The global burden of malnutrition remains a cause for worry as nearly half of all deaths in children under five years is linked to poor nutrition. India is the home to one fifth of the global population and the health of our women and children continues to pose several challenges. Out of the 26 million children suffering from severe acute malnutrition worldwide, 8.1% of them are estimated to be in India. Reportedly, poor nutrition, leading to iron deficiency has been the principal underlying factor in more than 60% of all anaemia cases. Also more than half of all women of reproductive age and children under five years are anaemic. Despite various interventions, chronic malnutrition (stunting - low height for their age) in children under five years of age reduced by only one-third between 1992 and 2016.
Results of the Comprehensive National Nutrition Survey 2016-18, recently released by the Union health ministry, should serve as a wake-up call for effecting corrective measures to overcome the poor state of nutrition as also its impact on the body and mind of our children.
Yes, the first survey of its kind undertaken to estimate the prevalence of malnutrition among children and adolescents primarily to identify key factors associated with the nutrition transition, collected data across 30 States covering rural and urban households from three target population groups comprising of 38,060 pre-schoolers (0–4 years), 38,830 school-age children (5–9 years) and 35,830 adolescents (10–19 years). About 112,316 children and adolescents were interviewed. Blood, urine and stool samples were drawn from 51,029 children and adolescents. It evaluated nutritional status on the basis of diet diversity, meal frequency and minimum acceptable diet.
The results ought to serve as an eye-opener. Anaemia continues to be a severe public health problem among women, adolescent girls and young children in India. 41% of pre-schoolers, 24% of school-age children and 28% of adolescents were anaemic - female adolescents had a higher prevalence of anaemia (40%) when compared to their male counterparts (18%). Children and adolescents in urban areas had a higher prevalence of iron deficiency when compared to their rural counterparts. 35% of children under five were stunted, 17% of children under five were wasted (low weight for their age) and 33% of children under five were underweight. 11% of children 6–59 months were acutely malnourished and 1% of children under five were overweight. 22% of school-age children were stunted, 10% of school-age children were underweight and 23% of school-age children were thin, while 4% of school-age children were overweight or obese. One in ten school-age children and adolescents were pre-diabetic. 5% of adolescents were classified as having hypertension. The survey also found a growing risk of non-communicable diseases among children aged 5 to 9 years and adolescents aged 10–19 years.
The inadequacies were found in diet diversity, meal frequency and minimum acceptable diet, some of which are attributable to social and economic reasons that need to be tackled in the right earnest. Notably, children received better diets when mothers had higher levels of schooling. But children of highly educated and working women received meals less frequently and were prone to lifestyle diseases caused by the consumption of sugary and unhealthy food. While 11.4% of children of mothers with no schooling received adequately diverse meals and 31.8% of those whose mothers educated to Class XII level received diverse meal, only 3.9% of children whose mothers had zero schooling got a minimum acceptable diet. Hence educating the girl child can bring rich dividends not only for betterment of their social-cum-economic status but also towards improving the health and welfare of their offspring.
There is an urgent need to tackle overweight and obesity in children. Under the POSHAN Abhiyaan, launched by the Union Government on 8 March 2018, to improve nutritional outcomes for children, pregnant women and lactating mothers, it is envisaged to reduce stunting and underweight by 2%, anaemia by 3% among young children, women and adolescent girls besides reduce low birth weight by 2% per annum.
As stunting in early life can have long-term effects on health, physical and cognitive development and even a 1 cm increase in height according to research has been associated with a 4% increase in wages for men and a 6% increase in wages for women, reduction of child malnutrition is crucial.
Various studies have concluded that good nutrition is one of the key factors for advancing human well-being and economic prosperity. Importantly, malnutrition (lack of proper nutrition) and specifically undernutrition (insufficient intake of energy and nutrients to meet an individual’s need to maintain good health) is not only a consequence of poverty, food insecurity etc., but also one of the reasons for the lack of progress in economic development throughout the developing world. Consequently, undernutrition not only slows economic growth but among others, also deepens poverty through productivity losses arising out of poor physical performance and cognitive capacity. In the case of children, owing to nutrient deficiencies their growth pattern becomes disrupted.
The Delhi High Court, in 2015 while deciding a public interest litigation, had directed the Food Safety and Standards Authority of India to come out with regulations to promote healthy food for school children. The draft regulations which are under consideration among others propose to ban advertisements of unhealthy food in and around school premises in an attempt to promote safe and wholesome food among school children. Beyond legislation, it needs to be appreciated that poverty, hunger and malnutrition are linked. So are lifestyle, genetics and poor dietary habits. A balanced diet that includes green vegetables, pulses, fresh fruits etc., is needed to lead a healthy life. But l ess than 47% of all Indians, especially women consume dark green, leafy vegetables daily and another 38% eat them once a week. With a burgeoning packaged fast food industry expanding its reach even to small towns and villages, although it gives a variety of choices, it is imperative to ensure that healthy food prevails over “junk” to reduce the ever increasing risk of obesity and its consequences.
(Published on 28th October 2019, Volume XXXI, Issue 44)