Malnutrition is one of the biggest challenges for India - Seeker's Thoughts

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Wednesday, 27 February 2019

Malnutrition is one of the biggest challenges for India

Malnutrition is one of the biggest challenges for India. Time and again various national and international surveys underline the quantum of the challenge before India. 

What is Malnutrition?

Malnutrition has various forms, such as wasting, stunting, obesity and lack of adequate vitamin and minerals. It is the world’s biggest health problem. 

Around 2 billion people suffer from some form of malnutrition. While it impacts on the people of all ages, malnutrition has particularly devastating effects on children, who can suffer permanent cognitive and physical harm.

Some of the important facts about malnutrition in India are listed below:

UNICEF report notes that nearly one in three people in India have at least one form of malnutrition and this will increase to one in two by 2025 going by current trends.

According to National Family Health Survey (NFHS)-4, 2015-16, one in every five Indians (both genders) is too thin with a BMI of less than 18.5, while every fourth male and second female is anaemic.

The NFHS-4 highlighted that one in three women consume dark green leafy vegetables, chicken/meat/fish/eggs only once a week while one in two women do not consume fruits even once a week.

The NFHS report also noted that one in five women however, consume aerated drinks weekly, one in 10 women consume fried food daily. Only one in 10 children aged 6-23 months receive an adequate diet.

The Global Nutrition Report stated that India is facing a major malnutrition crisis as it holds almost a third of the world’s burden for stunting.

The Global Nutrition report highlighted that 46.6 million children in India are stunted and India tops the list, followed by Nigeria (13.9 million) and Pakistan (10.7 million).

The Global Nutrition report also noted that India also accounted for 25.5 million children who are wasted, followed by Nigeria (3.4 million) and Indonesia (3.3 million).

Together with various governmental interventions, it is necessary to bring behavioural change to eradicate malnutrition from India. This necessitates educating the families about the need for nutrition.

Around 45% of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low and middle- income countries. At the same time, in these same countries, rates of childhood overweight and obesity are rising.

The global burden of malnutrition is serious and lasting, for individuals and their families, for communities and for countries. It raises economic, social and medical burden too.

The reality is that a third of the world’s stunted children under five — an estimated 46.6 million who have low height for age — live in India. 

A quarter of the children display wasting (that is, low weight for height) as well. District-level data show high and very high levels of stunting mainly in central and northern India (more than 30% and 40%, respectively), but less than 20% in almost the entire south. 

The Importance of Political Commitment 

This shows the important role played by political commitment, administrative efficiency, literacy and women’s empowerment in ensuring children’s health. 

Food and freedom go together, and the availability of one strongly influences access to the other; social institutions can work to improve nutrition and children’s welfare in free societies, and the absence of hunger enables people to develop their capabilities.

What exactly the malnutrition is?

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and nutrients. The malnutrition addresses 2 broad groups of conditions:
-         Undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age)
-         Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess.
-         Overweight, obesity and diet-related non-communicable diseases (such as heart disease. Stroke, diabetes and some concerns)

Micronutrient – related malnutrition

Lack in intake of vitamin and minerals often referred to as micronutrients, can also be grouped together. Micronutrients enable the body to produce enzymes, hormones, and other substances that are essential for proper growth and development.

Iodine, vitamin A, and iron are the most important in global health terms; their deficiency represents a major threat to the health and development of populations worldwide, particularly children and pregnant women in low-income countries.

Diet-related non-communicable diseases 

Diet-related noncommunicable diseases (NCDs) include cardiovascular diseases (such as heart attacks and stroke, and often linked with high blood pressure), certain cancers, and diabetes. Unhealthy diets and poor nutrition are among the top risk factors for these diseases globally.

WHO's stand against malnutrition

WHO aim for a world free of all forms of malnutrition, where people achieve health and wellbeing. According to the 2016-2025 nutrition strategy, WHO works with member states and partners towards universal access to effective nutrition interventions and to healthy diets from the sustainable and resilient food system. 

WHO uses its power to help set, align and advocate for priorities and adopting policies that move nutrition fulfilment globally. It also develops evidence-informed guidance based on the scientific and ethical framework.

India’s action to fight with malnutrition

Indian government launched the National Nutrition Strategy aimed at Kuposhan Mukt Bharat. It intends at bringing nutrition to centre-stage of national development agenda.

NFHS-4 result shows a decline in overall levels of undernutrition

India, 20% of children under five years of age suffer from wasting due to acute undernutrition. The NFHS-4 result shows a decline in overall levels of undernutrition in women, children and adults.

 Currently, there is a lack of real-time measurement of nutritional determinants, which reduces capacity for targeted action among most vulnerable mothers and children. There is no coverage in tribal areas where people don’t get an adequate amount of food.

Indian government rolled-out action plan for “September Maah”, to focus on poshan, mobilizing different sectors, developing and standardizing advocacy materials, targeting the service providers, roping in those agencies which have been working in the issue for decades------ be it UNICEF, Tata Trust or others. The idea is to create a “buzz” around Poshan.

Target – government has set yearly targets for itself, like a 2 per cent reduction in stunting and underweight children, or a 3% reduction in anaemia ( 7 out of 10 children in India are anaemic – anaemic is a condition in which blood doesn’t’ have enough healthy red blood cells.), it will need to track progress closely, and consider a yearly survey instead of the six -yearly National Family Health Survey (NFHS).

What is the reason behind the high rate of malnutrition in India?

There is another reason why the problem has persisted. Child nutrition does not disturb as it should it has been the most ignorant problem in India. Over 115 million children in India ------ almost double the population of UK, or FRANCE, or ITALY— huge numbers of populations are not aware of malnutrition. 

They are less concerned about the children health. They don’t even address that their children are weak and if he or she is weak. Lack of education is also one of the major reasons behind this problem. There are no awareness campaigns to aware people, especially in rural areas. Somewhere administration is also least bother about this issue.

India’s Position in World Hunger Index

India has been ranked at 103 out of 119 counties in the index, with hunger in the country categorised as “serious”. India's ranking has dropped their place from last year, although the index says its results are not accurately comparable from year to year and instead provides a few reference years for comparable data. The 2018 scores reflect data from 2013-2017. 

At least one in five Indian children under the age of five are wasted which means they have extremely low weight for their height, reflecting acute under-nutrition, according to the Global hunger index 2018. The only country with a high prevalence of child wasting is the war-torn nation of South Sudan, says report. 

Main indicators which are used to calculate hunger levels in the world hunger index
There are 4 main indicators used for the calculation of hunger level report, which is peer-reviewed publication released annually by Welthungerhilfe and concern worldwide. The international food policy research institute was also involved with the publication until this year. 

Four main indicators: -
1- The first indicator is undernourishment, which is the share of the population which is undernourished and reflects insufficient caloric intake.
2- child wasting (low weight and height) reflecting acute undernutrition; 
3 - child stunting (low height for age), reflecting chronic under-nutrition.
4 – child morality.

Though India has shown improvement in three of the indicators over the comparable reference years. The percentage of undernourished people in the population has dropped from 2000 to 2018. Whereas child mortality rate has halved, while child stunting has dropped over the same period.

Child wasting is high across south Asia, which creates a critical public health emergency, according to the UN organisation. The report notes that wasting rates are highest for infants aged 0 to 5 months.

A way ahead

The government started addressing malnutrition problem in India. However, there is still a need to act on a large scale where every malnutrition person gets proper treatment. In rural and tribal areas, there is a large population of children who are still lagged to get benefit from the government’s Kuposhan Mukt Abhiyan. Accurate data is needed from every villages and city of the country. Proper inspection work should be done. Administrative work will play an important key role in this mission.  Every Child is the future of the country they deserve a healthy life and adequate nutrients.