One-year-old Chaittali sits quietly next to her mother at a clinic in Mokhada, a rural village five hours from India’s financial capital, Mumbai. This is the second time in the past four months her mother has brought Chaittali to a nutritional rehabilitation center at the government-run hospital to be treated for severe malnutrition.
As in much of rural India, agriculture is the main revenue source for Mokhada. When rainfall is good, there is surplus food to eat and sell. In the years that rainfall is poor, agriculture suffers and so does the nutrition of those relying on the produce for livelihood. This leads to a surge in cases of children with moderate (MAM) and severe (SAM) acute malnutrition appearing at the clinic.
But climate affects children like Chaittali in other ways, too. While her mother works in the fields, the toddler spends time sleeping or playing in the dirt in the open. Summer days are not easy for the young ones, often left to entertain themselves in sweltering heat. It was this exposure to the sun that led to the deterioration in Chaittali’s condition the second time.
The link between malnutrition and climate has long been discussed. Drought years cause crop failures and this hits the supply chain. There is evidence that households that depend on rain-fed agriculture for livelihood are disproportionately affected by malnutrition during a drought year. Dehydration caused by heat waves also pushes vulnerable children who are on the borderline of malnutrition into MAM. Floods spread dirty water, but also disease that can lead to dehydration and malnutrition.
There has been an increase in technology to predict several climate variables, including rainfall, heat waves and droughts. The question now is how to use the data to plan for these events and help prevent the spread of malnutrition. India is already experimenting with some novel strategies, including targeted messages to warn people about impending climate events. But to cut down on malnutrition, experts say officials need to be doing more.
Malnutrition rates in India are already astronomical. At least 38.4 percent of children under the age of five are stunted and 21 percent are wasted. For a country with more than 1.3 billion people, these percentages translate into populations larger than those of entire European countries. The district where Chaittali lives alone has more than 30,000 children with malnutritionm according to the government.
Climate-related events can make those numbers far worse. Changes in rainfall can affect productivity, with extremes like floods or droughts capable of creating widespread nutrition emergencies, particularly in poorer communities.
At the COP 23 summit in Rome last year, the Food and Agriculture Organization (FAO) reminded nations of the cost of ignoring the impact of climate events on agriculture systems and malnutrition. With the changes in climate set to make droughts frequent and push hunger up by 20 percent, world bodies agreed climate cannot be ignored in the fight against malnutrition.
For healthcare workers in Mokhada, their main climate worry are seasonal temperature variations. During summer months, when temperatures rise up to more than 100 F (37 C), there is a steady increase in the number of children with acute malnutrition. In October, the month right after the monsoon season, when the temperature shoots up once again, they also see an increase in cases.
A few hours’ drive away from Mokhada in the town of Nandurbar, MAM cases rose from 29,000 in 2016 to close to 34,000 in 2017 for the same season, but after a bad monsoon spell. In Latur, a heat wave in October 2016 was followed by a spike in MAM cases reaching 20,000, up from 12,000 in the preceding months. The number of cases was back to 12,000 in December.
The situation is more complex, though, than just changes in temperature.
“In general, rising temperatures can reduce productivity of some cereal crops in regions where these crops are growing on the edge of their thermal tolerance, such as parts of the tropics,” said Kristie Ebi, the director of the Center for Health and the Global Environment (CHanGE) at the University of Washington. “In addition, extreme weather and climate events” – like droughts and floods – “also can reduce productivity.”
And, decades ago, researchers in El Salvador, a small central American nation known for its Pacific beaches, first pointed out a correlation between seasonal diseases and worsening of malnutrition. For instance, in months that diarrheal diseases shoot up so do cases of malnutrition, as they dehydrate children who are already experiencing health problems.
Using Data for Results
The first step to addressing these kinds of problems is learning to anticipate these kinds of events.
Because monsoons in most parts of India end in September, they should be easy to plan for, said Dr. Dileep Mavalankar who heads the Indian Institute of Public Health, Gandhinagar, and also helms the heat action plan project in India. “While malnutrition is a chronic condition, drought and heat can combine to make it worse. It is possible though to predict an incoming drought early based on the rainfall quantity the previous season.”
The weather department is able to send an alert warning five days ahead of a heat wave. Seasonal trends in diseases, too, are well established, and public health officials in a region can be trained to watch for them.
Learning to plan for these events, though, is key to mitigating the impact they have on children’s health. For instance, ahead of a bad monsoon, the government could already be preparing to increase the presence of health workers and provide more resources to rural clinics like the one Chaittali frequents, experts said.
Residents in many tropical countries are familiar with government advisories in monsoon months asking them to take preventive measures against mosquitoes. If there is adequate data to prove a correlation, then such targeted advisories could also be used to warn citizens against communicable diseases known to worsen malnutrition in high-risk areas in summer months.
Several Indian cities are already using climate data to warn civic bodies ahead of heat waves. The low-cost initiative that relies only on better communication between climate and public health officials has cut down deaths caused by heat waves according to Indian government’s disaster management department. At the moment, though, it focuses primarily on the impact of heat waves and not other events, which might help reduce climate-related malnutrition.
With a large affected population, using targeting messaging and evidence to direct resources could make the delivery of services more efficient.
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