A reflection on inadequate nutrition and unsupervised child care
October 6, 2023
SPECIAL ARTICLE
By Teresa Khyriem
“If we could have but one generation of properly born, trained, educated and healthy children, a thousand other problems of government would vanish” Herbert Hoover
In my experience as a public health nurse, I have come across countless numbers of young children who are deprived of adequate nutrition and care that would enable them to be healthy in every sense. This concerns me greatly because a child’s growth and overall development is of utmost importance and largely depends on the child’s parents and caregivers.
The UN Convention on the Rights of the Child, says every infant and child has the right to good nutrition. WHO states that undernutrition is estimated to be associated with 2.7 million child deaths annually or 45 percent of all child deaths globally. Optimal breastfeeding is so critical it could save the lives of 8,20,000 children under the age of 5 years each year.
WHO and UNICEF recommend exclusive breastfeeding for the first six months of life and introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.
As per National Family Health Survey (NHFS-5), 42.7 percent of infants in Meghalaya were exclusively breast-fed and 66.8 percent introduced timely complementary feeding (6-8 months). As per NFHS-5, timely introduction of complementary feeding at 6-8 months and diet adequacy are important indicators of young child feeding practices.
From my experiences of serving in rural areas, and having interacted with mothers from time to time in my daily practice, I learnt that a vast majority of mothers don’t follow exclusive breast-feeding. They feed rice or rice gruel to their infants as early as two months. The reason they cite is that breastmilk alone cannot satiate the baby’s hunger. Their complementary feeding mostly includes rice and boiled vegetables. Meat, eggs or milk are rarely fed to their child as a complementary feeding. Instead, infants and young children are given rice gruel or red tea, two to three times a day in place of milk. This is due to poor socio-economic status.
On a recent visit to a child clinic, I met an elderly woman who hails from a village in Ri-bhoi district. She was carrying a 9-month-old baby on her back. We chatted for a while and she narrated that the child she is carrying is her grandchild whose mother died a few months back leaving behind her 9-month-old into her care. Out of concern, I asked her what she feeds her grandchild as she appeared sick and under-nourished. She replied “I feed her only rice with a pinch of salt everyday”. This moved me and the least I could do at that time was a little bit of counselling on healthier food choices she can add to the child’s diet.
A study conducted in 2019 reported many deficiencies in the diet of primary children in Meghalaya like deficiency in vitamins (vitamin B, C and D) and minerals like iron. This study also reported that non-inclusion of milk and milk products has resulted in nutrient deficiency in tribal primary children of Meghalaya.
Most rural mothers work hard and don’t receive as much pampering or support as other modern, privileged women. A mother of seven children says her day starts by going to a nearby river to wash clothes and then she goes to the field and toils there tirelessly all day. Sometimes she takes her infant along with her on her back to work. Her tiresome duty makes her less available to provide quality time to her children.In rural areas, what is commonly seen is that the family size is large (6-8 children per household) and income is low, thus resulting in poor health condition.
Most rural parents in Meghalaya are farmers, so when they set out to their fields to work, their infant is left to be cared for by an older sibling who is a child himself/herself. Children as young as 9 years old are left alone with no adult supervision in the house since parents need to earn their daily bread. In such circumstances, children accidentally play with sharp objects like knives and daggers which are unintentionally kept within their reach and they succumb to injuries. I’ve seen many such instances of injured children being brought to the health centers where I used to work. Apart from this, unsupervised children are more likely to fall prey to many anti-social behaviours like stealing, bullying and sexual assault/abuse. This is indeed a sad reality that is happening in this day and age.
Several studies have reported on the dangers of leaving children unsupervised at home. One such study by Monica et al, 2018 reports that lack of quality supervision is linked to unintentional childhood injuries and negative outcomes. Children are too young to be doing child-care. The study also reports that in many countries, young children from the poorest households are likely to experience non-adult supervision.
I have also come across instances of poor feeding practices and poor child-care during my long-term work experience in the rural areas.
In urban areas, the child feeding practices and care are slightly better among educated parents and those with higher family incomes. They can also afford better facilities for their child. Educated parents feed their children the right food values including exclusive breast-feeding.
However, the case with urban poor is different from the rich and educated as problems of inadequate nutrition and poor child care are highly prevalent. In fact, Singh and Sandhu cited in their study (2014) that the nutritional status of urban slum children is worst among all groups and even worse than those of rural poor.
A study by a team of doctors of a tertiary hospital in Meghalaya (2022) states that the staple food of people in Meghalaya is mostly rice with a portion of meat or fish. There is poor protein intake in their diet which leads to stunting and poor cognitive development.
Proteins are the building blocks that also repair tissues in our bodies. Deficiency in protein can result in stunting, decreased muscle mass, and weakened immunity. Local foods that are rich in protein include: ‘rymbai ja’ (soybean seed), ‘shana jhieh nei-iong’ (black chickpea with black sesame seeds), dai nei-iong (pulse with black sesame seeds). Ja neilieh (rice and perilla seeds pulao) and ja neiiong (rice and black sesame seeds pulao) are rich in iron and calcium. Tubers such as sweet potatoes and ‘shriew’ (yam) are rich in calories and calcium. The traditional snacks like putharo, pumaloi, pukhlein are rice-based snacks and have a high carbohydrate and calorie content. Meghalaya is home to many other wild edibles which are rich in vitamins and minerals. (Study by Blah and Joshi 2013)
The extent of nutrient deficiency in children in Meghalaya is distressing given the fact that there is a wealth of both cultivated and wild food resources. Good nutrition for a child should start from pregnancy through lactation and so forth. Effective communication and education to mothers since pregnancy is important for better outcomes (study by Chyne 2018). (The writer is with IIPH, Shillong)
Health, especially ‘child health’ is one of the most important indicators in any State or country. I urge that more maternal and child health support groups be set-up in different parts of rural and urban Meghalaya and existing ones to be strengthened in order to fill the gaps. People need to be properly educated on incorporating affordable yet nutritious food. As health is a right of every individual, it is only fair that everyone attains it!
(The writer is with IIPH, Shillong)