"I have also planted guava, banana, and papaya trees. It not only gives us more nutrition but we also save money on vegetables," said Majhi, who belongs to the Kondh tribe.
Many villagers like Majhi in Tumudibandha block were unaware of the nutritional value of fruits and green vegetables. They ate their staple of rice often without any green accompaniment. The hilly terrain of Kandhamal has a good number of drumstick trees, but the tribals did not know that its leaves and fruit can be cooked.
Majhi started planting vegetables and fruits in 2017 after volunteers of Jeebika Suraksha Mancha, a people's collective working in Kandhamal, educated the villagers about the health benefits of eating green vegetables and fruits and the importance of building a kitchen garden. The nutritional kitchen garden initiative, with the additional support of Noida-based NGO, Atmashakti Trust, is helping rural communities in 267 villages under Kotagada and Tumudibandha blocks of Kandhamal district grow vegetables at home. Until now, they have assisted over 2,120 kitchen gardens take root, each growing around 13 to 17 varieties of vegetables.
Rashmita Patmajhi, 30, weighed only 45 kg two years ago. With a poor haemoglobin count, she used to feel tired all the time. "I built a kitchen garden and also started eating fruits and vegetables. I weigh 49 kgs now and now I know the importance of a nutritious diet."
In Kandhamal, at least, this knowledge is critical.
The official statistics of the Odisha government in 2018 listed about 3,500 malnutrition deaths in Kandhamal in the past five years. The district has over 53 per cent tribal population, which is among the top communities that report higher incidences of malnutrition in the state.
"Undernutrition is more prevalent among tribals in comparison to other communities. In Odisha, where 37.26 per cent of its population is deprived of nutritious food, there is a stronger need for building kitchen gardens, which will go a long way to secure nutritional status for their families," added Sameet Panda, convener of Odisha chapter of Right to Food Campaign.
Supplementing support
"Malnutrition is more than lack of food, and tribals are traditionally agrarian communities who grow vegetables and fruits. So, there is no visible hunger among these communities," said Ruchi Kashyap, Executive Trustee at Atmashakti Trust. "But, they do not know what a varied diet is and what fruits and vegetables will meet their nutritional needs. So, we used a behavioural change communication approach to overcome this challenge. We helped communities know food diversity, the technique to grow a kitchen garden, and avail of government schemes such as Mo Upakari Bagicha, Millets Mission, and Iron Plus Initiative to make this effort sustainable and beneficial," she said.
The state government too has recognised and supported these kitchen gardens over the years. In 2018, Odisha Livelihoods Mission (OLM), in partnership with Azim Premji Philanthropic Initiatives (APPI), implemented a nutrition project called �Mo Upakari Bagicha' to spread the knowledge of nutritional outcomes from dietary diversity by promoting kitchen gardens in rural households across the state.
In June 2020, OLM converged with MGNREGA to scale up nutritional kitchen gardens in all 314 blocks with an additional budgetary allocation of Rs 500 crore from the Odisha government. The aim was to reach 5 lakh households in the financial year 2020-21 with a focus on Scheduled Caste, Scheduled Tribes, Below Poverty Level (BPL) households, beneficiaries of rural housing, and small and marginal farmers.
Santosh Kumar Rath, District Project Manager of OLM in Kandhamal said in an effort to reduce undernutrition among children, women of reproductive age groups and adolescent girls, "in the last financial year, we have helped over 24,000 families build kitchen gardens in Kandhamal".
And there has been some progress in this tribal hinterland which has recorded a significant improvement in malnutrition over recent years.
According to the National Family Health Survey (NFHS-5) 2019-21, stunting in Kandhamal has decreased significantly from 38.4 per cent to 34.2 per cent in NFHS-4 (2015-2016); the percentage of underweight children has reduced from 43.1 per cent to 35.40 per cent, and there has been a marginal improvement in the figures on wasting disease but these figures are all still below the state average.
Delinking nutrition and poverty
Odisha is also rated among the top 10 states with a substantial share of the population living in poverty as per the report of NITI Aayog's National Multidimensional Poverty Index (MPI) 2021. One in every two people (44.75 per cent) in Kandhamal is below the poverty line.
"Nutritional kitchen gardens can play the role of inflation insulation for them as vegetable prices remain high all through the year," said Panda.
Kitchen gardens are vital to cater to the villagers' nutritional needs by providing access to food that is harvested, prepared, and consumed by family members.
Sindhimai Patmajhi, 55, from Badjal village under Jubaguda Gram Panchayat in Kotagarh block, grows papaya, drumstick, banana, lemon, radish, guava, carrot, pineapple, brinjal, beans, cucurbit, cabbage, cauliflower, and beet nutritional kitchen garden. She said her frequent visits to the hospital have reduced drastically in the past two years after eating vegetables every day.
"The members of Jeebika Suraksha Manch explained to us the nutritional value of each fruit and vegetable. They asked us to grow vegetables and fruits so that we readily get the required nutrition in our food," she said.
Although Patmajhi and her husband earned through Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), it was a meagre amount. With the flourishing kitchen garden, they do not have to worry about nutritious food.
An increase of vegetable yield has ensured that the villagers are not only consuming healthy food but also earning by selling the surplus.
"This year, we have received an additional income of around Rs 6,500 by selling surplus vegetables. This helped our family build another room in our house," said Rita Majhi, 28, from Pagarpadi village under Guma Gram Panchayat of Tumudibandha block.
The visible results of the kitchen gardens have motivated other non-beneficiary farmers and women to create these in their communities and homes.
Taking to Twitter on Wednesday, the UN agency referred to the case of a two-year-old child and said: "Having recently recovered from acute watery diarrhoea, two years old Soria is back in the hospital, this time suffering from oedema and wasting. Her mother has been by her bedside for the past 2 weeks anxiously waiting for Soria to recover."
In the following tweet, Unicef added that "without urgent action, 1 million children could die from severe acute malnutrition".
According to Unicef estimates, 24.4 million Afghans, including 13.1 children, will need humanitarian assistance in 2022.
Of this number, 1.1 million are acutely malnourished children under the age of five years due to the food crisis and poor access to water, sanitation and hygiene services.
Outbreaks of life-threatening diseases continue, with over 60,000 cases of measles reported in 2021.
The Taliban's Ministry of Public Health has claimed that the number of children suffering from malnutrition is around 4.4. million in Afghanistan.
"To overcome malnutrition in Afghanistan, there have been some measures enforced to enhance the health sector and also to recruit the international aid to support the Afghan health sector," said Javid Hajir, a spokesman for the Ministry.
A bench headed by Chief Justice N.V. Ramana told Attorney General K.K. Venugopal, "See if you want to take care of hunger, no constitution, law or court will say no. My suggestion again is...already we're delaying, so further adjournments won't help... We'll give you the final time of two weeks, please hold that meeting (with state governments to develop a scheme)..."
The Chief Justice told the Centre that 'people are dying of hunger and malnutrition is a separate issue, and do not mix them', and added that it is not bothered about the international malnutrition index, but it's only aim is to curb the hunger issues in the country. The bench said for any welfare state, the first responsibility is not to allow people to die of hunger.
At the beginning of the hearing, the bench, also comprising Justices A.S. Bopanna and Hima Kohli slammed the Centre stating that it appears from the affidavit and submissions of the Centre that it is still in the process of gathering suggestions on the matter.
The bench noted, "It looks like the government is not in a mood to implement the scheme..."
After hearing detailed arguments in the matter, the top court said it will grant three weeks' time to the Central government to come up with some scheme which can be agreeable by various state governments also.
The bench noted that if state governments have any objection, it will be taken up in the next hearing. "We direct all states to cooperate with the Government of India in coming up with a scheme...", said the bench.
The petition sought subsidised canteens in all states and union territories to ensure food security, in the backdrop of the havoc wreaked by the pandemic.
Jajpur collector Ranjan Kumar Das and local legislator Priti Ranjan Ghadai launched the daily bus service at Danagadi. The bus will ply between Chandikhol and Nagada via Sukinda and the Kalinganagar Industrial area.
The local legislator said after the bus service is launched, Nagada people will be able to commute to other parts like Jajpur, Chandikhol and Bhubaneswar. “Thereby they will get a scope to learn many things for behavioural changes. They will have no more problems after this,” said Ghadai.
It remains to be seen how much the MLA’s claim of a bus service being enough to make the Nagada residents aware about health and sanitation comes true. With no mobile network, the residents cannot even avail ‘108’ ambulance services but the administration has come up with yet another step to dust off its hands of responsibility to change the lives of people here.
Nagada hogged limelight last year after 19 children lost lives due to malnutrition.
This is not a case in isolation but such cases prevail in all of Nagada, an area that languishes in the shadow of development, on a hilly terrain close to a hub of industrial development in Jajpur.
Just a year ago, the situation was no different when multiple child deaths due to malnutrition shocked the entire nation. As many as 19 children died in a span of a month or two. The news made headlines not only in the state but throughout the world. Government officials, political leaders soon flocked the area to assess the situation and made big promises to change the grief stricken area. Several developmental reforms were announced by the government ever since, but all in vain.
The condition of children here still remains the same. Despite roads, clean drinking water, provision of egg and BPL rice, light and medical care which were incorporated into the three Nagadas, failed to get into the mindset of people – all uneducated and averse to change. With the condition at present, apprehensions of child deaths due to malnutrition or negligence in healthcare cannot be ruled out.
“We don’t have access to BPL rice and even though it has been a year since we had applied for BPL cards we are yet to get it,” Hira Pradhan, a resident of upper Nagada said.
On the other hand administration says the locals resist changes in their way of living. “We are trying to make people aware about their health; ways of living but however hard we may try people here are not changing,” Champabati Jarika, Integrated Child Development Services (ICDS) Supervisor said.
A ground zero report by OTV on Wednesday found government vehicles making a beeline to the place. Still, as many as 10 children were found struggling with malnutrition at a time when a four-month-old son of Brahma Pradhan had also died a couple of months back.
It has been alleged that a four-month-old son of villager Brahma Pradhan lost his life to malnutrition and malaria in April this year.
Further allegations include that while doctors are visiting Nagada every Wednesday, they are unable to identify the disease. And nutritious food and drinking water is not available for the children and pregnant women of the area.
Talking to OTV, Women and Child Development Minister Prafulla Samal said, "People here are not aware about health care and nutrition till date. We are trying to raise awareness among them. The department has taken all steps so that the Nagada incident will not be repeated."
Jajpur Collector Ranjan Kumar Das said, "A team of doctors from ICDS are setting up camps there. In coming days we are planning to set up a 24X7 Medical Research Centre (MRC) in the area."
Death of 19 children due to malnutrition in Nagada had shocked the nation last year. The government took steps to change the face of Nagada. Roads were constructed, officials visited the place regularly for inspection but the picture remains the same.
As per sources, Mansi, daughter of Dhaneswar Pradhan died of malaria while under treatment at Tisco hospital in Kaliapani. She was admitted to the hospital two days back.
A wave of death had swept through Nagada last summer when as many as 19 children died in the village within three months.
“She had fever for two days and was brought to the hospital. However, she could not be treated,” said Dhaneswar.
“Yesterday we got information that she was ill and admitted to hospital. Doctors identified that that she was suffering from malaria,” said Sukinda Block CDPO, Tilotamma Mohapatra.
After the meeting Patnaik told media, “Malnutrition among pre-school children, lactating and pregnant women in the State were talked about. Besides, in an effort to encourage the Anganwadi workers and helpers, we also discussed increase in their honorary pay.”
The Minister for Women and Child Development said, “The Centre is considering steps on how it can help the State and fund institutions to help malnourished women and children.”
The Odisha government has already extended its community management of malnutrition programme to all 30 districts of the State.
The State is focussing on infant mortality rate and maternal mortality ratio reduction strategies through a multipronged converged model where nutrition finds a prominent mention, said an official.
Around Rs 808.98 crore was earmarked for supplementary nutrition programme in the annual programme implementation plan of ICDS for 2017-18, the official added.
From reports we have received for the month of June, 23,256 children are underweight 2096 children are suffering from severe malnutrition, district social welfare officer Harekrushna Pradhan told OTV.
Reports from the office suggested an increase in the cases of malnutrition over last two months. 22,571 cases were registered in the month of May out of which there were 2,019 cases of severe malnutrition while the statistics rose to 23,226 last month in June with 77 more kids adding to underweight category.
Though there are several government schemes like Positive Deviance Approach (PDA), Integrated Child Development Services (ICDS) program, Community based Management of Severe Acute Malnutrition (CMAM) programme designed to cater to the needs of children and pregnant women, so many cases of malnutrition is astonishing.
But with questions over quality of sattu amid allegations of irregularities and cancellation of funds under CMAM programme by the State Government, the fight against malnutrition seems to have weakened.
On the other hand debates have started to heat up on the issue with Assembly Public Accounts Committee Chairperson and Leader of Opposition Narasingha Mishra saying that not only Bolangir but such irregularities in basic food supplies meant for welfare of children and women are occurring throughout the state.
“I had raised the issue with the collector and it is also a responsibility of the PAC to inspect whether government funds are being spent in right manner.
District administration meanwhile has refuted the allegations. "The figures of malnutrition cases that are being alleged are incorrect. We don’t have any such figures,” Collector Asish Thakrey said.
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According to the AHS, The Clinical, Anthropometric and Biochemical (CAB), survey conducted by the Registrar General of India, Odisha has the highest prevalence of undernourishment among males (five to 18 years age group) at 36.1%. The report said Rajasthan and Bihar account for maximum cases of undernourishment at 33.8 % and 33.7 % respectively.
Uttarakhand showed the least prevalence at 21.8 per cent, figures in the report showed.
For undernourished female in the same age group, Odisha (32.2%) occupies the third slot after Bihar (33%) and Rajasthan (32.5%).
The state of elderly people so far as the body mass index (BMI) is concerned is no better in Odisha.
It said, among elderly population (aged 60 years and above) the percentage of underweight population with BMI less than 18.5 is the highest in Odisha (37.6 per cent) and lowest in Uttarakhand (23.4 per cent).
Uttarakhand, which has placed itself in least prevalence of undernourished cases in a list of 100 districts, records highest (21.6 per cent) in overweight population with BMI greater than or equal to 25 in 18-59 age groups. Chhattisgarh recorded the lowest at (6.3 per cent), the report noted.
Among females aged 18-59 years, Odisha shows the highest underweight prevalence at 30.3 per cent while Chhattisgarh shows the lowest at 18.5 per cent.
It raises a question mark on whether benefits of social welfare schemes meant for the poor and deprived reach to the beneficiaries. As the survey indicates, the ground situation remains grim, be it Dana Majhi’s case in Kalahandi or the malnutrition deaths in Nagada in industrially-rich Jajpur district.
The State government however said it has chalked out a plan to overcome the situation.
“Undernourishment is linked to several factors. So we have asked departments including Women and Child Development, School and Mass Education, Sc/ST Development, Health and Family Welfare and Rural Development to work in tandem to eradicate hunger and prevent malnutrition. We will review the situation on a periodical basis to achieve goal of complete poverty eradication”, Women and Child Development secretary Vishal Dev said.
The report showed, of the 100 districts surveyed, Hoshangabad in Madhya Pradesh reported the highest level of undernourishment with 48.7%, followed by Shabiganj (44.1%) and Gumla (40.2%) districts of Jharkhand.
It further said the Odisha district ranked 15th on child wasting and 3rd on child underweight among 100 districts of Empowered Action Group (EAG) states. In India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh, referred to as the EAG states, lag behind in the demographic transition and have the highest infant mortality rates in the country.
According to the report, the economically backward district, currently in news for the outbreak of Japanese Encephalitis (JE) which has already claimed lives of 17 children, showed very low levels of full immunization at 29.6 per cent. Cases of no immunization were highest in Uttar Pradesh (7.6 per cent) and the lowest in Odisha (0.8 per cent), it noted.
In list of 100 districts with highest prevalence of underweight in age group 18-59 years, 3rd, 4th and 5th position have been occupied by Malkangiri, Nabarangpur and Kalahandi respectively.
It said Kalahandi (47.7%, rural undernourishment 50.1%) stands 7th in list of 100 districts with highest percentage of undernourished population.
After reaching the nondescript village on the hilltop, the five-member team interacted with the residents and enquired about their lifestyle.
“First of all, the State government has responded positively towards the problem in the region, which is clearly visible. There are some problems which are perennial to the whole country and some problems are acute. So I don’t think there will be a solution for everything in one capsule,” Arun Singh, a member of the team, said.
Suggesting that long-term development plans are needed for the social upliftment of the people of this backward region, he said some perennial problems must be taken care of.
“Again I say, there are some problems which are pan-Indian. I think the more acute problem which had cropped up will be contained and discussed to sort it out,” he hoped.
During the visit, the officials spoke to the family members and relatives of the victims of malnutrition.
According to media reports 19 children, all in the age group of 0-5, have lost their lives due to malnutrition in the past three months. Besides, more than 40 children of the same age group have developed blister-like rashes on their bodies.
Officials of Odisha government accompanying the Central team to the village maintained that the situation is improving.
“We are stressing on permanent health camps and anganwadis. Basically long term engagement and long term mobilisation are our strategy … The permanent facilities will soon be here and I’m sure there will be a lot of change in the area,” commissioner of Bhubaneswar Municipal Commission (BMC) Vishal Dev, one of the officials accompanying the Central team, said.
Reports said the State government has provided solar lamps and water filters to each tribal family of the region after Nagada hogged the headlines for all wrong reasons.
The Central team is scheduled to meet officials of Odisha government tomorrow.
According to sources, the team is being accompanied by the collector of Jajpur district.
Upon their arrival in Odisha yesterday, the central team reviewed the mitigation measures undertaken by the concerned departments after the deaths came to light.
The team, which is led by the joint director in the Union Health department Chetan Sanghvi, held a meeting with the Jajpur collector and other senior officials yesterday.
According to sources, the team is scheduled to hold discussions with the concerned authorities of the State government after returning from Nagada.
According to sources, the team is scheduled to hold discussions with the concerned authorities of the State government after returning from Nagada.
Meanwhile, the 5-member team has arrived in Bhubaneswar.
Yesterday, National Commission for Protection of Child Rights (NCPCR) asked the State government to submit a report on the situation in the village, predominantly inhabited by people of the primitive Juang tribe, in 10 days.
Commission member Priyanka Kanungo has written a letter to the Odisha Chief Secretary asking him to explain the reason behind the child deaths and list the steps taken by the government to mitigate the situation.
Following this, the Women and Child Welfare department has sought a report from the Jajpur district Collector.
Commission member Priyanka Kanungo has written a letter to the Odisha Chief Secretary asking him to explain the reason behind the child deaths and list the steps taken by the government to mitigate the situation.
Following this, the Women and Child Welfare department has sought a report from the Jajpur district Collector.
Meanwhile, Prasad Harichandan, PCC chief, came down heavily on the state government, saying; "Nagada village is the naked picture of BJD government’s version of development. A total 1.40 crore people in the state are suffering from malnutrition. It seems this government itself is ailing.”
Refuting the charges, Sashi Bhusan Behera, BJD spokesperson, said, “The government has taken several steps to eradicate malnutrition in the State. Those who want to defame the State government by citing Nagada as an example will never succeed in their goal.”
Interestingly, the Chief Minister’s Office (CMO) does not have any information on the Nagada issue till date. The CMO had asked the Women and Child Welfare Department to submit a report on the matter within three days on July 20 after the Nagada issue was highlighted in the media.
However, the CMO is yet to get any communication on the issue from the department, said sources.
“The current food grains entitlement of each family in the area will be doubled. Food grain entitlement under all state and central schemes, including the National Food Security Act (NFSA), will be doubled,” Agriculture secretary Manoj Ahuja said.
“We are in the process of sending energy-rich nutritious food items to the region. It will reach them soon,” Ahuja noted.
The ruling party, which woke up to the issue of malnutrition leading to the alleged death of 18 children in the hilly terrains of the mineral rich district in the last three months, also announced ‘emergency’ plans to address issues like health and transportation, sectors that have never received any attention of the government.
Besides announcing a 24x7 health camp on the hilltop, houses to 85 families, the State government also discussed plans to construct motorable roads to reach the hamlet.
“Currently we are focussing on health and transportation issues in the area. If we go from Dhenkanal side, then we will reach the place a little early. So we are planning a feasibility study to construct roads from both the sides. For supply of water also the discussion is going on,” Ahuja stated.
Since there is no electricity in the village, we have decided to provide one solar light to each family, the official said.
After reviewing the situation two days back, Child and Women Development Minister Usha Devi had announced the opening of four mini Anganwadi centres in the village.
Official sources said, the State government has chalked out both short-term and long-term programmes to develop the area.
Meanwhile, with three new cases, the number of children admitted to the nearby hospital has reached 22. Doctors treating the children said 15 of them have been affected by malaria.
Talking to newsmen, Patnaik said, “The task force will also see that such incidents do not recur.”
Meanwhile, Agriculture director PK Meherda and Principal Secretary, Agriculture department, and State Task force nodal officer Manoj Ahuja visited the Kaliapani hospital and enquired about the condition of 19 malnourished kids undergoing treatment. Later they visited Tala Nagada area.
Notably, as many as 18 children have allegedly died of malnutrition in the last three months in the mining area.
Nagada is situated on a hilltop in a dense forest under mineral-rich Sukinda block. Located about 30 km from Sukinda chromite valley and more than 50 km from Kalinga Nagar Industrial complex, there is virtually no road to the village.
Even for basic necessities, the villagers have to trek more than 15 km through a dense forest to reach a motorable road, sources said.
A team of the saffron party, which visited the hilltop village yesterday where 18 families of the Juang tribe reside said the State government has failed misereably to provide basic facilities to the inhabitants of the region.
“We didn’t see a single pucca house provided by the Centre under IAY in Nagada. The scene in nearby hamlets is also no different. Forget about primary schools, there is not a single community health centre (CHC) in the area. How do the people live here? We want to know what the government has done with the IAY funds of the tribals?” asked BJP legislator Pradeep Purohit.
Addressing the media, he stated the development plans of the State government have gone horribly wrong as lack of drinking water facility in the area has made matters worse.
“Can someone survive without pure drinking water? Go to Nagada and you will see people are still alive and waiting for the government to dig a bore well for them,” said Purohit.
Unfortunately, acute poverty and lack of basic welfare services in the villages came to light only after loss of precious human lives, he rued.
On the other hand, the nine-member Congress team, which was forced to cancel its Nagada tour midway on Tuesday and returned from Ekulu, some three kilometres from the hilltop village, due to inaccessible roads, also blamed the district administration for not providing even rudimentary infrastructure in the area.
“The development of the area is restricted to pen and paper only. When we travelled in a tractor for about nine kilometers to reach Ekulu, think about the 419 population of the tribe including 127 children aged 0-5,” said Congress spokesperson Sulochana Das.
“After two back to back similar cases - first in Phulbani and now in Jajpur - we are not going to sit idle. We will begin a mass movement against the ruling party soon,” she noted.
However, in a belated move to salvage the situation, the State government on Monday announced formation of a task force for development of Nagada village. Development Commissioner R Balakrishnan told media persons that Revenue Divisional Commissioner (RDC), central division, will head the task force. “The RDC will submit weekly report on the developmental activities of the area,” he said.
"The government has effected a quantum increase of about 33 per cent in cost norms, which have been revised for the first time since 2011 in the case of ICDS (Integrated Child Development Services)," Women and Child Development Secretary Rakesh Srivastava said in a statement on Friday.
The government under its flagship programme ICDS provides morning snack which can be milk, banana, fruits or micronutrient food at Anganwadi centres to children aged six months to three years.
Pregnant women, lactating mothers and severely malnourished children can take the food home.
There are about 13.5 lakh Anganwadi centres in the country.
In the case of Scheme for Adolescent Girls, cost norms had been increased for the first time since 2010, said Srivastava.
"With this, an additional Rs 9,900 crore has been given for supplementary nutrition in Anganwadis over the next three years and Rs 2,276 crore in the scheme for adolescent girls over the next three years," he explained.
He said the cost norms had now also been linked to the Food Price Index, which will enable the government to increase the cost norms annually without any hindrance.
For pregnant women and lactating mothers, the revised cost would be Rs 9.5 from Rs 7. The severely malnourished children would now get supplementary nutrition worth Rs 12.5 from the existing Rs 9, according to the new guidelines.
Cost norms for nutrition provided to adolescent girls of 11-14 years have also been revised to Rs 9.5 from Rs 5.
"After the resounding success of Modiji's Beti Bachao Beti Padhao programme that brought about a phenomenal change in the mindset, a similar approach is needed to fight malnutrition, particularly among mothers and children," she said.
The Minister was addressing the "National Conference on Mission Mode to address Under-Nutrition" here.
The conference was organised by the WCD Ministry in collaboration with the Ministry of Drinking Water and Sanitation and the Ministry of Health and Family Welfare, keeping in mind the goal of "Mission Malnutrition Free India-2022".
Gandhi gave away awards to three states -- Chhattisgarh, Arunachal Pradesh and Gujarat -- for substantial reduction in stunting (impaired growth and development that children experience from poor nutrition) during the 10-year period between National Family Health Survey (NFHS)-3 and NFHS-4.
She also released a book "Forest Lanterns" containing essays on solutions to improve nutrition among children in tribal areas.
Gandhi said there is an urgent need to improve the quality of supplementary nutrition and to make the delivery system efficient.
"We must provide 1,000 calories to women and 600 calories to children under ICDS (Integrated Child Development Services). The focus of the entire mission should be to administer nutrition rather than feeding beneficiaries by giving nutrient dense food."
A change in policy is required to implement this, the Minister said. The Ministry will soon issue new guidelines on supplementary nutrition in this regard in the next few days which will supersede all existing guidelines.
"Similarly, a separate self contained protocol for severely and acutely malnourished (SAM) children will also be issued shortly," she added.
Minister of State for WCD, Virendra Kumar, said: "The country has succeeded in eliminating several difficult problems like chickenpox and polio and thus it should not be difficult to overcome the problem of malnutrition."
Secretary, Ministry of Drinking Water and Sanitation, Parameswaran Iyer, said the problem of malnutrition is closely linked to the problem of drinking water and sanitation.
"The Swachh Bharat Mission is trying to achieve the goal of total sanitation which will also contribute to reducing malnutrition," he said.
During a trial in Burkina Faso in West Africa, more than 1,600 small children with moderate acute malnutrition were given either lipid-based nutrient supplement (LNS) or corn-soy porridge for 12 weeks.
The study published in the journal PLOS Medicine found that children who received the lipid-based nutrient supplement experienced greater weight gain, and the large majority of the weight gain was healthy lean tissue.
"Previous studies of nutritional supplements have mainly looked at the effect on weight gain. It has been a concern that LNS, with its very high fat content, would result mainly in weight gain composed of fat," said Christian Fabiansen from the University of Copenhagen in Denmark.
"But by using a method based measurement of heavy water in the child's body we have found that LNS mainly increase lean mass, that is muscles and organs, which are important for immune function, survival and development," Fabiansen added.
Malnutrition in children can be chronic or acute. In acute malnutrition children are thin relative to their height. Globally, more than 50 million children are affected by acute malnutrition.
Acute malnutrition is more life-threatening than chronic. In chronic malnutrition the children are short relative to their age, or stunted. More than 30 per cent of children in the world have chronic malnutrition.
Previous research has focused on treatment of severe acute malnutrition. Those with the most severe acute malnutrition have more than ten times increased mortality, and those surviving may have impaired development, compared to children without malnutrition.
But this can be prevented if children are treated early, while they only have moderate acute malnutrition.
The children of the tribal-dominated village had died last year in the absence of medical facilities. The incident had hogged the headlines causing an outrage and the state government drawing flak from all quarters.
OFC chairman Rangalal Jamuda reviewed the progress of several social welfare schemes like ration, livelihood, agriculture, horticulture, education, health and drinking water facilities being undertaken by the district administration for the village.
Jamuda was accompanied by Jajpur district Collector Ranjan Kumar Das, member secretary of the Commission, Rajashree Mohanty, member Sipra Mallik, Jajpur ADM Bikash Chandra Mohapatra, sub collector Narayan Chandra Dhal and other officials.
He stressed on availability of potable water, pucca house, provision of land patta and education of the tribal villagers.
He appreciated the initiative taken by the district administration to connect the hilltop village with a motorable road.
"Though we have laid a motorable road up to Nagada hilltop, still lot of work needs to be done. The road would be later on handed over to the Road and Bridge department as per the instruction of the government," said Jajpur collector Ranjan Kumar Das.
The district administration has started construction of three Anganwadi centres at Nagada village and "three ponds will be dug under MGNREA to store water," Das said.
He said the district administrations was thinking of multiple measures on how to change the behavioural attitude of the tribals residing in Nagada.
"We are thinking of providing some training to the villagers to achieve this objective," Das added.
Using a measuring tape to measure arm circumference is the most reliable factor in diagnosing malnutrition, said Adam Levine, emergency medicine physician at the Rhode Island Hospital in the US.
Measuring tapes are inexpensive and readily available in resource-limited environments.
The traditional measure for determining whether a child is moderately or severely malnourished is based on evaluating the child's weight directly.
"Dehydration lowers a child's weight, using weight-based assessments in children introduced with diarrhoea may be misleading," Levine said.
"When children are rehydrated and returned to a stable, pre-illness weight, they may still suffer from acute malnutrition."
About half a million children die annually from severe malnutrition and nearly 100 million children are underweight, mostly in the world's poorest countries.
Diarrhoea is common among children who visit health facilities in developing nations.
Levine and his team studied the clients of an urban hospital in Dhaka, Bangladesh.
They analysed 721 records of all children under 60 months of age who visited the hospital's rehydration unit with acute diarrhoea.
They found that 12-14 percent of children were misclassified with malnutrition using weight-based measures compared to only one-two percent who were measured by arm circumference.
The study was published in the Journal of Nutrition.
"One-third of the children in India are growing up stunted and tackling malnutrition is a key challenge for India. The main reason is lack of awareness around nutrition issues. This requires introducing behavioural changes in a campaign mode to reach every household," Kumar said while speaking at an event organised by the Unicef.
The private sector should take up experimental projects and come up with packages and solutions for nutritious food, he added.
Private companies like Tata Trusts, Sight and Life, CSRBOX, CII and WeCan joined hands with Unicef and Nasscom Foundation and launched a programme "Impact4Nutrition" which targets to eradicate malnutrition and stunting and positively impact the nutritional and health status of India.
"The private sector has not only the resources but also the convening power to improve nutrition awareness in the country. After all, the private sector employs the largest share of a country's workforce and through the programme, it can directly influence the nutritional status of its business ecosystem," Arjan De Waqt, OIC Deputy Representative at Unicef India, added.
Sample how grave is the enormity of child under nutrition in Odisha. As per the data exclusively accessed, during the period of April - May 2019, the State has seen around 47,000 live births. And of the total live births, nearly 45, 620 infants were weighed. As high as 19 per cent of the total infants weighed were found underweight (weighing below 2.5kg) in the State. Underweight babies are direct outcome of under nutrition.
Moreover, in over a dozen of districts, the underweight infant proportion was over one-fourth of the total live births registered. Nabarangpur topped the dubious chart with a high of over 31 per cent underweight infants. Besides tribal districts, Bargarh, known as rice bowl of Odisha, has recorded a high of around 23 per cent underweight infants of the total live births registered during the period.
In the indicator of malnourished children in the age-group of 0-6 years, Odisha figured among the top - 5 states in the country. An analysis done on the basis of 2011 census child population data, Odisha has a whopping over 13.5 lakh malnourished children in the age-group of 0-6 years.
However, the same analysis has also indicated a dip in the proportion of malnourished children in the State during the last decade by nearly 2.5 per cent. Moreover, a link could clearly be established between the dip in under nutrition and the cheap-rice scheme launched in the State.
UN organisation like Unicef has long been demanding that millets need to be included in the PDS. As per Unicef study, millets could prove a double bonanza for the State. Not only it will ensure a smart dip in under nutrition in the State, but also augment farmers’ income in the tribal districts.
Under nutrition and low per capita income have emerged a vicious cycle in State's poor tribal districts. For which, in the indicator of the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR), Odisha fares at the bottom.
Despite the demand since long, the State government had decided to procure millets for PDS last year after Modi-led NDA government had fixed MSP for millets to boost the traditional tribal farming in the country. Taking to the logical conclusion, the State government on Monday has decided to include millets in the PDS delivery akin to cheap rice scheme.
"Our goal as a home healthcare provider is to help patients get back on their feet as quickly as possible and to keep them out of the hospital," said study lead author Katie Riley from Advocate Aurora Health in the US.
Paying attention to nutrition care helps promote patients' strength and prevents them from going back to the hospital, which ultimately reduces healthcare costs, she said.
For the study, published in the Journal of Parenteral and Enteral Nutrition, more than 1,500 home health patients were followed for 90 days.
The research found that when patients at risk for malnutrition received a comprehensive nutrition care program to aid in their recovery, risk of being hospitalised was significantly reduced by 24 per cent in the first 30 days, nearly 23 per cent after 60 days and 18 per cent after 90 days.
It was also found that healthcare costs were reduced by more than $2.3 million or about $1,500 per patient at risk for malnutrition.
"Healthcare systems are driven to improve patient care while reducing costs. Our research shows that prioritising nutrition across different settings of care - from hospital to home - can significantly cut costs while improving patients' health," said study co-author Suela Sulo.
The schemes include Poshan Abhiyaan or national nutrition mission, Pradhan Mantri Matru Vandana Yojana a maternity benefit programme and Anganwadi Services Scheme.
Sources said the periodic monitoring to assess the impact of the national nutrition mission or Poshan Abhiyaan is done by NITI Aayog's technical unit.
"A National Nutrition Resource Centre Central Project Monitoring Unit (NNRC CPMU) has been constituted to ensure regular monitoring and review of all sectoral programmes under Poshan Abhiyaan," a source said.
Regular monitoring of the PMMVY is done through web-based Management and Information (MIS) Software, sources said.
An in-built monitoring system has been developed to track the physical progress of the anganwadi services.
"The scheme is evaluated through various input, output and impact indicators by the MIS," the source said.
"For further strengthening the performance of Anganwadi services the government has introduced monitoring and review mechanism at different levels at national, state, district, block and anganwadi level," he added.
For monitoring scheme for adolescent girls, monitoring committees have been set up at all levels national, state, district, block and village.
The monitoring of the other schemes is also undertaken through meetings and video conferences with the officials of state government.
According to the Global Nutrition Report 2018, India is facing a major malnutrition crisis as it accounts for almost a third of the world's burden for stunting.
With 46.6 million children who are stunted, India tops the list of countries, followed by Nigeria (13.9 million) and Pakistan (10.7 million), the report had said.
By Uzmi Athar
Congenital Zika Syndrome (CZS) refers to a collection of developmental malformations associated with Zika virus (ZIKV) congenital infection.
This syndrome includes devastating conditions that have a huge impact on the rest of the life of the individual and their family, such as smaller (microcephaly) and unfolded (lissencephalic) brains, retinal abnormalities, enlarged ventricles of the heart, a lack of the inter-hemispheric connections and calcifications in the brain.
Brazil has been widely affected by ZIKV, but 75 per cent of CZS have been found in the socio-economically disadvantaged region of the Northeast, said the study, published in the journal Science Advances.
"We knew that areas of Brazil with the lowest socioeconomic status had the highest level of developmental impairment in babies due to CZS, which is why we looked at the possible link between ZIKV and one of the potentially most important co-factors, nutrition," said researchers from University of Oxford in US and Federal University of Rio de Janeiro in Brazil.
This study showed that developmental impairment caused by ZIKV congenital infection is made much worse by environmental co-factors, specifically diets poor in protein, which explains why the devastating effects of CZS vary across ZIKV endemic regions.
The link between Zika virus infection and the CZS has been demonstrated in previous studies, which helped researchers understand how the infection affected brain growth and development of blood vessels.
These showed that ZIKV infects the cells that develop into the brain and alter genes and proteins related to the normal cell cycle and blood vessel development.
The current study also used a mouse model to replicate the effects of Zika infection in mice that had a low-protein diet, and found that several of the pathological signs found in humans appeared in the undernourished mice in a similar way.
"When we replicated the effects seen in humans who had poor diets in mice we saw similar effects in the foetuses, such as placental damage as well as poor embryonic body growth and a reduction in brain size of newborns born to undernourished pregnant mouse," said study researcher Zoltan Molnar from the University of Oxford.
According to the researchers, the mouse mothers were clearly less able to fight against ZIKV, which was shown by a robust and persistent ZIKV infection in the spleens of undernourished mothers, in contrast to healthy mice.
"Our undernourished mouse model helped us to identify the cellular mechanisms that are responsible for the differences in humans. Improving diet alone will not protect against ZIKV infections, but it can determine the severity of the CZS," Molnar said.
(IANS)
In a letter to all states and UTs, the Women and Child Development Ministry asked all chief secretaries to launch a drive for identification of severe acute malnutrition in children for referral to hospitals, if required, and AYUSH centres and complete this exercise by January 31.
The ministry shared the guidelines and stressed on the need to ensure that entitlements of Supplementary Nutrition Programme reach the intended beneficiaries in a time-bound manner as per quantity and nutritional standards.
"The states shall launch a drive for identification of SAM children for referral to hospitals (if required) and AYUSH centres in accordance with the detailed action plan approved by the District Nutrition Committee to be finalised in consultation with the Chief Medical Officer. This exercise shall be completed by January 31, 2021," the ministry said.
The ministry said it has streamlined guidelines on quality assurance, roles and responsibilities of duty holders, procedure for procurement, integrating AYUSH concepts and data management and monitoring through 'Poshan Tracker' for transparency, efficiency and accountability in delivery of supplementary nutrition.
The ministry has asked all states to mandatorily implement POSHAN Tracker that uses centralised data architecture to align with digital technology systems of other ministries and programs.
"The system provides a digital identity to each beneficiary and generates automated alerts to the critical last mile beneficiaries. lt also ensures efficient audit of the delivery system by documenting real time attendance of beneficiaries and duty bearers," the ministry said in the letter issued on January 13.
The tracker also gives a robust digital technology platform and management information system with help the nutrition mission to scale efficiently, thereby generating significant positive impact and documentation thereof, the ministry said.
The ministry has also asked for integrating AYUSH concepts for holistic nourishment.
"The science of AYUSH is a system that builds and promotes health and wellness and can address the requirements of nutrition by tapping into the country's indigenous traditional practices," it said.
The ministry said Poshan Vatikas (kitchen gardens and nutri-gardens) shall be set up where benefits can easily be given to women and children.
The main objective of introducing the concept of Poshan Vatika is to encourage community members to cultivate local food crops in their backyards. Poshan Vatikas can meet the important dietary diversity gap that has been repeatedly revealed in different surveys by providing different fruits, nuts, herbs and vegetables round the year, thus helping in introducing healthy eating practices to address malnutrition, the ministry said.
The ministry said AYUSH will propagate the campaigns of 'Yoga at Home, Yoga with Family' at AWCs and households to encourage beneficiaries to practice yoga and stay healthy.
Speaking about the new guidelines, Dr Sujeet Ranjan, Executive Director, The Coalition for Food and Nutrition Security, New Delhi said these guidelines further establish the commitment of the government to improve nutritional status of children and women through POSHAN Abhiyaan.
These guidelines have focused on early identification of children with severe acute malnutrition in the community and refer to the facility. However, given the scale of SAM burden in India, community-based management is the best way that many children can be treated, as facility-based treatment can address only a small percentage of children with SAM, he said.
"These guidelines are providing a direction at both system and community level with the synergistic engagement of stakeholders from various sectors and an overall involvement of the community," he said.
Dr. Khan Amir Maroof, Professor, Department of Community Medicine, University College of Medical Sciences and GTB Hospital said the challenge of grassroot implementation remains.
"I would mainly comment on the Poshan Tracker. Technology is as good as those using it. The digital competency of our grassroot workers need a major boost. Not only upskilling, but added manpower is needed, if data recording needs to be kept in paper as well as digital formats. More research is needed to find out feasibility of a paperless system of record keeping," he said.
The involvement of the AYUSH system will be a welcome addition to the efforts to improve nutrition. This will add more manpower and converge health along with nutrition platforms.
The manner in which this AYUSH system will support this need to be seen. It would be better if the existing supportive supervision system is strengthened in ICDS. It can even be done by involvement of Community Medicine departments of medical colleges in respective districts," he added.
The National Family Health Survey-5, which was released in December, found that malnutrition increased among children in 2019-20 from 2015-16 in 22 states and UTs.
Around 13 states and UTs out of the 22 surveyed ones recorded a rise in percentage of children under 5 years who are stunted in comparison to 2015-16.
(With PTI Inputs)