Child Malnutrition declining, though not fast enough
There is some good news amid gloom! Preliminary findings of a survey in India as quoted by the Global Nutrition Report 2014 shows that prevalence of malnutrition among children aged below 5 years has come down between 2005-06 and 2013-14, even though we have a long way to go. (See links and bullet points below).
The survey on malnutrition and hunger, called the Rapid Survey on Children (RSOC), was conducted after a persistent demand from CSOs and health & food experts who need to monitor nutrition figures as a basis for advocacy and scientific policy making. Similar data was made available last by the National Family Health Survey-3 (NFHS-3) in 2005-06.
Brought out by the International Food Policy Research Institute (IFPRI), the Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition says that the prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (NFHS-3) to 38.8% in 2013-14 (RSOC). As a result, the population of under-five children affected by stunting has reduced from 5.82 crore in 2005-06 to 4.38 crore in 2013-14. This also means that the task ahead is daunting despite the decline. (See Table 1).
Although the average annual rate of reduction in stunting is 2.6%-- below India’s target rate of 3.7% -- it is well above the rate of 1.7% estimated on the basis of previous surveys. Since India has a high population of stunted children, the reduction in stunting prevalence will affect the global numbers significantly, says the Global Nutrition Report 2014.
Similarly, prevalence of wasting among children below 5 years of age has reduced from 20% in 2005-06 to 15% in 2013-14. The population of under-five children affected by wasting has declined from 2.43 crore in 2005-06 to 1.69 crore in 2013-14, the Report points out.
Although the RSOC's data and methodologies have not yet been reviewed by international agencies like WHO and UNICEF, and the survey results do not yet appear in the WHO’s Global Database on Child Growth and Malnutrition, India will be able to meet the global World Health Assembly (WHA) goals if the finalized rates of undernutrition are close to the preliminary rates reported, the report adds.
It is worth noting that the report is going by the figures supplied by the Government of India. The Government, however, is yet to disclose all the findings of the 2013–2014 RSOC. The new national survey, covering all 29 states in India, relies on data collected by the Ministry of Women and Child Development in partnership with UNICEF India.
Alongside the declining prevalence of malnutrition among children, one can notice the rise in exclusive breastfeeding rates from 46.4% to 71.6% in eight years between NFHS-3 and RSOC.
Earlier, the Global Hunger Index 2014 report found that the prevalence of underweight children below 5 years fell by almost 13 percentage points between 43.5% in 2005–2006 and 30.7% in 2013–2014. As a result, India now ranks 55th out of 76 countries, before Bangladesh and Pakistan, but still trails behind neighboring Nepal (rank 44) and Sri Lanka (rank 39).
Key factors that reduced malnutrition in India as per the report entitled Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition are:
• Experiences from the Indian state of Maharashtra suggest that significant change in nutrition status can happen over the medium term as a result of determined action sustained over a period of 6–12 years.
• There is a new statewide survey from Maharashtra in India (Haddad et al 2014). In the Maharashtra case study, it took only seven years to reduce child stunting by one-third, from 36.5 to 24.0 percent, for an annual average rate of reduction of 5.8 percent. Stunting declines resulted from a combination of nutrition-specific interventions, improved access to food and education, and reductions in poverty and fertility.
Key factors that reduced malnutrition in India as per the report entitled Global Hunger Index 2014: The Challenge of Hidden Hunger are:
• There are many factors that are responsible for reducing hunger and malnutrition situation in India. Since the last NFHS-3, the Government of India rolled out and expanded several programs that targeted a mix of direct and indirect causes of undernutrition. Nutrition-specific interventions that were scaled up after 2006 include (1) a final push to expand the Integrated Child Development Services (ICDS) programme that aims to improve the health, nutrition, and development of children in India and establish 1.4 million centers; and (2) the launch of the National Rural Health Mission, a community-based outreach and facility-based health initiative to deliver essential health services to rural India (Avula et al. 2013).
• Indirect factors that reduced hunger are the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a rural jobs program, and reforms in several states to the Public Distribution System, which distributes food to the poor.
• Efforts have also been made to create an enabling environment for nutrition. Within the context of India’s decentralized governance system, state governments have taken ownership of nutrition and tried to strengthen delivery of targeted nutrition efforts. The state of Maharashtra was the first of several to bring high-level political and bureaucratic leadership to nutrition through a Nutrition Mission, a program with greater flexibility and freedom than usual (Gillespie et al. 2013).
• Another key element in the enabling environment for food security and nutrition in India was the creation of a body called the Commissioners to the Supreme Court on the Right to Food Act, a group that supports independent monitoring of the delivery of food-based programs like the Integrated Child Development Services program and the Public Distribution System.
Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition, prepared by IFPRI (please click here to access)
Global Hunger Index 2014: The Challenge of Hidden Hunger, prepared by International Food Policy Research Institute, Welthungerhilfe and Concern Worldwide (please click here to access)
2012 Global Hunger Index-The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses (please click here to access)
Nutrition Barometer: Gauging national responses to undernutrition (2012), Save the Children and World Vision (please click here to access)
NFHS 3 Summary of findings (please click here to access)
Image Courtesy: UNDP India