Saturday, August 25, 2007

Malnutrition 'killing millions of kids'

Malnutrition kills nearly six million children a year, mainly in developing countries, despite the availability of relatively cheap solutions that could improve global nutrition, a report said.

While low and middle-income countries bear the brunt of the problem, malnutrition affects some rich countries as well, said the report by the Population Reference Bureau, a Washington policy research group.

The bureau's "2007 World Population Data Sheet" and two companion reports provide up-to-date demographic, health and environmental data for all the countries and major regions of the world.

The report said poor nutrition during the mother's pregnancy and the baby's early years causes severe and irreversible mental and physical damage.

Bill Butz, president of the Population Reference Bureau, said the public often does not consider the deadly toll of malnutrition among children "because it does not kill young children directly, as does pneumonia or diarrhoea.

"Many of these deaths could be averted through nutrition measures that are known to be effective, often at low cost," Butz said.

"Malnutrition often increases susceptibility to disease, while ill health exacerbates poor nutrition," the report said. "For countries ravaged by the HIV/AIDS epidemic, malnutrition appears to increase vulnerability to infection and render retro viral treatments less effective."

Despite some important progress, the report said, about 30 per cent of children in low- and middle-income countries are underweight. The largest problems are in South Asia and sub-Saharan Africa.

For example, almost half the children are underweight in some Indian states.

To improve nutrition In the short term, the report said, countries should begin monitoring and promoting growth, changing nutritional behaviour, improving communication with people at risk of malnutrition and introducing iodised salt.

Later they could establish community-based nutrition programs that target young children, adolescent girls and pregnant women.

Other highlights in the report:

-World population growth will continue. It is projected to rise to 9.3 billion by 2050 from 6.6 billion in 2007.

-Fertility rates may be rising again in some European countries where they have been on the wane. The number of children women are having is increasing in Italy, Spain and Sweden, among others.

-The prevalence of HIV/AIDS probably is lower than earlier estimated but remains an international crisis. More than 4 million people were newly infected in 2006.

-The international refugee population increased during 2006 to 9.9 million from 8.7 million. It attributed the increase in large part to Iraqis leaving for other countries, particularly to neighbouring Syria and Jordan.

Thursday, August 23, 2007

Engaging India: A matter of national shame

Financial Times
By Amy Yee, New Delhi correspondent


At a health centre in India’s Madhya Pradesh state, three-year-old Rajkumar clings to his mother, a woman named Anita whose youth is hinted at only when a smile cracks her weathered face. Rajkumar wails when his mother moves away slightly, standing by himself on the cot where she sits.

I am unsure whether he is crying for his mother or because it is painful to stand: his legs are matchstick thin – merely the width of two of my fingers. Rajkumar weights only 5.9 kg (13 pounds) when he should weigh 12 kg. His hair is brittle, light brown – another tell-tale sign of malnourishment.

Nearby, another mother looks on from amid the rows of cots lined up across the large room. She cradles her baby, whose head dwarfs his frail, doll-like body.

Severely malnourished children like Rajkumar and their mothers are sent to health centres like this one by government health workers who work, with assistance from Unicef, in surrounding villages at ”anganwadi” – half-day pre-schools where children are fed, immunised, weighed, and monitored. If left untreated, children at this stage are likely to die from infections that plague their weakened bodies. Indeed, more than half of all deaths among under-fives are linked to malnutrition, says the World Health Organisation.

At the health centres, launched by Unicef and the Madhya Pradesh state government a few years ago, mothers are counseled on nutrition and hygiene. At this town clinic in Shivpuri district, about five hours from Delhi by train, children and their mothers are fed and monitored for two weeks.

At an anganwadi in a small hamlet miles from the health centre, children sing cheerful songs and crowd the floor of a simple shack. There they eat a daily lunch prepared from local ingredients on a wood-burning hearth. Today it is a meal of soy, groundnuts, rice, potato, onion, mint, oil and salt. The anganwadi also acts as a resource centre for mothers: its walls bear posters with bright cartoons that warn of polio and anemia.

Government-run anganwadi have been in place for three decades. The network has been expanded as part of a national plan to improve children’s health. In recent years Unicef has stepped up its presence in landlocked Madhya Pradesh, or ”Middle State”, which has some of the worst levels of malnutrition among already alarming national numbers.

An astonishing 46.3 per cent of all children under the age of three in India are malnourished, and nearly 80 per cent are anemic, according to the government’s National Health and Family Survey of 2005-06. There has been marginal improvement since 1992-93, when 51 per cent of under-threes were underweight. But in Madhya Pradesh, figures have worsened from 55 per cent in 1998-1999 to 60 per cent in 2005-2006.

The statistics are stupefying given India’s ambition of becoming a global power. It is hard to take that aspiration seriously with almost half the country’s infants malnourished during critical years of cognitive and physical development. Even if Rajkumar lives to adulthood, he may be mentally and physically stunted. One wonders how India will reap the much-touted ”demographic dividend” of its youth where half of its 1.1bn population is under the age of 25.

Aid agencies say it is difficult to fund projects to combat the pervasive problem of malnutrition because of ’fatigue’ among donors. But India’s malnutrition ranks far worse than sub-Saharan Africa’s average rate of 27 per cent for children under the age of five, an ugly fact that rouses officials from complacency.

Manmohan Singh, India’s prime minister, condemned malnutrition as ”a matter of national shame” in his Independence Day address last week. Mr Singh ambitiously urged eradicating malnutrition in five years, and said communities must help ensure that corruption does not divert funds from the needy.

Of course, this is all much easier said then done. The challenges are starkly laid out during this visit to Madhya Pradesh. The state’s large population of 60m is scattered across thousands of villages with dirt roads and limited or no electricity, making them difficult and expensive for health workers to reach. Low literacy of 60 per cent makes it is hard to spread knowledge through pamphlets and posters.

Many mothers simply don’t know how to care for infants in the absence of adequate education. Only 55 per cent of mothers in Madhya Pradesh deliver in hospitals – though that’s an improvement from 26 per cent a few years ago – so most lack advice from healthcare professionals from the start. Anita, for example, says she didn’t know Rajkumar was malnourished in spite of his emaciated state.

Most rural diets are dominated by grain, which is inadequate for a growing child who needs protein, vitamins and minerals. Lunch at the anganwadi cannot compensate for a paltry diet at home.

But even if they have money, accessing better food is a major challenge for rural families. The nearest open-air markets are miles away and transport is not readily available. Supermarkets, so ubiquitous in the developed world, seem like a bizarre fantasy while standing among the low, mud-walled homes in this village in Shivapur.

Superstitions and taboos also are deeply ingrained in local culture. Anita admits she did not breastfeed her son in the first critical days after her birth because her mother-in-law discouraged her.

Yet there are glimmers of hope. Back at the town health centre, a casual labourer named Papku sits with his 10-month old son who is stricken with diarrhea. Sleeping next to the infant on the cot is Papku’s three-year-old son, Krishna, who was admitted to the centre a year ago weighing just 6 kg. After his parents were counseled on proper nutrition, Krishna’s weight has doubled to 12 kg (26.5 pounds) in a year. The boy looks robust and meaty although his father earns only Rs60 ($1.50) a day to support his family of six, which includes his wife and three young daughters.

Given his modest means why did Papku have five children? Papku matter-of-factly states that even after his eldest son was born, he wanted two sons in case one died. It is a jarring explanation. But the pragmatic answer reflects life for Papku and his family – and hundreds of millions like them across India.

Copyright The Financial Times Limited 2007

Tuesday, August 21, 2007

Using village planning to address community problems

A village planning initiative has been launched by the district administration in Guna, Madhya Pradesh, jointly with the UNICEF and NGOs. Institutional delivery has since improved; now, more girls go to schools; immunization levels have increased.
AT GUNA, Madhya Pradesh, it was meeting of a different kind; more than eighty village facilitators, supporting village planning initiatives in the district of Guna in the State of Madhya Pradesh, were at Guna block headquarters to share their experience in helping the children and women of the district.

Village planning initiative is a process initiated by the district administration and UNICEF (United Nations Children’s Fund) with the support of NGOs (non-government organizations), in Guna. It is based on engaging the community, using the norms of participatory rural appraisal techniques. As part of the process, social maps were prepared to assess the distribution of the available resources in the villages. Household and family surveys were then conducted to collect basic information about the village, the community and the needs of children, primarily in the areas of health, education, nutrition, drinking water and sanitation in addition to information on socio-economic conditions.

Using the said information as the basis, the community groups prepared village plans for presentation and approval in a special Gram Sabha or village meeting. Sunil Raghuvansahi, a facilitator, who works in Aaron block of Guna district with a non-government organization, sees his role as that of one which can help has-ten the pace of social development. Basanti Pant, another village facilitator, who works in Sungahwasa, Piproda village and the hamlet of Chak Dingahwas of Guna block explained the process and how she, along with other members of her community, were able to sort out the issues and concerns of the villagers. ‘This is important, if one has to solve the problem of the community; the community needs to come together; then only we can resolve the concern facing the community at village level’, she adds. She sees the change happening. Institutional delivery is increasing, more girls are going to school and immunization levels have increased. Electricity and water scarcity are still a challenge which needs to be addressed.

Ladbai, a friend of Basanti Pant and another facilitator helping in the ‘process of social change’ for five Gram Panchayats of Raghogarh block in the same district, says that it is not only the community members, but the Sarpanch, members of the service delivery system like auxiliary nurses, midwives and anganwadi workers who are actively involved, so they can respond to the needs and wishes of the people. She proudly says, ‘now we have all the information with us - like how many children need to be immunized; how many women are pregnant, etc. Similarly Hemlata Sharma, who works in Raghograh block, talks about her experience; on how she got many girls into school and on how she got 18 toilets constructed at her village. ‘We are a link between the district administration and the community and help the community monitor services’, adds Mukesh Kumar Chandel, who works in Chachoda block, while explaining his role as facilitator.

These facilitators use tools like community-monitoring chart for the various services provided at the village level. ‘Any change, however small, which benefits children and women is important, as it contributes to saving the lives of children and women, and you are a contributor to that change’ said UNICEF’s Planning Officer Veena Bandyopadhyaya, while interacting with these facilitators.

The intensive process has helped increase the engagement between community members, NGOs and the district delivery system and support the State in strengthening its implementation of the initiative for women and children. Micro-plans for all the villages in Guna are ready and the district response team has worked out an action plan which is responding to the needs of the community. These village facilitators have worked out the following four-point action plan to hasten the pace of work in the district:

(1) To periodically review village plans with the various stakeholders, namely the Sarpanch, Secretary of the Panchayat, Anganwadi worker, school teacher, ANM and others.

(2)To support progressive community-monitoring by using various charts jointly with the members of the community.

(3)Collate accurate village-level statistics in the areas of concern and use the same to advise people at the village level during the block and district task force meetings.

(4)‘Their problem first’: community problems rank first and to help in addressing the said problems, the village facilitators will promote community-level dialogue, listen to the problems and concerns of the community first and help in the redress of the problems.

Anil Gulati

Saturday, August 18, 2007

Regional Consultation Meet: Rights of the Child discussed

With an aim of inviting suggestions to prepare the report on Convention on the Rights of the Child, a consultation meet was organised in Bhopal. The meet was attended by representatives of various organisations of national and state level repute.
A THREE-DAY REGIONAL consultation meet for preparation of India’s country report on the Convention on the Rights of the Child was recently held at Bhopal. This was second such meeting organised by Ministry of Women and Child Development, Government of India, wherein first one was held at Chandigarh. More than 50 civil society and state partners from states like Madhya Pradesh, Maharashtra, Gujarat, Goa, Rajasthan, Chhattisgarh participated in the consultation. The Convention on the Rights of the Child (CRC) is an international treaty signed by Government of India in year 1992. It is also a legal binding international instrument, incorporating the full range of human rights—civil, cultural, economic, political and social rights.

The Convention sets out these rights in 54 articles and two Optional Protocols to which India is signatory and these are for the benefit of children. The four core principles of the Convention are non-discrimination; devotion to the best interests of the child; the right to life, survival and development; and respect for the views of the child. Dr Hamid El Bashir, State Representative, UNICEF office for Madhya Pradesh, participating in the meet said that society needs to lead the change process and could lead the thinking of the government as well. Children have unmet rights in Madhya Pradesh and we need a holistic approach when we talk about child’s rights. We need to create a mass movement around children for making that happen. Madhya Pradesh state needs to strengthen the child rights monitoring and take into account child views when we decide for children view. When we decide not to include children in fact we are missing important members of the society.

Karuna Bishnoi, Communication Officer, UNICEF Delhi who was participating in the meet spoke on the need of taking views of children into account and also increase our understanding of many issues which have got reflected at the consultation so that suitable recommendations can be provided. She said that India will be reporting for the first time on the Optional Protocols on children affected by armed conflict and sale of children, may be we need to understand the context better and provide suitable suggestions. Razia Ismail Abbasi, Co-Convenor of India Alliance for Child Rights, a national network of non governmental organisation working for child rights who participated in the workshop said that we need to invest more in children and young people and it is an investment not just the welfare.

Issue of ’defining the age of a child’ in India came up in the meeting. As per ’Convention on the Rights of the Child article one, anyone below 18 is considered a child. Whereas Indian laws like juvenile justice, child labour etc. differ on the age parameters.

Participants suggested that we should work towards making ‘18 years age’ a common parameter for defining a child, under all Indian laws. They also proposed that there is a need of strengthening of implementation of the various laws and policies besides engaging communities in implementation. “There is need of increasing awareness not only amongst communities but also among implementers,” added a participant from Maharashtra.

Representatives of World Vision, Plan International, and Child Line Foundation along with others contributed various suggestions for the report. Non-governmental organisations from Madhya Pradesh namely Aarambh, Oasis, Madhya Pradesh Samaj Sewa Sanstha, Madhya Pradesh Voluntary Health Association, Vikas Samvad, Janshas, National Institute of Women Youth and Child Development contributed from the state perspective. C K Reejonia, Under Secretary, Women and Child Development Department, Government of India; Representatives from Women and Child Development, Education and Social Justice from the state and Women and Child Development Maharashtra also participated in the meeting.

Monday, August 6, 2007

Immunisation need of the hour : Workshop gets under way

Bhopal, Aug 6: 'Need is to change at grassroots and you can inspire that change', Dr Hamid El Bashir State Representative UNICEF Office for Madhya Pradesh said while addressing District Immunisation Officers and others present from twenty four districts of the state in inaugural of three day Routine Immunisation workshop.

He added that though State of Madhya Pradesh has indicators, which are low, and have problems of delivery of services to the people at the village level. But he added that change is possible, imminent and is near. We need to strengthen monitoring, engage communities and support behaviour change. He added that UNICEF is committed to that change and suggested a five-point mechanism which can help bring in that change.

The points according to hims are 1. Identify pockets that are hard to reach which have low performance indicators, 2. Need to identify, difficult to reach populations in the above identified pockets, 3. To Increase focus on urban slums, 4. To strengthen monitoring system and database management and 5. To adopt a campaign that can build an enabling atmosphere of change by engaging civil society partners.

Dr Naresh Goyal Assistant Commissioner Government of India while opening the meeting stressed on the importance of immunisation. He said that Government of India had reviewed progress of routine immunisation in the year 2004 and all the recommendations that were suggested in that review were agreed by the Government in the year 2005. All efforts are being put both by Centre and State and in case still we are not reaching may be we need to look into it. He spoke on the need of strengthening reporting and accuracy of the reported data, which is very important. He added that ten districts in Madhya Pradesh have low routine immunisation indicators, but there are examples of districts which are doing well.

This is first of the series of the initiatives, Dr Gagan Gupta, Health Specialist with UNICEF office for Madhya Pradesh. He added that this training will not only look at the elements of strengthening routine immunisation, but will also look into the issue of adverse events following Immunisation and issue of the database.

Dr Yogiraj Sharma, Director Public Health, while addressing the participants said that we must use this training an opportunity to improve. We need to follow a bottom up approach and not only plan better, deliver better and also ensure timely reporting. Dr Balwinder of WHO, Dr Vijay Kiran of 'Immunisation Basics, Dr A N Mittal Joint Director RCH Directorate of Health Services, Dr Jayshree Chandra, Deputy Director, Child Health, Directorate of health services were also present.