Supplementary feeding and nutrition education in Pakistan

M. Ramzan Azhar
UNICEF Islamabad Office, Islamabad, Pakistan

A nationwide nutrition programme, assisted by the World Food Programme, was begun in 1982. Lady health visitors were trained to play a key role in the project through nutrition education and integrated health services. The existing food habits, beliefs, and taboos were surveyed, and these studies revealed that urgent changes are required in child care.

Twenty-four basic messages were identified and used to form the basis of all training and extension materials. Message designs provided different levels of sophistication to suit the target audience: lady health visitors (LHVs) and other health workers, such as traditional birth attendants (TBAs) or child health workers (CHWs), or relatively illiterate mothers. All materials were carefully designed and extensively tested for use as tools to support nutrition education by the peripheral workers.

Posters were developed to illustrate the nutritional needs of pregnant mothers, and to promote breast-feeding, proper child feeding and care, and child growth. Another poster was used to describe food distribution and available integrated health services.

Flip charts giving information on primary health care were developed and are used by TBAs and CHWs after they are trained by LHVs. Another flip chart on breast-feeding was produced to support the LHVs' teaching of mothers, and yet another gives weaning-food recipes to serve as LHV teaching aids. The LHV has a book version as her reference source, while mothers are given recipe charts. Cooking demonstrations have been provided at selected centres. On-the-spot feeding of mothers and preschool children has also been introduced. Growth charts are used as a monitoring tool, on a nationwide scale. Two hundred and fifty food demonstration centres and 20 on-the-spot feeding centres have been established. Weaning food is distributed by LHVs at these centres as well as by other health services, and nutrition education is being imparted by the LHVs.

Currently, 500 fully trained paramedics and LHVs are the frontline workers who provide nutrition education. Teaching and training aids are widely available to primary health-care workers, and the available health facilities have been increasingly utilized. Awareness of the importance of nutrition is gradually being recognized by urban slum dwellers. A total of 360,000 mothers and children are directly benefiting from these projects. An in-depth evaluation is to be carried out soon to assess the impact of the programme on the target population.