NRCs crunch shoots up acute malnutrition
With interventions via the Nutrition Rehabilitation Centres (NRCs) to curb severe malnutrition (SAM) in Odisha moving at a snail’s pace, the enormity of acute malnutrition haunts the State.
The recently-released National Family Health Survey (NFHS)-4, 2015-16 reveals the grim fact of a rise in proportion of severely-hit children below five years in last decade by a whopping 1.2 points to touch 6.4 per cent vis-a-vis 5.2 per cent in 2005-06.
The rise is not unexpected because the harsh fact is a high of 18 districts (Malkangiri, Koraput, Rayagada, Gajapati, Ganjam, Kandhamal, Kalahandi, Balangir, Nabarangpur, Nuapada, Bargarh, Boudh, Subarnapur, Sambalpur, Jharsuguda, Sundeargarh, Keonjhar and Mayurbhanj) have more than half of the child populace under five in the stunting category.
Another four districts have a proportion of 40 per cent to 50 per cent stunted children. On an average, at least one-third of children under five years of age in 29 of 30 districts are in the grip of malnutrition, reveals a recent National Rural Health Mission (NRHM) analysis.
In this context, the shocker is Odisha could see a mere 45 functional NRCs in the high-burden under-nutrition districts, which the Unicef termed as a game-changer intervention in reviving young lives.
Highly-placed sources in State Health Department revealed that a lackadaisical approach in bringing up adequate NRCs as intervention centres to curb under nutrition in high-burden districts was the main cause of high U-5 and infant deaths at the Cuttack Shishu Bhawan and the VSS Burla last year. Even, the latest data with State Health Department revealed that nearly 18 per cent of newborn deaths in Odisha in 2016-17 have been for the cause of low birth weight (LBW), which is an outcome acute malnutrition.
How apathetic was the State in establishing NRCs is evidenced by fact that when a non-high focus State like Gujarat had a total of 124 NRCs in 2015-16, Odisha being a high-focus State had a mere 45. In comparison, high-focus States like MP, Chhattisgarh and Jharkhand have 315, 62 and 68 NRCs, respectively. Besides, Odisha could add up a mere four NRCs during the period 2013-16 to reach 45. Only around 16 NRCs are functional in as many as nine high-burden western Odisha districts.
Moreover, MP, which has been the leading State in country in effective implementation of NRC intervention, has on an average recorded enrolment of a whopping 315 children per NRC annually vis-a-vis a mere 150 in Odisha. Even, Chhattisgarh has a better figure to show with 190 enrolments annually. Reason: The bed occupancy (each NRC has around 10 beds) in Odisha has been around 50 per cent only.
Why has Odisha been poorer in enrolment? According to NRHM sources, poor detection of SAM in the ground owing to poor use of MUAC (Mid-upper arm circumference) tape and poor detection rate of SAM with complications in CHCs (Community Health Centres). Also, many SAM children with complications were admitted to paediatric wards despite the NRCs having a paediatrician each. Poor detection rate and high load at paediatric wards then resulted in more U-5 mortality recently in Odisha.
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