The Impact of the Central Asia Stunting Initiative on Stunting Among Children Under Five Years Old in Gilgit Baltistan and Chitral, Pakistan

<b>Background</b>: Stunting, a form of chronic malnutrition, is a global health concern, especially in South Asia. Stunting remains a significant public health issue in Pakistan, particularly in remote regions like Gilgit-Baltistan and Chitral, where geographic isolation and socioeconomic challenges exacerbate malnutrition. The Aga Khan Development Network is leading the implementation of a program, Central Asia Stunting Initiative (CASI), with an aim to reduce stunting through community-driven maternal and child health interventions in the targeted areas of Gilgit Baltistan and Chitral. This study aimed to evaluate the effectiveness of CASI in improving child nutritional outcomes in Gilgit-Baltistan and Chitral. <b>Methods</b>: In this study, a single-group pre-post evaluation design was employed using baseline and midline cross-sectional surveys among households with children aged 0-59 months in Gilgit-Baltistan and Chitral. Data on child anthropometry, household food security, maternal education, and child feeding practices were collected from over 500 households using stratified sampling. <b>Results</b>: Results showed improvement in child health indicators between baseline and midline. Between baseline and midline, stunting declined from 40.9% to 35.4% in GBC (<i>p</i> = 0.02), with severe stunting dropping significantly (17.8% to 10.9%, <i>p</i> < 0.001). Wasting and underweight rates also showed marked reductions. Improvements in breastfeeding rates (71.3% to 88.3%) and dietary diversity (4.0% to 26.8%) were observed. However, food security declined sharply from 95.2% to 11.9%, underscoring persistent economic stress. <b>Conclusions</b>: CASI interventions yielded substantial improvements in child nutrition and maternal behaviours. However, sustained progress requires integrated strategies addressing food insecurity, economic empowerment, and long-term resilience. Future programs should adopt a multi-sectoral approach to tackle chronic malnutrition comprehensively. Despite this, results indicated an overall improvement due to CASI interventions, signifying the importance of integrated, community-based approaches in addressing stunting.