Malnutrition in India: A tale as old as time, a toil as harsh as war!
With less than four years remaining for the POSHAN Abhiyaan to end, malnutrition continues to remain a burden. Addressing malnutrition is an international public health issue and is a major milestone of the 2030 Agenda for Sustainable Development. As per WHO 2019 estimates, the total burden of stunting and wasting in India is 20% and 39%, respectively, higher than the regional (South East Asia) average. Similarly, various population-level studies have highlighted the increasing burden of malnutrition in India.
The POSHAN Abhiyaan has been instrumental in trying to address malnutrition in the country, but more needs to be done in terms of proper implementation and community outreach. In addition, Indian children are also suffering from “hidden hunger” or micronutrient deficiency. There is an emergent need of multipronged approach with package of evidence-based interventions to tackle this formidable problem.
As a socio-cultural problem, malnutrition has continued to plague the population. Further studies have shown that factors such as low socioeconomic standing, illiteracy, and lack of knowledge on adequate feeding practices, are some of the leading risk factors for malnutrition among children in India.
Internationally, ‘wasting’ is the key identifier for acute malnutrition among children, and these cases must be identified and treated early. Globally, nearly 20 million children under five (U5) years of age are suffering from SAM and until date, it remains a major killer of children. According to NFHS-4, 7.5% of under-five children in India are suffering from SAM/severe wasting.
As a response to the malnutrition burden, various national programmes have been put in place to date, with little or slow outcomes. The institutional (Hospital-based) setting is the most widely used avenue for identifying and addressing SAM among children in India and worldwide. Correspondingly, the Government of India (GoI) in 2011, with the help of the National Rural Health Mission (Ministry of Health and Family welfare), launched its first operational guidelines on facility-based management of children with acute malnutrition for the Nutrition Rehabilitation Centers (NRC), which are now operational at the NITI Aayog-identified aspirational districts.
In 2018, the Government of India (GoI) launched the POSHAN Abhiyan, a multi-faceted method towards tackling the Malnutrition burden in India. Besides, The Integrated Child Development Services (ICDS) has been instrumental in catalysing POSHAN Abhiyan’s efforts for tackling malnutrition and health problems among children below 6 years of age and their mothers. This year in celebration of the first POSHAN month, various activities are being carried out around the country, from the state to the village level, some to celebrate the accelerated efforts in addressing malnutrition, while in other to push another mile in joining the battle against this public health issue.
The indisputable burden of SAM in India and the limited availability of SAM treatment atjust hospitals makes it is impossible to treat every SAM child just at the facility level. This kind of limitation results in a large number of children who are living with SAM at the community to go completely undetected and without appropriate medical attention.
As an ideal solution, a complementary community-based approach/community-based management of acute malnutrition (CMAM) for addressing children with SAM (for those without medical complications only) can help in timely detection and provision of treatment for SAM at the community level. It has been seen that working with community health workers to increase the prevention and treatment coverage is feasible and cost-effective in tackling both moderate and severe acute malnutrition (SAM).
Whereas treatment of malnutrition is important, a greater focus is required on prevention. The first 1000 days ranging from conception to the end of the second year of life are crucial for brain development. Ensuring adequate nutrition during this period increases the child’s chance of having a healthy and productive life in the future, and helps to break the inter-generational cycle of poverty. Prevention of foetal and early childhood malnutrition deserves particular attention in view of the effect of nutrition on brain development. A life cycle approach – care during intrauterine life, infancy, early childhood as well as adolescent period is recommended. Evidence has shown that breast-feeding support and counselling, appropriate complementary feeding, prevention of infection and growth monitoring, are few among many other approaches that can improve nutrition of children.