A Lasee; K S Khan; MH Rahbar; JB McCormick,

Department of Community Health Sciences, Aga Khan University.

Introduction: Malnutrition is a serious problem in Pakistan and other developing countries, where it contributes to childhood morbidity, disability and mortality. Studies in rural Sindh by the department of Community Health Sciences, Aga Khan University, showed a prevalence of malnutrition as high as 40- 50 percent for severe or moderate degree malnutrition in children under five. School Nutrition Program (SNP) is a pilot project to promote health and education of rural children in Sindh through involvement of communities and local NGOs. SNP was initiated in four districts of Sindh, and involved four local NGOs. Eight schools per district were selected in the remote or less remote areas of these districts. The four districts encompass three major ecological zones desert, arid, and fertile.

Objectives: We wished to devise a measure of infrastructure development in the villages and look at its relationship to the health and school attendance of the children. The main indicators of infrastructure considered here are: housing, electricity, water and sanitation, communication, and access to health care and school. The results will help to develop a framework for improving the health and education of children through SNP interventions.

Methods: Data from baseline and nutritional assessment surveys of School Nutrition Program (SNP) was used. To devise an index of village infrastructure development , we used chi-square test of independence to examine the association between infrastructure variables. Electricity and water type were highly associated with other infrastructure variables. Therefore, a simple rule based on presence or absence of electricity and sweet water in village was used to classify villages into most, less and least developed. According to this classification, 14 %, 52 % and 34 % of villages are classified into most, less and least developed respectively. To assess the educational development of children, an education index was created by dividing the total number of children attending school by the total number of household in village. In the preliminary analysis, nutritional development of the children was measured by the availability of food in the village.

Results: There was a relationship between village development classification and food availability in the village (p <.05). This suggests that the infrastructure of the village is associated with the nutrition of the children. Presence of NGOs and local committees in the village showed a significant association with village infrastructure (p < .03). Villages with the lowest developmental index had the lowest mean educational index and villages with the highest development index had the highest educational index. (p<.01 by ANOVA)

Conclusion: The results suggest a strong association between village infrastructure, especially electricity and water type, and education and nutrition of children. It further suggests that establishing a village organization aimed at providing basic services of water and electricity may be the most effective route to improved education and nutrition. These measures of basic village infrastructure should be more widely explored as tools to target developmental strategies in the rural areas.

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