Alappuzha: The parents of a two-year-old boy, who allegedly died of malnutrition in Alappuzha, had previously lost another son and had often refused to cooperate with health care measures, according to officials.

The child, Rahul, who died on Sunday, was the sixth child of Thaimootil Rajesh and Thara. According to Karthikapally ward member Lekha Liji, the couple and their five children arrived in Valiyakulangara two months ago. "Nobody knows exactly where they are from. Before arriving here, they were living on the premises of the Haripad municipality," Lekha said.

Dr Jaya, medical officer at the Karthikapally Family Health Centre, said health officials and panchayat representatives had repeatedly visited the family and attempted to arrange medical care for the children and Thara. However, she alleged that Thara did not cooperate with them.

"Thara never cooperated with us. Whenever a nurse or doctor was sent to assess their health and provide treatment, she refused," Dr Jaya told Onmanorama.

After repeated attempts to engage with the family failed, health officials and an ASHA worker informed the ward member, the panchayat president and other officials.

Lekha said Thara and her five children were shifted to Gandhi Bhavan in Pathanapuram about a month ago in the hope that she would receive proper care during her pregnancy. However, Thara left the facility with her children and returned home, Dr Jaya said.

The health officials subsequently visited her again. "She then threatened to commit suicide if she was forced to go anywhere," Dr Jaya said.

Despite these difficulties, officials continued their efforts to arrange medical care for the family.

Karthikapally panchayat health standing committee chairperson Jiju S said none of the children had been attending school. Lekha also said the couple had lost one of their sons several years ago.

Jaya said a junior public health nurse had been sent to Thara's home for health check-ups, but the mother did not cooperate.

She also allegedly refused to provide her Aadhaar card or other identification details when asked to complete registration with the panchayat and the health department, making it difficult to arrange treatment. "Whenever the ASHA worker approached her, she would abuse them," Jaya alleged.

About two weeks ago, Thara was firmly advised to undergo a blood test and was taken to the Haripad Taluk Health Centre. The doctor there referred her to Vandanam Medical College Hospital.

However, although Thara assured the officials that she would go to the medical college, she did not do so. "She said she would call a 108 ambulance if anything went wrong," Jaya said.

The day before she delivered her seventh child, Thara began experiencing labour pain and contacted the ward member and other officials for help.

An ambulance was arranged, and she was taken to Haripad hospital, accompanied by an ASHA worker and a staff nurse from the Karthikappally Family Health Centre. She was subsequently taken to Vandanam Medical College Hospital.

Jaya said the officials informed Rajesh about his wife's condition. "He said he would come with their children in his autorickshaw," she said.
However, Rajesh, who is an auto driver, did not arrive, and the children remained at home. On Sunday morning, Rahul was found dead at home.

Jaya said the family's living conditions had also caused concern among the officials who visited their home.
"Whenever we went there, the eldest girl, who is around 10 to 12 years old, would be making roti for her sisters. Rahul, the sixth child, was also underweight. We tried several times to take him for treatment," she said.

She alleged that whenever officials attempted to take Rahul for medical care, Thara would scream and refuse to let them take the child. The officials found it difficult to intervene, particularly as she was pregnant.

Thara gave birth to her seventh child on Sunday and remains at Vandanam Medical College Hospital. Jaya said Thara had high blood pressure and had previously been advised to seek treatment.
"I had told her earlier to come and receive treatment, but she never did," the medical officer said, adding that the newborn was healthy.

Meanwhile, Lekha said the couple's four other children were shifted to the care home under the Child Welfare Council.

Panchayat and health officials maintained that they had made every effort within their capacity to help the family, but alleged that the parents had repeatedly refused assistance and failed to provide adequate care for the children.

The death of the toddler has raised concerns over the steps to prevent malnutrition and awareness of family planning. In 2016, Rudra, a 4-month-old child, died at Kottamugal in Thiruvananthapuram due to malnutrition. While the parents initially alleged that the child died of medical negligence, a five-member expert panel found out that she died of acute malnutrition.