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.^[1] 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.^[2]

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).^[3] 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.^[4] 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.^[5] The implications of both overnutrition and undernutrition indicates that a country can exert rates of infectious diseases and chronic diseases simultaneously: A situation that has not been observed before in history. This new phenomenon of the rising incidence of chronic diseases such as heart disease, cancer and type II diabetes along with the presence of infectious diseases such as pneumonia, and tuberculosis is mainly attributed to rapid population growth and the increase in the country's economy. The increase in income has made it possible for people living in urban areas to have access to a wider range of food outlets, to afford transportation and other luxuries of western society that have led to an increase in fast food consumption and a more sedentary lifestyle.

Undernutrition

According to the World Food Program and the M.S. Swaminathan Research Foundation (MSSRF)^[6] , 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.^[7]

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.^[8] 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.^[9]

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).^[9]

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.^[10] 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.^[11] 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.^[12] India is hence considered as the country with the largest population of diabetics.^[13] This diabetes (diabetes mellitus) is one of the diseases closely associated with overweight.^[14] 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.^[12] Over-nutrition is most prevalent in the cities among affluences^[15] 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.^[16]

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.^[17]

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.^[18]

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.^[18]

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.^[18]

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.^[18]

In urban areas, overweight status and obesity are over three times as high as rural areas.^[18]

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.^[19]

Punjab, Kerala, and Delhi also face the highest rate of overweight and obese individuals.^[18]

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.^[20]

Caste

Those belonging to scheduled castes, schedules tribes, or other backwards castes are also at increased risk of malnutrition. In particular, children of scheduled tribes have the poorest nutritional status and the highest wasting.^[20]

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^[21] 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^[22] 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

• Grade I. Severe Malnutrition

• 90%-100%

• Grade II. Moderate Malnutrition

• 75%-89%

• Grade III. Mild Malnutrition

• <60%^[23]

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.^[22]

Programs to address the causes of malnutrition in india

The Government of India has launched several programs to converge the growing rate of undernution children. They include ICDS, NCF, National Health Mission.

Mid-day 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 Mid-day 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.^[24]

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.^[25]

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

1. ^ "World Bank Report". Source: The World Bank (2009). http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html. Retrieved 2009-03-13. "World Bank Report on Malnutrition in India" 
2. ^ "2011 Global Hunger Index Report". International Food Policy Research Institute (IFPRI). http://www.ifpri.org/sites/default/files/publications/ghi11.pdf. 
3. ^ "World Bank Report". Source: The World Bank 2009. http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20195738~pagePK:141137~piPK:141127~theSitePK:295584,00.htm. Retrieved 2009-11-25. "India Country Overview 2009" ^{[dead link]}
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8. ^ Rieff, David (2009-10-11). "India's malnutrition Dilemma". Source:New York Times Magazine. http://www.nytimes.com/2009/10/11/magazine/11FOB-Rieff-t.html. Retrieved 2009-12-02. 
9. ^ ^{a b} "CHAPTER 1 WHAT ARE THE DIMENSIONS OF THE UNDERNUTRITION (Nutrition) PROBLEM IN INDIA?". Source: The World Bank. http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546-1147272668285/undernourished_chapter_1.pdf. Retrieved 2009-12-02. 
10. ^ "Combating Poor Nutrition in India". Source: Des Moines Central Camus. http://www.worldfoodprize.org/assets/YouthInstitute/05proceedings/DesMoinesCentralCampus.pdf. Retrieved 2009-11-27. 
11. ^ "India had Enormous Under-Nutrition and Over-Nutrition Problems". Source: Express Healthcare Management 2003. http://www.expresshealthcaremgmt.com/20030430/convers.shtml. Retrieved 2009-11-27. 
12. ^ ^{a b} "Health News: India to have most diabetics in world". Source: upl.com. http://www.upi.com/Health_News/2009/10/21/India-to-have-most-diabetics-in-world/UPI-54241256127678/. Retrieved 2009-11-27. 
13. ^ "Over 30 Million Diabetics in India". Source: Indiaserver.com 2008. http://www.india-server.com/news/over-30-million-diabetics-in-india-954.html. Retrieved 2009-11-27. 
14. ^ "Other Health Issues: Obesity". Source: Life clinic Personal Health Management. http://www.lifeclinic.com/focus/diabetes/obesity.asp. Retrieved 2009-11-27. 
15. ^ "Combating Poor Nutrition in India". Source: Des Moines Central Camus. http://www.worldfoodprize.org/assets/YouthInstitute/05proceedings/DesMoinesCentralCampus.pdf. Retrieved 2009-11-27. 
16. ^ "The American Journal of Clinical Nutrition". Source: The American Journal of CLINICAL NUTRITION 2006. http://www.ajcn.org/cgi/content/full/84/3/633. Retrieved 2009-11-26. 
17. ^ "Express India=2009-11-26". Source: Express India News 2009. http://www.expressindia.com/latest-news/msu-study-reveals-stark-contrast-in-nutrition-levels-in-rural-and-urban-areas-of-district/418522/. 
18. ^ ^{a b c d e f} "NFHS-3 Nutritional Status of Adults". http://hetv.org/india/nfhs/nfhs3/NFHS-3-Nutritional-Status-of-Adults.ppt. Retrieved 2009-11-26. 
19. ^ "NFHS-3 Nutritional Status of Children". http://hetv.org/india/nfhs/nfhs3/NFHS-3-Nutritional-Status-of-Children.ppt. Retrieved 2009-11-26. 
20. ^ ^{a b} "Nutrition and Anaemia". http://hetv.org/india/nfhs/nfhs3/NFHS-3-Chapter-10-Nutrition-and-Anaemia.pdf. Retrieved 2009-11-26. 
21. ^ CMAJ (2005). Malnutrition an and health in developing countries by Muller and Krawinkel
22. ^ ^{a b} Journal of Bangladesh Social Physiology (2008) Serum Total Protein and Albumin Levels in Different Grades of P Protein Energy Malnutrition by Chowdhury et al
23. ^ Journal of Bangladesh Social Physiology (2008) Serum Total Protein and Albumin Levels in Different Grades of P Protein Energy Malnutrition by Chowdhury et al.
24. ^ "Child Development Website". Source: Child Development programmes site (2009). http://wcd.nic.in/childdet.htm. Retrieved 2009-03-14. "Programs to address malnutrition in India" ^{[dead link]}
25. ^ "National Rural Health Mission". Source: National Rural Health Mission (2005–2012). http://www.mohfw.nic.in/NRHM/Documents/Mission_Document.pdf. Retrieved 2009-11-26. 

External links

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