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Hunger / HDI | Malnutrition
Malnutrition

Malnutrition

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As per the Global Nutrition Report 2016, which has been prepared by International Food Policy Research Institute (IFPRI),

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• The Global Nutrition Report 2016 ranks the country 114 for under-5 stunting out of 132 countries, 120 for under-5 wasting out of 130 countries, 170 for anaemia out of 185 countries and 104 for adult diabetes out of 190 countries.

• The stunting prevalence (among children below age 5 years) in India is 38.7 percent, which is higher than that of China (9.4 percent), Sri Lanka (14.7 percent) and Bangladesh (36.1 percent).

• The wasting prevalence (among children below age 5 years) in India is 15.1 percent, which is higher than that of China (2.3 percent) and Bangladesh (14.3 percent).

• The per capita consumption of kilo calories per day in India is 2390 kcal/capita/day, which is low as compared to China (3040 kcal/capita/day).

• The proportion of calories from non-staples in India is 40 percent, which is low as compared to that of China (48 percent). 

• The country is off-course in making progress towards World Health Assembly (WHA) targets (on reducing the prevalence of under-5 wasting), as per 2015 and 2016 assessments.

• The country is off-course in making progress towards World Health Assembly (WHA) targets (on reducing the prevalence of under-5 stunting) but some progress has been made, as per 2015 and 2016 assessments.

• The overweight prevalence (among children below age 5 years) in India is 1.9 percent, which is higher than that of Sri Lanka (0.6 percent).

• The prevalence of anemia in women of reproductive age is 48.1 percent in India, which is higher than that of Bangladesh (43.5 percent), Nepal (36.1 percent), and Sri Lanka (25.7 percent).

• The exclusive breastfeeding (EBF) rate in India is 46.4 percent, which is higher than that of China (27.6 percent). In Sri Lanka, the EBF rate is 75.8 percent.

• The prevalence of diabetes among adult population in India is 9.5 percent, which is the same as in China.

• The prevalence of adult obesity in India is 4.9 percent, which is low as compared to China (6.9 percent).

• The adult overweight and obesity prevalence in India is 22 percent, which is lower than that of China (34.4 percent) but higher than that of Bangladesh (18.1 percent).

• Dramatic reductions in malnutrition in Brazil, Ghana, Peru, and the Indian state of Maharashtra were fueled by governments and others that made commitments—and kept them.

• Although declines in India’s child undernutrition rates have accelerated since 2006, these faster developments are still well below the rates of progress needed to achieve the global nutrition targets adopted by the World Health Assembly (WHA) to which India is a signatory. India lags behind many poorer countries in Africa south of the Sahara; at current rates of decline, India will achieve the current stunting rates of Ghana or Togo by 2030 and that of China by 2055.

• Nutritional status and progress in India vary markedly across its states. India urgently needs to take target setting to the subnational level to achieve global nutrition targets and Sustainable Development Goals (SDGs).

• The state nutrition missions of India are an example of where laudable commitment has not, to date, been fully backed up with targets. These missions serve six states, with a combined population of more than 300 million people, which have chosen to make a public commitment to nutrition improvement.

• Maharashtra was the first state in India to launch its mission in the form of an autonomous technical and advisory body, in 2005, under the Department of Women and Child Development. Subsequently, five other states have launched their respective missions based on the Maharashtra model: Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, and Karnataka. All six state nutrition missions focus on the 1,000-day post-conception period and commit to improving intersectoral coordination in order to improve child nutrition.

• One reason the nutrition missions in India do not cover all targets pertaining to Under-5 stunting, Under-5 wasting, Low birth weight, Under-5 overweight, Anemia in women of reproductive age and Exclusive breastfeeding is likely that they are typically housed in the state Department or Ministry of Women and Child Development (WCD), whose agenda is supplementary nutrition. Issues that fall in the domain of other departments, such as health, do not get articulated in WCD departments’ plans or missions. This situation demonstrates the need for multi-sectoral missions or agencies, cutting across departments, with clearly defined and measurable targets and monitorable action points for all sectors.

• Only two of the six states have clear, measurable targets for nutritional outcomes — Uttar Pradesh State Nutrition Mission and Odisha’s Nutrition Operation Plan. The action plan of Maharashtra’s Rajmata Jijau Mother-Child Health and Nutrition Mission includes monitoring of 10 important indicators related to maternal and child health but does not specify measurable targets and time frames for these indicators. The states of Gujarat, Madhya Pradesh, and Karnataka do not include any specific targets in their mission statements.

• Not all targets align with the global nutrition targets: Uttar Pradesh includes four of the six targets—it excludes low birth weight and overweight prevalence but includes underweight prevalence as an additional indicator that is not a global target. Odisha’s Nutrition Operation Plan includes only stunting, wasting, and underweight, excluding the other global targets of women’s anemia, exclusive breastfeeding, child overweight, and low birth weight.

• In states that have targets, the targets are based on older data. For example, the Uttar Pradesh State Nutrition Mission’s plan for 2014–2024 is based on findings from India’s National Family Health Survey 3 (NFHS-3), from 2005–2006, and includes time-bound targets for stunting, wasting, underweight, exclusive breastfeeding, and women’s anemia. Progress across the target indicators could instead be measured using the recently released Rapid Survey on Children 2014 data for baseline values to reflect the most recent status of undernutrition in the state. Likewise, Odisha’s Nutrition Operation Plan, aimed at accelerating underweight reduction in 15 high-burden districts of the state, includes targets for stunting, wasting, and underweight based on NFHS-3, 2005–2006 levels.

• An urgent action call is needed for all states to use new, updated data to report the current status of nutrition and set new targets, cover all six globally agreed target indicators, and ensure the availability of appropriate data collection mechanisms that deliver comparable data on these targets over time. Target setting is the first order of business to strengthen accountability. The next is collecting data on stated targets.

• Rapid increases in spending, and consequent improvements in nutrition, are possible, as places like the Indian state of Maharashtra have shown for undernutrition.

• India almost doubled the rate of stunting reduction in the past 10 years compared with the previous decade. That is highly significant given that India is home to more than one-third of the world’s stunted children. India’s awakening to all forms of malnutrition could be a significant game changer for the world’s prospects of reaching the SDGs, much as China was for the Millennium Development Goals. Like all other countries, though, India must pay attention to its growing rate of overweight and, in particular, high rate of diabetes.

• Much nutrition programming has been decentralized to subnational administrative units, yet examples of subnational target setting are few. Even the influential Indian state nutrition missions are inconsistent about setting nutrition targets.

• In India, the national rural health mission is taking on more work on nutrition—especially in the context of prenatal care provision, treatment of severe acute malnutrition (SAM), and micronutrient supplementation.

• Assets, women’s education, and open defecation are key factors behind stunting in India.

• Research shows that anti-poverty programmes, expansion of improved water and sanitation, and access to improved healthcare (which is driven by political leadership), health system reform, and public and private investment are some of the key drivers to nutrition improvement.

• In 2016, the Indian government, at the central level, allocated approximately US$5.3 billion in total to nutrition-specific programs such as the Integrated Child Development Services Scheme and the National Health Mission. It allocated $31.6 billion in total to several programs aimed at improving the underlying determinants of nutrition, such as the Public Distribution System (PDS), which focuses on food security, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), which focuses on livelihood security in rural areas, and the Swachh Bharat Mission, which is focused on sanitation.

• Although a large amount of money is committed to nutrition-specific interventions, it falls $700 million short of the $6 billion per year Menon, McDonald, and Chakrabarti (2015) estimate is needed. The Indian government could meet this independently assessed target by increasing the budget 13 percent.

• Programmes such as the PDS (food subsidy) and MGNREGA (employment security) that target underlying determinants account for about 70 percent of India’s expenditure on nutrition. Such allocations, and those available from the central government for the sanitation mission, can help create more supportive home environments for improved nutrition, if well implemented. For all these programs, the onus of strengthening centrally sponsored government schemes by reducing inefficiencies, improving targeting, and ensuring greater convergence of the schemes lies with the state governments.

• Due to changes in the country’s fiscal architecture, there are now opportunities for states to increase their commitment to nutrition and allocate additional state financing. But there is a risk that states may not prioritize nutrition. Guidelines for prioritizing and allocating financing available from the central government could help strengthen nutrition-financing efforts at the state level as well.

• The Indian government released its 2015–2016 budget in February 2016. Despite the lack of mention of any explicit commitments to nutrition in the budget speech by the finance minister, an analysis of the budget through a nutrition lens by the Centre for Budget and Governance Accountability in India reveals several insights about how the government of India is investing in areas that could support nutrition. Budgetary allocation to nutrition is not increasing, is short of what is needed, and is dominated by interventions at the underlying level (such as the Public Distribution System), which have to be well designed, with an intent to improve nutrition, if they are to be effective.

• A recent systematic review of the global impact of non-communicable diseases (NCDs) on household income (Jaspers et al. 2015) found that cardiovascular disease (CVD) patients in India spent 30 percent of their annual family income on direct CVD health care, where the mean out-of-pocket cost per hospitalization increased from $364 in 1995 to $575 in 2004. The authors also found that in India the risk of impoverishment due to CVD was 37 percent greater than for communicable diseases. The same review reports that “14.3% of high-income families in China experienced some form of household income loss due to cardiovascular disease (CVD) hospitalization, rising to 26.3% in India, to 63.5% in Tanzania, and to 67.5% in Argentina” (Jaspers et al. 2015, 170).

• The Global Nutrition Report 2014 showed how data disaggregated at the district level in India could be used to spark dialogue and debate between civil society and district officials about the who, what, why, when, where, how—and how much—of nutrition action.

 

• The economic consequences of malnutrition represent losses of 11 percent of gross domestic product (GDP) every year in Africa and Asia, whereas preventing malnutrition delivers $16 in returns on investment for every $1 spent. The world’s countries have agreed on targets for nutrition, but despite some progress in recent years the world is off track to reach those targets. This third stocktaking of the state of the world’s nutrition points to ways to reverse this trend and end all forms of malnutrition by 2030.

 

Rural Expert

Tagged with: Malnutrition



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