Is malnourishment killing Dharavi's infants too?

Aug 20, 2013, 01:54 IST | Anuradha Varanasi

Abject living conditions, grinding poverty, poor nutrition and lack of immunisation have claimed 19 fragile lives since 2011; authorities have done little to investigate the deaths, and their apathy is evident from the fact that most of the deaths are not officially recorded

If you thought that children were only succumbing to malnutrition and poor living conditions outside the city limits, think again -- infants are falling prey to illness, infection and ignorance right in the heart of the city. After MiD DAY reported on the 15 deaths of children in rural Thane in a span of two months, it has been found that abject poverty, compounded by illness, has started to take its toll on children in Dharavi as well.

In Mokhada taluka, 150 km away from Mumbai, several kids were found to be underweight. Pic/Atul Kamble

While Dharavi rubs shoulders with upscale suburbs like Bandra, life here is contrasting to that lived in the ‘queen’ of the suburbs -- heaps of garbage grow by the hour, a foul stench pervades the narrow, squalid lanes, and the rows of cramped, ramshackle structures are home to families that are crushed by the weight of grinding poverty. Almost all the infants are underweight and susceptible to infection. Lack of immunisation compounds this problem, and has resulted in a slew of infant deaths since February last year.

Kunal Wakode’s grandmother and mother Kavita, claim the child weighed barely 1 kg at the time of his death

The Integrated Child Development Services (ICDS) has recorded 19 deaths of children since 2011, between the ages of 0-3 years. Of this, one was underweight, said Mahendra Gaikwad, Child Development Programme Officer (CDPO) in Dharavi.

Death toll
2011: 3

Three deaths were reported in 2011, of which two were stillborn in April. A one-month-old female infant died of a respiratory ailment in June.

2012: 12
The 2011 figure rose sharply in 2012, when 12 infant deaths were recorded. The cause of death in one case was that the child was ‘underweight.’ Two-year-old Ganesh Potraj died of malnourishment on July 28. Barely three days later, one-month-old infant Kunal Wakode died, which ICDS officers claim was from a rat bite. However, the actual cause of death is still shrouded in mystery (see box below). In September, a 10-day-old HIV positive infant died, weighing only 10.60 grams at time of death.

2013: 4
In 2013 so far, four infant deaths have been reported.

What paper work?
Surprisingly, Kunal is not the only infant among the 19 whose death certificates or case papers are not available with the ICDS. From these 19 deaths recorded since 2011, case papers of only four infants were submitted by parents, and death certificates of only two. “In other cases, the family had either migrated or the deaths took place outside Dharavi which does not fall into our jurisdiction”, said Gaikwad.

The recorded cause of death (CoD) is often vague. For example, ICDS attributed the death of two infants aged two and one (in 2012 and 2013 respectively) to ‘unhygienic conditions,’ while there was no CoD given for another infant death as the family had migrated to another location, explained Gaikwad. “Of the 16 deaths that took place between 2012-13, four took place outside the city, while five other families migrated to other locations altogether, making it difficult for us to track the infants and the case papers or death certificates,” said the child development project Officer (CDPO).

In 2012-13, children have succumbed to diseases like pneumonia, diarrhoea and fever.

Four deaths were caused by congenital heart defect, while a 10-month-old infant died following snakebite in 2012.

One-month-old’s death shrouded in mystery
One-month-old infant Kunal Wakode’s death in 2012 is shrouded in mystery, as till date, ICDS officials and the anganwadi supervisors are unaware if a post mortem was conducted on the infant, neither was a death certificate submitted by the parents. The infant’s death was recorded by the ICDS only after the parents of the infant informed the anganwadi supervisors.

Kunal’s mother, Kavita who has two more young sons, said, “When he was born, his weight was 3 kg but a few days later he rapidly started losing weight and even though we he was undergoing treatment in Sion Hospital, doctors were unable to determine what the problem was.”

“He was also suffering from diarrhoea and though I tried to feed him, he did not gain any weight. When he was sleeping on the floor one morning, a rat bit his hand, after which he died. Though we took him to the hospital, he was declared dead on arrival,” added Kavita, who sells utensils in Dharavi with her husband for a living. 

Though the anganwadi supervisors were unaware of his weight at the time of death, Kunal’s kin said it was barely 1 kg.

Asked if a police case was registered or a post-mortem was conducted, the young mother said that her infant was rushed to the hospital after the incident took place. Surprisingly, the ICDS did not have the infant’s death certificate or knowledge about the actual cause of death.

Is malnutrition the real killer?
While admitting that the ICDS has certificates for just a couple of deaths without the cause of death mentioned in them, Gaikwad insisted that the 19 infants from Dharavi who died since 2011 were not malnourished or underweight, but died mostly due to other health problems.

However, out of the 16 infants between the ages 0-3 who have died since 2011, only one 11-month-old infant weighed 8.2 kg. The weight of all the 15 other infants recorded at the time of death was way below normal.

“While the normal weight at the time of birth is 2.5 kg, an infant is supposed to put on at least 500 gms each month after that. The normal weight for a one-year-old baby is 10 kg,” said Dr Yeshwant Ghabale, paediatrician at Sion Hospital.

According to the death reports compiled by ICDS, all the one-year-old children one who died weighed below 8 kg, making them underweight. The three-year-old girl who succumbed to diarrohea weighed only 9.2 kg at the time of death, which Dr Yeshwant said is extremely low. “A three-year-old girl should weigh at least 14 kg; she was malnourished,” she explained. “None of these underweight children from Dharavi are immunised, which makes them prone to all sorts of infections, which some of them succumb to. Additionally, the infants are not breastfed, aggravating the problem,” she added.

Officer’s response
Mahendra Gaikwad said, “Many of these children were suffering from health problems since birth which was making it more difficult for them to put on weight. When a child is suffering from another illness or a congenital heart defect, he or she steadily loses weight. In one or two cases, the infants died because of a hole in the heart. An infant can not die due to malnourishment per se.” State Minister for Woman and Child Welfare Varsha Gaikwad remained unavailable for comment.

Rs 15,850Cr
The funds allocated by the Government of India to ICDS in 2012 

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