A quiet health revolution is underway in villages where debilitating malnutrition had afflicted tribal people in the Udaipur district of Rajasthan, an Indian state better known for the graceful palaces, colorful festivals and deserts crisscrossed by camels luring tourists from around the world.
Nutritional deficiencies are rampant in Rajasthan. A national health survey found high levels of anemia among both women and men in the state, as well as high rates of stunting and wasting among children. That is because a typical home-cooked meal here is imbalanced. It includes a high percentage of grains, which are cheap and provide energy, but few pulses (lentils or dried beans) or fruits and vegetables, which are rich sources of vitamins and minerals, critical for proper growth and building immunity.
Widespread malnutrition in India has had devastating effects, especially among women and children. Unicef estimates that around 46 percent of all Indian children under age 3 are too small for their age, 47 percent are underweight and at least 16 percent show signs of wasting. Anemia affects 74 percent of children under age 3, according to the agency, as well as more than 90 percent of adolescent girls and 50 percent of women.
Since September 2012, however, households dotting the arid countryside around Udaipur have been motivated to use wheat flour fortified with micronutrients, such as iron, folic acid and Vitamin B12 as part of an initiative introduced in the region by the Global Alliance for Improved Nutrition, which has offices around the world, and the Indian Institute of Health Management Research in the Rajasthani city of Jaipur. The program is carried out by the Bhoruka Charitable Trust, a philanthropic foundation that is also based in Rajasthan.
“Considering that the diets of these population groups are not diversified, provision of staple foods, such as wheat, oil and milk that have been fortified with vitamins and minerals has been recognized as one of the best ways of improving overall health,” said Deepti Gulati of Global Alliance. “Not only is food fortification easy and cost-effective for the food producers to implement, it is also an inexpensive way to provide good nutrition to the consumers. This is one way of ensuring that people get sufficient vitamins and minerals through their regular diets, to improve their health in a short period of time.”
A community health worker named Sumitra, 30, in the village of Singhavat, saw the change in her own life. “I don’t get tired very soon these days and even my husband’s knee pain has reduced considerably,” she said. “It’s great to be healthy and energetic.”
Varsha Sevak, 26, a teacher in Banora village, had a similar experience: “Till just a few months back, there was not a day when I didn’t feel listless or feverish,” she said. “Carrying out my duties as a government school teacher and helping out in serving the midday meal wasn’t easy. Thankfully, I feel much better and stronger.”
In some areas around Udaipur, wheat became the vehicle for fortification after a baseline survey indicated that local people were suffering from high levels of micronutrient deficiencies, said Rahul Sharma of the Institute of Health Management Research. The next step was to make sure that villagers started using fortified flour. Reaching out to the friendly millers where households generally had their wheat grains milled became imperative.
The idea was to convince them of the advantages of adding the micronutrient-rich mix to the flour so that they could become “agents of change” and lead the community.
Two-hundred millers in the area were actively engaged on the nutrition and health issues through formal and informal discussions. “We trained the millers on how and when to add the premix while grinding, and provided them with 10 kilos of the mix along with two spoons, calibrated to fortify five kilos and one kilo of grain, respectively, so that the quantity of micronutrient premix added to the grains added is accurate and consistent,” Sharma said.
Teaching the millers how to use the premix was not enough. As is common in many community-based projects, many challenges soon emerged. Some people complained that the dough made from the fortified flour was turning black and that the rotis [flatbreads] were too dry.
“At first, we found it quite baffling,”said Shivendra Kumar Jha of the Bhoruka Trust, who is directing the micronutrient project. “But when we looked into the matter, we realized that a few millers, in their enthusiasm for improving nutrition, were mixing higher quantities of premix in the wheat flour, as they felt that if it is good for health, then why stop at adding just one spoon!
These issues have been successfully addressed and now both the millers and the consumers are happy and satisfied,” he said.
“In addition to the millers who directly talk to the people, we have put up wall writings and posters to publicize the advantages of consuming fortified wheat flour to improve health and reduce anemia,” Jha said. “We organize community meetings, school-level campaigns and street plays to discuss this issue.”
Despite all these concerted efforts, in some villages using fortified flour is taking time to pick up. “I serve about 100 households, and only 60 to 65 of them regularly ask for their flour to be fortified,” said one miller, Khajhrulal Jain. He added that these customers seemed to be the more educated people.
Nevertheless, Jha is happy to say that in the last eight to nine months, use of fortified flour has stabilized in the area. “There are altogether 6,600 homes where fortified flour is being used regularly. All those people who have felt its health benefits are recommending it to their friends and acquaintances.”
[© Women’s Feature Service]