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Why malnutrition is such a big challenge

The phenomenon of high rates of child malnutrition in South Asia has been termed the “the South Asian enigma” by Ramalingaswami and other experts, Amitav Banerjee, a community medicine expert had said.


Malnutrition continues to be a significant public health problem in India despite having several major programmes to address the issue, namely the Integrated Child Development Scheme ICDS, Mid –Day Meal (MDM) and also Food Security Act. Data from the Global Hunger Index that measures malnutrition, stunting and mortality rates of under-five shows that one in three children in India has stunted growth, whereas 15 per cent of the country’s population is undernourished. The 2016 Global Hunger Index (GHI) that was released this week said 38.7 per cent of Indian children under five years are stunted due to lack of food.

The report by the International Food Policy Research Institute (IFPRI), also ranked India 97 among 118 countries, faring worse than all its neighbours China (29), Nepal (72), Myanmar (75), Sri Lanka (84) and Bangladesh (90), except for Pakistan (107) in measures of hunger.

At the Indian Council of Medical Research (ICMR), Director General Dr Soumya Swaminathan explained that the issue of undernourishment of children is complex: it is not just lack of food (macronutrients) but the quality (micronutrients) as well as the capacity to absorb and utilize nutrients. These are affected by poor water and sanitation. Hence we need a more holistic approach to address all these factors. Also, low birth weight (LBW) can be reduced through attention to maternal nutrition. A LBW child is likely to remain stunted.

Hunger levels in developing countries have fallen 29 per cent since 2000, but efforts to curb hunger must be accelerated in order to meet an international target to eradicate it by 2030, according to the annual index and India along with Indonesia and Nigeria is among 43 countries that have `serious’ hunger levels. Under nutrition is an underlying factor in many diseases in both children and adults, and it contributes greatly to the disability-adjusted life years worldwide. It is particularly prevalent in developing countries where it affects one out of every three pre-school-age children. Preventing under-nutrition has emerged as one of the most critical challenges to India’s development planners in recent times.

Experts feel that lack of institutional framework to address malnutrition, the lack of inter-sectoral convergence amongst multiple government departments critical to address this problem, the lack of monitoring and accountability in public funded nutrition programmes are among the reasons why India continues to suffer from this significant public health challenge.

As Amitav Banerjee, a community medicine expert, wrote in an editorial in a medical journal of the D Y Patil medical college in 2014, one of the paradoxes in the India growth story is that the improvement in the nation’s health has not been commensurate with its economic growth.

Selected indicators for the world’s 16 poorest countries outside of sub-Saharan Africa show that while India heads the list in gross domestic product (GDP) per capita, it fares poorly in all health indicators such as life expectancy at birth, infant mortality rate, under-five mortality rate, access to sanitation, proportion of under-five children who are malnourished and child immunization rates. The most embarrassing statistic is the proportion of Indian children below 5 years who are underweight.

The phenomenon of high rates of child malnutrition in South Asia has been termed the “the South Asian enigma” by Ramalingaswami and other experts, Banerjee had said. They postulated that the low status of women in South Asia leads to poor nutrition and other deprivations during pregnancy causing intra-uterine growth retardation and low birth weights, affecting the children’s nutritional status right from birth and even conception. This hypothesis is consistent with more recent reports

According to Prof Chandrakant Pandav, in charge of the Centre for Community Medicine, AIIMS, New Delhi, there has also been too much focus on food-based programmes and neglect of other nutrition sensitive interventions like environment, safe water and sanitation.“Malnutrition is primarily a social disease and will require holistic broad-based interventions,” he expert, said adding a positive note to the gloomy picture painted by the Global Hunger Index 2016. “On a brighter side India is seeing significant improvement in reduction in malnutrition in last few years with some of the states like Maharashtra performing exceedingly well,” he added.

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