The Crisis of Malnourishment

Capstone Health State Taluk

The never-ending prevalence of malnourishment looms like a curse on the children of Lingasugur.

Yaseen, a four-month old girl has been in the hospital for four days and her parents are worried about the condition of their child. The doctor has been assessing her regularly but there has been no improvement yet. Sainaat and Hussain Ahmed are worried about their daughter’s stunted growth. They admitted her in the hospital with the concern that she is not developing and is losing weight. Sainaat had been noticing the condition of her daughter for a long period of time and decided to take her to the doctor. While Yaseen is silently sleeping away on the hospital bed her mother is having sleepless nights thinking about what will happen to her daughter, if her condition fails to improve.

Many parents like Sainaat and Hussain Ahmed are worried about their children not developing and growing. In the Lingasugur taluka of Raichur district, located in North Karnataka, malnutrition is a really big issue that people are facing.

With a population of about four lakh, the taluka of Lingasugur has been severely affected by malnourishment. On an average, 11,000 children out of 35,000 children of the taluka fall prey to this condition. In the state of Karnataka, the figure stands strong at 1.2 million children who are suffering from this ailment. According to the data provided by the government general hospital of the taluka, the rate of malnourishment among children is not declining and the problem is like a curse for the locals of the place.

“The problem is not serious, it is very serious. There are too many malnourished children and too many pregnant women who are malnourished,” said Dr. Basavaraj, the Medical Superintendent at the hospital.

Yaseen only weighs about 3.5 kg whereas her ideal weight should be around 6-7 kgs. One can see the bones poking out from her flesh. The doctor has been giving her medicines and had run some body scans. Sainnat and Hussain are waiting for the situation to get better so that they can take their daughter home.

The problem is not only limited to Raichur or Karnataka, this is an issue of the whole of the country. According to another report by Assocham-Ey, India has the largest number of malnourished children in the world.

 

“It is really painful to see her in this condition in the hospital taking all the medicines and still not getting better. The doctor has asked us to take her home even though there has been no improvement in her growth. He asked us to provide her with proper food and diet,” added his wife.

There are more children like Yaseen , who are suffering from the same problem. Shankar, a five- year old boy who weighs only 13 kgs was also in the hospital that had come to the pediatrician for checkup. His ideal weight should be around 18 kgs.

People who do not get enough nutrients and are not taking a proper diet are most vulnerable to malnourishment. Patients suffer from weight loss, fatigue and lack of appetite. In cases of severe malnourishment, one can suffer from a number of diseases like scurvy, rickets, marasmus and kwashiorkor among many. It can also cause various mental and physical ailments. The problem arises when a person does not get enough nutrients and vitamins in their diet which results in a stunted growth and loss in body muscle and weight. This, in turn, leads to the victims not developing and growing, making it a serious problem. 

The problem can arise due to a number of reasons like poverty, non-availability of food and other social and economic reasons.

“Main cause of malnourishment is feeding problem. After six months of breastfeeding, certain feeding practices are to be followed by the mothers but due to lack of awareness among them, these practices are not followed most of the times. Majority of malnourished cases arise due to problem in these feeding practices.” said Dr. Anil Kumar, the pediatrician at the taluka general hospital.

Breastfeeding is an important source of nutrient that is crucial for the growth of a child but to breastfeed, the mother also needs to have a proper diet, in order to lactate. In most of the rural areas, the women do not receive enough nutrition and proper diet. Moreover, breastfeeding should be followed up to 24 months which most women fail to follow. After six months of birth, children are to be provided with safe solid foods along with breastfeeding up to two years of age but many infants do not receive the kind of care and nutrition.

The women needs to be educated on this subject and should be made aware of the proper breastfeeding practices. The child should be exclusively breastfed for six months and within one hour of the birth the breastfeeding should be initiated. The breastfeeding should be continued up to the age of two years and along with that they should also be fed soft or semi-solid foods so that, they get the essential nutrients that they need for a normal growth.

  • Yaseen and her mother at the taluka general hospital.

Dr. Basavaraj, Medical Superintendent of the hospital, highlighted some other reasons as well. He said, “The other reasons of this is improper food habits, poverty, poor economic status and also taboos. Even low education and lack of awareness is one of the reasons that people are suffering from the problem of malnourishment.”

He also said that the problem arises due to some religious reasons as well like one should not eat non-vegetarian food and social stigma that surrounds the consumption of eggs and chicken. He said that the problem is serious in the North Karnataka belt because most of the people living there are vegetarians.

Malnourishment is not only caused by economic and religious reasons but also arises due to social issues as well. Dr. Mohammed Irfan, the anesthesiologist at the hospital informed that, “Here, in our taluka, the males residing in the villages are good for nothing. They just smoke and drink and don’t do any work. Whatever is managed is managed by the females. Apart from doing household chores like cooking food and washing clothes, they also have do other work like collecting firewood, collecting fodder for cattle and taking care of their babies. They also have to work in fields. When these women get pregnant, they don’t get proper facilities and this causes a number of problems. They do not go for proper health check-ups which causes anemia. Apart from this, the lack of nutrition, lack of proper care and no home care from husband and in-laws results in this problem. Malnourishment is more like a social problem than a medical problem.”

The same was also mentioned by Dr. Basavaraj who said that in most of the pregnant women the hemoglobin is less than 10, and this causes problem like anemia and also affects the health of their child.

The normal hemoglobin level of a pregnant woman should range between 12-16g/dl. During pregnancy, a woman needs more oxygen because the concentration of hemoglobin depends on the oxygen-oxygen-carrying capacity of the blood. The low level of hemoglobin leads to anemia in many women which can cause complications in pregnancy and also affects the child’s growth.

Malnourishment is a problem due to which the country has been suffering since decades.  A report by the National Family Health Survey 4 (NFHS 4) says that 38.4 percent of children in our country are stunted and as many as 21 percent of the total children are labeled ‘wasted.’ As far as Karnataka is concerned, 42.4 percent of children in the state have a stunted growth and 18.9 percent of children are ‘wasted.’ A child is labeled ‘wasted’ when he fails to gain enough weight according to his height. India ranks 100 out of 118 countries on the Global Hunger Index 2017. Another report by Global Nutrition Report, 2018 India has the most number of wasted children and children with stunted growth with the figures standing at 25.5 million and 46.6 million.

For dealing with the high rates of malnourishment, the government has introduced a number of schemes like mid-day meal scheme and Public Distribution System (PDS). The mid-day meal scheme is a program designed by the government to provide free lunch to government school children on all working days who are studying in primary and upper primary classes.

For children below school age, anganwadi system has been put in place by the government where food and community health services are provided to the children and the mother. Regarding the PDS, the government provides food grains to below poverty line card holders at a very less price. Every district has a fair price shop which provides these food grains by showing the BPL card.

Even though the government has introduced a number of schemes for combating the problem of malnourishment, there has been no improvement. There are many loopholes to these schemes.

“We don’t get enough food for our family. We are five members and we only get one packet of daal and six kgs of rice from the government ration shop” told Hussain, who works as a laborer.

The system of anganwadis was started by the government in 1975 where the children are looked after and they are provided with food. At times, the children are also sent to anganwadis as they provide good facilities to them.

  • Children at the anganwadi

Anifa, an anganwadi worker and a mother of four said, “The local government ration shop ‘Society’ does not provide us with the specified amount of food grains. We are eight members in the family and we only get 30 kgs of rice. It has been two months that the shop has no daal or wheat. It becomes difficult for me to provide for my family and I am not able to give my children enough food which they need.”

Shamshad Begum, who is a teacher at the same anganwadi, said that when she went to the ration shop to get food supplies, no wheat, salt, ghee or sugar was available. She also said that the owner of the shop did not provide the specified amount. 

Malnourishment is seriously affecting the country’s development and has crippled the growth of the country. If the country continues to be under the grip of malnourishment, the future of the country will get affected. The ailment affects both the physical and the mental development of the country. It hampers the economic growth and can also lead to low productivity and poverty.

When a child suffers from malnourishment, cannot lead a normal life. With different diseases hitting him hard, the child is unable to attend school and in severe cases, can cause a student to drop out. Malnourishment also affects a child’s cognitive skills, motor development and his ability to concentrate.

The problem is deeply rooted but it can be eradicated with proper steps and preventive measures. Intake of proper diet, creating awareness, proper medical treatment and introducing some dietary changes can help tackle this problem. There are government schemes also in place to fight this problem.

“The problem can be solved by providing proper food, proper utilization of government resources, educating people and improving economic status of the people” said Dr. Basavaraj. Dr. Anil Kumar said that the situation can be improved by improving the feeding practices by the mothers.

With proper system in place, we can fight the problem of malnourishment and get rid of it. The rate of malnourishment can be brought down by taking definitive measures and creating awareness among people.

Dr. Rudragouda, the taluka health officer, said, “The rate of malnourishment was really high in the last two to three years but it has started to improve. We have introduced monthly camps for medical examination of children and opened a special ward called Malnourishment Rehabilitation Centre (M-NRC) ward. We are trying to improve the situation and deal with it permanently.”

The M-NRC ward was opened in the taluka in January and the children who are severely malnourished are referred to this ward. But, this ward has been locked down due to non-availability of resources. With such poor condition of health management, the future of Yaseen and other children lie uncertain. 

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