DHARNI: Mothers with wailing, protesting children troop to the anganwadi in Dharan Mahu village, about 10 km from Dharni in Maharashtra. The children seem to dread what's inside, though it is only a simple machine brought to record their weight.

Dr. Renuka Naik and her assistant set up the weighing scale, to which is attached a makeshift chair for infants. Dr. Naik works with Dr. Ashish Satav in a three-year tribal health research project in Melghat, which comprises Dharni and Chikaldhara taluks of Amravati district. The project covers 36 villages, a statistically significant sample size.

In its first year of work, from January 1 to December 31, 2004, the study recorded that the infant mortality rate for the area was 75 per 1,000 live births as opposed to the Government's figure of 44 per 1,000 live births. Based on this study, Dr. Satav says that about 800 children under five years of age would have died in Melghat in 2004-05 as opposed to the Government figure of 468. Since 1994-95, over 500 children are dying every year in the Melghat region, many of them due to malnutrition. In 1996-97, more than 1,000 children died. Dr. Satav's study indicates that the Government data is far from accurate. The infant and under-five child mortality rate in Melghat is the highest in Maharashtra.

The project early on realised that the best way to reduce child deaths was prevention, and door-to-door health care played a vital role in this. Last year, it had launched a programme of arogya doots or health workers in each of these 36 villages. Emulating the example set by pioneering community health doctors, Dr. Abhay and Dr. Rani Bang in Gadchiroli, Dr. Satav too trained these arogya doots in the identification and treatment of commonly prevalent diseases such as malaria, diarrhoea, pneumonia and also to tackle malnutrition. Their practice of weighing children every month and recording their weight forced the anganwadi workers in some villages to do the same, and to include severely malnourished babies in their list, says Dr. Satav.

The Government too made efforts to step up the Integrated Child Development Scheme (ICDS) in Melghat and make sure the anganwadis get enough food for distribution. There is a special focus on weighing children and feeding the malnourished ones four times a day. The anganwadis provide food to children below six years and pregnant women. The Government is now tackling malnutrition in a mission mode and had appointed an evaluation committee on child deaths in 2003. Its report was submitted earlier this year.

Up to 13 children

However, despite the scaling up of health services, the people often go to private doctors or local healers or in some cases, Sumitra Maraskole, the anganwadi sevika at Dharan Mahu, says that some women have up to 13 children. "When we advise the mother on curtailing births, they tell us not to interfere, specially in such matters," she says. She admits, though, that the woman, who delivered 13 times, was now left with just two children.

Savita Jambhekar, the arogya doot in Dharan Mahu, records births and deaths and fills forms every month keeping her records up to date. She feels women are quite careless about their children. "They don't even name their children. There are so many women calling their children Ramkali, so we change the name," she says. One in four children born in Dharan Mahu weighs below two kg. Many of them are kept in incubators for a couple of days. There are 105 children in grade one of malnutrition and 77 in grade two. Nine children are severely malnourished. In Beradaballa village most of the 20 pregnant women weigh an average 42 kg. All are anaemic and complain of blackouts, swollen feet and a burning sensation during urination, according to Urmila Kasdekar, the arogya doot. Many women also start eating less when they are pregnant to have a safe delivery and this is what causes malnutrition in the children, according to the anganwadi sevikas.

Urmila, who has studied up to VII standard, tries to advise the women and she can diagnose and treat pneumonia and malaria.The Government too has appointed "pada" workers for each hamlet but they seem to have few medicines and are not available when needed. Urmila treats about 60 people.

Shamim Sheikh of Hirabambai village, 45 km from Dharni, says that sterilisation of women is important to safeguard their health. That reduces the pressure on women, she says. However, that is no answer to many women who have no health care and are to travel to far-away government hospitals. The high mortality rate of children also makes them reluctant to go in for sterilisation.

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