Health Watch Malnutrition, anaemia, cleanliness and vaccination Civil society and health care

India needs a massive rural and slum health initiative programme for children. We all know that malnutrition and anaemia are the commonest medical disorders in childhood often undiagnosed and untreated. Both are recognised public health problems of epidemic proportion. What is bothering the nation today is that malnutrition and anaemia limit development and capacity to learn. Both these problems also cost lives, as about 50 per cent deaths in childhood are attributed to malnutrition and anaemia. It is pertinent for civil society to also know ?if moderate to severe malnutrition which sets in prior to three years is not corrected very little can be done in later life?.

In addition, despite the Government of India and UNICEF'sbest efforts, an estimated 4,00,000 children under five years of age die each year due to diarrhoea. Several million more suffer from jaundice, hepatitis A, typhoid, intestinal worms, eye and skin infections caused by poor hygiene and unsafe drinking water. Only 36 per cent of Indian population use adequate sanitation facilities (rural 22 per cent, urban 70 per cent.)

It is sad that 60 years after Independence we have no clear road map; no core implementation and monitoring committees on health, and above all lack of accountability in our total government system.

The civil society, village and slum volunteers are needed to ?take the plunge? in these public health issues especially if we are serious about the health of children and public at large. Nutritious food, cleanliness and vaccination are the three important ?body guards? that keep children healthy and protect them against many sicknesses.

Nutritious food
It is important that children eat the most nutritious food they can get so that they grow well and do not get sick. The best food for children at different ages include: Breast milk and nothing more in the first six months; breast milk and also other nutritious foods such as mashed up beans, kichari (dal and rice), cereals, mashed fruits, vegetables, etc. from six months to one year; feed small meals frequently?each meal should include body-building and protective foods especially milk and foods made from milk, eggs, kichari, fish, beans, lentils, nuts, fruits and vegetables from one year on.

Indian parents and volunteers should know that many children are malnourished because they do not get enough food to eat. But equal number are malnourished because they eat a lot of starchy foods like corn, rice, cassava, or plantain and not enough body-building and protective foods.

Small frequent meals should be fed to a child (5-6 times a day), give the child a small bowlful to eat at a time, do not add spices to child'sfood, add a spoonful of ghee/butter to the food, do not dilute the milk/dal before feeding a child, and all parents should watch for signs of malnutrition among their children and should give them the best food they can. They should also get their haemoglobin (Hb) done as well.

Quiz shows like Kaun Banega Carorpati often ask about several mythological issues, people know about their BP, diabetic status, but nobody asks what is their Hb and how much it should be, why it is below 12 gm, what should be done to improve it and how we grade malnutrition among our children?

Cleanliness
Children are more likely to be healthy if their village, homes and they themselves are kept clean. In rural India and in slums, the families have no latrines and go in open. Each family should follow the guidelines of cleanliness. We should teach children to follow them and to understand their importance. The most important guidelines are: Bathe children and change their clothes often; teach them always to wash their hands when they get up in the morning, after they have a bowel movement and before they eat or handle food; make latrines or ?outhouses? and teach children to use them; do not let children go barefoot, have them wear sandals or shoes; teach children to brush their teeth at least twice a day?once in the morning and then at night just before going to bed and do not give them a lot of candies, sweets or carbonated drinks, cut fingernails very short; do not let children who are sick or have sores, scabies, lice, or ringworms sleep with other children or use the same clothing or towels; treat them quickly for scabies, ringworm, intestinal worms, and other infections that spread easily from child to child; do not let children put dirty things in their mouths or let dogs lick their faces; keep pigs, dogs, chickens and cattles out of the house; and use only boiled water for drinking. This is especially important for babies.

Vaccinations
Vaccinations protect children against many of the most dangerous childhood diseases like whooping cough, diphtheria, tetanus, polio, measles, tuberculosis, neonatal tetanus. Lack of awareness and full knowledge among village elders and health care providers themselves is responsible for many misconceptions about vaccinations. Overcoming the challenges of misconception is a tough battle.

All children should be given the vital vaccinations as per the national immunisation schedule. Elder members of civil society, Panchayat pradhans and its constituent members should take the responsibility and motivate every household to vaccinate their children. Policy of reward and recognition for good work done will go a long way to make it a people movement.

A child who gains weight more slowly than other children or stops gaining weight or is losing weight is not healthy. He may not be getting enough of the right kind of foods or he may have a serious illness or both.

A good way to check whether a child is healthy and is getting enough nutritious food is to weigh him each month and see if he gains weight normally. If a monthly record of the child'sweight is kept on a Road to Health Chart, it is easy to see at a glance whether or not the child is gaining weight normally.

(The author is chairperson, Women Wing of IMA.)