“Though quieter than famine, persistent undernutrition kills many more people slowly in the long run than famine do” (Dre’ze and Sen 1998)
India’s much coveted ‘demographic dividend‘ might be in jeopardy. It is estimated that by 2030, there will be 484.86 million youth (aged between 15 to 34) in India. Much has been said about its potential for the Indian economy to reap rich harvest in the coming days.
But, the question is – what percentage of that population is healthy? fit enough to work in a challenging, highly competitive world?
MAGNITUDE OF MALNUTRITION
National Family Health Survey – III (NFHS-III) (2005-06) revealed shocking data regarding the health status of India children – long before Prime Minister Manmohan Singh, called malnutrition as matter of national shame.
According to NFHS-III, which is conducted by Ministry of Health and Family Welfare, India has 48% stunted, 20% wasted, and 43% underweight children below 5 years (45%, 23% and 40% respectively for children below 3 years). Stunted indicates chronic malnutrition; wasted – acute malnutrition and underweight indicates a composite index of chronic and acute malnutrition.
According to UNICEF:
- Stunting, or low height for age, is caused by long-term insufficient nutrient intake and frequent infections. Stunting generally occurs before age two, and effects are largely irreversible. These include delayed motor development, impaired cognitive function and poor school performance. Nearly one third of children under five in the developing world are stunted.
- Wasting, or low weight for height, is a strong predictor of mortality among children under five. It is usually the result of acute significant food shortage and/or disease. There are 24 developing countries with wasting rates of 10 per cent or more, indicating a serious problem urgently requiring a response.
- Since 1990, underweightprevalence has declined from 32 per cent to 27 per cent in the developing world. The East Asia/Pacific and CEE/CIS regions have made the greatest progress in reducing underweight prevalence, and 58 countries are on track to reach the MDG target. Yet, 143 million under-fives in the developing world continue to suffer from malnutrition, more than half of them in South Asia. Most countries failing to make sufficient progress are in sub-Saharan Africa.
The causes for malnutrition are various and are multidimensional. To sum up, they include:
– Household food insecurity
– illiteracy specially in women
– Poor access to health services
-Lack of availability of safe drinking water
– Poor sanitation and environmental conditions and low purchasing power etc.
– Early marriages of girls
– Teenage pregnancies resulting in low birth weight of the newborns
– Poor breastfeeding practices
-Poor complementary feeding practices
– Ignorance about nutritional needs of infants and young children and repeated infections further aggravate the situation.
– Number of other factors such as environmental, geographical, agricultural, and cultural including various other factors have contributive effects resulting in malnutrition.
Therefore it is widely recognized that a multi sectoral approach is necessary to tackle the problem of malnutrition.
CONSEQUENCES OF MALNUTRITION
Undernourished children have significantly lower chances of survival than children who are well-nourished. They are much more prone to serious infections and to die from common childhood illnesses such as diarrhoea, measles, malaria, pneumonia, and HIV and AIDS. The risk of dying increases with the severity of the under-nutrition. For instance, a child suffering from severe acute malnutrition is nine times more likely to die than children who are not undernourished.
Nutrition is important to ensure proper brain formation and development, which starts in the womb: development of the brain goes on during early childhood. Evidence suggests that children who are stunted often enrol late in school, complete fewer grades and perform less well in school. This, in turn, affects their creativity and productivity in later life. Iodine deficiency is known to affect a child’s Intelligence Quotient (IQ) adversely. It has also been established that children with deficient growth before age two are at an increased risk of chronic disease as adults, especially if they gain weight rapidly in the later stages of childhood. A low birth weight baby, who is stunted and underweight in its infancy and gains weight rapidly in childhood and adult life, is much more prone to chronic conditions such as cardiovascular disease and diabetes. (FRONTLINE)
RECOMMENDATIONS OF PLANNING COMMISSION
A Task Force was constituted by the Planning Commission in December 2007 to study the Problems of Childhood Malnutrition.
The recommendations of the Task Force include:
- regular annual survey under ICDS on malnutrition rates ;
- Village Health and Sanitation Committee to monitor nutrition programmes through the Village Health and Nutrition Days ;
- introduction of BMI as another index for assessing nutritional status at the Anganwadi level ;
- effective antenatal care and conditional maternity entitlements to reduce incidence of low birth weight babies ;
- focus on health and nutrition of adolescent girls ;
- promoting appropriate infant and young child feeding practices and timely immunisation;
- child specific growth monitoring cards ;
- special focus on severely malnourished children ;
- hot cooked meals and community participation under ICDS;
- capacity building of the Anganwadi workers ;
- convergence with other programmes etc.
Good nourishment is the right of every child, and the state must ensure proper nutrition for all children. In this regard government has taken number of steps, but in spite of these measure, malnourishment is highly prevalent. This is mainly because of failure in delivering services, and loopholes in some of the schemes.
Direct interventions schemes include:
- Integrated Child Development Services (ICDS) Scheme,
- National Rural Health Mission (NRHM),
- Mid-Day Meal Scheme,
- Rajiv Gandhi Schemes for Empowerment of Adolescent Girls (RGSEAG) namely SABLA and
- Indira Gandhi Matritva Sahyog Yojna (IGMSY)
SIMPLE MEASURES WITHOUT INCURRING COST
There is overwhelming evidence to suggest that tackling child under-nutrition requires a life-cycle approach, which implies that different interventions are needed at different stages in the life of a woman (during adolescence and pre-pregnancy as well as during pregnancy and after the birth of the child) and of a child (immediately at birth, up to six months, 6-23 months and 24-59 months). Listed below are such five critical technical interventions.
1. Improve breastfeeding practices in the first six months of life by ensuring that:
• All newborns start breastfeeding within one hour after birth (early initiation);
• All newborns are fed the nutrient-rich colostrum in the first three-to-four days of life (colostrum feeding); and
• All infants are fed only breast milk in the first six months of life (exclusive breastfeeding) and are not fed any other solid or liquid, not even water.
2. Improve foods and feeding practices for children 6-23 months old by ensuring that:
• Infants are fed complementary foods beginning at about six months of age while breastfeeding continues until two years and beyond;
• Complementary foods are rich in energy, protein, and micronutrients (vitamins and minerals).
3. Control micronutrient deficiencies and anaemia in the first years of life by ensuring that:
• All children 6-59 months old are provided with vitamin A supplements twice a year (about six months apart);
• All children 12-59 months old are provided with deworming tablets twice a year (about six months apart); and
• All children with diarrhoea receive appropriate treatment with zinc supplements and oral rehydration solution (ORS).
4. Control micronutrient deficiencies and anaemia in adolescent girls and women by ensuring that:
• Anaemia is prevented in adolescent girls and pregnant women through supplementation programmes with iron and folic acid and deworming tablets;
• Iodine deficiency is prevented in adolescent girls and women by ensuring that all salt for direct human consumption contains adequate levels of iodine.
5. Provide quality care for children with severe under-nutrition by ensuring that:
• Cases of severe acute under-nutrition are managed at home with simplified protocols and also clinically (wherever required) under appropriate medical supervision.
In terms of immediate actions that can yield quick results, four priorities for the child would be the initiation of breastfeeding within one hour after birth, exclusive breastfeeding in the first six months of life, introduction of appropriate complementary foods after six months, and bi-annual vitamin A supplementation with deworming for children under five. (SOURCE: Frontline)
To realize the potential of demographic dividend, India must ensure that its children grow healthily. Economic growth of 9% can not guarantee good health to the citizens if the state do not take pains to redistribute wealth properly to make India a safer place for its children to grow with dignity.
Apart from these, I have liberally taken paragraphs from Frontline magazine and PIB website and credits are duly acknowledged with links to the sources.