Their mission is to protect children from the scourge of SAM

When Phoolkumari was brought to the Manpur nutrition rehabilitation centre in Gaya district, Bihar, she had high fever. Severely malnourished, the two-year-old weighed just six kg. After Sunita Kumari, the auxiliary nurse midwife, found she was also suffering from pneumonia, Phoolkumari was immediately admitted. It took 17 days of close monitoring, medication and an appropriate nutritious diet before Phoolkumari recovered and could return with her mother back to their village.

Phoolkumari was lucky she was brought to the government-run NRC in time. A delay could have been fatal since the risk of death among children like Phoolkumari with severe acute malnutrition (SAM) is nine times higher than among healthy children. This danger gets magnified if the SAM children are diagnosed with a medical complication. In a high-priority district like Gaya, which has the dubious distinction of the second highest prevalence of SAM in the State, NRCs can prevent deaths with timely clinical and nutritional management.

Long-term damage

“Studies have shown that if not treated, malnutrition can have a lifelong impact on a child. Besides stunting physical and cognitive development, undernourishment can make common childhood illnesses, like pneumonia and diarrhoea, potentially fatal,” said Shailendra Kumar, the district coordinating and planning officer of Manpur NRC.

Not having enough to eat or not eating the right things can cause malnutrition. It manifests in stunting (very low height for age), wasting (very low weight for height) and being underweight (very low weight for age).

In Gaya, majority of the families below the poverty line do not have access to the public distribution system (PDS) and less than half of the eligible households receive any take-home ration, critical factors contributing towards making 52.9 per cent children stunted, 25.6 per cent wasted and 53.1 per cent children underweight. These figures are 7.6 per cent higher than the State figures.

Worrying as these figures are, the good news is that SAM is treatable. Once the condition of the child is identified and assessed at the NRC, recovery takes 15-21 days, depending on the severity of the situation. Siyamani Devi has been at the NRC for 10 days.

A daily-wage labourer, Siyamani was unable to understand why the youngest of her four children, her son, continued to lose weight even after she had taken him to a private practitioner four times. When she brought him to the NRC on the advice of the village accredited social health activist (ASHA), she learnt that pneumonia was common in malnourished children. “I didn’t know that he was malnourished. In the last 10 days, his weight has increased and he no longer suffers from pneumonia. He is doing well here, so I am happy,” she said.

It took 19 days for Sarita Devi’s seven-month-old SAM son to recover. But the resident of Nagma village, Fatehpur block, isn’t complaining. “I was unable to breastfeed my son. He is my third child and has been weak from birth. Here, he is getting a good diet. I am glad that I came here,” said Sarita.

Counselling the mothers on the importance of nutrition and what to feed the child is one of the crucial responsibilities of Madhavi Prasad, the NRC feeding demonstrator. Once she assesses the nutritional status of the children using standard anthropometric measures (height, weight and mid-upper arm circumference), she conducts an appetite test based on World Health Organization (WHO) protocols. This test helps in identifying SAM children with medical complications who will need hospitalisation. “Most of the women who come here are uneducated and don’t know how lack of nutrition can lead to wasting. They also believe in many myths on breastfeeding.

One mother believed she had to only breastfeed her child for two years after birth. When she came with her eight-month baby, he was malnourished because she didn’t feed him any semi-solid food as required when a baby is six months old. We also inform them about what they need to feed the child after discharge from the NRC so that his growth continues to improve,” stated Prasad. Although the NRC has enabled 2,694 of the 2,998 children, less than six years, admitted since it was instituted in 2011 achieve the required growth parameters, the 20-bed facility remains underutilised. But not for want of proper infrastructure or quality of service. Run under the aegis of the government’s district health society with technical support from UNICEF, the NRC is well-maintained and credited with saving many lives.

Better compensation, a must

The biggest challenge is the low awareness among communities, coupled with reduction in compensations for wage loss and transportation paid to the SAM child’s caregiver. On the first visit, under National Health Mission guidelines, the mother is paid ₹200 as transportation costs and ₹50 as wage loss compensation for every day she spends at the NRC. This is way below the minimum wage the parent forgoes to bring the child. Also, the cash payment, which remained the same for the mandatory four follow-up NRC visits after discharge, has been drastically cut. Since 2015, compensation for transportation is ₹50 and for wage loss is ₹25. Unless there is greater community mobilisation and better wage loss compensation, the district’s 40,000 SAM children will continue to languish from a treatable condition.

The writer is a senior journalist based in Delhi

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