Yang Cao

Objectives: This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan. Methods: Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017–2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition. Results: The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers’ education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children. Conclusion: Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan.

Maternal nutritional awareness might reduce the risk of malnutrition in children. This study assesses the impact of mothers' nutritional and health awareness (MNHA) on the nutritional status of pre-school children in rural South Punjab. Using a proportionate purposive simple random sampling technique we collect data with the help of a self-administered questionnaire on height, age, the weight of children, and socio-economic profile from 384 rural households in one of the marginalized districts of Punjab. The study applied the binary logistic regression model to compute the probability of malnutrition. The results indicate that malnutrition was high in the district (the prevalence rate for underweight is 46.1%, for stunting 34.83%, and for wasting is 15.49%). Around 91.84% of malnourished children belonged to the low MNHA category compared to medium (5.61%) and high (2.55%) MNHA categories. The results further show that the prevalence of moderate and severe stunting, wasting, and underweight in low MNHA categories was much higher with large differences compared to both medium and high MNHA categories. The binary logistic regression results depict that, across the household deprivation index (HDS), the odds of a child becoming malnourished were lower in households HDS-2 category (OR = 0.02, 95% CI: 0.01–0.89), and odds were also lower in households HDS-3 category (OR = 0.001, 95% CI: 0.001–0.16). Similarly, across the scores of MNHA index, the odds of malnutrition were lower among the children of those mothers who had medium MNHA (OR = 0.04, 95% CI: 0.002–1.24), and also the probability of child malnutrition was lower among the children of mothers who had high MNHA (OR = 0.008, 95% CI: 0.002–0.29). The study urges that well-resourced, targeted, and coordinated health and nutritional education and awareness programs are required to tackle malnutrition.

Although water insecurity has been discussed in general, its impacts on mothers’ physical and mental health, and infants’ and young children’s feeding (IYCF), has largely been ignored. This study explores household water insecurity experiences and their association with optimal health and nutrition of women and children in the Rajanpur district of Punjab Province. Using focus group discussions (FGDs) and key informants (KIIs) interviews from an area with high maternal-child malnutrition prevalence, a qualitative study was conducted to describe local experiences of water acquirement and arrangement, and of the consequences of water insecurity. The findings highlight that rural Western marginalized populations of the Rajanpur district rely on brackish, canal, or flood surface water as the water supply is absent, which intensifies mothers’ work burden and stress, and often makes them victims of violence, stigma, and sickness. Water fetching impacts women in unforeseen ways, impacting the psychosocial and physical health of mothers engaged in maternal breastfeeding. Water insecurity, originally rooted in regional disparities, compounds with gender inequities, which leads to maternal stress and child sickness. Justice in water resources is imperative and urgent in the deprived South of Punjab province for improving public health nutrition.