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Malnutrition rates 4 times higher in tribal district of Nandurbar

Written by Tabassum Barnagarwala | Mumbai | Updated: July 14, 2018 11:00:19 am

In Nandurbar, 16.8 per cent of the over one lakh children, aged less than six years, screened were malnourished. (Express Photo/File)

Ahead of monsoons, a fresh door-to-door screening in the tribal district of Nandurbar, which carries one of the highest burden of malnutrition in Maharashtra, has found cases of severely acute malnourished children four times more than the existing figures.

In Nandurbar, of the 1.13 lakh children aged less than six years registered with the state women and child development (WCD) department, over a lakh were screened. The survey found 16,900 (16.8 per cent) of the children malnourished. Among them, 3,455 were severely acute malnourished (SAM). This was four times higher than the 821 SAM children recorded in anganwadis across the district in April.

Officials from WCD said the intensive screening has led to a higher case record. Realising that a higher number of children face the risk of slipping into malnourishment, Integrated Child Development Services (ICDS) officials have been directed to intensify screening in other districts.

“One factor of under-reporting is the practical difficulty of reaching out to a larger population. The state has taken up the task of rolling out village child development centres (VCDC) in all tribal and non-tribal districts to tackle malnourished children,” said Indra Mallo, the ICDS commissioner.

A VCDC is a centre in an anganwadi that provides six meals per day instead of the traditional two meals daily in an anganwadi. Under VCDC, they are provided six meals for 40 days at a stretch.

The detailed screening in the northern Maharashtra district was directed following a state-level core committee meeting in April, where similar findings of an NGO and the state public health department were discussed.

In April, The Indian Express had reported the findings of the health department in three districts — Pune, Nandurbar and Raigad — where the percentage of wasting and of under nutrition was found higher than the National Family Health Survey 4 and the ICDS records. In certain blocks of Pune for instance, the survey had found 28.18 per cent children underweight as opposed to the ICDS data that stood at 10.38 per cent.

A similar survey by NGO Sathi in 2017 had found that of the 1,659 children it surveyed, anganwadis records in 50.9 per cent of the cases were either missing or incomplete. The study also pointed that there were 29.1 per cent malnourished children, and the proportion of under-reporting was higher in Palghar and Nandurbar.

“Both the civil society and the health department have agreed that there is massive under-reporting of malnutrition. This is not exceptional,” said Abhay Shukla, who was part of the Sathi survey. Maintaining that this problem exists in all districts, he added: “We miss a large number of children at risk of dying. A moderately malnourished child faces 2.2 times and severely malnourished children 6.8 times higher risk of death than a normal child.”

Civil society activists said that anganwadi workers were either facing issues such as lack of proper calibrated weighing machines or purposely not reporting accurate figures to avoid displaying high malnourishment in their area.

Last week, WCD Minister Pankaja Munde had informed the state Assembly that 995 children, aged less than six, had died in the last five months across the state. In 2017, across 16 districts, 2,161 children had died.

Malnutrition has been a contributing factor in making a child prone to infections, specially during monsoons. The under-reporting is also suggestive of a large section of children falling frequently ill but getting missed by the WCD department.

Latest data from ICDS in January showed that across Maharashtra, 29,007 children were severely underweight and 1.29 lakh were moderately underweight. In January alone, 302 children had died. According to WCD officials in Nandurbar, in January, the district had recorded 38.7 per cent of underweight children — 35,270 of the 90,904 children screened.

Hunger: On paper, Nandurbar should have won its malnutrition battle

From eggs to medicines, doctors to allowance and at least 15 schemes — on paper, Nandurbar should have won its malnutrition battle. The Indian Express on how the govt. failed this tribal district

Written by Tabassum Barnagarwala | Updated: April 23, 2017 7:31:24 am

With parents away at work, children don’t get timely medical help(Express Photo by Tabassum Barnagarwala)

EVERY monsoon, over 40,000 children slip into malnutrition in tribal-dominated Nandurbar. Last year in September, 118 infant deaths were reported in the district, with the overall number for 2015-16 at 484. A recent Health Ministry survey, conducted in December 2016, of Bhil and Pawara tribes in two blocks found 4,556 children (or 9 per cent) malnourished.

On paper, there are at least 15 schemes to augment the nutrition of children and mothers in Nandurbar. On the ground, as funds for these schemes see a cut for the second consecutive budget, the road out of hunger is paved with their failures.

Scheme 1: Trained ASHA workers to give ORS (oral rehydration solution) to children with diarrhoea living in inaccessible pockets

2: Rs 200 for parents who miss a day’s labour to bring their malnourished child to hospital

3: ‘Flying Doctors’ — homeopathic doctors on motorbikes — to treat cases of fever in inaccessible pockets

4: Navsanjivani Yojana for ante-natal care, immunisation, and monitoring of children below 6 in tribal areas

Nestled within the Western Ghats is Toranmal, one of the most inaccessible tribal hamlets in Nandurbar. The Health Ministry survey found 103 severe acute malnourished (SAM) and 142 moderately acute malnourished (MAM) children in these villages.

Jiten Harsingh (5) and Dhilu Harsingh (2) of Khadki village were among them. Their sibling, Viren (18), says no government health worker has ever visited them. The only time the boys were weighed was when they were a month old.

“There is an anganwadi, I don’t know who the worker is. She never comes,” claims Viren, who lives in a mud-splatter hut with Jiten, Dhilu, four other siblings, and two donkeys. Their parents work as labourers in Madhya Pradesh.

Anganwadis are centres where children below six are given free breakfast and lunch under the Women and Child Development (WCD) Ministry’s Integrated Child Development Services (ICDS) to control malnourishment. There are 2,364 anganwadis across Nandburbar. The system also ensures children of working parents are looked after by anganwadi workers.

Jiten and Dhilu have never visited an anganwadi. Viren says Jiten had fever last monsoon, along with severe vomiting that left him weak. He took him to the Toranmal Rural Hospital, 9 km away, where he was given antibiotics. For the past seven days, Dhilu has had high fever and has been vomiting. But Viren hasn’t been able to take the two-year-old to a doctor so far. “I have to carry him and climb up 9 km to reach the hospital. Who will look after the other children while I am gone?” says the 18-year-old, who does farming to support the family. Though there is no pediatrician, the rural hospital is the closest to their house and has medicines for occasional fever.

Toranmal also does not have a single toilet, with open defecation causing stunting and scabies. Government officials claim transporting construction material is difficult in the hilly terrain.

Of Toranmal’s eight villages with over 11,000 children, immunization has reached only 17 per cent, with the scattered population making any monitoring difficult. Those requiring medical aid mostly cross the border to Madhya Pradesh, over 15 km away, where they find private doctors easy to reach.

Awareness about the scheme that pays tribals Rs 200 for loss of wages in bringing a child to hospital is low. Besides, tribals do not have bank accounts in which the money is to be transferred. At 20.57, the infant mortality rate in Nandurbar is higher than the state average.

In 2015-16, of Rs 2 crore sanctioned by the Tribal Department to the ICDS in Nandurbar, there has been zero expenditure.

Latika Rajput of the NGO Narmada Bachao Andolan says the reasons medical help remains out of reach are the same as several years ago. “There is no mobile range to call for an ambulance, no road network and very few health workers visit these tribals,” she says.

While 23 of the 25 posts of Flying Doctors have been filled, since road connectivity is poor, they sometimes spend hours reaching a tribal’s hut.

Malnutrition deaths on the rise in Maharashtra


Three districts in Maharashtra have reported 1,274 child malnutrition deaths in the past 10 months.

Three districts in Maharashtra have reported 1,274 child malnutrition deaths in the past 10 months, Minister of State for Women and Child Welfare Vidya Thakur informed the State council on Monday.

The three districts, according to Ms. Thakur, are Nandurbar (662 deaths), Palghar (418 deaths ) and Thane (194 deaths). “These cases have almost doubled in Thane’s Bhiwandi area despite a number of initiatives taken by the State government. We are taking a number of measures to reduce the cases,” she said.

“The number of children with less than average weight was 286 in 2013 in Bhiwandi-2 project area and this jumped to 497 in 2014,” she added, accepting that the number of children dying due to malnutrition was alarming.

However, Council chairman Health Minister Dr. Deepak Sawant to reply on the issue as it also involves his ministry.

“We have started keeping an account of pregnant women in Melghat since January. With the data it has become easy to know if they are receiving adequate help and care. The monitoring has helped and in March the death rate among pregnant women was brought down to zero,” he said, explaining the initiatives taken by his ministry in Melghat, a tribal area in Amaravati district that has high malnutrition rate among children.

Large-scale child deaths in tribal Maharashtra

From April to August this year, almost 300 children fell prey to malnutrition in just two blocks (Akkalkua and Taloda) of Maharashtra’s Nandurbar district

By Neelam Singh, Last Updated: Saturday 04 July 2015

From April to August this year, almost 300 children fell prey to malnutrition in just two blocks (Akkalkua and Taloda) of Maharashtra’s Nandurbar district. The nightmare has been recurring in the entire region since 1995, with the death toll crossing 12,000. Although even studies commissioned by the authorities identify malnourishment as the main culprit, the state government refuses to acknowledge the problem.

The reason for this is not far to seek. Among the prime causes of malnutrition in the area are degradation of forests, deficient healthcare, unemployment, landlessness of local people and a defective public distribution system. And all these ills can be ascribed to rampant maladministration.

“We suspect that in at least 60 per cent cases (470 children had died in Akkalkua and Taloda in the five-month span), death was malnutrition related,” observes Pratibha Shinde of Punarvasan Sangharsh Samiti, a tribal welfare body. The district health officer declined to comment on the issue. But a report brought out by the state government-run Tribal Research and Training Institute ( trti ), Pune, notes that last year over 75 per cent of child deaths in Nasik were malnutrition related. In Nandurbar, which comes under Nasik division, more than 2,385 children died between April 2002 and March 2003 (see graph: Mounting toll ).

“Malnourishment is a result of a host of factors,” stresses Shinde, adding: “These have not been dealt with because though crores are spent in the name of tribal development, only a fraction of the amount reaches the beneficiaries.”

widespread graft: The problem is endemic in the region and permeates every sphere of activity. Not only is the fact highlighted in official reports, a minister, too, accepts it. “The allegations of rampant corruption in the district are true. Employment schemes are not functioning well, doctors hardly visit health centres and people in resettlement villages are landless. All in all, the situation is bad,” concedes R R Patil, the state’s rural development minister. Yet he attributes malnutrition in the area to early marriages and a high birth rate.

Local officials, meanwhile, claim that all is well on the administrative front. “Most of the schemes are in place and corruption is not an issue,” asserts district collector Sanjay Khandare. His claims fly in the face of a November 2002 trti report that documents siphoning of Rs 9 lakh meant for a watershed development programme.

out of work: In 1972, the Employment Guarantee Scheme ( egs ) was launched by the state government to combat famines. It was conceived to create productive works like tanks and other irrigation structures, and envisaged regeneration of forests. Sadly, the focus of the scheme has now shifted to constructing roads and buildings.

“We are rarely provided employment opportunities,” laments Indira from Dabh, a tribal hamlet in the district. “The government says there are no takers for egs . The fact is local people aren’t even aware they have to approach the collector for work,” points out Arun Bhatia, ex-commissioner, trti .

basic needs not met : “Beneficiaries hardly get any food from the anganwadi (mother and child care centre) in my village,” says a primary health centre ( phc ) doctor in Dadgaon village. Shinde concurs and adds: “In some places, up to 150 children, scattered in hamlets at least a kilometre away from each other, are covered by one anganwadi .” Despite this Khandare maintains that the cause of child deaths is not lack of food. “Rather, tribal families need to be taught how to take care of children,” he says.

Shinde draws attention to a major problem: “Land records have yet to be settled. As a result, tribals are routinely harassed by the forest department.” Kakarya Surjiya of Narmadanagar village, whose grandchild died of malnutrition, is bitter: “There wasn’t enough food since we don’t have enough land.”

severe disorder: Nandurbar’s healthcare system is in a shambles. “It is difficult to provide medical facilities in remote places like Akrani and Dadgaon,” admits a senior government official. “My niece would have been alive today had she received timely treatment,” says Kirta of Narmadanagar. The girl, who was not even five years old, died a few weeks ago. The phc of the area has had no doctor for four months.

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26,619 kids died in 16 months


Published : Jul 6, 2018, 2:29 am IST

Updated : Jul 6, 2018, 2:28 am IST

Welfare minister says government’s efforts are yet to show results.

Vegetables are being cultivated which will provide nutrients to children.

Nagpur: Women and child welfare minister, Pankaja Munde on Thursday admitted in legislative council that 26,619 infants and children died across the state between October 2016 to February 2018. Though the government has undertaken efforts to reduce the number of deaths due to malnutrition and other such reasons, those are yet to show the desired result.

Responding to the questions asked by Kiran Pawaskar, Hemant Takale among others, Ms Munde said, “As per the official records, 26,619 children died in span of 17 months out of which 23,865 infants were below the age of one year. 2,754 children were in the age group of one to five years. In Melghat region of Amaravati, 133 child deaths were reported and 46 deaths were noted in Nandurbar district.

While informing about the efforts taken by the state government, Ms Munde said, “Government has provided all medicines in primary health centres and sub centres in 16 tribal districts. 281 teams have been visiting the villages and doing checkups and providing with necessary medicines.”

‘Special cells were opened for infants who are in a critical condition, children suffering from malnutrition and vitamin deficiency,” she added. She further said that MBBS doctors are not available in these tribal areas, so government has decided to depute BAMS doctors and the recruitment process is going on.

MLA Anant Gadgil, Sanjay Dutt also raised the issue of malnutrition. Explaining government’s situation, welfare minister said, “NGO’s and foundations are helping the state. Government has signed MoU on February 6, 2018 with the foundation.

They have developed backyards in the 7,379 Anganwadis in Thane, Palghar, Jalgaon, Wardha, Pune, Osmanabad, Parbhani, Yavatmal districts. Vegetables are being cultivated which will provide nutrients to children. More than 1.7 lakh children are benefiting from this initiative.

High Court concerned over 17,000 deaths due to malnutrition in Maharashtra

By: PTI | Published: September 21, 2016 11:23 PM

Voicing concern over death of 17,000 persons due to malnutrition in tribal areas of Maharashtra in the last one year, the Bombay High Court today asked the state government to take immediate steps to tackle it and submit details of central grants received for tribal welfare.

A division bench of Justices V M Kanade and Swapna Joshi was hearing a bunch of PILs regarding malnutrition among children in Melghat region of Vidarbha and other tribal areas in Maharashtra. (Representative image: Reuters)

Voicing concern over death of 17,000 persons due to malnutrition in tribal areas of Maharashtra in the last one year, the Bombay High Court today asked the state government to take immediate steps to tackle it and submit details of central grants received for tribal welfare.

A division bench of Justices V M Kanade and Swapna Joshi was hearing a bunch of PILs regarding malnutrition among children in Melghat region of Vidarbha and other tribal areas in Maharashtra.

One of the petitioners showed the court a reply received through the Right to Information (RTI) Act which said over 17,000 persons, including women and children, had died due to malnutrition in the state in the last one year.

The court was also informed that 283 persons had died in Melghat region during 2015-16 and additional 83 from January 2016 to July 2016.

“This is a very serious matter that so many people have died due to malnutrition in the state. We direct the government to take immediate steps to tackle the menace”, said the judges.

The bench also asked the state to improve the working conditions of the doctors in tribal areas.

The Maharashtra government today submitted to the High Court a report of the core committee formed to tackle the menace of malnutrition in tribal areas.

The government also informed the high court that it did not have enough gynaecologists, general practitioners and other doctors in tribal areas to improve the health condition of people particularly women and children.

However, it had taken measures to improve the health conditions of the people in tribal areas because of which the number of deaths due to malnutrition had come down, said the government pleader.

The bench sought to know how much grant was received by the state government from the Centre for development of tribal areas and asked the administration to file a reply by October 14 on this issue.

A report by the state Women and Child Development department filed earlier showed that in Melghat tribal area in Amravati district, 500 children on an average die every year, against its population of three lakh.

In 2013-14, the number of child deaths rose to 600 and in 2014-15 another 426 children died in just two blocks of Melghat, the report said.

The high court had noted that in spite of directives given by it earlier, there was no significant decline in the child and maternal deaths in these areas as these directions have not been complied with.

“Several reports have been submitted by UNICEF and other NGOs working in tribal areas. The child deaths is on account of malnutrition. We have further been told that pediatricians have not been posted in these areas, further aggravating the problem,” observed Justice Kanade during the hearing in July 2016.

The high court has directed the state government to inform whether any action has been taken on these reports relating to the situation in Melghat and whether any qualified pediatrician has been appointed or is working in that area and if food and nutrients are being provided to pregnant women and newborn children.

The court also asked whether in other areas like Nashik, Thane, Nandurbar and Yavatmal, medical facilities are provided to these children and whether any doctor was available for their treatment.

Last year, the high court had convened a special hearing on the issue wherein it was highlighted that doctors and specialists are not always available at primary health centres and government hospitals in tribal areas.

The Maharashtra government was asked to provide reservations for admissions to post graduate medical courses and other health courses to doctors who render services in such tribal areas and also consider granting reservations of seats in MBBS course in favour of students who study in schools in hilly tribal areas.

The matter has been posted for further hearing on October 14.