MALNUTRITION

In India
What is Malnutrition?
• lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things,
or being unable to use the food that one does eat.
India remains malnourished
• India is facing a serious burden of under-nutrition, according to a global report released today
which shows that more than half the women of reproductive age in the country suffer from anaemia.
• MEASUREMENT EFFORTS WORLDWIDE
• 1970s: Countries do not have measures for malnutrition. Towards the late 1970s, the National
Centre for Health Statistics (NCHS) of the US develops a standard for monitoring child growth. WHO
adopts this and recommends it to other countries for measuring malnutrition among children
1980s: The NCHS measure runs into controversy. Experts complain that breastfed infants grow taller
than the standard set by NCHS
1990s: WHO’s Department of Nutrition sets up a working group to assess the growth pattern of
breastfed infants. Its report published in 1994 highlights a number of problems with the NCHS
standard. WHO begins work for a new measure. Experts propose that the standard should suggest
“how children should grow” instead of “how children are growing”
2000s: WHO begins survey in six countries, including developed, developing and under-developing
economies. In 2006 it publishes its new growth reference. All countries adopt the model the same
year
• More than 100 districts in the country share the fate of Shivpuri, making India home to the largest
number of malnourished children. In the absence of latest government figures, estimates by the
National Family Health Survey (NFHS) in 2006 show that 48 per cent, or 61 million, under-five
children in the country are stunted (they have low height for their age); 43 per cent, or 53 million,
are underweight; and nearly 20 per cent, or 25 million, are wasted (low weight for height).The three
“The child may eventually die of a
indicators are age, weight and height.
disease, but that disease was lethal because the child was
unable to fight back due to malnutrition,”

•
Point to be noted
• All surveys indicate that India is slipping into a vicious cycle of malnutrition. Scientists say the initial
1,000 days of an individual’s lifespan, from the day of conception till he or she turns two, is crucial
for physical and cognitive development. But more than half the women of childbearing age are
anaemic and 33 per cent are undernourished, according to NFHS 2006. A malnourished mother is
more likely to give birth to malnourished children.
• In popular perception, poverty is synonymous with malnutrition. Reports show a major chunk of
malnourished children belong to poor families and traditionally poor states. But rates of
malnutrition are also significant among middle- and high-income families.
WHO’s Standard
• It is based on children from well-off background
In 2006, the world adopted a growth standard developed by WHO to measure
malnutrition. These standards were prepared after measuring the growth of 8,500 children
from six countries—Brazil, Ghana, India, Norway, Oman and the United States—for two
years. Selection of the children was made on the following conditions:
Good economic condition of parents
• Access to safe drinking water and sanitation
• Low mobility of mother so that children receive regular care
• Mothers adhering to breast feeding and other recommended diet patterns
• Access to nearby hospitals and total immunisation
• Use of micronutrient supplements
• One of the parents must have 17 years of education
• Mother must be non-smoker
WHO Results
• In India, the sample was drawn from 58 affluent families in South Delhi, a plush area of the capital
city. In the late 1990s, WHO conducted two surveys of the region to identify 1,000 pregnant women
from 111,084 households. WHO officials monitored the growth of their children for close to two
years. At the global level, the survey began with the enrollment of the first newborn in Pelotas,
Brazil, on July 1, 1997, and ended in November 2003.During the survey, WHO officials measured
height, weight, and circumference of the head and the mid-upper arm is proportion to the age of
under-five children. Based on the survey findings, WHO created the growth chart.
• Though these standards show how a child is growing, countries use it as a standard to check
malnutrition. Countries measure the growth of children against this WHO chart to identify if a child
is malnourished. A child is categorized as underweight (low weight for age or less than 2.5 kg at
birth), wasted (low weight for height) and stunted (low height for age). Stunting is an indicator of
chronic under nutrition, especially protein-energy malnutrition, and is caused due to prolonged
food deprivation and/or disease or illness. Wasting is an indicator of acute under nutrition and is the
result of more recent food deprivation or illness. Underweight is used as a composite indicator to
reflect both acute and chronic under nutrition.
Conflicts
• The formula uses height and weight as yardsticks to measure the growth of a child. Panagariya
argued that the height of an individual can vary depending on the nutrition status as well as genetic
makeup. For instance, Indians are not genetically programmed to be as tall as WHO expects. But the
WHO formula does not take this disparity into account.
• Anganwadi workers
• The mid-upper arm circumference (MUAC) of a child. A child whose MUAC is less than 115 mm
is considered severely acute malnourished, those with 115-125 mm of MUAC are moderately
acute malnourished and those with more than 125 mm of MUAC are considered normal.
However, this measurement is yet to gain momentum. Few anganwadi workers know about it
and even fewer have the skill to measure MUAC properly. One has to first calculate and mark
the mid-point of the arm after measuring the arm length; MUAC is determined at this mid-
point.
Problems
• One missing piece of the malnutrition puzzle is social inequality. For
example, girl children are more likely to be malnourished than boys,
and low-caste children than upper-caste children.
• Sanitation issues-Lack of sanitation and clean drinking water are the
reasons high levels of malnutrition persists in India despite
improvement in food availability
• Illiteracy
• Family planning issues
• Modernaization
• The improvement in nutritional status could be due to non-nutritional
factors, such as improved accessibility to health care facilities,
sanitation and protected water supply