How to write an anganwadi record
Salvation for the Overlooked
One often does not see malnutrition in children. This is fatal because it can damage your brain. The Child Growth app is designed to help.
• When the eyes have adjusted to the darkness, a woman and seven children can be seen in the hut. Alam-Ara Seikm, 32, stirs in a pot that is on a makeshift gas stove in the corner. A boy is rocking a cradle, a teenage girl has a baby in her arms, and the other children are playing on the floor in between.
The family lives in a slum in Mumbai. The father sells kebabs, but does not earn enough to support the family. The two youngest children are seriously malnourished. That this was discovered is already a success. You often don't see malnutrition, the children just grow slower, but they don't look emaciated. But this condition can be very detrimental to brain development.
In India, an app should now help to find malnourished children. It's called Child Growth Monitor, the software is based on machine learning and augmented reality. Even a short scan should show whether a child is affected.
Kanti Gopal Pasi visits the family regularly, including today. She works for the international aid organization "Action Against Hunger" and has accompanied the mother during her two previous pregnancies. She was the one who discovered that the two youngest children were malnourished. When the mother sees the visitor, she turns off the gas stove and sits down with her on the floor.
Almost 40 percent of all children in India grow slower because they do not get enough to eat.
Like Welthungerhilfe, the aid organization is involved in the development of the app. In future, all children under six years of age in India will be tested for malnutrition with it. Aid organization employees could then scan the children with a smartphone during a home visit like this, for example. The app depicts the body in a 3D model, calculates height and weight - and shows you whether the child is malnourished.
Kanti Gopal Pasi and her colleagues are currently collecting data that they use to train the app. To do this, they have to measure the children both analog and digital. In the cramped hut, she can only check the children's upper arm circumference with a tape measure, a common but imprecise method. She needs exact data for the app. So she asks her mother to come to the organization's office on the edge of the slum with her children. There they could be measured and scanned. It is known that they are malnourished. However, the family does not show up in the office that day.
The Child Growth Monitor should enter the beta phase at the end of 2019 and be ready for the market at the beginning of 2021. The technology already has sponsors before it has even reached the alpha phase. Microsoft collected and tripled donations from its employees at Christmas 2018 - a total of 93,000 euros were raised - and donated storage space on its cloud platform Azur. The World Food Program contributed $ 100,000 and the UK telephone company GSMA contributed £ 300,000. The Boston Consulting Group analyzed the project free of charge and sent employees to do research on site. Their conclusion: if the app is used in many countries, it will make a major contribution to achieving the goal of the United Nations - a world without hunger by 2030.
The high hopes are justified, says Robert Johnston from Unicef. The American nutrition researcher has been working on how to recognize malnutrition for years, he is not involved in the development of the app. "The current system does not work particularly well," he says, "the data are inaccurate and incomplete." This applies not only to India, where he is currently doing research, but also to South America, Southeast Asia and African countries. In order for the app to make a difference, enough helpers have to be equipped with it, he says. Then it would revolutionize the fight against malnutrition. He thinks this is realistic, because augmented reality technology will soon be able to run on almost every smartphone.
When the Action Against Hunger employee steps out of the hut, she is standing between the crooked walls of the slum. It smells of urine and rubbish, the already narrow paths replace the sewer system. The hut of the family with the seven children is marked from the outside next to the entrance. UAFZD is there in bright red color, including 42. Gopal Pasi explains what that means: Action Against Hunger Foundation, Zone D, House 42. With the red marking, the employees show where families live that are affected or threatened by malnutrition. Many entrances are now marked in red.
The Indian government is not a big fan of the aid organization's activities, especially the name, Action Against Hunger, that bothers them. Because officially there is no problem in the up-and-coming India. Mathias Mogge, Secretary General of Welthungerhilfe, says: The Indian government is financing “important aid programs” to support the 200 million undernourished people in the country, “but it is not easy for them to recognize that hunger is a huge problem”.
India has an ambitious space program and is one of the largest economies in the world - but it does poorly when it comes to feeding its people. According to the Global Hunger Index: Rank 103 out of 119. Although the under-five-year-old mortality rate has fallen to around four percent, almost 40 percent of all children are stunted in growth because they cannot get enough to eat.
"The older children were probably also malnourished," says Gopal Pasi of the family she has just visited. Only at that time no helpers had access to the slum, the mother and her seven children had been overlooked. This often happens, even when state prevention programs are actually supposed to prevent it.
Officially, every child in India has been weighed and measured regularly since 1974 until they are six years old. But children keep falling through the cracks. Those who are not present at home visits are left out. And sometimes government-funded agencies aren't particularly interested in discovering malnourished children.
The measurements are often wrong
According to figures from Welthungerhilfe, which the Boston Consulting Group surveyed on site, the result is only correct in 35 percent of the children who are examined for malnutrition, the result is incorrect in just as many - and 30 percent of them are not tested at all. So aid from the state and non-governmental organizations reaches only a few.
The code on the house of the mother of seven ensures that her children can no longer be overlooked. But in order to determine how serious the condition of your children actually is, the app needs data, and very precise data. Then hunger can be combated in a more targeted manner.
Markus Matiaschek is working on the development of the software. The German invented the Child Growth Monitor - in an innovation competition organized by Welthungerhilfe in 2016. His idea won, so he quit his job in an IT company to realize his vision. For this he receives money from Welthungerhilfe. Since then he has dealt a lot with Artificial Intelligence (AI) and knows that the app only works with a lot of exact data. Failure to measure the children to the millimeter can overlook malnutrition and skew the results of the AI, rendering the system useless. But data is not exactly easy in India, as his journey into rural reality shows.
He leaves at five in the morning to avoid the traffic jam in Mumbai, which never completely subsides. It still takes five hours to reach the village of Mokhada, 150 kilometers to the north. There is no longer any trace of the big city here. The roads are like dirt roads, some of them beaten track.
In the local Action Against Hunger office, ten employees are discussing the day Matiaschek arrives. "Here are the tablets that no longer work," says program manager Barada Mahapatra when he greeted them. "Hm, full," mumbles Matiaschek. The employees saved the children's scans and the associated measurement data that they collected by hand. Actually, the data should have been regularly transferred to the cloud. “Can I have the WiFi password?” “The WiFi doesn't work.” “Okay, then mobile internet,” says Markus Matiaschek and opens a hotspot on his smartphone - then he stops. The device shows an upload rate of 20 kilobytes per second. “It's like a modem from the 1980s.” But every tablet has 46 gigabytes of data. He has to get it from their memory somehow.
“Offline first”, that in itself is Markus Matiaschek's goal. An app that only works with the internet is worthless in rural India. But the children's measurement data still has to leave the device so that the app can learn from them. Matiaschek first loads the data onto a mobile hard drive and gives the tablets to two employees of the aid organization who are already standing in front of the house with a motorcycle ready to go. The driver carries a rucksack in front of his stomach with the scales inside, his passenger heaves a huge rucksack onto his back, it contains the height measuring device. You drive half an hour on dusty roads to the village of Chas.
There, as in many rural regions, Action Against Hunger works with the state-funded Anganwadi centers for child development. Among other things, there is basic medical care there. As soon as the employee sees the visitor, she calls out: “Eat! Measure up! Come on, children! ”Within seconds, everyone under the age of six streams into the center. Big siblings carry babies, adults cannot be seen. The employees grab one child at a time: First they have to stand in the height measuring device. Two women hold the child, one presses her feet against the wall, the other holds her head straight, then they push a wooden plate onto the head from above. The child screams and squirms, but the two women can read the largest under the plate to the nearest millimeter. Then they put it on a scale.
Children should also be able to test the smartphone
The employees then note “severely acutely malnourished”, “moderately acutely malnourished” or “healthy”. Those who stay below the norm get one of the packages that the aid organization stores in a corner of the room. “Ready-to-use Therapeutic Food”, a kind of peanut butter paste, 540 kilocalories, plus vitamins and minerals.
In addition, the Action Against Hunger employees scan the children with the app. To do this, they hold a tablet in front of the child as if they wanted to photograph them. As soon as the child's body fits into a green frame, a scan of a few seconds begins. The child is picked up from the front and back and while turning on itself. The process takes just under a minute. “It could be that simple in the future,” says Matiaschek. No more heavy, expensive scales, no height measuring devices, no more wriggling children. "In India, almost everyone has a smartphone, and parents could even do it themselves."
The tablet scans the child using an infrared sensor, and the system uses this to calculate a 3D model. It recognizes where the child is, as well as body parts such as shoulders, elbows, knees, chin and feet. The algorithms compare the data from the scans with those that the helpers enter by hand. How to find patterns in the data. So far, 7,000 scans and measured values have flowed into the system, and by the end of 2020 there should be 210,000.
Markus Matiaschek believes that the app will be self-sufficient. “So many are interested in the discovery of malnutrition,” he says, “the aid organizations, the WHO and many countries.” Because the previous analog measurement methods are time-consuming, error-prone and expensive. A portable measuring stick costs around $ 200, a calibrated bathroom scale more than $ 300 - a tablet only around 300 euros. In addition, the software should also run on smartphones. NGOs and governments should pay for them.
The children are measured for three hours in the village of Chas. A three and a half year old weighs less than nine kilograms, a five year old just under twelve. None of the children look noticeably thin, but most are noted in the critical area. When the children then get their government-sponsored lunch - an egg, lentils, and rice - Artificial Intelligence has 15 more records to learn from. ---
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