declining malnutrition in maharashtra-6-the tribal issues
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Child Malnutrition in Child Malnutrition in
Maharashtra (India) Maharashtra (India) August 2013August 2013-- January 2014January 2014
Situation, Efforts, Decline and Challenges
A Review A Review
1
A Review A Review For the State Nutrition MissionFor the State Nutrition Mission
P o w e r P o i n t 6 / 6P o w e r P o i n t 6 / 6
Malnutrition in Difficult Tribal AreasMalnutrition in Difficult Tribal Areas
Dr Shyam Ashtekar, MD (Community Med)
shyamashtekar@yahoo.comAnganwadi-supplementary feed--Dr Shyam ashtekar jan 2014
Persisting Malnutrition Persisting Malnutrition
Problem In The Difficult Problem In The Difficult
Tribal Blocks of Tribal Blocks of
MaharashtraMaharashtra
PowerPoint 6/6PowerPoint 6/6PowerPoint 6/6PowerPoint 6/6Dr Shyam Ashtekar 2014Dr Shyam Ashtekar 2014
This Photo belongs to year 2000 there is less of this
B U T T H E I S S U E R E M A I N S
Some Pockets of Some Pockets of
Malnutrition in MaharashtraMalnutrition in Maharashtra3
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014
Maharashtra has 9% tribal population and ..Maharashtra has 9% tribal population and ..
15 blocks15 blocks have more malnutrition have more malnutrition , ,
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 4
> 30% children malnourished.> 30% children malnourished.
� In some tribal blocks child malnutrition (-2SD) rates are 30-40%
� In this 4-5% is severe malnutrition (-3SD)
� In Maharashtra 9% tribal population implies about 1 crore people
� The U6 child population is about 10-12 lakhs.
5
� The U6 child population is about 10-12 lakhs.
� Of these 3-4 lakh U6 children belong to the difficult tribal blocks.
� Possibly 1.5 to 2 lakh U6 children are malnourished.
� Hence about 15-20 thousand U6 children may be severely
malnourished or perhaps more.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014
The 15+ difficult Tribal BlocksThe 15+ difficult Tribal Blocks
� Jawhar, Mokhada, Wada
� Dhadgaon, Akkalkuwa,
Shahada
� Dharni-Chikhaldare
� Bhamragarh, Armori,
Korchi
� Peth, Surgana,
Trimbakeshwar
� Rajur
� Some blocks have more
pop, so more children in
MN
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 6
Contributors Contributors of tribal of tribal
Malnutrition Malnutrition
Child
Poverty and
Migration Roads and Power Problems
Forest restrictio
ns
More illnesses
Ignorance and blind faith
Malnutrition in Tribal blocks- Dr. ShyamAshtekar, Jan. 20147
Child Malnutrition Weak
Governance
Weak Health System
Malnourished
Women
Less Birth weight
Poor Breast feeding
Unclean condition
s
The malnutrition The malnutrition (MN)causes(MN)causes--in a in a pyramidpyramid
Resulting Child deaths
Child MN & illness cycle 0-5Y age group 40-50% MN, 10% U6 children severely wasted.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 8
MN anemia and less BMI in women and adolescence, many reasons for this---early marriage, child birth, weak ANC, Less Birth weight Neglect of breast feeding and complementary feeding,
Lack of hygiene. poor nutrients, weak health system, lack of awareness, blind faith, gender
bias, migration, terrain, no employment, inflation, PDS problems etc.
Govt. Schemes and ServicesGovt. Schemes and Services
� Many Schemes and services are weak in tribal areas.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 9
Scattered Habitats in Tribal Blocks
Google map of Molgi in Nandurbar-
major weekly market, village spread on 4-5 Kms distance
And a typical Non-tribal village
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 10
Forest and Animal Sanctuaries, Forest Forest and Animal Sanctuaries, Forest
zone laws, zone laws, Lack of Transport…Lack of Transport…
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 11
Seasonal Migration is a Fact ofSeasonal Migration is a Fact of lifelife
◦ Many families migrate for 6-
8 months leaving the AWC
little scope for help.
� Construction and agriculture are
major sectors for migration.� Migration for 6-8 months
◦ Construction and
agriculture sectors attract
most migration-both cause
stress
◦ Migration worsens
malnutrition ..or does it ?
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 12
Hard Work and Hilly Terrains Hard Work and Hilly Terrains
� Hard labor and less food lives
little flesh in the body.
� BMI less than 18.5 affects 40-
80% women
� Hilly roads and head loads
� Famished women bear weak
children
� Low BMI reflects poverty.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 13
Blind faith, Faith Healers and Black MagicBlind faith, Faith Healers and Black Magic
� Blind faith and lack of
awareness are major
� Deep rooted problems � Blind faith and Bhagatscarry on..
awareness are major
issues.
� This is a major impediment
in scientific treatment.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 14
LiquorLiquor--struck struck
� For Tribal societies
liquor has a traditional
� Home distilled liquor� A livelihood for some
tribes
liquor has a traditional
value.
� But some tribal
communities are hard
hit with liquor problem
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 15
Water and Firewood take so much of Life and LaborWater and Firewood take so much of Life and Labor..
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 16
Back Breaking Farm Labor and Little ReturnsBack Breaking Farm Labor and Little Returns
� The tribal agriculture is mainly rice and
millets, of little value in the market.
� The PDS rice comes at 3Rs. a Kg.
� Home grown rice costs about 20Rs. a � Home grown rice costs about 20Rs. a
Kg.
� One season crop and almost no water
thereafter.
� Farming only for staying alive not for
prosperity.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 17
Public Distribution System and Food Public Distribution System and Food SecuritySecurity
� The door step PDS scheme
offers 35Kg. for each family
every month.
� Hence about 100Kg. For 3
months.
� Food supply is a problem in
some parts.
� Some tribes can not use
wheat and rice may be too
bad to use.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 18
Many Homes have Stocks for 2 YearsMany Homes have Stocks for 2 Years
� Currently the doorstep
PDS, farming and wage
labor bring home enough
food for most homes food for most homes
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 19
But Proper Nutrients in Good Measure are But Proper Nutrients in Good Measure are
missing. missing.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 20
High fertility: 7High fertility: 7--8 children is a common 8 children is a common scenescene
� More children
� Rapid succession
� No spacing of births� No spacing of births
� Hence neglect of
children and mothers
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 21
Early Marriage and ChildbearingEarly Marriage and Childbearing
� More than 50% early
marriages
� Under-age pregnancies � Under-age pregnancies
also common.
� Many unwed mothers get
pregnant and bear children
that may get neglected
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 22
Low Birth WeightLow Birth Weight
� 40-50% babies weigh
less than 2.5KGs.
� One in three of these
babies are premature
� These babies do not
thrive well without
really good efforts.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 23
Faulty Feeding PracticesFaulty Feeding Practices
� Just about 50% babies are
breast fed within the first hour
of birth.
� Exclusive breast feeding till 6
months is also barely 50%---
there are also lifestyle causes
for this.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 24
Faulty Complementary Feeding Faulty Complementary Feeding
� 6-8 semi solid feeds necessary after 6
months. Barely 10% babies get this.
� diversity, vitamin A and iron rich feeds
often missing .often missing .
� There are difficulties like work and
migration but the result is the same-
Malnutrition
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 25
Sanitation and HygieneSanitation and Hygiene
� The spread of illnesses � Toilet is necessary, but
atleast a hand wash is a must
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 26
Less of Immunization Less of Immunization
� < 50% full immunization rate.
� Many reasons for this.� Many reasons for this.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 27
Illness cycleIllness cycle
� Diarrhea pneumonia major illnesses
� IMNCI program trained AWC sevikas for this
� But Govt. of India change this policy.
� Now they expect NRHM-ASHAs to do this.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 28
The Intergenerational Cycle of The Intergenerational Cycle of MalnutritionMalnutrition
� Malnutrition carried to next generation.
� Quick birthing is part of the problem.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 29
Anemia in 60Anemia in 60--70% Women and Children70% Women and Children
� Low hemoglobin invites
several problems.
� Causes maternal
morbidity and mortality.
� Causes Infections,
malnutrition for children.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 30
55--10% Children Suffer from Sickle Cell 10% Children Suffer from Sickle Cell AnemiaAnemia
� Genetically faulty hemoglobin causes many
health problems.
� Infections, malnutrition, pains and growth lag.
� 5-10% children suffers from this disease
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 31
Weak Health SystemWeak Health System
� Doctors unwilling to go
and work in tribal areas.
� There are many
administrative hindrances
� Many specialist positions
remain vacant.
� This is a recent news from
Gondiya district in Daily
Loksatta about vacant
positions
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 32
InfrastructureInfrastructure--Leaking Roofs are CommonLeaking Roofs are Common
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 33
Lack of FacilitiesLack of Facilities
� Many projects have no vehicles.
� Lack of support staff in most projects
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 34
Weak Health system
50% childbirths happen at home. Barely 50% women get some ANC care
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 35
Getting help from NGO & CSRGetting help from NGO & CSR
� Very few NGOs especially in Nandurbar
� In Melghat, we have some NGOs..no study on
their impact on general situation
� NGOs can undertake some assignments in the
affected areas, with a flexible approach.
� CSR can help in special interventions like
RUTF.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 36
Child Neglect..Child Neglect..
� Causing gaps in child feeding
� Lack of cleanliness and hygiene because
of either an old or too young attendant
There are substantial reasons like a � There are substantial reasons like a
working mother, migration etc..
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 37
Some Families are Less ConcernedSome Families are Less Concerned
� Some tribal families feel less
about malnutrition unless it is
a severe malnutrition..
� Problems of daily life more
� Some AWC workers report
that families may starve the
child to get Khavati loans
� Loan amount –Rs 3000- is
important than a malnourished
child.
sometimes wasted
� This is possible and we need
to review this scheme for
better utilization.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 38
Need to Know TribeNeed to Know Tribe Specific Facts Specific Facts in in Malnutrition Stat. Malnutrition Stat.
� Scheduled Castes (SC) and VJNT
communities also have sizable malnutrition, communities also have sizable malnutrition,
some more than others
� Nomadic Tribes needs special attention and
mentorship
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 39
Some Tribes are More Malnourished Than Some Tribes are More Malnourished Than
Others in the Same Village. Others in the Same Village.
� Some tribes are backward in cultural and
educational aspects than others in the same region
(e.g. Katkaris as compared to Warlis in Thane)
� Some are afflicted with liquor addiction
� We need to study these differences closely and
take appropriate action.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 40
Food Security and MalnutritionFood Security and Malnutrition
� We cannot link all malnutrition with food
insecurity.
� Many homes have enough stocks of
foodgrain
� Specific causes need to be explored,
proximate factors like nutrients and health
care are often more important.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 41
Community Participation NecessaryCommunity Participation Necessary……
It is difficult to
expect local
participation for
combating combating
malnutrition in
tribal areas at this
stage.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 42
KhavtiKhavti Loan for Affected FamiliesLoan for Affected Families
� Families get 3000 Rs. loan as help if their baby is
malnourished. It is almost never returned.
� Families eager to get this dole even fight to get this.
But the cash is often used for other purposes, even � But the cash is often used for other purposes, even
spent for liquor
� Is Khavti helping for reducing malnutrition?
� Can we promote this as an award scheme? will that
help? Need a review!
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 43
Nutrition RehabilitationNutrition Rehabilitation
� The NRHM assistance is
available for nutrition
rehabilitation from village to
district hospital.
� This is expected to prevent � This is expected to prevent
further malnutrition if not cure
the problem.
� Also helps to avert some child
deaths.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 44
Crèche Crèche
� The crèche scheme has
been started in some
tribal blocks. The crèche
attends to pre AWC age
� Crèche is a good social facility.
attends to pre AWC age
group including nutrition.
� The crèche also frees
the mothers from child-
duties for some hours.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 45
Line listing of Malnourished children on Line listing of Malnourished children on
Website ..But These Lists are Rather Old. Website ..But These Lists are Rather Old.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 46
Media Can Help in Fighting Tribal MalnutritionMedia Can Help in Fighting Tribal Malnutrition
� Media.. should focus on comparative statistics,
causes and management options.
� The AWC Sevikas are honorary workers, not
well paid servants.... they are not the causes of
malnutrition themselves. malnutrition themselves.
� Need to be sensitive also to the problems of
staff working in difficult areas.
� Tribal malnutrition is a complex problem and is
bound to take more efforts and time.
� Media can play a constructive role
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 47
A Road MapA Road Map
Income Programs
Social Reforms
Administrative Reforms
Health & Nutrition measures
� There is no magic wand
� We need a practical Road Map
� Need for wider collaboration
� Need a rational and realistic program with achievable
objectives.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 48
Need for Balanced EffortsNeed for Balanced Efforts
� Need to balance between
family/social efforts with
administrative measures.
� Govt. cannot do it alone
unless families are also
able to participate.
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 49
A Senior Journalist SaysA Senior Journalist Says
� I met a senior journalist who had reported on Bamani--
the ground zero of malnutrition deaths in Nandurbar
which first hit the headline in eighties.
� He says “there is a visible decline in severe
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014 50
He says “there is a visible decline in severe
malnutrition even in those areas that were worst hit.
We used to see the affected children while passing any
village. We see there is a big difference”.
� I hope another decade will see more change
Best WishesBest WishesDr Shyam Ashtekar (MD, Community Medicine)
21 Cherry Hills Society, Anandwalli, Nashik India
422013
shyamashtekar@yahoo.com
Cell +919422271544
Website:
51
arogyavidya.org,
bharatswasthya.net
A study of Anganwadis and campaign against malnutrition in Maharashtra
for and with support of
Rajmata Jijau Mission,
August to Dec 2013
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014
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