lNew Delhi: Of the 1.04 million under-five deaths in India in 2017, malnutrition was responsible for two-thirds of child deaths in India in 2017 killing 706,000 children under five, reveals the findings of the India State-Level Disease Burden Initiative’s report. According to the global nutrition report of 2018, India has one-third of the world’s stunted (low height for age) children. India has the highest level of child wasting (low weight for height) in South Asia, states the Global Hunger Index. Not only is this, but India also has more than a million overweight children. Also, the Comprehensive National Nutrition Survey (CNNS) reveals that in India only 6.4 per cent of children under the age of two years get a minimum acceptable diet. Acute malnourishment afflicts 11 per cent of children between 6 and 59 months. The CNNS identifies a high level of micronutrient deficiency among India’s youth.
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Dr Rajan Sankar, Programme Director, Nutrition, Tata Trusts told NDTV,
Malnutrition is a complex problem and over and under nutrition are both not harmful. Nutrition is key to unlocking wellness which helps fighting diseases, also in productive citizens and overall a healthy country.
Malnutrition in children is a major public health problem in our country. It can cause irreversible damage to children’s brain development and their physical growth, leading to a diminished capacity to learn, poorer performance in school, greater susceptibility to infection and disease and a lifetime of lost earning potential.
Nutrition has many implications on growth, GDP, productivity and IQ. In fact India’s IQ is abysmally low compared to other countries because of malnutrition and has a lot of implication on the demographic dividend. About 810 million people are in productive work force so if you analyze the history and pattern and 50% in childhood would have been malnourished. 1% anemia can decrease productivity by 1%, 1 % stunting decreases productivity by 1.5% and it is estimated that Malnutrition has a bearing on 5-7% GDP so the return on investment on nutrition so if you invest Re 1, you get 16 rupees as return so you can imagine how it has implications on growth, GDP, human capital potential and demographic dividend, said Basanta Kumar Kar, Global ‘Transform Nutrition Champion’ Awardee.
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Malnutrition, in all its forms, includes undernutrition which is wasting, stunting, underweight, inadequate vitamins or minerals, anaemia, overweight, obesity, and resulting diet-related non-communicable diseases.
The first 1000 day window period is considered the most important period to intervene to prevent the lifelong damage caused by malnutrition. Almost all stunting takes place in the first 1000 days after conception. Soumya Swaminanthan, Deputy Director-General, World Health Organisation said,
The first thousand days of a child is really important from the time the child is conceived and child is in mother’s womb till the first two years after birth and this is because most of the physical mental cognitive development occurs in those first 1000 days of life therefore everything can go right or everything can go wrong if the environment is not suitable, so if you look at a two year old child the height of a two year old child is already half that of an adult so in the first two years the child is growing to the half of the height of an adult similarly most of the brain development occurs in first two years of life and after that there is very little scope for further growth of the brain and so the period of pregnancy and first two years of life are so important both in terms of having the right nutrition for the growing baby but also in terms of cognitive and intellectual and social stimulation that the child gets from the environment in which he/she is growing up in order to foster optimal brain growth and if that doesn’t happen then you end up with a child who is physically stunted or cognitively or intellectually stunted or both and this has a long term implication for a child when they grow and become adult and they can never achieve their full genetic potential and as you know this the focus on human capital now is really important because that what leads to our country’s economic success and therefore it all boils down to paying attention to first 1000 days of life in order for any other country to aspire to be an economic powerhouse or to become a successful country with a happy and healthy population.
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In fact, evidence shows that appropriate complementary feeding practices reduce the incidence of stunting whereas severe infectious diseases in childhood like measles, diarrhoea, pneumonia, meningitis, and malaria provoke wasting and possibly stunting.
After 6 months stunting increases as diseases start affecting the child and infections also go up as children start crawling so they are prone to to falling unwell. Even exclusive breast feeding is low in our country so we need family to strengthen the mother’s ability, encourage kangaroo position and the also help the child with optimum introduction of food as that does not happen; less than 10% children are fed enough in this period so behavior change and compliance is needed, shared Dr Vinod Paul, Member, NITI AAYOG.
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Hygiene Too Plays A Key Role
Environmental enteropathic disorder identified by reduced intestinal absorptive capacity, altered barrier integrity in the intestine and mucosal inflammation is found in young children living in unhygienic conditions. Childhood Diarrhoea is a major health burden in India. The World Health Organisation estimates that 50% of malnutrition is associated with repeated diarrhoea or intestinal worm infections as a result of unsafe water, inadequate sanitation or insufficient hygiene.
The link between water and sanitation and causes of ill health including diarrheal disease and diarrheal deaths in children is really strong and this has been seen time and again that when you provide clean drinking water and safe sanitation then disease burden due to diarrhea drops in those communities and overall health and well-being of children starts improving. So I think certainly we are beginning to see and we should see much stronger links between those districts who have become open defecation free but I would just like to give stress that its really important to keep up the focus on sanitation as well as clean drinking water so I think swachh bharat campaign and the jal abhyan program are great because they focus on the very essential elements of safe drinking water and sanitation, added Soumya Swaminanthan, Deputy Director-General, World Health Organisation
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After early infancy which is the first 1000 days of life also called the first window of opportunity; prioritising interventions for enhancing nutrition for adolescent girls—the mothers of tomorrow, which represents the second window of opportunity for making ‘nutrition for all’ a reality. Addressing malnutrition before women become pregnant is the only effective exit to malnutrition within the life cycle.
A third of women of reproductive age in India are undernourished, and an undernourished mother inevitably gives birth to an undernourished baby, perpetuating an intergenerational cycle of undernutrition. Shaheena from Kamali village in Bahraich, Uttar Pradesh, delivered six babies in the span of 12 years. But given that Shaheena was herself weak and anaemic, her lack of nutrition not just complicated her pregnancy but also proved to be fatal for one of her children, while the rest were all born malnourished. Growth-retarded adult women are likely to carry on the vicious cycle of malnutrition by giving birth to low birth-weight babies so by the time she had her twins they were severely malnourished.
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Shaheena told us,
My 1st child died, 2nd was serious then I had two set of twins… I was serious after twins but with medication and treatment I am better and have been trying to improve health of my children by giving them nutritious food”.
Anaemia in adolescent girls perpetuates the cycle of malnourishment for subsequent generations. As anaemic girls grow into adults, subsequent pregnancies not only endanger their own health by way of pre-term deliveries and high risk of maternal haemorrhages, but also put their children at a higher risk of anaemia and of being born as ‘low-birth weight’ babies—perpetuating an unending loop.
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Anaemia In Mothers Linked With Malnutrition In Children
As per the United Nations report, 51.4 per cent of women in reproductive ages are anaemic and maternal Anaemia has a significant effect on the nutritional status of young children leading to stunting and underweight. As per estimates, anaemia is the underlying cause for 20–40 per cent of maternal deaths in the country. India alone contributes to about 80 per cent of the maternal deaths due to anaemia in South Asia. India has the highest number of anaemic individuals globally; according to the National Family Health Survey 2015-2016, nearly 53 per cent adult women and 50 per cent pregnant women in India are anaemic.
Undernutrition is a major cause of anaemia in children, and has the most detrimental effect during the development stages of a child. While child malnutrition is the single biggest contributor to under-five mortality due to greater susceptibility to infections and slow recovery from illness it is maternal malnutrition that increases the risk of poor pregnancy.
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Early marriage, limited life skills, little or no education, low economic and social self-reliance, lack of nutrition-hygiene-family planning related counselling and more, triggers a cascading effect. The outcome is poorly planned families, malnutrition, and heightened challenges with larger groups of vulnerable women and children. In fact as many as 26.8 % of Indian women marry before turning 18years of age.
Basanta Kumar Kar, Global ‘Transform Nutrition Champion’ Awardee emphasized on the importance of women needing to take over the nutrition revolution.
Malnutrition is also caused because of social exclusion, geographical inclusion, economic exclusion and policy level exclusion so we need to address these 4 forms of exclusion and women need to be involved in every way.
While malnutrition and under nutrition are old problems in India, another key cause of malnutrition is micronutrient deficiencies; also called hidden hunger. Deficiency of essential vitamins and minerals such as Vitamin A, Iron, Iodine and Zinc continue. The Government of India has done a survey on Micronutrient Deficiency among Children for the First Time in our country.
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Micronutrients of public health importance in childhood and adolescence generally include iron, vitamin A, iodine and zinc. More recently, folate, vitamin B12 and vitamin D have received greater attention. Micronutrient deficiencies not only affect the health but are also projected to cost around 0.8-2.5 per cent of the gross domestic product. Rajan Sankar added,
Micro nutrient deficiency arises if the body doesn’t get a proper diet and the deficiencies leads to consequences, productivity in adults and its widespread in India.
Low productivity, poor cognitive and physical development, and increased morbidity and mortality especially in infants and pre-school children arise from micronutrient deficiencies and contribute to India’s disease burden. Even mild to moderate micronutrient deficiencies can lead to impaired cognitive development and poor physical growth. Ayush was born underweight and today at 6 years he is suffering from a severe micronutrient deficiency of Vitamin D.
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Ayush’s mother, Barkha didn’t know she was pregnant till her 7th month and did not eat her supplements and folate.
Ayush was born severely malnourished and was very weak which also led to many deficiencies in his body and now he has many physical growth related issues, said Barkha.
The challenge of undernutrition in India is compounded by yet another burden— 20.7 per cent women and 18.6 per cent men in India are reportedly obese or overweight. This ‘double burden of malnutrition’, therefore has an immense negative bearing on the nutritional status of India. Overweight in mothers is also associated with overweight and obesity in their offspring. Furthermore, the nutrition transition that has resulted from globalization and economic growth has led to greater consumption of high-energy and nutrient – poor processed foods and more sedentary lifestyles, contributes to the rapidly growing overweight and obesity epidemic in India and globally.
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Vinod Paul, Member, NITI AAYOG shared,
Double burden is over nutrition and obesity and obesity is rising since 2005 its nearly doubled. Also, prediabetics amongst the adolescents is rising and we must control it now.
A major challenge is that mothers, families and communities are often not aware that the young infant is slipping into malnutrition- growth has started to falter. The problem is often recognized only after the child has become visibly undernourished, becomes listless, does not feed well, becomes more prone to infections and becomes severely undernourished. So how can one make sure the child does not slip into malnutrition?
The need for a nutrition revolution is extremely urgent and it’s crucial to address malnutrition. The Malnutrition burden is not equally shared between India’s states and union territories. In the article next week, we will share how interventions can help, the various government policies like Poshan Abhiyan and also the importance of dietary diversity, supplementation and food fortification.
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January 7, 2020 at 8:35 am