even more convenient for the citizens.” 

Children born to parents married at a young age often face issues related to malnutrition. Another major cause of malnutrition is child marriage. Minimising child marriage alone can only lead to a partial reduction of this problem. 

However, according to the Chairman of Chaukune Rural Municipality, Mr. Khadka, it was mentioned that it is not currently possible to operate a Nutrition Rehabilitation Home based on local resources. He mentioned that in the upcoming policies and programs, they will include nutrition-related issues to facilitate easy access to healthcare services for the citizens. 

When analyzing the data from the past five years, the municipalities from Surkhet district have made the most referrals to the Nutrition Rehabilitation Home in Surkhet. The data shows that the municipalities in this district referred 79 children in the fiscal year 2017/18, 68 children in 2018/19, and 69 children in 2019/20 to the Nutrition Rehabilitation Home. 

Similarly, in the fiscal year 2021/22, 53 children, in 2022/23, 63 children, and until the month of February in 2023/24, a total of 13 malnourished children from Surkhet have received services from the Nutrition Rehabilitation Home. 

Condition of Nutrition Rehabilitation Home 

In the last six fiscal years, apart from Surkhet in Karnali Province a total of 178 individuals from Kalikot, Humla, Dolpa, Dailekh, Jumla, Salyan, Jajarkot, Mugu, and Rukum West have received services from the Nutrition Rehabilitation Home. 

This gives a clear picture of the problem of malnutrition in this region and the limited availability of effective treatment methods. Karnali Province, lags behind in development and has a significant population living below the poverty line. 

Karnali is economically and socially disadvantaged and lags behind in many aspects. In recent years, the rate of malnutrition in Karnali has been rising alarmingly. 

Looking at the data from the past three years of the Nutrition Rehabilitation Home, out of the 273 individuals who sought services here, 198 of them were adolescent girls below the age of 20. 

In the fiscal year 2020/21, 180 individuals received services at the Nutrition Rehabilitation Home. In the fiscal year 2021/22, 115 individuals received services, and until the month of February in the fiscal year 2022/23, 50 mothers have accessed services at the Nutrition Rehabilitation Home. 

The number of individuals accessing the services has increased, and according to the data provided by Manager Singh, 80 percent of the individuals those who visit the rehabilitation home are girls under the age of 20. 

Dr. Nawaraj KC, working as a pediatric specialist at the Provincial Hospital in Surkhet for a long time, has mentioned that factors such as child marriage, lack of education for mothers, the perspective of households towards mothers, and social values contribute to the problem of malnutrition and have an impact on it. 

He mentioned that the situation of malnutrition in Karnali Province is severe, and effective steps need to be taken by the local authorities to prevent malnutrition. He says that local and state governments have not been able to invest well in the field of nutrition. 

The local bodies in Karnali have allocated less than one percent of their budget in the field of nutrition. Karnali Province has adopted the “Provincial Health Policy-2076” while adhering to the national health policy guidelines. 

However, this policy has not been implemented yet. Majority of the population in Karnali province, which is lagging behind in development, is below the poverty line. 

Karnali is economically disadvantaged and socially backward. The malnutrition rate in Karnali has been increasing alarmingly for the last few years. 

According to the Nepal Demographic and Health Survey (NDHS) 2022, Karnali region the following rates among children under the age of five has been observed: 36% of children are underweight, 18% of children are stunted, and 4% of children are wasted. 

Similarly, 40 percent of children under the age of five are anemic. 

21 percent of girls and women between the ages of 15 and 49 have anemia. This data highlights the severe problem of malnutrition in Karnali Province. 

It is evident that appropriate data and effective measures need to be taken to address the state of malnutrition in Karnali and improve the condition of malnourished children. 

- Prabha Kumari Raut