Maharashtra: Healthcare of malnourished children takes a back seat in Covid pandemic
While the state is still struggling with the second wave of the pandemic, severely malnourished children with compromised immunity have been at the receiving end. Though the Women and Child Development (WCD) has taken up several initiatives to improve their outreach programme, to improve the health of malnourished children, social activists said the burden of such children in the state will further increase due to the closure of anganwadis and discontinuation of mid-day meal programmes. Doctors said severely malnourished children are most vulnerable to contracting Covid-19 infection.
Malnutrition is a non-communicable disease that is referred to when a person’s diet does not provide enough nutrients or the right balance of nutrients for optimal health.
According to the last measurement in March 2020, before the pandemic hit the state, Maharashtra had 45,217 severely malnourished children below six years, and around 1.5 lakh children were identified as moderately malnourished. This counted as 3.5% of the total children weighed. Most children are from rural parts of the state like Nandurbar, Palghar, Raigad, Marathwada among other districts.
However, activists in rural areas said the number will increase drastically like a ‘ripple effect’ in the pandemic.
Dr Ravikant Singh, founder, Doctors for You, said that since the lockdown last year, anganwadi centres have been closed down to reduce transmission of infections. “Also, the mid-day meal programme that provides the primary source of nutrition supplementary to school-going children has halted. Due to the lockdown, many parents have lost their jobs and are facing financial constraints to take care of their children. This will cumulatively contribute to the rise of the acute under-nutrition among children.”
With the rise in cases of malnutrition, doctors said these children are likely to become more vulnerable to contracting Covid-19 due to low immunity and several other underlying health issues.
MA Patil, president of the Mumbai wing of the Maharashtra Asha Workers and Gatpravartak Sangh said post-Covid, nutrition-related deaths among children would surge.
“Malnutrition is classified into various categories. Only if a child is severely malnourished, he can not only contract Covid but other infections like tuberculosis. Since they also have underlying health issues like cardiac or kidney problems among others, they become easy targets for any virus,” said Dr Subhas Prabhu, who heads the paediatric task force. However, so far, the task force hasn’t provided any suggestion on it to the state government.
Compared to the first wave, in the second wave, more children below the age of 10 have been infected with Covid-19. Considering this, social activists said the battle against the pandemic is a long term struggle that requires strengthening the implementation of the community-based management strategy for addressing malnutrition among children.
To address the issue, Integrated Child Development Services under WCD has been distributing take-home ration to the children registered with anganwadis. “Since the lockdown, we are making all possible efforts to provide an uninterrupted supply chain of nutritious foods to the children. For moderately and severely malnourished children, we are sending doctors and trained Asha workers to their home to check their health parameters. If we find anyone unwell, we immediately shift them to the hospitals and nutritional rehabilitation centres,” said IA Kundan, principal secretary WCD.
“We are also sending ready-to-eat energy-dense nutritious food which is a mixture of peanuts, oil sugar, nuts and nutrition-rich ingredients to severely malnourished children,” she added. However, activists claimed only 10% of the total severely malnourished children are getting it.
Patil said the take-home ration isn’t providing much help. The state government should focus on providing daily ration to the malnourished children. “At present, the ration is provided every month which is also being consumed by the parents of the children. Along with just dal, wheat and rice, the department should provide more nutrient-rich foods like dry foods and fruits,” he said.
Many rural nutritional rehabilitation centres have recorded a sizable drop in the number of referred children. “Earlier, we used to get around 15 referral children every month. Now, we barely get 3-5 cases. In most cases, patients reach us only when they have an infection or develop any health complication,” said an officer from government medical college in Nandurbar.
The department is also providing training to the caregivers on how to use the Mid Upper Arm Circumference to measure the degree of malnutrition among children. Also, the state health department has instructed the WCD to make planning for vaccination of lactating and new mothers.
Take flu shots as a precautionary measure
The paediatric task force has, as a precautionary measure, suggested that children be inoculated with the influenza vaccine. The suggestion has also been submitted to chief minister Uddhav Thackeray.
Dr Prabhu said since symptoms of Covid-19 and seasonal flu are similar, taking the shot might help control the mental anguish of parents if their children develop flu.
“There is no scientific evidence that children will be more affected in the third wave. But if taking the shot helps control the development of seasonal infection, it will save parents from getting paranoid and decrease the unnecessary burden on the hospitals. This is just for a precautionary measure,” he said.
When HT enquired with private and civic-run hospitals, they said that so far, they haven’t recorded any sudden surge in the demand for the influenza vaccine from parents.