THECHO, Nepal (Thomson Reuters Foundation) - Shanti Maharjan, who gave birth to a baby girl 10 days ago, has spent the last two months living under corrugated iron sheets with her husband and five others after two major earthquakes reduced her mud-and-brick home to rubble.
Adequate food, drinking water and aid such as tents and blankets have been hard to come by, she says, though scores of aid agencies rushed to the Himalayan nation to help survivors.
What worries the 26-year-old mother most is her inability to produce breastmilk for her new-born daughter, who she fears is at serious risk of malnutrition in the aftermath of the 7.8 and 7.3 magnitude quakes in April and May.
"The earthquake destroyed everything, including our food reserves," said Maharjan, sitting under the iron sheeting on farmland on the outskirts of the capital, Kathmandu.
"There is not enough food. Getting meat, oil and fruits to eat is difficult in this situation. I am worried about my daughter's nourishment," she said as the baby, wrapped in a green cloth, lay sleeping on a wooden bed.
The government, aware that disruption caused by the quakes could worsen the country's already high rate of child malnutrition is sending out teams of community nurses to give advice and food supplements to women and children in the affected areas.
A 2011 government study showed that more than 40% of Napel's under-five-year-olds were stunted, showing that the country's child malnutrition rate was one of the world's highest.
Experts say the two quakes, which killed 8,895 people and destroyed half a million houses, could make things worse as survivors have inadequate food, water, shelter, healthcare and sanitation.
United Nations officials warn that the rate of stunting among children in the South Asian nation could return to the 2001 level of 57%, if authorities and aid agencies do not respond effectively.
"The risk of malnutrition is high and requires the nutrition and other sectors like agriculture, health, water, sanitation, education and social protection to respond adequately," said Stanley Chitekwe, UNICEF's nutrition chief in Nepal.
DRIVE TO NOURISH
Child malnutrition is an underlying cause of death for 3 million children annually around the world - nearly half of all child deaths - most of whom die from preventable illnesses such as diarrhoea due to weak immune systems.
Those lucky enough to survive grow up without enough energy, protein, vitamins and minerals, causing their brains and bodies to be stunted, and they are often unable to fulfill their potential.
Government officials admit the challenges, citing data showing that almost 70% of Nepali children under the age of two suffer from anaemia caused by iron deficiency.
"This shows that (poor) nutrition is a very big problem. The earthquake will further worsen the situation because people simply don't have enough to eat, let alone have a nutritious diet," said Health Ministry official Krishna Prasad Paudel.
Supported by UNICEF, authorities have now launched a drive to reach out to more than 500,000 women and children who need supplementary food and medicines.
More than 10,000 female community volunteers will be fanning out across 14 districts affected by the earthquakes, visiting devastated towns and villages and speaking to new and expectant mothers about breast-feeding their infants.
The volunteers will also advise families on eating locally available nutritious foods such as green vegetables and meat and will distribute vitamin A, iron and folic acid, and other micronutrient supplements to pregnant and breastfeeding women.
In Imadole, a prosperous district on the outskirts of the ancient town of Patan, health volunteer Urmila Sharma Dahal found an extremely thin two-year-old boy weighing 7.5 kg (16.5 pounds) last week, suffering from severe acute malnutrition.
Dahal said she provided his family with sachets of ready-to-use therapeutic food - a paste of peanut, sugar, milk powder, vitamin and oil - and the child gained nearly a kilo (2.2 pounds) in weight in just seven days.
"It does not take much. It can be done with small but right interventions," said Dahal as she sat next to the child in the family's brick-and-cement home.
Reuters Health Information © 2015