New Delhi: The central government’s ambitious POSHAN nutrition programme that focuses on the first 1,000 days of a newborn, including the nine-month pregnancy period, is staring at a major challenge: reducing malnourishment in the country. Several targets are likely to be missed, says a study, which is a joint initiative of the Indian Council of Medical Research, Public Health Foundation of India and the ministry of health and family welfare.
Comprehensive estimates of trends on key child and maternal malnourishment published in The Lancet Child & Adolescent Health journal show that dietary deficiency continues to be the main reason for disease burden and death rate in children. This despite child mortality attributable to malnourishment dropping by two thirds since 1990. Malnutrition is, however, still the underlying risk factor for 68 per cent of the deaths in under-five children in India, and is the leading risk factor for disease burden in people of all ages.
Prof K Srinath Reddy, president of the Public Health Foundation of India, says, “India’s growth story would remain incomplete if malnourishment continues to throw a dark shadow on development. The national resolve to eliminate undernutrition in all forms must be translated into effective action across all states of India, through earnest execution of POSHAN Abhiyaan.”
Among the malnutrition indicators, low-birth weight is the largest contributor to child deaths in India, followed by child growth failure which includes stunting, low weight, and wasting. Rajasthan, Uttar Pradesh, Bihar and Assam are the worst-performing states, the study says.
The prevalence of low birth weight was 21 per cent in India in 2017, ranging from 9 per cent in Mizoram to 24 per cent in Uttar Pradesh. The annual rate of reduction was 1.1 per cent in the country between 1990 and 2017 – from 3.8 per cent in Sikkim to 0.3 per cent in Delhi.
Dr Henk Bekedam, WHO representative to India, also put the spotlight on poor sanitation and hygiene and how malnourishment is really not a nutrition issue. “And that is why a comprehensive approach is needed. And I see it happening in India though Swachh Bharat, through Jal Shakti Abhiyan and through Ayushman Bharat. You can have the perfect food but if you don’t wash your hands it will lead to disease burden.”
According to the data, the prevalence of child stunting was 39 per cent in India in 2017. This ranged from 21 per cent in Goa to 49 per cent in Uttar Pradesh, and was generally highest in the empowered action group (EAG) states. The annual rate of reduction was 2.6 per cent in the country between 1990 and 2017, which varied from 4 per cent in Kerala to 1.2 per cent in Meghalaya. Also, the prevalence of underweight children was 33 per cent in thwecountry in 2017 – from 16 per cent in Manipur to 42 per cent in Jharkhand. The annual rate of reduction in India was 3.2 per cent between 1990 and 2017, ranging from 5.4 per cent in Meghalaya to 1.8 per cent in Delhi.
The targets set for the National Nutrition Mission for 2022 or the POSHAN Abhiyaan – the world’s largest nutrition programme that aims to check anaemia, reduce disease burden, low weight, stunting and promote exclusive breastfeeding – will be tough to meet, the report suggests.
“Maternal nutrition is important and that is what could help tackle low birth weight,” says Professor Balram Bhargava, secretary to the Government of India and also director general of the Indian Council of Medical Research.
Low birth weight is a consequence of undernutrition and antenatal care as a whole, experts involved in preparing the report say. There are a combination of factors. Foetal growth retardation is a big problem, and 15 to 16 per cent of babies are stunted. Premature babies may have problems when it comes to organ development but they have the potential to grow in later stages of their lives.
Professor Vinod K Paul, member of the Niti Aayog, the brains behind the POSHAN Abhiyaan, says, “Between the age of 6 months and 24 months, you see adequacy of food in addition to breastfeeding is a dismal 10 per cent. Ninety per cent of India’s kids may not be hungry in terms of hunger but they are hungry in terms of nutrition.” The findings show that in spite of adequate food availability, children are not eating. Optimal semi-solid feeding is satisfactory only in 10 per cent of children.
There is another worrying trend: that of increasing childhood obesity. It is happening for various reasons like changes in lifestyle, changes in consumption and physical activity patterns. Most striking is the fact that the rate of overweight children is the highest in more developed states.
“Overall obesity rates have doubled between National Health Survey 4 and National Health Survey 5,” says Professor Paul.
The prevalence of obesity in Indian children increased significantly during 1990-2017, which is the period of the study, with an annual rise of 4.98 per cent. The projected prevalence is 17.5 per cent in 2030, an estimate that has experts worried.
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