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Malnutrition: Responsible for two-thirds of child deaths

Malnutrition .jpgMalnutrition was responsible for almost seventy percent of child deaths in India in 2017, a recent review of data has revealed.

Every state in India lost more lives of children under five to malnutrition than to any other cause, the review revealed, with 68.2 percent of total child deaths in the country caused by malnourishment. In total, 706,000 children’s lives were lost. The finding reinforces what has long been understood: malnutrition is the leading threat to health and wellbeing among India’s youth. The findings were published in The Lancet and jointly compiled by a consortium of institutions with expertise in the field, including the Indian Council of Medical Research (ICMR); the National Institute of Nutrition (NIN); and the Public Health Foundation of India (PHFI). 

Overall, the prevalence of numerous malnutrition-related conditions was relatively high in India in 2017. For wasting, the prevalence was 15.7 percent; for low birth weight, it was 21.4 percent; for underweight in children, it was 32.7 percent; for stunting, it was 39.3 percent; and for anaemia, it was 59.7 percent. Stunting refers to when a child falls short on growth parameters, leaving them at a reduced height for their age. The condition can result in both physical and mental developmental delays.

Schoolchildren consume a midday meal in the village of Radhu Khandu in Sikkim. Undernourishment affects a staggering number of children in India, with high prevalences of associated conditions such as stunting and wasting. 

The data also reflects other facets of malnutrition such as obesity, the prevalence of which in children was 11.5 percent in 2017. While economic growth can be linked with declining rates of undernutrition-related conditions such as stunting and wasting, it can also foster obesity – in itself a form of malnutrition due to an imbalanced diet,often coinciding with a lack of sufficient nutrients. Obesity is expected to increase in India in the coming years, including among children. By 2025, India is expected to be home to at least seventeen million obese children. This is concerning news, given that obesity is associated with a range of negative health consequences including diabetes, hypertension, and heart disease. 

For undernutrition, the data gives an insight into the prevalence of risk factors for children such as breastfeeding and anaemia in women aged fifteen to 49. Anaemia during pregnancy increases the risk of a child being born underweight. As such, it is concerning that the data reports that anaemia affects 54.4 percent of Indian women. Breastfeeding, meanwhile, is credited with providing children with essential nutrients during their first few months of life. As such, the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months and that breastfeeding be initiated within an hour of birth. Yet just 41.5 percent of children in India are breastfed in the first hour whilst the recent data published in The Lancet reflects an exclusive breastfeeding rate of just 53.5 percent.  

Image ID: 80522468 (L)<em><strong>Consumption of the lychee or litchi fruit in Bihar's Muzaffarpur district by undernourished children is thought to have been the root cause of an outbreak of acute encephalitis syndrome there earlier this year - highlighting the negative health effects of malnutrition.</strong></em>
Consumption of the lychee or litchi fruit in Bihar’s Muzaffarpur district by undernourished children is thought to have been the root cause of an outbreak of acute encephalitis syndrome there earlier this year – highlighting the negative health effects of malnutrition.

In terms of malnutrition, the worst-affected states include Assam, Bihar, Rajasthan, and Uttar Pradesh, the data revealed, with these states leading the country in terms of most disability-adjusted life years (DALYS) – effectively referencing the number of years of ‘healthy life’ lost. More than 60,000 DALYS were recorded in these states. They were followed by Chhattisgarh, Madhya Pradesh, Nagaland, Odisha, and Tripura, who recorded DALYS between 50,000 and 59,999 – ranking in the second worst-performing tier of states and union territories. 

The findings pertaining to DALYS are important given the manifold effects malnutrition can have, both in childhood and later life. Indeed, malnutrition’s effects extend from the immediate impact on health and can have lasting consequences, including negatively affecting educational performance and future economic prospects. This perpetuates a cycle of poverty leading to undernourishment leading to further poverty and ill health. 

Health Issues India recently highlighted the poor performance of Bihar and Uttar Pradesh on indicators related to nutrition. Poor infrastructure for nutritional support schemes and a relative dearth of adequate funds for such programmes were identified as being among the reasons behind their underperformance. For Bihar, the news comes months after malnutrition was linked to a spate of deaths after undernourished children consumed lychees on an empty stomach. This led to cases of acute encephalitis syndrome (AES) and hypoglycaemia, with numerous fatalities following and the performance of the state government on nutrition being flagged by, among others, the Supreme Court. 

Malnutrition concept. Hunger.
“Efforts are needed in each state to control malnutrition. State governments are being encouraged to intensify efforts to reduce malnutrition and undertake robust monitoring to track the progress.”

The latest findings reinforce the need for political will in vulnerable states as well as the national level to ensure India’s children receive the nourishment they need for a healthy life and the opportunity for positive physical and socioeconomic development. Fortunately, efforts are underway to promote awareness of malnutrition in India. 

The government is recognising September as Rashtriya Poshan Maah (National Nutrition Month), with initiatives to counter malnourishment and promote the importance of a healthy diet. Prime Minister Narendra Modi has pledged to rid India of malnutrition by 2022. Yet, as Professor Vinod K. Paul of government think tank Niti Aayog points out, “efforts are needed in each state to control malnutrition. State governments are being encouraged to intensify efforts to reduce malnutrition and undertake robust monitoring to track the progress.” For the worst-performing states in particular, this is essential.

“Malnutrition in children is an outcome of inadequate maternal nutrition, poor sanitation and hygiene and suboptimal infant feeding practices,” notes R. Hemalatha, director of the NIN. “Improvement in nutrition, therefore, is linked not only with food availability and access, but also with food safety and environment.”

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