Even as the National Human Right Commission sent a notice to the Maharashtra government amidst media reports of 600 children dying of malnutrition in Palghar district, the government’s ministries seem to be focussed on trading blame for these deaths.
The government has rejected claims that as many as 600 children might have died in the district. It has also rejected that the leading cause of these deaths might be malnutrition. News reports in the local press about the death of six-year-old malnourished boy Sagar Wagh led to opposition parties the questioning the government on the issue.
Malnutrition is a state where a person does not receive adequate calories and proteins which are required for growth. Malnourished children are more likely to contract infections compared to healthy children.
Contradictory records maintained by the state's Health and Family Welfare department and the Women and Child Development department indicate a lack of coordination and lack of clarity on why so many children are dying.
The Health and Family Welfare department registers show that 340 children died in the Palghar between April and August this year. The Women and Child Development minister, Pankaja Munde told media persons that 208 children have died in the district during the same period. Either death toll is appallingly high, especially given that Palghar, which is inhabited mostly by tribal communities and with a population of close to 30 lakh people, is only a hundred kilometers away from Mumbai, India’s financial capital.
Neither the health department nor the department of women and child development, which are responsible for tackling malnutrition, keep any data on the deaths that can be attributed to malnutrition.
15% rise in child deaths
If the health department had studied its own data it would have found that Palghar has seen an increase in child deaths over the last two years. Between the last two fiscal years, the district witnessed a 15% increase in both the numbers of deaths of infants younger than the age of one and of children between the ages of one and five. The recorded causes of death range from prematurity, low birth weight, and asphyxia in which the body is deprived of oxygen.
In 2014-2015, 623 children of age five and below died in the district and 721 children died in 2015-2016. Apart from Palghar, seven other district in Maharashtra have shown a rise in infant and child mortality.
Officials from the health department however said that the rise in deaths could be a result of better reporting and does not necessarily mean that more children are dying.
"If that's the case, the reporting should have got better in other districts too," said a doctor working closely with the government on issues of child health.
Malnutrition? Nobody knows
The state health minister Dr Deepak Sawant at a press conference last week insisted that the children did not die of malnutrition. “Sagar Wagh died of tuberculosis and Ishwar Sabra who was admitted to our child treatment center was discharged against medical advice by his family,” said Sawant.
Wagh died at the Nashik Civil Hospital while Sabra died at his home. Both children were malnourished, according to local non-profit.
When asked for an estimate of child deaths due to malnutrition, Vinita Vaid-Singal, Maharashtra's commissioner of the Integrated Child Development Scheme that aims to tackle malnutrition, said that she would have to consult her records. But she also said that there were no records of how many of the 208 dead children had been malnourished. “This is a new district but we are already ready with a plan to tackle the issue,” she said.
Vaid-Singal said that the deaths recorded under the schemes are not all associated with malnutrition. “Some children have congenital anomaly and some die of snake bite, malnutrition has nothing to do with these deaths,” she said. However, she did concede that severely malnourished children are at nine times the risk of contracting infections.
While the health minister has denied that the deaths have been due to malnutrition additional director of health services Dr Archana Patil said that her department will start collecting data to understand how many of the children were malnourished at the time of their death.
“Malnutrition is an associated factor," said Patil. "We are seeing that children born with low weight are succumbing for which we are focusing on improving the pregnant woman’s health.”
To better the health of mothers, the tribal welfare department had initiated the Amrut Aahar Scheme under which a pregnant woman in her third trimester is given nutritious food. The scheme, however, was not implemented properly in Palghar which irked both locals and non-profits working in the area.
According to Vivek Pandit from Sharamjivi Sangathna, a non-profit working in Palghar, the closure of the village child development centres run by the state health department triggered the deaths. “These centers were helping children to gain weight and improve their health protecting them from infections,” said Pandit.
Health officials said that budget cuts led to the closure of these centers in August last year.
Political circus in Palghar
Maharashtra’s tribal minister, Vishnu Savara on his visit to the family of six-year-old Sagar Wagh who died recently reportedly said “let it be” as a response to the deaths, a remarkthat caused uprar and which he later denied.
Then when Women and Child Development Minister Munde decided to visit Palghar, the district collector issued prohibitory orders disallowing the assembly of more than five persons within a radius of one kilometer in two villages. Munde received flak from the opposition parties following which the order was revoked.
In fact, Maharashtra governor C Vidyasagar Rao called for coordinated efforts from various departments to address the issue of malnutrition effectively.
“The entire issue has been politicised,” said Sunanda Patwardhan, chief secretary of the Pragati Pratishtan, a non-profit working in Palghar. Patwardhan believes that poorly educated parents among tribal communities in Palghar are ill-equipped to care for their children.
Another challenge comes from the lack of attendants for young children, according to said Sunil Bhat, president of a non-profit working in tribal areas. “Both parents go to the field and children are left at home to fend for themselves which leaves them hungry and ill all the time,” he said.
Patil pointed out that because of the migration, the families shift to neighboring states for a considerable period making it difficult for the healthcare staff of Maharashtra to monitor their health progress.
Others claimed that food habits among tribal communities contributed to their undernourishment. "They don’t have proteins in their diet," said an official with the Intergrated Child Development Scheme. "What we provide is supplementary nutrition and not food at our aanganwadis."
“There is a need to ensure that they get employed and paid enough for them to fill the stomachs of their families and children,” he added.