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Facts hard to digest

There is more to malnutrition in India than just lack of food which accounts for half of the 2.3 million child deaths annually, writes Siddharth Agarwal.more »

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India is a paradox. While it is one of the fastest growing economies in the world, it is also home to 57 million of the world’s 146 million malnourished children. Malnutrition continues to remain a silent emergency in India, with 47 per cent of children under five either underweight, stunted, wasted or with micronutrient malnutrition. Malnutrition not only retards their physical and cognitive growth and increases their susceptibility to infection, but it also affects their educational achievements, health and overall productivity when they grow up. Consequently, child malnutrition is not only responsible for 22 per cent of India’s disease burden and half of the 2.3 million child deaths annually, but it also costs India at least $ 10 billion annually in terms of lost productivity, illness and death. Such a colossal loss is unacceptable for a growing global power like India.

Malnutrition in children is an outcome of insufficient food intake, impaired utilisation or depletion of nutrients due to repeated infectious diseases and parasites and low birth weight (LBW). While poverty and food insecurity contributes to malnutrition in India, some important causes, most of which are preventable, include improper and unsafe infant feeding and child care practices, gender disparity in distribution of food and general neglect of the girl child, as a result of which 60 per cent of Indian women in the reproductive age group are anaemic, a major contributing factor for LBW.

Breastfeeding is an effective way of ensuring healthy growth and development of infants and protecting them against infections. However, only 37.1 per cent newborns are breastfed within a day of birth in India. Colostrum (first milk), which is essential for the infant’s nutritive and immunologic value, is often discarded as ‘old and impure milk’. Instead babies are fed with pre-lacteals like tea, ghutti, diluted milk in many rural and poor urban households. Many families either do not initiate complementary food when the baby reaches six months or give foods with sub-optimal nutritive value. Often, owing to the caregiver’s lack of knowledge, such food may be unhygienic and may introduce infection resulting in diarrhoea. The vicious cycle of malnutrition and infection thus begins. The common practice of restricting food and breast milk during illness further deprive them of nutrients at a time when they need them most.

Promotion of optimal breastfeeding and infant feeding practices can prevent malnutrition significantly. A mother from a poor household needs both information and counselling to overcome potentially harmful traditional practices. Unfortunately, nutrition and health education continues to be relatively neglected.

All contact points for antenatal care and immunisation need to be utilised for imparting nutrition education to the community. Efforts in health facilities should be linked with outreach efforts especially in villages and urban slums so that information on optimal feeding practices reaches high-risk families. Disadvantaged groups like the urban poor are more vulnerable owing to insecure income, weak social support and lack of basic infrastructure and unhygienic living conditions. Such communities should receive special attention. Peer counselling should be facilitated through mothers’ meetings in villages and urban slums. Mass media such as television, radio and public announcements also play an important role in spreading awareness.

Providing social support and infrastructure such as crèches for working women, especially from slums, migrant and farmer communities, can enable families to take better care of their children. Improvement of environmental sanitation, provision of safe drinking water, promotion of good hygiene practices and care seeking during illness are also critical for combating malnutrition.

Malnutrition among children occurs almost entirely during the first two years of life and is virtually irreversible after that. Studies have shown that a group of effective nutrition interventions including breastfeeding, timely and adequate complementary feeding, and nutrient supplementation could actually prevent 25 per cent of all child deaths in India each year. Thus, it is important for government and non-government programmes to invest greater effort and resources on malnutrition prevention and early action rather than coping with malnutrition when it has already set in. Fortunately, most nutrition interventions are simple and inexpensive household measures that can be delivered through ongoing programmes like Integrated Child Development Scheme (ICDS), Reproductive and Child Health and the National Rural Health Mission.

Dr Siddharth Agarwal is Executive Director, Urban Health Resource Centre (UHRC)