ISSUES OF CONCERN

Malnutrition Can be Managed

Saadia Azim

It was the same old fare that Pramila Hembram, 22, a resident of Siri Village in Deoghar District, Jharkhand, used to dish out for every meal-rice, potatoes and, sometimes, dal. Despite the fact that wild greens and pumpkin grew in the vicinity of her home, they were never generally cooked because traditionally, food in the family was all about rice and potatoes. What Pramila did not know was that such sustained imbalanced intake was effectively making her family vulnerable to ill health and putting her four-year-old son, Pramod, at risk of malnutrition.

According to Rajesh Jha of the Centre for World Solidarity (CWS), a local non-government organization that is involved in combating malnutrition in the region under the Fight Hunger First Initiative (FHFI), Pramila was not the only one who was cooking up a carbohydrate-rich meal in the region. He says, “Siri wasn’t an isolated village facing nutrition deficiency. The reality was that people were not aware of the need to have an adequate and balanced diet. When we conducted a study on nutrition security in rural Jharkhand what came to our notice was that people just liked to eat rice and potato. Their idea of ‘proper food’ was the quantity consumed and not the quality.”

Last year when several incidents of infant death were reported from Deoghar District and attributed to chronic, neonatal and pregnancy-related complications, they brought into sharp focus the problem of malnutrition that the region was facing. This was also when the CWS decided to do the hunger mapping exercise here, randomly picking fifty villages in Devipur Block for the survey. The findings that emerged certainly proved to be an eye-opener.

Of the total population surveyed, 14.6 per cent reported to be chronically ill, 20.5 per cent were malnourished and 64.9 per cent had some kind of disease. Analysis of the dietary intake provided further clarity. While 90 per cent of households mainly ate starchy foods, protein consumption was found to be low in 60 per cent of the population. Other nutrients such as iron, potassium and calcium were rarely present in the average meal. Ironically, although vegetable production was good in the area, most of produce was sent off to the markets to be sold.

Reveals Sangita Devi, 30, a mother of four growing children in Daranga Panchayat, talking about the foods she usually cooks, “Like any other tribal household, we have boiled rice and potatoes three times a day. That’s our staple meal. In fact, my children relish potato curry. We do grow vegetables at home and in the nearby fields but they are seen as stock to be sold off.” 

The hunger mapping clearly pointed to the fact that even though the carbohydrate-rice diet gave the local people high levels of energy to work tirelessly in the fields, it was also one of the reasons behind the moderate to severe malnutrition and anaemia rampant among the children and women. The survey disclosed that 9 per cent women were severely malnourished, while 40 per cent pregnant showed severe signs of anaemia, with pale lower eyelids and nails. Additionally, more than 15 per cent of them complained of oedema or swelling.

Besides irregular eating patterns, there were other factors that contributed to the dismal health scenario. Bat sanitation practices meant women especially developed worm infestations which, in turn, meant low appetite and lethargy. Additionally, only 55.3 per cent of pregnant women were registered with the government’s Integrated Child Development Scheme (ICDS) and most of them were availing of the free or subsidized support services available only once during their pregnancy.

Armed with this information, Jha and his team realized that by simple motivating women to add variety to their daily meals, they could improve the health of the community. To ensure the positive behavioural change, they introduced the tiranga bhojan, or tricolor meal, approach in all the 50 project villages in block.

When activists and nutritionists of the CWS first came to Pramila Hembram to talk to her about including all the three colors of the national flag- orange, white and green- in her family ‘s daily diet, she was confused. What was the need to alter their age-old food habits? And what had these colors got to do with the health? That’s when she was told that her son, Pramod, would end up weak and ill, just like many of the neighbourhood children, if she did not keep a check on what he was eating. “They told me that besides rice and potato we also need vegetables and milk to develop immunity and make the bones strong,” she reveals. That information had her hooked. Today, Pramila, who is expecting her second child, is conscious of what she eats and makes it a point to incorporate foods rich in iron and calcium in every meal. Money is a constraint of course because her husband, Nirmal Mahji, a daily wage labourer, only periodically manages to find work on MGNREGA sites. But that has not stopped her from being innovative and resourceful.

She elaborates, “I know I need to eat tiranga bhojan in order to be a healthy mother. We get yellow from the lentils, the green comes from leafy vegetables whereas white comes from the rice and milk. I ensure that the tricolor content is present in all our meals. I have seen the difference it has made to my child. He has definitely grown taller; his skin is clearer and his hair is black and thick.” For a steady supply of greens and other veggies in her kitchen, Pramila has created a small food garden. The leafy pumpkin and gourd creepers hang temptingly from her rooftop. And whatever is surplus she sells in the weekly village market to make some quick money.

According to the CWS team’s observations, none of the elements of the tiranga bhojan are difficult to either source or cultivate locally. Produce such as jackfruits, fenugreek, spinach, bathua (wild spinach), red spinach, and a variety of beans, grow easily within a span of two months and provides the much-needed iron. Yet, despite this, it wasn’t simple getting women to make the switch. There were even culture practices to contend with. In some pockets, tribal customs banned the intake of certain nutrition-rich foods like soyabean and mushrooms.

What did help, however, were local volunteers like Sweta Devi, 26, who, incidentally, is a graduate in Rural Development, who took her role as a health volunteer very seriously. “I know how difficult it sometimes can be to put food on the table in these parts. During the monsoon season, in particular, villages here become inaccessible and we have seen severe food scarcity in many households. So we try to tell everyone to utilize what is locally available and is good for health,” says Sweta Devi. She finds that with the tiranga bhojan approach- where people are instructed not only to eat the right kinds of food but to cultivate their own small garden patches- things have improved considerably. “Women know it’s better to forage or grow tricolor foods than look for a competent doctor later on,” adds Sweta Devi.

In Kasudih Village, which is part of the Tatkiyo Panchayat, Sheela Devi practices ‘circle garden farming’ to cook up a tiranga bhojan. “Unlike in Siri Village where irrigation is not a problem, in Kasudih water is scarce. So I recycle the waste water from household chores and irrigate my garden where I grow local varieties of vegetable,” she says.