Introduction
Malnutrition is one of the major health problems faced by India. It is not only a direct cause of death among children under five-years of age, it also gives rise to diseases by reducing resistance to infections. Malnutrition begins from womb as a baby born with an intra-uterine growth retardation is more likely to become a stunted child and unable to attain full growth potential. Despite programme commitments, since 1975, such as creating Integrated Child Development Services (ICDS), and national coverage of Mid-day Meal Scheme, India continues to grapple with a high rate of malnutrition. As per the Global Nutrition Report 2018, India tops the list of countries where 46.6 million children are stunted, followed by Nigeria (13.9 million) and Pakistan (10.7 million). Among the malnutrition indicators, low birth weight is the largest contributor to child deaths in India, followed by child growth failure. Over weight, among a subset, is also becoming a significant public health problem across all states.
Stunting in India
India is home to the largest number of stunted children in the world, around two in five (38.4 per cent) under 5 too short for their age, and 35.8 per cent are underweight. According to 2018 Human Capital Index, India ranks 115 out of 157 countries. Since 53.1 per cent of women were anaemic in 2015, this will have a lasting effect on their future pregnancies and children. Malnutrition is shockingly high in both rural and urban India. About nine in ten children between 6 and 23 months do not get ‘adequate’ age-appropriate diet, as per National Family Health Survey 4 (NFHS-4) (2015–16). Only 11.6 per cent urban and 8.8 per cent rural kids have adequate diet.
One in three children under five-years of age are underweight, including 29 per cent in urban India. Around 70 per cent adolescent girls are anaemic and 50 per cent are underweight.
Causes of Malnutrition
As per the Global Nutrition Report, 2018, the following are the causes of malnutrition in India:
* mother’s poor health and undernutrition;
* low birth weight;
* faulty and sub-optional infant and child-feeding practices;
* repeated episodes of illnesses, such as diarrhoea, pneumonia, and worm infestation;
* mother’s poor nutritional health and large family sizes;
* poor sanitation practices;
* lack of commitment on the part of many state governments in improving healthcare governance and health provisioning;
* child growth failure like stunting, vesting, and underweight;
* acute shortage of nurses, auxiliary nurse midwives, and laboratory technicians;
* large number of dysfunctional anganwadi centres;
* more than half of Bihar’s children could not be included in the ICDS survey;
* lack of ICDS services;
* use of funds, released by government undernutrition programme (mission).
Effects of Malnutrition
The following are the effects of malnutrition:
* Malnutrition impacts not only the mental, physical, and cognitive development of a child but lowers his/her immunity and learning outcomes as well.
* Vitamin A deficiency can increase infections like measles and diarrhoeal diseases.
* Two-thirds of the 1.04 million deaths in children under five-years are attributable to malnutrition in India.
* Disability-adjusted life years (DALYs) rate attributable to malnutrition varies seven-fold among the states and is the highest in Rajasthan, Uttar Pradesh, Bihar, Assam, Madhya Pradesh, Chhattisgarh, Odisha, Nagaland, and Tripura.
* Stunting lowers learning capacity, raises the risk of infections, and leads to chronic diseases, such as diabetes, hypertension, obesity and heart disease.
Measures Taken by Government
The government is running several programmes to reduce malnutrition. The Integrated Child Development Scheme (ICDS), POSHAN Abhiyan, National Health Mission (NHM), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Matru Vandana Yojana (PMMVY), Mid-day Meal Scheme, and Anganwadi are to name a few.
(i) Integrated Child Development Scheme Integrated Child Development Scheme (ICDS), launched in 1975, provides food, pre-school education, primary healthcare immunisation, health check-up, and referral services to children under six years of age and their mothers.
(ii) POSHAN Abhiyan Prime Minister’s Overreaching Scheme for Holistic Nourishment (POSHAN), launched in 2018, is a malnutritional convergence mission and aims to attain malnutrition-free India by 2022. Implemented by the Ministry of Women and Child Development (MWCD), it is currently working in 315 districts (first year) and will work in 235 districts (second year) and in the remaining districts in the third year.
(iii) National Health Mission The National Health Mission (NHM), launched in 2013, subsumes the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). It is headed by Mission Director whereas National Level Monitors, appointed by Government of India to monitor it. The main objective of the mission is to address India’s malnutrition crisis.
(iv) Janani Shishu Suraksha Karyakram (JSSK) The Janani Shishu Suraksha Karyakram (JSSK), launched in 2011, aims to benefit pregnant women who access government health facilities for delivery. It motivates those who still choose to deliver at homes to opt for institutional deliveries. It is working across the country.
(v) Pradhan Mantri Matru Vandana Yojana (PMMVY) The Pradhan Mantri Matru Vandana Yojana, launched in 2016, is a maternity benefit programme and is implemented by the Ministry of Women and Child Development (MWCD). It also runs a conditional cash transfer scheme for pregnant and lactating women of 19 years or above for their first live birth.
(vi) Mid-day Meal Scheme Mid-day Meal Scheme, launched in 1995, supplies free lunches on working days for children in primary and upper primary schools in government, government-aided, local body, Education Guarantee Scheme Centres, Madarsa and Maktabs supported by Sarva Shiksha Abhiyan, National Child Labour Project schools. The largest of its kind in the world, it is covered under the National Food Security Act, 2013.
(vii) Anganwadi Anganwadi, launched in 1975, is a type of rural childcare centre to combat child hunger and malnutrition. It also provides basic childcare in villages and is a part of Indian Public Health Care System. Besides, it provides contraceptive counselling, provides rehydration salt and basic medicines. As of January 2013, it consisted of 13.3 lakh centres across the country.
Monitoring and Evaluation of Schemes
A monitoring and review mechanism to check the performance of the schemes has been started by the government. The periodic monitoring to assess the impact of the national nutrition mission (NNM) (renamed as POSHAN Abhiyan) is done by NITI Aayog’s technical unit. A National Nutrition Resource Centre Control Project Monitoring Unit (NNR-CCPMU) regularly monitors the PMMVY through web-based management and information software. The scheme is evaluated through various input, output, and impact indicators by the Management and Information Software (MIS).
To further strengthen the performance of Anganwadi services, the government has introduced monitoring and review mechanism at national, district, block, and anganwadi levels. The monitoring of other schemes is also undertaken through meetings and video conferences with the officials of state governments.
Report of the Survey
The National Family Health Survey (2015–16) indicates some dismal trends with the proportion of stunted (low height for age), wasted (low weight for height), and underweight (low weight for age) children at as high as 38.4 per cent, 21 per cent, and 35.8 per cent respectively. One in three children under-5 years are underweight, including 29 per cent in urban India. Around 70 per cent adolescent girls are anaemic and 50 per cent are underweight. Nearly two in five children are too short for their age (stunted), accounting for the largest number of stunted children in the world at 38.4 per cent.
Geographically, Bihar, Uttar Pradesh, and Jharkhand have very high rates of stunting at 48, 46, and 45 per cent respectively. On the other hand, Kerala and Goa have the lowest rate at 20 per cent. The most significant decline has been noted in Chhattisgarh, i.e., a 15 per cent decline in the past decade. The least progress was made in Tamil Nadu. Almost 40 per cent of districts have stunting levels, above 40 per cent. Uttar Pradesh tops the list, where six out of ten districts have the highest rate.
Since stunting prevalence tends to increase with the passage of time, timely nutritional interventions of breastfeeding, age-appropriate complementary feeding, full immunisation, and Vitamin A supplementation have given improved outcomes to children. Despite that, only 41.6 per cent children are breastfed within one hour of birth, 54.9 per cent are exclusively breastfed for six months, 42.7 per cent are provided timely complementary foods, and only 9.6 per cent below two years receive an adequate diet. About 40 per cent of children do not get full immunisation and Vitamin A supplementation.
* Rate of Reduction According to a study, published in the journal ‘Lancet Child and Adolescent Health’, the prevalence of low weight was 21 per cent in India in 2017, ranging from 9 per cent in Mizoram to 24 per cent in Uttar Pradesh. The annual rate of reduction was 1.1 per cent between 1990 and 2017, ranging from 3.8 per cent in Sikkim to 0.3 per cent in Delhi.
The prevalence of child stunting was 39 per cent in 2017. This ranged from 21 per cent in Goa to 46 per cent in Uttar Pradesh and was generally highest among socio-economically backward states of Bihar, Chhattisgarh, Jharkhand, Odisha, Rajasthan, Madhya Pradesh, and Uttar Pradesh. The annual rate of reduction in child stunting was 2.6 per cent in India between 1990 and 2017, which varied from 4 per cent in Kerala to 1.2 per cent in Meghalaya.
The prevalence of child underweight was 23 per cent in 2017, ranging from 16 per cent in Manipur to 42 per cent in Jharkhand. The annual rate of reduction was 3.2 per cent between 1990 and 2017, ranging from 5.4 per cent in Meghalaya to 1.8 per cent in Delhi.
The prevalence of child anaemia was 60 per cent in India in 2017, ranging from 21 per cent in Mizoram to 74 per cent in Haryana. The reduction rate in anaemia in India between 1990 and 2017 ranged from 8.3 per cent in Mizoram to no change in Goa.
As for death rate due to malnutrition in under-5 children, it has dropped by two-thirds from 1990 to 2017. Bihar, Rajasthan, Chhattisgarh, and Uttar Pradesh are the states with the highest proportion of total under-5 deaths in 2017, standing at 72.7, 72.2, 71.6, and 68.6 per cent respectively. Similarly, Kerala, Meghalaya, Tamil Nadu, Mizoram, and Goa are the states with the lowest proportion of total under-5 deaths, standing at 50.8, 59.1, 59.8, and 60.1 per cent respectively.
* Inadequate Use of Funds National Nutrition Mission (NNM) set up a three-year budget of ` 9,046.17 crore starting 2017–18 of which the Central share is
` 2,846.54 crore. Unfortunately, the take-up of the NNM has been very slow. Of ` 2,555 crore, released by the Central and state governments in 2018–19, only up to ` 568.72 crore (22 per cent) was spent. Fund utilisation was the lowest in Punjab, nearly ` 30.88 lakh of ` 60.9 crore (0.50 per cent) in 2018–19, Kerala at 2.12 per cent used only ` 1.37 crore of ` 64.91 crore. Assam, Delhi, Haryana, and Jharkhand used 5–6 per cent. Chhattisgarh spent close to 16 per cent, Uttar Pradesh 20.23 per cent, and Bihar 35.86 per cent.
Among the best states are North-East and Union Territories (UTs). Meghalaya spent 88.28 per cent, Dadra and Nagar Haveli used 95.87 per cent. In 2017–18,
` 584.53 crore was released, but only 119.74 (0.20 per cent) was recorded by only one state, Tripura.
Conclusion
Given the above scenario, states will need to implement an integrated nutrition policy to efficiently address the issue of malnutrition. Correct information needs to be shared. State and Central governments should use all communication tools to provide services when and where needed. Health and nutrition programmes should be pushed for convergence. A multi-pronged approach must be adopted to bring about socio-behavioural change. And lastly, effective monitoring and implementation of programmes must be ensured.
Best Sellers in Office Products
Best Sellers in Apps for Android