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Mini anganwadis for malnourished kids in remote areas is need of the hour

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On the morning of India’s Independence Day in 2019, Kuna Munda, 30, of Jayapura village, along with a group of 70 villagers, gathered in a small community building in Chasagurujang village. They were demanding that a mini anganwadi centre — a childcare centre catering to a population of 150 to 300 — be set up in their village.


“Our child’s nutrition has been compromised because we don’t have an anganwadi centre in the village,” said Munda, who lives in a small hamlet in the Pallahara block of Odisha’s Angul district. “We have to cross a river to get to the nearest anganwadi. How am I supposed to send my four-year-old son to the centre every day?”

The poorest people — those in the “lowest wealth quintile” or the 20 per cent with the least amount of wealth—and other disadvantaged social groups such as the scheduled castes (SCs) and scheduled tribes (ST) living in small hamlets such as in Pallahara have the least access to anganwadi services, data from the fourth National Family Health Survey (NFHS) show. Living in remote areas, as many from STs do, exacerbates this inaccessibility.


STs comprise 8 per cent of India’s population (104 million) but 45.9 per cent of those from STs were in the lowest wealth bracket, more than any other social group, as IndiaSpend reported in February 2018. In 2015-16, as many as 19.7 per cent of ST children under five years were stunted—had short height for age —and 19.0 per cent of SC children, as compared to 16.4 per cent of other backward castes and 11.9 per cent of ‘general’ castes, NFHS data show.


Low- to middle-income social groups are more likely to get food supplements, health check-ups and other ICDS services, NFHS-4 data show. In 2015-16, 63.3 per cent of the poorest children did not get a health check-up as against 54.9 per cent children from the second wealth quintile (poorest 21 per cent to 40 per cent of the population). Those better off prefer private services and hence have a low utilisation of ICDS services.


In 2015-16, a higher proportion of ST children received food supplements, health check-ups and pre-school education than other social groups, but this is low as compared to the proportion of poor people belonging to STs that need these services. For instance, even though almost half of the ST population (45.9 per cent) belongs to the poorest quintile (poorest 20 per cent), and 24.8 per cent to the second lowest quintile, 60.4 per cent of their children received food supplements under ICDS, NFHS data show.


Compare this to other backward castes: 18.3 per cent of their population belongs to the lowest wealth bracket, and 19.3 per cent to the second lowest, while 45.6 per cent of children received food supplements under ICDS, data show.


Administrative shortcomings






The meeting that Munda attended was organised by members of the gram panchayat (elected village committee) and community leaders to hear people’s concerns and educate them about the need for a mini anganwadi.


“We are proposing two mini anganwadi centres in distant hamlets,” said Sashank Shekhar Naik, 47, sarpanch (village head) of Chasagurujang. “Our priority is to make mini-anganwadi centres available to children from the scheduled tribes who live in faraway villages. Children from here never get their take-home rations. It is impossible for parents to take them to the anganwadi centre every day and lose their wages.”

Since 1975, the government has run a supplementary nutrition programme under ICDS, which provides take-home rations — chhatua (powdered grain), eggs and pulses in the case of Odisha —for pregnant women, lactating mothers and children. It also provides hot, cooked meals for children, as well as pre-school education for children aged three to six, at anganwadi centres, as IndiaSpend reported in August 2019.


This helps support a child’s first 1,000 days — a window of opportunity in early childhood when a child’s growth and cognitive development are the fastest.


ICDS was universalised in 1995-96 to cover all community development blocks, and now reaches remote corners of the country. However, the poor, especially those from disadvantaged groups, are still left behind, as IndiaSpend reported in February 2018. Even in better-performing states such as Odisha, the lowest on the social ladder are excluded as they often live in remote areas.


“Anganwadi workers are not from our village, even if our children go to the centres, they are the last ones to be fed,” said Munda Saunto, 44, a panchayat member. “Auxiliary nurse midwives and ASHAs (grassroot health workers) hardly ever visit our village because of the rough terrain.”

“Children from distant hamlets are supposed to come to my anganwadi centre, but their attendance is the lowest,” said Nirupama Nayak, 31, an anganwadi worker in Udayapur village, which also covers Jayapur village. “They cannot travel 3 km every day, alone, to visit the centre. As a result, they miss out on their hot cooked meals, neither do they get pre-school education.”

The government sanctioned 116,848 mini anganwadi centres in 23 states and Union Territories in 2007, data from the National Institute of Public Cooperation and Child Development show. There are no data on how many mini anganwadis are currently operational.


Until 2005, only one of the six services — hot cooked meals —were provided in a mini anganwadi under the ICDS. In 2007, norms were revised so that all six services were to be provided, ICDS guidelines show.


Even though the villagers in Pallahara want an anganwadi, there is an administrative issue: Kuna Munda’s village, Jayapur, overlaps with another gram panchayat; half the population comes under that panchayat, which means that Jayapur does not have the minimum 150 people to make it eligible for a mini anganwadi centre. The villagers have proposed two mini anganwadis, one in each gram panchayat.

Mini anganwadis for malnourished kids in remote areas is need of the hour


Even the panchayat members were unsure whether Munda’s village belonged to the panchayat of Chasagurujang, where the meeting was taking place, or if he should have gone to the other panchayat that Jayapur is also a part of.


“We have submitted proposals to the government for a mini anganwadi centre especially in the hamlets without an anganwadi, where children cannot reach the nearest centre by foot. It is under consideration and the government will sanction it soon,” said Manoj Mohanty, district collector of Angul.


Renu Pati, the child development project officer for Angul district who oversees ICDS services, and should have been involved in sending the proposal, said she had not received any proposals yet for a mini anganwadi. She refused to answer any other questions.


Reduced burden, improved health

The lack of access to nutrition could be felt most acutely in disadvantaged communities. For instance, in 2013, 19 infants died due to malnutrition when the Odisha government ran a special project for the development of vulnerable tribal groups — the most disadvantaged among STs. Under the project, 216 children were identified as severely underweight and suffering from severe acute malnourishment, but 60 of these were not referred to any hospital, found the 2017 Comptroller and Auditor General report, the latest on particularly vulnerable groups. “No remedial measures were taken by micro-projects to eradicate malnutrition,” the report said.


In addition to helping children and families, mini anganwadi centres would also reduce the burden on the government. Currently, nutritional rehabilitation centres support highly malnourished children and mothers, spending Rs 125 a day per child and mother in Odisha. A malnourished child, along with their mother, is kept for a minimum of 15 days at the nutritional rehabilitation centre under close observation, while focusing on their nutrition.


In January 2019, Nayak, the anganwadi worker, sent three children to the nutritional rehabilitation centre in Pallahara block’s community health centre, 40 km from the village. Two of the children were in the red zone — signifying severe malnourishment with very low weight for height — and the third child was in the orange zone, showing moderate malnourishment. A closer anganwadi centre could have helped these mothers and children supplement their nutrition and avoid severe malnourishment.





Printed with permission from Indiaspend.org, a data-driven not-for-profit organisation


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4 of 5 Indian children do not survive cancer. What led to this sorry state?

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How long does a cancer diagnosis take?


Six months, according to Bipin Jana, 45, whose eight-year-old son Parmeshwar has stage-4 Hodgkin’s lymphoma. That is how long it took the family, travelling 2,000 km across West Bengal, New Delhi and finally, Mumbai, to get an effective diagnosis and start treatment.


Parmeshwar is currently undergoing chemotherapy at the Tata Memorial Hospital (TMH), Mumbai, India’s foremost

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Vitamins and omega-3 fatty acids may help children with autism

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Children with autism who take supplements of vitamins and omega-3 fatty acids may have fewer symptoms than kids who don’t, a research review suggests.


Researchers examined data from 27 trials involving a total of 1,028 children with autism spectrum disorder. Kids were randomly selected to take various dietary supplements, including vitamins or omega-3s, or to take a dummy pill instead.


Omega-3s and vitamin supplements were more effective than the placebo pill at improving several symptoms, functions, and clinical domains, researchers report in Pediatrics. Gains varied in the trials but included improved language and social skills, reduced repetitive behaviours, improved attention, less irritability and behaviour difficulties, and better sleep and communication.


“These results suggest that some dietary interventions could play a role in the clinical management of some areas of dysfunction specific to ASD,” said David Fraguas, lead author of the study and a researcher at Hospital General Universitario Gregorio Maranon and Universidad Complutense de Madrid in Spain.


Even though the analysis was based on controlled experiments — the gold standard for testing the effectiveness of medical interventions — the individual studies were too varied in what supplements they tested and how they measured results to draw any broad conclusions about what type or amount of supplements might be ideal for children with autism, researchers note in Pediatrics.


“The underlying mechanisms involved in the potential efficacy of dietary interventions in autism spectrum disorder are unknown, Fraguas said by email. “Our study does not assess this important question and current literature is inconclusive.”


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New transplant research aims to salvage infected donated organs

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Retired subway and bus driver Stanley De Freitas had just celebrated his 70th birthday when he started coughing, tiring easily and feeling short of breath. He was diagnosed with pulmonary fibrosis, a severe scarring of the lungs, and put on the wait list for a transplant.


“Life became unbearable. From the time I got up in the morning until when I went to bed at night, I struggled through every breath of air,” De Freitas, now 74, told Reuters by phone from his home in Toronto.


After two years, De Freitas was offered a lung, with one significant downside: The donor had hepatitis C.


In October 2017, he became the first patient enrolled in a just published study conducted at Toronto General Hospital testing a technique that aimed to flush out and inactivate the hepatitis C virus from donor lungs before a transplant.


The research comes amid a spike in available organs linked to the opioid overdose crisis, meaning many are contaminated by hepatitis C as the virus is commonly spread by sharing needles. Since it can easily infect an organ recipient, those organs are usually discarded despite the urgent need.


Data from the United Network for Organ Sharing (UNOS), which matches donors with recipients, shows that 97 percent of people waiting for a lung in the United States last year were unwilling to accept an organ from a donor who tested positive for hepatitis C.


While hepatitis C causes serious liver disease, the virus can be present in the blood in other organs.


Researchers are testing different approaches to salvage infected organs.


A study published in April showed that giving patients antiviral therapy just hours after transplant surgery can successfully attack the virus before it gains a foothold in the recipient.


Eliminating the virus prior to transplant would simplify the procedure for patients, said UNOS Chief Medical Officer David Klassen. It could also significantly cut down on wasted donor organs.


The technique used in Toronto, known as ex vivo lung perfusion, keeps organs “alive” outside the body by pumping them with a bloodless oxygenated liquid. They used ultraviolet C light to irradiate the solution, aiming to deactivate the hepatitis C virus and make it non-infectious.


Perfusion allows doctors to evaluate and potentially rehabilitate organs for transplant, and buys them more time than storage in ice boxes, which can cause tissue damage.


Toronto researchers used a solution from Sweden’s Xvivo Perfusion AB with the hospital’s own ex vivo lung perfusion system, a bubble-like machine made from off-the-shelf components and an intensive care ventilator.


The study of 22 patients, published in The Lancet Respiratory Medicine on Wednesday, had mixed results. Adding light therapy significantly decreased the amount of virus, but all but two of the patients contracted hepatitis C, which is now curable.


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