Persistent diarrhea, lactose intolerance, and gut dysbiosis are major gastrointestinal conditions that worsen malnutrition in children, especially in low and middle-income countries. Due to these factors, there is a vicious cycle in which diarrhea worsens malnutrition by reducing the gut’s capacity to absorb nutrients. Persistent diarrhea is defined by WHO, diarrhea (≥ 3 loose/watery stools daily) lasting 14 days or longer posing higher risk of malnutrition than acute diarrhea. This review explores the interconnected nature of these conditions and their cumulative impact on child health and development. A comprehensive literature review was conducted using databases such as Google Scholar, PubMed, Web of Science and Scopus, focusing on studies examining the pathophysiology, clinical manifestations, and management strategies in malnourished children. This review explores current evidences on etiology (E. coli, Cryptosporidium, sequential infections), pathophysiology (malabsorption, villus atrophy, enteric inflammation), dietary interventions (zinc, vitamin A, glucose-polymer ORS) and microbiome-based (probiotics, dysbiosis, correction) strategies of persistent diarrhea. Findings show that persistent diarrhea causes mucosal damage and nutrient malabsorption, while secondary lactose intolerance leads to osmotic diarrhea and further caloric loss. Gut dysbiosis, marked by the depletion of beneficial bacteria and overgrowth of pathogens, impairs digestion, disrupts immune function, and sustains chronic inflammation. Together, these conditions create a vicious cycle that perpetuates malnutrition and stunting. Recommended interventions include oral rehydration therapy, lactose-restricted diets, micronutrient supplementation (particularly zinc and vitamin A), and microbiota-based therapies such as probiotics and prebiotics. The review concludes that integrated approaches—combining nutritional support, microbiome restoration, and improved hygiene—are essential for breaking the cycle of malnutrition and gastrointestinal disease. Addressing these issues through targeted public health policies and personalized interventions can significantly improve outcomes for vulnerable pediatric populations.

Objective: To evaluate the serum phosphate level of children with severe acute malnutrition and effect of therapeutic feeds (F75 and F100) on serum phosphate levels. Study Design: Prospective Observational Study. Place and Duration of Study : The study was conducted at Stabilization center of Children's Hospital and Institute of Child Health Multan from 1 March 2018 to 30 March 2019. Materials and Methods: The total 270 children with severe acute malnutrition, who were under 5 years of age and admitted to the stabilization center for complicated SAM during study duration were included in the study. Initial management of the patients were started by following WHO protocols for Severe Acute Malnutrition management and the baseline labs along with serum phosphate levels were sent for evaluation. Patients were admitted at Stabilization Centre for the management plan as per guidelines. Once the patients were stabilized in one week approximately the transition towards rehabilitation phase of severe acute management started. Serum phosphate levels were assessed at admission, at stabilization (day 7 of admission) and at the time of discharge. Data was analyzed using SPSS version 21. Results: The mean age of our patients was 22 ± 2 months. The male to female ratio were 1:2. Hypophosphatemia was documented in 180 (66%) patients with mean 0.96 ± 0.40 mmol/ltr < (1.45 –1.78mmol/ltr) serum phosphate levels at the time of admission. During transition phase the phosphate levels were 1.1± 0.45 mmol/l and after rehabilitation phase 1.45 ± 0.45 mmol/l on average of 15 days of management. After using F75 and F100 therapeutic feeds in stabilization, transition, and rehabilitation phase 178 (98.9%) children were treated and had normal serum phosphate level at the time of discharge. Conclusion: Hypophosphatemia is commonly present in SAM children. Introduction of therapeutic feeds F75 and F-100 during stabilization phase and rehabilitation phase significantly improves phosphate levels in SAM children with low phosphate levels.

Objective: To create gender and age-specific mid -upper arm circumference (MUAC) growth centile curves for nourished Pakistani children and adolescents aged 2 - 18 years, as well as to define cut -points for assessing under and over-nutrition.Methodology: This research was based on secondary data from a cross-sectional multi-ethnic anthropometric survey-2016. Age, gender, and MUAC measurement were extracted as variables from this data. The lambda-mu-sigma (LMS) approach was used to get the MUAC growth reference values and their related charts.Results: In both sexes, the smoothed MUAC percentile curves rose with age. Between the age of 7 and 12, girls were shown to have higher values of percentiles than boys. When comparing the LMS, MUAC 50th percentile to references from 2007-WHO and corresponding data from other countries, it is clear that Pakistani children and adolescents have much lower MUAC percentiles than their counterparts in the reference group. Age-specific MUAC cut-offs defined for thinness (<-2SD) ranged between 12.18 - 18.10cm in boys and 12.24 - 18.08 cm in girls, and for excess weight (> +1SD) were 14.49 - 24.11 cm in boys and 14.60 - 25.23cm in girls.Conclusion: The study results suggest that WHO data and MUAC reference data from other countries are not suitable as standards for the Pakistani pediatric population. The newly MUAC reference data and proposed cut-off values will be beneficial in a variety of situations as a nutritional evaluation tool.

OBJECTIVE:To identify echocardiography-based myocardial changes in children with severe acute malnutrition. Methods:The prospective study was conducted from January to November 2020 at a territory care paediatric hospital in Multan, Pakistan, and comprised severe acute malnutrition patients of either gender aged 1-60 months and an equal number of matching healthy controls. Malnutrition was categorised using the World Health Organisation criteria. Echocardiographic evaluation was done by expert cardiologists. Values for ejection fraction shortening, left ventricular mass, E/A wave ratio as well as mitral and tricuspid annular plane systolic excursions were noted. Data was analysed using SPSS 21. RESULTS:Of the 150 subjects, 75(50%) each were cases and controls. Age and gender were not significantly different between the groups (p>0.05). Left ventricular mass and left ventricular mass index with body surface area were significantly reduced in the cases compared to the controls, and the same was the case with left ventricular ejection fractional shortening (p<0.05). There was no significant difference between the groups in terms of E/A wave ratio as well as mitral and tricuspid annular plane systolic excursions (p>0.05). Among the cases, cardiac evaluation showed 26(34.6%) were kwashiorkor and 49(65.3%) were marasmic patients. CONCLUSIONS:Left ventricular parameters in malnourished children were found to be reduced. As such, the assessment of these parameters may appear to be a significant indicator for timely identification of cardiac malfunction in severe acute malnutrition cases.

Objective: To determine the prevalence of urinary tract infections, causative organisms and culture sensitivity pattern in children with CP. Study Design: Cross Sectional Descriptive. Setting: The Children Hospital and The Institute of Child Health Multan. Period: September 2020 to September 2021. Material & Methods: After consent from parents and ethical approval, 52 children diagnosed case of CP, 2-12 years, of both gender were enrolled. Demographic data and socioecononomical status was noted. Type of CP was ascertained. Complete urine examination was sent for microscopy and culture sensitivity. Results: Out of 52 children male were prominent with age range of 2-7 years (mean age ± SD, 5.8 years ± 3.27). Mostly children were malnourished, belonged to low socioeconomic status {73.1% (n=38)} and spastic quadriplegic type, {53.8% (n=28)}. UTI was significantly found in 73.1% (n=38) of CP children (p-value=0.002), predominantly in male (76.5%), of 2-7 years of age (66.7%), malnourished (66.6%), with low socioeconomic status (73.7%) and Spastic quadriplegic type (85.7%). No organisms were detected in 52.7% (n=20) of UTI positive children with predominantly E-coli 26.4% (n=10), and was found most susceptible to amikacin, gentamicin, imipenum and meropenum, while least susceptible to Nalidixic acid, Amoxicillin-clavulanic acid, Piperacillin-Tazobactum, cefotaxime and ceftriaxone. Other organisms were, Klebseila pneumonia in 10.1% (n=4), Enterobacter and Pseudomonas Aurigenosa in 5.4% (n=2) children each. Abdominal USG showed positive findings in 63.1% (n=24) children. 16 children detected thick walled urinary bladder, 2 fullness of pelvocalyceal system, 2 echogenic urinary bladder walls, and in 2 echogenic kidneys. Conclusion: UTI is common complication which can lead to renal compromise. So all the CP children must be properly screened and managed for UTI to minimize the complications. Appropriate antibiotic must be used to avoid the antibiotic resistance.

Objective: The main purpose of the study was to assess the nutritional status of lactating mothers. Study Design: Cross Sectional study. Setting: Fatima Jinnah Hospital, Chowk Ghantaghar, Multan. Period: March 2019 to November 2019. Material & Methods: The study comprised of 250 lactating mothers aged 18-40 years. The data for this study was collected by trained nutritionist when lactating mothers came for checkup and SPSS software was used for data analysis. Results: This study showed that mother status mostly effected due to iron deficiency. Only 20% women were having normal Hemoglobin level. 80% women were anemic and 61.6% women were underweight and 4.8% women were overweight during lactation period. Their serum ferritin level was significantly low due to iron deficient diet/ low iron supplementation. In this conducted study 34.4% women were uneducated and 70.8% women were from rural areas of Multan. 42.4% women were poor socioeconomic status. Conclusion: Nutritional status of lactating mother is mostly affected by iron deficiency. Iron deficient diet or lack of iron supplementation due to poor socioeconomic status/ lack of education about nutrients affect the lactating status of mother.

Objective: To assess the prevalence of hypomagnesaemia and its co-occurrence with other diseases in children aged 6-60 months admitted to Children's Hospital and Institute of Child Health, Multan (CH&ICH Multan). Methodology: This prospective observational study was conducted in Nutrition Stabilization Center at Children's Hospital and Institute of Child Health, Multan from May 2019 to January 2020. A total number of 384 malnourished children aged 6-60 months were included in the study. The nutritional status of children was accessed according to WHO criteria as weight for height or length <-3SD or mid upper arm circumference <11.5 cm and presence of severe signs of wasting and bilateral edema. For data analysis SPSS version 20 was used. Results: Out of 384 children, 163(42.45%) had hypomagnesaemia. The mean age was 18.4 +/- 2.8. Male to female ratio was 1.21:1 with 96(58.89%) male and 67(41 .11%) female had hypomagnesaemia. We found that 62(38.04%) hypomagnesaemia children belonged to age group 12-24 years. Most children, 121(31.51%) were aged 12-24 months and 282(73.44%) belonged to very poor socio-economic status. Conclusion: Hypomagnesaemia was very common among hospitalized children which can cause many complications that increases the mortality rate and hospital stay.

Objective: To determine the percentage of Hypothyroidism in children with severe acute malnutrition. Study Design: Cross Sectional study. Setting: Nutrition Rehabilitation Center, Children’s Hospital and Institute of Child Health Multan. Period: January 2019 to December 2019. Material & Methods: A total of 255 malnourished patients (as per inclusion criteria) were included in current study. A written Performa was designed to collect history, anthropometric measurements and systemic examination. Taking aseptic measures venous blood was sent for baseline tests as well as for T3, T4 and TSH, total serum protein albumin and total ferritin levels to hospital laboratory. Correlation between serum thyroid concentrations and total protein, albumin, hemoglobin and serum ferritin were estimated by using t-test and p-vlaue less than 0.05 was considered as significant. Total collected data was entered and analyzed in SPSS version 21.0. Results: A total of 255 malnourished children were included in this study. Majority of studied subjects were male (52.5%) with 83.92%, 3-5 years of age. Amongst the 255 children mean values of T3 in MAM and SAM patients were 105.4 ng/dl and 89.7 ng/dl respectively. There was a statistically significant (p <0.001) association between decreased T3 and type of malnutrition. Similarly, mean values of T4 in MAM and SAM patients were 6.3 ug/dl and 5.7 ug/dl respectively that was statistically significant (p <0.05). Lower values of T4 were higher among SAM children in 1 to 3 years age group compared to respective MAM children with p value .0.05 and high T4 value in 3-5 years age group of MAM children were both statistically insignificant. Higher mean Values of TSH was found in SAM compared to MAM children both age groups. Conclusion: Severe acute malnutrition (SAM) is associated with reduction in T3 and T4 levels and higher levels of TSH in SAM children as compared to MAM. The altered thyroid hormone status in children with PEM is perhaps a protective phenomenon to limit protein catabolism and lower energy requirements.

Abstract Objective: Neck circumference (NC) is currently used as an embryonic marker of obesity and its associated risks. But its use in clinical evaluations and other epidemiological purposes requires sex and age-specific standardised cut-offs which are still scarce for the Pakistani paediatric population. We therefore developed sex and age-specific growth reference charts for NC for Pakistani children and adolescents aged 2–18 years. Design: Cross-sectional multi-ethnic anthropometric survey (MEAS) study. Setting: Multan, Lahore, Rawalpindi and Islamabad. Participants: The dataset of 10 668 healthy Pakistani children and adolescents aged 2–18 years collected in MEAS were used. Information related to age, sex and NC were taken as study variables. The lambda–mu–sigma (LMS) and quantile regression (QR) methods were applied to develop growth reference charts for NC. Results: The 5th, 10th, 25th, 50th, 75th, 90th and 95th smoothed percentile values of NC were presented. The centile values showed that neck size increased with age in both boys and girls. During 8 and 14 years of age, girls were found to have larger NC than boys. A comparison of NC median (50th) percentile values with references from Iranian and Turkish populations reveals substantially lower NC percentiles in Pakistani children and adolescents compared to their peers in the reference population. Conclusion: The comparative results suggest that the uses of NC references of developed countries are inadequate for Pakistani children. A small variability between empirical centiles and centiles obtained by QR procedure recommends that growth charts should be constructed by QR as an alternative method.

Objectives: Pakistan is facing double burden of malnutrition. The purpose of current study was to access the nutritional status by different anthropometric methods and common barriers that affect the nutritional status of children. Study Design: Cross Sectional study. Setting: Children Hospital & Institute of Child Health Multan, Pakistan. Period: From 1st March 2019 to 1ST January 2020. Material & Methods: The study contained of 405 children with 216 boys and 187 girls. The data was collected by trained nutritionist in OPD of Children Hospital & Institute of Child Health and data was analyzed by using SPSS version 21.0. Results: The study showed that malnutrition is caused by poor socioeconomic status and low education level of care giver. The data showed that 318 (78.51%) participants involved in this study were malnourished. Nutritional status mostly affected during first birthday (36.79%). In this study 50.12% participants belonged to poor nutritional status and 47.65% mother were uneducated. Conclusion: The mother education and good socioeconomic status can prevent children from malnutrition. Feeding practices and weaning starting time also play role in defining nutritional status of children. Children under five year of age are at very sensitive of age and more prone to diseases so well balance diet and mother feeding upto-2 years of age can prevent children from chronic diseases and improve nutritional status.

OBJECTIVE To scrutinise the contribution of childhood disease awareness in mothers to minimise the risk of disease severity in children aged <5 years and to evaluate the effectiveness of a proposed app in this context. METHODS The evolutionary study was conducted in Children's Hospital and the Institute of Child Health Multan from September 2018 to February 2019 and comprised two sessions with the app involving 30 mothers who were provided with smartphones with the app installed. The mothers were divided into 4 age groups. The app was evaluated using quantitative and qualitative measures. Suggestions and opinions were obtained in the first session and all suggestions were implemented by the second session. RESULTS Of the 30 mothers, 8(26.6%) were in Group 1 aged 14-20 years, 12(40%) in Group 2 aged 21-27 years, 7(23.3%) in Group 3 aged 28-34 years and 3(10%) in Group 4 aged 35 years and above. The participants were able to diagnose their children's diseases accurately by following the instructions provided by the app. The subjects also agreed that they diagnosed the diseases accurately. All the participants were interested in the app and expressed the desire to have it available across the healthcare facilities in Pakistan. CONCLUSIONS All subjects showed acceptance for the app and affirmed its easy usability, especially for illiterate mothers.

Objectives: To determine the average weight gain after lactation counseling therapy in infants up to six months of age having severe acute malnutrition. Study Design: Quasi experimental trial. Setting: Stabilization Center Unit, the Children’s Hospital & the Institute of Child Health, Multan. Period: 1st October 2015 to 1st October 2016. Material & Methods: A total of 205 children with SAM were included in this study using non-probability consecutive sampling technique. Mothers of these children were motivated for more than 8 feeds/day, positioning and attachment at breast feeding was advised, demonstrated and monitored. All the data obtained was entered and analyzed by SPSS version 20. Results: Of these 205 study cases, 142 (69.3%) were boys and 63 (30.75) were girls. Mean age of our study cases was 3.75 ± 1.39 months (with minimum age of our study cases was 2 months while maximum age was 6 months). Of these 205 study cases, 101 (49.3 %) were from rural areas while 104 (50.7%) were from urban areas. Mothers of 117 (57.1%) study cases were literate while 88 (42.9%) were illiterate. Majority of our study cases i.e. 129 (62.9%) were from middle income background and 76 (37.1%) were from poor social background. Partial breast feeding was positive in 145 (70.7%) of our study cases and no breast feeding was noted in 60 (29.3%). Mean baseline weight was 2737.07± 585.60 grams. Mean weight at discharge was 2995.37 ± 621.97 grams and mean weight gain was 800.0 ± 258. 29 grams. Average daily weight gain was noted to be 11.27 ± 4.73 g/kg/day. Conclusion: Our study results have shown that lactation counseling therapy significantly improves weight gain in children under 6 months of age with severe acute malnutrition. Mothers of infants presenting with malnutrition must be counselled to breast feed to improve their clinical outcomes. Mean weight gain was significantly associated with maternal education and socioeconomic status. Further studies are suggested from different parts of the country to generate our local data at national level which may be incorporated for national health policy guidelines.

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers. Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined for clinical signs of iron deficiency anaemia. Results: Of the 100 women, 20(20%) were malnourished, 42(42%) were of normal weight, and 38(38%) were either overweight, pre-obese or obese. The caloric intake of 26(26%) mothers was less than 1500 kcal per day, while 42(42%) were taking between 2000- 2500 kcal per day and 32(32%) were taking >2500 kcal daily. Also, 67(67%) women were suffering from anaemia and 80(80%) women had some myths related with dietary restrictions during pregnancy, lactation and complimentary feeding of children. Overall, 23(23%) women breastfed their babies.

Background Stunting is a major public health issue in most of developing countries. Although, its worldwide prevalence is decreasing slowly but the number of stunted children is still rising in Pakistan. Stunting is highly associated with several long-term consequences, including higher rate of mortality and morbidity, deficient cognitive growth, school performance, learning capacity, work capacity and work productivity. To prevent stunting, we proposed Stunting Diagnostic and Education app. This app includes detailed knowledge of stunting and it’s all forms, symptoms, causes, video tutorials and guidelines by the Pediatricians and Nutritionists. Methods A cross-sectional study has been conducted in schools of Multan District, Pakistan for the period of January 2019 to June 2019. Sample data of 1420 children, aged 4 to 18 years using three age groups, were analyzed by using SPSS version 21.0 to assess the prevalence of stunting and to analyze the risk factors associated with it in children under and over 5 age. Chi square test was applied in comparison with rural and urban participants and p -value < 0.05 was considered as significant. This study includes distribution of sociodemographic characteristics, parental education, working status of mothers, dietary patterns of school going children and prevalence of stunting in school going children. After getting study results, Stunting Diagnostic and Education app was developed according to the instructions of child experts and nutritionists. Results 354 (24.93%) participants were stunted out of 1420, 11.9% children were obese and 63.17% children were normal. Out of 354 stunted children, higher ratio of stunting was found in the age group of 8–11 years children with 51.98 percentage. 37.85% stunted children were found in the age group of 4–7 years and 10.17% stunting was found in the age group of 12–18 years children. It was observed in the study that male children were highly stunted than female with 57.91 and 42.09% respectively. Children living in rural areas were more stunted affected as compared to the children living in urban society with percentage 58.76 and 41.24 respectively. Conclusions Our study concluded that 24.93% children were stunted, out of which, age group of 8–11 years children were highly stunted. The study showed that the literacy of mother or caregiver had high impact on children’s health. Therefore, Stunting Diagnostic and Education app was developed to educate mothers to diagnose stunting and to teach about the prevention of stunting.

Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age.

BACKGROUND AND PURPOSE:There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children.METHODS:This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0).RESULTS:The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group.CONCLUSIONS:Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.

Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. In current study, awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children was evaluated. The results showed that 99% mothers considered breast milk safe and effective but practically only 23% babies were breast fed while 77% were bottle fed. According to 58% mothers, there should be a early initiation of breast feeding, while 57% were un aware of the facts that clostrum should be given while 43% (43/100) of then considered it unhealthy and non effective. The current awareness reveals that most of the mothers prefer to give commercially available foods for their infants instead of breast feeding. This situation is alarming regarding child health and there is need to educate the mothers especially about the beneficial and health curing effects of breast feeding.

Background: Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. Objective:To evaluate the awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children. Study Design: This is a descriptive /cross sectional study. Place and duration of study: This study was conducted at the department of preventive pediatrics Children hospital and institute of child health, Multan from March 2013 to September 2013. Materials and Methods:This study included a total of 100 females that were the mothers of malnourished children visiting the follow up room of department of preventive pediatrics Children hospital and institute of child health, Multan. A questionnaire was designed and others were interviewed in detail after taking proper consent. Results:In this study, the mean age of the sample was25years +/_3 years. 70 % females (70/100) were from urban areas while 30 %(30/100) were from rural areas. Of the 100 respondents 54%( 54/100) of mothers were illiterate and this study showed that 99% (99/100) considered breast milk safe and effective than other feeds but practically only 23%(23/100) babies were breast fed while 77%(77/100) were bottle fed. Pre-lacteal feed was given by 82% (82/100). According to 58% (58/100) mothers there should be a early initiation of breast feeding, while 57% (57/100) were un aware of the facts that clostrum should be given while 43 %(43/100)of then considered it unhealthy and non effective,82%(82/100) considered 4 months a period of exclusive breast feeding,61% (61/100) were counseled by doctors regarding the benefits of breast feeding,50%(50/100) were aware of the use of exclusive breast feeding as a contraceptive tool and 34 % (34/100) were aware of its importance for the prevention of breast cancer. Conclusion:The findings of the study indicated the various important policy implications for the intervention of breastfeedig. Strategies to encourage mothers to follow breastfeeding recommendations should concentrate on improving their knowledge.

Background: Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. Objective:To evaluate the awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children. Study Design: This is a descriptive /cross sectional study. Place and duration of study: This study was conducted at the department of preventive pediatrics Children hospital and institute of child health, Multan from March 2013 to September 2013. Materials and Methods:This study included a total of 100 females that were the mothers of malnourished children visiting the follow up room of department of preventive pediatrics Children hospital and institute of child health, Multan. A questionnaire was designed and others were interviewed in detail after taking proper consent. Results:In this study, the mean age of the sample was25years +/_3 years. 70 % females (70/100) were from urban areas while 30 %(30/100) were from rural areas. Of the 100 respondents 54%( 54/100) of mothers were illiterate and this study showed that 99% (99/100) considered breast milk safe and effective than other feeds but practically only 23%(23/100) babies were breast fed while 77%(77/100) were bottle fed. Pre-lacteal feed was given by 82% (82/100). According to 58% (58/100) mothers there should be a early initiation of breast feeding, while 57% (57/100) were un aware of the facts that clostrum should be given while 43 %(43/100)of then considered it unhealthy and non effective,82%(82/100) considered 4 months a period of exclusive breast feeding,61% (61/100) were counseled by doctors regarding the benefits of breast feeding,50%(50/100) were aware of the use of exclusive breast feeding as a contraceptive tool and 34 % (34/100) were aware of its importance for the prevention of breast cancer. Conclusion:The findings of the study indicated the various important policy implications for the intervention of breastfeedig. Strategies to encourage mothers to follow breastfeeding recommendations should concentrate on improving their knowledge.