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Hunger / HDI | Malnutrition
Malnutrition

Malnutrition

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Previous national surveys had not collected nationally representative data on children between the age of 5 and 14 years. These populations received less attention than those who are considered to be more vulnerable (pre-school children and adolescents). School-age children are beneficiaries of the world’s largest school feeding programme (Mid-Day Meal Scheme, 2014). Obtaining representative data on undernutrition and associated factors for this important, but neglected, age group, was therefore a key objective of the Comprehensive National Nutrition Survey (CNNS).

Prior national and sub-national surveys (National Family Health Survey-NFHS, District Level Household and Facility Survey-DLHS, Annual Health Survey-AHS and National Nutrition Monitoring Bureau-NNMB) provided some, but not adequate information on risk factors for non-communicable diseases. The identified information gaps between previous surveys and CNNS included: 1. limited or no data on micronutrients deficiencies across age groups; 2. limited data for 5–14 age groups in most of nutrition indicators; 3. no data on NCDs for under 5 and 10–14 year age groups; 4. lack of data on lipid profiles to assess the risk of heart disease in school-age children and adolescents; 5. measures of chronic kidney disease (CKD) in school-age children and adolescents; and 6. correlates of NCDs including truncal adiposity (waist circumference), other measures of adiposity (skinfold thicknesses), muscular strength, and physical fitness.

The CNNS was conducted in all 30 states of India using a multi-stage survey design covering rural and urban households. The survey collected data from three target population groups: pre-schoolers (0–4 years), school-age children (5–9 years) and adolescents (10–19 years). Around 112,316 children and adolescents interviewed with anthropometric measures collected for the purpose of CNNS.

The CNNS collected data for three population groups from 30 states in India: (a) 38,060 pre-schoolers aged 0–4 years; (b) 38,355 school-age children aged 5–9 years; and (c) 35,830 adolescents aged 10–19 years.

The key findings of the report entitled India: Comprehensive National Nutrition Survey 2016-2018 (released in October 2019), which was jointly prepared by Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council (please click here to access), are as follows:

Initiation of breastfeeding

• Fifty-seven percent of children aged 0–24 months were breastfed within one hour of birth

Exclusive breastfeeding

• Fifty-eight percent of infants under age six months were exclusively breastfed

Continued breastfeeding at age one year

• Eighty-three percent of children aged 12 to 15 months continued breastfeeding at one year of age

Complementary feeding

• Timely complementary feeding was initiated for 53 percent of infants aged 6 to 8 months

Minimum dietary diversity, meal frequency and acceptable diet

• While 42 percent of children aged 6 to 23 months were fed the minimum number of times per day for their age, 21 percent were fed an adequately diverse diet and 6 percent received a minimum acceptable diet

Food consumption among school-age children and adolescents

• More than 85 percent of school-age children and adolescents consumed dark green leafy vegetables and pulses or beans at least once per week

• One-third school-age children and adolescents consumed eggs, fish or chicken or meat at least once per week

• 60 percent school-age children and adolescents consumed milk or curd at least once per week

Malnutrition in pre-school children (0–59 months)

• 35 percent of children under five years were stunted (HAZ<-2 SD viz. who have low height for their age; SD means standard deviation)

• Stunting, or low height-for-age, is a sign of chronic undernutrition that reflects failure to receive adequate nutrition over a long period and is also affected by recurrent and chronic illness. Children are defined as stunted if their height-for-age is more than two standard deviations below (<-2SD) the WHO Child Growth Standards median (WHO, 2009)

• A number of the most populous states including Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, and had a high (37–42 percent) stunting prevalence. The lowest prevalence of stunting (16–21 percent) was found in Goa and Jammu and Kashmir

• A higher prevalence of stunting in under-fives was found in rural areas (37 percent) compared to urban areas (27 percent). Also, children in the poorest wealth quintile were more likely to be stunted (49 percent), as compared to 19 percent in the richest quintile

• 17 percent of children under five years were wasted (WHZ<-2 SD viz. who have low weight for their height)

• Wasting, or low weight-for-height, is a measure of acute undernutrition and represents the failure to receive adequate nutrition leading to rapid weight loss or failure to gain weight normally. Children are defined as wasted if their weight-for-height is more than two standard deviations below (<-2SD) the WHO Child Growth Standards median (WHO, 2009). Wasting may result from inadequate food intake or from a recent episode of illness causing weight loss

• High wasting prevalence (greater than or equal to 20 percent) states included Madhya Pradesh, West Bengal, Tamil Nadu and Jharkhand. The states with the lowest prevalence of under-five wasting were Manipur, Mizoram and Uttarakhand (6 percent each)

• A higher proportion of children under five years of age in the poorest wealth quintile were wasted (21 percent) compared to those in the highest wealth quintile (13 percent)

• 33 percent of children under five years were underweight (WAZ<-2 SD viz. who have low weight for their age)

• Underweight, or low weight-for-age, is a composite index that takes into account both acute and chronic undernutrition. Children are defined as underweight if their weight-for-age is more than two standard deviations below (<-2SD) the WHO Child Growth Standards median (WHO, 2009)

• Many states in the north-east of India, such as Mizoram, Sikkim, Manipur, Arunachal Pradesh and Nagaland, had the lowest prevalence (less than or equal to 16 percent) of underweight

• The states with the highest prevalence (greater than 39 percent) of underweight were Bihar, Chhattisgarh, Madhya Pradesh and Jharkhand. Rural areas had higher prevalence of underweight in children under five (36 percent) compared to urban areas (26 percent)

• Scheduled tribes had the highest prevalence of underweight (42 percent) as compared to scheduled castes (36 percent), other backward classes (33 percent), and other groups (27 percent)

• Children under five from the poorest wealth quintile had a prevalence of underweight more than twice that of the children from households in the richest wealth quintile (48 percent versus 19 percent)

• 11 percent of children 6–59 months were acutely malnourished as measured by mid-upper arm circumference (MUAC-for-age<-2 SD)

• 5 percent of children 6–59 months were acutely malnourished as measured by absolute MUAC (MUAC<125mm)

• The states with the highest prevalence (greater than or equal to 7 percent) of acute malnutrition by MUAC were Jammu and Kashmir, Uttar Pradesh, Meghalaya, Assam and Nagaland. The states with the lowest (less than or equal to 1 percent) prevalence of acute malnutrition by absolute MUAC (MUAC <125 mm) were Uttarakhand and Arunachal Pradesh

• Children from households in the lowest wealth quintile had a higher prevalence of acute malnutrition by MUAC (9 percent), as compared to those from the highest wealth quintile (3 percent)

• 2 percent of children under five were overweight or obese (WHZ>+2 SD)

• Overweight and obesity, or high weight-for-height, reflect body weight that is higher than what is considered a healthy weight for a given height. Children under five are defined as overweight if their weight-for-height is more than two standard deviations (>+2SD) above the WHO Child Growth Standards median (WHO, 2010)

• 1 percent of children under five were overweight as measured by triceps skinfold thickness (TSFT-for-age>+2 SD)

• The highest prevalence (greater than or equal to 4 percent) of overweight, as measured by TSFT, was in Mizoram, Tripura and Uttarakhand

• 2 percent of children 1 to 4 years were overweight as measured by subscapular skinfold thickness (SSFT-for-age>+2 SD)

• The highest prevalence of overweight (greater than or equal to 5 percent), as measured by SSFT, was in Andhra Pradesh, Karnataka, Mizoram, Tripura and Uttarakhand.

• Socio-economic status had a demonstrated effect on overweight as measured by SSFT, with 3 percent prevalence in the highest wealth quintile versus 1 percent in the lowest wealth quintile

Malnutrition in school-age children (5–9 years)

• 22 percent of school-age children were stunted (HAZ<-2 SD)

• The prevalence of stunting among children aged 5–9 years was lowest in Tamil Nadu (10 percent) and Kerala (11 percent) and highest in Meghalaya (34 percent)

• 10 percent of school-age children were underweight (WAZ<-2 SD)

• The prevalence of underweight was lowest in Arunachal Pradesh, Jammu & Kashmir, Manipur and Sikkim (17 percent) and highest in Jharkhand (45 percent)

• 23 percent of school-age children were thin (BMI-for-age<-2 SD; BMI means body mass index)

• A gender differential was observed in the prevalence of low BMI, with boys having a higher prevalence compared to girls, both among children 5–9 years (26 percent versus 20 percent) and adolescents (29 percent versus 19 percent)

• 4 percent of school-age children were overweight or obese (BMI-for-age>+1 SD)

• For children and adolescents 5–19 years, overweight and obesity are defined as BMI-for-age > +1SD and > +2SD above the WHO Child Growth Standards median (WHO, 2007).

• 2 percent of school-age children were overweight as measured by TSFT (TSFT-for-age>+1 SD)

• 8 percent of school-age children were overweight as measured by SSFT (SSFT-for-age>+1 SD)

• 2 percent of school-age children had abdominal obesity (waist circumference-for-age>+1 SD)

Malnutrition in adolescents (10–19 years)

• 24 percent of adolescents were thin for their age (BMI-for-age<-2 SD)

• 5 percent of adolescents were overweight or obese (BMI-for-age>+1 SD)

• 4 percent of adolescents were overweight as measured by TSFT (TSFT-for-age>+1 SD)

• 6 percent of adolescents were overweight as measured by SSFT (SSFT-for-age >+1 SD)

• 2 percent of adolescents had abdominal obesity (waist circumference-for-age>+1 SD)

Anaemia and Iron Deficiency

• Forty-one percent of pre-schoolers, 24 percent of school-age children and 28 percent of adolescents were anaemic

• Anaemia was most prevalent among children under two years of age

• Female adolescents had a higher prevalence of anaemia (40 percent) compared to their male counterparts (18 percent)

• Anaemia was a moderate or severe public health problem among pre-schoolers in 27 states, among school-age children in 15 states, and among adolescents in 20 states

• Thirty-two percent of pre-schoolers, 17 percent of school-age children and 22 percent of adolescents had iron deficiency (low serum ferritin)

• Female adolescents had a higher prevalence of iron deficiency (31 percent) compared to male adolescents (12 percent)

• Children and adolescents in urban areas had a higher prevalence of iron defi ciency compared to their rural counterparts

Micronutrients

• The prevalence of vitamin A deficiency was 18 percent among pre-school children, 22 percent among school-age children and 16 percent among adolescents

• Vitamin D deficiency was found among 14 percent of pre-school children, 18 percent of school-age children and 24 percent of adolescents

• Nearly one-fifth of pre-school children (19 percent), 17 percent of school-age children and 32 percent of adolescents had zinc deficiency

• The prevalence of vitamin B12 deficiency was 14 percent among pre-school children, 17 percent among school-age children and 31 percent among adolescents

• Nearly one-quarter (23 percent) of pre-school children, 28 percent of school aged children and 37 percent of adolescents had folate deficiency

• Adequate iodine status (median urinary iodine concentration greater than or equal to 100 µg/L and less than or equal to 300 µg/L) was observed in all three age groups - 213 µg/L among pre-school children, 175 µg/L among school-age children and 173 µg/L among adolescents

• Children and adolescents in all states, except Tamil Nadu had adequate levels of urinary iodine concentration. The estimate from Tamil Nadu showed the urinary iodine concentration was just at the lower limit of excess intake (median ~320 µg/L)

Markers of Non-Communicable Diseases

• There is a growing risk of non-communicable diseases among children aged 5 to 9 years and adolescents aged 10–19 years in India

• One in ten school-age children and adolescents were pre-diabetic with fasting plasma glucose >100 mg/dl & less than or equal to 126 mg/dl or with glycosylated haemoglobin (HbA1c) between 5.7 percent and 6.4 percent

• One percent of school-age children and adolescents were diabetic with fasting plasma glucose >126 mg/dl

• Three percent of school-age children and 4 percent of adolescents had high total cholesterol (greater than or equal to 200 mg/dl) and high low-density lipoprotein (LDL) (greater than or equal to 130 mg/dl)

• One-quarter (26 percent) of school-age children and 28 percent of adolescents had low high-density lipoprotein (HDL) (<40 mg/dl)

• One-third (34 percent) of school-age children (greater than or equal to 100 mg/dl) and 16 percent of adolescents (greater than or equal to 130 mg/dl) had high serum triglycerides

• Seven percent of school-age children and adolescents were at risk for chronic kidney disease (serum creatinine > 0.7 mg/dl for 5–12 years and > 1.0 mg/dl for greater than or equal to 13 years)

• Five percent of adolescents were classified as having hypertension (systolic blood pressure >139 mmHg or diastolic blood pressure >89 mmHg)

 

Rural Expert

Tagged with: Malnutrition



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