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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 693-698

Pulse of Gujarat during lockdown


1 Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat; Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
2 Indian Institute of Public Health Gandhinagar, Gandhinagar, Gujarat, India

Date of Submission29-Aug-2020
Date of Decision29-Dec-2020
Date of Acceptance05-Jan-2021
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Somen Saha
Indian Institute of Public Health Gandhinagar, NH-147, Palaj Village, Opp. New Air Force Station HQ, Gandhinagar - 382 042, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_318_20

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  Abstract 


Background: Coronavirus pandemic has dealt a severe blow to India's poor and socioeconomically disadvantaged group. Among a nationwide lockdown to contain the spread of the infection. This study assessed the availability of food and access to healthcare among the vulnerable population of Gujarat– pregnant women and severe acute malnourished children. Specifically, we assessed events of starvation or skipped meal, availability of healthcare services, and self-reported psychological distress during the lock down. Materials and Methods: A cross-sectional study across 252 talukas and 33 districts of Gujarat was undertaken using a structured questionnaire. A telephonic survey was carried out and positive responses were received from 161 households (HHs) with severe acute malnourished children, 328 pregnant women with severe maternal anemia, and 402 lactating women. Results: We found 79.7% of surveyed HHs received ration where major reliance was on public distribution system (51.7%). Less than half of the beneficiaries (48.6%) received take-home ration under the ICDS program. Despite efforts of the State as well as voluntary agencies, 7.3% of HHs experienced episode of hunger, mostly from Devbhumi Dwarka, and Navsari district. A third of the respondents showed signs of psychological distress associated with lockdown. Conclusion: Food insecurity may lead to malnutrition impairing the immunity of the individuals to cope with the disease. Thus, given the uncertainty around the emergency situation, preparedness measures should not only focus on the availability of healthcare commodities but also to ensure the availability of other essentials, especially to the socioeconomic disadvantaged group.

Keywords: COVID-19 pandemic, food availability, Gujarat, mental health, pregnant women, severe acute malnutrition


How to cite this article:
Saha S, Puwar T, Saxena D, Kotwani P, Raval D, Kandre Y, Qureshi A. Pulse of Gujarat during lockdown. J Datta Meghe Inst Med Sci Univ 2022;17:693-8

How to cite this URL:
Saha S, Puwar T, Saxena D, Kotwani P, Raval D, Kandre Y, Qureshi A. Pulse of Gujarat during lockdown. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 1];17:693-8. Available from: http://www.journaldmims.com/text.asp?2022/17/3/693/360211




  Introduction Top


Coronavirus pandemic has dealt a severe blow to India's poor and socioeconomically disadvantaged group. The learnings from the past pandemics or epidemics suggest the importance of limiting breakdown of various critical organizational arrangements such as electricity, water, and food for the survival and health of the community as majority of the public health responses to a pandemic depend on these arrangements. Countries, irrespective of their status of development may face shortage of food supplies during pandemics.[1] A study used a system dynamics model to demonstrate the likely effects of a pandemic on the USA's food system and found that if the pandemic hampers 25% or greater of its labor availability, it can create significant and widespread food shortages.[1] West Africa also faced shortage of food availability during EBOLA epidemic in 2014.[1] Such shortages in the amount of available food are likely to impact the community negatively and also leading to psychological distress.[1] The World Health Organization in its situational analysis report on Coronavirus Disease highlights that “All public health measures to stop disease spread can be balanced with adaptive strategies to encourage community resilience and social connection, protect incomes and secure the food supply.”[2] Thus, it is highly imperative to improve the resilience of the food system during such infectious disease pandemics.

At the time of nationwide lockdown, when socioeconomically disadvantaged people are largely dependent on the public distribution system (PDS) and other supports from Government for their survival, the Government of India (GoI) under the National Food Security Act has arranged the distribution 5 kg of free grains per person and 1 kg of free pulses per family under “PM Garib Kalyan Ann Yojana” in addition to 7 kg grains that will be provided at the subsidized rates. The GoI aims for reaching out to 800 million poor beneficiaries across the nation.[3] Moreover, following the directives of GoI to closedown the educational institutions and non-essential services during the nation-wide lockdown, the Anganwadi centers in the rural areas are closed as well. In spite of this, to ensure the availability of food for the pregnant and lactating women and malnourished children, the Anganwadi workers are distributing take-home ration (THR) packets to beneficiaries.

The purpose of this study is to assess availability of food to the vulnerable section of Gujarat– pregnant women with severe maternal anemia, lactating women, and severe acute malnourished children. Specifically, we assessed events of starvation or skipped meal, availability of healthcare services, and self-reported psychological distress during the lock down. The findings of the study will help the state to take appropriate measures to address the deprivation of food in vulnerable sections of the society.


  Materials and Methods Top


A cross-sectional state-wide mobile phone survey covering all 33 districts of Gujarat was undertaken from March to May 2020. Households (HHs) with severe acute malnourished children, severely anemic pregnant and lactating women were approached. The sampling was done to ensure coverage of all 252 talukas across 33 districts to ensure representativeness of the data. The sampling was done at the level of primary health centers.

For the purpose of sampling, contact details of 5% of the total severe acute malnourished children and severely anemic pregnant and lactating women of Gujarat registered in the month of March were fetched. Population proportionate sampling was done to get representative data from all 33 districts of Gujarat. Positive responses were received from 161 HHs with severe acute malnutrition (SAM) children and 328 HHs with pregnant women with severe maternal anemia and 402 lactating women.

A short structured questionnaire, designed for no more than 3–5 min, was prepared and pilot tested in 10% of the selected sample. Based on the findings of pilot study, the questionnaire was modified. The semi-structured questionnaire was designed to collect the data on the below-mentioned variables.

  1. Ration received from PDS and its adequacy
  2. THR packets received from Anganwadi workers and its quantity
  3. Illness among children during lockdown
  4. Visit by ANM/ASHA/AWW during lockdown
  5. Any incident of hunger during the past one week
  6. Any symptom of anxiety or stress.


The data were analyzed using SPSS, version 20 (IBM, Chicago, IL, USA). Descriptive statistics was performed and categorical variables was presented as frequencies with percentages (%) and continuous variables as mean. Permission to undertake this study was obtained from COVID 19 Research Steering Committee of Health and Family Welfare Department, Gujarat, and the Institution's Ethics Committee of Indian Institute of Public Health Gandhinagar.


  Results Top


The findings of this study are presented under three subheadings:

  1. Food availability during lockdown
  2. Availability of THR and access to healthcare
  3. Stress and anxiety.


Food availability during lockdown

[Table 1] shows that 79.7% of the surveyed HHs received ration during the lockdown, where majority (51.7%) relied on PDS. Of those who received the ration during lockdown, 46.7% of them reported food was sufficient while 21.8% reported ration was partially sufficient for their family. When inquired about the time of receiving ration, 75% responded to have received after the lockdown was announced. Last ration was received about 15 days prior to the survey [Table 1].
Table 1: Source and sufficiency of ration during lockdown period

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Starvation

Episode of hunger or starvation was reported by 65 HHs which comprised 7% of the sampled population. Junagadh, Mahisagar, Mahesana, and Navsari districts reported ten or more HHs where ration was not received [Table 2]. Districts where ten or more HHs reported having received insufficient ration are Sabarkantha and Tapi. Ration received was partially sufficient among HHs from Anand, Arvalli, Devbhumi Dwarka, Gir Somnath, Tapi, Vadodara, Valsad, and Kheda. Episodes of hunger or starvation were reported by five or more HHs of Devbhumi Dwarka and Navsari district. [Table 2] reports heat map of ration availability and sufficiency as well as starvation by districts and corporations of Gujarat.
Table 2: Geographical distribution of households failed to receive ration or the ration received was insufficient/partially sufficient

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On an expected line, Pearson's Chi-Square test results show significant association between availability and sufficiency of food and if the HHs members have to starve in the last 7 days during the lockdown (P < 0.0001). It is seen the majority of the HHs who suffered starvation were those who received either insufficient amount of ration or who failed to receive ration at all during the period of lockdown [Table 3].
Table 3: Cross-tabulation between availability of food and events of hungers in past 7 days during lockdown

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Availability of take-home ration and access to healthcare

Although anganwadi centers are closed during the lockdown period, THR was expected to be delivered at doorsteps of beneficiaries. Our study shows the availability of THR has been influenced due to the nationwide lockdown as only 48.6% of the HHs received THR packets which were delivered by the anganwadi worker [Table 4]. Of this 48.6%, 79.8% of the respondents who remembered the number of packets received, availed an average of 4.76 THR packets. On an expected line half of the beneficiaries (49.4%) reported that an anganwadi worker or ASHA worker made home visit during the lockdown period [Table 4].
Table 4: Availability of take-home ration and visit of health worker during lockdown

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Availability of health services during lockdown

Health services availed for severe acute malnutrition children

Out of the total 161 HHs with SAM children 16 reported that their child suffered from illness during the lockdown. When inquired if they faced any difficulty in seeking health services 5 of the 16 HHs reported difficulties because of unavailability of public transport services, closed private clinics, and unavailability of doctor at the time of their visit.

Health services availed by severely anemic pregnant women

Majority of the severely anemic pregnant women approached during the survey were able to receive their routine health services. It is important to note that around 38% of the women received care from Private Clinic, followed by Primary Healthcare Center (30%) and Community Healthcare Center (13%). Very few sought antenatal care at either their home or health and wellness center during the pandemic. Irrespective of the point of healthcare service delivery 82% of the severely anemic pregnant women had unhindered access to their regular medicines [Table 5].
Table 5: Availability of health services to severely anemic pregnant women during lockdown

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Mental health status

To understand the need of mental health services during pandemics, we found 31% of the total respondents or their family members were facing psychological distress [Figure 1].
Figure 1: Mental health status during pandemics

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  Discussion Top


The PDS had been established to provide food security to the poor and act as a safety net by distributing the essential commodities at a subsidized rate. In the times of pandemic where the entire nation is in lockdown and economic activities have come to a stand-still, the socioeconomically disadvantaged group, especially the daily wage labors are the major sufferers. In spite of Government's initiative for the provision of free grains and pulses to the family, around 15% of our sample failed to receive its benefits. This could be because of the failure to undertake regular estimations of actual income of the families for identification of true below poverty line families, and some HHs may not be holding ration cards.[4]

During our survey, it was found that around 7.3% of HHs experienced hunger or starvation due to nonavailability of food as they had no money to afford even the basic commodities for their survival during the lockdown. Devbhumi Dwarka and Navsari appear to be the district of particular concern. Devbhumi Dwarka has a significant proportion of the migrant population engaged with factories and industries and remains an area of concern for want of documentation required to avail PDS.

The integrated child development scheme, a flagship program launched by the Ministry of Women and Child, under its supplementary nutrition program provides nutrition to the children from 6 months to 6 years, pregnant and lactating women, and adolescent girls as THR.[5] Our study findings report that 48.1% of the HHs surveyed did not receive THR. A study conducted in Telangana also reported that around 30% of the mothers with children aged 6–35 months of age did not receive THR and cited stock outage at AWC as one of the reasons.[6] During the time of lockdown, keeping the supply chain unhindered is a challenge. We should report that some of our respondents were unaware of receipt of THR, this could be because the calls were answered either by the husband or father-in-law who may not be completely aware of services received.

Pandemics often lead to stress among population and anxiety is the most common response to any stressful situation.[7] Our study found that 31% of respondents or their family members were anxious due to the COVID-19 pandemic. Similar observations were made during the swine-flu epidemic which reports 23.8% prevalence of anxiety.[8] An Indian study reports perceived mental healthcare need as high as 80% due to the COVID-19 pandemic.[7] In response to the rising demand of mental health services, the Government of Gujarat has taken measures to provide psychological counseling services for people in need.


  Conclusion Top


Governments – both union and state – are taking unprecedented steps to mitigate the effect of loss of livelihood and food security. It is high time that nongovernment bodies such as corporates and factories employing migrant workers rise up to the occasion and provide support to complement government effort. Given the uncertainty around the emergency situation, preparedness measures should not only focus on the availability of healthcare commodities but also to ensure the availability of other essentials, especially to the socioeconomic disadvantaged group.

Acknowledgment

We would like to acknowledge the study team members Nikita Vadsaria, Rutu Trivedi, Khushi Kansara, Priyanka Shah, Dhwani Shah, Vishal Ghangar, Kalpana Pachillu, Zuned Mansuri, Hussain Himani, Vijay Rajput, Tanveer Umallawala, Vrunda Pathak, Anant Gohil, Ami Badgujar, Priya Bhavsar, Abhi Thakar, Mihir Joshi, Poonam Trivedi, Ruchi Bhatt, Farzana Memon.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Huff AG, Beyeler WE, Kelley NS, McNitt JA. How resilient is the United States' food system to pandemics? J Environ Stud Sci 2015;5:337-47.  Back to cited text no. 1
    
2.
Coronavirus Disease 2019 (COVID-19) |Situation Report. WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200428-sitrep-99-covid-19.pdf?sfvrsn=119fc381_2. [Last accessed on 26 Sep 2020].  Back to cited text no. 2
    
3.
Government Gives Extra 5 kg Grains, 1 kg Pulses for Free Under PDS for Next 3 Months. Available from: https://economictimes.indiatimes.com/news/economy/policy/govt-to-provide-5-kg-grains-1-kg-pulses-for-free-over-next-3-months--fm/articleshow/74827003.cms?from=mdr. [Last accessed on 26 Sep 2020].  Back to cited text no. 3
    
4.
Mane RP. Targeting the poor or poor targeting: A case for strengthening the public distribution system of India. J Asian Afr Stud 2006;41:299-317.  Back to cited text no. 4
    
5.
Press Information Bureau | Government of India | Ministry of Women and Child Development. Available from: https://pib.gov.in/newsite/printrelease.aspx?relid=104046. [Last accessed on 26 Sep 2020].  Back to cited text no. 5
    
6.
Leyvraz M, Wirth JP, Woodruff BA, Sankar R, Sodani PR, Sharma ND, et al. High coverage and utilization of fortified take-home rations among children 6-35 months of age provided through the integrated child development services program: Findings from a cross-sectional survey in Telangana, India. PLoS One 2016;11:e0160814.  Back to cited text no. 6
    
7.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety &; perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020;51:102083.  Back to cited text no. 7
    
8.
Rubin GJ, Amlôt R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: Cross sectional telephone survey. BMJ 2009;339:b2651.  Back to cited text no. 8
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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