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A matter of life and diet
APR 14 -
I was not much surprised when my helper, Seeta, who hails from Kavrepalanchok district, about 80 km from Kathmandu, gently asked me to keep the used clothes of my 14-month-old baby. I knew she was asking them for her five-year-old daughter. However, my sister-in-law instantly reacted, “Why would you need them? Those clothes do not fit your child.” Sadly, and almost in a crying mood, Seeta replied, “No, they fit my daughter perfectly.” To normalise the situation, I gave a hint to my sister-in-law not to argue with her.
Undoubtedly, one in every two children in Nepal is undernourished placing the country at the 10th position among countries with the highest prevalence of stunting. Though infant mortality has decreased (from 61 percent in 2004 to 43 percent in 2007), the rate is still considered frighteningly high. The Department of Health Services (DOHS) Nutrition Report Card released last month reveals a disturbing fact that 74 percent of children below two years in Nepal suffer from anaemia and 49 percent from chronic malnutrition (measured by stunting rates). Accordingly to the Ministry of Health, iron deficiency anaemia is a major public health issue, as 36 percent of women aged 15-49 are anaemic.
Gregg Tully, development director of the Nepalese Youth Opportunity Foundation (NYOF), opines that ignorance is the major cause of under-nourishment in Nepali children. Mansa Bhattarai, nutrition coordinator of the NYOF, further adds that many parents in rural areas are unaware of their children’s nutritional requirements. Mothers just knowing that they need to feed their babies four-five times a day at certain time intervals will make a huge difference in the growth of their children.
Both Gregg and Mansa emphasise the need for programmes with a two-pronged approach. First, bringing a sustained cultural shift in children’s health; and second, offering life saving interventions for children in need. Citing an example of the NYOF nutritional rehabilitation homes, Gregg maintains that programmes with provisions for both treatment of undernourished children and nutritional education for their parents, particularly mothers, are very crucial. Child malnutrition is very much intertwined with maternal nutrition. Maternal nutrition is a means of improving child nutrition. So, if the means are well taken care of, the ends will improve for sure. Parents pass on their skills and knowledge to their children. The danger of a troubling knowledge gap will remain when the parents themselves are unaware of proper nutritional needs. Hence, educating them on proper dietary and nutritional requirements of children is key to breaking the cycle of ignorance and malnutrition and to pass on the awareness to generations.
The story of two-year-old Leena from Chhitaha VDC, Sunsari, substantiates Gregg’s point. Leena is the youngest child of Kabir and Sebaki Chaudhary. Kabir works as a tenant tiller and Sebaki as a daily wage labourer. Hard pressed by the challenge of making ends meet, Sebaki hardly has enough time to take care of her babies. Their elder son, Pravin is four years old. Just a few months ago, Kabir had to borrow some money to bring Leena to Biratnagar hospital when she suddenly became unconscious while playing with other kids. They were advised by the doctor to feed Leena nutritious food on time as she was undernourished. Sebaki later revealed that Pravin had also been diagnosed as being malnourished a few years ago, but nothing serious happened. Presumably, Leena’s parents have no idea of the consequences of their children’s malnutrition. They are not turning a blind eye to the problem but are completely ignorant about it.
Research studies have shown a significant correlation between low maternal literacy and poor nutrition status of children. A 2007 study undertaken in Pakistan depicted that mothers with no schooling had a majority of undernourished infants. The study also observed that educated mothers helped improve the situation of infants by feeding complementary foods.
Looking at the global picture of malnutrition from the gender perspective, it appears that there is minimal difference between boys and girls below five years of age in terms of their nutritional status. However, the typical South Asian situation reveals discriminatory attitudes and practices perpetuated by power relations and social norms practiced in the countries of the region. Analysts argue that in many developing countries, women’s low status or subordinate position is believed to be one of the key determinants of child and maternal malnutrition. For example, a study conducted in India showed that women’s access to economic resources and mobility were less likely to contribute to stunting among children compared to those who had lesser access to resources.
Nutritionists say that malnutrition is a multi-faceted problem tightly linked to health, education and the well-being of the people and is fundamentally an outcome of deficient food intake. Lack of proper maternal care and sanitation, absence of dietary information, unsuitable feeding practice and inadequate access to food are the other key underlying drivers of malnutrition among children. Chronic malnutrition in children will have severe consequences on their intellectual ability, which in the long run will be detrimental for the country’s overall well-being.
The epicentre of the problem lies in the pro-male bias distribution of food and food intake habits prevalent in our rural homes. Unless proper measures are taken to change these habits, the magnitude of the problem of child malnutrition will remain as a looming fact. The reason is very simple: Malnutrition occurs right from the womb. It is so true that 80 percent of brain development takes place within two years of birth, and thus lack of a proper diet with proper nutrition during pregnancy and in the first two years seriously hinders the intellectual development of a child.
Experts argue that the most effective way to treat malnutrition at the national level is by raising awareness because it would be an extremely difficult and costly affair for a resource-poor country like Nepal to address malnutrition by identifying and treating each of the malnourished patients separately. Awareness raising will also help supply side intervention by contributing to marked growth in the visibly limited number of independent nutrition practitioners in Nepal as more and more people apparently seek their professional services. Programmes based on appropriate policies, regulatory frameworks and effective service delivery systems with adequate resources would be imperative to curb this crisis.
The government’s effort towards the needed coordination among centre and local level healthcare systems and service providers and sectoral agencies is important to have a coherent effort among different stakeholders to ensure an effective integrated response. For example, in the absence of corresponding resources and technical know-how, community health posts are not able to execute the activities specified by the national plan and the sectoral strategy. Hence, here lies a crucial role for international/national non-governmental organisations (I/NGOs) in terms of facilitating the implementation of plans and programmes. Among all, raising awareness to bring about widespread change in community and household attitudes, behaviours and practices is very crucial to ensure that no kid is bound to “fit” clothes used by others who are five years younger.
Upadhyay_b@yahoo.com
(These are the writer’s personal views)
Posted on: 2010-04-15 07:15
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