Out of 1,02,692 children aged 0 to six, 779 are in severe malnutrition category

Four-year-old Pravin Maskare has spent a fortnight at the Nutrition Rehabilitation Centre (NRC) in Gondia, where his weight increased to 8.3 kg. Even that is far from the ideal, but his mother is unwilling to let him continue here for another week, despite medical advice.

His limbs weak, Pravin plays with a red plastic bat. He weighed 7.9 kg at the time of admission. He suffers from severe deficiencies of calcium and other minerals, which makes his body and limbs look sticklike. His ideal weight should be at least 10.6 kg, doctors say. The NRC is one of six such centres in Maharashtra where malnourished children are cared for.

Civil surgeon Naseem Akhtar says that, at a time, ten children are admitted to the Centre and kept for a maximum of 15 days. All the children are from adivasi families and below the poverty line (BPL).

In the next bed four-year-old Ravindra Bawne sits in the lap of his father Tekaram. His 21-month-old sister Kiran too is in hospital. Both are underweight. Kiran's mother Shishola weeps at the plight of her children but there is little she can do. Kiran's condition is of concern — her ideal weight should have been 9 kg, says Dr. Akhtar but she weighed only 3.4 kg when she was admitted to the Centre.

B.K. Meshram, district health officer, says there are 1,02,692 children between the ages of 0 to six in Gondia district. Of these, 779 were in the severe acute malnutrition (SAM) category and 3,411 in the moderate acute malnutrition (MAM) category, which is calculated according to the weight for height criteria as set by the World Health Organisation (WHO).

Since April till July this year, 118 infants did not reach the age of one and another 25 died between ages one to six. While malnutrition may not be directly responsible for the deaths, the infants have low immunity and cannot fight off infections, Dr. Akhtar says.

Of the children between the ages of 0 to six, 76,160 or 74.93 per cent are normal weight, while 22.12 per cent are underweight and 2.999 or 2.95 per cent are severely underweight, according to official figures.

The situation in four tribal talukas of Gondia is particularly sensitive with respect to child health, says Dr. Meshram. The weaker children are identified by anganwadi workers or Accredited Social Health Activists (ASHA) under the National Rural Health Mission (NRHM) and brought to the NRC, which opened only on August 15.

The situation in Gondia may not be as critical as Melghat, which has a much higher number of malnourished children but it was important to intervene now or the situation could get out of hand, explains Dr. Akhtar.

Poverty, neglect

People in the far-flung villages were reluctant to bring weak children to the NRC or even seek medical attention, she adds. Poverty was one of the main reasons and the parents mostly worked as agricultural labourers and found it difficult to stay in hospitals and look after their children.

However, Gondia has many things going for it. It has a high rate of hospital deliveries — 85 per cent — in the district, and ranks third in Vidarbha, Dr. Akhtar points out. It has better infrastructure services for public health, according to officials. While malnutrition among infants was emerging as a major challenge, the district administration maintains that the situation was better than last year and that the health of infants had registered an improvement.

In neighbouring Gadchiroli district, which has a tribal population of more than 50 per cent, the situation is not very different. Dr. Suresh Mote, district reproductive and child health officer says that of the total of 93,983 children between 0 to six years, 59,382 or 63 per cent are of normal weight.

About 29.3 per cent or 27,573 are medium underweight while 5,413 or 5.8 per cent are severely underweight according to the Integrated Child Development Services (ICDS) norms, which rely on weight for age specifications. However, applying the WHO system, there are 7,577 children in the MAM category and 2,244 in the SAM category, making a total of 9,821, according to official figures.

From April to July this year, 101 infants below six have died due to various causes, 84 of them below the age of one. Gadchiroli has very poor human development indicators and the scattered population makes access to health care very difficult. Infants are neglected after birth and do not get adequate nutritional supplements, Dr. Mote explains.

Many villages are in inaccessible areas. Poor nutrition is also reflected at birth with 20 per cent of infants having low birth weight. Malaria and other diseases compound the health situation even more.

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