Development and implementation of "

Background: Undernutrition remains a leading driver of child mortality and morbidity in low- and middle-income countries, yet surveillance and case management in Pakistan still rely largely on infrequent surveys and paper-based registers that cannot track nutritional status in real time. The private sector, where most Pakistani households seek care, has been largely excluded from nutrition programming. We describe the development and early implementation of Mazboot Bunyad, a digital nutrition registry embedded within an integrated nutrition-immunization programme at private provider clinics in high-risk, low-income settlements of Karachi. Methods: The Android application and web dashboard used in this implementation study were designed through a participatory process using the AHEAD framework, in consultation with provincial health authorities, immunization staff, and community nutrition worker. The system used QR-linked child records, an embedded digital decision-support system that classified children by mid-upper arm circumference and has automated follow-up reminders. The tool was deployed across 33 clinics, and routinely collected programme data, a preliminary analysis of data from 1 July to 31 December 2024 were retrospectively reviewed. Results: During the period of 6 months, the Conclusions: Early implementation of Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s44247-026-00303-7.