"Some of these children might not make it. They might die any time. All it takes is Rs15 a day to keep them alive if we get to them on time," says Dnyaneshwar Tarwade, head, resource, mobilisation and health at Indira Nagar’s Nutrition Rehabilitation Centre, pointing to the row of children in a 10x15 room.
This year, Indira Nagar alone has seen six malnutrition deaths in children, he added.
"Some children couldn’t even walk when they got here. A month later, their condition improved. In the beginning, when we put food in front of them, they didn’t know what to do because all they’re given at home is water or milk. So our staffers have to feed each of them," he says.
After the state government recently released The Comprehensive Nutrition Survey, a report along with International Institute of Population Sciences and Unicef, stating that the malnutrition figures had dipped in Maharashtra, social workers and doctors working in Govandi feel the figures are much higher.
"In villages in Maharashtra, the issue comes under the health department but in Mumbai, the state government runs the Integrated Child Development System (ICDS) and health comes under the Brihanmumbai Municipal Corporation. That’s why the issue is not addressed comprehensively," says Tarwade, who has worked in this field for 25 years.
He adds: "Moreover, the number of home deliveries and deaths are not registered so the government has no clue and the figures are low."
Professor Sayeed Unisa of IIPS, who was a part of the survey, echoes Tarwade. "There is no consolidated data from the past in these slums for us to compare the figures. So there’s no way to see if the situation has improved. Our data was from different income groups (low, middle and high) of different communities and not only from hospital records. Obviously, if we concentrate on the low-income group then the figures will automatically be high," she says.
The findings of The Comprehensive Nutrition Survey suggested that the ICDS works better in the rural setup rather than the urban areas, Unisa said. "In the urban areas, people don’t even know where the ICDS centres are. Awareness is much better in villages, where pregnant women and children both get nutrition," she says.
Sanitation issues, scarcity of clean water, early marriage due to insecurity of girl children in the slums, early pregnancy and no spacing between children are some of the reasons for malnutrition in the slums.
Susceptibility to diseases like pneumonia and diarrhoea in children and stunted growth are some of the effects of malnutrition, which lead to death. "The deaths are often attributed to the diseases so the figures of malnutrition might appear less, when they are not," said a social worker.
Leena Joshi, project director of the M Ward Project from the Tata Institute of Social Sciences, says: "Slumdwellers are deprived of water and sanitation. This affects the health of adults and children, who are even more vulnerable. As it is, these communities live on the fringe of society and have insecure livelihoods, housing and infrastructure. Their overall human development indicators are extremely poor so it leads to death. Malnourished children will be the worst affected as their resistance to diseases is low."
With a population of six lakh, Shivaji Nagar has several bastis. Apnalaya runs programmes in some of the peripheral bastis housing 35,000 people. "Around 6,000 families reside there. We run deworming programmes, administer Vitamin A and run a supplementary nutrition programme there," said Tarwade.
Ideally, the children should be weighed every month. But, Tarwade says that out of the 135 anganwadis in Shivaji Nagar, which feed 19,000 children, 50% don’t have weighing scales to monitor a child’s health.
Only 5,000 to 6,000 children are weighed, say healthcare workers. "Then, how will the state have accurate figures?" says Tarwade.
Either anganwadis have electronic weighing scales that are defunct or teachers don’t know how to operate them. Electronic scales have automatic gradation of weight which points out which category of malnutrition the child falls in.
Since September, Apnalaya with government officials has been weighing children and found that 55% suffer from severe or acute malnourishment.
To make matters worse, 70% of anganwadis in the area run in people’s homes, where there is hardly any space. The central government, through the ICDS, has stipulated Rs750 as rent for an anganwadi, says Bharati Pandirkar, a field officer who has worked in the area for a decade. "Rent here is much higher than that. Families give their room on rent and it can barely accommodate 30 children. The woman of the house becomes the teacher," she says.
"How will they study there for three years? Anganwadis should be a separate entity and the government needs to increase the rent. The corporator uses his funds to open gyms, why can’t they contribute towards an anganwadi?" she adds.
Dr Sudha Datye, who has designed the nutrition timetable at the Indira Nagar centre, blames the ignorance of parents for the high death rate.
Between April and October this year, Mankhurd’s eight slums saw 14 children die of malnutrition. Thirty percent of the deliveries are at home and if the death occurs at home, often there is no record. "Parents stick to their religious beliefs and have children one after another. There is no family planning. They don’t know that after six months, a baby should be given nutrition and not just milk," says Dr Datye.
The state uses only weight-for-height category to measure malnutrition.
"The figures will be much higher if they adhere to the World Heath Organisation guidelines, which includes the weight-for-age and height-for-age categories," she adds.