Abstract

Nutrition and health are important for everyone, but they are especially significant for children as it is directly linked to their growth and development; factors which will have a direct impact on their health as adults. Nutrition and the health of the children of the age group 0-5 years is an important focus area as onset malnutrition at this stage can have long term and long lasting repercussions. Children are particularly vulnerable to malnutrition in the first two years of their life. If proper care is taken, these two years can become window of opportunity for tackling poor h3ealth and nutritional status of the children. Children belonging to the marginalized sections like Dalits and Tribes are especially vulnerable to poor nutritional and health status. This study was an attempt to assess the various factors which may be directly or indirectly influencing the nutritional health status of the study population in the study area.

Introduction

Malnutrition has been defined as “a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients.” It consists of four forms: Under- nutrition, Over-nutrition, Imbalance and the Specific Deficiency (Srilakshmi, 2006). It is, therefore, one of the major public, administrative challenges faced by most of the developing nations. Malnutrition is serious and one of the major concerning issues in the public and administrative space of the developing countries and is the underlying cause of the death of around half out of the ten to eleven million children every year under six years of age. The latest HUNGAMA Report (2012) released says ‘every third malnourished child on the planet is an Indian’. The report is said to have represent the first statistically valid study on malnutrition since 2006 and the data in the report covers vast portion of the Indian villages and the children of the 100 poorest districts (defined by the UNICEF in 2009) called the 100 Focus Districts. In study, majority of the children under five years of age were underweight and were stunted. India’s Global Hunger Index (GHI, 2009) score on malnutrition says that India has the largest number of stunted, wasted and underweight children in the world with twelve Indian states having ‘alarming’ level, and the condition of Madhya Pradesh, known as the heart state of India, is ‘extremely alarming’ and is same also according to the Indian State Hunger Index (IFPRI) and received a severity rating between Ethiopia and Chad.

With the above issues, and the importance for study of the nutritional health status of the tribal children, the present paper shows important factors related to the issue of the nutritional health status of the tribal children. The study was conducted To understand the Socio-economic, demographic, cultural practices of the study population., to understand the nutritional status of the study population, To understand the health care services availability and utilization of the study population, to understand various programmes (ICDS, PDS, Mid-Day Meals, and NREGA) related to the present study in the study area, to evolve appropriate strategies related to the programmes and policy implementation for the welfare of the population of the study area.

Laying the Frame and Context of the Study

Maharashtra (Abbreviated as MH) is a state in the western region of India and is the nations and also the world’s second-most populous sub-national entity. It has over 110 million inhabitants and its capital, Mumbai, has a population of approximately 18 million. Mumbai is also the financial capital of the nation and the headquarters of all major banks, financial institutions and insurance companies in the country. India’s Hindi film industry, Bollywood, and Marathi film and television industry are also located in this state. Maharashtra’s business opportunities along with its potential to offer a higher standard of living attract migrants from all over India.

Raigad District

Raigad District (Marathi: रायगड), is a district in the state of Maharashtra, India. It is located in the Konkan region. The district was renamed after Raigad, the fort that was the former capital of the Maratha leader Shivaji Maharaj, and is located in the interior regions of the district, in dense forests on a west-facing spur of the Western Ghats of Sahyadri range. In 2011 the district had a population of 2,635,394, compared to 2,207,929 in 2001. In 2011 urban dwellers had increased to 36.91percent from 24.22% in 2001.

The district is bounded by Mumbai Harbor to the northwest, Thane District to the north, Pune District to the east, Ratnagiri district to the south, and the Arabian Sea to the west. It includes the large natural harbor of Pen-Mandwa, which is immediately south of Mumbai harbor, and forming a single landform with it. The northern part of the district is included in the planned metropolis of Navi Mumbai, and its port, the Jawaharlal Nehru Port. The district includes towns/cities of Panvel, Alibag, Mangaon, Roha, Pen, Khopoli, Kharghar, Taloja, Khalapur, Uran, Patalganga, Rasayani, Nagothana, Poladpur, Alibag, Karjat and Mahad. The largest city both in area and population is Panvel. The district also includes the isle of Gharapuri or Elephanta, located in Uran which has ancient Hindu and Buddhist caves. Raigad district is divided into four subdivisions, with fifteen talukas, and 1,967 villages.

Demographics of Raigad

According to the 2011 census, Raigad district has a population of 2,634,200, roughly equal to the nation of Kuwait or the US state of Nevada. This gives it a ranking of 153rd in India (out of a total of 640). The district has a population density of 368 inhabitants per square kilometer (950/sq mi). Its population growth rate over the decade 2001-2011 was 19.36%. Raigad has a sex ratio of 955 females for every 1000 males, and a literacy rate of 83.89%. Several scheduled tribes live in Raigad district. Among these are the Mahadev, Koli, Katkari and Thakur.

The People

Several districts in coastal Maharashtra face the perennial problem of water shortage despite getting bountiful rains during the monsoons. Lack of water is a particularly acute problem during the months after the monsoon season. Raigad is one such district, where a number of villages and hamlets inhabited by Adivasis or tribals face acute water shortage leads to many health and socio-economic problems. The total population of the Raigad district is 18, 24,816, of which the tribal population is 2, 33,953 (12.82 percent of the total population of the district, which is higher than the state and national average). Most of the households in Gudwanwadi hamlet live below the poverty line. Further, 51.11% households are landless. The main community in the village – the Thakars finds a place at the bottom of the socio-economic hierarchy. While the overall literacy rate is 44.67%, the literacy rate among persons below the age of 25 is around 90percent. However, the extent of unemployment in the hamlet is very high. Basically the villagers depend on agriculture for their livelihood. However, it is hard for them to survive on agriculture alone. As a result, the working population of the hamlet migrates to nearby mainstream towns and cities. Large-scale migration occurs in the lean season between November and May, the extent ranging from 60-80 percent in Karjat taluka. Families migrate to work on brick kilns in the villages or towns nearby and also engage in agricultural or construction labour. Agriculture in the village is of a subsistence type and is rain fed. Rice is the staple crop in the hamlet. The staple diet consists of rice, dal and vegetables. In nutritional terms, this falls far short of the requirements of a balanced diet. Poverty also contributes in placing a nutritionally sound diet beyond the reach of the average household. This is manifested in the form of various diseases among the people, women and children mostly.

The Community

Raigad district is one of the most populated districts of the Adivasi (Scheduled Tribe) community in the Konkan region of Maharashtra. The Adivasis who are present are the Thakars, Mahadev Koli while the Katkaris are also prominent in the region. These tribes are concentrated in different parts of the district. There is a hierarchy of tribes, but this hierarchy is ambiguous and may not be accepted by a particular tribe in question. In Raigad district particularly, the tribal community is often characterized by mutual mistrust. Thakars believe themselves to be superior to Katkaris but Katkaris believe that they are not dominated by any other community. This may happen because the community is polarized along political lines in several villages, where the Kunbi upper strata land owing community also one of the dominant social groups.

Economic Status: The community suffers from a high degree of economic deprivation. Single season subsistence agriculture is the norm, with the second season being taken up by migration to brick-kilns and other sorts of daily wage work. This is despite the fact that the region receives plentiful rainfall in the monsoon. Unfortunately, the absence of rainwater harvesting methods means that rainwater goes waste and water sources dry up by January- February. Thakars are a landless community and depend upon laboring in the farms of land owner tribal as well as those of non-tribals in nearby villages. This migration could be categorized as daily migration as they have to go in search of employment in nearby villages to get work and the two square meals a day. Alcoholism is high in the community, also the consumption of tobacco.

Political Situation: The Indian National Congress Party, Communist influenced Shetakari Kamagar Party and Shiv Sena are the major influential parties in the area. However, social- political rivalry does not arise from ideological commitment; party loyalty is dictated by personal gain more than anything else.

Epistemological Considerations

The study area of research is the Karjat Tribal Block. It has a substantial tribal population. The main tribes in that area are “Mahadev-Koli”, “Katkari”, “Thakar” and “Warli” tribes. These are the tribes which have been subjugated for long time in the past and that they are not having access to the resources, facilities makes it crucial to study them.

The hamlet where the study is conducted is a tribal hamlet. All residents of the village belong to the Katkari Tribe and are followers of Hindu religion. In spite of being in proximity to a city like Karjat, the area is still underdeveloped in plethora of aspects. The people are illiterate, landless, unemployed residents. The Tribal Community is one of the marginalized sections of the society and Tribal Children are further vulnerable. Any nation develops when the population of the age group 15-59 is developed physically and psychologically. The process of this development starts right at a very tender age. In this, Nutrition plays an important role of development of the Child. However, there are many children who are affected by the issues of nutrition. There are two types of malnutrition viz. Over-nutrition and under-nutrition. Also, it becomes essential to understand why children were selected. As per international standards, there are five vulnerable groups in any society viz. Children, Adolescent Girls, Pregnant Mothers, Lactating Mothers and Elderly People. Out of them, Children are the foundations of the future development of the society. Therefore, it becomes essential to select and study Children. The rural area faces the grave problem of Malnutrition due to several factors. Also, there is very little awareness regarding Malnutrition in the rural area.
Are the schemes and programs being implemented is the crucial question. Also, there is very less availability of the medical services in the rural area. Therefore, the study of Tribal Malnutrition becomes extremely essential.

Purposive sampling technique was used for the study due to time constraint. A house to house survey was conducted in Salokhwadi village of Karjat Taluka in Raigad district of Maharashtra. Mothers who have children less than or equal to 5 years of age are taken as respondents for the study. Sample size of 50 mothers was interviewed for socio-economic, health, nutritional and cultural information. Anthropometric measurements of 50 children were taken. The youngest child under the above mentioned age group of the family was considered as the sample. A structure interview schedule was prepared for the respondents. A focus group discussion guide was also prepared for discussion between two separate groups viz. the women who were illiterate and mothers who had taken formal education. Focus group discussion aimed to understand the impact of mother’s child care experience on child’s nutritional status and health. Open ended interviews were done with key informants in the village. Along with this, information of various cultural practices has been collected from village elders. The quantitative data has been analyzed by using the Statistical Package for Social Sciences (SPSS). Anthropometric Measurements were used wherein the height and body weight of the child was recorded. For measuring weight, standard weighing machines were used; for height standard measurement tape and scale were used.

HEALTH STATUS: THE CONCRETE CONDITION

In this chapter, the issues and information about the health care services in the study area are discussed. This part predominantly deals with the medical and health care services in the area. Here, the researcher probes about the sex of the child, age of the child, birth order of the child, Vaccination details, Questions regarding the delivery of the child, illness of the child, treatment given during the child was ill etc. Also, questions regarding the various health care institutions were also asked.

Ante Natal Care Visits for the Mother: All the respondents have availed the facility of Ante Natal Care. It was also confirmed from the ASHA Worker that all the mothers had Ante Natal Care Visits.

Tetanus Shots: All the respondents received Tetanus Shots. This happened due to the constant check by the Anganwadi worker whenever the delivery took place.

Iron and Folic Acid Tablets: All the respondents (100.0%) have consumed Iron and Folic Acid Tablets during the pregnancy of the child.

Vaccination of the Child: All the Children are vaccinated. There is a 100.0% vaccination.

Place of Child Birth: There were three places where the deliveries took place viz. Home, PHC and District Hospital. Out of the 50 respondents, 64.0% of the deliveries (32 families) took place at home. While the data shows that 26.0% (13 families) at PHC, 10.0% (5 families) took at District Hospital in Raigad. Data on place of delivery reveals that majority of the births (64.0%) took place in Home. This shows that there are large numbers of non-institutionalized deliveries.
Table 1: Place of Delivery

Non-institutionalized deliveries are dangerous for both the mother as well as the child. Poor sanitation and hygiene, use of unsterilized equipments and medically untrained or inadequately trained persons make non-institutionalized deliveries highly dangerous. Chances of Tetanus and sepsis drastically increase in such scenario. This data implies that one needs to push for the awareness about institutionalized deliveries and avoid deliveries taking place at home.

Type of Delivery: All the deliveries were Normal Deliveries. No Caesarean was observed

Health Personnel Assisted in Delivery of the Child: Deliveries assisted by trained medical professionals are essential for the safety of the mother and child. From the table, it can be seen that there was a range in response given by the respondents on the question of who assisted them in their deliveries. As most of the deliveries took place at home, the traditional assistant, also known as Dai in the local language, was the one to assist. In all, 62 .0% deliveries took place where Dai was the assistant during the time of delivery. In addition, there were 28.0% (14 families) deliveries where Auxiliary Nurse Midwife (ANM) was the assistant during the delivery. Also, 10.0% (5 families) deliveries were such where the doctor was the assistant during the delivery. The data shows that only 38.0% of the deliveries were institutionalized deliveries with majority being the home deliveries.

New Born Child Weighed: All the Children were weighed after their birth.

Health Seeking Behavior of the Child: When asked whether the child has experienced any illness during last six months, 62 .0% said yes while 38 .0% respondents said that their child had not experienced any illness during the last six months.

Place of Treatment: Further when asked about, To whom did you take your child to get treatment, out of the 31 respondents, 7 said that they do self-medication while 3 said that they go to the traditional healer, 3 go to government hospitals at Kadav or Karjat.

Table 2: Place of Treatment

Majority of the respondents (13 respondents) said they go to quack practitioners or private hospitals. These accounted to 41.93%. 5 respondents said they opt for ‘Other’ treatment options. (Table 2)

Colostrum Given to Child: All the respondents have given Colostrum (चीक दध) to their child immediately after the birth. This is an indicator of the fact that the community supports feeding Colostrum to the new born child. The Anganwadi Workers had special efforts to make the community to understand the importance of the Colostrum to the child. This has benefitted the child immensely.

Number of times breastfeeding to the child: Majority of the respondents (34.0%) breastfeed the child once in a day followed by respondents feeding twice a day (30.0%). There are cases (26.0%) where the child is breastfeed three times a day followed by respondents feeding four times a day (10.0%). This shows the different practices related to breastfeeding.

Number of Months of Breastfeeding: From the data, it is seen that majority of the respondents (44.0%) did breastfeeding for less than 6 months followed by respondents (22.0%) continuing breastfeeding till 6 months from the time of birth. There were respondents (18.0%) who continued breastfeeding for more than 6 months but less than one year. There were also respondents (10.0%) who continued breastfeeding for than one year followed by respondents (6.0%) who breastfeed for one year.

Birth Order of the Child: The majority of the respondents (34.0%) have responded that the birth order of the child is 1, followed by second birth order (30.0%). Some respondents (26.0%) said that the birth of the child was 3, while some respondents (8.0%) said that the birth order of their child was 4 and another 2.0% stated the birth of their child as 6.

Number of Living Child: Majority of the respondents (44.0%) said that they had 1 living child followed by respondents (24.0%) responding having 2 living children. Also, another nearly one fourth respondents (24.0%) responded of having three children. The minimum number of respondents (8.0%) said that they have 4 living children.

Outcome of the First Pregnancy: Majority of the respondents (86.0%) had a living child followed by respondents (10.0%) responding of children born but died later. There were abortions of 4.0% of respondents. There were no still births.

Outcome of the Second Pregnancy: Majority of the respondents (66.0%) had a living child followed by respondents (4.0%) responding of children born but died later. There were 30.0% of respondents who had no second child therefore; this question was not applicable to as many respondents. There were no abortions or still births.

Outcome of the Third Pregnancy: Majority of the respondents (62.0%) had no third child therefore; this question was not applicable to as many respondents. There were 36.0% respondents who had a living child followed by respondents (2.0%) responding of having abortion. There were no children born but died later or still births.

Outcome of the Fourth Pregnancy: Majority of the respondents (90.0%) had no fourth child therefore; this question was not applicable to as many respondents. There were 8.0% respondents who had a living child followed by respondents (2.0%) responding of having abortion. There were no children born but died later or still births.

Outcome of the Fifth Pregnancy: Majority of the respondents (98.0%) had no fifth child therefore; this question was not applicable to as many respondents followed by respondents (2.0%) responding of having abortion. There were no living children or children born but died later or still births.

Outcome of the Sixth Pregnancy: Majority of the respondents (98.0%) had no sixth child therefore; this question was not applicable to as many respondents followed by respondents (2.0%) responding of having living child. There were no living children or children born but died later or still births.

NUTRITIONAL STATUS: THE CONCRETE CONDITION

In this section, the information related to nutrition, food habits in general and food habits during the pregnancy etc. are discussed. The researcher also enquires about the taboo food for the mother and the child, the supplementary food and the subsequent information. There are also questions about the usage of various forest products.

Food Habits in the family: Generally, the families consume diet rich in Carbohydrates and to some extent proteins. These include consumption of vegetables, rice, cereals and pulses. The food consumed majority is rice and products related to rice like Rotis of Rice (भाकरी(, Ghaavan (घावन( etc. Generally, these Rotis are consumed with curry of meat (मटण रस्सा), fish curry (मच्छीचा रस्सा) or meat of hen (चचकन रस्सा( They consume meat of Bengal Monitor (घोरपड), Wild Rabbits (रानटी ससा). The fish meat they consume is generally of Freshwater Crabs (नदीचा खेकडा), Prawns (कोळंबी(

Staple food during the breakfast: Majority of the study population (86.0%) eat Rice Bhakaris for their breakfast followed by freshly cooked rice (14.0%). Majority of the population is engaged in growing rice and paddy crops. Thus, this forms the staple diet. Therefore, generally, they consume what they grow. Additionally, they also consume vegetables during the breakfast. They do not consume pulses or Eggs and/or Chicken for breakfast. Thus, they consume food which is rich in carbohydrates.

Staple food during the lunch: Majority of the study population (50.0%) eat Rice and Dal (Curry0 for their lunch followed by Rice Bhakaris with Vegetables (28.0%). At times they also consume Rice Bhakaris with Curry (20.0%) Majority of the population is engaged in growing rice and paddy crops. Thus, this forms the staple diet. Therefore, generally, they consume what they grow. Additionally, they also consume vegetables and pulses during the lunch. They do not consume or Eggs and/or Chicken for lunch. Thus, they consume food which is rich in carbohydrates.

Staple food during the Dinner: All the respondents said that they consume Rice and Dal (Curry) during their dinner. They occasionally consume Eggs and/or Chicken or Meat, Fish etc.

Age When the Supplementary Nutrition Started:
The table shows the information about the Age When the Supplementary Nutrition Started. Majority of the respondents (35.0%) started the supplementary when the child’s age less than six months followed by 15.0% of respondents feeding the child after six months of birth. (Table 3)

Table 3: Age When the Supplementary Nutrition Started

Serving Pattern: The serving pattern is instrumental in analyzing the social conditions, gender dynamics in any community. From the table above, it is evident that majority of the respondents (46.0%) sit together with their family while having food.

Table 4: Serving Pattern