Overcoming Under Nutrition
By Vidya Kulkarni
Everybody from Salgara Primary Health Center in Osmanabad district knows the story of Karan, a beaming two year old in the village. They have not only witnessed his growth from being severely underweight at birth to a healthy child by now, but they have also actively contributed to making it happen.
Karan weighed only 1200 grams, at the time of his birth in January 2005 and clearly required immediate specialized care and proper nutrition later to ensure healthy growth. Thankfully the health staff and Aanganwadi Worker in Salgara village were equipped to successfully deal with the problem having undergone an intensive training on Integrated Management of Neonatal and Childhood Illnesses.
IMNCI is a special strategy to prevent neonatal mortality, with special emphasis on care of new borns with a focus on infant feeding as well as care of children upto five years. The Government of India together with UNICEF adopted the IMNCI package and it was first piloted in Osmanabad district in 2003. The health staff and Aanganwadi workers in Salgara PHC, covering over 30,000 populations in 19 villages and 11 tandas, had received training in November 2004, just before Karan’s birth in January 2005.
Sharda Jagtap, Aaganwadi worker from the village, vividly recalls how she and other health workers got into action to put their new found knowledge into practice. This was challenging, according to her, as it was their first case. ‘We passed on seemingly simple measures that we had learned in the training to the child’s family, such as immediate and exclusive breast feeding, kangaroo care to keep the baby warm and advise against giving him a bath. Fortunately the family members followed our advice, even though they were a little uncertain to begin with. We also visited the baby frequently in the first month to monitor his weight increase. Our measures to create a protective environment for the child did well and the baby soon caught up reasonable weight gain.’
Apart from specialized and localized neonatal care, IMNCI also attempts to inculcate right feeding practices to check malnutrition among children upto five years. The IMNCI manual, a handy guide to trained health workers, presents a comprehensive chart on nutritional advice for children from their birth upto five years. According to health workers, who find this chart immensely useful to counsel mothers on child nutrition, the chart details specifics of diet and other related significant aspects of feeding for various age groups.
‘We were generally aware of what kind of a diet to be suggested to a mother once complementary feeding starts. However general suggestions do not work always. Moreover the timing and method of feeding, quantity and nature of food equally matter and need to be considered in a diet plan. IMNCI enabled us to look at these specificities and suggest them to mothers,’ explains the worker.
Thus the health workers are equipped to pass on significant information or suggest required changes concerning the child’s diet from a nutrition point of view. Such adequate care and nutritional advice have helped Karan and other children to recover from malnutrition. IMNCI knowledge complements the Aanganwadi worker’s routine work, which involves distribution of dietary supplements to under nourished children, admits Sharda Jagtap. She has been able to help 8 under weight births and malnourished children in her village to improve health in last two years. Most importantly, the outcome of her own work has enhanced the worker’s confidence and conviction to convince families on adopting appropriate feeding practices to safeguard nutritional qualities of diet.
As a result of this and similar efforts in all villages coming under Salgara Primary Health Center, one observes remarkable improvement in curbing infant mortality and malnutrition over past two years. The IMR has gone down from 27 in 2004-2005 to 17 in 2006-2007. The proportion of malnourished children in 0-6 age group has also come down considerably. The number of grade 2 children has come down from 1960 in 2004-2005 to 1540 in 2006-2007. Lack of proper feeding and caring practices is major cause for children falling in this category and it has been addressed adequately through IMNCI intervention. The latest numbers of grade 3 and grade 4 children in the entire PHC area are 6 and 4 respectively, which mainly constitute children suffering for incurable illnesses.