Moderate malnutrition (>30%) still lingers in 15-20 tribal blocks, including some severe grade MN calling for rehab effort. The tribal Malnutrition is a complex web--poverty, culture, migration, terrain, services, lack of awareness, supply gaps etc. We need a roadmap, a practical and pragmatic agenda.

1. Child Malnutrition in
Maharashtra (India)
August 2013- January 2014
2013-
Situation, Efforts, Decline and Challenges
A Review
For the State Nutrition Mission
PowerPoint6/6
Malnutrition in Difficult Tribal Areas
Dr Shyam Ashtekar,
MD (Community Med)
shyamashtekar@yahoo.comnganwadi-supplementary feed--Dr Shyam
A
ashtekar jan 2014
1

2. Persisting Malnutrition
Problem In The Difficult
Tribal Blocks of
Maharashtra
PowerPoint 6/6
Dr Shyam Ashtekar 2014
This Photo belongs to year 2000 there is less of this
BUT THE ISSUE REMAINS

3. 3
Some Pockets of
Malnutrition in Maharashtra
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014

4. Maharashtra has 9% tribal population and ..
15 blocks have more malnutrition ,
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
4

5. > 30% children malnourished.
5
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.
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

6. The 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

7. Ignorance
and blind
faith
Contributors
of tribal
Malnutrition
Poverty
and
Migration
Roads
and
Power
Problems
Forest
restrictio
ns
More
illnesses
Child
Malnutrition
Unclean
condition
s
Poor
Breast
feeding
Weak
Health
System
Malnouris
hed
Women
Less Birth
weight
Malnutrition in Tribal blocks- Dr. Shyam Ashtekar, Jan. 2014
Weak
Governan
ce
7

8. The malnutrition
(MN)causes(MN)causes-in a
pyramid
Resulting Child
deaths
Child MN & illness cycle
0-5Y age group 40-50%
MN, 10% U6 children
severely wasted.
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.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
8

9. Govt. Schemes and Services
Many Schemes and services are weak in tribal areas.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
9

10. Scattered Habitats in Tribal Blocks
Google map of Molgi in Nandurbarmajor 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

11. Forest and Animal Sanctuaries, Forest
zone laws, Lack of Transport…
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
11

12. Seasonal Migration is a Fact of life
Construction and agriculture are
major sectors for migration.
Migration for 6-8 months
◦ Many families migrate for 68 months leaving the AWC
little scope for help.
◦ 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

13. Hard Work and Hilly Terrains
Hilly roads and head loads
Hard labor and less food lives
little flesh in the body.
BMI less than 18.5 affects 4080% women
Famished women bear weak
children
Low BMI reflects poverty.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
13

14. Blind faith, Faith Healers and Black Magic
Deep rooted problems
Blind faith and Bhagats
carry on..
Blind faith and lack of
awareness are major
issues.
This is a major impediment
in scientific treatment.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
14

15. LiquorLiquor-struck
Home distilled liquor
A livelihood for some
tribes
For Tribal societies
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

16. Water and Firewood take so much of Life and Labor.
Labor.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
16

17. Back 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
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

18. Public Distribution System and Food
Security
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

19. Many Homes have Stocks for 2 Years
Currently the doorstep
PDS, farming and wage
labor bring home enough
food for most homes
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
19

20. But Proper Nutrients in Good Measure are
missing.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
20

21. High fertility: 7-8 children is a common
7scene
More children
Rapid succession
No spacing of births
Hence neglect of
children and mothers
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
21

22. Early Marriage and Childbearing
More than 50% early
marriages
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

23. Low 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

24. Faulty 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

25. 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 .
There are difficulties like work and
migration but the result is the sameMalnutrition
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
25

26. Sanitation 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

27. Less of Immunization
< 50% full immunization rate.
Many reasons for this.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
27

28. Illness 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

29. The Intergenerational Cycle of
Malnutrition
Malnutrition carried to next
generation.
Quick birthing is part of the
problem.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
29

30. Anemia in 60-70% Women and Children
60Low hemoglobin invites
several problems.
Causes maternal
morbidity and mortality.
Causes Infections,
malnutrition for children.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
30

31. 5-10% Children Suffer from Sickle Cell
Anemia
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

32. Weak 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

33. InfrastructureInfrastructure-Leaking Roofs are Common
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
33

34. Lack of Facilities
Many projects have no vehicles.
Lack of support staff in most projects
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
34

35. Weak Health system
Barely 50% women get
some ANC care
50% childbirths happen at home.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
35

36. Getting 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

37. 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
working mother, migration etc..
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
37

38. Some Families are Less Concerned
Some tribal families feel less
Some AWC workers report
about malnutrition unless it is
that families may starve the
a severe malnutrition..
child to get Khavati loans
Problems of daily life more
Loan amount –Rs 3000- is
important than a malnourished
sometimes wasted
child.
This is possible and we need
to review this scheme for
better utilization.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
38

39. Need to Know Tribe Specific Facts in
Malnutrition Stat.
Scheduled Castes (SC) and VJNT
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

40. Some Tribes are More Malnourished Than
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

41. Food 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

42. Community Participation Necessary…
Necessary…
It is difficult to
expect local
participation for
combating
malnutrition in
tribal areas at this
stage.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
42

43. Khavti Loan 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
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

44. Nutrition Rehabilitation
The NRHM assistance is
available for nutrition
rehabilitation from village to
district hospital.
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

45. Crèche
The crèche scheme has
been started in some
Crèche is a good social
facility.
tribal blocks. The crèche
attends to pre AWC age
group including nutrition.
The crèche also frees
the mothers from childduties for some hours.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
45

46. Line listing of Malnourished children on
Website ..But These Lists are Rather Old.
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
46

47. Media 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.
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

48. A Road Map
Income
Programs
Social
Reforms
Administr
ative
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

49. Need 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

50. A 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 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
Malnutrition in Tribal blocks- Dr. Shyam
Ashtekar, Jan. 2014
50

51. Best Wishes
51
Dr Shyam Ashtekar (MD, Community Medicine)
21 Cherry Hills Society, Anandwalli, Nashik India
422013
shyamashtekar@yahoo.com
Cell +919422271544
Website:
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