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CNNS: Malnutrition’s continued burden in India

Bowl of rice on Indian flag, malnutrition/poverty concept.
India has been called the hunger and malnutrition capital of the world. New figures remind us why, with high prevalences of conditions such as stunting and wasting.

Malnutrition continues to be a significant public health and development burden in India, impacting the health of the nation’s children in manifold ways – as the Comprehensive National Nutrition Survey (CNNS) reminds us. 

Recent Union Health Ministry data, based on the findings of the CNNS which was conducted between 2014 and 2018, found high prevalences of conditions such as stunting and wasting among children under five throughout the country. In addition, the survey flagged high numbers of overweight children and adolescents and a concerning trend of prediabetes – a condition where blood sugar is elevated, but not to the extent that diabetes can be diagnosed. 

“The current nutrition situation in India justifies its high level national commitment with strong policy initiatives based on evidence-informed interventions towards combating all forms of malnutrition in the country,” the study asserts. Approximately 112,316 children and adolescents were surveyed. 

<em><strong>School children having mid-day meal in school, Radhu Khandu Village, Sikkim, India. Fewer than seven percent of children below the age of two consume an adequate in India according to the CNNS.</strong></em>
School children having mid-day meal in school, Radhu Khandu Village, Sikkim, India. Fewer than seven percent of children below the age of two consume an adequate in India according to the CNNS.

According to the CNNS, stunting affected 35 percent of children under five and wasting affected seventeen percent. 33 percent of children are underweight, with 35 percent of children aged five to nine years being underweight and ten percent being severely underweight.

By comparison, the prevalence of stunting and wasting stood at 39.3 percent and 15.7 percent respectively in 2017 – a lower figure for stunting compared to the CNNS, but higher for wasting. In addition, the figure in 2017 for underweight stood at 32.7 percent compared to 33 percent according to the CNNS. 

Fewer than seven percent of Indian children below the age of two consume an adequate diet according to the CNNS, lending an insight into the trends the survey identifies. A mere 6.4 percent of children in this age bracket receive a “minimum acceptable diet”. Acute malnourishment afflicts eleven percent of those aged between six and 59 months. 

Diabetes and oral health risks.
Increased availability of sugary drinks and fast food are leading to rising rates of obesity, unhealthier diets and contributing to an increase in cases of diabetes and prediabetes among India’s youth.

The CNNS also identifies a high level of micronutrient deficiency among India’s youth. Among the preschool age, school-age, and adolescent demographic, zinc deficiency affects nineteen percent, seventeen percent, and 32 percent respectively; vitamin A deficiency affects eighteen percent, 22 percent, and sixteen percent respectively; and vitamin D deficiency affects fourteen percent, eighteen percent, and 24 percent respectively.

The CNNS also identified relatively high rates of deficiencies of folate and vitamin B12. Anaemia – a condition linked to iron deficiency – affects 41 percent of preschool children, 24 percent of school-age children and 28 percent of adolescents. 

As far as obesity goes, between four and eight percent of adolescents are either overweight or obese according to the CNNS. The survey found that, among children and adolescents, there is now a relatively high prevalence of prediabetes, which affects 10.4 percent of those aged between ten and nineteen.

This forebodes a growing diabetes crisis in India, with 98.0 million type-2 diabetes patients anticipated to reside in the country by 2030. Unless action is taken to address the factors driving this crisis, such as high consumption rates of processed foods, fast food, and sugar, it is clear that India’s youth will bear the brunt of this explosion of cases. This is to say nothing of the plethora of other conditions linked to obesity. 

20948537 - poverty and hunger concept with a fork and knife on a broken asphalt road shaped as a dinner plate as a social problem of food shortage hardships caused by financial distress or natural disaster resulting in living poor on the streets as a health risk
The malnutrition burden in India is far from evenly shared between states, with significant variations between them in the prevalence of conditions like stunting and wasting.

Unsurprisingly, the malnutrition burden is far from equally shared between India’s states and union territories. 

A number of the most populous states including Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, and had a high (37-42 percent) stunting prevalence,” the CNNS says. “The lowest prevalence of stunting (sixteen-21 percent) was found in Goa and Jammu and Kashmir. A higher prevalence of stunting in under-fives was found in rural areas (37 percent) compared to urban areas (27 percent). Also, children in the poorest wealth quintile were more likely to be stunted (49 percent), as compared to nineteen percent in the richest quintile.” 

The latest findings reinforce the need for India to take action on malnutrition in all its forms, be it undernourishment or obesity. In 2017, malnutrition was responsible for two-thirds of child deaths in India, killing 706,000 children under five. Prime Minister Narendra Modi has issued a pledge that India will become free from malnutrition by 2022 but, as we have seen, there is a long way to go before this ambition is realised. 

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