Sundarbans: Unlike other children of his age, four-year-old Nirmal Mandal is still learning how to walk on his legs. He still crawls like a baby.
When brought to the nearest primary health centre by his farmer parents in Pathar Pratima block of Sundarbans, doctors said the child is chronically malnourished and his legs are too weak to be able to take the weight of his body.
Repeated climatic shocks in the form of cyclones and floods, geographical adversities, especially in the remote islands, and an inadequate health infrastructure have made many such children in the Sundarbans malnourished.
Prof Barun Kanjilal of The Indian Institute of Health Management Research (IIHMR), who has been studying the region, said that more than one-third of the children here are chronically malnourished due to under-nutrition.
"A child from a poor household born without adequate antenatal care and inappropriately fed during the first few months of his or her life makes a perfect recipe for under-nutrition and associated morbidity, a common phenomenon in the Sundarbans," he said.
According to Sundarbans Health Watch report, about sixty per cent of the children did not receive breast milk immediately after birth. Breastfeeding is a critical determinant of a child's health.
"Health awareness is very poor. One third of the mothers are also underweight and this has a direct impact on the health of the children," Dr Kanjilal said.
A study conducted by the National Institute of Cholera and Enteric Diseases (NICED) and international NGO Save the Children has found that the overall prevalence of anaemia in women is as high as 64 per cent.
NICED's Dr Samiran Panda, who led the study, said malnutrition is a serious health issue in the Sundarbans affecting both the mother and the child.
"Basic food supply to the population should be improved with additional food to all children and vulnerable groups. Selective supplementary feeding to the malnourished should be undertaken in areas where the prevalence of malnourishment has crossed 10 per cent but remained below 15 per cent among under-five children," he said.
Children of the Sundarbans face an extra burden of morbidity, with a report from IIHMR suggesting that 0.3 million children will be ill in a month and 26,000 children will need hospitalisation in one year in the Sundarbans.
Prevalence of respiratory infection or gastrointestinal disorders among children is much higher in the Sundarbans than the district or state average.
The available public health care system is also being blamed for the child health concern.
"Public health centres are not only less available, but many of them run ineffectively with shortage of critical inputs," he said adding that a parallel market of rural medical practioners or 'quacks' have cropped up to bridge the huge gap in the curative care market.
"This is obviously a potential threat to child health," he warned adding that 84 per cent of ailing children seek treatment from such 'quacks' while government facilities were visited by only 4 per cent.