An Investigative Study on Assessment and Scoring of Malnutrition in Deprived Nomadic Children of Khyber Pakhtunkhwa, Pakistan

Abstract

Malnutrition affect all age groups, with infants and children being particularly vulnerable due to their high nutritional requirements. Under nutrition in children is influenced by a multifaceted interplay of factors, including socio-demographic characteristics, hygiene practices, environmenta, comorbidities etc. Nomadic communities are vulnerable to malnutrition and its severe consequences on productivity, health, and survival. The present study therefore, aimed to extensively survey the nomadic populations of Khyber Pakhtunkhwa, particularly focusing on the malnutrition among children. Materials and Methods: This cross-sectional study was carried out among random 18 Nomadic populations (Kudwal) of Malakand division, Khyber Pakhtunkhwa with a sample size of 500, from May 2021 to June 2022 that included pastoral nomads (bezogar/kucchi/Bakarwal) and peripatetic nomads (churgarh). Data collection involved, interviewing adults (guardian or parents) using a pre-designed semi-structured questionnaire. Anthropometric measurements i.e. height, weight, Head circumference Mid Upper Arm Circumference were recorded from children of above 1 year to 16 years of age (including both 1 and 16 years) for assessment of malnutrition. Data was entered into Microsoft Excel for preparation of database and were assessed using simple Pearson’s chi-square test in STATA v13. Results: The Height-for-Age (HFA), Weight-for-Height (WFH), Weight-for-Age (WFA), Body Mass Index-for-Age (BFA), Head Circumference-for-Age (HC/A) z-score analysis revealed that malnourishment (stunting, wasting and underweight) was present across all districts, with an overall prevalence of 11%, 95.46%, 14.42%, 98% and 97.73% in children, respectively. Mid-Upper Arm Circumference (MUAC) measurements revealed that children under 5 years, acute malnutrition showed statistically significant. The Percentage of median for Height-for-Age, Weight-for-Age and Weight-for-Height analysis revealed that 99.25% , 26.97% and 93.18% of the total study population exhibited some form of growth deviation (Stunting, wasting and under nutrition). Malnutrition indices across different types of nomadism (Peripatetic and Pastoralist) revealed that, both nomadic groups showed high prevalence of malnutrition (p=0.920). Majority among both populations exhibited adequate malnutrition levels (Peripatetic: 89.94%, Pastoralist: 88.33%). Age-specific MUAC/A analysis revealed high rates of malnutrition (Peripatetic: 83.6%, Pastoralist: 88.88%), in 10-16 years age group (p=0.354). The BFA z-score assessment showed similar patterns of acute malnutrition/thinness between the groups (p=0.167). Conclusion: These findings highlight the complex nature of malnutrition among nomadic populations, with different indices revealing varying patterns of nutritional deficiencies. The significant difference suggests that Pastoralist communities might be more vulnerable to acute malnutrition compared to Peripatetic nomads, possibly due to differences in lifestyle, food access, or cultural practices.