Health interventions in Attappady must be remodelled so that protein supplementation programmes get priority over iron and folic acid supplementation.
This is because acute protein malnourishment during pregnancy and its subsequent health impact on the infants born to the mothers is the main cause of the high infant and neonatal mortality in Attappady, according to a report submitted to the government by N. Sreedhar, Additional Director of Health Services (DHS), Health and Family Welfare, who had visited several hamlets in Attappady.
He has pointed out the fact that the haemoglobin levels of ante-natal women in Attappady does not seem to be improving despite adequate iron and folic acid supplementation. Majority of the women are of short stature and their weight gain during pregnancy is highly inadequate.
This is related not to anaemia alone but to a diet significantly low in protein. Anaemia is the major reason why most women here are delivering their babies prematurely. The babies born are of low birth weight mainly because of the low protein intake of the mother during gestation. A report by the National Rural Health Mission (NRHM)’s State Mission Director earlier had indicated that babies with birth weight as low as 500 gm had been born to mothers here.
“This deficit seems out of proportion to the anaemic status and more due to protein malnourishment. Infants gaining weight during breast feeding period and suddenly losing weight after the introduction of supplementary feeds and ending up with Kwashiorkor disease also points to the severe protein inadequacy in the diet of the tribal people,” Dr. Sreedhar’s report says.
He has suggested that the staff at the proposed Nutritional Rehabilitation Centre at Attappady be given adequate training at the SAT Hospital in Thiruvananthapuram in the preparation of protein rich foods. The report also points to the need for training field-level health workers in identifying protein and energy malnourishment in children and women and spot diseases such as Kwashiorkor and Marasmus. Another suggestion is that the Mother and Child Protection (MCP) cards, a health record of ante-natal women and their babies, be used as an effective tool by heath workers to monitor the health status of tribal women and their children.
The MCP cards have just begun to be issued in the region and the doctors in Attappady also need to be given training and orientation in mother and child tracking system. Anganwadis should be better utilised as hubs for disseminating health information in local dialect to women. Take-home rations should be given and ‘nutri mix’ or the ‘SAT mix’ (a high-protein, nutritious food which is prepared and distributed to all mothers at the SAT Hospital in Thiruvananthapuram for years) may be prepared and given to the tribal mothers through anganwadis.
The report also points out that the lack of potable water is creating health problems and KWA should be asked to ensure regular supply of potable water to the anganwadis as it is necessary for preparing and distributing supplementary meals.
Dr. Sreedhar also recommends that the Community Medicine Departments in medical colleges may be asked to conduct studies on the prevalence of congenital organic diseases in the tribal population and their general health issues. Blood protein analysis study, average dietary intake of protein, and the prevalence of anaemia may be subjected to further studies.