Despite recent official statements about rising average living standards, grinding poverty and the conflict, the effects of junk food in cities have made undernourishment and malnutrition a serious national epidemic.

Protein-energy malnutrition affects 63 percent of Nepali children which means they don't get enough food to ensure normal physical and mental development. More than half of Nepali children are therefore physically stunted, and although this is reversible if the child starts eating enough after age two, they may suffer learning disabilities as well if undernourishment persists .

Hunger increases their susceptibility to diarrhoea, measles and acute respiratory infection. Diarrhoeal dehydration alone causes an estimated 30,000 child deaths every year as undernourished children are weaker and more likely to be brought down by the vicious spiral of disease and malnutrition. Combined with worms, undernourishment is seen by many as Nepal's primary health concern for children.

"Global studies have shown that malnutrition is an underlying factor in 55 percent of all child deaths. Since the rates of malnutrition are very high in Nepal-South Asia is the worst in the world, worse than Africa-we can assume that the situation is similar or worse," says UNICEF's nutrition expert, PO Blomquist.

Malnutrition hits many Nepali children even before they are born because their mothers don't have adequate food while pregnant. Between 30-50 percent of Nepali children are born underweight, below 2.5 kg.

The need to combat undernourishment doesn't get as much attention from donors or the government as it deserves. Protein-energy malnutrition, they say is much more serious than Vitamin A, iron or iodine deficiency. Surveys have shown it is responsible for 70 percent of child deaths through related illnesses."Malnutrition doesn't get priority because it doesn't yield visible and immediate results," explains Dilli Raman Adhikari of the government's Child Health Division.

"The government has to introduce more nutrition wards and programs to specifically deal with malnourished children," says Som Paneru of Nepali Youth Opportunity Foundation (NYOF), which runs nutrition rehabilitation centres in Kathmandu, Mechi and Bheri.

"Usually, sick children are discharged from hospitals after having had other diseases treated but their malnourishment remains neglected," says Paneru, "this causes relapse and leads to other diseases and often death."

Child health experts have pushed for school feeding programs and it was implemented with donor support in coordination with the Health, Education and Agriculture Ministries. But it was phased out in 1990 due to lack of coordination. Nepal's target to reduce malnutrition by half by 2015 is therefore not going to be met.

A UNICEF report says that even with 6.2 percent of annual reduction of malnutrition, it will take another 26 years.

A hungry war

Nutrition experts are concerned that the conflict has worsened the state of child malnutrition. "The constant migration and displacement of villagers has made the problem even worse because it is the children whose food habits we have to change once they arrive in the cities," says Pradeep Silwal of World Vision International Nepal which has been working in several food deficit districts and villages with nutrition projects. Silwal adds that the parents won't be able to afford green vegetables or enough rice, so the children are fed dry and non-nutritious food lacking in proteins.

In Maoist-affected areas like Kalikot, Jumla and Dailekh a recent security ban on transport of food items, clothing and shoes is sure to make the situation worse. In Diktel and Khotang in the east, a Maoist ban on transporting food items is causing a severe food shortage. Even in Kathmandu, the internally displaced are under nourished.
"Scarcity of food due to constant road blockades cause severe crises, especially in deficit areas," says World Visions's Indra Baral. This is already evident in Humla which has the highest hunger rate in Nepal, with 90 percent of the children suffering chronic malnutrition.

The problem is getting worse because whatever nutrition projects that remained are gradually phasing out as more organisations shift towards conflict-related humanitarian and relief work.

Junk food malnutrition

Lakpa Sherpa's staple diet while growing up in Solu Khumbu was instant noodles.

By age 13, she was so addicted to it that she had lost all appetite for regular meals. Her mother didn't detect Lakpa's deteriorating health because she had four other children to look after. Last month, Lakpa collapsed from severe stomach pain and headaches. She had become weak and weighed barely 19 kg. She was flown to Kathmandu for treatment. Her condition has improved steadily afterwards at the Nutrition Rehabilitation Centre (NRC) which has helped over 1,000 malnourished children.

"The problem is not just poverty and ignorance but neglect by mothers especially those who bear more than five children," says nutritionist Manosa Bhattarai. Lakpa suffered protein-energy malnutrition, a chronic form of undernourishment, indicated by stunting and underweight. It is usually the result of lack of food but can also be caused by the wrong kind of food, as in Lakpa's case. Lakpa is lucky to have survived because her family could afford to fly her to Kathmandu. Many other Nepali children aren't so lucky.