A study of Nutrition Status of Preschool Tribal children in Rural Nandurbar District of Maharashtra

Abstract

Ensuring proper nutrition is imperative for the overall health, growth, development, and economic prosperity of individuals and communities. Malnutrition, characterized by inadequate, excessive, or imbalanced food intake misaligned with nutritional needs, constitutes a significant public health challenge. This issue contributes to elevated rates of maternal and child morbidity and mortality. Early childhood nutrition not only influences health but also significantly determines one's quality of life and overall growth. Undernutrition escalates the risk of illness and mortality, with 45 percent of deaths among children under 5 attributed to various forms of undernutrition (Black et al., 2013). Poor nutrition compromises the immune system, making individuals more vulnerable to illnesses and infections while hindering recovery. The right to freedom from hunger and malnutrition is considered a fundamental human right, crucial for both individual and national development (WHO EMRO, 2012). Nutritional status during the pre-school years emerges as a pivotal factor influencing health outcomes in adulthood (Nigudi, 2012). Despite global efforts, progress in mitigating malnutrition has been gradual and inconsistent. In 2021, approximately 149 million children under five were stunted (21.9%), 49 million experienced wasting (7.3%), and 40 million were overweight (5.9%) worldwide (WHO, 2022). The burden of malnutrition is excessively burnt by disadvantaged communities across the globe. Recognizing the multifaceted nature of malnutrition, the Sustainable Development Goals (SDGs), specifically SDG-2, aim to eradicate hunger, achieve food security, improve nutrition, and promote sustainable agriculture by 2030 (UNSCN, 2015). Aims and objectives: The main objective of this study is to understand the recurring phenomenon of malnutrition among the tribal communities living in rural areas of Nandurbar district of Maharashtra. Study tries to understand different casual factors at interplay leading to the severe conditions of malnourishment among children in rural areas of Nandurbar district. Methodology: The current study was conducted in rural areas of Nandurbar district of Maharashtra. The study followed a cross-sectional survey followed by qualitative interviews for understanding the phenomenon of malnutrition. The study employed a mixed research design and a deductive approach. Multistage sampling was used; for selection of blocks and villages simple random sampling was used with the criteria that 80 percent or more population living in village consists of schedule tribes. At the village level the sampling was done by snowball method. Key informants’ interviews of Anganwadi worker, CDPO of a development block, doctor at public health center and Auxiliary Nurse Midwife at sub center were held to understand the problem. Two focus group discussions were held for two women cohort of illiterate women and literate women, who have passed secondary exams to understand their perception about the persistent problem of malnutrition. Data were collected from August 2019 to February 2020. Bivariate and multivariate techniques have been used to understand the effect of household food security, access to healthcare services, role of ICDS services and different government schemes in tackling problem of malnutrition. To understand the effect of Covid- 19, key informants’ interviews were held with ANM and Anganwadi worker during the month of February 2022. Results: The study found that 80 percent of the tribals are living in poor households. The incidence of nutrition is at a higher end among the children living in rural areas. The access to healthcare services for pregnant and lactating mothers is constrained by social milieu. pproximately 38.5% of children are underweight when mothers receive full antenatal care, while the prevalence increases to 51.6% among children whose mothers did not avail any antenatal care visits (p > 0.1). The assessment of ICDS services reveals low utilization and subpar service quality, hindering effective functioning. Community participation in malnutrition management through VHSNC meetings has shown limited impact, emphasizing the need for a shift in community perceptions. To enhance engagement, incentives for attending VHSNC and Anganwadi center meetings should be considered. Introducing simple practices, such as offering snacks during Mata Bhaitak at Anganwadi centers, has the potential to boost attendance and participation. In accessing the Public Distribution System (PDS), households in rural Nandurbar face challenges due to inconvenient fair price shop timings and poor-quality food grains. The study indicates that underweight prevalence is significantly influenced by food insecurity compared to stunting and wasting. Approximately 12% of households are severely food insecure, correlating with higher rates of undernutrition in children from these households. Monoculture agriculture practices have adversely impacted dietary diversity, emphasizing the need for agricultural crop diversification and awareness about cropping patterns to address food insecurity in the region. Conclusion: The study commenced with the objective of comprehending the various factors contributing to the prevalence of undernutrition in rural Nandurbar. Framed within the conceptual framework established by UNICEF in 1990, which delineates the multifaceted factors leading to undernutrition in children, the research aimed to validate the existence of undernutrition among preschool children in rural Maharashtra. Beneficiaries of the Integrated Child Development Services (ICDS) were selected for participation in Focus Group Discussions (FGDs), facilitated with the assistance of Anganwadi workers from ICDS. In- depth interviews were conducted with key stakeholders such as CDPO, AWW, ICDS supervisor, and community elders. The study underscores the need for the state to broaden the reach of the Public Distribution System (PDS) to households lacking ration cards. Additionally, it recommends translating informational materials for pregnant and lactating mothers into Bhili language to enhance community understanding of undernutrition and potential solutions.