Project Report Study of malnutrition among under-6 children of Sheopur district with special focus on Saharia tribe Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis Project Report Study of malnutrition among under-6 children of Sheopur district with special focus on Saharia tribe Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis Project Team Under the Guidance of Akhilesh Argal, Director, AIGGPA Madan Mohan Upadhyay, Principal Advisor, Centre for Social Sector Development, AIGGPA Project Coordinator Richa Sharma, Deputy Advisor, State Health Resource Centre (SHRC), Centre for Social Sector Development, AIGGPA Consulant Anil Mishra Research Associate Manisha Chouhan Index S.No Particulars Page No Executive Summary 1 1 Introduction 4 1.1 Understanding Malnutrition 5 1.2 About Sheopur 7 1.3 Karahal Block 8 1.4 Introduction to Saharia tribe 8 2 Objectives and methodology 9 2.1 Objectives of the study 10 2.2 Key stakeholders involved 10 2.3 Interaction with Saharia community at 11 Institute 2.4 Methodology and sampling 12 2.5 Data collection 13 2.6 Limitations of the study 14 3 Data analysis 15 3.1 Socio-Economic Parameters 15 3.2 Hygiene related aspects 23 3.3 Food habits in the community 25 3.4 Family Planning related issues 28 3.5 Pregnancy and childcare related aspects 30 3.6 Action taken during common childhood 35 illnesses 3.7 Services of Anganwadi 39 3.8 Vaccination 41 3.9 Nutrition Rehabilitation Centre 43 3.10 Alcohol and consumption of tobacco 44 3.11 Observation during field visit 44 3.12 MNREGA in the district and Karahal 48 4 Findings against key objectives 50 5 Recommendations 57 References 68 Annexures 70 Abbreviations and Acronyms ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWC Anganwadi Centre AWW Anganwadi Worker, Anganwari Karyakarta BPL Below Poverty Line CSR Corporate Social Responsibility ICDS Integrated Child Development Services IFA Iron Folic Acid MUAC Mid Upper Arm Circumference NFHS National Family Health Survey NRC Nutrition Rehabilitation Centre NRHM National Rural Health Mission POSHAN PM’s Overarching Scheme for Holistic Nourishment WASH Water, Sanitation and Hygiene WCD Women and Child Development Study of malnutrition among under-6 children of Sheopur district with 2018 special focus on Saharia tribe Executive Summary Childhood under nutrition is an important area of concern in India. Children with Severe Acute Malnutrition (SAM) have nine times higher risk of dying than well-nourished children.With appropriate nutritional and clinical management, many of such deaths can be prevented.Malnutrition among children is actually a manifestation of many other socio- economic and cultural factors. General poverty coupled with lack of assured employment round the year is the major issue which needs to be looked into. Generally there is a tendency among the planners and administrators to look into malnutrition as a health related issue and accordingly the interventions also focus on it. The main livelihood and poverty gets missed out. All this necessitate that the problem is dealt with in a more comprehensive and multi- disciplinary approach. Sheopur is a predominantly tribal district with the Saharia being the major tribe residing mostly in Karahal block of the district. This study has been planned in order to understand the causal factors of malnutition in the area and thereby devising a context specific strategy to combat this problem. On account of various parameters of deprivation, Karahal block in Sheopur district was chosen as focal area for the study. In order to develop an understanding of the issues faced by the Saharia community, men and women from the Saharia community in Sheopur district were invited to Bhopal and discussion was held on various aspects like climate in the region, livelihood opportunities, drinking water etc to get an overall view.After getting an understanding of the overall situation a detailed questionnaire was developed .The sample comprised of 200 families of Saharia community and 200 Non-Saharia .Four local female field investigators who were residents of the Sheopur district were involved in collection of data by means of the questionnaire. It was found that overall the children from the Saharia community had almost twice the incidence of malnutrition the Non-Saharia community.Illiteracy in the block is very high, 73 % of the Saharias and 65 % of the Non-Sahariia respondents were illiterate. 90% the Saharia community respondents worked as labourers while it was 48% for Non- Saharia. Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 1 Study of malnutrition among under-6 children of Sheopur district with 2018 special focus on Saharia tribe Migration is a very significant aspect of the community in the area. It has an impact on the uptake of the health and other ICDS, nutrition, vaccination related facilities in the area. This breaks the continuity of the service delivery. Migration also reflects on the lack of livelihood related options available in the area. Overall 34% of the households migrated to neighbouring places for work. However among the Saharia households approximately 56% migrated for work while only 12% of those from Non-Saharia households migrated for work. Though women were adviced to consume additional food during pregnancy, it was found that additional food consumption was up to a maximum of 3-6 months.The most common illnesses reported for diarrhoea,fever and common-cold. Saharia is notified as the Primitive Tribe Group (PTG) in Madhya Pradesh.It is strongly recommended that the government should have a higher allocation for PTG predominant blocks. It is also proposed that the quota of MNREGA allocation for 100 days may be increased to 150 -200 days in the year for the next 5 years in Sheopur district.The possibility of introducing a crash program for the next 4-5 years needs to be explored in order to address livelihood related problem and nutrition requirement in the region. Approximately 60 % of the area of Sheopur district is under forest cover. Collecting tendu patta is one of the commonly used forest based source of livelihood for the people in this area. Forests also provide a range of marketable products like Resins (gum), Bahera, Nagar motha, Edible gond, Satawar, Mahua etc. Many of the locally collected medicinal herbs fetch a good price in open markets but the tribal people end up selling these products to the intermediaries at abysmally lower prices. The support for marketing and value addition by creating processing facilities would enhance the income in the community.It is recommended that a special plan is drawn by the MFP cooperative federation, which has the resources, to identify all marketable Minor Forest Products and create Self Help Groups (SHGs) for them. Such SHGs should be empowered to scientifically harvest, process and sell at competitive prices to the larger markets outside Karahal. With effect from December 2017 onwards the Government has initiated a cash assistance scheme of Rs 1,000 per month to each of the families of special backward scheduled tribes (STs) as part of its efforts to eliminate malnutrition among the communities. The amount of Rs 1000 per month is being provided to special backward ST communities, including Saharia, Baiga and Bharia, to address the problem of malnutrition among them. The amount is being deposited in the bank account of the woman head of the family to be used for Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 2 Study of malnutrition among under-6 children of Sheopur district with 2018 special focus on Saharia tribe buying nutritious food items. This initiative of the Government is likely benefit the community in addressing the problem of malnutrition among Saharia and other tribes also. The focus should be on expanding access to primary education in this region .There is a need for expansion of health care services in the affected area including reproductive and child care, pre and post-natal care, vaccination etc. Intensive health awareness in the target group of expectant mothers / adolescents needs to be launched in the campaign mode through women and child development department and health and family welfare department. The district of Sheopur is identified under Phase –I of the Poshan Abhiyaan programme. It is the flagship programme of the Ministry of Women and Child Development (MWCD),which ensures convergence with various programmes.It lays emphasis on the first 1000 days of the child, which includes the nine months of pregnancy, six months of exclusive breastfeeding and the period from 6 months to 2 years to ensure focused interventions on addressing under nutrition. It is recommended that increased allocation of PDS be given to families having severely underweight children and for and SAM children discharged from Nutrition Rehabilitation Centres. Intensive monitoring is required at all levels including District Collector, CEO Zilla Panchayat, Saharia Vikas Pradhikaran, Chief Medical Officer, Block Medical Officer, Staff at Nutrition Rehabilitation Centre, Community Health Centre, Primary Health Centre, ANMs, ASHA Karyakarta, Anganwadi Karyakarta etc need work in co- ordination towards the aim of reducing malnutrition in the area. This will ensure that the problem of malnutrition is addressed properly in the region. Looking into the level of illiteracy in the regio and to address the specifics needs of the tribal community in local languages resource is available in