Malnourished and under nourished children in India-A reality check

Food, health and life are intricately interlinked and unless there is a balance and moderation in food intake, health is bound to be seriously affected adversely. An oft repeated question is whether the world to day is a better place to live compared to that which existed 5-6 decades ago? If the yardstick for measuring the quality of life is the health, definitely it is much worse than before. There is terrible inequality in accessing available food across the population with opulent countries enjoying a surplus of foods which are very often wasted ignoring the pitiable living conditions of millions of people spanning the three continents Asia, South America and Africa. The two aspects of food which are important to be kept in mind are quality and quantity. In many developed countries quantity of food available, if taken on an average, is more than sufficient to meet the calorie needs of their population. What is sorely missing is the quality of food consumed by them which leaves very much to be desired. Look at the health status of people in the US where more than half the population is over weight while almost one third is afflicted by obesity epidemic. This raises the inevitable question as to what constitutes a good diet and what happens if the diet is not based on factors that influence maintaining of good health.

As a thumb rule,human beings generally need about 2000 kCal, 50 g of proteins, 50 g of fat, 25 g of dietary fiber, 8 essential amino acids and two essential fatty acids which human body cannot make and vitamins and minerals. Water, though not considered a nutrient is also essential corresponding to an intake of 1 ml per calorie ingested. This is supposed to be a golden guideline for preventing development of many health disorders in life and can be easily met by judicial combination of natural food ingredients like cereals, pulses, milk, nuts, fruits, vegetables with or without animal based foods like meat, egg and fish. If the above assumption is correct why is that Americans eating rich foods including an abundance of highly nutritious animal based products still suffer from many diseases to day? Answer to this lies in the fact that the cereals they consume are highly refined devoid of practically all natural nutrients, most calories coming from highly refined white sugar or HFCS, heavy consumption of fat rich foods such as fried ones, baked goods etc and eating too much animal products. It is only recently that a scientific study in the US brought out the startling truth that eating even a small amount of whole grains about 33 g a day can reduce the chance of premature death very significantly! 

What about situation that is obtaining in India? Here again there are sufficient foods available in the country to meet the needs of every citizen but the access to these foods is constrained by economic factors. For many poor people constituting almost 40% of the country's population high quality foods like milk, pulses, egg and meat in sufficient quantities are beyond their reach. This problem is all the more intractable in the rural hinterlands of the country where most poor people live eking out a dreary existence. The highly unpredictable agricultural situation and lack of opportunities for engaging in income generation avocations make matter worse! The much touted Food Security Act does promise almost 1000 kCal of food in the form of very low priced cereals like rice and wheat, while other needs like proteins, fat and some of the essential nutrients are ignored in the scheme of things. All government programs designed so far and being implemented are just to keep hunger away among the poor people but do not bother about the quality of the food distributed under the social responsibility umbrella. 

The most recent circus government is doing under the FSA is giving away rice at Re 1 per kg and wheat at Rs 2 per kg for almost two thirds of the country's population whether all of them really deserve them or not based on economic criteria. The existing school feeding programs are also heavily loaded in favor of cereals. There are supposed to be about 7 lakh kitchens staffed by 26 lack cooks cum helpers serving about 11 crore children in thousands of schools across the country, probably the largest socially oriented scheme any where in the world. This is no doubt a tremendous feat worth appreciating and admiring. Unfortunately these numbers hide more than what they reveal. The program claims to provides about 300 kCal of energy and 16 g of protein for every kid though no one knows how far this target is fulfilled by cooking foods in these school kitchens out of cereals supplied by the government. Providing calories and proteins once a day may be theoretically adequate partially as far as nutrition is concerned but does it fill the tummy of the child who comes to the school hungry? Hardly! Many kids are reported to be coming to the school with empty stomach and wait eagerly till lunch time to get their share of meals cooked at the school. If this is so can the children be expected to concentrate on the lessons taught in the class rooms?

Some pundits have suggested that government should consider providing break fast also to the school kids besides the midday meals   May be a good suggestion but where is the end for such freebies , especially in a country like India not considered to be very rich to squander its resources? A honest citizen often wonders what is the role of the government in welfare of a citizen? A family which spawns a child has no responsibility to look after it and see through its adulthood and further till it can stand on its own legs? Look at India to day where there are government freebies for practically every thing from conception till the end whether they deserve them or not! If government has to give free medical service, child care service, educational service, housing service, subsidized transportation, special allowances for female children, heavily subsidized food grains, pension for old age population and widows, write off loans taken from government banks, provide subsidized fertilizers to farmers whether rich or poor and many other hidden economic help, what is the role of the parents? In this case if breakfast and lunch are provided at school, what else parents have to do? How can a child consider his parent as his own if they are not providing him with food at home? After all government is even giving jobs under NREGA for at least 100 days that puts about Rs 15000 in the hands of many laborers who declare that they do not have any other income.With Rice and Wheat being made available at Rs 1-2 per kg where is the problem in feeding the children at home? If low response to the NREGA scheme as reported in Karnataka is really true, poor people might be hard to find who are enamored by the Rs 15000 that can be earned by working for 100 days! May be there are a few genuine cases with extremely low income who must be identified  as targets for such freebie schemes.             

Many NGOs and international bodies are lamenting that 1 out of 3 children in India is malnourished and world's largest malnourished children live in India. It may sound shocking that 50% of childhood mortality is attributed to malnutrition and under nourishment. Similarly another stock claim is that 46% of children below 3 years of age in India have low Body Mass Index (BMI) which is supposed to be a manifestation of undernourishment and malnutrition. They further aver that inadequate food in quantity and nutritional quality during pregnancy, lactation and after birth are responsible for this sordid situation. One of the critical deficiencies being focused is essential fatty acids (EFA) like Omega-6 and Omega-3 fatty acids which are necessary for proper development of brain, eyes and preempting onset of diseases like CVD, high blood pressure, diabetes, obesity, Alzheimer's, dementia and others during growth later. Plant foods are not considered excellent sources of these essential fatty acids and well to do population derive them from fish and marine food sources. But two plant sources Soybean and Sunflower seeds can be significant sources of EFA , both Omega-6 and Omega-3 and all the programs presently running under the food service schemes must consider including one or more of these oil seeds in the meal recipes being followed.  

V.H.POTTY

http://vhpotty.blogspot.com

http://foodtechupdates.blogspot.com

CHILDREN OF THE POOR-A CARE SYSTEM DESERVING SOME ACCOLADES

Children are generally the focus of almost all family system because they are vulnerable to many problems at least till they cross 6 years of age. Human child is one of the rare creatures in nature requiring all the help and attention from the parents till it is able to do its daily chores on its own. Imagine how helpless a human child is as soon as it is born and it is a series of trials and tribulations every second it lives. Only around the age of 1 year it is able to stand, takes another year to walk freely and the learning process starts seriously when it is 3 years old. Even at this stage it needs undivided attention of the parents till self-confident to go to school on its own. The logistics of child bearing and rearing can be awesome and most mothers do well by instinct and some guidance.

Another aspect of child rearing is the adequacy of nutrition available to the child. Quality and quantity of food consumed by a child till the age of 5 determines its brain development and physical growth. While breast feeding is insisted upon by child specialists for at least one year but preferably for two years, there are many problems connected with this desirable practice and many children start on formula milk as early as 6 months of age. If proper nutrition is neglected at this stage, stunted development of body and brain is certain to happen. A country like India cannot afford to leave behind millions of kids with improper and insufficient food from its ambit of development because of poverty and lack of accessibility to good food. It took independent India more than 25 years to realize the significance of poverty and its impact on proper development of the child born in this country and in 1975 the government started the much acclaimed Integrated Child Development Service (ICDS) to provide institutional support to poor children in a substantial way.

It is true that even to day more than 47% of children in the country are malnourished according to reliable statistics acknowledged by international agencies though infant mortality has come down significantly after 35 years of operation of ICDS system. Probably the situation could have been worse if this service were not in place. Full credit must go to the government for conceptualizing the Scheme which is one of the most effective programs any where in the world, at least on paper. The Anganwadis, the very foundation of this program is a well conceived one where children, pregnant women, nursing mothers and women in the age group 15-49 years are "supposed" to find solace for all their problems. Can any country on earth has such a system that cares for these vulnerable groups all round the year? Probably not.

According to the government there is supposed to be one Anganwadi for every 1000 persons and at present 1.053 million Anganwadis are providing the services to 58.1 million children and 12.23 million pregnant women and nursing mothers across the country. What a massive operation! According to experts the number of Anganwadis needs to be increased to 1.6 million if 100% coverage is to be targeted and what prevents the government to expand the scheme is somewhat a mystery. After all billions of rupees are poured into the country's wasteful subsidy system and finding the resources must be a priority for the government if every child is to be protected from under development and multitude of diseases that ravage the infants if not cared for suitably.

Organizationally ICDS is a well structured net work with Anganwadi worker at the bottom of the service pyramid, supervised by Mukhyasevikas and managed at the top by Child Development Project Officer. The Anganwadi workers, mostly women are expected to be committed and sincere judicially spending the funds for the betterment of the children under their jurisdiction. Though they receive 4 months training to handle the job reasonably well, their service conditions are not good enough to lead a honest life with practically no job security and absence of post retirement benefits. It is not realized that people will give respect and recognition only if these Anganwadi workers are provided good service conditions and a place of honor. Government must not delay in revisiting the crucial role of more than 1.6 million workers presently working in ICDS program.          

If dispassionate observers are to be believed there are two issues that confront ICDS program affecting its efficiency. While quality of service provided is often unsatisfactory, gross corruption in management is debilitating this useful scheme, which must be addressed immediately without further delay. It appears many intended beneficiaries are in the dark regarding this scheme and therefore are ignorant about their entitlement. What is needed is the involvement of local people in guiding the needy people to Anganwadis. A proactive approach on the part of the worker to establish contact with all those eligible for benefits under ICDS will further strengthen the efficacy of the program. If the local people, who are an important stakeholder in the ICDS program, do not have the information on what to get, what is available and what their legitimate rights are under the scheme, they are in no position to question the way it functions and cannot demand their rights. This is probably what is happening now and sooner some degree of transparency is insisted upon better it will be for its effectiveness. 

The ICDS can educate the community about the objectives of the scheme and the benefits they can derive by cooperating with the Anganwadi programs. It is unfortunate that in these days of dominance of private sector in practically every endeavor in the country, here is an example of disaster when private parties were brought in to supply foods for serving in the Anganwadis.  Many don't know that a Bal Vikas Samiti (BVS) should have mothers whose children go to anganwadis and local body representatives as members. The BVS, which is supposed to monitor procurement of ration, use of stock and supply of food to children by the anganwadis, is not properly empowered and has now been reduced to a mere rubber stamp with the introduction of a private party in the supply chain. In stead of local foods prepared and served private players are introducing processed foods of little relevance in this program. Of course Involving private parties also promotes  corruption, besides compromising on the quality of food served to children. 

With the rudimentary infrastructure already in place, India can increase the efficacy of this program manifold. But for this to happen the quality of Anganwadi worker must be upgraded. He or she should be the focal development of the village giving some security to the women, most of whom are generally illiterate. This is possible only if these personnel are adequately equipped with the wherewithal to instill confidence, respect and appreciation from the beneficiaries. Many Anganwadis are run from dilapidated buildings with practically no facility for doing what they are supposed to do. After all the very name of Anganwadi was derived from the traditional system of living where the typical "courtyard shelter' in the house or in the community settlement is a place of social interaction and development of kinship. Modern Anganwadis must reflect this spirit in creating the right atmosphere for cordiality, mutual respect and help besides generating a sense of sacredness associated with all activities. Probably after 35 years of past experience, time has come to reassess the impact of ICDS program as it runs to day and take appropriate action for making this institution more relevant and useful.

Instead of running under the bureaucratic control of the Ministry of Women and Child Welfare, a more practical approach would be to set up a national apex body with statutory powers and annual grants from the government. Such a body must manage the program in a professional way with modern management tools. If this happens, there is a distinct possibility to rope in large industrial giants for funding and patronizing the program in different geographical areas. Also there are hundreds of NGOs, Stree Shakti Groups, Charitable organizations, Social networks and foreign aid agencies doing yeoman service to the welfare of Indian children. Government owes this to the citizens of this country in stead of continuing to run a dilapidated scheme as is being done now with bad reputation for its inefficiency and corruption.

V.H.POTTY
http://vhpotty.blogspot.com/
http://foodtechupdates.blogspot.com