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Malnutrition was the predominant risk factor for death in children younger than five in every state of India in 2017, accounting for 68.2 per cent of the total under-5 deaths, translating into 706,000 deaths (due to malnutrition). It was also the leading risk factor of loss of health among all age groups.
This was revealed in the state-wide data on malnutrition presented by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and National Institute of Nutrition (NIN).
The prevalence of low birthweight in India in 2017 was 21.4 per cent, child stunting 39.3 per cent, child wasting 15.7 per cent, child underweight 32.7 per cent, anaemia in children 59.7 per cent, anaemia in women 15–49 years of age 54.4 per cent, exclusive breastfeeding 53.3 per cent and overweight child 11.5 per cent.
According to the findings, if the trends estimated up to 2017 for the indicators in the National Nutrition Mission 2022 continue in India, there would be 8.9 per cent excess prevalence for low birthweight, 9.6 per cent for stunting, 4.8 per cent for child underweight, 11.7 per cent for anaemia in children, and 13.8 per cent for anaemia in women relative to the 2022 targets.
The DALY (disability adjusted life years) rate due to malnutrition was found to be highest in Uttar Pradesh, Bihar, Assam, and Rajasthan. The worst effect of child and maternal malnutrition is reflected in neonatal disorders, followed by lower respiratory infections and diarrhoeal diseases in children below 5 years.
Although the all causes under-5 death rate in India decreased from 2,336 per 100,000 in 1990 to 801 per 100,000 in 2017, the proportion of under-5 deaths attributable to malnutrition changed only modestly from 70.4 per cent to 68.2 per cent in 2017. This, is a major concern because this indicates that the malnutrition menace is hardly on the wane in India.
Similarly, the DALY rate in children attributed to all causes declined substantially in these years but DALY rate attributed to malnutrition declined by less than 2 per cent age points only.
Low birthweight, the largest contributor to the malnutrition DALYs in India, had a prevalence of 21 per cent in 2017, which showed a modest declining trend. Within child growth failure, the highest contribution to DALYs was from wasting, the prevalence of which declined only moderately in India during 2010–17.
The prevalence of stunting and underweight has been decreasing, however, the prevalence has remained very high in India at 39 per cent and 33 per cent respectively, in 2017. The prevalence of anaemia has been extremely high in India at 60 per cent in children and 54 per cent in women in 2017, with only moderate decline during 2010–17, the paper said.
The prevalence of overweight children, on the other hand, has increased in India in the past decade, with a prevalence of 12 per cent in 2017.
These findings also raise concern about a host of policies in India which have been in practice since 1990 to tackle malnutrition, the key ones being Integrated Child Development Scheme launched in 1975, the National Nutrition Policy 1993, the Mid Day Meal Scheme for school children 1995, and the National Food Security Act 2013, as the prevalence of stunting, wasting and underweight remains high.
“Substantial improvements across malnutrition indicators in the states of India would require an integrated nutrition policy to effectively address the broader determinants of undernutrition across the life cycle,” the paper said.
“These improvements include providing clean drinking water, reducing rates of open defecation, improving women’s status, enhancing agricultural productivity and food security, promoting nutrition sensitive agriculture, coupled with harmonisation of efforts across ministries and sectors, political will and good governance, and strategic investments in a multi-sectoral approach,” it added.