Stunted growth

Published : Dec 02, 2011 00:00 IST

Child malnutrition in Gulbarga and Bijapur districts is a blot on Karnataka's image.

in Gulbarga and Bijapur

Ba Ba Basavanna Anganwadi Hogona Avarekaalu Tinnona Ah, Aaa, Ee, Eee, Bariyona Mane Kadege Hogona (Come, Come, Basavanna Let's go to the anganwadi Let us eat beans And write A, B, C, D, And head towards home.)

As Savitri Nimbad sings this ditty, the more than 20 children seated in a circle around her repeat each line in shrill voices. Almost all of them are between three and six years of age, except for a couple of older children and a toddler in the arms of her elder sister. From a distance, the scene children sitting under a large tree and singing their hearts out is straight out of an idealised setting in rural India. But it does not take long to realise what is behind the idyllic veneer.

Savitri is an anganwadi worker (AWW) in charge of the 12th anganwadi centre (AWC) in Almel panchayat in Karnataka's Bijapur district. One of the children forming the ring around her is Ashwini Devi Bhovi, who is five years and three months old but weighs only 13 kilograms. Malur Gundappa Marnal, also 5, weighs just 10.5 kg. According to the growth charts released by the World Health Organisation (WHO) in 2010-11 to measure child malnutrition, both of them fall in the extremely underweight' category.

Ashwini's father, Nagappa Bhovi, makes Rs.150 a day working as an agricultural labourer in lands around Almel. Maize is the most common crop grown here. Red gram and tur dal are also widely cultivated. The most productive non-agricultural activity here is stone mining.

A short distance away is the 11th anganwadi centre in Almel. It also functions under a tree and is located in an area with a high percentage of Muslims. Behind where the children sit, pigs forage in a shallow open drain and buffaloes sift curiously through piles of hay. Firdose A. Momin, the AWW here, is gathering her group of children to distribute their daily snack of nutri-corn puffs. As she opens a large bag of corn puffs, a crunchy savoury commonly known by a brand name, the children get excited. They relish these puffy yellow balls.

On Firdose Momin's arms is Shabana Bi, who is 15 months old and weighs 6 kg. Shabana's house is just across the anganwadi, and her mother, Chand Bi, is carrying Shabana's elder sister. Their father, Mohammed Rasool, is a construction labourer who earns Rs.100 a day. Four other adults live in their small hut in front of which red chilli is being dried.

Another sickly looking child comes running behind Firdose as the snacks are distributed. He is two-year-old Ameen Mehboob, who weighs 10 kg.

Ashwini, Gundappa, Shabana and Ameen are among the 71,605 children who are classified as severely malnourished/extremely underweight in Karnataka, according to figures available (until August 2011) with the State Department of Women and Child Development (DWCD). They constitute 2.17 per cent of the population of children between the ages of 0 and 6 in the State. Of the 33,02,370 children in the State whose weights were recorded, 21,00,818 were found to be of normal weight for their age and 11,29,947 were moderately malnourished.

According to information from the National Family Health Survey-3 (NFHS-3) of 2005-06, Karnataka fared the worst among south Indian States as far as malnutrition among children was concerned. The same survey pointed out that malnutrition in the State, as measured by underweight children below three years, was at 45.9 per cent. Infant mortality rate (IMR) in the State was 43 compared with 30.4 and 15.3 in Tamil Nadu and Kerala respectively, the survey said.

Malnutrition has been the underlying cause of at least half the deaths of under-five children in the country. According to the United Nations Children's Fund (UNICEF), one out of every three malnourished children in the world is in India. Rates of child malnutrition in the country are among the highest in the world. Malnutrition is more common in India than even some countries in sub-Saharan Africa, which have the worst human development indicators in the world. Prime Minister Manmohan Singh recognised the urgent need to address the problem of child malnutrition in his Independence Day speech on August 15, 2011.

Inefficient recording

The accuracy of the figure of 71,605 for the severely malnourished children in Karnataka is also suspect. During its visit to anganwadi centres in Gulbarga and Bijapur, Frontline found that many cases of malnourished children were underreported and the recording of weights of children was inefficient. According to the new WHO guidelines, children need to be weighed every month to chart their nutritional status. But only one in four anganwadi centres in Bijapur had a weighing machine. In AWC 105 in Honagunta village in Gulbarga district, the AWW first claimed that there was only one severely malnourished child. When children who were present in the centre were randomly chosen and weighed, three more turned out to be underweight. Kalamma Basavaraj Pattar, the AWW, said she had just discovered this fact.

The problem in child malnutrition in Karnataka which, ironically, boasts the software capital of the country may not seem as dire as in some other States such as Madhya Pradesh, but this is because of the relative prosperity of southern and coastal Karnataka which lifts the average across the State. The incidence of undernourishment is severe in the backward districts of north Karnataka.

For instance, Bagalkot (with 8,957 severely malnourished children), Bijapur (8,983), Bellary (6,411), Davangere (3,724), Belgaum (7,016), Haveri (4,537), Koppal (4,085) and Raichur (4,537) are all located in northern Karnataka. Between them, these eight districts (of the 29 districts in the State) account for 70 per cent of the malnourished children in the State.

Of the 14 anganwadi centres in Almel, only three have permanent structures. The rest operate under trees or on temple verandahs. Both the AWCs of Savitri Nimbad and Firdose Momin were approved in 2006-07, and since then outdoor premises have served as places to provide preschool education, a meal and a snack to children.

According to the DWCD, only 50 per cent of the AWCs in Karnataka have permanent structures. An AWC is formed on demand, and on an average there is supposed to be an AWC for every 800 people (children between the ages of 0 and 6 form 11.2 per cent of the population in a representative sample in Karnataka). Currently, Karnataka has 63,377 AWCs. The importance of an AWC in the prevention of child malnutrition cannot be stressed enough as it is responsible for the health of pregnant and lactating women as well as the early years of a child's life.

Child malnutrition in Karnataka grabbed attention in October after a local television news channel broadcast visuals of children from Devadurga taluk in Raichur district who were on the verge of death due to severe malnutrition. The Karnataka High Court took cognisance of the report and came down heavily on the local administration. It also demanded a report from the DWCD. In its report, the DWCD has disagreed with the television channel's assessment that these were cases of malnutrition and has blamed other causes like premature birth, child marriage, consanguineous marriage, juvenile diabetes, and cerebral palsy for the malady. Contesting this report, activists claim that more than 2,000 children have died in Raichur since 2009 of severe malnutrition.

Denial mode

Officers of the DWCD also dismiss the activists' claim that there is a link between malnutrition and disability. But, according to people like Pramila of the State Disabled People's Organisation working in Bijapur, there is a direct link between malnutrition and disability.

Malnutrition in early childhood has severe consequences in a person's life as he or she grows up. Considering the value of early nutrition in a child's life, the Central government has been supporting the AWCs along with State governments. The flagship programme of the country to provide nutritious food to young children is the Integrated Child Development Services (ICDS).

In Karnataka, critics say that the food supplied under this scheme has not been providing sufficient nutrition to the child. Apart from nutri-corn puffs, children are provided with a ready mix of traditional dishes such as kesari baath, bisi bele bath, and an energy food. Rice and tur dal are also provided.

Except for a few noncommittal responses, people whom Frontline met in Gulbarga and Bijapur gave mostly negative responses about the food provided. Kalamma Basavaraj Pattar said: Children do not like the bisi bale bath masala that is mixed with the rice. A few parents have also complained that the pasty energy food that is also served causes constipation. Padmavathi, the mother of an eight-year-old in Bhimnagar in the same village, said as much. Honagunta has five AWCs, of which only two have permanent structures.

In Yedgol, another backward village in Bijapur, Dawalbi S. Kuri, the AWW, said that some children complained of stomach problems after eating the energy food and that they did not like the masala mixes. As she was speaking to Frontline, a sickly child crawled in. Shankaranand Doddamane is 21 months old and at 9.5 kg is severely underweight. This AWC has 68 children belonging to the Scheduled Castes, Scheduled Tribes and the Muslim community out of a total enrolment of 101.

The menu in anganwadis was changed in 2010 following several complaints across the State about the siphoning off of food destined for anganwadis at the taluk level. Until then, children were provided a combination of ready-mixes and freshly prepared rice and dal along with local vegetables, green gram and jaggery.

In Tamil Nadu, Andhra Pradesh and Kerala, local ingredients are used to prepare food for children at AWCs. Why can't this be followed in Karnataka as well? asks Y. Mariswamy, State president of the Samaja Parivartana Janadolana, an organisation working on the issues of infant mortality and child malnutrition.

From 2010, pre-packaged ready-mixes manufactured by a private contractor in 137 centres across Karnataka have begun to form the major part of the children's diet. The distribution mechanism of these was direct and there was no middle tier between the State and the AWC. This helped in cutting down on corruption in distribution at the taluk and zilla panchayat levels and in providing regular food for 300 days in a year, said Dr Shamla Iqbal, Director, DWCD. According to her, each child is given 22 grams of nutri-corn puffs, 40 gm of kesari baath, 35 gm of rice, 5 gm of tur dal, 10 gm of bisi bele bath mix and 45 gm of an energy food a day and this contains the required nutrition. Children between the ages of 0 and 3 are mainly given 98 gm of Amylase Rich Energy Food (AREF). Yet Shamla Iqbal concedes that the situation of malnutrition is serious and wants the budget of the department to be enhanced so that better-quality food can be provided.

Under the prevailing conditions we are spending around Rs.4 per child per day (pcpd) whereas in Tamil Nadu it is almost Rs.10 pcpd and children are given eggs. The amount is much higher in Maharashtra also. Kerala has raced ahead because of its efficient local government, she said.

She said there was hardly any coordination between her department and the Department of Health and Family Welfare in Karnataka, which was also responsible for tackling child nutrition.

A report prepared by Clifton Rozario, Adviser to Commissioners on Food Security appointed by the Supreme Court of India, lists several hurdles in eliminating childhood malnutrition: poor quality of food; inefficient identification of children suffering from malnutrition; failure of officials to take required and necessary steps in regard to malnourished children; lack of monitoring; failure of the Health Department to address the issue; infrastructural problems; and the severe effect of this on the Scheduled Castes and other backward groups.

In March 2010, then Chief Minister B.S. Yeddyurappa announced a Comprehensive Nutrition Mission (CNM). Even though this has been in place for a year, it has not been sufficient to address the problem.

According to the Karnataka Comprehensive Nutrition Mission Concept Paper of 2010, ...poverty is a prominent, but not the sole, cause of malnutrition. The fact that the percentage of people suffering from malnutrition far exceeds the percentage of people below the poverty line clearly establishes that malnutrition has other causes as well.

The idea behind the CNM was noble, but it has not been sufficient to target the main sources of the problem. With the High Court keenly following the issue, the State's institutions are now pulling up their socks. The court has directed the DWCD to form a subcommittee to look into the high rate of infant mortality in Karnataka.

Back in Savitri Nimbad's class under the tree, Ashwini and Gurnal stretch out their steel plates for the kesari baath gruel. As the anganwadi helper ladles out the afternoon meal, it is easy to become aware of the many ironies in her ditty. There is no permanent building or even a blackboard. Open sewers in the vicinity add to the miserable state of the anganwadi. A ready mix of kesari baath along with a savoury is the healthiest meal that many of these children will get in a day. How will Basavanna grow up to lead a healthy life?

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