In Baran district, child malnutrition is an everyday emergency as even toddlers are fed just the twin addictions of snacks and pan masala. Even if their parents can afford nutritious fare, many children get only junk food, as it is cheap and easily available, and the intoxicant, which induces sleep.
The problem assumes the worst dimensions among the Sahariya tribe, which report very high malnutrition levels among its children. Every year, malnutrition deaths are reported during the monsoon despite the steps the government take. Last year, between September and November, 12 deaths were reported. Though the official cause of deaths may be some medical condition, the underlying reason is malnutrition, which makes the children vulnerable to infections and diseases.
A report brought out by Action Against Hunger (ACF), a French non-governmental organisation, says despite interventions for the past three years, the situation remains grim with SAM (severe acute malnutrition) at 7.6 per cent and SCM (severe chronic malnutrition or stunting) at 14.9 per cent among children aged six to 59 months in the district.
Isolated lot
The National Family Health Survey-3 data show SAM at 8.4 per cent among the Scheduled Tribes, 7 per cent among the Scheduled Castes and 5.2 per cent among the Other Backward Classes in Rajasthan. Sahariyas are among the particularly vulnerable tribes of the State. They prefer to live in isolated habitats and report high infant mortality, high fertility and low educational levels.
“There is no dearth of food because they get enough of it from the government. The challenge is in creating awareness of eating the right kind of food and leading a hygienic life,” District Collector Lalit Kumar Gupta told The Hindu.
Free food, housing
The government gives the Sahariyas, settled in Kishanganj and Shahbad blocks, free housing and other facilities too. But, every year, dozens of children lose their lives and hundreds are hospitalised. Parents and children crowd the malnutrition treatment centres. At the centre in the district hospital, where children from other centres too are referred, beds are in perennial shortage.
“These are preventable deaths and hospitalisations. Unfortunately, the community is so isolated that they are not even aware of what is good or bad for children. Despite screening, treatment and monitoring, the children fall back into the SAM category once they are discharged from the centres,” says Shivangi Kaushik, deputy programme manager, ACF.
The ACF has been working in 36 villages of Kishanganj since 2011, along with the Centre for Community Economics and Development Consultants Society, accredited social health activists (ASHAs), anganwadi workers and auxiliary nurse midwives, to build capacities for the management of malnutrition by way of detection, referrals, nutrition education and care practices.
“Unfortunately, there is reluctance to take children to the malnourishment treatment centres for treatment or adhere to the treatment protocol, even in feeding the child the food made available in the food basket given after discharge. The parents leave the centre against medical advice, though they are paid for wage loss because they have to stay home to look after children,” Ms. Kaushik says.
The Integrated Child Development Services and the Health Ministry follow different methods to measure malnutrition. Hence treatment protocols differ. Some paediatricians even question the UNICEF protocols. “The primarily milk-based nutrition given at the malnourishment treatment centres is not adequate for weight gain. The children need much more than that but we are not allowed to deviate,” J.P. Saini of the Baran centre, says.
Early marriage, unhygienic living conditions, too many children with less birth spacing, lack of child-centric and child-friendly care services and addictions such as tobacco and liquor make matters worse for the children. “Migration makes follow-up extremely difficult,” Ms. Kaushik says while recommending a community approach to the management of malnutrition as has been propagated by the ACF.
