Malnutrition: Reality behind Govt Health care services...!!!

When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.

Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Madhukar Mane, Health Coordinator with NGO Maitri, which organises monsoon campaigns to prevent deaths in the precarious season, says: "The figures are certainly better than the late 90s but the numbers are still very high in the tehsils of Dharni and Chikhaldhara. Government records child deaths under two categories: still birth and neonatal. What happens is that they write off several deaths as still births so that the infant mortality rate (IMR) could be kept under check.

Maximum child deaths occur during monsoons as the tribals are not able to work and feed their children. Ironically, most government schemes are launched after the monsoons.

About 50 per cent families in Melghat are below poverty line with a high rate of unemployment. Weak mothers often deliver children in grade 1 malnutrition.

It almost instantly deteriorates to grade 2, and then 3 & 4. The nearest emergency health care is about 120 km away that too without a child specialist or medical equipment. About 39 children are suffering from grade 4 malnutrition while 442 fall under grade 3 here.

Jayashree Shidore, coordinating activist with Maitri, says: "Children with a sunken face and a bloated stomach is a common sight in Melghat." Maitri is helping such kids by imparting basic health education, especially to nursing mothers, and lessons in personal hygiene.

 
Malnutrition mars Gujarat's growth story: HDI Report: Despite a shining Gujarat story of high economic growth model applauded by a US Congressional report, the India Human Development Report 2011 points out that the state fares the worst in terms of overall hunger and malnutrition in the country. Taking a dig at the Gujarat model, Union rural development minister Jairam Ramesh, while releasing the report, said, "On nutrition, I am puzzled why the high rate of malnutrition continues to persist even in pockets high economic growth.

105 child malnutrition deaths from April-June in Melghat : AMRAVATI: The Melghat region of Vidarbha is presently a picture of despair and what sounds a discordant note is the cries of kid dying due of malnutrition. A total 105 infants have died between April and June 2009 in Melghat. Despite efforts by the government and non-government agencies and after spending a large amount of money, the infant deaths in this tribal region are unabated. Health department sources said that about 69 children are reported to be in stage IV of malnutrition in Chilkhaldhara and Dharni tehsils of Melghat region.

http://www.dnaindia.com/mumbai/report_child-malnutrition-supriya-sule-to-visit-melghat_1604058

http://articles.timesofindia.indiatimes.com/2009-07-23/india/28197788_1_malnutrition-melghat-infant-deaths

http://in.news.yahoo.com/twelve-infants-die-kolkata-childrens-hospital-123053104.html 

Neonatal Health In India : UNICEF

Introduction
Child mortality is a sensitive indicator of a country’s development.  In India, the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in recent years.

The average decline of IMR per year between the years 2004 to 2008 has been about 1 per cent per year.

In 2008, the IMR was 53/1,000 live births. Eight states contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam. 

At the current rate of decline, India will miss the XI plan goal of reduction in IMR and the Millennium Development Goal-4 on child survival.
About 70 per cent of the childhood under-five is caused by perinatal conditions (33.1 per cent), respiratory infections (22 per cent) and diarrhea (13.8 per cent). Malnutrition is an underlying cause responsible for about one third of all deaths in childhood.
Fast Facts
• Averting neonatal deaths is pivotal to reducing child mortality. The Newborn period is the period starting from birth and continues throughout 28 days of life.

• Neonatal mortality rate (mortality in the newborn period) stands at 35/1000 lives births, and contributes to 65 per cent of all deaths in the first year of life.

• Between 2004-2008, neonatal mortality has moved from 37/1000 live births to 35/1000 only.

• 56 per cent of all newborn deaths occur in five states: UP, Rajasthan, Orissa, MP and Andhra Pradesh.

• Three major causes contribute to about 60 per cent of all deaths in the newborn period: pre-maturity and low birth weight, birth asphyxia and infections.

Key Issues
• Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. But they often are unable to provide the required care.

• Inappropriate practices such as delayed initiation of breastfeeding, delayed clothing and early bathing, not seeking care when newborns are sick and applying harmful material on cord-stump increase the risk of newborn deaths.

• Health facilities are often ill equipped to provide essential newborn care to all newborn and special newborn care to sick newborns.

Gender Equity Issues in India

Gender discrimination continues to be an enormous problem within Indian society. Traditional patriarchal norms have relegated women to secondary status within the household and workplace. This drastically affects women's health, financial status, education, and political involvement. Women are commonly married young, quickly become mothers, and are then burdened by stringent domestic and financial responsibilities. They are frequently malnourished since women typically are the last member of a household to eat and the last to receive medical attention. Additionally, only 54 percent of Indian women are literate as compared to 76 percent of men. Women receive little schooling, and suffer from unfair and biased inheritance and divorce laws. These laws prevent women from accumulating substantial financial assets, making it difficult for women to establish their own security and autonomy.

In Rajasthan, all of these problems are aggravated by high levels of seasonal migration. For many men in Rajasthan, migration is required since rural parts of Rajasthan often lack a sufficient economy to provide income for a family year-round. Women are commonly left behind to care and provide for the entire household. This is increasingly difficult because it is estimated that an average woman's wage is 30 percent lower than a man's wage working in a similar position. While these mothers work, they must also tend to domestic responsibilities. This formula for supporting Rajasthani families leaves little resource for the growth and development of women's rights and education levels.

A strong "son preference" exists in the region, as it does throughout the country, and high rates of female infanticide and female feticide plague the area. In 2001, for every 1,000 males living in Rajasthan there were only 922 women (Marthur et. al., 2004). Having sons is economically advantageous to families due to cultural institutions; these institutions serve to drastically devalue the roles women play in the traditional society. Women continue to struggle to achieve equal status to men, making gender equity an issue of particular importance for Rajasthan.

In Rajasthan several NGOs that have hosted FSD participants are instrumental in providing opportunities for women. These organizations help to build networks among women to create financial self-help groups. They introduce ideas about microfinance, allowing women to participate in management activities. Other local NGOs implement projects that export the skills of women abroad to generate significant income. In 2006, Olen Crane, an FSD intern, helped nearly 400 women artisans in the Udaipur area by collecting samples of their textile products and shipping them abroad to sell to American companies. Similar projects have enormous potential to improve the financial and social status of Rajasthani women. Organizing change at a local level and planning participatory action will help to eliminate bias and stereotypes, and generate awareness of the significant gender divide that exists within Indian society.

Child and Maternal Health Issues in India

Since its independence, India has become a world leader in medical advancement due to its incredible medical education system and state-of-the-art private medical facilities. It is now a major provider of health services and contains some of the most highly skilled and qualified medical providers in the world. Quality health care, however, remains inaccessible for many undeveloped Indian regions. For example, in rural communities it is estimated that only 18 hospital beds are available per 100,000 people. Even when medical treatment is available, public hospitals are frequently understaffed and under supplied. The poor are forced to rely on overburdened, unsanitary facilities as their only source of health care.

Lack of national care has produced severe health issues throughout the nation: the highest prevalence of tuberculosis in the world; over 1.5 million children dead each year before their first birthday; and nearly 500 million lacking sufficient nutrition along with the second highest number of people living with HIV/AIDS. Growth of HIV/AIDS is a particular concern since there is not a secure infrastructure to measure the virus’s spread and impact, particularly with women in rural areas. While prevalence is not high, the country is extremely susceptible to a massive epidemic if left unchecked.

This lack of national healthcare infrastructure is having severe and lasting effects on the livelihoods of Indian citizens. In Rajasthan, about half the children suffer from malnutrition, 49 percent of women are anemic, and about one-third of children are born with a low birth weight. Additionally, only 14 percent of children between 12 and 23 months receive the necessary vaccinations to prevent diseases such as small pox and polio. Public hospitals have insufficient funds to support their communities, and since only 15 percent of Indian citizens have health insurance, quality health care remains unattainable for millions in dire need (Bhagat, 2004).

Thousands of public health NGOs are intervening to provide the necessary medical care, support, and treatment. In Udaipur and Jodhpur, FSD collaborates with local organizations that interview the local community to identify weaknesses in rural health care and then provide the underprivileged with the necessary supplies and medical advice. Additionally, FSD supports programs that host educational workshops to promote the importance of hygiene and sanitation, and assists healthcare centers that provide immunizations to at-risk children. FSD partner organizations are working within the communities with the greatest need to ensure that all citizens are guaranteed their basic right to continued health and physical well-being.

Indian Health Facts: Report by UNICEF

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Approximately 2 million under-5 children die in India every year (UNICEF state of the World s Children Report, 2007). This is about one-fourth of the global burden of infant and child deaths. Adding to this gloomy statistic is the status of maternal mortality in India. Over 70,000 women die in India every year due to pregnancy related issues. This too accounts for almost one-fourth of the world s maternal deaths. India has among the poorest maternal mortality indicators in the world, and child survival has not improved as it should have. Better early care and immunization, along with tackling diarrhoea and pneumonia among children ensure improvements in child survival, and also contributes to reducing the family size and population stabilization in India India faces the enormous challenge in achieving the Millenium Development Goals by reducing infant mortality from 53 per 1000 live births to less than 30 and maternal mortality from 254 per 100,000 live births to less than 100 by 2015. On the face of it, this challenge seems almost unsurpassable in the given timeframe. With just five years to the 2015 deadline for achieving the MDGs the country as a whole will not be on track for a majority of the targets related to poverty, hunger, health, gender equality and environmental sustainability unless concerted national efforts are made by government and all sections of civil-society working in tandem.