The figure is chilling. Sixteen children die every day in Mumbai. Health minister Dr Deepak Sawant admitted this in the recently concluded monsoon session of the Assembly. While Sawant did not specify the areas where the deaths occurred, health experts say it could be mainly urban slums.
The minister attributed the main reasons for these deaths to communicable diseases, diarrhoea and respiratory problems. However, health sector professionals were not willing to buy the explanation.
Malnutrition is the main reason, as it first leads to low immunity, and later into some disease, they argue.
“It is absolutely wrong to say there is no malnutrition in Mumbai,” said Neeraj Hatekar, director and professor of econometrics, department of economics, University of Mumbai, co-author of a study: “Quietly they Die: A Study of Malnourishment Related Deaths in Mumbai City” in 2003.
Amin Patel, one of the two Congress MLAs who raised the question in the Assembly, said: “Malnutrition is the biggest reason for these deaths. The government has not admitted this … it must accept this (fact) and sort it out.”
Agrees a former BMC executive health officer. “Malnutrition exists in urban slums, though we usually presume it is prevalent only in rural and tribal areas. In urban slums and lower income group areas, parents are forced to work for a living and cannot pay attention to the needs of their children,” he said.
“Actually, malnutrition in Mumbai’s kuccha slums equals malnutrition among the poorest families in tribal areas,” said Hatekar. “Malnutrition must be declared as an epidemic since they lead to so many deaths,” he demanded.
“Malnutrition is not a disease. (However)… it can lead to diseases like diarrhoea and vomiting. This cycle leads to malnutrition (again),” said Hatekar, adding that the ultimate cause of death was seen as these diseases.
Lack of clean water, sanitation and employment of mothers in the unorganised sector, which prevented them from breast-feeding children at regular intervals, are some other causes, he said.
“These children do not get proper health care. Moreover, many women have a low body mass index (BMI), which results in their children being born with low weights. This is a cycle of low nutrition and infections,” said Hatekar.
So, what’s the government’s action plan? According to Sawant, to prevent these deaths, the Brihanmumbai Municipal Corporation (BMC) was registering and vaccinating pregnant women, conducting pre- and post-delivery health check-ups, promoting breast-feeding, providing iron and Vitamin A tablets, guidance about nutrition and personal cleanliness. The BMC is in the process of establishing a committee to screen deaths of newly born and infants.
“The issue is linked to lack of potable water and unhygienic conditions,” said Dr Anuradha Sahasrabuddhe, director of Pune-based Dnyanadevi and a nutritionist. She said that misconceptions about keeping infants hydrated when they had diarrhoea and not maintaining the required electrolyte balance also took a toll on children. “There is a cycle of infection, diarrhoea, malnutrition… (exacerbated by) ignorance and neglect,” said Sahasrabuddhe, adding that if the mother was malnourished, this was passed on to the child.
Gender factors like sex of the child and the number of siblings also had a bearing on child health care. “Neo-natal care and facilities have not percolated to the ground level,” said Sahasrabuddhe.
According to Sawant, 32,664 children have died in Mumbai from 2008 to 2012. His written reply was in response to a question by Radhakrishna Vikhe Patil (Congress- Shirdi) and Amin Patel (Congress- Mumbadevi).
In these five years, the number of deaths of children were 3,365 in Thane, 172 in Nashik, 6,113 in Pune, 1,707 in Aurangabad and 8,427 in Nagpur.
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