Background:
The extent of malnutrition in the tribal areas still remains high in spite of various government nutrition schemes for the pregnant and lactating mothers and children in the age group of 0-6 years. The reasons are in plenty ranging from the death of one or both of the parents, multiple pregnancies, teenage pregnancies, alcoholism, child neglect, cultural taboos and lack of awareness of facilities.
One such story is that of Monali Dahawad, a-eleven month old baby girl from Dandval village in Mokhada block. Her mother passed away recently due to illness and negligence on the part of the family members. Her father is a farm labourer, addicted to alcohol and does not care or support the family. Monali is the youngest of six children, the eldest brother lives in another city for work, her 2 elder sisters are married and Asha her 12-year old sister has to care for her and her other 3-year old sister. Asha had to quit her school due to household responsibilities.
After her mother’s death, Monali was taken care of by her grandmother, but her father forcibly took the child away, which led to deterioration in the child’s nutritional status. Due to constant neglect, Monali continued to fall ill and became severely malnourished.
Intervention by AROEHAN staff:
When Ishwar, our Program Community Mobiliser visited Monali’s house on the 26th of December 2019, she was found to be very ill with difficulty in breathing, she weighed around 5.5 kg and her MUAC (mid-upper arm circumference) was 11 cm.
With no adult caretaker in the house and the child to be taken to the hospital immediately, the PCM contacted the ANM, but she was out on vacation. He then contacted the Sarpanch and ordered for the 108 ambulance services and the child was shifted to the Mokhada Rural Hospital with her elder sister.
The next day when Ishwar visited the hospital, the paediatrician diagnosed the case as Severe Acute Malnutrition (SAM) with Pneumonia and said that she will have to be kept in the hospital under treatment for 5 days and then in the Nutrition Rehabilitation Centre (NRC) for another 14 days.
Now arose the need for a parent to accompany her, but her father was addicted, and the next option was her grandmother. Ishwar along with ASHA, AWW, and ICRP visited Monali’s grandmother to convince her to stay at the hospital. But the fear of her son-in-law stopped her from going, until she was persuaded by some senior citizens in the village. Monali’s grandmother and sister stayed at the hospital and her married sister stayed at home to look after her 3-year old sibling.
The outcome:
When the AROEHAN team visited Monali in the hospital after 5 days, she looked better and her weight had increased by 100 gm. She gradually responded to treatment and was much better on discharge. In the meanwhile the team also met her father and explained to him the importance of care and support that Monali required. He responded to their pleas and decided to keep Monali and her sister with their grandmother.
Monali is now staying with her grandmother. As of March 2020 she weighs 8.9 kg and her MUAC is 12.5 cm. She has recovered from severe malnutrition, but still has to be monitored closely. The team has also requested the Sarpanch to help reinstate her elder sister Asha in school, so that she can become self-sufficient in the future.
Lessons learnt:
Malnutrition is not due to poverty alone but also sometimes due to child neglect. Counselling for behaviour change is as important as treatment. It is the shared responsibility of the family and the community to eradicate malnutrition in the long run.
All’s well that ends well!
