Islamabad: Food secure households crashed from 95.2 percent to just 11.9 percent during the four-year Central Asia Stunting Initiative in Gilgit Baltistan and Chitral, an evaluation report by the Ministry of National Health Services, Regulations and Coordination (MoNHSR&C), Aga Khan University and partner agencies has revealed.
The evaluation by federal health ministry and AKU warned that while the programme succeeded in improving child nutrition practices, families themselves slipped sharply into food insecurity due to rising prices, limited income opportunities and growing dependency on purchased food.
The report, authored by researchers of the Central Asia Stunting Initiative monitoring and evaluation team, shows that mild food insecurity rose from 1.3 percent to 36.6 percent, moderate food insecurity surged from 1.2 percent to 44.1 percent, and severe food insecurity almost quadrupled from 2.3 percent to 7.5 percent, indicating that nine out of every ten households are now struggling with some form of food stress.
Researchers note that households which were once growing or storing their own food became dependent on local markets during this period, at a time when inflation and supply disruptions made basic food items unaffordable.
Despite this economic deterioration, the report notes improvements in several child health indicators. Stunting among children under five dropped from 40.9 percent at baseline to 35.4 percent at midline, while severe stunting decreased from 17.8 percent to 10.9 percent.
Wasting fell from 9.8 percent to 4.9 percent, and severe wasting from 5.0 percent to 1.5 percent. Underweight prevalence reduced from 20.8 percent to 15.5 percent, and severe underweight cases dropped from 7.0 percent to 2.9 percent. The evaluation credits consistent growth monitoring, breastfeeding counselling, vitamin supplementation and treatment of acute malnutrition for these improvements but warns that these gains are at risk if food insecurity remains unchecked.
District-level data shows that in Chitral, stunting dropped from 46.0 to 38.8 percent, while severe stunting declined from 22.3 to 13.1 percent. Wasting reduced from 10.9 to 5.1 percent, with severe wasting falling from 5.0 to 1.3 percent. Underweight cases in Chitral dropped from 22.1 to 18.8 percent, and severe underweight from 8.4 to 3.7 percent.
In Gilgit Baltistan, stunting shifted from 33.1 to 30.3 percent, while severe stunting moved from 10.9 to 7.6 percent. Underweight fell from 19.8 to 11.9 percent with severe underweight cases reducing from 4.9 to 1.7 percent, and wasting declined from 8.6 to 4.7 percent, with severe wasting improving from 5.0 to 1.6 percent.
Feeding practices also changed over the intervention period. Any breastfeeding increased from 71.3 to 88.3 percent, and minimum dietary diversity in children aged 6–24 months improved from just 4.0 percent to 26.8 percent, suggesting that despite food scarcity, mothers adopted improved feeding practices when guided through community health worker support.
Immunisation coverage of children aged 12–23 months remained high at 99.1 percent, although partially immunised children saw a marginal increase due to mobility and service access barriers.
Maternal literacy improved from 50.0 to 67.9 percent, while paternal literacy increased from 64.2 percent to 79.7 percent, a factor the report links with better participation in counselling sessions. However, women’s economic participation remained stagnant, with only 4.9 percent of mothers engaged in paid work at baseline and 5.2 percent at midline, highlighting that while women played a central role in child nutrition improvements, they had very limited control over household income.
Housing indicators reflected stress on livelihoods. Finished walls increased from 50.5 to 65.4 percent, but finished roofing collapsed from 41.9 percent to only 11.1 percent, replaced by rudimentary roofing which rose from 28.5 percent to 88.8 percent, indicating that families cut back on housing quality to cope with rising costs.
Access to improved sanitation moved from 96.8 to 99.0 percent, while access to safe drinking water sources slightly dipped from 99.1 to 98.2 percent.
The initiative focused on the first 1,000 days of life and extended support up to the age of five through a package that included antenatal and postnatal care, iron and folic acid supplements, micronutrient powders, exclusive and continued breastfeeding promotion, immunisation drives, vitamin A distribution, treatment of severe and moderate acute malnutrition and behaviour change communication on food hygiene and safe feeding practices.
The report by MoNHSR&C, Aga Khan University and Central Asia Stunting Initiative evaluation team concludes that while counselling and health system strengthening improved child indicators, families were left alone to deal with rising food prices and shrinking local production, making it difficult for them to maintain improved practices.
It recommends that future nutrition policy must combine nutrition services with livelihood protection, food price subsidies, community grain banking, climate-adapted agriculture and direct support to food-insecure households, warning that without food stability children may slip back into stunting and wasting despite health system efforts.
Ends