Malnutrition among children
Source: By Arvind Virmani: The Tribune
Malnutrition is the most persistent challenge for policymakers. According to the FAO, 18 per cent of India's population was undernourished in 2012. And worst, children are the most visible victims of under-nutrition, which is the underlying cause of diarrhea, malaria, measles, and pneumonia. Under-nutrition accounts for half of the deaths in children below the age of five years.
According to UNICEF, India houses one-third of the stunted/wasted (termed malnourished) children of the world and 46 per cent of the children below the age of three are too small for their age and 47 per cent are underweight. Under-nutrition can result from lack of nutrients in an individual's diet, a weakened immune system and inability to absorb nutrients. Under-nutrition increases the risk of chronic diseases and its impact lasts lifelong.
Malnutrition is a complex multi-dimensional and inter-generational problem and needs multi-spectral as well as direct and specific interventions. In recent times, as these issues have been worrying global policymakers, there are new indices, different from the popular Global Hunger Index released annually since 2006 that are being developed to illustrate the complexity of hunger and malnutrition. Though these indices do not capture important national, cultural and political dimensions, they do highlight the problem.
The Global Hunger Index (GHI), released recently, combines three equally weighted indicators into one index: (a) under-nourishment (b) child underweight and (c) child mortality. The multi-dimensional approach to measuring hunger reflects the nutritional situation not only of the population as a whole but also of a physiologically vulnerable group, children, who could be sick or stunted because of lack of nutrients. In terms of the GHI components, India has the highest prevalence of underweight children under 5 -- 40.2 per cent; the only worst country is Timor-Leste at 45.3 per cent. The proportion of under-nourished in India as a percentage of the total population declined from 21.3 per cent in 1999-01 to 17.5 per cent in 2010-12. The under-5 mortality rate is the worst in India. It is for the above reasons that the overall GHI for India is very serious and not because of hunger per se.
The Hunger and Nutrition Commitment Index (HANCI), launched in 2013, compares the performance of 45 developing countries using 22 indicators of political commitment to reduce hunger and under-nutrition. It examines government action in terms of policies and programmes, legal frameworks and public expenditures. And also takes into consideration women's empowerment, social protection, food and agriculture, and health and nutrition environment. Overall, on HANCI, India is ranked 29th (2 ranks above its per capita GDP rank) below Brazil (4th), China (22nd) and South Africa (23rd). According to HANCI, there is low commitment by the government in India towards addressing the problem of stunting in children below 5 years of age.
Banerjee and Duflo (2011) find that a typical poor household could spend up to 30 per cent more on food than it actually does and if it completely cuts expenditures on alcohol, tobacco and festivals. Further, even the money that people spend on food is not spent to maximise the intake of calories or micro nutrients. To illustrate, the poorest group in Maharashtra in 1983 would prefer to buy better tasting, more expensive calories rather than millets which provide calories but may not be good in taste. It is widely documented that poor people spend large amounts of money on weddings, dowry and christenings probably due to social compulsions. On nutrition, it needs to be debated whether India should distribute vitamin A and iron supplements or adopt bio-fortification of crops with essential micronutrients as researched under the Harvest Plus initiative? Pritchard, Rammohan, Sekhar, Parasuraman and Choithani in Feeding India (2013) argue that the problem of under-nutrition in India represents the inability of different institutions to deliver resources to individuals to adequately feed themselves. They also flag another important issue pertaining to gender-based differences in under-nutrition between girls and boys.
Earlier, Virmani (2006) showed that much of the inter-state variation in child malnutrition (more precisely wasting and stunting) in India could be explained by the differences in the availability of clean water and access to toilets. Other causal factors were related to information, education and nutritional knowledge particularly of mothers. The role of the PDS system was ambiguous (positive/negative but non-significant), suggesting that the availability of cereals was not per se an important causal element in child malnutrition! Virmani (2013) showed that the same was true of cross-country differences in child malnutrition (stunting and wasting). Thus much of the outlier status in terms of child malnutrition was attributable to the absence of sanitation with lack of clean drinking water and female education playing a supporting role. In both the inter-state (India) and the cross-country studies, poverty rates were not a separate determinant of 'malnutrition' once these factors were accounted for!
Other studies have also shown that hygiene, clean drinking water, level of mother's education and dietary diversification positively impact the balanced nourishment of the child. Angus Deaton (2013, The Great Escape) reiterates that in countries like India it is malnutrition, lack of clean water and prevalence of poor sanitation that is the main cause of high child mortality. In fact, according to Deaton, net nutrition, more than food, after making an allowance for nutrition lost to diseases like diarrhea, fevers and infections is important. The other cause of high mortality is unhygienic disposal of human waste, lack of protein, energy insufficiency, and lack of vital micro nutrients such as iron.
On the basis of expert opinion, India needs a focused public health and nutritional policy with a concerted public campaign that would help in successfully achieving positive nutritional outcomes. The quick-fixes may not be sufficient and the need is for providing cleaner water and better sanitation. India can dramatically close the gap in child malnutrition (wasting) if sewage and sanitation are brought on a par with other countries, at least those with similar per capita income levels.
Malnutrition is the most persistent challenge for policymakers. According to the FAO, 18 per cent of India's population was undernourished in 2012. And worst, children are the most visible victims of under-nutrition, which is the underlying cause of diarrhea, malaria, measles, and pneumonia. Under-nutrition accounts for half of the deaths in children below the age of five years.
According to UNICEF, India houses one-third of the stunted/wasted (termed malnourished) children of the world and 46 per cent of the children below the age of three are too small for their age and 47 per cent are underweight. Under-nutrition can result from lack of nutrients in an individual's diet, a weakened immune system and inability to absorb nutrients. Under-nutrition increases the risk of chronic diseases and its impact lasts lifelong.
Malnutrition is a complex multi-dimensional and inter-generational problem and needs multi-spectral as well as direct and specific interventions. In recent times, as these issues have been worrying global policymakers, there are new indices, different from the popular Global Hunger Index released annually since 2006 that are being developed to illustrate the complexity of hunger and malnutrition. Though these indices do not capture important national, cultural and political dimensions, they do highlight the problem.
The Global Hunger Index (GHI), released recently, combines three equally weighted indicators into one index: (a) under-nourishment (b) child underweight and (c) child mortality. The multi-dimensional approach to measuring hunger reflects the nutritional situation not only of the population as a whole but also of a physiologically vulnerable group, children, who could be sick or stunted because of lack of nutrients. In terms of the GHI components, India has the highest prevalence of underweight children under 5 -- 40.2 per cent; the only worst country is Timor-Leste at 45.3 per cent. The proportion of under-nourished in India as a percentage of the total population declined from 21.3 per cent in 1999-01 to 17.5 per cent in 2010-12. The under-5 mortality rate is the worst in India. It is for the above reasons that the overall GHI for India is very serious and not because of hunger per se.
The Hunger and Nutrition Commitment Index (HANCI), launched in 2013, compares the performance of 45 developing countries using 22 indicators of political commitment to reduce hunger and under-nutrition. It examines government action in terms of policies and programmes, legal frameworks and public expenditures. And also takes into consideration women's empowerment, social protection, food and agriculture, and health and nutrition environment. Overall, on HANCI, India is ranked 29th (2 ranks above its per capita GDP rank) below Brazil (4th), China (22nd) and South Africa (23rd). According to HANCI, there is low commitment by the government in India towards addressing the problem of stunting in children below 5 years of age.
Banerjee and Duflo (2011) find that a typical poor household could spend up to 30 per cent more on food than it actually does and if it completely cuts expenditures on alcohol, tobacco and festivals. Further, even the money that people spend on food is not spent to maximise the intake of calories or micro nutrients. To illustrate, the poorest group in Maharashtra in 1983 would prefer to buy better tasting, more expensive calories rather than millets which provide calories but may not be good in taste. It is widely documented that poor people spend large amounts of money on weddings, dowry and christenings probably due to social compulsions. On nutrition, it needs to be debated whether India should distribute vitamin A and iron supplements or adopt bio-fortification of crops with essential micronutrients as researched under the Harvest Plus initiative? Pritchard, Rammohan, Sekhar, Parasuraman and Choithani in Feeding India (2013) argue that the problem of under-nutrition in India represents the inability of different institutions to deliver resources to individuals to adequately feed themselves. They also flag another important issue pertaining to gender-based differences in under-nutrition between girls and boys.
Earlier, Virmani (2006) showed that much of the inter-state variation in child malnutrition (more precisely wasting and stunting) in India could be explained by the differences in the availability of clean water and access to toilets. Other causal factors were related to information, education and nutritional knowledge particularly of mothers. The role of the PDS system was ambiguous (positive/negative but non-significant), suggesting that the availability of cereals was not per se an important causal element in child malnutrition! Virmani (2013) showed that the same was true of cross-country differences in child malnutrition (stunting and wasting). Thus much of the outlier status in terms of child malnutrition was attributable to the absence of sanitation with lack of clean drinking water and female education playing a supporting role. In both the inter-state (India) and the cross-country studies, poverty rates were not a separate determinant of 'malnutrition' once these factors were accounted for!
Other studies have also shown that hygiene, clean drinking water, level of mother's education and dietary diversification positively impact the balanced nourishment of the child. Angus Deaton (2013, The Great Escape) reiterates that in countries like India it is malnutrition, lack of clean water and prevalence of poor sanitation that is the main cause of high child mortality. In fact, according to Deaton, net nutrition, more than food, after making an allowance for nutrition lost to diseases like diarrhea, fevers and infections is important. The other cause of high mortality is unhygienic disposal of human waste, lack of protein, energy insufficiency, and lack of vital micro nutrients such as iron.
On the basis of expert opinion, India needs a focused public health and nutritional policy with a concerted public campaign that would help in successfully achieving positive nutritional outcomes. The quick-fixes may not be sufficient and the need is for providing cleaner water and better sanitation. India can dramatically close the gap in child malnutrition (wasting) if sewage and sanitation are brought on a par with other countries, at least those with similar per capita income levels.
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