malnutrition among indian children

1: Malnutrition among Indian children August 25th, 2007

3: Underweight Prevalence of underweight children is highest in the world, double of sub-Saharan Africa, more than a third of undernourished kids of the world live in India. Most retardation occurs by age 2 (30% low birth weight) In 1998-99, 73% of children underweight (of which 18% severe, 26% mild) 46% stunted (long term), 16% wasted (short term) Total of 37M kids under 3

4: "South Asian Enigma" People puzzled that south Asian countries have worse incidence of malnutrition than Africa. Characteristics of south Asia: low birth weight, less powerful women, poor sanitation.

5: Distribution by demographics or socio-economic factors Rural (50%) vs. urban (38%) Girls (48.9%) vs. boys (45.5%) SC/ST (53-56%) vs. others (44%) 60% in lowest wealth quartile. Interestingly, spread among all quartiles. These differences widened in 1990s

6: Distribution by demographics or socio-economic factors (contd.) It is concentrated in pockets One in 2 children underwieght in: Maharashtra, Orissa, Bihar, Madhya Pradesh, UP and Rajasthan. Last 4 account for 43% of underweight children. 10% of villages account for 28% of underweight children

7: Micronutrient deficiencies Preschool children: 75% (iron) 57% (Vit.A) 87% of pregnant women have anemia Distribution across demographic and socio-economic factors similar to underweight

8: Has there been improvement? Reduction not good enough 11% between 92-93 and 98-99, but not comparable to countries with similar socio-economic factors

9: ICDS (Integrated Child Development Services) World's largest early child development program Multi-sectoral approach. Anganwadi centers Supplementary feeding, immunization, health checkups, health and nutrition education to adult women, micronutrient supplements, pre-school education, growth monitoring By 2004 6lakhs AWC workers, 33M children and 6M women

10: Impact of ICDS No statisticaly significant relationship between presence of anganwdi center and nutritional status! Covers 90% of administrative blocks Does not cover states where underweight is most prevalent (or is it other way around?) Growth rate higher in poorer villages Poorer states have lower coverage of ICDS A whole bunch of studies, some say it has helped, some say not. Another paper said it helped younger kids more than 4-6 kids.

11: Bright spots of ICDS Doing well in a bunch of states Synergizing with RCH (Reproductive and Child Health program) Different states adopt different flavors of the ICDS program Promoting community participation: Mothers committees, self help groups etc. are working together with the anganwadi workers in many places. Having more volunteers (change agents)

12: ICDS Problems Food and supplements delivery not proper - leakage to non-targeted individuals, irregularity, mis-communication with parents More focus on expanding coverage than distributing food; instead, should be on nutritional and family-based feeding/caring and educating people. Does not target kids nder 3, or preferentially target girls/lower income groups Not in proportion to magnitude of problem Operational challenges: workers overburdened in providing primary education also to kids aged 4-6

13: Determinants of nutritional status Food security Access to health resources Appropriate child care behavior

14: How to overcome these problems Refocus objectives: either pre-school education or malnutrition Emphasis on educating to improve feeding pratices, better overall health and sanitation, how to cook nutritious food in a low budget Work with health sector more Redirected to vulnerable groups (kids < 3, pregnant women, neglected states and castes). Mini anganwadi centres;split work into 2 roles - one for health and one for preschool education Improve food procurement; make it decentralized or contract More community based; tailored to local needs