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Western India sets example in tackling malnutrition

Oct 08, 2008

In the tribal belts of Maharashtra in western India, a high nutrition diet programme has significantly reduced mortality rates in the state. Provided jointly by two NGOs through the anganwadis, the meal for mother and child contains locally made mixture of millet, jaggery and milk.

In the tribal village of Hirve in the hills of the Western Ghats, fragmented farm holdings mark the monsoon-washed land. 

There is an impoverished lull in the air, and at the Gavit home a dozen pair of eager eyes are fixed on little Praveen as he breaks into a small run. It's a miracle, as for the first year of his life the toddler was hardly able to stand on his feet and weighed a mere five kilograms.

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A persistent fever and frequent bouts of dysentery had taken their toll. His mother did not have the energy to feed him. Praveen's condition looked hopeless.

Now, as he nears two, there's a little colour on his cheeks and he's gained some weight. An "impressive" eight kgs now, he's still 1.5-2 kgs less than what a healthy two-year-old weighs.

It's all thanks to a nutrition programme launched a year ago through the anganwadis, says Gulab Bandu who had lost her own first child to malnourishment four years ago. "He just died within a year and I didn't know what to do," she says.

The template provided could serve as a pointer for other malnutrition afflicted districts in the country.

Holding her new seven-month baby, Gulab says he is healthy largely due to the "mixture" mother and child have every day.

The mixture was introduced to their diet a year ago by the concerted efforts of the Bharatiya Agro Industries Foundation (BAIF) and the Council for Advancement of People's Action and Rural Technology (CAPART). It's here that the first war against malnourishment was launched.         

Lessons to learn

There are many Praveens in Thane's tribal belt today. Four years back, the two blocks of Jawhar and Mokhada had one of the highest malnutrition mortality rates (60 deaths for 1,000 infants born). The trend is being reversed slowly, and the template provided could serve as a pointer for other malnutrition afflicted districts in the country.

It's Madhya Pradesh that immediately needs to learn a few lessons from Thane. Four tribal districts here—Satna, Shivpuri, Khandwa and Sheopur—have seen 125 malnutrition deaths in the last five months. Annual mortality rates are at a high of 60-70 per 1,000 infants, and all for lack of enough nutrients.

But like the Thane officials four years ago, the MP authorities are in denial. They attribute the deaths to pneumonia or diarrhoea, even go on to discount the malnutrition factor.

So what is the Thane formula? It's all about providing a simple, high nutritional value meal for mother and child. In the tribal belt here, they call the mixture lapsi—it's actually a paste of locally grown green millet, soaked, germinated, dried, roasted and mixed with peanuts and jaggery. This is mixed with milk and served to children below six and their mothers.

"It's important to address the issue as an inter-generational one, and look for cures to the ills that occur in successive generations of women"

Around a year ago, over 33 per cent of the babies born in Jawhar and Mokhada were born severely underweight. Almost 85.8 per cent of the pregnant women had a body mass index (BMI) of less than 18, an indicator that they were malnourished.

Today, lapsi has changed things. The infant mortality rate (IMR) in the two blocks—with close to 50 villages—is down to 2.26 in Jawhar (from 53 per 1,000) and 8 (from 54.66 per 1,000) in Mokhada.

Sustained interventions

Equally encouraging is the fact that local authorities readily acknowledge now that there is a malnutrition problem. And that despite the success there is much more work to be done.

Dr Ramdas Marad of the Cottage Hospital in Jawhar is candid, "We are trying hard to tackle the cause of malnutrition. Factors like illiteracy of the parents, particularly the mothers, have to be addressed before we can really do something".

In clinical terms, malnutrition is divided into four categories. Grade I, or mild malnutrition is when the body weight of a person is between 70-80 per cent of the expected weight. Grade II represents moderate malnutrition—body weight is between 60-70 per cent of the average. In Grade III, the body weight is 50-60 per cent and in Grade IV it is down to 50 per cent of the average.

To educate and provide expectant mothers with the right nutrition is critical here. Veena Rao, secretary, Development for Northeast Region, who initiated the drive against malnutrition a year ago during her CAPART stint, says, "The figures tell the story of how interventions done so far have focussed only on the weight of the child. It's important to address the issue as an inter-generational one, and look for cures to the ills that occur in successive generations of women. No single intervention can eradicate malnutrition".

She adds that the intervention package must be widely inter-sectoral (as in government departments involved) and must cover the entire life-cycle of women and children to create an impact within one generation by tackling the nutritional status of the three critical links—children, adolescent girls and women.

"Only then can the benefits be sustainable enough to break the cycle and be passed on to the next generation. Policymakers have to make a choice between waiting for the benefits of growth to trickle down or just immediate intervention," says Rao.

In Thane this began with plugging the protein deficiency. Mixed with water and milk, the green millet mixture, lapsi, was the supplementary food given to underweight babies. The workers at the anganwadi or the local palnas (creches) were trained to give this mixture at regular intervals. The weight of the babies was monitored once in two months.

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Along with this adolescent girls were taught the importance of not marrying young, a practice widely prevalent here, and one that activists admit is unlikely to change immediately.

Building commitment

There are other issues too. Most anganwadis lack basic sanitation and other infrastructure, and it's an uphill battle for activists working here. But results are showing and everyone's upbeat. As Ravindra Vishay, a social scientist with BAIF, says, "Within a year, we will be able to change the script of the story."

He has his task cut out. Illiteracy is nothing unusual here and even those who go to school rarely go beyond the eighth standard. Employment opportunities are next to nil and infant survival comes at a price. Yet, the interventionists are fighting it out. At Jawhar and Mokhada, anganwadi workers now maintain registers with details of every baby born.

The Maharashtra government has also started child development centres (CDCs), where extreme cases of malnourishment are referred to for treatment. Still, not every story has a happy ending. Till September this year, three infants had died in Jawhar and Mokhada.

One died due to hypothermia, the other was born to a mother who had already borne six children. Unfortunately, the CDCs can keep acutely malnourished children and their mothers for only 21 days. After that, they return home and usually regress. It is here that the battle has to be fought all over again.

The quiet transformation in Jawhar and Mokhada should be an eye-opener. It proves that initiatives involving the people at the grassroots level do produce results.

But for that to happen, one needs authorities at the local level who have the commitment and the vision.

Source : Outlook
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