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    Why Palghar is at risk of an upsurge in undernutrition during the COVID-19 crisis?

    Although tribal regions are less dependent on the supply chain for processed foods and perishables, farmers are affected the most by the value chain affecting their own produce

    The emergency preparedness to COVID-19 pandemic to handle increasing infected cases has been quite encouraging in Palghar. This however is offset by the prevailing conditions of poverty, undernutrition, and lack of basic requirements of household drinking water and sanitation facilities in the tribal regions of Palghar, in Maharashtra.

    There is no shortage of evidence for the disproportionately large child deaths due to severe undernutrition even pre-COVID times. These were also the results of our assessment of undernutrition and its risk factors among children under five years in these regions. A pandemic such as COVID-19 is predicted to have both direct and indirect effects of the pandemic. And the worst outcomes of the pandemic are likely to be faced by the vulnerable sections of the population and Palghar is unprepared for this. 

    Among the few talukas, Palghar district is identified as a containment zone. A lockdown period extending more than 60 days, allows only essential services to remain functional. While Maharashtra boasts of economic growth, inequality in growth apparent in these tribal settings. During these unprecedented times, people living here will perhaps face severe food insecurity. Moving to and from this region has been restricted that would disrupt the supply chain for essential goods.

    Although tribal regions are less dependent on the supply chain for processed foods and perishables, farmers are affected the most by the value chain affecting their own produce. In contrast, those partly dependent on agriculture migrate to urban settings as daily wage labourers. Restrictions in movements have already affected the lives of migrant labourers pushing them to poverty and serious hunger.

    To make situations worse, the robust food safety nets such as the supplementary nutrition program and the mid-day meal program have abruptly stopped, reflecting the weak policies for emergency preparedness to ensure food security. More serious issues arise in the management of severely undernourished children (SAM) that Palghar houses in significant numbers.

    While facility-based care would continue, utilization during the lockdown period is likely to witness a decline. Further, initiatives such as community-based management of moderately undernourished children (MAM) have been affected due to discontinuation of services, as these are not classified as essential services. 

    Food and nutrition alone are not the causative factors of undernutrition in these settings. Nutrition sensitive indicators such as lack of household supply of drinking water, garbage disposal facilities, and dysfunctional toilets with lack or inadequate water supply increase the risk of infections, specifically diarrhea among children. The link between infection and undernutrition is well established.

    The effect is bidirectional i.e., infections can be the cause and consequence of undernutrition. Conditions worsen in summer as they face extremes of climates such as serious drought or excess rainfall. The prevalence of infections is high during such situations. And, COVID-19 spread in summer when lack of water is a serious public health issue in Palghar. The simple public health strategies to wash hands with soap is impractical in these settings, as women walk five kilometres to fetch water for their daily needs.

    Our work identified that more than 50% did not wash hands before having food. Low levels of literacy combined with lack of awareness, social practices, taboos, and myths bring the challenge of communicating effectively to this vulnerable population for behavior change. Despite this fact, we observed their knowledge of hygienic practices to be fairly good and this population primarily needs water to wash their hands. It is a disgrace to the public health fraternity and policymakers to have neglected their basic needs such as food and water.

    In these times their vulnerability further increases due to the combined risk of COVID -19, along with pre-existing conditions of diarrhoea, hunger, and poverty. This situation is comparable to Africa where there is a pre-existing high prevalence of HIV-AIDS, while COVID-19 brings the additional burden to tackle a very similar situation of multiple burdens of disease to an already low resilient health system. A post-pandemic upsurge in undernutrition and child mortality as a consequence of hunger has been predicted due to both the direct and indirect effects of the pandemic. NGOs and the general public distributing food is not the issue discussed here. Any resurgence of undernutrition is strong evidence of the failure of services during emergencies. Our programs that address food insecurity need to be prepared for such emergencies. While India fights COVID-19, children cannot remain hungry. These programs should have been classified as essential services and must have been highly active in these settings to address hunger while adhering to the safety norms.  

    For policymakers it is a lesson well learned for emergency preparedness, specifically to address hunger and to prioritize tribal regions while planning for development. Along with strengthening our food security systems, effective planning where economic development embraces tribal regions is the need of the hour. 

    The author is an Assistant Professor at the Interdisciplinary School of Health Sciences in Savitribai Phule Pune University, Pune.

    The views expressed by the author are personal and may not in any way represent those of TIME8.

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