<p>The National Nutrition Week from Sept 1 to Sept 7 is being observed by the ministry of women and child department since 1982, in anticipation of a well nourished India. Ironically, in the middle of the same week on Sept 3, there was the case of the death of 11 new born infants, all less than 5 days old, within 48 hours in the Kurnool government hospital. A similar tragedy had occurred in June 2010, when 18 infants had died at Dr BC Roy children’s hospital, Kolkata.<br /><br />The Kurnool infants’ death were reportedly caused by medical negligence, malfunctioning ventilators, callousness etc. The hospital authorities, in defence, stated that the infants were of low birth weight, premature, malnourished, had serious respiratory disorders and hypothermia, and had little chance of survival.<br /><br />Without commenting upon the quality of care given by the Kurnool doctors in the absence of authentic information, I can state with a high degree of certainty that if the deceased newborns were indeed of low birth weight (below 2.5 kg), and malnourished, their chances of survival were already bleak. <br /><br />The NFHS 3, 2005-2006 states that Infant Mortality Rate is 49 (out of 1000 live births) for an average or large size baby, 62 for a smaller than average baby and 129 for a very small baby, and neonatal mortality rate is 30 per cent higher for a smaller than average baby and 183 per cent higher for a very small baby. The phenomenon of low birth weight babies is particularly acute in India.<br /><br />Poverty-primary cause<br />Why are these infants born with low birth weight? While poverty may be the primary cause, low birth weight babies are born because their mothers were malnourished, anaemic, with low body mass index and chronic energy deficiency. <br /><br />Evidence indicates that pregnant women, especially in rural areas, do not receive additional nutrition which they require. Hence their average weight gain during pregnancy is a mere 5 kg, against a desired weight gain of at least 8-10 kg. Going one step backward, these mothers are malnourished, because they were malnourished and underweight as adolescent girls, married in their teens and had repeated pregnancies, further deteriorating their already weak nutritional status. <br /><br />These inter-generational factors remain largely invisible, and even those afflicted are not aware of their seriousness. Because of lack of information and awareness, they are not considered serious health concerns by the family or community, but merely accepted as natural physical traits or the results of poverty. <br /><br />This perhaps accounts for an absence of popular demand to address it by the sufferers, no activists for the cause, and low priority to address it by government which is already submerged by visible high priority demands, such as providing schools, health centres, drinking water, electricity, roads, etc.<br /><br />The low birth weight babies that died in Calcutta and Kurnool are a logical outcome of the inter-generational and attendant factors described above.<br /><br />District and state hospitals are stretched beyond capacity because of inadequate primary and tertiary health care. They have just two options—either turn away emergency patients who have travelled long distances, saying they have no beds, or treat them in corridors or shared beds.<br /><br />So who do we blame? The doctors, the parents, the society, or the government? The nation appears to have forgotten Article 47 in the Directive Principles of State Policy of the Constitution that prescribes the “Duty of the state to raise the level of nutrition and the standard of living and to improve public health. The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties...”<br /><br />Unless the Central and state governments under their constitutional obligation formulate a comprehensive strategy to address the causes for low birth weight and malnourished newborns in the entire life cycle, the Kolkata and Kurnool tragedies will keep repeating. The Karnataka government is attempting precisely this through the Karnataka Comprehensive Nutrition Mission.<br /><br />The problem is complex, and so is the solution, but it is doable. We know the causes, we know the solutions, but must demonstrate political and administrative will towards action. The Maradonian explanation given by the health minister of Andhra Pradesh regarding the ‘hand of God’ in the tragedy simply cannot hold.<br /><br /><em>(The writer is a retired IAS officer)</em></p>
<p>The National Nutrition Week from Sept 1 to Sept 7 is being observed by the ministry of women and child department since 1982, in anticipation of a well nourished India. Ironically, in the middle of the same week on Sept 3, there was the case of the death of 11 new born infants, all less than 5 days old, within 48 hours in the Kurnool government hospital. A similar tragedy had occurred in June 2010, when 18 infants had died at Dr BC Roy children’s hospital, Kolkata.<br /><br />The Kurnool infants’ death were reportedly caused by medical negligence, malfunctioning ventilators, callousness etc. The hospital authorities, in defence, stated that the infants were of low birth weight, premature, malnourished, had serious respiratory disorders and hypothermia, and had little chance of survival.<br /><br />Without commenting upon the quality of care given by the Kurnool doctors in the absence of authentic information, I can state with a high degree of certainty that if the deceased newborns were indeed of low birth weight (below 2.5 kg), and malnourished, their chances of survival were already bleak. <br /><br />The NFHS 3, 2005-2006 states that Infant Mortality Rate is 49 (out of 1000 live births) for an average or large size baby, 62 for a smaller than average baby and 129 for a very small baby, and neonatal mortality rate is 30 per cent higher for a smaller than average baby and 183 per cent higher for a very small baby. The phenomenon of low birth weight babies is particularly acute in India.<br /><br />Poverty-primary cause<br />Why are these infants born with low birth weight? While poverty may be the primary cause, low birth weight babies are born because their mothers were malnourished, anaemic, with low body mass index and chronic energy deficiency. <br /><br />Evidence indicates that pregnant women, especially in rural areas, do not receive additional nutrition which they require. Hence their average weight gain during pregnancy is a mere 5 kg, against a desired weight gain of at least 8-10 kg. Going one step backward, these mothers are malnourished, because they were malnourished and underweight as adolescent girls, married in their teens and had repeated pregnancies, further deteriorating their already weak nutritional status. <br /><br />These inter-generational factors remain largely invisible, and even those afflicted are not aware of their seriousness. Because of lack of information and awareness, they are not considered serious health concerns by the family or community, but merely accepted as natural physical traits or the results of poverty. <br /><br />This perhaps accounts for an absence of popular demand to address it by the sufferers, no activists for the cause, and low priority to address it by government which is already submerged by visible high priority demands, such as providing schools, health centres, drinking water, electricity, roads, etc.<br /><br />The low birth weight babies that died in Calcutta and Kurnool are a logical outcome of the inter-generational and attendant factors described above.<br /><br />District and state hospitals are stretched beyond capacity because of inadequate primary and tertiary health care. They have just two options—either turn away emergency patients who have travelled long distances, saying they have no beds, or treat them in corridors or shared beds.<br /><br />So who do we blame? The doctors, the parents, the society, or the government? The nation appears to have forgotten Article 47 in the Directive Principles of State Policy of the Constitution that prescribes the “Duty of the state to raise the level of nutrition and the standard of living and to improve public health. The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties...”<br /><br />Unless the Central and state governments under their constitutional obligation formulate a comprehensive strategy to address the causes for low birth weight and malnourished newborns in the entire life cycle, the Kolkata and Kurnool tragedies will keep repeating. The Karnataka government is attempting precisely this through the Karnataka Comprehensive Nutrition Mission.<br /><br />The problem is complex, and so is the solution, but it is doable. We know the causes, we know the solutions, but must demonstrate political and administrative will towards action. The Maradonian explanation given by the health minister of Andhra Pradesh regarding the ‘hand of God’ in the tragedy simply cannot hold.<br /><br /><em>(The writer is a retired IAS officer)</em></p>
