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Abstract
Background: Child undernutrition remains a major public health problem in Pakistan, and local data from District Swabi, Khyber Pakhtunkhwa, are limited. Nationally, about 40% of children under five years are stunted and nearly 18% are wasted, and feeding practices, recurrent infection, poor sanitation and household poverty are closely interrelated determinants. Nurses deliver growth monitoring and feeding counselling at primary care level, yet the nutritional and environmental profile of children attending health facilities in this district has not been well described.
Objective: To describe growth status, infant feeding practices, recent morbidity and water, sanitation and hygiene (WASH) conditions among children under five years, and to test whether weight and height categories differ by sex.
Methods: A facility-based descriptive cross-sectional study was conducted in June 2026 using consecutive sampling at public health facilities in District Swabi. Mothers or caregivers completed an interviewer-administered questionnaire and children were weighed and measured. Weight and height were recoded into three ordinal categories, and sex differences were tested with Pearson’s chi-square test.
Results: Of 400 mother–child pairs surveyed, 398 had valid data on sex (77.6% male); 77.5% lived in rural areas and 74.9% of fathers were unemployed. Mean weight was 11.23 ± 3.84 kg and mean length/height 76.92 ± 11.53 cm. Most mothers initiated breastfeeding within one hour (82.1%) and reported exclusive breastfeeding for six months (81.0%), yet 68.4% gave pre-lacteal feeds. In the previous two weeks, 65.3% of children had diarrhoea and 68.5% had fever; 29.1% of households used unprotected drinking water and 66.7% disposed of waste in open fields. Weight (χ²(2) = 0.04, p = 0.982) and height categories (χ²(2) = 0.97, p = 0.614) did not differ by sex.
Conclusion: Growth categories did not differ by sex in this facility-based sample, while morbidity, environmental and economic vulnerability were common. These exposures were not tested against growth outcomes, so causal conclusions cannot be drawn. Lactation counselling, WASH improvement and WHO z-score–based analyses with multivariable modelling are recommended.