The state government’s year-old scheme to curb severe malnutrition through a readymade paste is witnessing a poor response in tribal areas, with children either suffering side effects or refusing to eat the same.
Ready to use therapeutic food (RUTF), or energy-dense nutritious food (EDNF), is a fortified paste of peanuts, oil, sugar, vitamins, milk powder and mineral supplements. A survey — conducted by Jan Arogya Abhiyan, a collective of health NGOs, in May — on 20 malnourished children in seven tribal blocks across the state have shown that 50 per cent of the children remained severely malnourished despite consuming this paste for three months. In half of the cases, vomiting and dysentery were noticed.
In the tribal hamlet of Nandurbar, a year-and-half-old Samudra Pawara has slipped into severe malnourishment twice, despite consuming RUTF. Since August 13, she remains admitted in a nutrition rehabilitation centre in Dhadgaon hospital, where doctors are trying hard to improve her weight.
“She weighed only 5.5 kg. Now, after 15 days of intensive treatment, her weight has increased to 6.6 kg,” said dietician Vidya Nikumb. A toddler, Samud-ra’s age must weigh above 10 kg.
Her mother Mamata Pawara, a farmer, said Samudra vomited every time she ate RUTF. “After a few weeks, I stopped giving her the paste,” she added.
About 350 km away in Palghar, tribal children are facing similar issues. Aged two, Sarthak Bhoir weighs 7.5 kg, five kg less than the normal weight. Local anganwadi records showed that he has been severely malnourished since a year and eats dal and rice twice a day. “When the anganwadi gave him the paste, he didn’t like it. He still eats it, but his weight has not increased much,” mother Baby Bhoir said.
At Nandgaon, a remote tribal hamlet in Palghar, anganwadi workers said while the paste has pulled some children out of malnutrition, most children remain severely malnourished. “Children vomit, suffer dysentery, or can’t eat the full packet of RUTF. If the packet remains open, children may get infected,” said anganwadi worker Surekha Patekar.
Back in Nandurbar, Prakash Sonawane, attached with NGO Janarth, said: “In some cases, children get addicted to the paste and refuse to eat anything else. Parents approach anganwadis for RUTF even after the prescribed three-month course is over.”
“But once the course is over, the children relapse soon into malnourishment,” said Sonawane. A child development project officer told The Indian Express that the state women and child development department has been informed about these issues. Officials said that after multiple complaints, anganwadi workers have been asked to submit detailed reports on the performance of RUTF.
However, Indra Mallo, commissioner of Integrated Child Development Services, which is implementing the RUTF project, said: “There has been improvement in malnourishment. We are getting good results due to RUTF.”
Health activists said that the readymade paste is expensive when compared to locally cooked meals. The state government spends Rs 26.8 per packet for each child, and there are at least 80,000 severely malnourished kids. The cost of treating one child with RUTF for three months comes to Rs 7,236.
According to a Right to Information (RTI) reply, in September 2018, the department had awarded a tender of Rs 38.4 crore to three companies to make RUTF for 85,452 severely malnourished children, who have extremely low weight when compared to their age and height.
In February this year, two of these companies — Venkatesh-wara Mahila Audyogik and Mahalaxmi Mahila Audyogik Bal Vikas Bahuddeshiya Sanstha — were pulled up by the Supreme Court for falsely acting as self-help groups to win a take home ration tender. While the state went on to cancel the ration tender on the court’s order, it did not stop two companies from manufacturing RUTF.