Malnutrition in India
The World Bank estimates that India is one of the highest ranking countries in the world for the number of children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.
The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading countries with hunger situation. It also places India amongst the three countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7, while 78 out of the 81 developing countries studied, including Pakistan, Nepal, Bangladesh, Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and Malawi, succeeded in improving hunger condition.
- 1 Introduction
- 2 Related studies
- 3 Nutritional trends of various demographic groups
- 4 Identifying malnutrition
- 5 Programs to address the causes of malnutrition in india
- 6 National Health Mission
- 7 See also
- 8 Further reading
- 9 References
- 10 External links
India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1.2 billion and growing at 10–14% annually (from 2001–2007). India's Gross Domestic Product growth was 9.0% from 2007 to 2008; since Independence in 1947, its economic status has been classified as a low-income country with majority of the population at or below the poverty line. Though most of the population is still living below the National Poverty Line, its economic growth indicates new opportunities and a movement towards increase in the prevalence of chronic diseases which is observed in at high rates in developed countries such as United States, Canada and Australia. The combination of people living in poverty and the recent economic growth of India has led to the co-emergence of two types of malnutrition: undernutrition and overnutrition.
Malnutrition refers to the situation where there is an unbalanced diet in which some nutrients are in excess, lacking or wrong proportion. Simply put, we can categorise it to be under-nutrition and over-nutrition. Despite India's 50% increase in GDP since 1991, more than one third of the world's malnourished children live in India. Among these, half of them under 3 are underweight and a third of wealthiest children are over-nutriented.
One of the major causes for malnutrition in India is gender inequality. Due to the low social status of Indian women, their diet often lacks in both quality and quantity. Women who suffer malnutrition are less likely to have healthy babies. In India, mothers generally lack proper knowledge in feeding children. Consequently, new born infants are unable to get adequate amount of nutrition from their mothers.
Deficiencies in nutrition inflict long-term damage to both individuals and society. Compared with their better-fed peers, nutrition-deficient individuals are more likely to have infectious diseases such as pneumonia and tuberculosis, which lead to a higher mortality rate. In addition, nutrition-deficient individuals are less productive at work. Low productivity not only gives them low pay that traps them in a vicious circle of under-nutrition, but also brings inefficiency to the society, especially in India where labour is a major input factor for economic production. On the other hand, over-nutrition also has severe consequences. In India national obesity rates in 2010 were 14% for women and 18% for men with some urban areas having rates as high as 40%. Obesity causes several non-communicable diseases such as cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.
Subodh Varma, writing in The Times of India, states that on the Global Hunger Index India is on place 67 among the 80 nations having the worst hunger situation which is worse than nations such as North Korea or Sudan. 25% of all hungry people worldwide live in India. Since 1990 there has been some improvements for children but the proportion of hungry in the population has increased. In India 44% of children under the age of 5 are underweight. 72% of infants and 52% of married women have anaemia. Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases, physical retardation, and reduced cognitive abilities.
Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in india
A Study done by Palash Jain, Arianna Ulloa, and George Davey Smith, investigated the effect of socioeconomic status and nutrition in India. The study was based on a nationally representative sample involving 77,220 women from different socioeconomic status backgrounds, and with varying body mass indices.
The results of the study found that being underweight had an inverse relationship with socioeconomic position, meaning that as socioeconomic position increased, the chances of being underweight decreased. A positive correlation, however, was found between socioeconomic position and being pre-overweight, overweight, and obese.
The study concluded that undernutrition and overnutrition were epidemics of the impoverished and the affluent in India.
A study done by experts in the food and nutrition department of Maharaja Sayajirao University of Baroda (MSU), found that there was a big divide in the children aged six to fourteen of the urban and rural areas of the Vadodara district. The study found that 75% of 3,000 children in the rural areas of this district were malnourished, whereas 15% of the 23,000 children studied in the urban areas were overweight.
Nutritional trends of various demographic groups
Many factors, including region, religion, and caste affect the nutritional status of Indians. Living in rural areas also contribute to nutritional status.
In general, those who are poor are at risk for under-nutrition, while those who have high socio-economic status are relatively more likely to be over-nourished. Anaemia is negatively correlated with wealth.
When it comes to child malnutrition, children in low-income families are more malnourished than those in high-income families. Some cultural beliefs that may lead to malnutrition is religion. Among these is the influence of religions, especially in India are restricted from consuming meat. Also, other Indians are strictly vegan, which means, they do not consume any sort of animal product, including dairy and eggs. This is a serious problem when inadequate protein is consumed because 56% of poor Indian household consume cereal to consume protein. But unfortunately, the type of protein that cereal contains does not parallel to the proteins that animal product contain (Gulati, 2012).  Children of Muslim households and those belonging to scheduled castes or tribes also face higher rates of malnourishment. This phenomenon is most prevalent in the rural areas of India where more malnutrition exists on an absolute level. Whether children are of the appropriate weight and height is highly dependent on the socio-economic status of the population. Children of families with lower socio-economic standing are faced with sub-optimal growth. While children in similar communities have shown to share similar levels of nutrition, child nutrition is also differential from family to family depending on the mother's characteristic, household ethnicity and place of residence. It is expected that with improvements in socio-economic welfare, child nutrition will also improve.
Under-nutrition is more prevalent in rural areas, again mainly due to low socio-economic status. Anaemia for both men and women is only slightly higher in rural areas than in urban areas. For example, in 2005, 40% of women in rural areas, and 36% of women in urban areas were found to have mild anaemia.
In urban areas, overweight status and obesity are over three times as high as rural areas.
In terms of geographical regions, Madhya Pradesh, Jharkhand, and Bihar have very high rates of under-nutrition. States with lowest percentage of under-nutrition include Mizoram, Sikkim, Manipur, Kerala, Punjab, and Goa, although the rate is still considerably higher than that of developed nations. Further, anaemia is found in over 70% of individuals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, Karnataka, Haryana, and Jharkhand. Less than 50% of individuals in Goa, Manipur, Mizoram, and Kerala have anaemia.
Punjab, Kerala, and Delhi also face the highest rate of overweight and obese individuals.
Studies show that individuals belonging to Hindu or Muslim backgrounds in India tend to be more malnourished than those from Sikh, Christian, or Jain backgrounds.
Malnutrition can be identified into two constituents, protein-energy malnutrition and micronutrient deficiencies, where protein-energy malnutrition is clearly observed in India and other developing countries There are different methods of identifying malnutrition; physical findings generally help in the diagnosis of advanced malnutrition. In identifying it early in the development malnutrition, it is of advantage to allowing early rehabilitation One of the classification of protein-energy malnutrition is done by Gomez, which uses anthropometric indices.
Degrees of malnutrition
Gomez classification of PEM:
Degree of PEM % of desired body wt. for age and sex
- between 90 and 110% normal nutrition status
- Grade I (1st degree).Mild Malnutrition
- Grade II (2nd degree). Moderate Malnutrition
- Grade III(3rd degree).Severe Malnutrition
Protein-energy malnutrition can also be classified as marasmus, kwashiorkor, or a combination of both. In marasmus conditions are characterised by extreme wasting of the muscles and a daunt expression; where kwashiorkor is identified as swelling of the extremities and belly, which is deceiving to their actual nutritional status.
Programs to address the causes of malnutrition in india
The Government of India has launched several programs to converge the growing rate of under nutrition children. They include ICDS, NCF, National Health Mission.
Midday meal scheme in Indian schools
The Akshaya Patra Foundation runs the world's largest NGO-run midday meal programme serving freshly cooked meals to over 1.3 million school children in government and government-aided schools in India. This programme is conducted with part subsidies from the Government and partly with donations from individuals and corporations. The meals served by Akshaya Patra complies with the nutritional norms given by the government of India and aims to eradicate malnutrition among children in India.
Integrated child development scheme
The Government of India has started a program called Integrated Child Development Services (ICDS) in the year 1975. ICDS has been instrumental in improving the health of mothers and children under age 6 by providing health and nutrition education, health services, supplementary food, and pre-school education.The ICDS national development program is one of the largest in the world. It reaches more than 34 million children aged 0–6 years and 7 million pregnant and lactating mothers. Other programs impacting on under-nutrition include the National Midday Meal Scheme, the National Rural Health Mission, and the Public Distribution System (PDS). The challenge for all these programs and schemes is how to increase efficiency, impact and coverage.
National Children's Fund
The National Children's Fund was created during the International Year of the Child in 1979 under the Charitable Endowment Fund Act, 1890. This Fund Provides support to the voluntary organisations that help the welfare of kids.
National Plan of Action for Children
India is a signatory to the 27 survival and development goals laid down by the World Summit on children 1990. In order to implement these goals, the Department of Women & Child Development has formulated a National Plan of Action on Children. Each concerned Central Ministries/Departments, State Governments/U.Ts. and Voluntary Organisations dealing with women and children have been asked to take up appropriate measures to implement the Action Plan. These goals have been integrated into National Development Plans. A Monitoring Committee under the Chairpersonship of Secretary (Women & Child Development) reviews the achievement of goals set in the National Plan of Action. All concerned Central Ministries/Departments are represented on the Committee.
15 State Govts. have prepared State Plan of Action on the lines of National Plan of Action specifying targets for 1995 as well as for 2000 and spelling out strategies for holistic child development.
United Nations Children's Fund
Department of Women and Child Development is the nodal department for UNICEF. India is associated with UNICEF since 1949 and is now in the fifth decade of cooperation for assisting most disadvantaged children and their mothers. Traditionally, UNICEF has been supporting India in a number of sectors like child development, women's development, urban basic services, support for community based convergent services, health, education, nutrition, water & sanitation, childhood disability, children in especially difficult circumstances, information and communication, planning and programme support. India is presently a member on the UNICEF Executive Board till 31 December 1997. The board has 3 regular sessions and one annual session in a year. Strategies and other important matters relating to UNICEF are discussed in those meetings. A meeting of Government of India and UNICEF officials was concurred on 12 November 1997 to finalise the strategy and areas for programme of cooperation for the next Master Plan of operations 1999–2002 which is to synchronise with the Ninth Plan of Government of India.
National Health Mission
National Rural Health Mission
The National Rural Health Mission of India mission was created for the years 2005–2012, and its goal is to "improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women, and children."
The subset of goals under this mission are:
- Reduce infant mortality rate (IMR) and maternal mortality ratio (MMR)
- Provide universal access to public health services
- Prevent and control both communicable and non-communicable diseases, including locally endemic diseases
- Provide access to integrated comprehensive primary healthcare
- Create population stabilisation, as well as gender and demographic balance
- Revitalize local health traditions and mainstream AYUSH
- Finally, to promote healthy life styles
The mission has set up strategies and action plan to meet all of its goals.
- Measham, Anthony R.; Meera Chatterjee (1999). Wasting away: the crisis of malnutrition in India. World Bank Publications. ISBN 0-8213-4435-8.
- "World Bank Report". Source: The World Bank (2009). Retrieved 2009-03-13. "World Bank Report on Malnutrition in India"
- "2011 Global Hunger Index Report". International Food Policy Research Institute (IFPRI).
- "World Bank Report". Source: The World Bank 2009. Retrieved 2009-11-25. "India Country Overview 2009"[dead link]
- "World Bank Report". Source: The World Bank 2009. Retrieved 2009-11-25. "India Country Overview 2009"
- "Journal of the American Medical Association". Source: JAMA 2004. Retrieved 2009-11-26. "The global burden of chronic diseases"
- "Malnutrition". Retrieved 13 February 2012.
- "The Indian exception". The Economist. 31 March 2011. Retrieved 13 February 2012.
- "Putting the smallest first". The Economist. 23 September 2010. Retrieved 13 February 2012.
- "Turning the tide of malnutrition". World Health Organization. Retrieved 14 February 2012.
- "A call for reform and action". The World Bank. Retrieved 14 February 2012.
- "India in grip of obesity epidemic". The Times of India. 12 November 2010. Retrieved 14 February 2012.
- Superpower? 230 million Indians go hungry daily, Subodh Varma, 15 Jan 2012, The Times of India,
- "The American Journal of Clinical Nutrition". Source: The American Journal of CLINICAL NUTRITION 2006. Retrieved 2009-11-26.
- "Express India=2009-11-26". Source: Express India News 2009.
- "NFHS-3 Nutritional Status of Adults". Retrieved 2009-11-26.
- Kanjilal, B; et al (2010). "Nutritional Status of Children in India: Household Socio-Economic Condition as the Contextual Determinant". Int J for Equity in Health 9: 19.
- Gulati, A., Ganesh-Kumar, A., Shreedhar, G., & Nandakumar, T. (2012). Agriculture and malnutrition in India. Food And Nutrition Bulletin, 33(1), 74-86
- "HUNGaMA Survey Report". Naandi foundation. Retrieved 1 February 2012.
- Kanjilal, Barun; Mazumdar, Mukherjee, Rahman (January 2010). "Nutritional status of children in India: household socio-economic condition as the contextual determinant". International Journal for Equity in Health 9: 19–31.
- "NFHS-3 Nutritional Status of Children". Retrieved 2009-11-26.
- "Nutrition and Anaemia". Retrieved 2009-11-26.
- CMAJ (2005). Malnutrition and health in developing countries by Muller and Krawinkel
- Chowdhury et al. (2008). "Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition". Journal of Bangladesh Society of Physiologist 3: 58–60.
- "Child Development Website". Source: Child Development programmes site (2009). Retrieved 2009-03-14. "Programs to address malnutrition in India"[dead link]
- "National Rural Health Mission". Source: National Rural Health Mission (2005–2012). Retrieved 2009-11-26.
- India: Malnutrition Report World Bank
- Child Malnutrition In India Report
- Addressing the Food Insecure and malnutirition in the Delhi/NCR Region