Latest data from the government’s National Health Mission (NHM) shows that children with increased risk of mortality could not receive urgent in-patient care at special wards, also known as nutrition rehabilitation centres (NRCs), following the nationwide lockdown from March 25. These NRCs were either shut due to the lockdown or turned into quarantine facilities for COVID-19 patients.
Also read: COVID-19 will lead to 6.7 million additional ‘wasted’ children, say global bodies
The NHM data shows that the number of children admitted in NRCs from April to June was a mere fraction of the numbers for the same period last year.
There were 1,315 children admitted across nearly 966 NRCs in the country in April 2020, just 9% of the 15, 792 admitted in April 2019. There were 2,256 children admitted in May and 3,472 in June — 13% and 16% of the number in the corresponding months last year.
In March there was a marginal impact as admissions to NRC dropped by 24%.
Also read: COVID-19 induced food insecurity will lead to an increase in malnutrition, says UNICEF official
The sharp decline was recorded despite the Centre declaring nutritional services as essential services three weeks into the lockdown.
Impact of malnourishment
Two in three deaths of children under five years in India are known to be caused by malnourishment. Projections from multilateral bodies such as WHO, FAO, WFP and UNICEF have warned that disruption of food systems and access to healthcare services are likely to lead to an increase of 17.3% in global prevalence of wasting. This would further translate into an additional 6.7 million children under the age of five suffering from wasting, half of whom are likely to be from South Asia. The estimates also suggest that there will be more than 10,000 additional child deaths per month during this period.
Also read: Coronavirus | Ten child deaths recorded in Maharashtra
Frontline workers record anthropometric measurements of children between six months to six years and refer severe acutel malnourished (SAM) children or those who show poor levels of growth, medical complications and poor appetite to NRCs. At these special units children get medical treatment and nutrition support and their mothers are counselled on providing care.
However, following the lockdown, ASHAs and Anganwadi workers were either unable to screen children because of restrictions on mobility and additional COVID-19 related duties, or due to NRCs being declared quarantine centres, or parents being reluctant due to fears over COVID-19 infection at these facilities.
The data also bears this out and shows that children identified as SAM between April-June were a mere two-thirds of last year. 3,316 children were identified as SAM in April 2020 as compared to 10,957 in April 2019; 3,359 children were identified as SAM in May 2020 as compared to 11,554 in May 2019 and 3,785 in June 2020 as compared to 14,128 in June 2019. In March the number of SAM children saw a drop of 7% as compared to previous year.
Also read: Ensure children are not malnourished: NGO to govt.
Hunger crisis
“The data is very telling and shows that well after the lockdown was imposed in March, health and nutritional services continued to remain disrupted upto June end. It is a double whammy that when the country is staring at a hunger crisis leading to an increase in prevalence of malnutrition, regular health services too were not available. The most vulnerable such as those from tribal communities, backward castes and the poorest of the poor who record high levels of malnutrition will bear the biggest brunt,” said Dr. Subhashri B., Obstetrician Gynaecologist, CommonHealth, a coalition for reproductive health and safe abortion. She also raised concerns over the lack of crucial government data on service delivery for the past six months on the NHM website.
“The disruption of services indicate that there will be a dramatic and downward trend for child malnutrition in the time to come,” warns Vandana Prasad, public health expert and Member of the Advisory Committee of the Right to Food Campaign.
“The data shows that growth monitoring of children and identification of SAM children followed by referrals to NRC didn't happen. The immediate threat is child mortality as wasting is known to cause deaths. The larger determinants of rising levels of malnutrition are food and economic insecurity in the present as well as middle to long term. If measures are not taken to address these, whatever slow progress we had made on nutrition indicators will all be lost,” Ms. Prasad said.
