Malnutrition in India

The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition, after Bangladesh (in 1998), where 47% of the children exhibit a degree of 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 UN estimates that 2.1 million Indian children die before reaching the age of 5 every year – four every minute – mostly from preventable illnesses such as diarrhoea, typhoid, malaria, measles and pneumonia. Every day, 1,000 Indian children die because of diarrhoea alone. According to the 1991 census of India, it has around 150 million children, constituting 17.5% of India's population, who are below the age of 6 years.

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.

Introduction

India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1,139.96 million (2009) 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. Simplify put, we can categorize 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. they do not breast-feed their children or feed them poorly. 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 labor 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 anemia. Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases, physical retardation, and reduced cognitive abilities.

Undernutrition

Data from the third National Family Health Survey shows that 35% of the adult population of India is underweight (with a BMI of less than 18.5).

According to the World Food Program and the M.S. Swaminathan Research Foundation (MSSRF), over the past decade there has been a decrease in stunting among children in rural India, but inadequate calorie intake and chronic energy deficiency levels remain steady.. However, data from the National Sample Survey Organisation (NSSO) 66th Round and the Annual Reports of National Nutrition Monitoring Bureau (NNMB) both show a decline in the consumption of calories over the past 2 decades. NSSO data shows that the average daily intake of calories dropped by 133 kcal (6.2%) from 2153 kcal to 2020 Kcal in rural areas and by 125 Kcal (6%) from 2071 to 1946 Kcal in urban areas between 1993-94 to 2009-10, and NNMB data shows that between 1991-1992 and 2005-2006 the average daily intake of calories declined from 2139kcal/day to 1834kcal/day (a fall of 305kcal/day or 14% of the 1991-1992 total)..

Today child malnutrition is prevalent in 7 percent of children under the age of 5 in China and 28 percent in sub-Saharan African compared to a prevalence of 43 percent in India. The prevalence of stunting among under-5s in India is between 48% and 57% Undernutrition is found mostly in rural areas and is concentrated in a relatively small number of districts and villages with 10 percent of villages and districts accounting for 27–28 percent of all underweight children.

Undernutrition includes both protein-energy malnutrition and micronutrient deficiencies. Undernourishment not only affects physical appearance and energy levels, but also directly affects many aspects of the children’s mental functions, growth and development which has adverse effects on children’s ability to learn and process information and grow into adults that are able to be productive and contributing members of society. Undernourishment also impairs immune function leaving them more susceptible to infection. Children with infections are more susceptible to malnutrition and the cycle of poverty and malnutrition continues. Child malnutrition is responsible for 22 percent of India’s burden of disease..

Micronutrient deficiencies are also a widespread problem in India. The prevalence of micronutrient deficiencies varies in different states, More than 75 percent of preschool children suffer from iron deficiency anaemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD). Iodine deficiency is endemic in 85 percent of districts, mostly due to the lack of iodized salt that is common in the developed world. Progress in reducing the prevalence of micronutrient deficiencies in India has been slow. The prevalence of different micronutrient deficiencies varies widely across states.

Most growth retardation occurs by the age of two, and most damage is irreversible. The prevalence of underweight in rural areas 50 percent versus 38 percent in urban areas and higher among girls (48.9 percent) than among boys (45.5 percent).

National Nutrition Monitoring Bureau

HYDERABAD: That 42% of the country's children are malnourished is a statistic that finds stark reflection in Andhra Pradesh. While the state did not figure in the Naandi Foundation study, the latest findings by National Institute of Nutrition (NIN) note that 38.8% children in AP, in the age group 1-5 years, are undernourished. And, an alarming 48.1% of children have stunted growth, according to the 2010-11 study that is presently being finalised.

The NIN's National Nutrition Monitoring Bureau carried out the study in AP, Karnataka, Tamil Nadu, Kerala, Uttar Pradesh, Madhya Pradesh, Orissa, West Bengal, Gujarat and Maharashtra for a population of 5,000 pre-school children. It found that, overall, 45.6% of the children in rural areas are underweight and undernourished with 49.6% of them showing stunted growth.

The survey is expected to be completed in a month and NIN scientists said that its findings are virtually paradoxical. "Economically, the country is scaling heights but insofar as the tackling of malnutrition is concerned, progress is very slow," said Dr A Laxmaiah, deputy director, NIN. Dr Laxmaiah added that malnutrition exists not just in rural areas but that "undernourished children in urban areas account for 25-30% of malnourished children in the country".

Various factors contribute towards a high malnutrition rate but poverty, ignorance, faulty infant and child-feeding practices are the primary causes, Dr Laxmaiah said. He added that even among the educated, 'nutritional illiteracy' may be prevalent as there are socio-cultural factors also at play here.

The state has reported this dismal statistic despite a slew of nutritional programmes undertaken by it to address the problem of malnutrition. Experts said that the government had failed to obtain desired results due to poor programme implementation. In AP, efforts are being diluted by lack of monitoring and supervision. "Food supply is there but it is not reaching children. In cases where it is running properly, say as part of a midday meal scheme somewhere, the quality is very poor," said an expert.

Experts also claimed that children are not at all being benefited by the Integrated Child Development Services (ICDS) scheme when it is supposed to provide one-third of their total nutritional requirement. "ICDS gives a dry soya and wheat mixture which the children cannot eat. The children need to be given tender, tasty and fresh food. It is alarming that every second child in India is starving," said Dr Veena Shatrugna, former deputy director, NIN.

The World Bank estimates that India ranks second in the world in the number of children suffering from malnutrition, after Bangladesh.

Only 65% of all the food grains production is consumed and rest 35% go waste thanks to Indian government who is lacking behind regarding storage facility of food grains while 42% of Indian children go malnourished and unnoticed.Such a shame.

‎64 years after independence the picture still remains the same.

This is why Indian government has decided to sanction Facebook because the corrupt congress don't want Sophisticated Indian youth to bring such gruesome reality in front of the whole nation and world.The World Bank estimates that India ranks second in the world in the number of children suffering from malnutrition, after Bangladesh.

In India's financial capital, almost 25,000 children under five die every year due to malnutrition and related illnesses. Whatever happened to the National Urban Health Mission?

The time of the year does not matter here. Monsoon or summer, the plastic cans are waiting for the waterman to arrive in Rafi Nagar, a slum settlement situated in Govandi, in the north-eastern area of Mumbai. In a city where space is at a premium, this settlement sits on top of its refuse. Every day, hundreds of tonnes of Mumbai's leftovers are dumped here. The garbage pile is regularly flattened to make space for the constant demand for shelter. Rafi Nagar is part of Shivaji Nagar, a resettlement colony that hosts the constant stream of migrants flowing into the city. The floors of the makeshift shacks are covered with cardboard sheets to keep the garbage down.

The residents here are mostly migrants from Uttar Pradesh and Bihar and have lived in Mumbai for more than 20 years. Yet, half the settlement in Rafi Nagar has not been given a legal status despite being promised. Hence the eternal wait for the water truck to arrive. When the water arrives, the wallets empty out. Filling up a 25 litre plastic can costs Rs. 20-25. Considering the average family income here is around Rs.3,000-4,000 a month, a sizeable chunk of it goes to buying precious water. And even then, a family can ill afford to buy 100 litres a day. According to the Mumbai Human Development Report 2009, Mumbaikars on average get 200 litres per capita daily (lpcd) of water, whereas slum residents get less than 90 lpcd.

Deadly combination

The lack of access to clean, safe drinking water, the unhygienic living conditions, the lack of proper toilets all make a perfect breeding ground for disease to thrive. In this neighbourhood alone, 18 children under the age of five died in 2010 from malnutrition-related causes. Undernourished children have lowered immunity to diseases and are more likely to die from common childhood ailments. Jayeda has already lost one new-born son. Her 18-month-old daughter Haseena suffers from diarrhoea and worms. The child is also chronically malnourished. However, Jayeda is reluctant to take her to a healthcare facility. “If I leave the house to take her to the doctor, I am afraid our belongings will be stolen.”

Even as we talk, I notice Haseena playing with the worms that have passed out of her watery stools. Jayeda is, however, unconcerned. “She does this every day,” was the casual answer. There is little awareness that her child is susceptible to diseases because of her malnourished state. But then, Jayeda and the other women in her community are grappling with a much bigger problem, everyday survival. They live under constant threat of being evicted from their settlement; many of them do not have a ration card and if they do have one, all they get is very poor quality rice. This is hardly enough to feed the large families here, the typical size of which is 7-8. They then turn to the open market where the price of rice is higher. Survival here is a daily battle.

Rafi Nagar is just under an hour's drive from the commercial heart of Mumbai, India's financial capital. It is an incongruous reality that Rafi Nagar can exist in the same city where super specialty hospitals offer the best in medical treatment. It defies imagination that 60 per cent of Mumbai's population lives in slums and makeshift shanties while the city plays host to arguably the world's costliest house. According to Varsha, a health worker in Shivaji Nagar, there is just one maternity home in Shivaji Nagar that caters to a population of over six lakhs. This is hardly surprising considering the major part of the health infrastructure that exists in the city was planned between 1950 and 1980 to cater to a population of between 52 and 70 lakhs. The same facilities now cater to more than twice the population!

Creating local resources

Rafi Nagar has five ICDS centres, three of which work out of homes and two out of an NGO's office! The centres are understaffed and the workers untrained and overburdened. Jayeda's newborn son could have been saved had the health worker been trained to diagnose symptoms of asphyxia. When institutional care is not available or poor in quality, it is critical to have health workers rooted in the community to reach out to mothers and their newborns. Women with limited formal education can be trained to successfully deliver lifesaving services such as breastfeeding counselling, post-natal care, vaccines and antibiotics.

It is clear that in places like Rafi Nagar the ICDS model, originally conceived to deliver a range of services in rural areas, is inadequate. The problems in accessing healthcare are different for the urban poor from the rural poor. Despite acknowledging this, the Central Government has put in cold storage the National Urban Health Mission which was meant to cater for the health needs of the urban poor.

Getting Parliament nod for his 2011-12 Budget, Finance Minister Pranabh Mukherjee vowed that “we can, we shall do” in reference to India reaching nine per cent growth. Where is the same “We can” determination to remove the blight of malnutrition that is undermining the country's growth potential?

Mumbai: According to the Maharashtra government's own figures, 18,486 children in the age group of 0-6 years have died of malnutrition this year alone (Jan-Aug 2011). In 2010, 12,792 children had died of hunger and malnutrition during the same period. But this year, 5,694 more babies than last year have starved to death.

Most of the dead babies are adivasi children. The maximum deaths have occurred in the five districts with large adivasi populations.

Every government department DNA spoke to passed the buck to some other department. Maharashtra's tribal welfare commissioner Vikas Thakur said, "Once we release funds to the health, revenue, and education ministries for various schemes, the local collectorates and zilla parishads should ensure everything works on the ground. Ask them what they are doing."

State health minister Suresh Shetty washed his hands off the whole issue, saying, "This is under women & child welfare. My ministry has nothing to do with it."

Women & child welfare minister Varsha Gaikwad too wanted to wriggle out of it, claiming tribal welfare, health, social justice, and public health ministries were responsible. When asked what her ministry, the nodal agency for malnutrtion was doing, she said, "We conduct periodic workshops so that malnutrition is better understood." She then went on to talk about her ministry's new Kuposhan Mukt Gaon scheme, to be launched by PM Manmohan Singh on October 1.

But it is doubtful whether it will bring any succour to Pratap Shankar Mundola or his wife Jani in Shahpur tehsil of rural Thane. Last monsoon, their daughter Ujwala, 4, starved to death. This year, already, their son, Nivrutti, 4, and 6-month-old daughter Pinti have been diagnosed with severe acute malnutrition (SAM). Their condition is so serious that they have been brought to the Takipathar primary healthcare centre (PHC). "He can't even walk and has to be carried," says Mundola of his 6kg underweight son.

But Pinti and the Nivrutti aren't the only ones starving in their Thakar adivasi village. The anganwadi (government-run mother & child care centre) register of the village (which has a population of 300) shows that 27 children in the 0-6 age group malnourished.

In what is perhaps the most damning indictment of the administration is 11-month-old Karan Kishore Ughde. Karan - the only child of anganwadi worker Pramila, and weighs only 6.5 kg instead of 10 kg.

This story repeats itself in the Korku (an adivasi tribe) villages of Churni, Vairat, Pastalai, Memena, Bori, Gullarghat, Dhargad, Kelpani, Dolar, Dhakna, Rora, Adhao, Koha, Kund, Pili, Mangia, Semadoh, Raipur, Makhla, Madizadap, Chopan and Malur in Amravati district, where malnutrition figures show that the clock has turned back to the mid-nineties.

Doctor and health activist Dr Ravindra Kolhe, who has worked with the adivasis for nearly 30 years, told DNA, "In 2006, the state's Infant Mortality Rate (IMR), which used to be 200 per 1000 children, came down to 40 per 1000 children. But instead of reducing further, it has now gone up to 66." According to him, this is a direct outcome of the pathetic state of the service delivery systems.

"Instead of strengthening our health infrastructure, like the PHCs and rural hospitals, the government plans to hand them over to NGOs of its choice. This kind of abdication of social responsibility of the state is why we are in such a mess."

State health minister Suresh Shetty washed his hands off the whole issue, saying, "This is under women & child welfare. My ministry has nothing to do with it."

Women & child welfare minister Varsha Gaikwad too wanted to wriggle out of it, claiming tribal welfare, health, social justice, and public health ministries were responsible. When asked what her ministry, the nodal agency for malnutrtion was doing, she said, "We conduct periodic workshops so that malnutrition is better understood." She then went on to talk about her ministry's new Kuposhan Mukt Gaon scheme, to be launched by PM Manmohan Singh on October 1.

But it is doubtful whether it will bring any succour to Pratap Shankar Mundola or his wife Jani in Shahpur tehsil of rural Thane. Last monsoon, their daughter Ujwala, 4, starved to death. This year, already, their son, Nivrutti, 4, and 6-month-old daughter Pinti have been diagnosed with severe acute malnutrition (SAM). Their condition is so serious that they have been brought to the Takipathar primary healthcare centre (PHC). "He can't even walk and has to be carried," says Mundola of his 6kg underweight son.

But Pinti and the Nivrutti aren't the only ones starving in their Thakar adivasi village. The anganwadi (government-run mother & child care centre) register of the village (which has a population of 300) shows that 27 children in the 0-6 age group malnourished. In what is perhaps the most damning indictment of the administration is 11-month-old Karan Kishore Ughde. Karan - the only child of anganwadi worker Pramila, and weighs only 6.5 kg instead of 10 kg.

This story repeats itself in the Korku (an adivasi tribe) villages of Churni, Vairat, Pastalai, Memena, Bori, Gullarghat, Dhargad, Kelpani, Dolar, Dhakna, Rora, Adhao, Koha, Kund, Pili, Mangia, Semadoh, Raipur, Makhla, Madizadap, Chopan and Malur in Amravati district, where malnutrition figures show that the clock has turned back to the mid-nineties.

Doctor and health activist Dr Ravindra Kolhe, who has worked with the adivasis for nearly 30 years, told DNA, "In 2006, the state's Infant Mortality Rate (IMR), which used to be 200 per 1000 children, came down to 40 per 1000 children. But instead of reducing further, it has now gone up to 66." According to him, this is a direct outcome of the pathetic state of the service delivery systems.

"Instead of strengthening our health infrastructure, like the PHCs and rural hospitals, the government plans to hand them over to NGOs of its choice. This kind of abdication of social responsibility of the state is why we are in such a mess."

NEW DELHI — Small, sick, listless children have long been India’s scourge — “a national shame,” Alarming words for shameless prime minister, Manmohan Singh. But even after a decade of galloping economic growth, child malnutrition rates are worse here than in many sub-Saharan African countries, and they stand out as a paradox in a proud democracy. Multimedia I

Vivek, a malnourished boy, on a scale last November at 23 months old at a feeding center in Shivpuri. India runs the largest child feeding program, but experts say it is inadequately designed. Enlarge This Image Ruth Fremson/The New York Times

"The pathetic state of child health and education in India should be seen as no less than a total failure of its democracy, public institutions and civil society."

China, that other Asian economic powerhouse, sharply reduced child malnutrition, and now just 7 percent of its children under 5 are underweight, a critical gauge of malnutrition. In India, by contrast, despite robust growth and good government intentions, the comparable number is 42.5 percent. Malnutrition makes children more prone to illness and stunts physical and intellectual growth for a lifetime.

There are no simple explanations. Economists and public health experts say stubborn malnutrition rates point to a central failing in this democracy of the poor. Amartya Sen, the Nobel prize-winning economist, lamented that hunger was not enough of a political priority here. India’s public expenditure on health remains low, and in some places, financing for child nutrition programs remains unspent.

Yet several democracies have all but eradicated hunger. And ignoring the needs of the poor altogether does spell political peril in India, helping to topple parties in the last elections.

Others point to the efficiency of an authoritarian state like China. India’s sluggish and sometimes corrupt bureaucracy has only haltingly put in place relatively simple solutions — iodizing salt, for instance, or making sure all children are immunized against preventable diseases — to say nothing of its progress on the harder tasks, like changing what and how parents feed their children.

But as China itself has grown more prosperous, it has had its own struggles with health care, as the government safety net has shredded with its adoption of a more market-driven economy.

While India runs the largest child feeding program in the world, experts agree it is inadequately designed, and has made barely a dent in the ranks of sick children in the past 10 years.

The $1.3 billion Integrated Child Development Services program, India’s primary effort to combat malnutrition, finances a network of soup kitchens in urban slums and villages.

But most experts agree that providing adequate nutrition to pregnant women and children under 2 years old is crucial — and the Indian program has not homed in on them adequately. Nor has it succeeded in sufficiently changing child feeding and hygiene practices. Many women here remain in ill health and are ill fed; they are prone to giving birth to low-weight babies and tend not to be aware of how best to feed them.

A tour of Jahangirpuri, a slum in this richest of Indian cities, put the challenge on stark display. Shortly after daybreak, in a rented room along a narrow alley, an all-female crew prepared giant vats of savory rice and lentil porridge.

Purnima Menon, a public health researcher with the International Food Policy Research Institute, was relieved to see it was not just starch; there were even flecks of carrots thrown in. The porridge was loaded onto bicycle carts and ferried to nurseries that vet and help at-risk children and their mothers throughout the neighborhood.

So far, so good. Except that at one nursery — known in Hindi as an anganwadi — the teacher was a no-show. At another, there were no children; instead, a few adults sauntered up with their lunch pails. At a third, the nursery worker, Brij Bala, said that 13 children and 13 lactating mothers had already come to claim their servings, and that now she would have to fill the bowls of whoever came along, neighborhood aunties and all. “They say, ‘Give us some more,’ so we have to,” Ms. Bala confessed. “Otherwise, they will curse us.”

None of the centers had a working scale to weigh children and to identify the vulnerable ones, a crucial part of the nutrition program.

Most important from Ms. Menon’s point of view, the nurseries were largely missing the needs of those most at risk: children under 2, for whom the feeding centers offered a dry ration of flour and ground lentils, containing none of the micronutrients a vulnerable infant needs.

In a memorandum prepared in February, the Ministry of Women and Child Development acknowledged that while the program had yielded some gains in the past 30 years, “its impact on physical growth and development has been rather slow.” The report recommended fortifying food with micronutrients and educating parents on how to better feed their babies.

A World Food Program report last month noted that India remained home to more than a fourth of the world’s hungry, 230 million people in all. It also found anemia to be on the rise among rural women of childbearing age in eight states across India. Indian women are often the last to eat in their homes and often unlikely to eat well or rest during pregnancy. Ms. Menon’s institute, based in Washington, recently ranked India below two dozen sub-Saharan countries on its Global Hunger Index.

Childhood anemia, a barometer of poor nutrition in a lactating mother’s breast milk, is three times higher in India than in China, according to a 2007 research paper from the institute.

The latest Global Hunger Index described hunger in Madhya Pradesh, a destitute state in central India, as “extremely alarming,” ranking the state somewhere between Chad and Ethiopia.

More surprising, though, it found that “serious” rates of hunger persisted across Indian states that had posted enviable rates of economic growth in recent years, including Maharashtra and Gujarat.

Here in the capital, which has the highest per-capita income in the country, 42.2 percent of children under 5 are stunted, or too short for their age, and 26 percent are underweight. A few blocks from the Indian Parliament, tiny, ill-fed children turn somersaults for spare change at traffic signals.

Back in Jahangirpuri, a dead rat lay in the courtyard in front of Ms. Bala’s nursery. The narrow lanes were lined with scum from the drains. Malaria and respiratory illness, which can be crippling for weak, undernourished children, were rampant. Neighborhood shops carried small bags of potato chips and soda, evidence that its residents were far from destitute.

In another alley, Ms. Menon met a young mother named Jannu, a migrant from the northern town of Lucknow. Jannu said she found it difficult to produce enough milk for the baby in her arms, around 6 months old. His green, watery waste dripped down his mother’s arms. He often has diarrhea, Jannu said, casually rinsing her arm with a tumbler of water.

Ms. Menon could not help but notice how small Jannu was, like so many of Jahangirpuri’s mothers. At 5 feet 2 inches tall, Ms. Menon towered over them. Children who were roughly the same age as her own daughter were easily a foot shorter. Stunted children are so prevalent here, she observed, it makes malnutrition invisible.

“I see a system failing,” Ms. Menon said. “It is doing nothing and not solving the problem.”

Overnutrition

At the same time as a large number of population suffers from malnutrition, more than 100 million people (11% of Indian population) in India are over-nourished. Over-nutrition can be defined as consuming either too much calories or the wrong types of calories such as saturated fat, trans fat or highly refined sugar which leads to obesity and many other chronic diseases. For example, there are over 30 million people with diabetics in 1985 and by next year (2010) India is projected to have 50.8 million diabetics. India is hence considered as the country with the largest population of diabetics. This diabetes (diabetes mellitus) is one of the diseases closely associated with overweight. The direct cause of overweight in India would be lack of physical activity due to sedentary life style, loss of traditional diet, faulty diet, high stress etc. Over-nutrition is most prevalent in the cities among affluences from demographic transition due to sudden economic growth in India. This tells that indirect, underlying cause of over-nutrition would be significantly high rate of economic growth.

Related studies

Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in india

A Study done by S V Subramanian 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.

MSU study

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.

The study used anthropometrical surveys to calculate these numbers, focusing on the Body Mass Index (BMI) as the main indicator of nutrition.

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.

Gender

Women tend to be at higher risk of both under and over-nutrition than men. Nearly 50% of females aged 15 – 19 face under-nutrition, with a very low percentage of over-nutrition, however this trend reverses with age. As women get older, they are more at risk for over-nutrition and less for under-nutrition. Women are also at higher risk of developing anaemia than men.

On average, girls are better nourished at birth than boys are, especially in the first months of life. However, overtime, nutritional outcomes for both genders decline, declining faster for girls. Indicating potential feeding and care neglect of girls in infancy and early childhood. By the time girls reach the age of four, they are much more likely to be undernourished than their brothers. The effects of household income do not seem to vary by gender.

Maternal behaviours are major determinants of childhood malnutrition. Studies have shown that mother’s tobacco and/or alcohol consumption, and mass media exposure as well as characteristics of the mother such as height and education affect the vulnerability of rural children. Children of mothers exposed to mass media are less malnourished than those who are not. While mass media exposure indicates a higher standard of living, it also provides mothers with information on sanitary measures and healthcare methods. Children in rural India with taller mothers are also less undernourished than those with shorter mothers, height being an indication of the mother’s nutritional well-being and living standards. Educated mothers are more likely to be aware of the best childcare methods in terms of providing nutritional foods and implementing appropriate healthcare techniques. Education at a higher level also indicates emancipation of women in which case they may be able to work and provide for their families, leading to a higher standard of living. Child underweight and stunting rates are much higher among mothers with low level of education. Children of mothers with ten or more years of education are 27% underweight while 45% of those with mothers who cannot read are underweight.

Studies show that women have very little decision-making power regarding household purchases (13.7%) but much more significant decision-making power regarding child welfare (68.1%). Since mothers have so little influence when it comes to purchases but so much on child welfare, it is important that they are provided with information on sanitation and healthcare to ensure the wellbeing of their children to the best of their ability. Because women have lower status and less control over resources, they lack the power to ensure that their children’s needs are met. While there are other ways in which women can be aided in ensuring the welfare of their children, such as increased education and informational resources, in the long run their status in society and access to resources is what needs improvement. Based on studies in other countries of low economic development (such as Nepal and Ghana), female land ownership is believed to improve child nourishment because a larger sum of household spending is allocated to food. Recognizing this, governments across India are developing programs, which grant women property rights. The opening of the Women’s Land Rights Facilitation Centre in Orissa state is an example of this.

Socio-economic 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. 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.

Region

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.

Religion

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.

Identifying malnutrition

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

• 75-%-89%

• Grade II (2nd degree). Moderate Malnutrition

• 60%-74%

• Grade III(3rd degree).Severe Malnutrition

• <60%

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 1.2 million hungry 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 corporate. 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 children.

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.

See also

• Below Poverty Line
• Famine in India
• India State Hunger Index
• Poverty in India

Further reading

• Measham, Anthony R.; Meera Chatterjee (1999). Wasting away: the crisis of malnutrition in India. World Bank Publications. ISBN 0821344358. http://books.google.co.in/books?id=Valqj0xLVAoC&pg=PA11&dq=Malnutrition+in+India&cd=2. 

References

External links

• India: Malnutrition Report World Bank
• Child Malnutrition In India Report