Why community matters in tackling malnutrition

 Malnutrition is one of the leading causes of death and diseases in children under-five years of age globally. It adversely affects cognitive development and learning capacities among children, thereby resulting in decreased productivity in the booming years. According to a study by Lancet, 68 per cent of the under-5 deaths in India can be attributed to malnutrition. Besides, India is home to nearly half of the world’s “wasted or acute malnourished” (low weight for height ratio) children in the world.

Wasting is a critical health condition where a child is nine times more likely to die as compared to a healthy child. According to National Family Health Survey (NFHS)-4 conducted in 2015-16, 21 per cent of children in India under-5 suffered from Moderate Acute Malnourishment (MAM) and 7.5 per cent suffered from Severe Acute Malnourishment (SAM).

Despite various targeted outreach and service delivery programmes run by the government such as POSHAN Abhiyaan, Supplementary Nutrition and Anaemia Mukt Bharat, to name a few, 16 out of the 22 states and Union territories have still shown an increase in SAM, as per NFHS-5 conducted in 2019-20.

While the deteriorating facets of malnutrition continue to remain a matter of grave concern, the emergence of COVID-19 has only worsened it. The partial closure of Anganwadi Centres (AWCs) along with disruptions in supply chains due to subsequent lockdowns has resulted in halting of mid-day meals scheme, reduced access to take home ration (a nutritional measure to supplement some portion of a child’s calorie needs) and restricted mobility to health care services.

According to a study published in journal Global Health Science 2020, the challenges induced by COVID-19 are expected to push another four million children into acute malnutrition. This is also evident from India poor ranking, an abysmal 94th out of 107 countries on the Global Hunger Index 2020.

Acute malnutrition is a complex socio-cultural problem that lies at the interplay of inequitable access to nutritious foods and health services, sub-optimal infant, and young child-feeding practices (IYCF) including breastfeeding, low maternal education, low capacities of field functionaries in detection malnutrition, poor access to clean water and sanitation, poor hygiene practices, food insecurity and unpreparedness for emergencies. And COVID-19 has significantly unravelled all these inefficiencies, therefore, bringing to the fore, the need to adopt sustainable solutions aimed at integrated management of acute malnutrition in tandem with mitigating the impact of COVID-19.

The first step to reduce this burgeoning burden acute malnutrition is to ensure early identification and treatment of SAM children to stop them from further slipping into the vicious cycle of malnutrition. Currently, in India, SAM children with complications are usually referred to the Nutrition Rehabilitation Centres (NRCs), mostly established in district hospitals with a low ratio of hospital beds per population.

While access to health infrastructure is a major thorn in the flesh, it is also a proven fact that 70-80 per cent of the children face no medical complication and need not required to be hospitalised. Therefore, in such a scenario, it is feasible to adopt an approach that treats the uncomplicated SAM children more efficiently and “Community Management of Acute Malnutrition (CMAM)” works wonders in this regard.CMAM is recommended by both WHO and UNICEF and has shown positive results across many countries and some of the states and district in India where it has been implemented as a pilot project. One such state that has fared well in CMAM is Maharashtra.

Taking cognisance of growing SAM children, in 2007, the Maharashtra government went on to implement CMAM at four different levels in the Nandurbar district. The first step involved community level screening, identification, and active case finding of SAM children by Anganwadi/ASHA workers.

The second step initiated treatment of SAM children without any complications at community level through Village Child Development Centre (VCDC) by using different centrally and locally produced therapeutic food. These energy-dense formulations are often at the core of nourishing the children since they are fortified with critical macro- and micro-nutrients. It ensures that the target population gains weight within a short span of six to eight weeks.

The third step included treatment of children with complications at the NRCs. And the fourth step involved following-up of children discharged from the CMAM programme to avoid a relapse, along with promotion of good IYCF practices, child stimulation for development, hygiene and other practices and services to prevent the further occurrence of SAM.

As a result, the district witnessed a decline in SAM children — from 15.1 per cent in 2015-16 (NFHS-4) to 13.5 per cent in 2019-20 (NFHS-5). Nandurbar is a difficult terrain and if CMAM approach could achieve such favourable results in such a place, it has the potential to be scaled up anywhere in India.

Given the renewed political interest in nutrition through Poshan 2.0, CMAM must be given a serious thought if India plans to come anywhere close to meeting the stunting and wasting targets by 2025.

Written by M A Phadke

The writer is former Vice Chancellor Maharashtra University of Health Sciences

Source: Indian Express, 18/04/21

Protect the rights of women migrant workers

 The response from most states to these recommendations has been slow to non-existent. Many quarantine centres and shelters for migrant women are not safe, nor are they safe on the long road home where they have neither facilities nor physical security.With the surge in Covid-19 across the country, there are reports, yet again, of migrant workers being left with little choice but to go back to their villages. But within this, the gender dimension has been largely overlooked. In the process of migration driven by Covid, the impact of migration on women is different from that on men.

Women’s migration is not seen so much as employment-driven but as part of them relocating to places where their husbands get jobs. This is why, perhaps, they are invisible when discussing the problems that migrant workers are facing. Even though women enter the workforce in the areas they migrate to, the main reason many of them cite for migration is marriage. In the forced migration that happened last year and is re-emerging now, as in most disasters, there is an unequal gender impact.

Male migration often leaves women in their villages looking after their children and extended family. This increases their burden of having to take up traditional occupations, mainly agriculture as well as care work for the elderly and children and managing the household. Many of them often don’t have the local networks, knowledge base, and ability to access many welfare schemes.

The National Commission for Women had issued an advisory to the ministry of women and child development last year on measures which should be taken for the welfare of women migrants.

These include, ensuring accessibility of nutritious food and drinking water; ensuring no separation from family or children where possible; and provision of sanitary napkins and special steps for the dignity and safety of lactating mothers. The advisory also spoke of protection from eviction from their residences; ensuring reponses to gender-based violence from the police and inclusive redressal mechanisms; medical care, including mental health, in migrant clusters; access to communication with their family and measures to address trauma; and access to sanitation facilities such as masks, sanitisers and soap.

The response from most states to these recommendations has been slow to non-existent. Many quarantine centres and shelters for migrant women are not safe, nor are they safe on the long road home where they have neither facilities nor physical security.

Many women migrants, both those still in urban areas and those who have returned home, have had to compromise on many essential requirements in their daily lives. Those in urban ghettos have been largely trapped in their rooms with their out-of-school children, unable or unwilling to venture out for fear of the virus, making them more vulnerable to anxieties and worry. With all health care workers pressed into service to battle the pandemic, many migrant women have no access to health services for other ailments.

The government’s draft National Policy on Migrant Workers has largely overlooked the specific needs and concerns of migrant women. Now would be a good time to incorporate a rights-based approach in the policy with relation to migrant women. Women migrants and their vulnerabilities can be tackled only if the government addresses the structural and other challenges which cause them to be so invisible. It has to focus on women in the informal sector, especially migrant women, in its upgradation and skills programmes. The surge in Covid cases should occasion a rethink on the issue of women migrant workers and their needs, which can then be institutionalised so that they are less vulnerable during the pandemic and after.

lalita.panicker@hindustantimes.com

Source: Hindustan Times, 17/04/21

Why a Gauhati HC order on a citizenship case is important

 Apart from a careful consideration of the documentary evidence, it noted that the structure of the Foreigners’ Tribunal proceedings was such that those accused of being a foreigner had no knowledge about the circumstances under which they had been referred to the tribunal or the nature of the accusations against them — no documents or evidence had to be furnished to them.

Over the last two years, several reports have exposed the flawed workings of Assam’s Foreigners’ Tribunals, where individuals accused of being “illegal immigrants” have to prove their citizenship. The reports suggest that these tribunals have followed arbitrary processes, placed the burden of producing extensive documentary proof on marginalised individuals, exercised little genuine independence vis-a-vis the executive, and that their tenure is linked to how many people they can declare to be “non-citizens”. This is particularly serious, given that the stripping of citizenship means the loss of all basic rights, and vulnerability to deportation.

In this context, a recent Gauhati High Court (HC) judgment comes as an important corrective, and raises some hope for bringing the foreigners’ tribunal process more in line with the rule of law.

The tribunal had declared one Haidar Ali to be a non-citizen, despite extensive documentation — including voter lists and property documents — being placed to show that Ali’s parents and grandparents were Indian citizens, and had been so for decades. The tribunal did so on the basis of perverse reasoning — for example, that along with Ali’s parents, there were certain other names in the voting lists that had not been explained; that Ali had stated during oral evidence that he had certain siblings while he had not done so in his written evidence, and that this justified drawing an “adverse inference” against him; and that despite Ali’s father himself testifying to their relationship before the tribunal, a “sufficient link” between the two had not been proven.

The Gauhati HC — speaking through Justice N Kotiswar Singh — set aside the order, and declared Ali to be an Indian citizen. Apart from a careful consideration of the documentary evidence, it noted that the structure of the Foreigners’ Tribunal proceedings was such that those accused of being a foreigner had no knowledge about the circumstances under which they had been referred to the tribunal or the nature of the accusations against them — no documents or evidence had to be furnished to them. In HC’s words, the individual “is totally in [the] dark as to how he came to be considered a foreigner and not an Indian.”

For this reason, the court held that if an individual “introduces new facts to discharge his onus [of proof], it cannot be said to take the State by surprise ... in fact, all opportunities should be given to a proceedee to enable him to produce all such documents which come to his possession even at a later stage also, to substantiate his claim that he is an Indian. No pedantic view should be taken, if there has been some delay or if the same is not mentioned in the written statement.”

HC’s observations are important, as it is an oft-repeated statement that “strict procedural rules” do not apply to the workings of the Foreigners’ Tribunals. More often than not, however, this laxity in procedure is used to the disadvantage of accused individuals — for example, by denying the application of the rules of natural justice. HC, however, restored parity by specifying that in the same manner, strict procedural rules should not be used to shut out an individual’s ability to prove her citizenship.

Justice Singh also made two further important observations. First, he noted that in cases where individuals were illiterate, or where their birth had not been recorded, documentary evidence would be impossible to obtain. In such cases, facts about date or place of birth could be proved by oral evidence. And second, as the standard of proof was one of “preponderance of probabilities”, a few inconsistencies ought not to be used to defeat an individual’s claim to citizenship. Both observations — while not new — bore reiteration by HC, especially in view of the conduct of the Foreigners’ Tribunals.

While the judgment of the Gauhati HC will not solve all the issues that continue to plague the Foreigners’ Tribunals — and inflict great hardship and suffering on ordinary people — it, and more judgments like it, will at least help to restore a semblance of the rule of law to the process.

Gautam Bhatia is a Delhi-based advocate The views expressed are personal

Source: Hindustant Times, 18/04/21

Quote of the Day April 16, 2021

 

“The price of apathy towards public affairs is to be ruled by evil men.”
Plato

“सार्वजनिक मामलों के प्रति उदासीनता की कीमत बुरे पुरुषों द्वारा शासन किया जाना है।”
प्लेटो

Current Affairs:April 16, 2021

 

India

• India hosts BRICS seminar on misuse of Internet by terrorists; organised by National Investigation Agency (NIA)
• ISRO, French Space Agency CNES to cooperate on India’s Gaganyaan Human Spaceflight programme
• Indian Coast Guard apprehends Pakistani boat with 30 kgs of heroin off Jakhau, Gujarat
• Hardeep S. Puri, MoS (I/C), Housing and Urban Affairs launches EatSmart Cities Challenge, aim is to nudge the urban populace to make the right food choices
• Hardeep S. Puri, MoS (I/C), Housing and Urban Affairs launches Transport 4 All Challenge; aim is to develop digital solutions that will make public transport safe and affordable for all

Economy & corporate

• 2020-21: Exports at $290.63 billion (–7.26%), Imports: $389.18 billion (–18%)
• Wholesale price index (WPI) based inflation at over 8-year high of 7.39% in March
• RBI to set up new Regulations Review Authority (RRA 2.0) for a period of 1 year, to be headed by Deputy Governor M. Rajeshwar Rao
• India ranked 49th among 120 countries on Facebook ‘Inclusive Internet Index’ compiled by Economist Intelligence Unit (EIU)

World

• US President Joe Biden announces new sanctions on Russia, expulsion of 10 diplomats for interference in the 2020 US presidential election and the hacking of federal agencies
• US President Joe Biden announces complete withdrawal of US, NATO troops from Afghanistan by September 11
• Haiti: PM Joseph Jouthe resigns as the country faces a spike in violence

Cricket: Wisden awards

• England all-rounder Ben Stokes is ‘Cricketer of the Year’
• Dom Sibley, Zak Crawley, West Indian Jason Holder, Mohammed Rizwan and Darren Stevens named Wisden Cricketers of the Year in the 2021 edition of Wisden Almanack
• Australia’s Beth Mooney is ‘Leading Women’s Cricketer in the World’
• India captain Virat Kohli Wisden Almanack’s ODI player of the 2010s
• Sachin Tendulkar is the ODI Cricketer of the 1990s
• Kapil Dev was named as the ODI Cricketer for the 1980s

What is Forest fire Season?

 In April 2021, Uttarakhand recorded 361 forest fire incidents in just five days. During this period, over 567 hectares of forests have been destroyed. This includes 380 hectares of reserve forest areas. Though forest fire seasons occur every year, the damaged caused this year is high.

What is a forest fire season?

Every year forest fires begin in mid-February in the state of Uttarakhand. This happens on the onset of spring when the trees shed their dry leaves. Also, during this period the soil loses moisture due to increase in temperature. The forest season continues till June.
However, this year, the forest fires that began in October 2020 are still burning even in April 2021.

What causes forest fires?

The three main factors that cause forest fires are oxygen, fuel load and temperature. The dry leaves are the main fuel for the forest fires. They are in higher quantity during this period of time as compared to the rest of the year.

Also, the surface of hilly areas gets dried faster than the plains. This is mainly due to the lower accumulation of rainwater in the hills.

Current Scenario in Uttarakhand

Uttarakhand has 38,000 square kilo metres of forests. This is around 71% of its geographical area. Since 2000, the forest fires have affected more than 48,000 hectares. (Uttarakhand was formed in 2000).

As the forest fires began to increase in the state, the Chief Minster of Uttarakhand Tirath Singh Rawat sought help from the Union Minister Amit Shah. To this, the centre has sent two MI-17 helicopters to fight forest fires. These helicopters have been deployed in the Kumaon and Garhwal regions.

Way Forward

The Van Panchayats should be given incentives and rights to protect forest areas. The Forest Act, 1988 dissociates local community with forests. The local community villagers do not initiate dousing fires in the absence of a sense of belonging. More water holes should be developed to recharge groundwater and to maintain moisture in the soil.

What is Adenovirus?

 he US health authorities recently paused the rollout of one-shot Johnson and Johnson COVID-19 vaccine. The vaccine uses similar technology as that of the Astra Zeneca vaccine. Both the vaccines are developed from adenoviral vectors.

Why did the US stop Adenovirus based vaccines?

Around six women in the US suffered from blood clots out of seven million administered doses. The vaccine has been found to have a link with a very rare vaccine induced immune thrombotic thrombocytopenia.

The Astra Zeneca Vaccine uses Adeno virus from Chimpanzee. Other companies use Adenovirus from humans to develop COVID-19 vaccine.

What is Adenovirus?

• Adenovirus causes wide variety of illness in humans. This includes from gastrointestinal infections to common cold.
• Scientists use these viruses as “Viral Vectors” in making vaccines. Viral vectors are tools used to deliver genetic material into cells.

How is Adenoviral vector made?

The Adenoviral vector is made by removing the genetic material that could allow the virus to replicate or spread disease. This adenoviral shell is then inserted with genetic instructions on how to target another virus (like COVID-19 virus).

An adenovirus looks like a serious vector to the immune system of human body. Thus, the immune system responds seriously. This is why people have been reporting fatigue, fever or sore arm after receiving vaccine dose.

Why are Adenovirus based COVID-19 vaccines mostly single shot vaccines?

The Adenovirus infections are common in humans. Thus, human immune system would have already developed certain antibodies against them. This limits the number of administered doses. This is why several Adenovirus based COVID-19 vaccines are stopped with single shot. For instance, the Johnson and Johnson vaccine and Casino vaccine of China are both single dose vaccines.