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"THE tribals need to change their attitude and lifestyle," said R.K. Dixit, the Chief Medical Health Officer (CMHO) of Sheopur district in Madhya Pradesh, in response to a query about continuing reports of children starving to death in the region. The Sahariyas, one of the poorest tribal communities in Madhya Pradesh, live mostly in remote villages with little access to health care. Undoubtedly, they would like to change their lifestyle - to begin with, they would like to eat two square meals a day.

Since Frontline reported 13 hunger-related deaths in Patalgarh village in February 2005, there have been similar deaths in at least two of the four villages this correspondent visited this year in the same district. But, just like last year, local officials continue to seek refuge in denial. They deny that acute hunger is a problem. They insist that existing government schemes are being implemented properly. They deny that anything more could have been done. Officials do not readily admit hunger deaths among children in Sheopur. But looking at the distended bellies and wasted limbs of the surviving children, there is little doubt as to what is wrong with their health.

Hunger deaths are a sore spot with officials in Sheopur. Bring up the subject and official responses range from "it is their culture" to "they don't care about children dying; they have so many that they don't even remember" to "they're accustomed to hunger now" or "it wasn't really starvation... maybe some underlying malnutrition". When he was asked for the total number of malnourished children in the district, Dixit told this correspondent to consult the civil surgeon. The civil surgeon's office was found locked.

Not so remote, but starving

Karrai village in Karahal block was in the news recently after five children died. When Frontline visited the village, its residents spoke of seven deaths in July. Kishen's three-year-old daughter, Karan's four-year-old son, Heera's three-year-old son, Ramhit's one-year-old son, Laddoo's infant daughter, Jagram's seven-year-old daughter, Harvilas' one-year-old son. All of them appeared to have succumbed to fevers, coughs, measles, or something else that they did not know the name of. But looking at the surviving children's distended bellies, protruding eyes and wasted limbs, there can be little doubt as to what, at root, is wrong with their health.

Two other children were dangerously sick and were hospitalised at Sheopur. Hari Sahariya's son Gajraj and daughter Ramdhara are both very fragile, but at least they are alive. Hari told Frontline: "I stayed for 10 days at the big district hospital. But there was no money. The children were fed, but not us. How could we have stayed on longer?"

Hari does not know what is wrong with his children, but the medicines prescribed offer a clue - they are all vitamin or mineral supplements. It seems that all the children needed was better food.

Karrai is not particularly remote. The village is barely two minutes from the main highway. It even has a health centre, an anganwadi and a school. When asked if the school gives mid-day meals regularly, a student, Chatru, nodded uncertainly. "Sometimes, yes. When the master comes, there is food. The master comes after every two days."

The smallest children get a fistful of panjeeri (a roasted mixture of corn, soya, sugar and oil) at the anganwadi centre every day. But infants who are too small to eat are particularly vulnerable. Draupadi, a mother with a baby in her arms, said, "What can these little ones eat? If we eat, they'll drink some milk."

Several newborns go hungry since the mothers have not eaten, and mothers are forced to keep the babies alive by making them lick a little jaggery.

The other problem with the way the anganwadis handle malnutrition is that the registers are not maintained properly. The worker does not seem to know precisely how old the child is and therefore cannot judge how severe its condition is. Usually, malnutrition is measured against a chart balancing height and weight parameters; but because malnourished children are often stunted, it becomes impossible to assess whether they weigh enough unless age is taken into account. However, there are few birth registrations and the people, being illiterate, do not keep personal records. It is very important, under the circumstances, that the anganwadis keep a record of birth along with that of height and weight gain.

Uma Chaturvedi, a fellow with the Right to Food campaign who has been working in Sheopur for two years, says this is a significant problem: "The anganwadi registers are ill-kept. The weight and grade [of malnutrition, which is judged in grades of severity from 1 to 4] columns are often left blank; many column entries are completely bizarre. For instance, there was one entry in the name of Priti, daughter of Ghamandi. Between February 2003 and December 2004, the child was given seven different dates of birth. Between December 2004 and June 2005, no entries were made at all. How can one child be born seven times and how can she grow younger as time passes? How will you judge her level of malnourishment correctly then?" Uma Chaturvedi found at least 20 such cases of bungled age entries in the anganwadi centre of one tiny hamlet, Kishanpura.

According to officials, the anganwadi centres alone cannot be blamed for they are not equipped to deal with hunger on such a large scale. Sheopur's ICDS (Integrated Child Development Services) officer O.P. Pande told Frontline: "We are supposed to provide supplementary nutrition. For example, we can give about 300 calories worth, of the total requirement of 1,200. But if the child is entirely dependent on this small supplementary meal, it is bound to be malnourished."

Nevertheless, one cannot ignore the fact that in some villages, anganwadi services are either absent or only partially functional. In Patalgarh, despite assurances and visits from officials, the villagers say that at least eight children have died since the 13 deaths reported in February 2005. It was only in May that the village got a functional anganwadi centre. The village still has no midwife, no medicines and no nurse; the anganwadi worker does not have the skill or resources to help with deliveries or provide pre-natal care to women. There is one male "multi-purpose" health worker in the area, but he is responsible for three panchayats and would not be able to assist in childbirths anyway.

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