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Malnutrition among Indian children

This article delves into the prevalence, causes, and implications of malnutrition among Indian children, highlighting the need for improved strategies, such as refocusing objectives, enhancing community-based initiatives, and addressing operational challenges within programs like ICDS.

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Malnutrition among Indian children

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  1. Malnutrition among Indian children August 25th, 2007

  2. What is Malnutrition? • Both protein-energy malnutrition (underweight etc.) and micronutrient deficiencies • Retards physical and cognitive growth; increases susceptibility to infections • Cause of half of all child deaths, and more than half of deaths due to major diseases (malaria, diarrhea, pneumonia, measles) • Cause of 22% of disease burden of country • Implications on productivity - 2.5 B USD annually

  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

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