Malnutrition in India

 Malnutrition in India

Dr R.S.Dahiya
There are two thoughts regarding malnutrition in India.
1.
One way  of thinking regarding malnutrition in India is a medical emergency which may result in fatality. It is because of this that it requires specialised treatment under expert care. The treatment of 'uncomplicated' cases is provided through specially designed products called "Ready to use Therapeutic  Foods"(RUTF), which are standardized in their composition and include essential micronutrients.
This view is one which is promoted largely by experts in clinical management of malnutrition.
2.
The other way of thinking is that the malnutrition is the outcome of social economic and political inequalities. Malnutrition has to be managed in all its stages and manifestations , with a strong focus on the ' root causes'. The process and products used to address malnutrition need to reflect this overall approach. This view is largely promoted by public health experts.
     
    However the first approach has come to be regarded as the principal stress the in managing my location the alarming situation of malnutrition in India demand a comprehensive approach that address the needs both of those children who are malnourished and require treatment, as well as preventing much larger numbers with moderate malnutrition from deteriorating further.(Prasad and Sinha 2005)
   Unfortunately, the approach followed has been informed by a biomedical rather than public health perspective, where malnutrition is often treated without considering its broader social determinants , amongst which household food insecurity dominates.
    Efforts to mitigate food insecurity for children in India are primarily channelled through the Integrated Child Development Scheme (ICDS),under the Ministry of Women and Child Development. As part of the scheme , an 'Anganwadi' or child care centre is established for every 1000 children between the age of 0 and 3 years. The Anganwadi provides nutritional supplements and pre school education. However the programme has been unable to reach children under the age of 2 years even though it is widely recognised that this is the age group most critical for intervention.(Prasad and Sinha 2015).
  National Rehabilation Centre (NRCs) have been established after the rolling out of the National Rural Health Mission(NRHM ,2005) to treat children with Severe Acute Malnutrition(SAM). Experience , however has shown that NRCs are unable to cope with the large numbers of children suffering from malnutrition and are largely ineffective in addressing the problem. There are serious discrepancies in protocols in the management of SAM between NRCs and ICDS(Prasad, Sinha and Shridhar, 2012) creating operational problems. Families are also unwilling to admit children in the NRCs(often situated far from their homes) for prolonged periods of time. The NRCs treat the children as medical emergencies and donot offer any comprehensive system of prevention or continuity of care .

Haryana -- Some Health Indicators as per NFHS-5(2019-21)
1. Sex Ratio of the total population
(Females per 1000 males) -
Urban- 911, Rural-933, Total-926
2. Sex ratio at birth for children in the last 5 years(females per 1000 males)-
Urban-943, Rural-873, Total -893
3. Infant Mortality Rate-(IMR)--
Urban--28.6%, Rural--35.3%, Total-33.3% .It was total 32.8% in NFHS--4. Increased now.
4. Average out of pocket expenditure per delivery in a public health facility (Rs)--
Urban--1,766, Rural--1631, Total--1666, NFHS-4 it was 1569 total which was less.
5. Children with age of 3 years breastfed within one hour of birth(%)
Urban--37.7, Rural--43.3 Total--41.6

6. Children under 5 years who are Stunted(height for age)(%)
Urban--26.1, Rural--28.1, Total--27.5

7. Children under 5 years who are wasted(weight for height)(%)
Urban--10.8, Rural--11.8, Total--11.5

8. Children under 5 years who are under weight(weight for age)(%)
Urban--20.5, Rural--21.8, Total--21.5

9. Children age 6--59 months who are anaemic( less than 11.o g/dl(%)
Urban--68.1, Rural--71.5, Total--70.4

10. Pregnant women age 15--49 years who are anaemic(less than 11.0 g/dl(%)
Urban--54.6, Rural--57.2, Total--56.5

It was more than survey 4
11. All women age 15--19 years who are anaemic  (%)
Urban--59.3, Rural--63.5,Total--62.3

12. Men age 15--19 years who are anaemic(less than 13.0g/dl)(%)
Urban--26.7,Rural--31.5,Total--29.9
NFHS 4 --29.7
It is more than NFHS 4 data.
13. Ever married women age 18--49 years who have ever experienced spouse violence (%)
Urban--18.0, Rural--18.2 Total--18.2

14. Maternal Mortality Rate shot up 101 per lakh live birthday to 110 in 2018--2020
Times of India 1st Dec , 22


These parameters also indicate the malnutrition situation in one way or the other.