Download a PDF of this issue - Field Exchange - Emergency ...

Field Article
Valid International, India
Managing severe
acute malnutrition
in India:
prospects and
challenges
By Biraj Patnaik
Self Help Group outsde their facility for making
blended food for children under 3 years
Biraj Patnaik is the Principal Adviser to
the Commissioners of the Supreme
Court of India in the right to food case.
He is also associated with the Right to
Food Campaign in India. This paper
reflects his personal views.
This article is based on a case study and presentation delivered by Biraj Patnaik for the
Addis Ababa Conference on CMAM scale up in November 2011. He describes the scale of
nutritional problems in India, current institutional mechanisms, and challenges in addressing
the SAM burden in particular. Jamie Lee and Bernadette Feeney (Valid International) were
invited by the India delegation to describe a number of developments in India since the
conference around CMAM that are shared in a postscript.
The context
Despite being the second fastest growing economy
in the world, India continues to harbour
some of the worst social sector indicators. India
has the highest burden of child malnutrition in
the world, with 42.7% of children under 5 years
of age (U5s) classified as underweight (low
weight for age). Twenty per cent of children
under five years of age are wasted (low weight
for height). The child prevalence of malnutrition
in India is twice that of Sub-Saharan Africa
and more than one third of the world’s children
who are wasted live in India. Forty eight per
cent of U5s (61 million children) are (low height
for age) due to chronic undernutrition, accounting
for more than 3 out of every 10 stunted
children in the world 1 .
According to the most recent National
Family Health Survey (NFHS 3, 2005-06), one
Table 1: National Family Health Survey:
a comparative account
Status of children under six years NFHS-2 NFHS-3
of age
Infant Mortality Rate
68 57
(deaths/1,000 live births)
Children under three years who 19.7 22.9
are wasted (%)
Children under three years who 42.7 40.4
are underweight (%)
Percentage of children 12-23 43.5 42
months who received all
recommended vaccines (%)
Children with diarrhoea in the last 26.2 26.9
two weeks who received ORS (%)
Children age 0-5 months
46.3 40.8
exclusively breastfed (%)
Children age 6-35 months who are 78.9 69.4
anaemic (%)
Children age 3-5 years who are
attending a pre-school (%) (NSS,
2004-05) (%)
34.4
Note: The figures here are based on NCHS data to facilitate
comparison between NFHS-2 and NCHS-3. Figures for NFHS-
3 based on 2006 WHO Growth Standards are available at
http://www.nfhsindia.org/nfhs3.html and are reflected in
subsequent tables in this article.
third of children are born with a low birth
weight. The percentage of under three year olds
(U3s) who are anaemic has actually increased
from 74.2 per cent to 79.2 per cent and immunisation
coverage has decreased slightly from
26.9 per cent to 26.2 per cent. A recent survey by
the National Nutrition Monitoring Bureau
(NNMB 2007) shows that there is a daily deficit
of over 500 calories in the intakes of children in
the age group of 1-3 years and about 700 calories
in children in the age group 3-6 years.
The fact that these figures are the most
“updated” and that data on malnutrition is not
compiled more regularly, is in itself reflective of
the failure of the country’s policymakers to
appreciate the seriousness and scale of the problem
of child malnutrition in India. What is even
more worrying is the lack of progress in tackling
child malnutrition. In 1999, NFHS 2 had estimated
the child malnutrition rate at 47%. Only a
one percent reduction in the intervening six
years, between NFHS 2 and NFHS 3, points to a
Figure 1: Indian States in the Global Hunger Index
(Source: IFPRI, Global Hunger Index 2010)
serious crisis in tackling malnutrition. Table 1
(NFHS 3) reflects the indicators at the national
level on a range of nutritional indicators.
While the problem of malnutrition is
endemic across the country, some states bear a
more than disproportionate burden of hunger
and malnutrition. Figure 1 (IFPRI, Global
Hunger Index, 2010) classifies all the
states/union territories with respect to three
indicators of child malnutrition, infant mortality
and percentage of persons consuming less
than 1700 calories per day. The map demonstrates
how the regional distribution of
malnutrition in the country varies widely, with
Madhya Pradesh having the highest proportion
of malnourished U3 children (60%) and
Mizoram with the lowest percentage (19.9%).
There has been uneven progress in the
reduction of malnutrition in India, in terms of
regional variations. Table 2 summarises the
performance of the best performing States
between the two NFHS surveys (1999 and
2006). Sixteen states reported a reduction in
child malnutrition between 1999 and 2006.
However, 13 states reported an increase in child
malnutrition, in the corresponding period.
Even Kerala, which is also by far the best state
in India with respect to most social indicators,
showed a marginal increase in child malnutrition
rates. Table 3 summarises the worst
performing states. Ironically, some states with
the highest per capita income in country,
including Punjab, Haryana and Gujarat,
showed an increase in the child malnutrition
rates.
The causes of malnutrition in India are due
to a variety of factors, including low birth
weight of babies, early marriage and pregnancy,
low status of women and lack of access to quality
health care at the primary level. India has
the highest rate of open defecation in the world
1
Source of prevalence figures: UNICEF, accessed June 2012
http://www.unicef.org/india/nutrition.html
85