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Resource centre on India's rural distress
 
 

Young and wasted -TK Rajalakshmi
-Frontline.in

The 2018 Global Nutrition Report points to the link between income and malnutrition but falls short of examining critical factors such as enhanced public spending that determine the levels of hunger and nutrition.

In 2017, fewer than one in five children, six to 24 months of age, in the world ate a minimally accepted diet. More than half of them in the same age group did not get the recommended number of meals, and only two-thirds of the infants from six to eight months ate any solid food at all. In short, the burden of malnutrition, globally, was very high. South Asia was home to 38.9 per cent of the world’s stunted children, while India, Nigeria and Pakistan accounted for half of all the stunted children. India was also home to 25.5 million “wasted” (low weight for height) children. India, Nigeria and Indonesia were home to the largest number of children in the “wasted” category. These and other dismal statistics are part of the 2018 Global Nutrition Report, the outcome of a multi-stakeholder initiative started in 2013.

At the other end of the spectrum, the report says, there was an exponential growth in infant formula sales; globally, it went up from 7.1 kilograms an infant in 2005 to 11 kg an infant in 2017, marking a 54.9 per cent increase. The growth in sales of formula milk food in the follow-up months of infancy, including the toddler stage, was also high and happened despite the World Health Organisation’s (WHO) position that such food was unnecessary and should not supplant breast milk.

The report says that a faulty diet composition was one of the major reasons for the high prevalence of malnutrition and that 37.8 million children affected by stunting were in low-income countries where the daily average income was less than $2.80 per person a day. Another 101.1 million stunted children belonged to countries where incomes were less than $11 per person a day. Rural areas contributed a higher proportion of stunted and wasted children than urban areas.

The discourse on nutrition had picked up since 2014 following the Second International Conference on Nutrition. The following year marked the declaration of the 2016-25 period as United Nations Decade of Action on Nutrition in order to accelerate implementation of the Sustainable Development Goals.

According to the report, malnutrition was responsible for ill health more than any other cause and good health was impossible without good nutrition. On the face of it, these seem like platitudes, but what is important here is the decreased levels of commitment by countries in addressing malnutrition on the one hand and the increased levels of private interventions with regard to it, the latter being fraught with various implications.

In recent years, the reasons for widespread hunger and disabilities caused by that have been a matter of intense debate. Solutions to these have ranged from categorising various kinds of malnutrition to prescribing antidotes that include micronutrients and fortified food. This has, in turn, spawned an entire industry.

The most common cause of malnutrition among children under five was a suboptimal diet compounded and, perhaps, preceded by inadequate breastfeeding. Inadequate breastfeeding itself was a function partly of the ignorance of its benefits and also an outcome of the malnourished status of the mother.

The report also mentions other determinants such as access to water, sanitation, hygiene, income, education and quality health services as mitigating or contributing to malnourishment. It falls short of advocating better income distributive policies though there are sufficient indications in the report of a link between poor income and stunting and wasting among children below five years of age.

Undernutrition accounted for 45 per cent of the deaths among children below five years of age in low- and middle-income countries while overweight contributed to 7.1 per cent of all deaths among children. The report says that while diet alone is not necessarily enough to address malnutrition, it is necessary to reduce disability and death from malnutrition across all ages and income brackets.

Only around 39 per cent of the countries had reported that their nutrition policies were accompanied by operational plans that were financially provided for. Even where they were “costed”, or financially provided for, they were not fully funded. Tanzania, for example, which had a Multi-sectoral Nutrition Action Plan (2016-21) including an ambitious two-year action plan to reduce the burden of malnutrition, could not find adequate funding to implement it.

China has in place a National Nutrition Plan that includes delivering a multivitamin package to women and children in poorer regions. This plan links agriculture to nutrition. In addition, the country has a National Health Commission that takes stock of the nutritional challenges.

“Spotlight”, or case studies that form part of the report, argues that there is a need to break away from existing “silos”, such as wasting versus stunting, treatment versus prevention, and severe wasting versus moderate wasting. This perhaps indicates a positive shift in thinking and approach, from creating categories of malnutrition to looking at the problem of hunger and nutrition more holistically. It was evident that the larger the number of categories, the more the number of “solution silos”, says the report.

The Indian scenario

Stunting and wasting, says the report, ought to be looked at together rather than as two separate categories. Combined, they contributed to the highest mortality rates among a potentially larger proportion of children compared with wasting. India alone contributed to 31 per cent of the global burden of stunting. There were, however, geographical and spatial variations. A study by the International Food Policy Research Institute that looked at district-level data aggregated from the National Family Health Survey revealed that stunting varied greatly from district to district, ranging from as low as 12.4 per cent to as high as 65.1 per cent. As many as 239 of 604 districts had stunting levels above 40 per cent, the national average.

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