12 January 2012

Tackling our National Shame: Malnutrition

Malnutrition continues to prevail in India. As per the HUNGaMA (Hunger and Malnutrition) Survey, 2011 conducted in 112 rural districts of India, the rates of child malnutrition still continues to be unacceptably high in the country.

One child dies every 15 seconds in India due to neonatal diseases and 20 lakh children die before reaching the age of five. The country sees over four lakh newborn deaths every year within 24 hours of life and over 20 percent of the world's child deaths occur in India, the largest number anywhere in the world. One in three malnourished children of the world live in India.

Out of the 112 districts surveyed, 100 were selected from the bottom of a child development district index developed for UNICEF India in 2009 and are referred to as the 100 Focus Districts in the report. The 100 districts are located in 6 states. The 112 districts were categorized under 3 heads, namely, 100 Focus Districts (100FD), 6 best districts from focus states (6BDF) and 6 best districts from 'best states (6BD). The survey shows a positive change for child nutrition happening in India, inclusive of the 100 Focus Districts. But the rates of child malnutrition are still seen to be very high particularly in the Focus Districts where over 40 per cent of children are underweight and almost 60 per cent are stunted.

Based on the geographic area the child malnutrition prevalence was noted to be as follows: 58.8 percent of children are moderately or severely stunted in the 100 focus districts. 42.3 percent are moderately or severely underweight and 11.4 percent are moderately or severely wasted. For the category of 6BDF the figures were seen to be 43.3, 32.6 and 12.4 percent respectively. As for the 6 BD the figures were 32.5, 21.9 and 13.5 percent respectively. The ‘severe’ condition of being stunted, underweight and wasted seen in the 100 focus districts was 34, 16.4 and 3.3 percent. For 6BDF the percentage was 20.5, 11.3 and 3.4 respectively and for 6 BD the percentage was 14.2, 6.5 and 4.7 respectively.

The survey indicated that the prevalence of stunting increases sharply from birth to the first two years of life as children grow older, reaching a maximum among children aged 24 to 35 months. The percentage was noted to be 64.8, 50.9 and 36.1 in 100 FD, 6BDF and 6BD respectively. The prevalence of child underweight was observed to have a similar pattern with 44.1, 35.7 and 22.2 percent respectively in the three heads as mentioned above. The prevalence of wasting reached the maximum among children aged 12 to 23 months, and was seen to be as high as 16.9 percent in children aged 12 to 23 months in 100 FD.

The prevalence of malnutrition among children as per gender showed that stunting and underweight among boys was higher up to the age of 35 months in 100 FD while it was vice-versa in the age group of 36 to 59 months.

Another interesting finding from the survey was that prevalence of child malnutrition is significantly higher among children of mothers with little or no education. It was seen that 55 percent of mothers never went to school while 84 percent had never heard of "malnutrition". As for the hygiene and sanitation aspect it was noted that child wasting, underweight and stunting was higher in households without a toilet. It was also noted that only 55 percent women took their children to a trained doctor when he or she was ill with only 11 percent families using soap to wash their hands before meals.

Addressing the malnourishment issue in India, Prime Minister Manmohan Singh said "The survey reports high levels of malnutrition, despite impressive growth in our GDP. But it also indicates that one child in five has reached an acceptable healthy weight during the last seven years in 100 focus districts. This 20% decline in malnourishment is better than the rate of decline reported in National Family Health Survey 3”, as reported by The Economic Times.

The PM also said that the Integrated Child Development Services (ICDS), which is the government's most important tool to fight malnutrition, can no longer be relied on solely. He added that "We need to focus on districts where malnutrition levels are high and where conditions causing malnutrition prevail. Policy makers need to clearly understand many linkages -- between education and health, between sanitation and hygiene, between drinking water and nutrition - and then shape their responses accordingly.”

With a view to curb the malnutrition issue Singh said a multi-sectoral programme to combat malnutrition will be rolled out in 200 high-burden districts. A re-launch of a strengthened ICDS is also being planned. India also has planned to initiate a nationwide communication campaign against malnutrition.