Community-based help only hope for hungry kids

by December 21, 2019 0 comments

While there are Nutrition Rehabilitation Centres to help children suffering from Severe Acute Malnutrition-related life-threatening complications, evidence suggests that 80-90 per cent of them are without any such complaints and can be treated at the community level with the help of social workers

Reed-thin arms, the swelling of oedema distorting their body, some with distended tummies, others wheezing with pneumonia, and most of them with disinterest in their eyes and lethargy in their limbs… this is the state of India’s children.

India ranked 102 out of 117 in the Global Hunger Index 2019, which reported that around 90 per cent of the children aged between six and 23 months in the country, don’t even get the minimum food required by their growing bodies. To understand the ground realities surrounding malnutrition, I travelled to many States — Assam, Chhattisgarh, Jharkhand, Maharashtra and Odisha. Not surprisingly, during my visits, I found that the incidences of stunting, wasting and malnourishment were high in these populations, with an inordinately large number of children falling in the Severe Acute Malnutrition (SAM) category, which is the most extreme and visible form of undernutrition.

Strangely, though Assam is rich in tea, silk and oil, many parts of the State are still grossly underdeveloped. A high number of people are marginalised and subsist below the poverty line, solely dependent on food entitlements. The vulnerable groups comprise tea garden labourers, Bodo and Rabha tribes living in areas like the Bodoland Territorial Area Districts, migrant populations of the Brahmaputra floodplains, as well as predominantly Muslim communities in Darrang’s Kharupetia region. Assam continues to be one of the bottom-five States of the country when it comes to health and hygiene. There is a high prevalence of undernutrition among children, adolescent girls and mothers. The Infant Mortality Rate is high at 48 and 38 per cent of children under five, are stunted, primarily due to poor infant and child feeding practices. And 14 per cent of the children suffer from acute malnutrition, with four per cent falling in the SAM category.

It’s a similar story in Chhattisgarh, one of the richest States in terms of minerals. But, its population is one of the country’s poorest, and a large number of the inhabitants are indigenous tribal groups that often have nutrition-poor food habits, low literacy and subsistence-level economies. According to NHFS-4, the population of Chhattisgarh has high levels of wasting (15 per cent), whereas a report by the NITI Aayog shows that an alarming 37.6 per cent of children below five years in Chhattisgarh are suffering from malnutrition and 41.5 per cent of women in the State are anaemic.

There’s a unique issue with Jharkhand, that has been registering a higher rate of economic growth, when compared with the rest of the country, as reports show that more than 40 per cent of the population there lives below the poverty line, about 45 per cent of children under the age of five are stunted, and almost 48 per cent are underweight.

Maharashtra, considered as India’s wealthiest and most industrialised State with the largest contribution to the country’s GDP (15 per cent), should not even be on this list. Yet, less than a 100 km from Mumbai, Palghar district has become the epicentre of a SAM crisis over the last two decades. In 2015-2016, there were 555 SAM-related deaths, while the following year saw 475 similar deaths of children. In districts such as Nandurbar and Amravati too, the situation is dire. While the NFHS-4 reported that the prevalence of SAM in Maharashtra was 9.4 per cent, independent assessments by NGOs suggest that the actual number could be much higher.

In Odisha, as per UNICEF data, about 57 per cent of tribal children in the under-five year segment are chronically undernourished. As many as 26,184 children suffered from malnutrition and fell in the severely underweight category in 2018. State Women and Child Development (SWCD) department data shows that the number of children suffering from malnutrition is the highest in the districts of Kalahandi (3,114), followed by Kandhamal (2,887) in 2018. Nearly 3,500 children have died of malnutrition here during the last five years. I talked to the families of these children; I visited the district nutrition rehabilitation centres; I watched the women who have made it their life’s work to bring about change as they went about their daily duties… just to understand where it is all going wrong.

I found that, apart from poverty, which is the most obvious problem, many other factors contribute to dismal conditions in the homes of tribal communities and other marginalised sections of society. Unavailability of education, hygiene and access to medical treatment, early marriage, multiple pregnancies, the lack of nutrition from earlier generations, superstitious beliefs and faith in dubious medicine men instead of doctors, and many other reasons compounded the problem.

The sheer lack of awareness amongst parents about what constitutes a nutritious meal was one of the most startling findings. In many cases, the failure of the system to provide aid to the beneficiaries as well as to people who are working in the field, also added an extra pall of gloom to already dire realities.

Many organisations are working to address this huge problem besetting our next generation and its dire repercussions on productivity. But, is help reaching the right people? What exactly lies at the end of the chain? How do the Integrated Child Development Services’ (ICDS) outreach programmes via Anganwadi Centres work? Are there any success stories that throw light on how things can be done, right?

It is only by investigating conditions at the grassroots level that one can get answers that present the true and whole picture.  While there are Nutrition Rehabilitation Centres (NRCs) to address SAM children with life-threatening complications, evidence suggests that 80-90 per cent of SAM children are without any such complications and can actually be treated at the community level with the help of community workers.

Moreover, families are often hesitant to go to the NRCs because they can’t afford it or because the centres are overburdened and too far from their homes. The challenge here is to find a solution that integrates a model for community mobilisation, where civic-level convergence through community workers can treat the majority of the children. Strategies like community-based management of acute malnutrition (CMAM) in States like Maharashtra, Gujarat, Rajasthan, and so on, have been successful in bringing down the number of acutely malnourished children. Why can’t we scale CMAM at the national level, across all States?

Children are not just our future, but our present as well. I would like to advocate for these children who cannot speak for themselves and urge the policymakers to ensure that we bring help to them. Therefore, I support Jan Andolan, and I support a community-based model for addressing acute malnutrition among Indian children.

(Writer: Sudharak Olwe; Courtesy: The Pioneer)

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