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$adminprix = 'admin' $rn = object(App\Model\Entity\Article) { 'id' => (int) 13, 'title' => 'Malnutrition', 'subheading' => '', 'description' => '<p style="text-align:justify"><span style="font-family:Arial; font-size:medium">KEY TRENDS </span></p> <div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to The State of the World's Children 2019 report, the proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50 percent for South Asia region <strong>*19</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to the Comprehensive National Nutrition Survey (CNNS), 35 percent of children under five years were stunted, 17 percent were wasted and 33 percent were underweight <strong>*18</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• For several decades India was dealing with only one form of malnutrition -- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/ obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI <strong>*17</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The India specific profile of the Global Nutrition Report 2018 shows that there is some progress made by the country to reduce the prevalence of stunting among children below 5 years. However, there is no progress (or there is been worsening) made by India to reduce the prevalence of wasting among children below 5 years, prevalence of anaemia among women of reproductive age (WRA), prevalence of both adult male and female obesity, and prevalence of both adult male and female diabetes <strong>*16</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to the Urban HUNGaMA (Hunger and Malnutrition) Survey Report (released in 2018), in the 10 most populous cities of India, one in four children has stunted growth and development due to chronic nutrition deprivation <strong>*15</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The overall prevalence of underweight, stunting and wasting among urban children below 5 years during 2015-16 was 25.1 percent, 28.7 percent and 16.0 percent, respectively, as per the urban nutrition survey by National Institute of Nutrition (NIN) <strong>*14</strong><br /> </div> <div style="text-align:justify">• Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey-4 (NFHS-4) 2015-16 <strong>*13</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The Global Nutrition Report 2016 ranks the country 114 for under-5 stunting out of 132 countries, 120 for under-5 wasting (acute malnutrition) out of 130 countries, 170 for anaemia out of 185 countries and 104 for adult diabetes out of 190 countries <strong>*12</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Stunting rates in under-three children declined by only 8 percentage points in more than a decade in this age-group -- from 53 percent in 1992-93 to 45 percent in 2006 -- reflecting an average annual rate of decline of 1.2 percent. During this period, wasting declined by 1 percentage point and underweight by 8 percentage points. However, the rate of progress accelerated since National Family Health Survey-3 (NFHS-3), and India's average annual rate of under-5 stunting decline between 2006 and 2014 has been 2.3 percent per year, compared with a rate of decline of 1.2 percent per year between 1992 and 2006 <strong>*11</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• New government data show that nearly all Indian states posted significant declines in stunting rates from 2006 to 2014, and all showed strong increases in exclusive breastfeeding rates over the same period <strong>*10</strong><br /> <br /> • Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines <strong>*10</strong><br /> <br /> • While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal <strong>*10</strong><br /> <br /> • The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above <strong>*10</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Despite various interim orders issued by the Supreme Court from time to time (based on a writ petition that was filed by People’s Union for Civil Liberties in April, 2001), the Government of India has failed to universalize the Integrated Child Development Services (ICDS) scheme <strong>*9</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal for urban India during 2011-12 (based on Schedule Type 2) <strong>*8</strong><br /> <br /> • At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector during 2011-12 (based on Schedule Type 2) <strong>*8</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (National Family Health Survey, NFHS-3) to 38.8% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by stunting has gone down from 5.82 crore in 2005-06 to 4.38 crore in 2013-14 <strong>*7</strong><br /> <br /> • Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14 <strong>*7</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• In the Maharashtra state of India, the percentage of stunted children dropped from 39 per cent in 2005 to 23 per cent in 2012 largely because of support to frontline workers who focus on improving child nutrition <strong>*6</strong></div> <div style="text-align:justify"><br /> • Total number of malnourished children (Grade I, II, III and IV) exceeded the 40 percent mark in 10 states/ UTs (Andhra Pradesh: 49 percent, Bihar: 82 percent, Haryana: 43 percent, Jharkhand: 40 percent, Odisha: 50 percent, Rajasthan: 43 percent, UP: 41 percent, Delhi: 50 percent, Daman and Diu: 50 percent and Lakshadweep: 40 percent), as on 31 March, 2011 <strong>*5</strong><br /> <br /> • Poor hygiene and sanitation were noticed in the AWCs due to the absence of toilets in 52 percent of the test checked AWCs and non-availability of drinking water facility for 32 percent of the test checked AWCs <strong>*5</strong><br /> <br /> • India's 2012 GHI score is 22.9 (rank: 65) as compared to China's GHI score of 5.1 (rank: 2), Bangladesh's score of 24.0 (rank: 68), Pakistan's score of 19.7 (rank: 57), Nepal's score of 20.3 (rank: 60) and Sri Lanka's score of 14.4 (rank: 37) <strong>*4</strong><br /> <br /> • Children in the poorest households are more than twice as likely to be stunted as those in the richest households in India <strong>*3</strong><br /> <br /> • 48% of children in India are stunted. 450 million children will be affected by stunting in the next 15 years, if current trends continue <strong>*2</strong><br /> <br /> • Malnutrition is an underlying cause of the death of 2.6 million children each year–one-third of the global total of children’s deaths <strong>*2</strong><br /> <br /> • The HUNGaMA study (2011) shows that in the 100 Focus Districts, 42 percent of children under five are underweight and 59 percent are stunted. Of the children suffering from stunting, about half are severely stunted <strong>*1</strong><br /> <br /> • The HUNGaMA study (2011) conducted in the 100 Focus Districts shows that 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 percent while that among mothers with 10 or more years of education is 27 per cent <strong>*1</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>19. </strong>The State of the World's Children 2019-Children, Food and Nutrition: Growing well in a changing world, released in October, 2019, produced by UNICEF, please <a href="tinymce/uploaded/Executive%20Summary%20SOWC%202019%20South%20Asia.pdf" title="Executive Summary SOWC 2019 South Asia">click here</a> and <a href="https://www.unicef.org/reports/state-of-worlds-children-2019">here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>18.</strong> India: Comprehensive National Nutrition Survey 2016-2018, released in October 2019, Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council, please <a href="https://im4change.org/docs/357Comprehensive_National_Nutrition_Survey_2016_2018_India.pdf">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>17. </strong>Food and Nutrition Security Analysis, India, 2019 (released in June 2019), produced by the MoSPI & WFP, please <a href="https://im4change.org/docs/231Food_and_Nutrition_Security_Analysis.pdf">click here</a> to access </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>16. </strong>Global Nutrition Report 2018: Shining a light to spur action on nutrition, please click <a href="https://globalnutritionreport.org/reports/global-nutrition-report-2018/">here</a> and <a href="tinymce/uploaded/India%20Profile.pdf" title="India profile">here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>15. </strong>Urban HUNGaMA Report: Nutrition and the City (released in February 2018), prepared by Naandi Foundation and others, please <a href="tinymce/uploaded/Urban-Hungama-Report.pdf" title="Urban-Hungama-Report">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>14. </strong>Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidemia in Urban Men and Women, National Nutrition Monitoring Bureau (NNMB) Technical Report no. 27, National Institute of Nutrition (NIN), please <a href="https://im4change.org/docs/555NNMB%20Urban%20Nutrition%20survey%20report.pdf">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>13. </strong>Nourishing India: National Nutrition Strategy, NITI Aayog, please <a href="tinymce/uploaded/Nutrition_Strategy_Booklet.pdf" title="National Nutrition Strategy">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>12. </strong>Global Nutrition Report 2016[/inside], which has been prepared by International Food Policy Research Institute (IFPRI), Please click <a href="tinymce/uploaded/Global%20Nutrition%20Report%202016.pdf" title="Global Nutrition Report 2016">link1</a> to access, click <a href="tinymce/uploaded/Synopsis%20Global%20Nutrition%20Report%202016.pdf" title="Synopsis Global Nutrition Report 2016">link2</a> to access</div> <div style="text-align:justify"><br /> <strong>11.</strong> India Health Report: Nutrition 2015 by Public Health Foundation of India, Transform Nutrition and UK Aid (please <a href="tinymce/uploaded/India%20Health%20Report%20PHFI.pdf" title="India Health Report 2015 PHFI">click here</a> to access)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>10.</strong> 2015 Global Nutrition Report: Actions and Accountability to Advance Nutrition & Sustainable Development by International Food Policy Research Institute (IFPRI), please <a href="tinymce/uploaded/global%20nutrition%20report%202015.pdf" title="Global nutrition report 2015">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>9.</strong> Public Accounts Committee (2014-15) report on ICDS Scheme of Ministry of Women & Child Development, PAC no. 2045, Fourteenth Report (presented to Lok Sabha on 27 April, 2015 and Rajya Sabha on 28 April 2015), Please <a href="tinymce/uploaded/Public%20Accounts%20Commitee%20report%20on%20ICDS.pdf">click here</a> to access </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>8.</strong> NSS 68th Round Report entitled Nutritional Intake in India, 2011-12 (published in October 2014) (Please <a href="http://mospi.nic.in/Mospi_New/upload/nss_report_560_19dec14.pdf">click here</a> to access)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>7.</strong> Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition, IFPRI (Please <a href="tinymce/uploaded/Global%20Nutrition%20Report%202014.pdf" title="Global Nutrition Report 2014">click here</a> to download)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>6.</strong> UNICEF report titled: Improving Child Nutrition: The achievable imperative for global progress (April, 2013), please <a href="tinymce/uploaded/Improving%20Child%20Nutrition%20The%20achievable%20imperative%20for%20global%20progress.pdf" title="Improving Child Nutrition The achievable imperative for global progress">click here</a> to access</div> <p style="text-align:justify"><br /> <span style="font-size:medium"><strong>5.</strong> Report of the Comptroller and Auditor General of India on Performance Audit of Integrated Child Development Services (ICDS) Scheme, CAG Report no. 22 of 2012-13-Union Government (Ministry of Women and Child Development), </span><a href="http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html">http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html</a></p> </div> <div> <div style="text-align:justify"> </div> <div style="text-align:justify"><span style="font-size:medium"><strong>4.</strong> 2012 Global Hunger Index-The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses, produced by IFPRI, Concern Worldwide and Welthungerhilfe, please <a href="tinymce/uploaded/2012%20Global%20Hunger%20Index.pdf" title="2012 Global Hunger Index">click here</a> to access</span></div> <div style="text-align:justify"><span style="font-size:medium"> </span></div> <div style="text-align:justify"> </div> <p style="text-align:justify"><span style="font-size:medium"><strong>3.</strong> The Nutrition Barometer: Gauging national responses to undernutrition (2012) by Save the Children and World Vision, please <a href="tinymce/uploaded/Nutrition%20Barometer.pdf" title="Nutrition Barometer">click here</a> to access</span></p> </div> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:Arial; font-size:medium"><strong>2.</strong> A Life Free from Hunger: Tackling child malnutrition (2012), Save the Children, please <a href="tinymce/uploaded/A%20Life%20Free%20from%20Hunger%20Tackling%20child%20malnutrition%202012%20Save%20the%20Children.pdf" title="A Life Free from Hunger Tackling child malnutrition 2012 Save the Children">click here</a> to access </span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:Arial; font-size:medium"><strong>1.</strong> HUNGaMA: Fighting Hunger & Malnutrition (2011), Naandi Foundation, please <a href="tinymce/uploaded/Hungama%20Report%202011.pdf" title="Hungama Report 2011">click here</a> to access </span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"><span style="font-size:medium">O</span>VERVIEW </span></p> <p style="text-align:justify"> </p> <div style="text-align:justify">India’s story of attaining self sufficiency in food grain production is the stuff of the legend. But a proud India was soon to learn that self sufficiency did not mean food for every citizen, leave alone adequate nutrition. However, one must not undermine the value of self reliance, knowing well enough the sinister link between hunger and a country’s dependence on food imports. One must also remember that many developed countries where nutrition is not a problem happen to be big importers of food. Obviously, nutrition security depends on a large number of factors, many of which have nothing to do with food. <br /> <br /> The issue of nutritional security is extremely complex. Many countries with similar per capita food consumption have vastly different rates of life expectancies and child mortality. Clearly, oversimplified statistical correlations and juxtapositions don’t work here. Jean Dreze and Amartya Sen have argued in their seminal work, Hunger and Public Action (OUP 1989), that we need to broaden our attention: a) from food-sufficiency to food-adequacy, b) from food adequacy to food entitlements, and c) from food entitlements to nutritional and related capabilities. The authors capture the big picture of nutritional security through many non-food factors like “medical attention, health services, basic education, sanitary arrangements, provision of clean water, eradication of infectious epidemics, and so on.”<br /> <br /> If we want to know why one third of world’s underweight children (which comes to roughly 57 million) live in India, we only have to look at a child’s environment here. According to NFHS, two third babies are born anemic and about one third have stunted growth. Those who survive the lack of healthcare, immunization, sanitation or safe drinking water grow up as victims of human trafficking, child abuse or forced child labour. It is obvious that improving the nutritional security of its children is much more complex than achieving self-sufficiency in food production. True, the country is committed to achieving this through the UN Convention on the Rights of the Child and the Millennium Development Goals (MDGs) but its progress is agonizingly slow.</div> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">Please <a href="https://www.im4change.org/upload/files/RDA_short_report%281%29.pdf">click here</a> to access the report entitled [inside]Nutrients Requirements for Indians: Recommended Dietary Allowances and Estimated Average Requirement (released in September 2020)[/inside], A Report of the Expert Group, Indian Council of Medical Research (ICMR)-National Institute of Nutrition (NIN), Ministry of Health and Family Welfare.</p> <p style="text-align:justify"><strong>---</strong></p> <p style="text-align:justify">The key findings of the report entitled [inside]The State of the World's Children 2019-Children, Food and Nutrition: Growing well in a changing world (released in October, 2019)[/inside], which has been produced by UNICEF, are as follows (please <a href="tinymce/uploaded/Executive%20Summary%20SOWC%202019%20South%20Asia.pdf" title="Executive Summary SOWC 2019 South Asia">click here</a> and <a href="https://www.unicef.org/reports/state-of-worlds-children-2019">here</a> to access): <br /> <br /> • The proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50 percent for South Asia region.<br /> <br /> • Among all the countries studied in this report pertaining to burden of death among children below five years, India is ahead of others. In 2018, 8.82 lakh children under five years died in the country. For Nigeria that figure was 8.66 lakh and for Pakistan it was 4.09 lakh. <br /> <br /> • The median under-five mortality rate (viz. deaths among children below five years per 1,000 live births) for India is 37, Bangladesh is 30, Pakistan is 69, Nepal is 32, China is 9 and Sri Lanka is 7 in 2018.<br /> <br /> • India's under-five mortality rate reduced from 126 in 1990 to 92 in 2000 and further to 37 in 2018.<br /> <br /> • The country's infant mortality rate (viz. deaths among children below one year per 1,000 live births) reduced from 89 in 1990 to 30 in 2018.<br /> <br /> • The country's neonatal mortality rate (viz. deaths among children below 28 days age per 1,000 live births) reduced from 57 in 1990 to 45 in 2000 and further to 23 in 2018.<br /> <br /> • In 2018, 5.49 lakh children under 28 days age died in the country.<br /> <br /> • In 2018, neonatal deaths as a proportion of all under-5 deaths was 62 percent.<br /> <br /> • India's life expectancy at birth improved from 48 years in 1970 to 63 years in 2000 and further to 69 years in 2018.<br /> <br /> • The number of deaths among children aged 5–14 years in 2018 was 1.43 lakh.<br /> <br /> • The total number of maternal deaths in 2017 was 35,000 for India. The country's maternal mortality ratio in that year was 145. It refers to the number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000 live births in that year.<br /> <br /> • The proportion of children in the age-group 0-4 years who are stunted (moderate and severe) was 38 percent during 2013-2018. For the poorest 20 percent that figure was 51 percent and for the richest 20 percent it was 22 percent.<br /> <br /> • The proportion of children in the age-group 0-4 years who are severely wasted was 8 percent during 2013-2018. The proportion of children in the age-group 0-4 years who are severely and moderately wasted was 21 percent during the same time span.<br /> <br /> • The proportion of children in the age-group 0-4 years who are overweight (moderate and severe) was 2 percent during 2013-2018.<br /> <br /> • The proportion of children in the age-group 5-19 years who are overweight and obese was 7 percent during 2016.<br /> <br /> • Almost 24 percent women above 18 years were underweight (body mass index < 18.5 kg per meter square) in 2016.<br /> <br /> • Almost 51 percent women in the age-group 15-49 years suffered from mild, moderate and severe anaemia in 2016.<br /> <br /> • The percentage of households consuming iodized salt in 2013–2018 was 93 percent.<br /> <br /> • In 2018, the percentage of children aged 6–23 months who are eating at least 5 out of 8 food groups (Minimum Dietary Diversity) was 15 percent for Pakistan, 20 percent for India, 22 percent for Afganistan, 27 percent for Bangladesh, 45 percent for Nepal, 71 percent for Maldives, 20 percent for South Asia region and 29 percent globally. <br /> <br /> • In South Asia, children in the age-group 6-11 months are eating less diverse diets compared to children in the age-group 12–23 months.<br /> <br /> • In 2018, globally 149 million children under 5 years were stunted and almost 49.5 million were wasted. In South Asia, 58.7 million children under 5 years were stunted and 25.9 million were wasted.<br /> <br /> • In 2018, globally 40 million children under 5 years were overweight. Against that 5.2 million children under 5 years were overweight in South Asia.<br /> <br /> • Nearly three-fourth of children in South Asia were not being fed much-needed nutrients from animal source foods in 2018.<br /> <br /> • 56 percent children in South Asia were not fed any fruits or vegetables.<br /> <br /> • Malnutrition must now be used to describe children with stunting (short stature for age) and wasting (low weight for height), those suffering from the ‘hidden hunger’ of deficiencies in essential vitamins and minerals as well as the growing numbers of children and young people who are affected by overweight or obesity.<br /> <br /> • Undernutrition continues to affect tens of millions of children. Its presence is visible in the stunted bodies of children deprived of adequate nutrition in the first 1,000 days and beyond. These children may carry the burden of early stunting for the rest of their lives and may never meet their full physical and intellectual potential.<br /> <br /> • Undernutrition is also evident in the wasted bodies of children when circumstances like food shortages, poor feeding practices and infection, often compounded by poverty, humanitarian crises and conflict, deprive them of adequate nutrition and, in far too many cases, result in death.<br /> <br /> • Overweight and obesity, long thought of as conditions of the wealthy, are now increasingly a condition of the poor, reflecting the greater availability of ‘cheap calories’ from fatty and sugary foods around the world. They bring with them a heightened risk of non-communicable diseases, like type 2 diabetes.<br /> <br /> • Far too many children and young people are eating too little healthy food and too much unhealthy food.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">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).<br /> <br /> 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.<br /> <br /> 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.<br /> <br /> 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.<br /> <br /> The key findings of the report entitled [inside]India: Comprehensive National Nutrition Survey 2016-2018 (released in October 2019)[/inside], which was jointly prepared by Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council (please <a href="https://im4change.org/docs/357Comprehensive_National_Nutrition_Survey_2016_2018_India.pdf">click here</a> to access), are as follows:<br /> <br /> <strong>Initiation of breastfeeding</strong><br /> <br /> • Fifty-seven percent of children aged 0–24 months were breastfed within one hour of birth<br /> <br /> <strong>Exclusive breastfeeding</strong><br /> <br /> • Fifty-eight percent of infants under age six months were exclusively breastfed<br /> <br /> <strong>Continued breastfeeding at age one year</strong><br /> <br /> • Eighty-three percent of children aged 12 to 15 months continued breastfeeding at one year of age<br /> <br /> <strong>Complementary feeding</strong><br /> <br /> • Timely complementary feeding was initiated for 53 percent of infants aged 6 to 8 months<br /> <br /> <strong>Minimum dietary diversity, meal frequency and acceptable diet</strong><br /> <br /> • 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<br /> <br /> <strong>Food consumption among school-age children and adolescents</strong><br /> <br /> • More than 85 percent of school-age children and adolescents consumed dark green leafy vegetables and pulses or beans at least once per week<br /> <br /> • One-third school-age children and adolescents consumed eggs, fish or chicken or meat at least once per week<br /> <br /> • 60 percent school-age children and adolescents consumed milk or curd at least once per week<br /> <br /> <strong>Malnutrition in pre-school children (0–59 months)</strong><br /> <br /> • 35 percent of children under five years were stunted (HAZ<-2 SD viz. who have low height for their age; SD means standard deviation)<br /> <br /> • 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)<br /> <br /> • 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<br /> <br /> • 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<br /> <br /> • 17 percent of children under five years were wasted (WHZ<-2 SD viz. who have low weight for their height)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 33 percent of children under five years were underweight (WAZ<-2 SD viz. who have low weight for their age)<br /> <br /> • 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)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 11 percent of children 6–59 months were acutely malnourished as measured by mid-upper arm circumference (MUAC-for-age<-2 SD)<br /> <br /> • 5 percent of children 6–59 months were acutely malnourished as measured by absolute MUAC (MUAC<125mm)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 2 percent of children under five were overweight or obese (WHZ>+2 SD)<br /> <br /> • 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)<br /> <br /> • 1 percent of children under five were overweight as measured by triceps skinfold thickness (TSFT-for-age>+2 SD)<br /> <br /> • The highest prevalence (greater than or equal to 4 percent) of overweight, as measured by TSFT, was in Mizoram, Tripura and Uttarakhand<br /> <br /> • 2 percent of children 1 to 4 years were overweight as measured by subscapular skinfold thickness (SSFT-for-age>+2 SD)<br /> <br /> • 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.<br /> <br /> • 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<br /> <br /> <strong>Malnutrition in school-age children (5–9 years)</strong><br /> <br /> • 22 percent of school-age children were stunted (HAZ<-2 SD)<br /> <br /> • 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)<br /> <br /> • 10 percent of school-age children were underweight (WAZ<-2 SD)<br /> <br /> • The prevalence of underweight was lowest in Arunachal Pradesh, Jammu & Kashmir, Manipur and Sikkim (17 percent) and highest in Jharkhand (45 percent)<br /> <br /> • 23 percent of school-age children were thin (BMI-for-age<-2 SD; BMI means body mass index)<br /> <br /> • 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)<br /> <br /> • 4 percent of school-age children were overweight or obese (BMI-for-age>+1 SD)<br /> <br /> • 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).<br /> <br /> • 2 percent of school-age children were overweight as measured by TSFT (TSFT-for-age>+1 SD)<br /> <br /> • 8 percent of school-age children were overweight as measured by SSFT (SSFT-for-age>+1 SD)<br /> <br /> • 2 percent of school-age children had abdominal obesity (waist circumference-for-age>+1 SD)<br /> <br /> <strong>Malnutrition in adolescents (10–19 years)</strong><br /> <br /> • 24 percent of adolescents were thin for their age (BMI-for-age<-2 SD)<br /> <br /> • 5 percent of adolescents were overweight or obese (BMI-for-age>+1 SD)<br /> <br /> • 4 percent of adolescents were overweight as measured by TSFT (TSFT-for-age>+1 SD)<br /> <br /> • 6 percent of adolescents were overweight as measured by SSFT (SSFT-for-age >+1 SD)<br /> <br /> • 2 percent of adolescents had abdominal obesity (waist circumference-for-age>+1 SD)<br /> <br /> <strong>Anaemia and Iron Deficiency</strong><br /> <br /> • Forty-one percent of pre-schoolers, 24 percent of school-age children and 28 percent of adolescents were anaemic<br /> <br /> • Anaemia was most prevalent among children under two years of age<br /> <br /> • Female adolescents had a higher prevalence of anaemia (40 percent) compared to their male counterparts (18 percent)<br /> <br /> • 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<br /> <br /> • Thirty-two percent of pre-schoolers, 17 percent of school-age children and 22 percent of adolescents had iron deficiency (low serum ferritin)<br /> <br /> • Female adolescents had a higher prevalence of iron deficiency (31 percent) compared to male adolescents (12 percent)<br /> <br /> • Children and adolescents in urban areas had a higher prevalence of iron defi ciency compared to their rural counterparts<br /> <br /> <strong>Micronutrients</strong><br /> <br /> • The prevalence of vitamin A deficiency was 18 percent among pre-school children, 22 percent among school-age children and 16 percent among adolescents<br /> <br /> • Vitamin D deficiency was found among 14 percent of pre-school children, 18 percent of school-age children and 24 percent of adolescents<br /> <br /> • Nearly one-fifth of pre-school children (19 percent), 17 percent of school-age children and 32 percent of adolescents had zinc deficiency<br /> <br /> • The prevalence of vitamin B12 deficiency was 14 percent among pre-school children, 17 percent among school-age children and 31 percent among adolescents<br /> <br /> • Nearly one-quarter (23 percent) of pre-school children, 28 percent of school aged children and 37 percent of adolescents had folate deficiency<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> <strong>Markers of Non-Communicable Diseases</strong><br /> <br /> • There is a growing risk of non-communicable diseases among children aged 5 to 9 years and adolescents aged 10–19 years in India<br /> <br /> • 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<br /> <br /> • One percent of school-age children and adolescents were diabetic with fasting plasma glucose >126 mg/dl<br /> <br /> • 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)<br /> <br /> • One-quarter (26 percent) of school-age children and 28 percent of adolescents had low high-density lipoprotein (HDL) (<40 mg/dl)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • Five percent of adolescents were classified as having hypertension (systolic blood pressure >139 mmHg or diastolic blood pressure >89 mmHg)<br /> <br /> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">The Food and Nutrition Security Analysis, India 2019 report has attempted to analyse data from all three dimensions viz. food availability, accessibility and utilization to help the reader take stock of the food and nutrition situation in India over different periods of time. In supporting the monitoring of progress towards achieving the targets under SDG 2, the Ministry of Statistics and Programme Implementation (MoSPI) and World Food Programme (WFP) together conducted analyses of available food and nutrition security information.<br /> <br /> It may be noted that the Sustainable Development Goals (SDGs) are a set of 17 global goals to improve the lives of all people around the world, by 2030. The second goal, SDG 2 – Zero Hunger – pledges to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. An important component of this goal is to improve access to food for all, end all forms of malnutrition, including agreed targets on childhood stunting and wasting and improve agricultural income and sustainability. These goals represent an important progression from the Millennium Development Goals (MDGs) which ended in 2015, where food security was measured solely on the basis of the percentage of population below the minimum level of dietary energy consumption, and the prevalence of children under 5 years of age who are underweight. Thus, to achieve SDG 2 the focus is broadened beyond these two outcomes and includes a focus on nutritious dietary intake, all forms of malnutrition, support to smallholder farmers, strengthened food systems and improved biodiversity.<br /> <br /> The key findings of the report entitled [inside]Food and Nutrition Security Analysis, India, 2019 (released in June 2019)[/inside], which has been produced by the Ministry of Statistics and Programme Implementation (MoSPI) & The World Food Programme (WFP), are as follows (please <a href="https://im4change.org/docs/231Food_and_Nutrition_Security_Analysis.pdf">click here</a> to access):<br /> <br /> <em><strong>Foodgrains Availability in India</strong></em><br /> <br /> • <strong>Production: </strong>Over the last 20 years, total food grain production in India increased from 198 million tonnes to 269 million tonnes. Wheat and rice are the staple foods of Indians and are a major portion of food grain production, constituting around 75 percent of the total food grain production and thus serving as a major source of income and employment to millions of people. The state of Uttar Pradesh leads in the production of wheat, cereals and foodgrains, closely followed by Punjab and Madhya Pradesh. West Bengal is the ‘rice bowl’ of India, followed by Uttar Pradesh, Punjab and Bihar.<br /> <br /> • <strong>Net Availability: </strong>Since 1996, the per capita net availability of foodgrains has increased from 475 to 484 gm/capita/day in 2018, while per capita availability of pulses has increased from 33 to 55 gm/capita/day. Although there has been a huge increase in production of rice, wheat and other cereals, their per capita net availability has not increased at the same level, due to population growth, food wastage and losses, and exports.<br /> <br /> • <strong>Production Trends: </strong>Between 1996-99 and 2015-18, the annual growth rate for food grains was 1.6 percent. Production growth for other major crops are: 2.4 percent for pulses, 1.8 percent for wheat, 1.6 percent for other cereals, 1.4 percent for rice, and 0.9 percent for bajra. Maize had the highest growth, at 5.9 percent. Conversely, other crops saw fall in annual growth rates such as: jowar (-2.26 percent), small millets (-1.71 percent) and ragi (-1.21 percent).<br /> <br /> • <strong>Farm Productivity: </strong>Though yields in food grains have increased by 33 percent in last two decades, it has been far less than desired. For instance, India has set a target of achieving yields of 5,018 kgs per hectare for rice, wheat and coarse grains by 2030, compared to the present combined yield of 2,509 kgs per hectare. While no state or Union Territory (UT) in India has achieved this target yet, the UT of Chandigarh is nearing the targeted productivity with current levels at 4,600 kgs per hectare, followed by yields of 4,297 kgs per hectare in Punjab.<br /> <br /> <em><strong>Access to Nutritious Food</strong></em><br /> <br /> • <strong>Food Expenditure: </strong>According to Engel's law, the share of income spent on food decreases, even as total food expenditure rises. A higher share of total monthly expenditure for food shows lower purchasing power and is related to food access, so it is a relative measure of food insecurity. On average, people of India allocate about 49 percent of their monthly expenditure on food in rural areas and 39 percent in urban areas. The share of food expenditure is highest among the poorest (lowest 30 percent) expenditure group. In rural and urban areas, the poorest 30 percent spend as much as 60 percent and 55 percent respectively, on food.<br /> <br /> • <strong>Food Expenditure Trends: </strong>Between 1972-73 and 2011-12, the share of expenditure on food has decreased around 33 percent in rural areas and 40 percent in urban areas whereas non-food expenditures have increased during the same period. Between 2004-05 to 2011-12, among the poorest, the share of expenditure on food has declined by 9 percent in rural and 8 percent in urban areas of India. Declining trends suggest that incomes have increased in both rural and urban areas and that food is no longer the only predominant expenditure head for the people.<br /> <br /> • <strong>Food Consumption Pattern: </strong>In the food basket, it turns out that in both urban and rural areas, the share of expenditure on cereal and cereal substitutes has declined between 1972-73 and 2011-12, from 57 percent to 25 percent in rural areas and from 36 percent to 19 percent in urban areas. For the same period, the relative importance of some items especially beverages, milk and milk products and fruits and nuts has shown a remarkable increase, indicating an increased diversity in consumption in the country. In the food basket, the energy and protein intake from cereals has decreased in both rural and urban India, largely because of increased consumption of other food items such as milk and dairy products, oils and fat and relatively unhealthy food such as fast food, processed food, and sugary beverages. Notably, the consumption of unhealthy energy and protein sources is much higher in urban areas. This has likely contributed to the emerging problem of obesity in India.<br /> <br /> • <strong>Nutritional Intake: </strong>Between 1993-94 to 2011-12, the average daily per capita consumption of both energy and protein decreased in rural India while in urban areas, there was no consistent trend. This decline has happened despite the increase in household income. For energy consumption alone, the trend suggests that despite increases since 1983, the overall energy intake is marginally lower than the minimum requirement. For protein intake, despite the declining trends, per capita consumption in both rural and urban areas is higher than the minimum daily requirement. However fat intake has increased steadily since 1983 and is much higher than the minimum daily requirement.<br /> <br /> • <strong>Nutritional Intake Among the Poor:</strong> Among the lowest 30 percent of the expenditure/ income class, the average per capita consumption of energy is 1811 kcal per day which is much lower than the Indian Council of Medical Research (ICMR) norm of 2,155 kcal per day. For protein, it is 47.5 grams per day compared to 48 grams per day norm while for fat it is 28 grams per day which is the same as the ICMR norm for rural India. For urban areas, per capita intake of energy is 1,745 kcal per day compared to 2,090 per day norm from ICMR. For protein it is 47 grams per day compared to a norm of 50 grams per day and for fat it is 35 grams per day compared to the norm of 26 grams per day. The current intake level of nutrients such as the energy and protein were lower than the all-India average and the daily minimum consumption requirement. Only fat intake in rural and urban areas was at par or more than the daily minimum consumption requirement.<br /> <br /> • <strong>Public Distribution System (PDS) and Nutritional Intake: </strong>The Targeted Public Distribution System (TPDS) has provided a critical nutritional supplement to the people across all states in India. During 2011-12, the average per capita supplementation of energy from TPDS was 453 kcal per day in rural areas and 159 kcal per day in urban India. In terms of protein, the supplementation through PDS has averaged 7.2 grams per day in rural areas and 3.8 grams per day in urban areas. The PDS supplementation to the poorest 30 percent population has been around 339 kcal per day. It has been seen that the poorest 30 percent of households had lower capacity to access food, and as a result, despite the PDS support, they were not able to reach the Recommended Dietary Energy (RDA) levels of energy and protein intakes.<br /> <br /> <em><strong>Utilization</strong></em><br /> <br /> • <strong>National Malnutrition Decadal Trends: </strong>The prevalence of malnutrition in children 6-59 months in India has declined between 2005-06 to 2015-16 with chronic malnutrition, or stunting, decreasing from 48.0 percent in 2005-06 to 38.4 percent in 2015-16 and underweight decreasing from 42.5 percent in 2005-06 to 35.7 percent in 2015-16. The prevalence of acute malnutrition, or wasting, has marginally increased during the same period, from 19.8 percent to 21.0 percent. The prevalence of anaemia in young children has also decreased from 69.5 percent in 2005-06 to 58.5 percent in 2015-16.<br /> <br /> • <strong>Stunting Trajectories:</strong> Stunting has declined by one-fifth during last decade with an annual decline of around one percent. The prevalence of stunting is > 30 percent across all states in India, except Kerala. The trajectories to reduce stunting in India highlight that, with the present rate of reduction in stunting (1 percent per year), by 2022, 31.4 percent children will be stunted. The Government of India has envisaged a challenging target for itself through National Nutrition Mission (NNM) with the target to reduce stunting by at least 2 percent per annum to reach 25 percent by 2022. Goa and Kerala have already achieved this level in NFHS-4 (2015-16). Four other states (Daman and Diu, Andaman and Nicobar, Puducherry and Tripura) have already accomplished mission 25 and Punjab (25.7 percent) is close to achieving it (NFHS-4).<br /> <br /> • <strong>Inter and Intra State Variations in Malnutrition: </strong>The prevalence of stunting in children under five is the highest in Bihar (48 percent), Uttar Pradesh (46 percent), Jharkhand (45 percent), and Meghalaya (44 percent) and lowest in Kerala and Goa (20 percent each). Jharkhand also has the highest prevalence of underweight (48 percent) and wasting (29 percent). District level mapping of malnutrition shows considerable intrastate variations. However, very few districts in Northern and North-Eastern states have shown ‘Low’ level of wasting (2.5-4.9 percent) and underweight (less than 10 percent).<br /> <br /> • <strong>Vulnerable Pockets and Sections in India:</strong> As mentioned, the highest levels of stunting and underweight are found in Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat and Maharashtra. Few states have a very high burden of malnutrition. The poorest quintile of the population is the most vulnerable in terms of stunting. In addition to the earlier mentioned states, the two poorest quintile groups in Haryana, Meghalaya, Karnataka, Rajasthan and Punjab have high levels of stunting. At the national level, among social groups, the prevalence of stunting is highest amongst children from the Scheduled Tribes (43.6 percent), followed by Scheduled Castes (42.5 percent) and Other Backwards Castes (38.6 percent). The prevalence of stunting in children from Scheduled Tribes in Rajasthan, Odisha and Meghalaya is high while stunting in children from both Scheduled Tribes and Scheduled Castes is high in Maharashtra, Chhattisgarh and Karnataka.<br /> <br /> • <strong>Prevalence of Multiple Types of Malnutrition among Children: </strong>Multiple burden of malnutrition is the coexistence of any two or all three measures of malnutrition: stunting, wasting and underweight. The analysis of NFHS-4 reveals 6.4 percent of children under five are both stunted and wasted and also are underweight, while 18.1 percent of children are both stunted and underweight and 7.9 percent of children are both wasted and underweight. This analysis helps in identifying the most vulnerable section where children are suffering from multiple forms of macronutrient malnutrition.<br /> <br /> • <strong>Micronutrient Malnutrition: </strong>Vitamin A, iron and iodine deficiency disorders are the most common forms of micronutrient malnutrition in the world. Supplementation and fortification are the main ways to deal with these deficiencies at a large scale. In India, only 60 percent of children aged 9-59 months received Vitamin-A supplements in 2015-16, and 13 out of 36 states are lagging behind the national average including some larger states and the north-eastern states. In terms of fortification, around 93 percent of households were using iodized salt in 2015-16 which is very positive.<br /> <br /> • <strong>Anaemia Prevalence:</strong> Iron deficiency anaemia remains a major public health concern in India where half of women 15-49 years of age are anaemic, regardless of age, residence or pregnancy status. In the last decade, anaemia among women of reproductive age decreased by only 2.3 percentage points; an annual decline of 0.4 percent. In 2015-16, the prevalence of anaemia is much higher among women (53.1 percent) than men (23.3 percent). In 2015-16, 58.5 percent children aged 6-59 months were anaemic compared to 69.5 percent in 2005-06. The prevalence of anaemia is highest among children in Haryana (71.7 percent), followed by Jharkhand (69.9 percent) and Madhya Pradesh (68.9 percent). Several union territories have even higher prevalence of anaemia: Dadra and Nagar Haveli (84.6 percent), Daman & Diu (73.8), and Chandigarh (73.1 percent). Mizoram was the only state in 2015-16 having ‘mild’ level of anaemia prevalence according to WHO thresholds, followed by Manipur. A district level analysis shows that almost all the districts fall in to the ‘severe’ (more than 40 percent) category, very few in ‘moderate’ (20-39.9) category and around 10 districts in ‘mild’ (5-19.9) category.<br /> <br /> • <strong>Double Burden of Malnutrition:</strong> For several decades India was dealing with only one form of malnutrition -- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/ obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI.<br /> <br /> • <strong>Socio-Economic Determinants of Malnutrition among Children: </strong>Just over half the children born to mothers with no schooling are stunted, compared with 24 percent of children born to mothers with 12 or more years of schooling. The prevalence of underweight in children with uneducated mothers is 47 percent compared to 22 percent for those whose mothers have some education. By wealth quintile, the prevalence of malnutrition decreases steadily with increased wealth. Malnutrition is relatively more prevalent among Scheduled Tribes than Scheduled Castes at national level, while considerable variation exists between states. There is a strong negative correlation between stunting and improved sanitation.<br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> As per the [inside]Global Nutrition Report 2018[/inside]: Shining a light to spur action on nutrition, please click <a href="https://globalnutritionreport.org/reports/global-nutrition-report-2018/">here</a> and <a href="tinymce/uploaded/India%20Profile.pdf" title="India profile">here</a> to access: <br /> <br /> • There are three countries, which are home to almost half (47.2 percent) of all stunted children: India, Nigeria and Pakistan. The three countries with the largest number of children who are stunted are India (46.6 million), Nigeria (13.9 million) and Pakistan (10.7 million). The three countries with the most children who are wasted are almost the same ones – India (25.5 million) and Nigeria (3.4 million) but also Indonesia (3.3 million).<br /> <br /> • China, Indonesia, India, Egypt, US, Brazil and Pakistan have more than a million overweight children each.<br /> <br /> • The India specific profile of the Global Nutrition Report 2018 shows that there has been some progress made by the country to reduce the prevalence of stunting among children below 5 years. However, there is no progress (or there is worsening) made by the country to reduce the prevalence of wasting among children below 5 years, prevalence of anaemia among women of reproductive age (WRA), prevalence of both adult male and female obesity, and prevalence of both adult male and female diabetes.<br /> <br /> • Nearly 6.3 percent of children under 5 years of age are both stunted and wasted.<br /> <br /> • India is among 26 countries which is affected by both anaemia and stunting.<br /> <br /> • The International Food Policy Research Institute (IFPRI) used district-level aggregate data from the 2015–2016 National and Family Health Survey covering 6,01,509 households in 604 districts in the country so as to understand the causes of the spatial variation.<br /> <br /> • India holds almost a third (31 percent) of the world’s burden for stunting, and because the country is so diverse from state to state, it is important to understand how and why stunting prevalence differs. Researchers used mapping and descriptive analyses to understand spatial differences in distribution of stunting. The mapping showed that stunting varies greatly from district to district (12.4 percent to 65.1 percent), with 239 of 604 districts having stunting levels above 40 percent.<br /> <br /> • Using regression decomposition models, the study compared districts with low (less than 20 percent) versus high (more than 40 percent) burdens of stunting and explained over 70 percent of the difference between high and low-stunting districts. The study found that factors such as women's low BMI accounted for 19 percent of the difference between the low versus high-burden districts.<br /> <br /> • Other influential gender-related factors included maternal education (accounted for 12 percent), age at marriage (7 percent) and antenatal care (6 percent). Children’s diets (9 percent), assets (7 percent), open defecation (7 percent) and household size (5 percent) were also influential. This study is important in that it reinforced the multisectoral nature of stunting by highlighting that differences between districts were explained by many factors associated with gender, education, economic status, health, hygiene, and other demographic factors. India’s national nutrition strategy – which is focused on addressing district-specific factors – draws on analyses such as these along with district-specific nutrition profiles to enable diagnostic work and policy action to reduce inequalities and childhood stunting.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">The Urban HUNGaMA (Hunger and Malnutrition) Survey Report was released in February, 2018. Naandi Foundation carried out this survey in India’s ten most populous cities – Mumbai, Delhi, Bengaluru, Hyderabad, Ahmedabad, Chennai, Kolkata, Surat, Pune and Jaipur to measure the nutrition status of children aged 0-59 months. These 10 cities account for 5.3 percent of India’s population and 4.1 percent of the child population aged 0-71 months. The survey also provides estimated percentages of stunting, underweight, wasting and overweight by city and separately for boys and girls.<br /> <br /> A total of 12,286 mothers were interviewed and 14,616 children aged 0-59 months measured for height and weight. The Urban HUNGaMA Survey presents underweight, stunting and wasting data of children.<br /> <br /> The survey was carried out between April and July 2014. It used a three-stage systematic sampling methodology to select a representative sample of 11,955 households.<br /> <br /> According to the document entitled [inside]Urban HUNGaMA Report: Nutrition and the City (released in February 2018)[/inside], prepared by Naandi Foundation and others, please <a href="tinymce/uploaded/Urban-Hungama-Report.pdf" title="Urban-Hungama-Report">click here</a> to access: <br /> <br /> • The proportion of children born with low birth weight (i.e. less than 2.5 kg) was 15.7 percent, ranging from 13.5 percent in Hyderabad to 25.1 percent in Kolkata.<br /> <br /> • In all, 22.3 percent of children under five years of age were stunted (chronic under-nutrition) and 7.6 percent were severely stunted.<br /> <br /> • The prevalence of stunting ranged from 14.8 percent in Chennai to 30.6 percent in Delhi. It was significantly higher among children whose mothers had five years of schooling or less (35.3 percent compared to 16.7 percent among children whose mothers had 10 or more years of schooling) and children from households in the lowest wealth quintile (29.3 percent compared to 15.0 percent among children from households in the highest wealth quintile).<br /> <br /> • Overall, 13.9 percent of children were wasted (acute under-nutrition) and 3.2 percent were severely wasted.<br /> <br /> • The prevalence of wasting ranged from 10.8 percent in Jaipur to 19.0 percent in Mumbai.<br /> <br /> • As in the case of stunting, the prevalence of wasting was significantly higher among children whose mothers had five years of schooling or less (17.6 percent compared to 12.2 percent among children of mothers with 10 or more years of schooling) and children from households in the lowest wealth quintile (16.7 percent compared to 10.5% among children from households in the highest wealth quintile).<br /> <br /> • The prevalence of overweight in children was 2.4 percent, ranging from 0.7 percent in Hyderabad to 3.7 percent in Chennai.<br /> <br /> • The prevalence of overweight was significantly higher among children from the highest wealth quintile (3.6 percent compared to 1.8 percent among children from households in the lowest wealth quintile).<br /> <br /> • The Ministry of Health and Family Welfare, Government of India has issued recommendations on infant and young child feeding (IYCF) practices, and the survey revealed sub-optimal compliance with those recommendations: 37.7 percent of children aged 0-23 months were breastfed within one hour of birth (ranging from 13.3 percent in Jaipur to 66.8 percent in Chennai); 30.47 percent of children aged 0-5 months were exclusively breastfed (ranging from 12.0 percent in Chennai to 38.7 percent in Kolkata); 45.2 percent of children aged 6-8 months were fed complementary foods (ranging from 29.1 percent in Jaipur to 70.5 percent in Chennai); 47.2 percent of children aged 6-23 months met the standard of minimum meal frequency (ranging from 21.8 percent in Delhi to 88.8 percent in Mumbai); and 37.8 percent of children aged 6-23 months received at least a minimum number of food groups (dietary diversity) (ranging from 22.7 percent in Ahmedabad to 59.4 percent in Kolkata).<br /> <br /> • On indicators of minimum dietary requirements (breastmilk/ milk, minimum meal frequency, and minimum dietary diversity) 22.5 percent of children aged 6-23 months were fed in accordance with all three (ranging from 9.7 percent in Surat to 47.3 percent in Kolkata).<br /> <br /> • In the 10 most populous cities of India, one in four children has stunted growth and development due to chronic nutrition deprivation.<br /> <br /> • Poor infant and young child feeding practices, compounded by the poor status of women, the prevalence of household poverty and lack of government service delivery centre seem to be three major drivers of stunting among urban children.<br /> <br /> • Less than one in four children (22.5 percent) were fed a diet that meets the minimum requirements for healthy growth and development.<br /> <br /> **page**</p> <p style="text-align:justify"><br /> The key findings of the report entitled [inside]Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidemia in Urban Men and Women (released in 2017)[/inside], National Nutrition Monitoring Bureau (NNMB) Technical Report no. 27, National Institute of Nutrition (NIN), (please <a href="https://im4change.org/docs/555NNMB%20Urban%20Nutrition%20survey%20report.pdf">click here</a> to access), are as follows:<br /> <br /> • The overall prevalence of underweight, stunting and wasting among urban children below 5 years during 2015-16 was 25.1 percent, 28.7 percent and 16.0 percent, respectively.<br /> <br /> • The prevalence of underweight in urban children below 5 years age was highest in Uttar Pradesh (43.6 percent), followed by Madhya Pradesh (32.3 percent), Maharashtra (31.0 percent), West Bengal (25.4 percent) and Bihar (25.2 percent).<br /> <br /> • The prevalence of stunting in urban children below 5 years age was highest in Uttar Pradesh (40.8 percent), followed by Maharashtra (36.4 percent), New Delhi (35.7 percent), West Bengal (34.4 percent) and Madhya Pradesh (34.1 percent). <br /> <br /> • The prevalence of underweight among ST, SC, OBC and others urban male children below 5 years age was 32.4 percent, 32.6 percent, 25.8 percent and 21.0 percent, respectively.<br /> <br /> • The prevalence of stunting among ST, SC, OBC and others urban male children below 5 years age was 34.4 percent, 39.4 percent, 27.8 percent and 26.8 percent, respectively.<br /> <br /> • The prevalence of wasting among ST, SC, OBC and others urban male children below 5 years age was 17.4 percent, 18.0 percent, 16.9 percent and 13.7 percent, respectively.<br /> <br /> • The prevalence of underweight among ST, SC, OBC and others urban female children below 5 years age was 25.2 percent, 31.7 percent, 25.8 percent and 20.1 percent, respectively.<br /> <br /> • The prevalence of stunting among ST, SC, OBC and others urban female children below 5 years age was 33.1 percent, 33.4 percent, 26.4 percent and 25.6 percent, respectively.<br /> <br /> • The prevalence of wasting among ST, SC, OBC and others urban female children below 5 years age was 13.6 percent, 17.5 percent, 16.6 percent and 12.6 percent, respectively.<br /> <br /> • In urban areas the proportion of underweight, stunting and wasting is highest among those boys (below 5 years) who belong to households without any access to sanitary latrines i.e. 43.0 percent, 50.2 percent and 22.0 percent, respectively. The proportion of under-nutrition (for all 3 categories i.e. underweight, stunting and wasting) is lowest among those boys (below 5 years) who belong to households having and using sanitary latrines.<br /> <br /> • In urban areas, the proportion of underweight, stunting and wasting is highest among those girls (below 5 years) who belong to households without any access to sanitary latrines i.e. 40.5 percent, 44.6 percent and 19.7 percent, respectively. The proportion of under-nutrition (for all 3 categories i.e. underweight, stunting and wasting) is lowest among those girls (below 5 years) who belong to households having and using sanitary latrines.<br /> <br /> • Almost 82.0 percent of surveyed households in urban areas possess sanitary latrines. The proportion of urban households having sanitary latrines was highest in Kerala (99.0 percent), followed by Rajasthan (95.6 percent), Gujarat (90.7 percent) and Puducherry (90.3 percent). The proportion of urban households having sanitary latrines was lowest in West Bengal (51.6 percent), followed by Uttar Pradesh (69.8 percent), New Delhi (70.4 percent) and Maharashtra (75.2 percent).<br /> <br /> • The average household consumption of cereals and millets in urban areas was 69.6 percent of the Recommended Daily Intake (RDI). Similarly, the average household consumption of green leafy vegetables in urban areas was 59.5 percent of the RDI. <br /> <br /> • In urban areas, the average household consumption of protein, energy, calcium, iron, vitamin A, thiamin, riboflavin, and niacin was 89.8 percent, 83.2 percent, 67.0 percent, 77.6 percent, 22.8 percent, 83.3 percent, 50.0 percent, and 61.3 percent of the Recommended Dietary Allowance (RDA), respectively. <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">The key findings of the NITI Aayog report entitled [inside]Nourishing India: National Nutrition Strategy[/inside] (please <a href="tinymce/uploaded/Nutrition_Strategy_Booklet.pdf" title="National Nutrition Strategy">click here</a> to access) are as follows:<br /> <br /> • Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey-4 (NFHS-4) 2015-16.<br /> <br /> • As evident, while stunting and underweight prevalence has gone down, trends in wasting show an overall increase in the last decade. The decrease in stunting has been from 48% to 38.4%, that is, by 1 percentage point per year. Similarly, underweight prevalence has reduced by 0.68 percentage points from NFHS-3 to NFHS-4. Recent data, especially for challenging states is promising, suggestive of acceleration.<br /> <br /> • There has been a 16% decrease in the underweight prevalence among children below 5 years. Underweight prevalence in children under 5 years (composite indicator of acute and chronic undernutrition) has declined in all the states and UTs (except Delhi), although absolute levels are still high. Remarkable reductions are seen in Himachal Pradesh (by 41.9%), Meghalaya, Mizoram, Arunachal Pradesh (by 40%), Tripura (by 39%) and Manipur (by 37.8%); whereas Maharashtra, Goa, Karnataka, Uttar Pradesh and Rajasthan show near stagnation.<br /> <br /> • Recent findings from NFHS-4 (2015-16) highlight that stunting in children under 5 years has reduced in all the states, although absolute levels are still high in some states.<br /> <br /> • Most significant reductions in stunting are seen in Arunachal Pradesh (by 32.10%), Tripura (by 31.92%), Himachal Pradesh (by 31.86%), Punjab (by 29.9%) and Mizoram (by 29.6%). Reductions by more than 25% are also seen in the case of Chhattisgarh, West Bengal, Nagaland, Maharashtra and Haryana, Gujarat. While the overall prevalence of stunting has gone down, in terms of absolute values, it continues to remain high in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh and Dadra & Nagar Haveli, where more than 40% of the children remain stunted.<br /> <br /> • Findings from NFHS-4 (2015-16) highlight that wasting in children under 5 years (weight-for-height) or acute malnutrition is still high, with levels above 25 % in Jharkhand (29%), Dadra & Nagar Haveli (27.6%), Gujarat (26.4%), Karnataka (26.1%), Madhya Pradesh (25.8%) and Maharashtra (25.6%). Significant reductions are seen in Meghalaya (by 50%), Mizoram (by 32.33%), Tripura (by 31.7%), Himachal Pradesh (by 29.01%) and Madhya Pradesh (by 26.28%); although absolute values remain high. Sharp increase in the incidence of child wasting is seen in Punjab, Goa, Maharashtra, Karnataka and Sikkim.<br /> <br /> • As per NFHS-3, levels of severe wasting or severe acute malnutrition in children (0-5 years) were 6.4% for India. Data from NFHS-4 shows an overall increase in the levels of severe wasting to 7.5%. The level of severe wasting has increased in most of the states/ UTs and only 10 States/ UTs (Meghalaya, Madhya Pradesh, Tripura, Delhi, Himachal Pradesh, Bihar, Mizoram, Nagaland, Tamil Nadu and Jharkhand) have witnessed a decrease in the levels of severe stunting. States/UTs with the highest incidence of severe wasting are Daman & Diu (11.9%), Jharkhand (11.4%), Dadra & Nagar Haveli (11.4%), Karnataka (10.5%), Gujarat (9.5%) and Goa (9.5%).<br /> <br /> • As per NFHS-3, every third woman in India was undernourished (35.5 % with low Body Mass Index) and every second woman (15-49 years) was anemic (55.3%). About 15.8 % were moderately to severely thin, with BMI less than 17. Bihar (45%), Chhattisgarh (43%), Madhya Pradesh (42%) and Odisha (41%) were the states with the highest proportion of undernourished women.<br /> <br /> • Recent findings from NFHS-4 (2015-16) highlight that nutritional status of women and girls (in the age group 15-49 years) has improved for all states. Overall, there has been a decrease from 35.5% (NFHS-3) to 22.9% (NFHS-4) in the prevalence of women with low BMI. The decrease has been by almost 50% in the states of Tripura, J&K, Haryana, Tamil Nadu and Kerala.<br /> <br /> • The level of anemia among women and girls has stagnated over the last decade from 55.3% in NFHS-3 to 53% in NFHS-4. In terms of percentage points, States which have witnessed maximum decrease in the levels of anemia are- Sikkim (24.6), Assam (23.3), Mizoram (15.6), J&K (11.7), Tripura (10.6) and Chhattisgarh by 24.6 (10.5). Alternatively, 8 States/ UTs (Punjab, Himachal Pradesh, Meghalaya, Delhi, Haryana, Uttar Pradesh, Tamil Nadu and Kerala) have seen an increase in the prevalence of anemia.<br /> <br /> • Overall, the Total Fertility Rate (TFR) or the average number of children per woman has also gone down from 2.7 in NFHS-3 to 2.2 in NFHS-4.<br /> <br /> • More and more women now give birth in health care facilities and rates have more than doubled in the last decade in some states like Chhattisgarh (by as much as 390%), Jharkhand (by 238%), Uttar Pradesh (by 229%), Bihar (by 220%), Assam (by 215%), Madhya Pradesh (by 208%) and Rajasthan (by 183%). However, in terms of absolute values, institutional births continues to remain extremely low in Nagaland (32.8%), Meghalaya (51.4%), Arunachal Pradesh (52.3%), Jharkhand (61.9%) and Bihar (63.8%), which are the bottom five states with respect to institutional births.<br /> <br /> • The number of pregnant women receiving more than 4 Antenatal Care (ANC) visits has also gone up by 38.37% in the last decade, from 37% in NFHS-3 to 51.2% in NFHS-4. States which have shown remarkable improvement in providing ANC to pregnant women are Uttar Pradesh, Chhattisgarh, Assam, West Bengal, Odisha, Jharkhand and Rajasthan, although in terms of absolute values, the percentage of women receiving ANC continues to remain low. ANC visits have gone down in Uttarakhand, Tamil Nadu, Goa and Kerala over the last decade.<br /> <br /> • There has been improvement in the early initiation of breastfeeding rate, from 23.4% in NFHS-3 to 41.6% in NFHS-4. The figure varies from 73.3% in Goa to merely 25.2% in Uttar Pradesh. Similarly, there has been an overall improvement over NFHS-3 levels in children under six months who were exclusively breastfed, from 46.3% to 54.9%. States which have shown maximum improvements in terms of percentage point are Goa (by 43.2%), Himachal Pradesh (by 40%), Madhya Pradesh (by 36.6%), Tripura (by 34.6%), and Haryana (by 33.4%); while Kerala, Arunachal Pradesh, Karnataka, Chhattisgarh, West Bengal and Uttar Pradesh recorded a decrease in the percentage of children under six months who were exclusively breastfed.<br /> <br /> • Children aged between 6-8 months receiving solid or semi-solid food and breastmilk has gone down from 52.6% to 42.7%. In fact, most of the states/ UTs have witnessed a decrease in the percentage of children receiving solid or semi-solid food and breastmilk. States/ UTs that have recorded maximum dip are Kerala, Arunachal Pradesh, Bihar, Karnataka and Sikkim.<br /> <br /> • NFHS-4 findings reveal that around 26.8 percent of currently married women in the age-group 20-24 years were married before attaining the age of 18 years.<br /> <br /> • As per NFHS-4, 60.2% children aged 9-59 months received the six monthly Vitamin A supplement in the six months before the survey. However, inter-state variation in Vitamin A Supplementation for children aged 9-59 months continues with Goa at 89.5% and Nagaland at 27.1%.<br /> <br /> • Anemia is a major health problem affecting 53% of women (15-49 years) and 22.7% of men in India as per NFHS-4. 50.3% of pregnant women were found to be anaemic, as per NFHS-4.<br /> <br /> • As per NFHS-4, 93.1% households were using salt that was adequately iodized; others were using salt that was either inadequately iodized or was not iodized at all.<br /> <br /> • As per NFHS-4, the percentage of children with diarrhea in the last 2 weeks preceding the survey who received zinc supplementation is found to be 20.3%. However, inter-state variation in the ‘children with diarrhea in the last two weeks who received zinc’ continues with Puducherry at 69.6% and Andaman and Nicobar Islands at 8.3%.<br /> <br /> • In India, annually, it is estimated (as on 2011) that about 1.45 million children die before completing their fifth birthday (MHFW). Currently the mortality rate in children under 5 years is 50, as per NFHS-4. The Infant Mortality Rate is 37 i.e. 37 out of 1000 infants die in the first year of life as reported in SRS Report 2015. Current trends highlight the need to accelerate reductions in neonatal mortality- as this constitutes around two thirds of infant mortality and around half of under-5 child mortality. Maternal mortality also needs to be addressed as maternal mortality continues to be high with MMR at 167 (SRS 2011-13, RGI Special Bulletin on Maternal Mortality 2013).<br /> <br /> • NFHS-4 (2015-16) shows that there have been promising gains in child health care. The immunization rates have gone up. The number of children aged 12-23 months who were fully immunized (BCG, measles and 3 doses each of Polio and DPT) has gone up from 43.5% in NFHS-3 to 62% in NFHS-4. In terms of percentage points, maximum increase is seen in Punjab, Bihar, Meghalaya, Rajasthan and Uttar Pradesh. However, the number of children receiving full immunization has gone down in Tamil Nadu, Himachal Pradesh, Haryana, Maharashtra and Uttarakhand.<br /> <br /> • Prevalence of symptoms of Acute Respiratory Infection (ARI) has also gone down from 5.8% in NFHS-3 to 2.7% in NFHS-4. However, inter-state variation continues with Meghalaya at 5.8% and Sikkim at 0.3 with respect to the prevalence of ARI.<br /> <br /> • Occurrence of diarrhea among children has slightly increased over the last decade, from 9% in NFHS-3 to 9.2% in NFHS-4. Interstate variation in the prevalence of diarrhea continues with 17% in Uttarakhand to 1.8% in Sikkim. States which have shown maximum improvements in curbing diarrhea are Uttar Pradesh, Meghalaya, Uttarakhand and Chhattisgarh. However, in terms of absolute numbers, diarrhea among children continues to remain a challenge in Uttarakhand, Uttar Pradesh, Puducherry and Meghalaya.<br /> <br /> • NFHS-4 (2015-16) shows that families are now more inclined to use improved water and sanitation facilities. Over two-thirds of households in every State/UT (except Manipur) have access to an improved source of drinking water, and more than 90% of households have access to an improved source of drinking water in 19 states/Union Territories. More than 50% of households have access to improved sanitation facilities in 26 states/Union Territories. Similarly, in 20 States/ UTs, more than 50% households use clean cooking fuel, which reduces the risk of respiratory illness and pollution.<br /> <br /> • Even today, it is estimated that 48% of India’s population defecates in the open. Out of the total of one billion people defecating in the open across the world, an estimated 59.7% (597 million) reside in India (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).<br /> <br /> • As per Census 2011, the rural household toilet coverage stands at 32.7% and urban household toilet coverage stands at 87.4%. Open defecation is linked to the presence or absence of household-level sanitation infrastructure and the absence of household toilet coverage is presumed to be the percentage of Open Defecation. (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).<br /> <br /> • As per Census 2011, 53.1% households did not have latrines as compared to 63.6 % households in Census 2001. As per the Base Line Survey conducted by MDWS in 2012, about 40.23% of Households were having ndividual Household Latrines (IHHLs). Only 28002 (i.e. 11.19%) against total number of 250292 Gram Panchayats in the Country had achieved the status of Nirmal Gram, whereas the 12th Five Year Plan had aimed at ensuring that 50% of the Gram Panchayats attain Nirmal Gram status by the year 2017.<br /> <br /> • NFHS-4 reports that overweight/ obesity has affected almost 20.7% women and 18.6% men, mostly located in urban areas, in wealthier households and among older adults. It is seen that over nutrition is becoming an emerging issue, with Chandigarh and Lakshadweep indicating the prevalence of overweight women or obesity in women by more than 40%.<br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">As per the [inside]Global Nutrition Report 2016[/inside], which has been prepared by International Food Policy Research Institute (IFPRI),<br /> <br /> Please click <a href="tinymce/uploaded/Global%20Nutrition%20Report%202016.pdf" title="Global Nutrition Report 2016">link1</a> to access, click <a href="tinymce/uploaded/Synopsis%20Global%20Nutrition%20Report%202016.pdf" title="Synopsis Global Nutrition Report 2016">link2</a> to access:<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • The proportion of calories from non-staples in India is 40 percent, which is low as compared to that of China (48 percent). <br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • The prevalence of diabetes among adult population in India is 9.5 percent, which is the same as in China.<br /> <br /> • The prevalence of adult obesity in India is 4.9 percent, which is low as compared to China (6.9 percent).<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • Rapid increases in spending, and consequent improvements in nutrition, are possible, as places like the Indian state of Maharashtra have shown for undernutrition.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • Assets, women’s education, and open defecation are key factors behind stunting in India.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">• 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.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> According to the report entitled [inside]India Health Report: Nutrition 2015[/inside] by Public Health Foundation of India, Transform Nutrition and UK Aid (please <a href="tinymce/uploaded/India%20Health%20Report%20PHFI.pdf" title="India Health Report 2015 PHFI">click here</a> to access):<br /> <br /> • According to recent data from the Rapid Survey on Children-2014 (RSOC-2014), 38.7 percent of Indian children under the age of five years are stunted, 19.8 percent are wasted, and 42.5 percent are underweight. Stunting (low height for age) is a measure of chronic undernutrition; wasting (low weight for height) indicates acute undernutrition; and underweight (low weight for age) is a composite of these two conditions. <br /> <br /> • Stunting rates in under-three children declined by only 8 percentage points in more than a decade in this age-group -- from 53 percent in 1992-93 to 45 percent in 2006 -- reflecting an average annual rate of decline of 1.2 percent. During this period, wasting declined by 1 percentage point and underweight by 8 percentage points. However, the rate of progress accelerated since National Family Health Survey-3 (NFHS-3), and India's average annual rate of under-5 stunting decline between 2006 and 2014 has been 2.3 percent per year, compared with a rate of decline of 1.2 percent per year between 1992 and 2006. <br /> <br /> • The faster annual rate of reduction in stunting since 2006 i.e. 2.3 percent per year means that the rate of decline in India is finally approaching the rate of decline in other countries with similar levels of stunting, but this is not enough. Between 2011 and 2014, for instance, Nepal had a 3.3 percent average annual rate of decline in stunting rates compared to 2.3 percent in India. However, the rate of reduction in India is now similar to that of Bangladesh and Ethiopia (2.3 percent annual rate of decline in both countries). At this rate, India will achieve the current stunting rate of Ghana or Togo only by 2030, and the current stunting rate of China (10 percent) only in 2055. <br /> <br /> • Undernutrition is worse among children in scheduled castes (SCs) and scheduled tribes (STs). The RSOC highlights that stunting is about 9 percentage point higher in these groups, compared to higher caste groups (42 percent versus 33 percent). Underweight is highest among ST groups, with almost a 15 percentage point difference between ST children and children from "other" castes (37 percent versus 23 percent). Similarly, wasting is about 5 percentage point higher for ST groups (19 percent versus 14 percent). Analyses, using NFHS-3 surveys suggest that nutritional status of SC and ST children is lower than children of "other" caste groups at similar levels of wealth and mother's education. <br /> <br /> <em>Stunting</em><br /> <br /> • Eight states in India have under-5 stunting rates that exceed the national average: Uttar Pradesh, Bihar, and Jharkhand have stunting rates close to 50 percent, while Chhattisgarh, Meghalaya, Gujarat, Madhya Pradesh and Assam have stunting rates between 40 and 45 percent. Stunting rates in Kerala and Goa, which are 19.4 percent and 21.3 percent, respectively, are among the lowest in the country. All other states range between 20 and 40 percent.<br /> <br /> • All 29 states covered by the NFHS-3 and RSOC showed a reduction in stunting between 2006 and 2014. However, rates of progress vary tremendously. Six states, mainly in the northern and northeastern regions of India (Tamil Nadu, Mizoram, Sikkim, Arunachal Pradesh, Nagaland and Delhi) achieved an average annual rate of decline of more than 3 percent between 2006 and 2014 while Jharkhand, Manipur and Jammu & Kashmir, along with Uttar Pradesh and Bihar, showed slow rates of decline during this period.<br /> <br /> <em>Wasting</em><br /> <br /> • The national prevalence of children under age five years who are wasted is 15.1 percent according to RSOC (2014). 13 states have wasting levels higher than the national average: West Bengal, Goa, Kerala, Jharkhand, Arunachal Pradesh, Tripura, Madhya Pradesh, Karnataka, Odisha, Maharashtra, Gujarat, Andhra Pradesh and Tamil Nadu have the highest percentage of severely wasted children, whereas Sikkim has the lowest percentage of wasted as well as severely wasted children.<br /> <br /> <em>Underweight</em><br /> <br /> • The proportion of underweight children under age 5 ranges from 14.1 percent in Manipur to 42.1 percent in Jharkhand. Severe underweight prevalence varies between 2 percent in Goa and 16.8 percent in Tripura.<br /> <br /> • Recent national-level data on burden of overweight and obesity among children and adults are not available, but available estimates range between 4.3 and 15.3 percent in urban areas.<br /> <br /> <em>Anaemia</em><br /> <br /> • In 8 out of the 17 states covered by District Level Household and Facility Survey-4 (DLHS-4), more than 70 percent of children aged 6-59 months have anaemia. Similarly, more than half of Indian women in their child-bearing years, aged 15-49 years, in 13 states have anaemia. Anaemia prevalence ranges from 76.3 percent in West Bengal to 32.7 percent in Kerala.<br /> <br /> • With little change over time, 75 percent of children under five years and over half of women of child-bearing age are anaemic.<br /> <br /> <em>Breastfeeding and complementary feeding</em><br /> <br /> • Recent RSOC data indicate that 45 percent children were breastfed within 24 hours after birth (compared to 25 percent in NFHS-3) and 65 percent of children aged 0-5 months were exclusively breastfed (compared to 47 percent in NFHS-3). Rates of timely initiation of complementary feeding between 6 and 8 months of age appears to have declined slightly between NFHS-3 and RSOC, with only about half of children aged 6-8 months were being fed complementary foods in 2014, compared to 56 percent in 2006. <br /> <br /> • India's more than 65 million diabetics account for 17 percent of all diabetics in the world, and diabetes in India continues to rise.<br /> <br /> • The prevalence of Vitamin A deficiency is 57 percent among children under five years. Goiter (caused by iodine deficiency) affects 26 percent of total population and 19 percent of school-aged children.<br /> <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the [inside]2015 Global Nutrition Report: Actions and Accountability to Advance Nutrition & Sustainable Development by IFPRI (released in September 2015)[/inside] (please <a href="tinymce/uploaded/global%20nutrition%20report%202015.pdf" title="Global nutrition report 2015">click here</a> to access):<br /> <br /> • A new national survey—the Rapid Survey on Children (RSOC), conducted in 2013–2014 by the government and UNICEF—found that stunting had fallen from 48 percent in 2005–2006 to 39 percent in 2014.<br /> <br /> • India’s 2013–2014 Rapid Survey of Children (RSOC) provides important new data, although the survey results are still preliminary. The preliminary data suggest that India has accelerated its progress on stunting, wasting, and exclusive breastfeeding compared with results from the previous two surveys.<br /> <br /> • New government data show that nearly all Indian states posted significant declines in stunting rates from 2006 to 2014, and all showed strong increases in exclusive breastfeeding rates over the same period.<br /> <br /> • Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines. Changes in wasting rates are more variable across states (See chart 1).<br /> <br /> <strong>Chart 1: Stunting rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Stunting rate" src="tinymce/uploaded/Stunting%20rate.jpg" style="height:162px; width:361px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015)</em><br /> <br /> • The states with high levels of stunting do no worse in decreasing stunting than other states. However, Bihar, Jharkhand, and Uttar Pradesh are of particular concern, with high initial rates of stunting and subsequent declines in stunting that are lower than most other states (see chart 1).<br /> <br /> <strong>Chart 2: Wasting rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Wasting Rate" src="tinymce/uploaded/Wasting%20rate.jpg" style="height:135px; width:362px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015)</em><br /> <br /> • While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal. These figures should be viewed with caution because wasting rates vary by season even more than stunting rates do. More research is needed to understand why progress in reducing wasting in India appears to be so uneven (see chart 2).<br /> <br /> <strong>Chart 3: Exclusive breastfeeding rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Exclusive Breastfeeding rate" src="tinymce/uploaded/Exclusive%20breastfeeding%20rate.jpg" style="height:179px; width:474px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015) </em><br /> <br /> • The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above. Equally important, states with the lowest rates in 2005–2006 have achieved rates in the 60–70 percent range. Bihar, the worst ranked state in 2005–2006, quadrupled its rate of exclusive breastfeeding and is now ranked above 16 other states (see chart 3).<br /> <br /> • The prevalence of obesity among both the sexes in India has increased from 4.0 percent in 2010 to 4.9 percent in 2014. Among males, the prevalence of obesity has increased from 2.5 percent to 3.2 percent between 2010 and 2014. Among females, the prevalence of obesity has increased from 5.6 percent to 6.7 percent between 2010 and 2014.<br /> <br /> • The height of young children in India, for example, varies significantly by the month of their birth. Compared with children born in December, those born in the summer and monsoon months (April–September) have significantly lower height for their age.<br /> <br /> • If there are too many data that are incompatible, then the guidance to action, and accountability for delivering on action, quickly become confusing. India undertook 14 major nutrition surveys between 1992 and 2014, but taken together these surveys provide few opportunities for consistent tracking over time at the national level. In short, more data does not always generate greater clarity to guide action. Data also need to be consistently collected over time, as shown by case study of India. <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">Please <a href="https://im4change.org/news-alerts/govt-shows-laxity-in-battle-against-malnutrition-4676337.html">click here</a> to access the key findings of the [inside]Public Accounts Committee (2014-15) report on ICDS Scheme of Ministry of Women & Child Development[/inside], PAC no. 2045, Fourteenth Report (presented to Lok Sabha on 27 April, 2015 and Rajya Sabha on 28 April 2015). Please <a href="tinymce/uploaded/Public%20Accounts%20Commitee%20report%20on%20ICDS.pdf">click here</a> to access the full PAC report on ICDS. </p> <p style="text-align:justify"> </p> <p style="text-align:justify">The NSS 68th Round Report entitled Nutritional Intake in India, 2011-12 (published in October 2014) is based on information collected during 2011-12 from 7469 villages and 5268 urban blocks spread over the entire country. Two different schedules were used to collect information on consumption, the first being canvassed in 101662 households and the second in 101651 households.</p> <p style="text-align:justify"><br /> The key findings of the NSS 68th Round Report entitled [inside]Nutritional Intake in India, 2011-12 (published in October 2014)[/inside], Report No. 560(68/1.0/3) are as follows (please <a href="http://mospi.nic.in/Mospi_New/upload/nss_report_560_19dec14.pdf">click here</a> to access):<br /> <br /> <br /> <strong><em>Intake of Dietary Energy (based on Schedule Type 2*) </em></strong><br /> <br /> • Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal for urban India. All the major States had per capita rural/urban levels of calorie intake within 11% (plus or minus) of the all-India rural/urban average.<br /> <br /> • In each sector average calorie intake increased steadily with monthly per capita expenditure (MPCE) class. The difference between the lowest fractile class (poorest 5% of population ranked by MPCE level) and the next fractile class (the next 5%) in per capita calorie intake was as high as 183 Kcal per day in rural India.<br /> <br /> • About 59.5% of the all-India rural population had energy intake in the range 80-120% of 2700 Kcal/consumer unit/day (a level used in NSS tabulation for comparisons), that is, 2160-3240 Kcal/consumer unit/day.<br /> <br /> • The all-India urban calorie intake distribution was similar to the rural, with slightly higher numbers of households in the top and bottom intake classes. Inter-State differences in energy intake distributions, especially at the lower end, were much less prominent in the urban sector of India than in the rural.<br /> <br /> • Among the bottom 5% of rural population ranked by MPCE, 57% of households had calorie intake below 2160 Kcal/consumer unit/day, the proportion falling to 39% for the next 5%, and continuing to fall until it dropped to only about 2% for the top 5% of population.<br /> <br /> • Similarly, the proportion of urban households with calorie intake below 2160 Kcal/consumer unit/day was 59% for the bottom 5% of population, falling to 47% for the next 5%, and reaching 1.6% for the top 5% of population.<br /> <br /> • The share of energy intake contributed by cereals was about 57% for rural India and 48% for urban India. The contribution of cereals varied across the major States from 42% (Punjab) to 70% (Odisha) in the rural sector and from 39% (Haryana) to 60% (Odisha and Bihar) in the urban sector.<br /> <br /> • The contribution of cereals to calorie intake was seen to fall progressively with rise in MPCE level, from 70% for the bottom 5% of population to 42% for the top 5% ranked by MPCE in rural India, and from about 66% to about 29% in urban India.<br /> <br /> • Non-cereal food contributed about 43% of calorie intake in rural India. The percentage break-up of this part of calorie intake (the part coming from non-cereal food) was: oils and fats: 22%; miscellaneous food, food products and beverages: 21%; milk and milk<br /> <br /> • Non-cereal food contributed about 52% of calorie intake in urban India. On the whole, the pattern of calorie intake from non-cereal food was similar in rural and urban areas, though the share of roots and tubers was, at 7%, somewhat lower.<br /> <br /> • The share of “milk and milk products” in calorie intake contributed by non-cereals, which was between 8% and 27% in the urban sector of all the major States, ranged from 3% to 36% in the rural sector, being 7% or less in 4 major States.<br /> <br /> • “Sugar and honey” usually had a higher contribution to calorie intake from non-cereal food in States with higher average levels of living.<br /> <br /> <strong><em>Intake of Protein and Fat (based on Schedule Type 2*) </em></strong><br /> <br /> • At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector<br /> <br /> • The range of inter-State variation for major States was appreciably wider in the rural sector, where per capita intake per day varied from about 52gm (Chhattisgarh) to about 73gm (Haryana), than in the urban, where it varied from 55gm (Assam) to about 69gm (Haryana).<br /> <br /> • In some of the poorer States, protein intake was markedly lower in the rural sector than in the urban; examples are Jharkhand (rural: 54.7gm, urban: 60.3gm) and Chhattisgarh (rural: 51.7gm, urban: 55.8gm). On the other hand, in the States with the highest levels of protein intake, viz., Haryana, Rajasthan and Punjab, it was the rural population and not the urban that had higher protein intake (about 4-5gm higher).<br /> <br /> • Average protein intake per capita per day was seen to rise steadily with MPCE level in rural India from 43gm for the bottom 5% of population ranked by MPCE to 91gm for the top 5%, and in urban India from 44gm for the bottom 5% to about 87gm for the top 5%.<br /> <br /> • The share of cereals in protein intake was 58% for rural and 49% for urban India.<br /> <br /> • The share of milk and milk products in protein intake was 10% in rural India and 12% in urban India. It was highest in Haryana (rural: 27%; urban: 22%) and Punjab (rural and urban: 23%), and between 14% and 18% in Rajasthan and Gujarat. Among the 17 major States, these 4 States and Uttar Pradesh (rural: 11%; urban: 13%) were the only 5 States where the contribution of milk and milk products to protein intake was higher than the national average.<br /> <br /> • The share of meat, fish and egg in protein intake was only 7% in rural India and 9% in urban India. The share was 26% in both rural and urban Kerala, and was 10% or more in only 5 other major States: West Bengal, Assam, Andhra Pradesh, Tamil Nadu, and Karnataka.<br /> <br /> • The contribution of cereals to protein intake is seen to fall steadily with rise in MPCE from 72% for the bottom 5% of population to 42% for the top 5% in rural India and from 68% to 31% in urban India. On the other hand, the contribution of milk and milk products to protein intake is seen to rise from 3% for the bottom fractile class of population in the rural sector to 16% in the highest, and from 4% to 17% in the urban sector. The contribution of egg, fish and meat to protein intake, too, climbs quite noticeably across MPCE classes from 2% to 12% in rural India and from 4% to 11% in urban India.<br /> <br /> • Average fat intake for the country as a whole was about 46gm per person per day in the rural sector and 58gm in the urban sector. Considerable inter-State variation, however, existed, especially in rural India. In both sectors, per capita intake was lowest in Odisha and Assam. The States with highest fat intake were Haryana (rural: 69gm; urban: 75gm), Gujarat (rural: 62gm; urban: 73gm) and Punjab (rural: 70gm; urban: 69gm).<br /> <br /> • Urban fat intake per person per day exceeded rural intake by 9gm or more in nine of the major States and by more than 13gm in West Bengal and Jharkhand. Rural intake exceeded urban in only one major State – Punjab.<br /> <br /> • Per capita fat intake was about 100g in the top fractile class of the urban sector and about 27gm in the lowest fractile class. In the rural sector the intake of the top fractile class was 92gm while that of the bottom class was 21gm.<br /> <br /> • At all-India level, in contrast to the remarkable closeness of average protein intake across the rural-urban divide, average urban fat intake was noticeably higher than rural intake in all the fractile classes.<br /> <br /> <strong><em>Trends in Nutritional Intake (based on Schedule Type 1*) </em></strong><br /> <br /> • Comparison of estimates for India and the major States from NSS surveys between 1983 and 2011-12 shows calorie intake declining in both sectors after 1999-2000, the decline being sharper in the urban sector, but recovering again to regain a level of about 2100 Kcal per person per day in the rural sector and about 2060 Kcal in the urban in 2011-12. At the level of individual States, a rise in average calorie intake level between 2004-05 and 2011-12 is noted in rural areas of most of the major States.<br /> <br /> • The proportion of households with calorie intake under 2160 Kcal per consumer unit per day, which in both sectors increased over the period 1993-94 to 2004-05, is seen to have subsequently declined appreciably to reach about 20% in the rural sector and 23% in the urban. On the whole, the distribution of dietary energy intake appears to have experienced a reduction in dispersion since the 1990s.<br /> <br /> • Over the 18-year period from 1993-94 to 2011-12, the share of cereals in total calorie intake has declined by nearly 10 percentage points in the rural sector and nearly 7 percentage points in the urban. On the other hand, the share of oils and fats has risen by about 3½ percentage points in both sectors.<br /> <br /> • In rural India as a whole, protein intake per person per day has definitely declined since 1993-94. However, the decline at the all-India level shows signs of flattening out, being only 0.5gm less in 2011-12 compared to 2004-05. The decline in rural protein intake since 1993-94 has been prominent in Rajasthan (a fall of 11gm), Haryana (about 10gm), and Punjab (8gm). In the urban sector the decline between 1993-94 and 2011-12 is less marked than in the rural. In both sectors, all the southern States except Karnataka show slight increases in protein intake per person during this period.<br /> <br /> • An unmistakable rising trend in per capita fat intake is visible not only at all-India level but in every major State. For rural India the rise has been from 31.4gm per day in 1993-94 to 41.6gm in 2011-12 and for urban India, from 42.0gm to 52.5gm– a rise of over 10gm in both sectors over the 18-year period. In both sectors, all the major States show a rise ranging from 5-6gm to 17-18gm during this period.<br /> <br /> • Over the 18 years preceding 2011-12, the contribution of cereals to protein intake has fallen by about 7 percentage points in rural India and nearly 6 percentage points in urban India while the shares of the other major food groups have all risen slightly.<br /> <br /> <strong><em>* Note: </em></strong>The schedules of enquiry used were of two types. The two types had the same item break-up but differed in reference periods used for collection of consumption data. Schedule Type 1, as far as reference periods were concerned, was a repeat of the schedule used in most quinquennial rounds. For certain categories of relatively infrequently purchased items, including clothing and consumer durables, it collected information on consumption during the last 30 days and the last 365 days. For other categories, including all food and fuel and consumer services, it used a 30-days reference period. Schedule Type 2 used "last 365 days" (only) for the infrequently purchased categories, "last 7 days" for some categories of food items, as well as pan, tobacco and intoxicants, and "last 30 days" for other food items, fuel, and the rest. This was in line with the recommendations of an Expert Group that had been formed for the purpose of suggesting the most suitable reference period for each item of consumption.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> According to the [inside]Global Nutrition Report 2014[/inside]: Actions and Accountability to Accelerate the World's Progress on Nutrition, prepared by IFPRI (Please <a href="tinymce/uploaded/Global%20Nutrition%20Report%202014.pdf" title="Global Nutrition Report 2014">click here</a> to download):<br /> <br /> • Prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (National Family Health Survey, NFHS-3) to 38.8% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by stunting has gone down from 5.82 crore in 2005-06 to 4.38 crore in 2013-14.<br /> <br /> • Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14.<br /> <br /> • The Government of India is yet to release all the findings of the 2013–2014 Rapid Survey on Children (RSOC). This 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. The Government has made preliminary estimates available for use in this Global Nutrition Report. Only data for children under age five are reported here.<br /> <br /> • The average annual rate of reduction in stunting (47.9 percent to 38.8 percent in eight years) is 2.6 percent—below India’s target rate of 3.7 percent but well above the rate of 1.7 percent estimated on the basis of previous surveys. Because India has such a large population and a high stunting prevalence, this rate of change affects the global numbers significantly. Comparisons between the two surveys (i.e 2005–2006 NFHS and 2013–2014 Rapid Survey on Children-RSOC) also show declines in wasting.<br /> <br /> • The rise in exclusive breastfeeding rates from 46.4 percent to 71.6 percent in eight years represents an average annual rate of increase of 5.5 percent—far above the rate required to meet India’s World Health Assembly (WHA) target by 2025 (1.5 percent). In fact, if the preliminary numbers hold, by 2025 India will have far surpassed its WHA exclusive breastfeeding target of 57 percent.<br /> <br /> • For India—the second-most populous country in the world—new and preliminary national data suggest it is experiencing a much faster improvement in World Health Assembly (WHA) indicators than currently assumed. For example, if the new preliminary estimates undergo no further significant adjustments, then the numbers of stunted children under the age of five in India has already declined by more than 10 million.<br /> <br /> • The Government of India has produced a new national survey on children. WHO and UNICEF have not yet reviewed the survey’s data and methodologies, and the survey results thus do not yet appear in the WHO’s Global Database on Child Growth and Malnutrition, but if the finalized rates of undernutrition are close to the preliminary reported rates, they should make us more optimistic about India's ability to meet the global World Health Assembly (WHA) goals.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • The benefit to cost ratio of scaling up nutrition-specific interventions for stunting reduction in India is 34.<br /> <br /> **page**</p> <p style="text-align:justify">Please <a href="tinymce/uploaded/Lancet.pdf" title="Lancet">click here</a> to access the [inside]Executive Summary of the Lancet series on Maternal and Child Nutrition[/inside], published on 6 June, 2013</p> <p style="text-align:justify"><br /> According to the [inside]2013 UNICEF report: Improving Child Nutrition[/inside]: The achievable imperative for global progress, please <a href="tinymce/uploaded/Improving%20Child%20Nutrition%20The%20achievable%20imperative%20for%20global%20progress.pdf" title="Improving Child Nutrition The achievable imperative for global progress">click here</a> to access:<br /> <br /> • By 2011, the number of stunted children in India was 6,17,23,000 (i.e. 6.17 crore approximately) and its share in the world total of stunted children was 37.9 percent.<br /> <br /> • In South Asia, an estimated 28 per cent of infants are born with low birthweight. In South Asia, 39 percent of children are stunted. According to the NFHS-3 done in 2005-06, 48 percent of Indian children under the age 5 are stunted.<br /> <br /> • In Maharashtra, the wealthiest state in India, 39 per cent of children under age 2 were stunted in 2005–2006. But by 2012, according to a statewide nutrition survey, the prevalence of stunting had dropped to 23 percent.<br /> <br /> • In 2012, the Government of Maharashtra commissioned the first-ever statewide nutrition survey to assess progress and identify areas for future action. Results of this Comprehensive Nutrition Survey in Maharashtra indicated that prevalence of stunting in children under 2 years of age was 23 per cent in 2012 – a decrease of 16 percentage points over a seven-year period.<br /> <br /> • From 2005–2006 to 2012, the percentage of children 6 to 23 months old who were fed a required minimum number of times per day increased from 34 to 77 and the proportion of mothers who benefited from at least three antenatal visits during pregnancy increased from 75 to 90 per cent.<br /> <br /> • The provisional results of the Maharashtra survey showed that in spite of more frequent meals, only 7 per cent of children 6–23 months old received a minimal acceptable diet in 2012.<br /> <br /> • The proportion of stunted children under 5 in the poorest households compared with the proportion in the richest households ranges from nearly twice as high in sub-Saharan Africa (48 percent versus 25 per cent) to more than twice as high in South Asia (59 percent versus 25 per cent).<br /> <br /> • Recent longitudinal studies among cohorts of children from Brazil, Guatemala, India, the Philippines and South Africa confirmed the association between stunting and a reduction in schooling, and also found that stunting was a predictor of grade failure. Reduced school attendance and educational outcomes result in diminished income-earning capacity in adulthood. A 2007 study estimated an average 22 per cent loss of yearly income in adulthood.<br /> <br /> • Poor nutrition in the first 1,000 days of children’s lives can have irreversible consequences. More and more countries are scaling up their nutrition programmes to reach children during the critical period from pregnancy to the age of 2. From a life-cycle perspective, the most crucial time to meet a child’s nutritional requirements is in the 1,000 days including the period of pregnancy and ending with the child’s second birthday.<br /> <br /> • The World Health Assembly has adopted a new target of reducing the number of stunted children under the age of 5 by 40 per cent by 2025. A stunted child enters adulthood with a greater propensity for developing obesity and chronic diseases.<br /> <br /> • Globally, about one in four children under 5 years old are stunted (26 per cent in 2011). An estimated 80 per cent of the world’s 165 million stunted children live in just 14 countries.<br /> <br /> • Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low birthweight babies, perpetuating an intergenerational cycle.<br /> <br /> • More than 30 countries in Africa, Asia and Latin America have joined Scaling Up Nutrition (SUN). The present report highlights successes in scaling up nutrition and improving policies in 11 countries: Ethiopia, Haiti, India, Nepal, Peru, Rwanda, the Democratic Republic of the Congo, Sri Lanka, Kyrgyzstan, the United Republic of Tanzania and Viet Nam.<br /> <br /> • In Peru, stunting fell by a third between 2006 and 2011 following an initiative that lobbied political candidates to sign a commitment to reduce stunting in children under five by five per cent over the span of five years and to lessen inequities between urban and rural areas.<br /> <br /> • Ethiopia cut stunting from 57 per cent to 44 per cent between 2000 and 2011 by implementing a national nutrition programme, providing a safety net in the poorest areas and boosting nutrition assistance through communities.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <div style="text-align:justify">According to [inside]Report of the Comptroller and Auditor General of India on Performance Audit of Integrated Child Development Services (ICDS) Scheme[/inside], CAG Report no. 22 of 2012-13-Union Government (Ministry of Women and Child Development), <a href="http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html">http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html</a>:</div> <p style="text-align:justify"><br /> <strong><em>Status of Nutrition:</em></strong><br /> <br /> • Total number of ICDS Supplementary Nutrition beneficiaries had been 7.06 crore in 2006-07, 8.43 crore in 2007-08, 8.73 crore in 2008-09, 8.84 crore in 2009-10, 9.59 crore in 2010-11 and 9.72 crore in 2011-12.<br /> <br /> • Total number of ICDS Pre-school education beneficiaries had been 3.01 crore in 2006-07, 3.39 crore in 2007-08, 3.41 crore in 2008-09, 3.55 crore in 2009-10, 3.66 crore in 2010-11 and 3.58 crore in 2011-12.<br /> <br /> • Total number of malnourished children (Grade I, II, III and IV) exceeded the 40 percent mark in 10 states/ UTs (Andhra Pradesh: 49 percent, Bihar: 82 percent, Haryana: 43 percent, Jharkhand: 40 percent, Odisha: 50 percent, Rajasthan: 43 percent, UP: 41 percent, Delhi: 50 percent, Daman and Diu: 50 percent and Lakshadweep: 40 percent), as on 31 March, 2011. <br /> <br /> • The number of severely malnourished children (Grade III and IV) exceeded 1 percent of total weighed children in 8 states (Bihar: 26 percent, Chhattisgarh: 2 percent, Gujarat: 5 percent, Karnataka: 3 percent, Madhya Pradesh: 2 percent, Maharashtra: 3 percent, Uttarakhand: 1 percent and West Bengal: 4 percent) as on 31 March, 2011.<br /> <br /> • There was substantial decrease in the malnourished children in 6 states between 31 March 2007 and 31 March 2011 (Gujarat: from 71 percent to 39 percent, Karnataka: from 53 to 40 percent, Maharashtra: from 45 to 23 percent, UP: from 53 to 41 percent, Uttarakhand: 46 to 25 percent and West Bengal: 53 to 37 percent.<br /> <br /> • North-eastern states fared better in respect of the nutritional status of children, where percentage of normal children was satisfactory vis-a-vis the total weighed children as on 31 March 2011 (Arunachal Pradesh: 98 percent, Assam: 69 percent, Manipur: 86 percent, Meghalaya: 71 percent, Mizoran: 77 percent, Nagaland: 92 percent, Sikkim: 89 percent and Tripura: 63 percent).<br /> <br /> • In 5 other states/ UTs the percentage of normal children exceeded 70 percent as of 31 March 2011, viz. MP: 72 percent, Maharashtra: 77 percent, Uttarakhand: 75 percent, A & N Islands: 82 percent and Dadra & Nagar Haveli: 75 percent. <br /> <br /> <strong><em>Key findings: </em></strong></p> <p style="text-align:justify">• The CAG chose to audit the ICDS since India's status on key child development and health indicators did not compare well with its own targets as well as with the neighbouring and other regions. The Infant Mortality Rate (IMR) was 48 per 1000 live birth and the Child Mortality Rate (CMR) 63 per 1000 live birth in 2010 as against the targets of 30 and 31 respectively. These indicators (IMR and CMR) for the neighbouring countries were: China (IMR: 16, CMR: 18) and Sri Lanka (IMR: 14, CMR: 17). In industrialized countries, the IMR and CMR were as low as 5 and 6 respectively.<br /> <br /> • The performance audit covered 2730 of the test checked Anganwadi Centres (AWCs) from 273 project offices of 67 districts from 13 states (Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Meghalaya, Odisha, Rajasthan, Uttar Pradesh and West Bengal) for the period 2006-07 to 2010-11 on 3 services viz. supplementary nutrition, pre-school education and nutrition and health education under scheme. The selection of the states was made on the basis of population, funding and nutrition indicators as per the NFHS-3, 2005.<br /> <br /> • To universalize the ICDS, Hon'ble Supreme Court had directed the Central and state Governments to operationalize 14 lakh AWCs by December, 2008. The Ministry sanctioned 13.71 lakh AWCs and could operationalize 13.17 lakh. This left a shortfall of 0.54 lakh. Similarly, out of 7075 sanctioned ICDS projects, 7005 projects were operationalized.<br /> <br /> • 61 percent of the test-checked AWCs did not have their own buildings and 25 percent were functioning from semi-pucca/ kachcha buildings or open/ partially covered space. Separate space for cooking, storing food items and indoor and outdoor activities for children was not available in 40 to 65 percent of the test-checked AWCs.<br /> <br /> • Poor hygiene and sanitation were noticed in the AWCs due to the absence of toilets in 52 percent of the test checked AWCs and non-availability of drinking water facility for 32 percent of the test checked AWCs.<br /> <br /> • Functional weighing machines for babies and adults were not available in 26 and 58 percent, respectively, of the test-checked AWCs. The essential utensils required for providing supplementary nutrition to the beneficiaries were also not available in several test-checked AWCs.<br /> <br /> • Medicine kits were not available in 33 to 49 percent of the test checked AWCs due to failure of the state governments in spending the funds released to them by the Centre. <br /> <br /> • 53 percent of the test checked AWCs did not receive annual flexi-fund of Rs. 1000 from the state governments during the period 2009-2011.<br /> <br /> • There were shortages of staff and key functionaries at all levels.<br /> <br /> • The shortfall under various categories of training ranged from 19 to 58 percent of the targets fixed under the State Training Action Plan (STRAP).<br /> <br /> • The shortfall in expenditure on Supplementary Nutrition (SN) ranged between 15 percent and 36 percent of the requirements during the period 2006-2011. The average daily expenditure per beneficiary on SN was Rs. 1.52 to Rs. 2.01 against the norm of Rs. 2.06 during 2006-09 and Rs. 3.08 to Rs. 3.64 against the norm of Rs. 4.21 during 2009-2011.<br /> <br /> • 33 to 47 percent children were not weighed for monitoring their growth during 2006-07 to 2010-11. The data on nutritional status of children had discrepancies and were not based on WHO's growth standards.<br /> <br /> • There was a gap of 33 to 45 percent between the number of eligible beneficiaries identified and those receiving the SN during 2006-07 to 2010-11.<br /> <br /> • The Wheat Based Nutrition Programme suffered from lack of proper coordination among the Ministry of Women and Child Development, the Department of Food and Public Distribution and the state governments. The Ministry could allocate 78 percent of foodgrains demanded by the states. The actual take-offs by the states was merely 66 percent of total demand placed by them.<br /> <br /> • Pre-school education (PSE) kits were not available at 41 to 51 percent of the test-checked AWCs during the period 2006-11.<br /> <br /> • In 6 of the test checked states (Bihar, Haryana, Jharkhand, Madhya Pradesh, Uttar Pradesh and West Bengal) data on beneficiaries of PSE who joined mainstream education were not available. In 5 states (Andhra Pradesh, Chhattisgarh, Odisha, Rajasthan and Karnataka) shortfall in the number of children who actually joined the formal education during 2006-2011 ranged between 7 and 30 percent. <br /> <br /> • Shortfall of 40 to 100 percent was noted on the expenditure against the funds released for Information, Education and Communication (IEC) in many states.<br /> <br /> • Against the total release of Rs. 1753 crore to 13 states during 2008-09 and 15 states during 2009-2011 for meeting the expenditure on salary of ICDS functionaries, the actual expenditure was Rs. 2853 crore indicating unrealistic budgeting and consequent diversion of funds from other critical components of the scheme.<br /> <br /> • Rs. 57.82 crore were diverted to activities not permitted under the ICDS in 5 of the test-checked states and Rs. 70.11 crore were parked in civil deposits/ personal ledger accounts/ bank accounts / treasury resulting in blocking of funds.<br /> <br /> • The Central Monitoring Unit (CMU) under the ICDS failed to efficiently carry out assigned tasks, which included concurrent evaluation of the scheme, monitoring through the progress reports received from the states.<br /> <br /> • Impact assessment of the services under the SN and the PSE based on outcome indicators, such as nutritional status of the children, was not being done.<br /> <br /> • The follow-up action on internal monitoring and evaluation by the Ministry was inadequate and resulted in recurrence of shortcomings and lapses in the scheme implementation. <br /> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">The per capita per diem calorie intake is higher in the rural areas compared to urban areas, as could be deciphered from the graph below. However, both have seen a decline over the various rounds of National Sample Survey. </span></p> <p style="text-align:justify"> </p> <div style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><strong>Per capita per diem intake of Calorie (in Kcal)</strong></span></span></div> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"><img alt="Per capita per diem intake of Calorie (in Kcal)" src="tinymce/uploaded/graf1.jpg" style="height:242px; width:577px" /> </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><em><span style="font-size:small"><strong>Source: </strong>Nutritional Intake in India: 2004-2005, NSS 61st Round, July 2004- June 2005</span></em></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the [inside]2012 Global Hunger Index[/inside] - The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses, produced by IFPRI, Concern Worldwide and Welthungerhilfe, <span style="font-size:medium">please <a href="tinymce/uploaded/2012%20Global%20Hunger%20Index.pdf" title="2012 Global Hunger Index">click here</a> to access</span> </p> <p style="text-align:justify"><a href="http://www.ifpri.org/sites/default/files/publications/ghi12.pdf">http://www.ifpri.org/sites/default/files/publications/ghi12.pdf</a> </p> <p style="text-align:justify"><a href="http://www.ifpri.org/sites/default/files/publications/ghi2012fsasia.pdf">http://www.ifpri.org/sites/default/files/publications/ghi2012fsasia.pdf</a>: </p> <p style="text-align:justify"> </p> <p style="text-align:justify">• The 2012 Global Hunger Index (GHI) is calculated for 120 developing countries and countries in transition for which data on the three indicators of hunger are available. This year’s GHI reflects data from 2005-2010—the most recent country-level data available on the three GHI measures. It is thus a snapshot of the recent past. </p> <p style="text-align:justify">• The GHI combines three equally weighted indicators into one score: the proportion of people who are undernourished, the proportion of children under five who are underweight, and the mortality rate of children younger than age five.</p> <p style="text-align:justify">• The GHI ranks countries on a 100-point scale in which zero is the best score (no hunger) and 100 the worst, although neither of these extremes is reached in practice. An increase in a country’s GHI score indicates that the hunger situation is worsening, while a decrease in the score indicates improvement in the country’s hunger situation.</p> <p style="text-align:justify">• India's 2012 GHI score is 22.9 (rank: 65) as compared to China's GHI score of 5.1 (rank: 2), Bangladesh's score of 24.0 (rank: 68), Pakistan's score of 19.7 (rank: 57), Nepal's score of 20.3 (rank: 60) and Sri Lanka's score of 14.4 (rank: 37). </p> <p style="text-align:justify">• India's GHI score has improved from 30.3 in 1990 to 24.2 in 2001 and further to 22.9 in 2012. </p> <p style="text-align:justify">• India has lagged behind in improving its GHI score despite strong economic growth. After a small increase between 1996 (GHI 22.6) and 2001 (GHI 24.2), India’s GHI score fell only slightly, and the latest GHI returned to about the 1996 level. </p> <p style="text-align:justify">• India's stagnation in GHI scores occurred during a period when India’s gross national income (GNI) per capita almost doubled, rising from about 1,460 to 2,850 constant 2005 international dollars between 1995–97 and 2008–10 (World Bank 2012).</p> <p style="text-align:justify">• In India, 43.5 percent of children under five are underweight, which accounts for almost two-thirds of the country’s alarmingly high GHI score. From 2005-2010, India ranked second to last on child underweight— below Ethiopia, Niger, Nepal, and Bangladesh. </p> <p style="text-align:justify">• Bangladesh has also closed the gender gap in education through targeted public interventions and has overtaken India on a range of social indicators, including the level and rate of reduction of child mortality.</p> <p style="text-align:justify">• In India, 43.5 percent of children under five are underweight, which accounts for almost two-thirds of the country’s alarmingly high GHI score. From 2005-2010, India ranked second to last on child underweight— below Ethiopia, Niger, Nepal, and Bangladesh. </p> <p style="text-align:justify">• Bangladesh, India, and Timor-Leste have the highest prevalence of underweight children under five, more than 40 percent in each of the three countries.</p> <p style="text-align:justify">• According to surveys during 2000–06, 36 percent of Indian women of childbearing age were underweight, compared with only 16 percent in 23 Sub-Saharan African countries (Deaton and Drèze 2009).</p> <p style="text-align:justify">• Though India has worked to improve food security and nutrition in recent years through government-operated nutrition-relevant social programs, program effectiveness remains uncertain due to the absence of up-to-date information.</p> <p style="text-align:justify">• When comparing GHI scores with GNI per capita, it must be emphasized that India’s latest GHI score is based partly on outdated data: although it includes relatively recent child mortality data from 2010, FAO’s most recent data on undernourishment are for 2006–08, and India’s latest available nationally representative data on child underweight were collected in 2005–06.</p> <p style="text-align:justify">• Given that the Government of India has failed to monitor national trends in child undernutrition for more than six years, any recent progress in the fight against child undernutrition cannot be taken into account by the 2012 GHI.</p> <p style="text-align:justify">• Home to the majority of the world’s undernourished children, India is in dire need of monitoring systems for child undernutrition and related indicators that produce data at regular intervals, in order to improve program performance and scale up impact (Kadiyala et al. 2012).</p> <p style="text-align:justify">• The 2012 world GHI fell by 26 percent from the 1990 world GHI, from a score of 19.8 to 14.7. South Asia and Sub-Saharan Africa have the highest levels of hunger with regional scores of 22.5 and 20.7, respectively. </p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">The Nutrition Barometer produced by Save the Children provides a snapshot of national governments’ commitments to addressing children’s nutrition, and the progress they have made. It looks at 36 developing countries with the highest levels of child undernutrition. The Barometer measures governments’ political and legal commitment to tackling malnutrition (eg, whether they have a national nutrition plan), as well as their financial commitment. Countries’ progress in tackling malnutrition is measured by children’s nutritional status – the proportion who are underweight, stunted or suffering from wasting – and children’s chances of survival. Countries are then ranked according to both their commitments and their nutritional and child survival outcomes.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the report titled [inside]The Nutrition Barometer: Gauging national responses to undernutrition (2012)[/inside] by Save the Children and World Vision, please <span style="font-size:medium"><a href="tinymce/uploaded/Nutrition%20Barometer.pdf" title="Nutrition Barometer">click here</a></span> to access:<br /> <br /> • The Democratic Republic of Congo (DRC), India and Yemen show the weakest performance, with frail commitments and frail outcomes. Outcomes for India are dated as they are based on the National Family and Health Survey-3 from 2005–06. However, since the country has not had a nationally representative survey since then, these figures are still generally used.<br /> <br /> • India urgently needs a new population-based, nationally representative survey to check what has happened to nutrition since 2005–06. The fourth National Family Health Survey was about to take place in 2014.<br /> <br /> • Spectacular economic growth has not translated into better nutrition outcomes for many of India’s children. Growth has lifted millions out of poverty but it has also been largely unequal, with the benefits accruing to a small segment of the population. Many sources of data show that almost half its children are underweight and stunted, and more than 70% of women and children have serious nutritional deficiencies such as anaemia.<br /> <br /> • Children in the poorest households are more than twice as likely to be stunted as those in the richest households in India. However, even in the wealthiest 20% of the Indian population, one child in five is undernourished.<br /> <br /> • India's showing on commitments was set back by the lack of nutrition-specific commitments to Every Woman Every Child and not being a member of Scaling up Nutrition movement (SUN) as yet.<br /> <br /> • A criticism of the Integrated Child Development Services (ICDS) was its failure to target children between the ages of 0 and two years, which is the crucial growth period. One reform involves increasing the number of Anganwadi [community health] workers in the 200 districts with the highest levels of undernutrition.<br /> <br /> • In 13 of the countries (just over a third of the sample of 36 countries) the Nutrition Barometer study looked at, commitments and outcomes point in exactly the same direction. Three countries – Guatemala, Malawi and Peru–have both sound political and financial commitments and sound outcomes relative to the other countries in the group in this study.<br /> <br /> • The Barometer shows 12 countries where there are high political, legal and/or financial commitments to nutrition, yet outcomes are lower.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">The report titled [inside]A Life Free from Hunger: Tackling child malnutrition (2012)[/inside], which has been brought out by Save the Children (<span style="font-family:Arial; font-size:medium">please <a href="tinymce/uploaded/A%20Life%20Free%20from%20Hunger%20Tackling%20child%20malnutrition%202012%20Save%20the%20Children.pdf" title="A Life Free from Hunger Tackling child malnutrition 2012 Save the Children">click here</a> to access) </span>analyses the causes of malnutrition, focusing on chronic malnutrition and stunting in children. It identifies solutions that are proven to be effective in containing child malnutrition: a. direct interventions, such as exclusive breastfeeding, micronutrient supplementation and fortification; b. indirect interventions, such as introducing social protection programmes, and adapting agricultural production to meet the nutritional needs of children.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><em>Key findings of the report are as follows: </em></p> <p style="text-align:justify">• 48 percent of children in India are stunted. 450 million children around the world will be affected by stunting in the next 15 years, if current trends continue.</p> <p style="text-align:justify">• The economic losses due to undernutrition are pervasive–experimental evidence suggests that tackling malnutrition in early life can lead to as much as a 46% increase in earnings as an adult. Productivity loss due to foregone waged employment was estimated to be US$2.3 billion a year in India.</p> <p style="text-align:justify">• A study by Ravi and Engler (2009) on the impact of the Mahatma Gandhi NREGA in India, which guarantees poor households 100 days of paid employment, found the scheme increased food spending by 40% on average, and that the effect is strongest for the poorest households who participated in the scheme the longest.</p> <p style="text-align:justify">• It’s estimated that 2–3% of the national income of a country can be lost to malnutrition. Childhood malnutrition can lessen productivity – stunted children are predicted to earn an average of 20% less when they become adults</p> <p style="text-align:justify">• Staple food prices hit record highs globally in February 2011 and may have put the lives of upto 400,000 more children at risk.</p> <p style="text-align:justify">• One in four of the world’s children are stunted. In developing countries this figure is as high as one in three. That means their body and brain has failed to develop properly because of malnutrition.</p> <p style="text-align:justify">• Every hour of every day, 300 children die because of malnutrition. Malnutrition is an underlying cause of the death of 2.6 million children each year–one-third of the global total of children’s deaths.</p> <p style="text-align:justify">• Global progress on stunting has been extremely slow. The proportion of children who are stunted fell from 40 percent in 1990 to 27 percent in 2010 – an average of just 0.6 percentage points per year.</p> <p style="text-align:justify">• In 2008 the Lancet medical journal identified a package of 13 direct interventions – such as vitamin A and zinc supplements, iodised salt, and the promotion of healthy behaviour, including handwashing, exclusive breastfeeding and complementary feeding practices– that were proven to have an impact on the nutrition and health of children and mothers. This cost-effective and affordable package could prevent the deaths of almost 2 million children under five and a substantial amount of illness if it was delivered to children in the 36 countries that are home to 90% of the world’s malnourished children.</p> <p style="text-align:justify">• At a cost of just over US$1 per person per year, the World Bank has estimated that more than 4 billion people would be able to benefit from access to fortified wheat, iron, complementary food and micronutrient powders. Fortification, or the process of adding vitamins and minerals to food, is one of the most cost-effective direct interventions.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">For the report named [inside]HUNGaMA: Fighting Hunger & Malnutrition (2011)[/inside], Naandi Foundation deployed a trained team of over 1000 surveyors who interviewed 74,020 mothers and measured 109,093 children in 4 months. The HUNGaMA (Hunger and Malnutrition) survey that covered 73,670 households across 112 districts spanning nine states in India provides reliable estimates of child nutrition covering nearly 20% of Indian children. Of the 112 districts surveyed, 100 were selected from the bottom of a child development district index developed for UNICEF India in 2009, referred to as the 100 Focus Districts in this report.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><em>Key findings of the report titled: HUNGaMA: Fighting Hunger & Malnutrition (2011), </em><em><span style="font-family:Arial; font-size:medium">please <a href="tinymce/uploaded/Hungama%20Report%202011.pdf" title="Hungama Report 2011">click here</a> to access</span>, which has been prepared by the Naandi Foundation, are as follows:</em></p> <p style="text-align:justify"> </p> <p style="text-align:justify">• In the 100 Focus Districts, 42 percent of children under five are underweight and 59 percent are stunted. Of the children suffering from stunting, about half are severely stunted.</p> <p style="text-align:justify">• In the 100 Focus Districts, the prevalence of child underweight has decreased from 53 per cent (DLHS, 2004) to 42 per cent (HUNGaMA 2011); this represents a 20.3 percent decrease over a 7 year period with an average annual rate of reduction of 2.9 per cent. </p> <p style="text-align:justify">• By age 24 months, 42 percent of children are underweight and 58 percent are stunted in the 100 Focus Districts.</p> <p style="text-align:justify">• The prevalence of malnutrition is significantly higher among children from low-income families, although rates of child malnutrition are significant among middle and high income families.</p> <p style="text-align:justify">• In the 100 Focus Districts, 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 percent while that among mothers with 10 or more years of education is 27 per cent.</p> <p style="text-align:justify">• In the 100 Focus Districts 51 per cent mothers did not give colostrum to the newborn soon after birth and 58 percent mothers fed water to their infants before 6 months.</p> <p style="text-align:justify">• In the 100 Focus Districts 11 percent mothers said they used soap to wash hands before a meal and 19 per cent do so after a visit to the toilet.</p> <p style="text-align:justify">• There is an Anganwadi centre in 96 percent of the villages in the 100 Focus Districts, 61 per cent of them in pucca buildings; the Anganwadi service accessed by the largest proportion of mothers (86 percent) is immunization; 61 percent of Anganwadi Centres had dried rations available and 50 percent provided food on the day of survey; only 19 percent of the mothers reported that the Anganwadi Centre provides nutrition counseling to parents.</p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">According to the [inside]World Disaster Report 2011: Focus on Hunger and Malnutrition[/inside], which has been produced by International Federation of Red Cross and Red Crescent Societies, <a href="http://www.indiaenvironmentportal.org.in/files/file/WDR-2011-FINAL.pdf">http://www.indiaenvironmentportal.org.in/files/file/WDR-2011-FINAL.pdf</a>: <br /> <br /> • There has been progress in feeding more people than ever before even as the world’s population has grown by around 50 per cent since the mid-1970s. Even so, the number of undernourished people in the world was higher in 2010 – 925 million according to the Food and Agriculture Organization of the United Nations (FAO)–than in the early 1970s. There was a record peak of more than 1 billion hungry people in 2009 following dramatic food price rises in 2007–2008.<br /> <br /> • The majority of the hungry are in the Asia Pacific region, especially the Indian subcontinent, and in sub-Saharan Africa. Most of the hungry live in rural areas. A substantial and growing number of the world’s hungry also lives in urban and peri-urban areas.<br /> <br /> • In 2005 the World Bank estimated that malnutrition costs the global economy around US$ 80 billion a year. The loss to the Indian economy alone is at least US$ 10 billion a year, or 2 to 3 per cent of GDP.<br /> <br /> • The United States Department for Agriculture (USDA) reports that in 2010 about US$ 68 billion was spent through its Supplemental Nutrition Assistance Program – also known as ‘food stamps’ – to reach just over 40 million people – compared to US$ 250 million (1969 prices) in 1969 that benefited some 2.9 million people.<br /> <br /> • At least 1 billion people are undernourished and lack key vitamins and minerals, while at the same time a staggering 1.5 billion people are overweight or obese.<br /> <br /> • India’s public distribution scheme technically caters to 316 million people who are in the ‘below the poverty line’ category. Add the ‘above the poverty line’ category and the scheme is supposed to provide food to more than 900 million people. But the way the below the poverty line (which should be dubbed the ‘starvation line’) has been drawn, the distribution scheme fails to provide them with their minimal daily food intake. If the scheme had been even partially effective, there is no reason why India should be saddled with the largest population of hungry people in the world.<br /> <br /> • Despite four ministries administering 22 programmes to alleviate hunger and poverty, the budget allocation for which is enhanced almost every year, the poor still go hungry and hundreds of children die every day in India from malnourishment.<br /> <br /> • According to the recommendations of the Indian Council of Medical Research, each able-bodied adult needs a minimum of 14 kilograms (kg) of grains a month. Given that an average family comprises five members, the household allocation would be 70kg. The distribution scheme at present provides only 35kg of wheat and rice to each family, so the hungry remain perpetually hungry.<br /> <br /> • In a country that has emerged as the world’s fifth largest economy with a growth rate of almost 9 per cent, more than 700 million people remain food insecure.<br /> <br /> • One problem in India, according to the Deccan Development Society and others, is the neglect of small farmers – especially women – who are the main producers of local foods and traditional grains such as millet and sorghum. The Deccan Development Society has been working with poor, illiterate dalit (untouchable) women to help them to restore the fertility and productivity of the almost barren lands they received from the government as a result of land reforms and to have the means to communicate about their needs. It also works to get the government to include the millets and sorghums, which grow so well in drier areas such as the Deccan, into the national food distribution system and to consider actions to promote their production and consumption as a priority.<br /> <br /> • In New Delhi, India, a research project which gave thin and anaemic pregnant women a multiple micronutrient supplement in addition to their regular iron and folic acid, found a mean increase of 98 grams in the birth weight of their babies and a 50 per cent reduction in illness among the newborns compared to a placebo.<br /> <br /> • India has been a net exporter of agricultural and food products since 1995. It is also a net exporter of meat and dairy products. India, Pakistan, Thailand, the US and Viet Nam represent 80 per cent of world rice exports.<br /> <br /> • In countries with public procurement systems in place, such as Bangladesh and India, the governments were able to support farmers by procuring rice at a higher price and providing subsidies to poor and marginal farmers to mitigate higher costs of production for irrigation and fertilizer.<br /> <br /> • Evidence from India and elsewhere in Asia shows that smallholders consistently produce higher yields than larger capital-intensive farms. Small farmers generally use their land more intensively than larger operations, because they utilize every scrap and corner. Most importantly, there is an inverse relationship in low- and middle-income countries’ economies between farm area and both labour and output per hectare, because smallholders aim to maximize food production.<br /> <br /> • The Indian dairy industry has gone from being the 78th largest in the world to number one in just a few decades, almost entirely on the basis of cooperative dairies collecting milk from small farmers whose small herds are fed with home-grown fodder crops.<br /> <br /> • Globally, human nutrition has come to depend upon very few crops as its staples. Just three crops–rice, wheat and maize–account for more than half the energy intake from plants. Another six–sorghum, millet, potatoes, sweet potatoes, soybean and sugar–take the total to more than 75 per cent, while 90 per cent of humanity’scalorie intake comes from just 30 crops.<br /> <br /> • From 1988 to 1997, foreign direct investment in the food industry increased from US$743 million to more than US$2.1 billion in Asia and from US$222 million to US$3.3 billion in Latin America, significantly outstripping the level of investments in agriculture. At the same time, sales through supermarkets grew as much as they had in the United States over 50 years.<br /> <br /> • Much development policy has focused on industrialization and has neglected rural and agricultural development over the last 30 years. Attention has shifted away from agriculture in the big development agencies, such as the World Bank, which lent about 26 per cent of its total budget to agriculture in the 1980s but only 10 per cent in 2000.<br /> <br /> • Every year some 9 million children across the world die before they reach their fifth birthday, and about one-third of these untimely deaths is attributed to undernutrition.<br /> <br /> • Some 178 million children under the age of 5 suffer from stunted growth as a result of undernutrition. About 55 million under 5 years of age are acutely undernourished, which means that their bodies are wasted – they are underweight for their height – and 19 million of these children are severely wasted.<br /> <br /> • Anaemia in children has only relatively recently been recognized as a widespread problem, and there are almost no data before 1995. Haemoglobin is now one of the elements measured in demographic and health surveys, and they show that in sub-Saharan Africa around 60 per cent of children are anaemic compared with a global average of nearly half of all preschool-age children. Some 40 per cent of women in low- and middle-income countries are believed to suffer from anaemia, which affects a total of around 2 billion people worldwide.<br /> <br /> • Vitamin A deficiency, which is the most common cause of blindness in low- and middle-income countries, affects around 30 per cent – some 163 million – of children in poor countries. Two-thirds of affected children are in South and central Asia, which along with West Africa have the highest prevalence of childhood vitamin A deficiency, at more than 40 per cent. Latin America and the Caribbean have the lowest prevalence, at 10 per cent. Nearly 14 million children with the condition have some degree of visual loss, and 250,000 to 500,000 are blinded every year, half of them dying within 12 months of losing their sight.<br /> <br /> • More than 1.7 billion of the world’s people (of whom 1.3 billion live in Asia) suffer from iodine deficiency , which can lead to stunted growth and other developmental abnormalities and which is one of the commonest causes of mental impairment and retardation in children worldwide.<br /> <br /> • More than 3 billion people, or 31 per cent of the world’s population, are deficient in zinc, which increases the risk for children of diarrhoea, pneumonia and malaria, and is thought to contribute to more than 450,000 child deaths annually worldwide.<br /> <br /> • According to Save the Children, deficiency in vitamin A and zinc could be prevented with supplements costing just 6 US cents and US$ 1.6 per child per year respectively.<br /> <br /> • A multi-country study reported in The Lancet in 2007 found that for every 10 per cent increase in the prevalence of stunting in the population, the proportion of children reaching the final grade of school fell by 8 per cent.<br /> <br /> • The causes of hunger and undernutrition are complex and include structural factors such as lack of investment in agriculture, climate change, volatile fuel prices, commodity speculation and the ebb and flow of global market forces<br /> <br /> • About one-fifth of the world’s 185 million undernourished people live in towns and cities and the root cause of their hunger is overwhelmingly poverty.<br /> <br /> • Families in many countries consider their girls an economic burden and marry them off young, occasionally even before puberty. The practice is most common in sub-Saharan Africa and South Asia. Girls who become pregnant in their teens stop developing physically themselves and are at increased risk of delivering low birth weight babies, thus setting in motion the cycle of deprivation described earlier. In India, where 40 per cent of the world’s low birth weight babies are born, 8 per cent of women aged 20–24 years in 2006 had given birth to her first child before she was 16 years old.<br /> <br /> •<span style="font-size:medium"><span style="font-family:Arial"> </span></span>Save the Children estimated that in 2008 alone, a minimum of 4.3 million (and potentially as many as 10.4 million) additional children in low- and middle-income countries may have become malnourished as a result of food price rises.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to [inside]Common Wealth or Common Hunger? Malnutrition and its impact on Child Survival in the Commonwealth (2010)[/inside], Save the Children,</p> <p style="text-align:justify"><a href="http://www.savethechildren.in/custom/recent-publication/Report--Common_Wealth_or_Common_Hunger(2).pdf">http://www.savethechildren.in/custom/recent-publication/Report--Common_Wealth_or_Common_Hunger%282%29.pdf</a>: </p> <p style="text-align:justify">• India, host to the 2010 Commonwealth Games, has both the highest number and the highest proportion of malnourished children in the world. Nearly half of all under-fives in India–55 million children–are malnourished, almost 7 million of them with severe acute malnutrition.</p> <p style="text-align:justify">• The estimated number of severe acute malnutrition (SAM) children in India is 6941387, which is roughly 6 percent of total children in the age group 6-59 months. The prevalence of SAM among children in the age group 6-59 months is 6 percent in Pakistan and 3 percent in Bangladesh. </p> <p style="text-align:justify">• In Chhattisgarh, a ‘child protection month’ is celebrated twice a year (April and October) and delivers a package of services to more than 85% of children.The services include vitamin A supplementation, deworming, growth monitoring, immunisation focused on children never or only partially vaccinated, and salt testing for iodine content in households and community feeding centres.</p> <p style="text-align:justify">• There are three measures of child malnutrition:</p> <p style="text-align:justify">* Chronic, long-term malnutrition can result in children being too short for their age (stunted).</p> <p style="text-align:justify">* Acute, fast-onset malnutrition results in a child being dangerously thin for their height (wasted).</p> <p style="text-align:justify">* An underweight child has a low weight for their age and could be chronically and/or acutely malnourished. It is also the key indicator for MDG 1.</p> <p style="text-align:justify">• More than two-thirds of stunted children (88.5 million, 68.6%) and nearly half of those who are underweight (95 million, 48.7%) live in just seven Commonwealth countries–India, Bangladesh, Pakistan, Nigeria, Tanzania, Kenya and Uganda. India, alone, has 55.5 million underweight children.</p> <p style="text-align:justify">• A major cause of malnutrition is a poor diet, which makes newborn babies and infants more vulnerable to infection and less able to recover from common childhood illnesses such as pneumonia and diarrhoea. Poverty; household food insecurity; the low status of women; poor hygiene, sanitation and access to clean water; and inadequate public health services all contribute to malnutrition and are a threat to children’s survival.</p> <p style="text-align:justify">• Bangladesh and Pakistan have high rates of malnourished children – 41% and 31% respectively.</p> <p style="text-align:justify">• In India, 36% of women are malnourished with a body mass index of less than 18.5 kg/m2 compared with 12% in Nigeria. Malnourished mothers often give birth to smaller children. India, Pakistan and Bangladesh all have significantly higher levels of children being born at low birth weight than developing countries in other parts of the world. In these three countries, between 22% and 32% of babies are born weighing less than 2.5kg. They begin life already malnourished and at a disadvantage. Many are unable to catch up and therefore remain underweight.</p> <p style="text-align:justify">• Breast milk provides all the energy and nutrients an infant needs during the first six months of life. Rates of exclusive breastfeeding (children below 6 months) are poor at 37%, 43% and 46% in Pakistan, Bangladesh and India respectively, but are even lower in Nigeria and at 13%.</p> <p style="text-align:justify">• An estimated one third of children under five years old in the developing world are stunted–that’s 195 million–and 129 million are underweight.</p> <p style="text-align:justify">• Globally, more than 3 million children die every year from undernutrition related causes.</p> <p style="text-align:justify">• An estimated one-third of children under five years old in the developing world are stunted–that’s 195 million children–and 129 million are underweight.</p> <p style="text-align:justify">• The critical period, when malnutrition can have the most irrevocable impact, is during the 33 months from conception to a child’s second birthday – the first 1,000 days. After two years of age, it is much harder to reverse the effects of chronic malnutrition, particularly its impact on the development of the brain.</p> <p style="text-align:justify">• Thirty per cent of the world’s population lives in the 54 diverse countries that make up the Commonwealth–and at least 64% of the world’s underweight children.</p> <p style="text-align:justify">• Malnutrition is also an underlying cause in 35% of all preventable deaths in children under five each year. Even those who survive are likely to suffer from recurring sickness, impaired physical and mental development, and reduced productivity.</p> <p style="text-align:justify">• The success of vitamin A supplementation programmes targeting children 6–59 months of age has been proven, with an estimated 24% reduction in all-cause mortality.</p> <p style="text-align:justify">• In May 2008, the Copenhagen Consensus, a panel of top economists, determined that providing micronutrients in the form of iodised salt, vitamin A capsules and iron-fortified flour for 80% of the world’s malnourished children would cost US$347 million a year and yield US$5 billion from avoided deaths, improved earnings and reduced healthcare spending.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium">According to [inside]Investing in the future: A United Call to Action on Vitamin and Mineral Deficiencies-Global Report 2009[/inside], </span><br /> <a href="http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf"><span style="font-size:medium">http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf</span></a><span style="font-size:medium">: </span></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Vitamin A, iodine, iron, zinc and folate play pivotal roles in maintaining healthy and productive populations.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Approximately one third of the developing world’s children under the age of five are vitamin A-deficient, and therefore ill-equipped for survival.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron deficiency anaemia during pregnancy is associated with 115,000 deaths each year, accounting for one fifth of total maternal deaths.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Research has shown that, where a population is at risk of vitamin A deficiency, vitamin A supplementation reduces mortality in children between six months and five years of age by an average of 23%. Global efforts to provide young children with twice-yearly supplements have involved 103 countries. In 1999, just 16% of children in these countries received full supplementation. By 2007, that number had more than quadrupled to 72%.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In communities where iodine intake is sufficient, average IQ is shown to be on average 13 points higher than in iodine-deficient communities. Between 1993 and 2007, the number of countries in which iodine-deficiency disorders were a public health concern was reduced by more than half, from 110 to 47.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 2008, the Copenhagen Consensus panel determined that vitamin A and zinc supplementation for children provided the very best return on investment across all global development efforts.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron supplementation during pregnancy lowers the risk of maternal mortality due to haemorrhage, the cause of more than 130,000 maternal deaths each year.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Eliminating anaemia in adults can result in productivity increases of up to 17%. These increases are equivalent to 2% of GDP in the worst affected countries.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron-deficiency anaemia during pregnancy is associated with 115,000 women’s deaths each year, which account for one fifth of total maternal deaths</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Deficiencies in vitamin A and zinc are particularly dangerous for children who are fighting measles, diarrhoea and malaria.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron-deficiency anaemia is also estimated to cause almost 600,000 stillbirths or deaths of babies within their first week of life.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In developing countries, 38 million newborns each year are at risk of iodine deficiency.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 2006, approximately 1.62 billion people had anaemia.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In China, vitamin and mineral deficiencies represent an annual GDP loss of US$ 2.5-5 billion. In India, they may be costing the country US$ 2.5 billion annually – equivalent to approximately 0.4% of GDP.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to [inside]Tracking Progress on Child and Maternal Nutrition: A survival and development priority[/inside], UNICEF (2009),</span><br /> <a href="http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf</span></a><span style="font-family:arial,helvetica,sans-serif; font-size:medium">: </span></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A child’s future nutrition status is affected before conception and is greatly dependent on the mother’s nutrition status prior to and during pregnancy. A chronically undernourished woman will give birth to a baby who is likely to be undernourished as a child, causing the cycle of undernutrition to be repeated over generations.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Children with iron and iodine deficiencies do not perform as well in school as their well-nourished peers, and when they grow up they may be less productive than other adults.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In the developing world the number of children under 5 years old who are stunted is close to 200 million, while the number of children under 5 who are underweight is about 130 million.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In Africa and Asia, stunting rates are particularly high, at 40 per cent and 36 per cent respectively. More than 90 per cent of the developing world’s stunted children live in Africa and Asia.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The level of child and maternal undernutrition remains unacceptable throughout the world, with 90 per cent of the developing world’s chronically undernourished (stunted) children living in Asia and Africa.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Low birthweight is related to maternal undernutrition; it contributes to infections and asphyxia, which together account for 60 per cent of neonatal deaths. An infant born weighing between 1,500 and 2,000 grams is eight times more likely to die than an infant born with an adequate weight of at least 2,500 grams. Low birthweight causes an estimated 3.3 per cent of overall child deaths.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Supplementation of micronutrient can reduce the risk of child mortality from all causes by about 23 per cent.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Children from communities that are iodine deficient can lose 13.5 IQ points on average compared with children from communities that are non-deficient</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Stunting affects approximately 195 million children under 5 years old in the developing world, or about one in three. Africa and Asia have high stunting rates – 40 per cent and 36 per cent, respectively – and more than 90 per cent of the world’s stunted children live on these two continents.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Of the 10 countries that contribute most to the global burden of stunting among children, 6 are in Asia. These countries all have relatively large populations: Bangladesh, China, India, Indonesia, Pakistan and the Philippines.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Due to the high prevalence of stunting (48 per cent) in combination with a large population, India alone has an estimated 61 million stunted children, accounting for more than 3 out of every 10 stunted children in the developing world.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Of countries with available data, Afghanistan and Yemen have the highest stunting rates: 59 per cent and 58 per cent, respectively.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Since 1990, stunting prevalence in the developing world has declined from 40 per cent to 29 per cent, a relative reduction of 28 per cent. Progress has been particularly notable in Asia, where prevalence dropped from 44 per cent around 1990 to 30 per cent around 2008. This reduction is influenced by marked declines in China.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• An estimated 129 million children under 5 years old in the developing world are underweight – nearly one in four. Ten per cent of children in the developing world are severely underweight. The prevalence of underweight among children is higher in Asia than in Africa, with rates of 27 per cent and 21 per cent, respectively.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 17 countries, underweight prevalence among children under 5 years old is greater than 30 per cent. The rates are highest in Bangladesh, India, Timor-Leste and Yemen, with more than 40 per cent of children underweight.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Progress towards the reduction of underweight prevalence has been limited in Africa, with 28 per cent of children under 5 years old being underweight around 1990, compared with 25 per cent around 2008. Progress has been slightly better in Asia, with 37 per cent underweight prevalence around 1990 and 31 per cent around 2008.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• 13 per cent of children under 5 years old in the developing world are wasted, and 5 per cent are severely wasted (an estimated 26 million children).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A number of African and Asian countries have wasting rates that exceed 15 per cent, including Bangladesh (17 per cent), India (20 per cent) and the Sudan (16 per cent). The country with the highest prevalence of wasting in the world is Timor-Leste, where 25 per cent of children under 5 years old are wasted (8 per cent severely).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Although being overweight is a problem most often associated with industrialized countries, some developing countries and countries in transition also have high prevalence of overweight children. In Georgia, Guinea-Bissau, Iraq, Kazakhstan, Sao Tome and Principe, and the Syrian Arab Republic, for example, 15 per cent or more of children under 5 years old are overweight.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Some countries are experiencing a ‘double burden’ of malnutrition, having high rates of both stunting and overweight. In Guinea-Bissau and Malawi, for example, more than 10 per cent of children are overweight, while around half are stunted.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In developing countries, 16 per cent of infants, or 1 in 6, weigh less than 2,500 grams at birth. Asia has the highest incidence of low birthweight by far, with 18 per cent of all infants weighing less than 2,500 grams at birth. Mauritania, Pakistan, the Sudan and Yemen all have an estimated low birthweight incidence of more than 30 per cent.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A total of 19 million newborns per year in the developing world are born with low birthweight, and India has the highest number of low birthweight babies per year: 7.4 million.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron deficiency affects about 25 per cent of the world’s population, most of them children of preschool-age and women. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Vitamin A deficiency is widespread throughout India, but particularly so in rural India, where up to 62 per cent of preschool-age children are deficient, according to the latest estimates. Moreover, the high prevalence of wasting (20 per cent), stunting (48 per cent) and anaemia (70 per cent) in children under 5 years old indicates widespread nutritional deprivation.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><em><span style="font-size:medium">According to The State of Food Insecurity in the World Report 2009: Economic Crises-Impacts and Lessons Learnt, </span><a href="http://www.fao.org/docrep/012/i0876e/i0876e00.htm"><span style="font-size:medium">http://www.fao.org/docrep/012/i0876e/i0876e00.htm</span></a><span style="font-size:medium">: </span> </em></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In the case of India, proportion of undernourished in the total population has increased from 21% in 2000-02 to 22% in 2004-06. The number of undernourished people in India has increased from 223.0 million in 2000-02 to 251.5 million in 2004-06. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The economic turmoil sweeping the globe has led to a sharp spike in hunger affecting the world’s poorest, uncovering a fragile global food system requiring urgent reform. The combination of the food and economic crises have pushed more people into hunger, with the number of hungry expected to top 1 billion this year</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The World Food Summit target of reducing the number of undernourished people by half to no more than 420 million by 2015 will not be reached if the trends that prevailed before those crises continue.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Strides in improving access to food were made in the 1980s and early 1990s, thanks to stepped up agricultural investment after the global food crisis of the early 1970s. However, official development assistance (ODA) fell between 1995-1997 and 2004-2006, resulting in surges in the number of undernourished in most regions. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The increase in the number of the world’s hungry in times of both low prices and economic prosperity as well as periods of price spikes and recessions shows how weak the global food security governance system is</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Even before the consecutive food and economic crises, the number of undernourished people in the world had been increasing slowly but steadily for a decade. The most recent FAO undernourishment data covering all countries in the world show that this trend continued into 2004–06.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The number of hungry people increased between 1995–97 and 2004–06 in all regions except Latin America and the Caribbean. Even in this region, however, the downward trend was reversed because of the food and economic crises. While the proportion of undernourished continually declined from 1990–92 to 2004–06, the decline was much slower than the pace needed to meet the hungerreduction target of the first Millennium Development Goal (MDG).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The current economic crisis emerged immediately following the food and fuel crisis of 2006–08. While food commodity prices in world markets declined substantially in the wake of the financial crisis, they remained high by recent historical standards. Also, food prices in domestic markets came down more slowly, partly because the US dollar, in which most imports are priced, continued to appreciate for some time, but also, more importantly, because of lags in price transmission from world markets to domestic markets. At the end of 2008, domestic prices for staple foods remained, on average, 17 percent higher in real terms than two years earlier. This represented a considerable reduction in the effective purchasing power of poor consumers, who spend a substantial share of their income (often 40 percent) on staple foods.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The number of undernourished in the world will have risen to 1.02 billion people during 2009, even though international food commodity prices have declined from their earlier peaks. If these projections are realized, this will represent the highest level of chronically hungry people since 1970.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• During the 1990s and the current decade, however, the number of undernourished has risen, despite the benefit of slower population growth, and the proportion of undernourished increased in 2008.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Because the world energy market is so much larger than the world grain market, grain prices may be determined by oil prices in the energy market as opposed to being determined by grain supply.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Although domestic prices for most countries declined somewhat during the second half of 2008, in the vast majority of cases, and in all regions, their decline did not keep pace with that of international food commodity prices. At the end of 2008, domestic staple food prices were still 17 percent higher in real terms than two years earlier, and this was true across a range of important foodstuffs.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• India will be less affected than many other Asian countries because its cautious financial policies have reduced the country’s exposure to external financial shocks. In addition, continuing government support to the agriculture sector has transformed India from a net importer of grains to a net exporter.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Investing in agriculture in developing countries is key as a healthy agricultural sector is essential not only to overcome hunger and poverty, but also to ensure overall economic growth and peace and stability in the world.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium">According to the [inside]Nutritional Intake in India: 2004-2005[/inside], NSS 61st Round, July 2004- June 2005: </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> The consumer expenditure survey shows that the percentage share of food expenditure in total expenditure by Indian population was 55.0% in the rural areas and 42.5% in the urban areas. Relative to the comparable survey results for 1993-94, the share of food expenditure has dropped by 8.2 and 12.2 percentage points in rural and urban areas, respectively. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Average daily intake of calories by rural population has dropped by 106 kcal (4.9 percent) from 2153 kcal to 2047 Kcal from 1993-94 to 2004-05 and by 51 Kcal (2.5 percent) from 2071 to 2020 Kcal in the urban area.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Population reporting a calorie intake level of “less than 100%” of the norm of 2700 kcal, formed 66 percent of the total in rural areas and 70 percent of the total in urban areas. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Some states at the higher end of the average intake of calorie per consumer unit per diem were Punjab (2763), Uttar Pradesh (2743) and Rajasthan (2714) in the rural areas and Jharkhand (3013), Bihar (2683) and Punjab (2614) in the urban areas. On the other hand, Karnataka (2276) and Tamil Nadu (2294) in the rural areas and Maharashtra (2261), Karnataka (2385) and Tamil Nadu (2394) in the urban areas were found to have much lower intake of calorie than the Indian average. In terms of per capita calorie intake, Assam, Bihar, Haryana, Punjub, Rajasthan, West Bengal and Uttar Pradesh were higher than the national average of 2047 Kcal.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> In the rural areas, the people of Orissa (79%), Chhatisgarh (78%) and Jharkhand (75%) reportedly derived around 75% of actual intake of calorie from cereals. On the other hand, people of Punjab (50%), Haryana (54%) and Kerala (54%) reported a smaller percentage of calorie intake from cereals</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Average daily intake of protein by the Indian population has decreased from 60.2 to 57 grams in the rural area between 1993-94 and 2004-05 and remained stable around 57 grams in the urban area during the same period. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> While the intake of calorie was observed to be lower, the level of protein and fat consumption was considerably higher than the standard minimum requirement per diem per consumer unit in both the sectors. A higher intake of calorie and protein was observed in the rural India (2540 kcal and 70.8 gms.) as compared to urban India (2475 kcal & 69.9 gms.) whereas, the consumption of fat was relatively much lower in rural areas (44.0 gms.) compared to that in urban areas (58.2 gms.).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> A significant rise in per capita daily average intake of fat is observed during the decades (1993-94 to2004-05) in both rural and urban areas. It has increased from 31.4 gms. to 35.5 gms. (13.1 percent) in rural areas and from 42 gms. to 47.5 gms. (13 percent) in urban areas.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> At national level, the number of meals taken at home had decreased by 0.57%, major states having undergone similar declines were Karnataka (-13.0%), Gujarat (-75%), Andhra Pradesh (-7.37%) whereas in West Bengal it remained unchanged in the rural India. In the urban India, prevalence of home-cooked meals had gone down by 1.66% over last eleven years. The leading contributors were Karnataka (-13.2%), Andhra Pradesh (-9.35%), Assam (-8.56%) whereas the it had increased for states like Haryana (8.81%), Gujarat (1.46%) and West Bengal (0.42%).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> At the national level, the number of meals eaten at home by household members had decreased by 0.57% in the rural areas between 1993-94 and 2004-05. In urban India popularity of home kitchen had declined by 1.66% over last ten years. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Meals taken outside home were mainly concentrated among the age group 5-9 and 10-14 years for both the sex in all the sectors. Among the meals taken outside home in these age groups, most were from schools or Balwadi, might be in the form of ‘Mid-day Meals’. Both in rural and urban area, meals taken on payment were a rare phenomenon. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:small"><strong><em>Notes </em></strong></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><span style="font-size:small"><em><strong>Consumer unit: </strong>Consumer unit is the rate of equivalence of a normal person determined on the basis of age-sex composition of a person. It is usual to assess the calorie needs of men, women and children in terms of those of the average man by applying various coefficients to the different age-sex groups. Consumer unit of a normal male person doing sedentary work and belonging to the age group 20-39 is taken as one unit and the other coefficients are worked out on the basis of calorie requirements. Alternatively consumer unit is a normative rate of equivalence of a given age-sex specific person in relation to a ‘standard’ male person aged 20-39 years and doing sedentary work who is taken to be equivalent to one consumer unit. Nutritionists, attempting to assess calorie requirements per consumer unit, differ in their approaches to the problem, some specifying calorie requirement as function of body weight, while others assign requirements depending on nature of work (sedentary/moderate/heavy). From the 26th round, the NSS has been using a level to the tune of 2700 calories per consumer unit per day as a standard and measure of actual intake may be compared with it. This level (2700 calories per consumer unit per day) is referred to & reported as the "norm" level of calorie intake.<br /> <br /> <strong>Monthly per capita consumer expenditure (MPCE): </strong>For a household, this is the total consumer expenditure over all items divided by its size and expressed on a per month (30 days) basis. A person’s MPCE is understood as that of the household to which he or she belongs.</em></span></span></span><br /> <br /> <em><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span></em></p> <p style="text-align:justify"><em><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to the World Bank:</span><br /> <a href="http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20917151~pagePK:64257043~piPK:437376~theSitePK:4607,00.html"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20917151~pagePK:64257043~piPK:437376~theSitePK:4607,00.html</span></a></em><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span></p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa, the report says.. It also observes that malnutrition in India is a concentrated phenomenon. A relatively small number of states, districts, and villages account for a large share of the burden - 5 states and 50 percent of villages account for about 80 percent of the malnutrition cases.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Reductions in the prevalence of malnutrition over the last decade have been small – the prevalence of underweight has only fallen from 53 percent to 47 percent between 1992/93 and 1998/99</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• More than 75 percent of preschool children suffer from iron deficiency anemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD). Iodine deficiency is endemic in 85 percent of districts.<br /> <br /> • Child malnutrition is a leading cause of child and adult morbidity, mortality, and cognitive and motor development. Malnutrition is estimated to play a role in about 50 percent of all child deaths, and more than half of child deaths from malaria (57 percent), diarrhea (61 percent) and pneumonia (52 percent). Overall, child malnutrition is a risk factor for 22.4 percent of India’s total burden of disease.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In India, child malnutrition is responsible for 22 percent of the country’s burden of disease. Undernutrition also affects cognitive and motor development and undermines educational attainment; and, ultimately impacts on productivity at work and at home, with adverse implications for income and economic growth. Micronutrient deficiencies alone may cost India US$2.5 billion annually.<br /> <br /> • In India, child malnutrition is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding and caring practices, and has its origins almost entirely during the first two to three years of life. However, the commonly held assumption is that food insecurity is the primary or even sole cause of malnutrition. Consequently, the existing response to malnutrition in India has been skewed towards food-based interventions and has placed little emphasis on schemes addressing the other determinants of malnutrition.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• States with the highest levels of malnutrition have the lowest levels of ICDS program funding and a smaller percentage of their villages covered by ICDS centers than states with less malnutrition - The five states with the highest underweight prevalence, namely Rajasthan, Uttar Pradesh, Bihar, Orissa and Madhya Pradesh, all rank in the bottom ten in terms of ICDS coverage</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Underweight prevalence during NFHS-II was higher in rural areas (50 percent) than in urban areas (38 percent); higher among girls (48.9 percent) than among boys (45.5 percent); higher among scheduled castes (53.2 percent) and scheduled tribes (56.2 percent) than among other castes (44.1 percent); and, although underweight is pervasive throughout the wealth distribution, the prevalence of underweight reaches as high as 60 percent in the lowest wealth quintile. Moreover, during the 1990s, urban-rural, inter-caste, male-female and inter-quintile inequalities in nutritional status widened.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to the [inside]National Family Health Survey-III (2005-06)[/inside], </span><a href="http://www.nfhsindia.org"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://www.nfhsindia.org</span></a><span style="font-family:arial,helvetica,sans-serif; font-size:medium">:</span></p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Percentage of children (under 3 years) who are stunted declined from 45.5 during NFHS-II (1998-99) to 38.4 during NFHS-III at the all-India level. The prevalence of stuntedness (during NFHS-III) among children below 3 years was highest in Uttar Pradesh (46.0%), to be followed by Chattisgarh (45.4%) and Gujarat (42.4%). </span></p> <p style="text-align:justify">• Percentage of children (under 3 years) who are wasted increased from 15.5 during NFHS-II to 19.1 during NFHS-III at the all-India level. The prevalence of wastedness (during NFHS-III) among children below 3 years was highest in Madhya Pradesh (33.3%), to be followed by Jharkhand (31.1%), Meghalaya (28.2%) and Bihar (27.7%). </p> <p style="text-align:justify">• Percentage of children (under 3 years) who are underweight declined meagerly from 47.0 during NFHS-II to 45.9 during NFHS-III at the all-India level. The prevalence of underweightedness (during NFHS-III) among children below 3 years was highest in Madhya Pradesh (60.3%), to be followed by Jharkhand (59.2%), Bihar (58.4%), Gujarat (47.4%) and Uttar Pradesh (47.3%). </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Life cycle approach to inter-generational malnutrition</strong></p> <p style="text-align:justify"><img alt="life cycle nutrition" src="tinymce/uploaded/Life%20cycle%20nutrition.JPG" style="height:460px; width:700px" title="life cycle nutrition" /></p> <p style="text-align:justify"><span style="font-size:small"><em><strong>Source: </strong>ncbi.nlm.nih.gov </em></span> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><br /> According to [inside]Facilitating Improved Nutrition for Pregnant and Lactating Women, and Children 0–5 Years of Age[/inside] by Kathryn G. Dewey (2003), PhD, University of California, Davis, USA, <a href="http://www.enfant-encyclopedie.com/Pages/PDF/DeweyANGxp.pdf">http://www.enfant-encyclopedie.com/Pages/PDF/DeweyANGxp.pdf</a>:<br /> </p> <p style="text-align:justify">* Nutrition during childhood and adolescence influence a woman’s pre-conceptional nutritional status, which subsequently influences the outcome of pregnancy and the health of her child. Malnutrition is perpetuated across generations via this cycle. For this reason, programs to improve the nutrition of women and children must be comprehensive, targeting all stages of the life cycle.</p> <p style="text-align:justify">* Why are maternal and child nutrition important in the context of early childhood development? There are numerous linkages between adequate prenatal and postnatal nutrition and a child’s physical, cognitive, emotional, and motor development. For example, low birthweight resulting from intrauterine malnutrition is a key predictor of developmental delay, among other adverse outcomes. Duration of breastfeeding has been positively associated with a child’s cognitive and motor development. Maternal nutritional status, such as iron-deficiency anaemia, may affect the degree and quality of child caregiving. Lastly, maternal dietary practices and weight status are strongly related to a child’s risk of being overweight, a condition that can have lasting consequences on emotional and physical development.</p> <p style="text-align:justify">* Ensuring adequate diets prior to pregnancy, during pregnancy and lactation, and during early childhood (particularly the first two years) is essential. 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$adminprix = 'admin' $rn = object(App\Model\Entity\Article) { 'id' => (int) 13, 'title' => 'Malnutrition', 'subheading' => '', 'description' => '<p style="text-align:justify"><span style="font-family:Arial; font-size:medium">KEY TRENDS </span></p> <div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to The State of the World's Children 2019 report, the proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50 percent for South Asia region <strong>*19</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to the Comprehensive National Nutrition Survey (CNNS), 35 percent of children under five years were stunted, 17 percent were wasted and 33 percent were underweight <strong>*18</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• For several decades India was dealing with only one form of malnutrition -- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/ obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI <strong>*17</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The India specific profile of the Global Nutrition Report 2018 shows that there is some progress made by the country to reduce the prevalence of stunting among children below 5 years. However, there is no progress (or there is been worsening) made by India to reduce the prevalence of wasting among children below 5 years, prevalence of anaemia among women of reproductive age (WRA), prevalence of both adult male and female obesity, and prevalence of both adult male and female diabetes <strong>*16</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• According to the Urban HUNGaMA (Hunger and Malnutrition) Survey Report (released in 2018), in the 10 most populous cities of India, one in four children has stunted growth and development due to chronic nutrition deprivation <strong>*15</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The overall prevalence of underweight, stunting and wasting among urban children below 5 years during 2015-16 was 25.1 percent, 28.7 percent and 16.0 percent, respectively, as per the urban nutrition survey by National Institute of Nutrition (NIN) <strong>*14</strong><br /> </div> <div style="text-align:justify">• Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey-4 (NFHS-4) 2015-16 <strong>*13</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• The Global Nutrition Report 2016 ranks the country 114 for under-5 stunting out of 132 countries, 120 for under-5 wasting (acute malnutrition) out of 130 countries, 170 for anaemia out of 185 countries and 104 for adult diabetes out of 190 countries <strong>*12</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Stunting rates in under-three children declined by only 8 percentage points in more than a decade in this age-group -- from 53 percent in 1992-93 to 45 percent in 2006 -- reflecting an average annual rate of decline of 1.2 percent. During this period, wasting declined by 1 percentage point and underweight by 8 percentage points. However, the rate of progress accelerated since National Family Health Survey-3 (NFHS-3), and India's average annual rate of under-5 stunting decline between 2006 and 2014 has been 2.3 percent per year, compared with a rate of decline of 1.2 percent per year between 1992 and 2006 <strong>*11</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• New government data show that nearly all Indian states posted significant declines in stunting rates from 2006 to 2014, and all showed strong increases in exclusive breastfeeding rates over the same period <strong>*10</strong><br /> <br /> • Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines <strong>*10</strong><br /> <br /> • While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal <strong>*10</strong><br /> <br /> • The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above <strong>*10</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Despite various interim orders issued by the Supreme Court from time to time (based on a writ petition that was filed by People’s Union for Civil Liberties in April, 2001), the Government of India has failed to universalize the Integrated Child Development Services (ICDS) scheme <strong>*9</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal for urban India during 2011-12 (based on Schedule Type 2) <strong>*8</strong><br /> <br /> • At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector during 2011-12 (based on Schedule Type 2) <strong>*8</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• Prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (National Family Health Survey, NFHS-3) to 38.8% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by stunting has gone down from 5.82 crore in 2005-06 to 4.38 crore in 2013-14 <strong>*7</strong><br /> <br /> • Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14 <strong>*7</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify">• In the Maharashtra state of India, the percentage of stunted children dropped from 39 per cent in 2005 to 23 per cent in 2012 largely because of support to frontline workers who focus on improving child nutrition <strong>*6</strong></div> <div style="text-align:justify"><br /> • Total number of malnourished children (Grade I, II, III and IV) exceeded the 40 percent mark in 10 states/ UTs (Andhra Pradesh: 49 percent, Bihar: 82 percent, Haryana: 43 percent, Jharkhand: 40 percent, Odisha: 50 percent, Rajasthan: 43 percent, UP: 41 percent, Delhi: 50 percent, Daman and Diu: 50 percent and Lakshadweep: 40 percent), as on 31 March, 2011 <strong>*5</strong><br /> <br /> • Poor hygiene and sanitation were noticed in the AWCs due to the absence of toilets in 52 percent of the test checked AWCs and non-availability of drinking water facility for 32 percent of the test checked AWCs <strong>*5</strong><br /> <br /> • India's 2012 GHI score is 22.9 (rank: 65) as compared to China's GHI score of 5.1 (rank: 2), Bangladesh's score of 24.0 (rank: 68), Pakistan's score of 19.7 (rank: 57), Nepal's score of 20.3 (rank: 60) and Sri Lanka's score of 14.4 (rank: 37) <strong>*4</strong><br /> <br /> • Children in the poorest households are more than twice as likely to be stunted as those in the richest households in India <strong>*3</strong><br /> <br /> • 48% of children in India are stunted. 450 million children will be affected by stunting in the next 15 years, if current trends continue <strong>*2</strong><br /> <br /> • Malnutrition is an underlying cause of the death of 2.6 million children each year–one-third of the global total of children’s deaths <strong>*2</strong><br /> <br /> • The HUNGaMA study (2011) shows that in the 100 Focus Districts, 42 percent of children under five are underweight and 59 percent are stunted. Of the children suffering from stunting, about half are severely stunted <strong>*1</strong><br /> <br /> • The HUNGaMA study (2011) conducted in the 100 Focus Districts shows that 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 percent while that among mothers with 10 or more years of education is 27 per cent <strong>*1</strong></div> <div style="text-align:justify"> </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>19. </strong>The State of the World's Children 2019-Children, Food and Nutrition: Growing well in a changing world, released in October, 2019, produced by UNICEF, please <a href="tinymce/uploaded/Executive%20Summary%20SOWC%202019%20South%20Asia.pdf" title="Executive Summary SOWC 2019 South Asia">click here</a> and <a href="https://www.unicef.org/reports/state-of-worlds-children-2019">here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>18.</strong> India: Comprehensive National Nutrition Survey 2016-2018, released in October 2019, Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council, please <a href="https://im4change.org/docs/357Comprehensive_National_Nutrition_Survey_2016_2018_India.pdf">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>17. </strong>Food and Nutrition Security Analysis, India, 2019 (released in June 2019), produced by the MoSPI & WFP, please <a href="https://im4change.org/docs/231Food_and_Nutrition_Security_Analysis.pdf">click here</a> to access </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>16. </strong>Global Nutrition Report 2018: Shining a light to spur action on nutrition, please click <a href="https://globalnutritionreport.org/reports/global-nutrition-report-2018/">here</a> and <a href="tinymce/uploaded/India%20Profile.pdf" title="India profile">here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>15. </strong>Urban HUNGaMA Report: Nutrition and the City (released in February 2018), prepared by Naandi Foundation and others, please <a href="tinymce/uploaded/Urban-Hungama-Report.pdf" title="Urban-Hungama-Report">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>14. </strong>Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidemia in Urban Men and Women, National Nutrition Monitoring Bureau (NNMB) Technical Report no. 27, National Institute of Nutrition (NIN), please <a href="https://im4change.org/docs/555NNMB%20Urban%20Nutrition%20survey%20report.pdf">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>13. </strong>Nourishing India: National Nutrition Strategy, NITI Aayog, please <a href="tinymce/uploaded/Nutrition_Strategy_Booklet.pdf" title="National Nutrition Strategy">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>12. </strong>Global Nutrition Report 2016[/inside], which has been prepared by International Food Policy Research Institute (IFPRI), Please click <a href="tinymce/uploaded/Global%20Nutrition%20Report%202016.pdf" title="Global Nutrition Report 2016">link1</a> to access, click <a href="tinymce/uploaded/Synopsis%20Global%20Nutrition%20Report%202016.pdf" title="Synopsis Global Nutrition Report 2016">link2</a> to access</div> <div style="text-align:justify"><br /> <strong>11.</strong> India Health Report: Nutrition 2015 by Public Health Foundation of India, Transform Nutrition and UK Aid (please <a href="tinymce/uploaded/India%20Health%20Report%20PHFI.pdf" title="India Health Report 2015 PHFI">click here</a> to access)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>10.</strong> 2015 Global Nutrition Report: Actions and Accountability to Advance Nutrition & Sustainable Development by International Food Policy Research Institute (IFPRI), please <a href="tinymce/uploaded/global%20nutrition%20report%202015.pdf" title="Global nutrition report 2015">click here</a> to access</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>9.</strong> Public Accounts Committee (2014-15) report on ICDS Scheme of Ministry of Women & Child Development, PAC no. 2045, Fourteenth Report (presented to Lok Sabha on 27 April, 2015 and Rajya Sabha on 28 April 2015), Please <a href="tinymce/uploaded/Public%20Accounts%20Commitee%20report%20on%20ICDS.pdf">click here</a> to access </div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>8.</strong> NSS 68th Round Report entitled Nutritional Intake in India, 2011-12 (published in October 2014) (Please <a href="http://mospi.nic.in/Mospi_New/upload/nss_report_560_19dec14.pdf">click here</a> to access)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>7.</strong> Global Nutrition Report 2014: Actions and Accountability to Accelerate the World's Progress on Nutrition, IFPRI (Please <a href="tinymce/uploaded/Global%20Nutrition%20Report%202014.pdf" title="Global Nutrition Report 2014">click here</a> to download)</div> <div style="text-align:justify"> </div> <div style="text-align:justify"><strong>6.</strong> UNICEF report titled: Improving Child Nutrition: The achievable imperative for global progress (April, 2013), please <a href="tinymce/uploaded/Improving%20Child%20Nutrition%20The%20achievable%20imperative%20for%20global%20progress.pdf" title="Improving Child Nutrition The achievable imperative for global progress">click here</a> to access</div> <p style="text-align:justify"><br /> <span style="font-size:medium"><strong>5.</strong> Report of the Comptroller and Auditor General of India on Performance Audit of Integrated Child Development Services (ICDS) Scheme, CAG Report no. 22 of 2012-13-Union Government (Ministry of Women and Child Development), </span><a href="http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html">http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html</a></p> </div> <div> <div style="text-align:justify"> </div> <div style="text-align:justify"><span style="font-size:medium"><strong>4.</strong> 2012 Global Hunger Index-The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses, produced by IFPRI, Concern Worldwide and Welthungerhilfe, please <a href="tinymce/uploaded/2012%20Global%20Hunger%20Index.pdf" title="2012 Global Hunger Index">click here</a> to access</span></div> <div style="text-align:justify"><span style="font-size:medium"> </span></div> <div style="text-align:justify"> </div> <p style="text-align:justify"><span style="font-size:medium"><strong>3.</strong> The Nutrition Barometer: Gauging national responses to undernutrition (2012) by Save the Children and World Vision, please <a href="tinymce/uploaded/Nutrition%20Barometer.pdf" title="Nutrition Barometer">click here</a> to access</span></p> </div> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:Arial; font-size:medium"><strong>2.</strong> A Life Free from Hunger: Tackling child malnutrition (2012), Save the Children, please <a href="tinymce/uploaded/A%20Life%20Free%20from%20Hunger%20Tackling%20child%20malnutrition%202012%20Save%20the%20Children.pdf" title="A Life Free from Hunger Tackling child malnutrition 2012 Save the Children">click here</a> to access </span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:Arial; font-size:medium"><strong>1.</strong> HUNGaMA: Fighting Hunger & Malnutrition (2011), Naandi Foundation, please <a href="tinymce/uploaded/Hungama%20Report%202011.pdf" title="Hungama Report 2011">click here</a> to access </span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"><span style="font-size:medium">O</span>VERVIEW </span></p> <p style="text-align:justify"> </p> <div style="text-align:justify">India’s story of attaining self sufficiency in food grain production is the stuff of the legend. But a proud India was soon to learn that self sufficiency did not mean food for every citizen, leave alone adequate nutrition. However, one must not undermine the value of self reliance, knowing well enough the sinister link between hunger and a country’s dependence on food imports. One must also remember that many developed countries where nutrition is not a problem happen to be big importers of food. Obviously, nutrition security depends on a large number of factors, many of which have nothing to do with food. <br /> <br /> The issue of nutritional security is extremely complex. Many countries with similar per capita food consumption have vastly different rates of life expectancies and child mortality. Clearly, oversimplified statistical correlations and juxtapositions don’t work here. Jean Dreze and Amartya Sen have argued in their seminal work, Hunger and Public Action (OUP 1989), that we need to broaden our attention: a) from food-sufficiency to food-adequacy, b) from food adequacy to food entitlements, and c) from food entitlements to nutritional and related capabilities. The authors capture the big picture of nutritional security through many non-food factors like “medical attention, health services, basic education, sanitary arrangements, provision of clean water, eradication of infectious epidemics, and so on.”<br /> <br /> If we want to know why one third of world’s underweight children (which comes to roughly 57 million) live in India, we only have to look at a child’s environment here. According to NFHS, two third babies are born anemic and about one third have stunted growth. Those who survive the lack of healthcare, immunization, sanitation or safe drinking water grow up as victims of human trafficking, child abuse or forced child labour. It is obvious that improving the nutritional security of its children is much more complex than achieving self-sufficiency in food production. True, the country is committed to achieving this through the UN Convention on the Rights of the Child and the Millennium Development Goals (MDGs) but its progress is agonizingly slow.</div> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">Please <a href="https://www.im4change.org/upload/files/RDA_short_report%281%29.pdf">click here</a> to access the report entitled [inside]Nutrients Requirements for Indians: Recommended Dietary Allowances and Estimated Average Requirement (released in September 2020)[/inside], A Report of the Expert Group, Indian Council of Medical Research (ICMR)-National Institute of Nutrition (NIN), Ministry of Health and Family Welfare.</p> <p style="text-align:justify"><strong>---</strong></p> <p style="text-align:justify">The key findings of the report entitled [inside]The State of the World's Children 2019-Children, Food and Nutrition: Growing well in a changing world (released in October, 2019)[/inside], which has been produced by UNICEF, are as follows (please <a href="tinymce/uploaded/Executive%20Summary%20SOWC%202019%20South%20Asia.pdf" title="Executive Summary SOWC 2019 South Asia">click here</a> and <a href="https://www.unicef.org/reports/state-of-worlds-children-2019">here</a> to access): <br /> <br /> • The proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50 percent for South Asia region.<br /> <br /> • Among all the countries studied in this report pertaining to burden of death among children below five years, India is ahead of others. In 2018, 8.82 lakh children under five years died in the country. For Nigeria that figure was 8.66 lakh and for Pakistan it was 4.09 lakh. <br /> <br /> • The median under-five mortality rate (viz. deaths among children below five years per 1,000 live births) for India is 37, Bangladesh is 30, Pakistan is 69, Nepal is 32, China is 9 and Sri Lanka is 7 in 2018.<br /> <br /> • India's under-five mortality rate reduced from 126 in 1990 to 92 in 2000 and further to 37 in 2018.<br /> <br /> • The country's infant mortality rate (viz. deaths among children below one year per 1,000 live births) reduced from 89 in 1990 to 30 in 2018.<br /> <br /> • The country's neonatal mortality rate (viz. deaths among children below 28 days age per 1,000 live births) reduced from 57 in 1990 to 45 in 2000 and further to 23 in 2018.<br /> <br /> • In 2018, 5.49 lakh children under 28 days age died in the country.<br /> <br /> • In 2018, neonatal deaths as a proportion of all under-5 deaths was 62 percent.<br /> <br /> • India's life expectancy at birth improved from 48 years in 1970 to 63 years in 2000 and further to 69 years in 2018.<br /> <br /> • The number of deaths among children aged 5–14 years in 2018 was 1.43 lakh.<br /> <br /> • The total number of maternal deaths in 2017 was 35,000 for India. The country's maternal mortality ratio in that year was 145. It refers to the number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000 live births in that year.<br /> <br /> • The proportion of children in the age-group 0-4 years who are stunted (moderate and severe) was 38 percent during 2013-2018. For the poorest 20 percent that figure was 51 percent and for the richest 20 percent it was 22 percent.<br /> <br /> • The proportion of children in the age-group 0-4 years who are severely wasted was 8 percent during 2013-2018. The proportion of children in the age-group 0-4 years who are severely and moderately wasted was 21 percent during the same time span.<br /> <br /> • The proportion of children in the age-group 0-4 years who are overweight (moderate and severe) was 2 percent during 2013-2018.<br /> <br /> • The proportion of children in the age-group 5-19 years who are overweight and obese was 7 percent during 2016.<br /> <br /> • Almost 24 percent women above 18 years were underweight (body mass index < 18.5 kg per meter square) in 2016.<br /> <br /> • Almost 51 percent women in the age-group 15-49 years suffered from mild, moderate and severe anaemia in 2016.<br /> <br /> • The percentage of households consuming iodized salt in 2013–2018 was 93 percent.<br /> <br /> • In 2018, the percentage of children aged 6–23 months who are eating at least 5 out of 8 food groups (Minimum Dietary Diversity) was 15 percent for Pakistan, 20 percent for India, 22 percent for Afganistan, 27 percent for Bangladesh, 45 percent for Nepal, 71 percent for Maldives, 20 percent for South Asia region and 29 percent globally. <br /> <br /> • In South Asia, children in the age-group 6-11 months are eating less diverse diets compared to children in the age-group 12–23 months.<br /> <br /> • In 2018, globally 149 million children under 5 years were stunted and almost 49.5 million were wasted. In South Asia, 58.7 million children under 5 years were stunted and 25.9 million were wasted.<br /> <br /> • In 2018, globally 40 million children under 5 years were overweight. Against that 5.2 million children under 5 years were overweight in South Asia.<br /> <br /> • Nearly three-fourth of children in South Asia were not being fed much-needed nutrients from animal source foods in 2018.<br /> <br /> • 56 percent children in South Asia were not fed any fruits or vegetables.<br /> <br /> • Malnutrition must now be used to describe children with stunting (short stature for age) and wasting (low weight for height), those suffering from the ‘hidden hunger’ of deficiencies in essential vitamins and minerals as well as the growing numbers of children and young people who are affected by overweight or obesity.<br /> <br /> • Undernutrition continues to affect tens of millions of children. Its presence is visible in the stunted bodies of children deprived of adequate nutrition in the first 1,000 days and beyond. These children may carry the burden of early stunting for the rest of their lives and may never meet their full physical and intellectual potential.<br /> <br /> • Undernutrition is also evident in the wasted bodies of children when circumstances like food shortages, poor feeding practices and infection, often compounded by poverty, humanitarian crises and conflict, deprive them of adequate nutrition and, in far too many cases, result in death.<br /> <br /> • Overweight and obesity, long thought of as conditions of the wealthy, are now increasingly a condition of the poor, reflecting the greater availability of ‘cheap calories’ from fatty and sugary foods around the world. They bring with them a heightened risk of non-communicable diseases, like type 2 diabetes.<br /> <br /> • Far too many children and young people are eating too little healthy food and too much unhealthy food.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">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).<br /> <br /> 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.<br /> <br /> 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.<br /> <br /> 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.<br /> <br /> The key findings of the report entitled [inside]India: Comprehensive National Nutrition Survey 2016-2018 (released in October 2019)[/inside], which was jointly prepared by Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council (please <a href="https://im4change.org/docs/357Comprehensive_National_Nutrition_Survey_2016_2018_India.pdf">click here</a> to access), are as follows:<br /> <br /> <strong>Initiation of breastfeeding</strong><br /> <br /> • Fifty-seven percent of children aged 0–24 months were breastfed within one hour of birth<br /> <br /> <strong>Exclusive breastfeeding</strong><br /> <br /> • Fifty-eight percent of infants under age six months were exclusively breastfed<br /> <br /> <strong>Continued breastfeeding at age one year</strong><br /> <br /> • Eighty-three percent of children aged 12 to 15 months continued breastfeeding at one year of age<br /> <br /> <strong>Complementary feeding</strong><br /> <br /> • Timely complementary feeding was initiated for 53 percent of infants aged 6 to 8 months<br /> <br /> <strong>Minimum dietary diversity, meal frequency and acceptable diet</strong><br /> <br /> • 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<br /> <br /> <strong>Food consumption among school-age children and adolescents</strong><br /> <br /> • More than 85 percent of school-age children and adolescents consumed dark green leafy vegetables and pulses or beans at least once per week<br /> <br /> • One-third school-age children and adolescents consumed eggs, fish or chicken or meat at least once per week<br /> <br /> • 60 percent school-age children and adolescents consumed milk or curd at least once per week<br /> <br /> <strong>Malnutrition in pre-school children (0–59 months)</strong><br /> <br /> • 35 percent of children under five years were stunted (HAZ<-2 SD viz. who have low height for their age; SD means standard deviation)<br /> <br /> • 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)<br /> <br /> • 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<br /> <br /> • 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<br /> <br /> • 17 percent of children under five years were wasted (WHZ<-2 SD viz. who have low weight for their height)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 33 percent of children under five years were underweight (WAZ<-2 SD viz. who have low weight for their age)<br /> <br /> • 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)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 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)<br /> <br /> • 11 percent of children 6–59 months were acutely malnourished as measured by mid-upper arm circumference (MUAC-for-age<-2 SD)<br /> <br /> • 5 percent of children 6–59 months were acutely malnourished as measured by absolute MUAC (MUAC<125mm)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • 2 percent of children under five were overweight or obese (WHZ>+2 SD)<br /> <br /> • 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)<br /> <br /> • 1 percent of children under five were overweight as measured by triceps skinfold thickness (TSFT-for-age>+2 SD)<br /> <br /> • The highest prevalence (greater than or equal to 4 percent) of overweight, as measured by TSFT, was in Mizoram, Tripura and Uttarakhand<br /> <br /> • 2 percent of children 1 to 4 years were overweight as measured by subscapular skinfold thickness (SSFT-for-age>+2 SD)<br /> <br /> • 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.<br /> <br /> • 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<br /> <br /> <strong>Malnutrition in school-age children (5–9 years)</strong><br /> <br /> • 22 percent of school-age children were stunted (HAZ<-2 SD)<br /> <br /> • 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)<br /> <br /> • 10 percent of school-age children were underweight (WAZ<-2 SD)<br /> <br /> • The prevalence of underweight was lowest in Arunachal Pradesh, Jammu & Kashmir, Manipur and Sikkim (17 percent) and highest in Jharkhand (45 percent)<br /> <br /> • 23 percent of school-age children were thin (BMI-for-age<-2 SD; BMI means body mass index)<br /> <br /> • 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)<br /> <br /> • 4 percent of school-age children were overweight or obese (BMI-for-age>+1 SD)<br /> <br /> • 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).<br /> <br /> • 2 percent of school-age children were overweight as measured by TSFT (TSFT-for-age>+1 SD)<br /> <br /> • 8 percent of school-age children were overweight as measured by SSFT (SSFT-for-age>+1 SD)<br /> <br /> • 2 percent of school-age children had abdominal obesity (waist circumference-for-age>+1 SD)<br /> <br /> <strong>Malnutrition in adolescents (10–19 years)</strong><br /> <br /> • 24 percent of adolescents were thin for their age (BMI-for-age<-2 SD)<br /> <br /> • 5 percent of adolescents were overweight or obese (BMI-for-age>+1 SD)<br /> <br /> • 4 percent of adolescents were overweight as measured by TSFT (TSFT-for-age>+1 SD)<br /> <br /> • 6 percent of adolescents were overweight as measured by SSFT (SSFT-for-age >+1 SD)<br /> <br /> • 2 percent of adolescents had abdominal obesity (waist circumference-for-age>+1 SD)<br /> <br /> <strong>Anaemia and Iron Deficiency</strong><br /> <br /> • Forty-one percent of pre-schoolers, 24 percent of school-age children and 28 percent of adolescents were anaemic<br /> <br /> • Anaemia was most prevalent among children under two years of age<br /> <br /> • Female adolescents had a higher prevalence of anaemia (40 percent) compared to their male counterparts (18 percent)<br /> <br /> • 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<br /> <br /> • Thirty-two percent of pre-schoolers, 17 percent of school-age children and 22 percent of adolescents had iron deficiency (low serum ferritin)<br /> <br /> • Female adolescents had a higher prevalence of iron deficiency (31 percent) compared to male adolescents (12 percent)<br /> <br /> • Children and adolescents in urban areas had a higher prevalence of iron defi ciency compared to their rural counterparts<br /> <br /> <strong>Micronutrients</strong><br /> <br /> • The prevalence of vitamin A deficiency was 18 percent among pre-school children, 22 percent among school-age children and 16 percent among adolescents<br /> <br /> • Vitamin D deficiency was found among 14 percent of pre-school children, 18 percent of school-age children and 24 percent of adolescents<br /> <br /> • Nearly one-fifth of pre-school children (19 percent), 17 percent of school-age children and 32 percent of adolescents had zinc deficiency<br /> <br /> • The prevalence of vitamin B12 deficiency was 14 percent among pre-school children, 17 percent among school-age children and 31 percent among adolescents<br /> <br /> • Nearly one-quarter (23 percent) of pre-school children, 28 percent of school aged children and 37 percent of adolescents had folate deficiency<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> <strong>Markers of Non-Communicable Diseases</strong><br /> <br /> • There is a growing risk of non-communicable diseases among children aged 5 to 9 years and adolescents aged 10–19 years in India<br /> <br /> • 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<br /> <br /> • One percent of school-age children and adolescents were diabetic with fasting plasma glucose >126 mg/dl<br /> <br /> • 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)<br /> <br /> • One-quarter (26 percent) of school-age children and 28 percent of adolescents had low high-density lipoprotein (HDL) (<40 mg/dl)<br /> <br /> • 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<br /> <br /> • 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)<br /> <br /> • Five percent of adolescents were classified as having hypertension (systolic blood pressure >139 mmHg or diastolic blood pressure >89 mmHg)<br /> <br /> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">The Food and Nutrition Security Analysis, India 2019 report has attempted to analyse data from all three dimensions viz. food availability, accessibility and utilization to help the reader take stock of the food and nutrition situation in India over different periods of time. In supporting the monitoring of progress towards achieving the targets under SDG 2, the Ministry of Statistics and Programme Implementation (MoSPI) and World Food Programme (WFP) together conducted analyses of available food and nutrition security information.<br /> <br /> It may be noted that the Sustainable Development Goals (SDGs) are a set of 17 global goals to improve the lives of all people around the world, by 2030. The second goal, SDG 2 – Zero Hunger – pledges to end hunger, achieve food security, improve nutrition and promote sustainable agriculture. An important component of this goal is to improve access to food for all, end all forms of malnutrition, including agreed targets on childhood stunting and wasting and improve agricultural income and sustainability. These goals represent an important progression from the Millennium Development Goals (MDGs) which ended in 2015, where food security was measured solely on the basis of the percentage of population below the minimum level of dietary energy consumption, and the prevalence of children under 5 years of age who are underweight. Thus, to achieve SDG 2 the focus is broadened beyond these two outcomes and includes a focus on nutritious dietary intake, all forms of malnutrition, support to smallholder farmers, strengthened food systems and improved biodiversity.<br /> <br /> The key findings of the report entitled [inside]Food and Nutrition Security Analysis, India, 2019 (released in June 2019)[/inside], which has been produced by the Ministry of Statistics and Programme Implementation (MoSPI) & The World Food Programme (WFP), are as follows (please <a href="https://im4change.org/docs/231Food_and_Nutrition_Security_Analysis.pdf">click here</a> to access):<br /> <br /> <em><strong>Foodgrains Availability in India</strong></em><br /> <br /> • <strong>Production: </strong>Over the last 20 years, total food grain production in India increased from 198 million tonnes to 269 million tonnes. Wheat and rice are the staple foods of Indians and are a major portion of food grain production, constituting around 75 percent of the total food grain production and thus serving as a major source of income and employment to millions of people. The state of Uttar Pradesh leads in the production of wheat, cereals and foodgrains, closely followed by Punjab and Madhya Pradesh. West Bengal is the ‘rice bowl’ of India, followed by Uttar Pradesh, Punjab and Bihar.<br /> <br /> • <strong>Net Availability: </strong>Since 1996, the per capita net availability of foodgrains has increased from 475 to 484 gm/capita/day in 2018, while per capita availability of pulses has increased from 33 to 55 gm/capita/day. Although there has been a huge increase in production of rice, wheat and other cereals, their per capita net availability has not increased at the same level, due to population growth, food wastage and losses, and exports.<br /> <br /> • <strong>Production Trends: </strong>Between 1996-99 and 2015-18, the annual growth rate for food grains was 1.6 percent. Production growth for other major crops are: 2.4 percent for pulses, 1.8 percent for wheat, 1.6 percent for other cereals, 1.4 percent for rice, and 0.9 percent for bajra. Maize had the highest growth, at 5.9 percent. Conversely, other crops saw fall in annual growth rates such as: jowar (-2.26 percent), small millets (-1.71 percent) and ragi (-1.21 percent).<br /> <br /> • <strong>Farm Productivity: </strong>Though yields in food grains have increased by 33 percent in last two decades, it has been far less than desired. For instance, India has set a target of achieving yields of 5,018 kgs per hectare for rice, wheat and coarse grains by 2030, compared to the present combined yield of 2,509 kgs per hectare. While no state or Union Territory (UT) in India has achieved this target yet, the UT of Chandigarh is nearing the targeted productivity with current levels at 4,600 kgs per hectare, followed by yields of 4,297 kgs per hectare in Punjab.<br /> <br /> <em><strong>Access to Nutritious Food</strong></em><br /> <br /> • <strong>Food Expenditure: </strong>According to Engel's law, the share of income spent on food decreases, even as total food expenditure rises. A higher share of total monthly expenditure for food shows lower purchasing power and is related to food access, so it is a relative measure of food insecurity. On average, people of India allocate about 49 percent of their monthly expenditure on food in rural areas and 39 percent in urban areas. The share of food expenditure is highest among the poorest (lowest 30 percent) expenditure group. In rural and urban areas, the poorest 30 percent spend as much as 60 percent and 55 percent respectively, on food.<br /> <br /> • <strong>Food Expenditure Trends: </strong>Between 1972-73 and 2011-12, the share of expenditure on food has decreased around 33 percent in rural areas and 40 percent in urban areas whereas non-food expenditures have increased during the same period. Between 2004-05 to 2011-12, among the poorest, the share of expenditure on food has declined by 9 percent in rural and 8 percent in urban areas of India. Declining trends suggest that incomes have increased in both rural and urban areas and that food is no longer the only predominant expenditure head for the people.<br /> <br /> • <strong>Food Consumption Pattern: </strong>In the food basket, it turns out that in both urban and rural areas, the share of expenditure on cereal and cereal substitutes has declined between 1972-73 and 2011-12, from 57 percent to 25 percent in rural areas and from 36 percent to 19 percent in urban areas. For the same period, the relative importance of some items especially beverages, milk and milk products and fruits and nuts has shown a remarkable increase, indicating an increased diversity in consumption in the country. In the food basket, the energy and protein intake from cereals has decreased in both rural and urban India, largely because of increased consumption of other food items such as milk and dairy products, oils and fat and relatively unhealthy food such as fast food, processed food, and sugary beverages. Notably, the consumption of unhealthy energy and protein sources is much higher in urban areas. This has likely contributed to the emerging problem of obesity in India.<br /> <br /> • <strong>Nutritional Intake: </strong>Between 1993-94 to 2011-12, the average daily per capita consumption of both energy and protein decreased in rural India while in urban areas, there was no consistent trend. This decline has happened despite the increase in household income. For energy consumption alone, the trend suggests that despite increases since 1983, the overall energy intake is marginally lower than the minimum requirement. For protein intake, despite the declining trends, per capita consumption in both rural and urban areas is higher than the minimum daily requirement. However fat intake has increased steadily since 1983 and is much higher than the minimum daily requirement.<br /> <br /> • <strong>Nutritional Intake Among the Poor:</strong> Among the lowest 30 percent of the expenditure/ income class, the average per capita consumption of energy is 1811 kcal per day which is much lower than the Indian Council of Medical Research (ICMR) norm of 2,155 kcal per day. For protein, it is 47.5 grams per day compared to 48 grams per day norm while for fat it is 28 grams per day which is the same as the ICMR norm for rural India. For urban areas, per capita intake of energy is 1,745 kcal per day compared to 2,090 per day norm from ICMR. For protein it is 47 grams per day compared to a norm of 50 grams per day and for fat it is 35 grams per day compared to the norm of 26 grams per day. The current intake level of nutrients such as the energy and protein were lower than the all-India average and the daily minimum consumption requirement. Only fat intake in rural and urban areas was at par or more than the daily minimum consumption requirement.<br /> <br /> • <strong>Public Distribution System (PDS) and Nutritional Intake: </strong>The Targeted Public Distribution System (TPDS) has provided a critical nutritional supplement to the people across all states in India. During 2011-12, the average per capita supplementation of energy from TPDS was 453 kcal per day in rural areas and 159 kcal per day in urban India. In terms of protein, the supplementation through PDS has averaged 7.2 grams per day in rural areas and 3.8 grams per day in urban areas. The PDS supplementation to the poorest 30 percent population has been around 339 kcal per day. It has been seen that the poorest 30 percent of households had lower capacity to access food, and as a result, despite the PDS support, they were not able to reach the Recommended Dietary Energy (RDA) levels of energy and protein intakes.<br /> <br /> <em><strong>Utilization</strong></em><br /> <br /> • <strong>National Malnutrition Decadal Trends: </strong>The prevalence of malnutrition in children 6-59 months in India has declined between 2005-06 to 2015-16 with chronic malnutrition, or stunting, decreasing from 48.0 percent in 2005-06 to 38.4 percent in 2015-16 and underweight decreasing from 42.5 percent in 2005-06 to 35.7 percent in 2015-16. The prevalence of acute malnutrition, or wasting, has marginally increased during the same period, from 19.8 percent to 21.0 percent. The prevalence of anaemia in young children has also decreased from 69.5 percent in 2005-06 to 58.5 percent in 2015-16.<br /> <br /> • <strong>Stunting Trajectories:</strong> Stunting has declined by one-fifth during last decade with an annual decline of around one percent. The prevalence of stunting is > 30 percent across all states in India, except Kerala. The trajectories to reduce stunting in India highlight that, with the present rate of reduction in stunting (1 percent per year), by 2022, 31.4 percent children will be stunted. The Government of India has envisaged a challenging target for itself through National Nutrition Mission (NNM) with the target to reduce stunting by at least 2 percent per annum to reach 25 percent by 2022. Goa and Kerala have already achieved this level in NFHS-4 (2015-16). Four other states (Daman and Diu, Andaman and Nicobar, Puducherry and Tripura) have already accomplished mission 25 and Punjab (25.7 percent) is close to achieving it (NFHS-4).<br /> <br /> • <strong>Inter and Intra State Variations in Malnutrition: </strong>The prevalence of stunting in children under five is the highest in Bihar (48 percent), Uttar Pradesh (46 percent), Jharkhand (45 percent), and Meghalaya (44 percent) and lowest in Kerala and Goa (20 percent each). Jharkhand also has the highest prevalence of underweight (48 percent) and wasting (29 percent). District level mapping of malnutrition shows considerable intrastate variations. However, very few districts in Northern and North-Eastern states have shown ‘Low’ level of wasting (2.5-4.9 percent) and underweight (less than 10 percent).<br /> <br /> • <strong>Vulnerable Pockets and Sections in India:</strong> As mentioned, the highest levels of stunting and underweight are found in Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat and Maharashtra. Few states have a very high burden of malnutrition. The poorest quintile of the population is the most vulnerable in terms of stunting. In addition to the earlier mentioned states, the two poorest quintile groups in Haryana, Meghalaya, Karnataka, Rajasthan and Punjab have high levels of stunting. At the national level, among social groups, the prevalence of stunting is highest amongst children from the Scheduled Tribes (43.6 percent), followed by Scheduled Castes (42.5 percent) and Other Backwards Castes (38.6 percent). The prevalence of stunting in children from Scheduled Tribes in Rajasthan, Odisha and Meghalaya is high while stunting in children from both Scheduled Tribes and Scheduled Castes is high in Maharashtra, Chhattisgarh and Karnataka.<br /> <br /> • <strong>Prevalence of Multiple Types of Malnutrition among Children: </strong>Multiple burden of malnutrition is the coexistence of any two or all three measures of malnutrition: stunting, wasting and underweight. The analysis of NFHS-4 reveals 6.4 percent of children under five are both stunted and wasted and also are underweight, while 18.1 percent of children are both stunted and underweight and 7.9 percent of children are both wasted and underweight. This analysis helps in identifying the most vulnerable section where children are suffering from multiple forms of macronutrient malnutrition.<br /> <br /> • <strong>Micronutrient Malnutrition: </strong>Vitamin A, iron and iodine deficiency disorders are the most common forms of micronutrient malnutrition in the world. Supplementation and fortification are the main ways to deal with these deficiencies at a large scale. In India, only 60 percent of children aged 9-59 months received Vitamin-A supplements in 2015-16, and 13 out of 36 states are lagging behind the national average including some larger states and the north-eastern states. In terms of fortification, around 93 percent of households were using iodized salt in 2015-16 which is very positive.<br /> <br /> • <strong>Anaemia Prevalence:</strong> Iron deficiency anaemia remains a major public health concern in India where half of women 15-49 years of age are anaemic, regardless of age, residence or pregnancy status. In the last decade, anaemia among women of reproductive age decreased by only 2.3 percentage points; an annual decline of 0.4 percent. In 2015-16, the prevalence of anaemia is much higher among women (53.1 percent) than men (23.3 percent). In 2015-16, 58.5 percent children aged 6-59 months were anaemic compared to 69.5 percent in 2005-06. The prevalence of anaemia is highest among children in Haryana (71.7 percent), followed by Jharkhand (69.9 percent) and Madhya Pradesh (68.9 percent). Several union territories have even higher prevalence of anaemia: Dadra and Nagar Haveli (84.6 percent), Daman & Diu (73.8), and Chandigarh (73.1 percent). Mizoram was the only state in 2015-16 having ‘mild’ level of anaemia prevalence according to WHO thresholds, followed by Manipur. A district level analysis shows that almost all the districts fall in to the ‘severe’ (more than 40 percent) category, very few in ‘moderate’ (20-39.9) category and around 10 districts in ‘mild’ (5-19.9) category.<br /> <br /> • <strong>Double Burden of Malnutrition:</strong> For several decades India was dealing with only one form of malnutrition -- undernutrition. However, in the last decade, the double burden which includes both over- and undernutrition, is becoming more prominent and poses a new challenge for India. From 2005 to 2016, prevalence of low (< 18.5 kg/m2) body mass index (BMI) in Indian women decreased from 36 percent to 23 percent and from 34 percent to 20 percent among Indian men. However, during the same period, the prevalence of overweight/ obesity (BMI > 30 kg/m2) increased from 13 percent to 21 percent among women and from 9 percent to 19 percent. Children born to women with low BMI are more likely to be stunted, wasted, and underweight compared to children born to women with normal or high BMI.<br /> <br /> • <strong>Socio-Economic Determinants of Malnutrition among Children: </strong>Just over half the children born to mothers with no schooling are stunted, compared with 24 percent of children born to mothers with 12 or more years of schooling. The prevalence of underweight in children with uneducated mothers is 47 percent compared to 22 percent for those whose mothers have some education. By wealth quintile, the prevalence of malnutrition decreases steadily with increased wealth. Malnutrition is relatively more prevalent among Scheduled Tribes than Scheduled Castes at national level, while considerable variation exists between states. There is a strong negative correlation between stunting and improved sanitation.<br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> As per the [inside]Global Nutrition Report 2018[/inside]: Shining a light to spur action on nutrition, please click <a href="https://globalnutritionreport.org/reports/global-nutrition-report-2018/">here</a> and <a href="tinymce/uploaded/India%20Profile.pdf" title="India profile">here</a> to access: <br /> <br /> • There are three countries, which are home to almost half (47.2 percent) of all stunted children: India, Nigeria and Pakistan. The three countries with the largest number of children who are stunted are India (46.6 million), Nigeria (13.9 million) and Pakistan (10.7 million). The three countries with the most children who are wasted are almost the same ones – India (25.5 million) and Nigeria (3.4 million) but also Indonesia (3.3 million).<br /> <br /> • China, Indonesia, India, Egypt, US, Brazil and Pakistan have more than a million overweight children each.<br /> <br /> • The India specific profile of the Global Nutrition Report 2018 shows that there has been some progress made by the country to reduce the prevalence of stunting among children below 5 years. However, there is no progress (or there is worsening) made by the country to reduce the prevalence of wasting among children below 5 years, prevalence of anaemia among women of reproductive age (WRA), prevalence of both adult male and female obesity, and prevalence of both adult male and female diabetes.<br /> <br /> • Nearly 6.3 percent of children under 5 years of age are both stunted and wasted.<br /> <br /> • India is among 26 countries which is affected by both anaemia and stunting.<br /> <br /> • The International Food Policy Research Institute (IFPRI) used district-level aggregate data from the 2015–2016 National and Family Health Survey covering 6,01,509 households in 604 districts in the country so as to understand the causes of the spatial variation.<br /> <br /> • India holds almost a third (31 percent) of the world’s burden for stunting, and because the country is so diverse from state to state, it is important to understand how and why stunting prevalence differs. Researchers used mapping and descriptive analyses to understand spatial differences in distribution of stunting. The mapping showed that stunting varies greatly from district to district (12.4 percent to 65.1 percent), with 239 of 604 districts having stunting levels above 40 percent.<br /> <br /> • Using regression decomposition models, the study compared districts with low (less than 20 percent) versus high (more than 40 percent) burdens of stunting and explained over 70 percent of the difference between high and low-stunting districts. The study found that factors such as women's low BMI accounted for 19 percent of the difference between the low versus high-burden districts.<br /> <br /> • Other influential gender-related factors included maternal education (accounted for 12 percent), age at marriage (7 percent) and antenatal care (6 percent). Children’s diets (9 percent), assets (7 percent), open defecation (7 percent) and household size (5 percent) were also influential. This study is important in that it reinforced the multisectoral nature of stunting by highlighting that differences between districts were explained by many factors associated with gender, education, economic status, health, hygiene, and other demographic factors. India’s national nutrition strategy – which is focused on addressing district-specific factors – draws on analyses such as these along with district-specific nutrition profiles to enable diagnostic work and policy action to reduce inequalities and childhood stunting.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">The Urban HUNGaMA (Hunger and Malnutrition) Survey Report was released in February, 2018. Naandi Foundation carried out this survey in India’s ten most populous cities – Mumbai, Delhi, Bengaluru, Hyderabad, Ahmedabad, Chennai, Kolkata, Surat, Pune and Jaipur to measure the nutrition status of children aged 0-59 months. These 10 cities account for 5.3 percent of India’s population and 4.1 percent of the child population aged 0-71 months. The survey also provides estimated percentages of stunting, underweight, wasting and overweight by city and separately for boys and girls.<br /> <br /> A total of 12,286 mothers were interviewed and 14,616 children aged 0-59 months measured for height and weight. The Urban HUNGaMA Survey presents underweight, stunting and wasting data of children.<br /> <br /> The survey was carried out between April and July 2014. It used a three-stage systematic sampling methodology to select a representative sample of 11,955 households.<br /> <br /> According to the document entitled [inside]Urban HUNGaMA Report: Nutrition and the City (released in February 2018)[/inside], prepared by Naandi Foundation and others, please <a href="tinymce/uploaded/Urban-Hungama-Report.pdf" title="Urban-Hungama-Report">click here</a> to access: <br /> <br /> • The proportion of children born with low birth weight (i.e. less than 2.5 kg) was 15.7 percent, ranging from 13.5 percent in Hyderabad to 25.1 percent in Kolkata.<br /> <br /> • In all, 22.3 percent of children under five years of age were stunted (chronic under-nutrition) and 7.6 percent were severely stunted.<br /> <br /> • The prevalence of stunting ranged from 14.8 percent in Chennai to 30.6 percent in Delhi. It was significantly higher among children whose mothers had five years of schooling or less (35.3 percent compared to 16.7 percent among children whose mothers had 10 or more years of schooling) and children from households in the lowest wealth quintile (29.3 percent compared to 15.0 percent among children from households in the highest wealth quintile).<br /> <br /> • Overall, 13.9 percent of children were wasted (acute under-nutrition) and 3.2 percent were severely wasted.<br /> <br /> • The prevalence of wasting ranged from 10.8 percent in Jaipur to 19.0 percent in Mumbai.<br /> <br /> • As in the case of stunting, the prevalence of wasting was significantly higher among children whose mothers had five years of schooling or less (17.6 percent compared to 12.2 percent among children of mothers with 10 or more years of schooling) and children from households in the lowest wealth quintile (16.7 percent compared to 10.5% among children from households in the highest wealth quintile).<br /> <br /> • The prevalence of overweight in children was 2.4 percent, ranging from 0.7 percent in Hyderabad to 3.7 percent in Chennai.<br /> <br /> • The prevalence of overweight was significantly higher among children from the highest wealth quintile (3.6 percent compared to 1.8 percent among children from households in the lowest wealth quintile).<br /> <br /> • The Ministry of Health and Family Welfare, Government of India has issued recommendations on infant and young child feeding (IYCF) practices, and the survey revealed sub-optimal compliance with those recommendations: 37.7 percent of children aged 0-23 months were breastfed within one hour of birth (ranging from 13.3 percent in Jaipur to 66.8 percent in Chennai); 30.47 percent of children aged 0-5 months were exclusively breastfed (ranging from 12.0 percent in Chennai to 38.7 percent in Kolkata); 45.2 percent of children aged 6-8 months were fed complementary foods (ranging from 29.1 percent in Jaipur to 70.5 percent in Chennai); 47.2 percent of children aged 6-23 months met the standard of minimum meal frequency (ranging from 21.8 percent in Delhi to 88.8 percent in Mumbai); and 37.8 percent of children aged 6-23 months received at least a minimum number of food groups (dietary diversity) (ranging from 22.7 percent in Ahmedabad to 59.4 percent in Kolkata).<br /> <br /> • On indicators of minimum dietary requirements (breastmilk/ milk, minimum meal frequency, and minimum dietary diversity) 22.5 percent of children aged 6-23 months were fed in accordance with all three (ranging from 9.7 percent in Surat to 47.3 percent in Kolkata).<br /> <br /> • In the 10 most populous cities of India, one in four children has stunted growth and development due to chronic nutrition deprivation.<br /> <br /> • Poor infant and young child feeding practices, compounded by the poor status of women, the prevalence of household poverty and lack of government service delivery centre seem to be three major drivers of stunting among urban children.<br /> <br /> • Less than one in four children (22.5 percent) were fed a diet that meets the minimum requirements for healthy growth and development.<br /> <br /> **page**</p> <p style="text-align:justify"><br /> The key findings of the report entitled [inside]Diet and Nutritional Status of Urban Population in India and Prevalence of Obesity, Hypertension, Diabetes and Hyperlipidemia in Urban Men and Women (released in 2017)[/inside], National Nutrition Monitoring Bureau (NNMB) Technical Report no. 27, National Institute of Nutrition (NIN), (please <a href="https://im4change.org/docs/555NNMB%20Urban%20Nutrition%20survey%20report.pdf">click here</a> to access), are as follows:<br /> <br /> • The overall prevalence of underweight, stunting and wasting among urban children below 5 years during 2015-16 was 25.1 percent, 28.7 percent and 16.0 percent, respectively.<br /> <br /> • The prevalence of underweight in urban children below 5 years age was highest in Uttar Pradesh (43.6 percent), followed by Madhya Pradesh (32.3 percent), Maharashtra (31.0 percent), West Bengal (25.4 percent) and Bihar (25.2 percent).<br /> <br /> • The prevalence of stunting in urban children below 5 years age was highest in Uttar Pradesh (40.8 percent), followed by Maharashtra (36.4 percent), New Delhi (35.7 percent), West Bengal (34.4 percent) and Madhya Pradesh (34.1 percent). <br /> <br /> • The prevalence of underweight among ST, SC, OBC and others urban male children below 5 years age was 32.4 percent, 32.6 percent, 25.8 percent and 21.0 percent, respectively.<br /> <br /> • The prevalence of stunting among ST, SC, OBC and others urban male children below 5 years age was 34.4 percent, 39.4 percent, 27.8 percent and 26.8 percent, respectively.<br /> <br /> • The prevalence of wasting among ST, SC, OBC and others urban male children below 5 years age was 17.4 percent, 18.0 percent, 16.9 percent and 13.7 percent, respectively.<br /> <br /> • The prevalence of underweight among ST, SC, OBC and others urban female children below 5 years age was 25.2 percent, 31.7 percent, 25.8 percent and 20.1 percent, respectively.<br /> <br /> • The prevalence of stunting among ST, SC, OBC and others urban female children below 5 years age was 33.1 percent, 33.4 percent, 26.4 percent and 25.6 percent, respectively.<br /> <br /> • The prevalence of wasting among ST, SC, OBC and others urban female children below 5 years age was 13.6 percent, 17.5 percent, 16.6 percent and 12.6 percent, respectively.<br /> <br /> • In urban areas the proportion of underweight, stunting and wasting is highest among those boys (below 5 years) who belong to households without any access to sanitary latrines i.e. 43.0 percent, 50.2 percent and 22.0 percent, respectively. The proportion of under-nutrition (for all 3 categories i.e. underweight, stunting and wasting) is lowest among those boys (below 5 years) who belong to households having and using sanitary latrines.<br /> <br /> • In urban areas, the proportion of underweight, stunting and wasting is highest among those girls (below 5 years) who belong to households without any access to sanitary latrines i.e. 40.5 percent, 44.6 percent and 19.7 percent, respectively. The proportion of under-nutrition (for all 3 categories i.e. underweight, stunting and wasting) is lowest among those girls (below 5 years) who belong to households having and using sanitary latrines.<br /> <br /> • Almost 82.0 percent of surveyed households in urban areas possess sanitary latrines. The proportion of urban households having sanitary latrines was highest in Kerala (99.0 percent), followed by Rajasthan (95.6 percent), Gujarat (90.7 percent) and Puducherry (90.3 percent). The proportion of urban households having sanitary latrines was lowest in West Bengal (51.6 percent), followed by Uttar Pradesh (69.8 percent), New Delhi (70.4 percent) and Maharashtra (75.2 percent).<br /> <br /> • The average household consumption of cereals and millets in urban areas was 69.6 percent of the Recommended Daily Intake (RDI). Similarly, the average household consumption of green leafy vegetables in urban areas was 59.5 percent of the RDI. <br /> <br /> • In urban areas, the average household consumption of protein, energy, calcium, iron, vitamin A, thiamin, riboflavin, and niacin was 89.8 percent, 83.2 percent, 67.0 percent, 77.6 percent, 22.8 percent, 83.3 percent, 50.0 percent, and 61.3 percent of the Recommended Dietary Allowance (RDA), respectively. <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">The key findings of the NITI Aayog report entitled [inside]Nourishing India: National Nutrition Strategy[/inside] (please <a href="tinymce/uploaded/Nutrition_Strategy_Booklet.pdf" title="National Nutrition Strategy">click here</a> to access) are as follows:<br /> <br /> • Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per National Family Health Survey-4 (NFHS-4) 2015-16.<br /> <br /> • As evident, while stunting and underweight prevalence has gone down, trends in wasting show an overall increase in the last decade. The decrease in stunting has been from 48% to 38.4%, that is, by 1 percentage point per year. Similarly, underweight prevalence has reduced by 0.68 percentage points from NFHS-3 to NFHS-4. Recent data, especially for challenging states is promising, suggestive of acceleration.<br /> <br /> • There has been a 16% decrease in the underweight prevalence among children below 5 years. Underweight prevalence in children under 5 years (composite indicator of acute and chronic undernutrition) has declined in all the states and UTs (except Delhi), although absolute levels are still high. Remarkable reductions are seen in Himachal Pradesh (by 41.9%), Meghalaya, Mizoram, Arunachal Pradesh (by 40%), Tripura (by 39%) and Manipur (by 37.8%); whereas Maharashtra, Goa, Karnataka, Uttar Pradesh and Rajasthan show near stagnation.<br /> <br /> • Recent findings from NFHS-4 (2015-16) highlight that stunting in children under 5 years has reduced in all the states, although absolute levels are still high in some states.<br /> <br /> • Most significant reductions in stunting are seen in Arunachal Pradesh (by 32.10%), Tripura (by 31.92%), Himachal Pradesh (by 31.86%), Punjab (by 29.9%) and Mizoram (by 29.6%). Reductions by more than 25% are also seen in the case of Chhattisgarh, West Bengal, Nagaland, Maharashtra and Haryana, Gujarat. While the overall prevalence of stunting has gone down, in terms of absolute values, it continues to remain high in Bihar, Uttar Pradesh, Jharkhand, Meghalaya, Madhya Pradesh and Dadra & Nagar Haveli, where more than 40% of the children remain stunted.<br /> <br /> • Findings from NFHS-4 (2015-16) highlight that wasting in children under 5 years (weight-for-height) or acute malnutrition is still high, with levels above 25 % in Jharkhand (29%), Dadra & Nagar Haveli (27.6%), Gujarat (26.4%), Karnataka (26.1%), Madhya Pradesh (25.8%) and Maharashtra (25.6%). Significant reductions are seen in Meghalaya (by 50%), Mizoram (by 32.33%), Tripura (by 31.7%), Himachal Pradesh (by 29.01%) and Madhya Pradesh (by 26.28%); although absolute values remain high. Sharp increase in the incidence of child wasting is seen in Punjab, Goa, Maharashtra, Karnataka and Sikkim.<br /> <br /> • As per NFHS-3, levels of severe wasting or severe acute malnutrition in children (0-5 years) were 6.4% for India. Data from NFHS-4 shows an overall increase in the levels of severe wasting to 7.5%. The level of severe wasting has increased in most of the states/ UTs and only 10 States/ UTs (Meghalaya, Madhya Pradesh, Tripura, Delhi, Himachal Pradesh, Bihar, Mizoram, Nagaland, Tamil Nadu and Jharkhand) have witnessed a decrease in the levels of severe stunting. States/UTs with the highest incidence of severe wasting are Daman & Diu (11.9%), Jharkhand (11.4%), Dadra & Nagar Haveli (11.4%), Karnataka (10.5%), Gujarat (9.5%) and Goa (9.5%).<br /> <br /> • As per NFHS-3, every third woman in India was undernourished (35.5 % with low Body Mass Index) and every second woman (15-49 years) was anemic (55.3%). About 15.8 % were moderately to severely thin, with BMI less than 17. Bihar (45%), Chhattisgarh (43%), Madhya Pradesh (42%) and Odisha (41%) were the states with the highest proportion of undernourished women.<br /> <br /> • Recent findings from NFHS-4 (2015-16) highlight that nutritional status of women and girls (in the age group 15-49 years) has improved for all states. Overall, there has been a decrease from 35.5% (NFHS-3) to 22.9% (NFHS-4) in the prevalence of women with low BMI. The decrease has been by almost 50% in the states of Tripura, J&K, Haryana, Tamil Nadu and Kerala.<br /> <br /> • The level of anemia among women and girls has stagnated over the last decade from 55.3% in NFHS-3 to 53% in NFHS-4. In terms of percentage points, States which have witnessed maximum decrease in the levels of anemia are- Sikkim (24.6), Assam (23.3), Mizoram (15.6), J&K (11.7), Tripura (10.6) and Chhattisgarh by 24.6 (10.5). Alternatively, 8 States/ UTs (Punjab, Himachal Pradesh, Meghalaya, Delhi, Haryana, Uttar Pradesh, Tamil Nadu and Kerala) have seen an increase in the prevalence of anemia.<br /> <br /> • Overall, the Total Fertility Rate (TFR) or the average number of children per woman has also gone down from 2.7 in NFHS-3 to 2.2 in NFHS-4.<br /> <br /> • More and more women now give birth in health care facilities and rates have more than doubled in the last decade in some states like Chhattisgarh (by as much as 390%), Jharkhand (by 238%), Uttar Pradesh (by 229%), Bihar (by 220%), Assam (by 215%), Madhya Pradesh (by 208%) and Rajasthan (by 183%). However, in terms of absolute values, institutional births continues to remain extremely low in Nagaland (32.8%), Meghalaya (51.4%), Arunachal Pradesh (52.3%), Jharkhand (61.9%) and Bihar (63.8%), which are the bottom five states with respect to institutional births.<br /> <br /> • The number of pregnant women receiving more than 4 Antenatal Care (ANC) visits has also gone up by 38.37% in the last decade, from 37% in NFHS-3 to 51.2% in NFHS-4. States which have shown remarkable improvement in providing ANC to pregnant women are Uttar Pradesh, Chhattisgarh, Assam, West Bengal, Odisha, Jharkhand and Rajasthan, although in terms of absolute values, the percentage of women receiving ANC continues to remain low. ANC visits have gone down in Uttarakhand, Tamil Nadu, Goa and Kerala over the last decade.<br /> <br /> • There has been improvement in the early initiation of breastfeeding rate, from 23.4% in NFHS-3 to 41.6% in NFHS-4. The figure varies from 73.3% in Goa to merely 25.2% in Uttar Pradesh. Similarly, there has been an overall improvement over NFHS-3 levels in children under six months who were exclusively breastfed, from 46.3% to 54.9%. States which have shown maximum improvements in terms of percentage point are Goa (by 43.2%), Himachal Pradesh (by 40%), Madhya Pradesh (by 36.6%), Tripura (by 34.6%), and Haryana (by 33.4%); while Kerala, Arunachal Pradesh, Karnataka, Chhattisgarh, West Bengal and Uttar Pradesh recorded a decrease in the percentage of children under six months who were exclusively breastfed.<br /> <br /> • Children aged between 6-8 months receiving solid or semi-solid food and breastmilk has gone down from 52.6% to 42.7%. In fact, most of the states/ UTs have witnessed a decrease in the percentage of children receiving solid or semi-solid food and breastmilk. States/ UTs that have recorded maximum dip are Kerala, Arunachal Pradesh, Bihar, Karnataka and Sikkim.<br /> <br /> • NFHS-4 findings reveal that around 26.8 percent of currently married women in the age-group 20-24 years were married before attaining the age of 18 years.<br /> <br /> • As per NFHS-4, 60.2% children aged 9-59 months received the six monthly Vitamin A supplement in the six months before the survey. However, inter-state variation in Vitamin A Supplementation for children aged 9-59 months continues with Goa at 89.5% and Nagaland at 27.1%.<br /> <br /> • Anemia is a major health problem affecting 53% of women (15-49 years) and 22.7% of men in India as per NFHS-4. 50.3% of pregnant women were found to be anaemic, as per NFHS-4.<br /> <br /> • As per NFHS-4, 93.1% households were using salt that was adequately iodized; others were using salt that was either inadequately iodized or was not iodized at all.<br /> <br /> • As per NFHS-4, the percentage of children with diarrhea in the last 2 weeks preceding the survey who received zinc supplementation is found to be 20.3%. However, inter-state variation in the ‘children with diarrhea in the last two weeks who received zinc’ continues with Puducherry at 69.6% and Andaman and Nicobar Islands at 8.3%.<br /> <br /> • In India, annually, it is estimated (as on 2011) that about 1.45 million children die before completing their fifth birthday (MHFW). Currently the mortality rate in children under 5 years is 50, as per NFHS-4. The Infant Mortality Rate is 37 i.e. 37 out of 1000 infants die in the first year of life as reported in SRS Report 2015. Current trends highlight the need to accelerate reductions in neonatal mortality- as this constitutes around two thirds of infant mortality and around half of under-5 child mortality. Maternal mortality also needs to be addressed as maternal mortality continues to be high with MMR at 167 (SRS 2011-13, RGI Special Bulletin on Maternal Mortality 2013).<br /> <br /> • NFHS-4 (2015-16) shows that there have been promising gains in child health care. The immunization rates have gone up. The number of children aged 12-23 months who were fully immunized (BCG, measles and 3 doses each of Polio and DPT) has gone up from 43.5% in NFHS-3 to 62% in NFHS-4. In terms of percentage points, maximum increase is seen in Punjab, Bihar, Meghalaya, Rajasthan and Uttar Pradesh. However, the number of children receiving full immunization has gone down in Tamil Nadu, Himachal Pradesh, Haryana, Maharashtra and Uttarakhand.<br /> <br /> • Prevalence of symptoms of Acute Respiratory Infection (ARI) has also gone down from 5.8% in NFHS-3 to 2.7% in NFHS-4. However, inter-state variation continues with Meghalaya at 5.8% and Sikkim at 0.3 with respect to the prevalence of ARI.<br /> <br /> • Occurrence of diarrhea among children has slightly increased over the last decade, from 9% in NFHS-3 to 9.2% in NFHS-4. Interstate variation in the prevalence of diarrhea continues with 17% in Uttarakhand to 1.8% in Sikkim. States which have shown maximum improvements in curbing diarrhea are Uttar Pradesh, Meghalaya, Uttarakhand and Chhattisgarh. However, in terms of absolute numbers, diarrhea among children continues to remain a challenge in Uttarakhand, Uttar Pradesh, Puducherry and Meghalaya.<br /> <br /> • NFHS-4 (2015-16) shows that families are now more inclined to use improved water and sanitation facilities. Over two-thirds of households in every State/UT (except Manipur) have access to an improved source of drinking water, and more than 90% of households have access to an improved source of drinking water in 19 states/Union Territories. More than 50% of households have access to improved sanitation facilities in 26 states/Union Territories. Similarly, in 20 States/ UTs, more than 50% households use clean cooking fuel, which reduces the risk of respiratory illness and pollution.<br /> <br /> • Even today, it is estimated that 48% of India’s population defecates in the open. Out of the total of one billion people defecating in the open across the world, an estimated 59.7% (597 million) reside in India (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).<br /> <br /> • As per Census 2011, the rural household toilet coverage stands at 32.7% and urban household toilet coverage stands at 87.4%. Open defecation is linked to the presence or absence of household-level sanitation infrastructure and the absence of household toilet coverage is presumed to be the percentage of Open Defecation. (Report of the Sub Group of Chief Ministers on Swachh Bharat Abhiyan 2015).<br /> <br /> • As per Census 2011, 53.1% households did not have latrines as compared to 63.6 % households in Census 2001. As per the Base Line Survey conducted by MDWS in 2012, about 40.23% of Households were having ndividual Household Latrines (IHHLs). Only 28002 (i.e. 11.19%) against total number of 250292 Gram Panchayats in the Country had achieved the status of Nirmal Gram, whereas the 12th Five Year Plan had aimed at ensuring that 50% of the Gram Panchayats attain Nirmal Gram status by the year 2017.<br /> <br /> • NFHS-4 reports that overweight/ obesity has affected almost 20.7% women and 18.6% men, mostly located in urban areas, in wealthier households and among older adults. It is seen that over nutrition is becoming an emerging issue, with Chandigarh and Lakshadweep indicating the prevalence of overweight women or obesity in women by more than 40%.<br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">As per the [inside]Global Nutrition Report 2016[/inside], which has been prepared by International Food Policy Research Institute (IFPRI),<br /> <br /> Please click <a href="tinymce/uploaded/Global%20Nutrition%20Report%202016.pdf" title="Global Nutrition Report 2016">link1</a> to access, click <a href="tinymce/uploaded/Synopsis%20Global%20Nutrition%20Report%202016.pdf" title="Synopsis Global Nutrition Report 2016">link2</a> to access:<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • The proportion of calories from non-staples in India is 40 percent, which is low as compared to that of China (48 percent). <br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • The prevalence of diabetes among adult population in India is 9.5 percent, which is the same as in China.<br /> <br /> • The prevalence of adult obesity in India is 4.9 percent, which is low as compared to China (6.9 percent).<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • Rapid increases in spending, and consequent improvements in nutrition, are possible, as places like the Indian state of Maharashtra have shown for undernutrition.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • Assets, women’s education, and open defecation are key factors behind stunting in India.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • 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).<br /> <br /> • 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.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">• 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.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> According to the report entitled [inside]India Health Report: Nutrition 2015[/inside] by Public Health Foundation of India, Transform Nutrition and UK Aid (please <a href="tinymce/uploaded/India%20Health%20Report%20PHFI.pdf" title="India Health Report 2015 PHFI">click here</a> to access):<br /> <br /> • According to recent data from the Rapid Survey on Children-2014 (RSOC-2014), 38.7 percent of Indian children under the age of five years are stunted, 19.8 percent are wasted, and 42.5 percent are underweight. Stunting (low height for age) is a measure of chronic undernutrition; wasting (low weight for height) indicates acute undernutrition; and underweight (low weight for age) is a composite of these two conditions. <br /> <br /> • Stunting rates in under-three children declined by only 8 percentage points in more than a decade in this age-group -- from 53 percent in 1992-93 to 45 percent in 2006 -- reflecting an average annual rate of decline of 1.2 percent. During this period, wasting declined by 1 percentage point and underweight by 8 percentage points. However, the rate of progress accelerated since National Family Health Survey-3 (NFHS-3), and India's average annual rate of under-5 stunting decline between 2006 and 2014 has been 2.3 percent per year, compared with a rate of decline of 1.2 percent per year between 1992 and 2006. <br /> <br /> • The faster annual rate of reduction in stunting since 2006 i.e. 2.3 percent per year means that the rate of decline in India is finally approaching the rate of decline in other countries with similar levels of stunting, but this is not enough. Between 2011 and 2014, for instance, Nepal had a 3.3 percent average annual rate of decline in stunting rates compared to 2.3 percent in India. However, the rate of reduction in India is now similar to that of Bangladesh and Ethiopia (2.3 percent annual rate of decline in both countries). At this rate, India will achieve the current stunting rate of Ghana or Togo only by 2030, and the current stunting rate of China (10 percent) only in 2055. <br /> <br /> • Undernutrition is worse among children in scheduled castes (SCs) and scheduled tribes (STs). The RSOC highlights that stunting is about 9 percentage point higher in these groups, compared to higher caste groups (42 percent versus 33 percent). Underweight is highest among ST groups, with almost a 15 percentage point difference between ST children and children from "other" castes (37 percent versus 23 percent). Similarly, wasting is about 5 percentage point higher for ST groups (19 percent versus 14 percent). Analyses, using NFHS-3 surveys suggest that nutritional status of SC and ST children is lower than children of "other" caste groups at similar levels of wealth and mother's education. <br /> <br /> <em>Stunting</em><br /> <br /> • Eight states in India have under-5 stunting rates that exceed the national average: Uttar Pradesh, Bihar, and Jharkhand have stunting rates close to 50 percent, while Chhattisgarh, Meghalaya, Gujarat, Madhya Pradesh and Assam have stunting rates between 40 and 45 percent. Stunting rates in Kerala and Goa, which are 19.4 percent and 21.3 percent, respectively, are among the lowest in the country. All other states range between 20 and 40 percent.<br /> <br /> • All 29 states covered by the NFHS-3 and RSOC showed a reduction in stunting between 2006 and 2014. However, rates of progress vary tremendously. Six states, mainly in the northern and northeastern regions of India (Tamil Nadu, Mizoram, Sikkim, Arunachal Pradesh, Nagaland and Delhi) achieved an average annual rate of decline of more than 3 percent between 2006 and 2014 while Jharkhand, Manipur and Jammu & Kashmir, along with Uttar Pradesh and Bihar, showed slow rates of decline during this period.<br /> <br /> <em>Wasting</em><br /> <br /> • The national prevalence of children under age five years who are wasted is 15.1 percent according to RSOC (2014). 13 states have wasting levels higher than the national average: West Bengal, Goa, Kerala, Jharkhand, Arunachal Pradesh, Tripura, Madhya Pradesh, Karnataka, Odisha, Maharashtra, Gujarat, Andhra Pradesh and Tamil Nadu have the highest percentage of severely wasted children, whereas Sikkim has the lowest percentage of wasted as well as severely wasted children.<br /> <br /> <em>Underweight</em><br /> <br /> • The proportion of underweight children under age 5 ranges from 14.1 percent in Manipur to 42.1 percent in Jharkhand. Severe underweight prevalence varies between 2 percent in Goa and 16.8 percent in Tripura.<br /> <br /> • Recent national-level data on burden of overweight and obesity among children and adults are not available, but available estimates range between 4.3 and 15.3 percent in urban areas.<br /> <br /> <em>Anaemia</em><br /> <br /> • In 8 out of the 17 states covered by District Level Household and Facility Survey-4 (DLHS-4), more than 70 percent of children aged 6-59 months have anaemia. Similarly, more than half of Indian women in their child-bearing years, aged 15-49 years, in 13 states have anaemia. Anaemia prevalence ranges from 76.3 percent in West Bengal to 32.7 percent in Kerala.<br /> <br /> • With little change over time, 75 percent of children under five years and over half of women of child-bearing age are anaemic.<br /> <br /> <em>Breastfeeding and complementary feeding</em><br /> <br /> • Recent RSOC data indicate that 45 percent children were breastfed within 24 hours after birth (compared to 25 percent in NFHS-3) and 65 percent of children aged 0-5 months were exclusively breastfed (compared to 47 percent in NFHS-3). Rates of timely initiation of complementary feeding between 6 and 8 months of age appears to have declined slightly between NFHS-3 and RSOC, with only about half of children aged 6-8 months were being fed complementary foods in 2014, compared to 56 percent in 2006. <br /> <br /> • India's more than 65 million diabetics account for 17 percent of all diabetics in the world, and diabetes in India continues to rise.<br /> <br /> • The prevalence of Vitamin A deficiency is 57 percent among children under five years. Goiter (caused by iodine deficiency) affects 26 percent of total population and 19 percent of school-aged children.<br /> <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the [inside]2015 Global Nutrition Report: Actions and Accountability to Advance Nutrition & Sustainable Development by IFPRI (released in September 2015)[/inside] (please <a href="tinymce/uploaded/global%20nutrition%20report%202015.pdf" title="Global nutrition report 2015">click here</a> to access):<br /> <br /> • A new national survey—the Rapid Survey on Children (RSOC), conducted in 2013–2014 by the government and UNICEF—found that stunting had fallen from 48 percent in 2005–2006 to 39 percent in 2014.<br /> <br /> • India’s 2013–2014 Rapid Survey of Children (RSOC) provides important new data, although the survey results are still preliminary. The preliminary data suggest that India has accelerated its progress on stunting, wasting, and exclusive breastfeeding compared with results from the previous two surveys.<br /> <br /> • New government data show that nearly all Indian states posted significant declines in stunting rates from 2006 to 2014, and all showed strong increases in exclusive breastfeeding rates over the same period.<br /> <br /> • Nearly all states in India showed significant declines in child stunting between 2006 and 2014. However, three states with very high rates in 2006—Bihar, Jharkhand, and Uttar Pradesh—showed some of the slowest declines. Changes in wasting rates are more variable across states (See chart 1).<br /> <br /> <strong>Chart 1: Stunting rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Stunting rate" src="tinymce/uploaded/Stunting%20rate.jpg" style="height:162px; width:361px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015)</em><br /> <br /> • The states with high levels of stunting do no worse in decreasing stunting than other states. However, Bihar, Jharkhand, and Uttar Pradesh are of particular concern, with high initial rates of stunting and subsequent declines in stunting that are lower than most other states (see chart 1).<br /> <br /> <strong>Chart 2: Wasting rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Wasting Rate" src="tinymce/uploaded/Wasting%20rate.jpg" style="height:135px; width:362px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015)</em><br /> <br /> • While most states show declines in wasting, not all do. Arunachal Pradesh, Maharashtra, Andhra Pradesh, Goa, and Mizoram show increases in wasting, although the increases for the first two are marginal. These figures should be viewed with caution because wasting rates vary by season even more than stunting rates do. More research is needed to understand why progress in reducing wasting in India appears to be so uneven (see chart 2).<br /> <br /> <strong>Chart 3: Exclusive breastfeeding rates in 2005–2006 and 2013–2014 in 29 Indian states</strong><br /> <img alt="Exclusive Breastfeeding rate" src="tinymce/uploaded/Exclusive%20breastfeeding%20rate.jpg" style="height:179px; width:474px" /><br /> <br /> <em><strong>Source: </strong>2015 Global Nutrition Report, based on data from India, Ministry of Women and Child Development (2015) </em><br /> <br /> • The all-India rate of exclusive breastfeeding has increased from 46 to 65 percent. In 2005–2006 only five states had rates of 60 percent or higher. Now 17 states have breastfeeding rate of 60 percent or above. Equally important, states with the lowest rates in 2005–2006 have achieved rates in the 60–70 percent range. Bihar, the worst ranked state in 2005–2006, quadrupled its rate of exclusive breastfeeding and is now ranked above 16 other states (see chart 3).<br /> <br /> • The prevalence of obesity among both the sexes in India has increased from 4.0 percent in 2010 to 4.9 percent in 2014. Among males, the prevalence of obesity has increased from 2.5 percent to 3.2 percent between 2010 and 2014. Among females, the prevalence of obesity has increased from 5.6 percent to 6.7 percent between 2010 and 2014.<br /> <br /> • The height of young children in India, for example, varies significantly by the month of their birth. Compared with children born in December, those born in the summer and monsoon months (April–September) have significantly lower height for their age.<br /> <br /> • If there are too many data that are incompatible, then the guidance to action, and accountability for delivering on action, quickly become confusing. India undertook 14 major nutrition surveys between 1992 and 2014, but taken together these surveys provide few opportunities for consistent tracking over time at the national level. In short, more data does not always generate greater clarity to guide action. Data also need to be consistently collected over time, as shown by case study of India. <br /> <br /> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify">Please <a href="https://im4change.org/news-alerts/govt-shows-laxity-in-battle-against-malnutrition-4676337.html">click here</a> to access the key findings of the [inside]Public Accounts Committee (2014-15) report on ICDS Scheme of Ministry of Women & Child Development[/inside], PAC no. 2045, Fourteenth Report (presented to Lok Sabha on 27 April, 2015 and Rajya Sabha on 28 April 2015). Please <a href="tinymce/uploaded/Public%20Accounts%20Commitee%20report%20on%20ICDS.pdf">click here</a> to access the full PAC report on ICDS. </p> <p style="text-align:justify"> </p> <p style="text-align:justify">The NSS 68th Round Report entitled Nutritional Intake in India, 2011-12 (published in October 2014) is based on information collected during 2011-12 from 7469 villages and 5268 urban blocks spread over the entire country. Two different schedules were used to collect information on consumption, the first being canvassed in 101662 households and the second in 101651 households.</p> <p style="text-align:justify"><br /> The key findings of the NSS 68th Round Report entitled [inside]Nutritional Intake in India, 2011-12 (published in October 2014)[/inside], Report No. 560(68/1.0/3) are as follows (please <a href="http://mospi.nic.in/Mospi_New/upload/nss_report_560_19dec14.pdf">click here</a> to access):<br /> <br /> <br /> <strong><em>Intake of Dietary Energy (based on Schedule Type 2*) </em></strong><br /> <br /> • Average dietary energy intake per person per day was 2233 Kcal for rural India and 2206 Kcal for urban India. All the major States had per capita rural/urban levels of calorie intake within 11% (plus or minus) of the all-India rural/urban average.<br /> <br /> • In each sector average calorie intake increased steadily with monthly per capita expenditure (MPCE) class. The difference between the lowest fractile class (poorest 5% of population ranked by MPCE level) and the next fractile class (the next 5%) in per capita calorie intake was as high as 183 Kcal per day in rural India.<br /> <br /> • About 59.5% of the all-India rural population had energy intake in the range 80-120% of 2700 Kcal/consumer unit/day (a level used in NSS tabulation for comparisons), that is, 2160-3240 Kcal/consumer unit/day.<br /> <br /> • The all-India urban calorie intake distribution was similar to the rural, with slightly higher numbers of households in the top and bottom intake classes. Inter-State differences in energy intake distributions, especially at the lower end, were much less prominent in the urban sector of India than in the rural.<br /> <br /> • Among the bottom 5% of rural population ranked by MPCE, 57% of households had calorie intake below 2160 Kcal/consumer unit/day, the proportion falling to 39% for the next 5%, and continuing to fall until it dropped to only about 2% for the top 5% of population.<br /> <br /> • Similarly, the proportion of urban households with calorie intake below 2160 Kcal/consumer unit/day was 59% for the bottom 5% of population, falling to 47% for the next 5%, and reaching 1.6% for the top 5% of population.<br /> <br /> • The share of energy intake contributed by cereals was about 57% for rural India and 48% for urban India. The contribution of cereals varied across the major States from 42% (Punjab) to 70% (Odisha) in the rural sector and from 39% (Haryana) to 60% (Odisha and Bihar) in the urban sector.<br /> <br /> • The contribution of cereals to calorie intake was seen to fall progressively with rise in MPCE level, from 70% for the bottom 5% of population to 42% for the top 5% ranked by MPCE in rural India, and from about 66% to about 29% in urban India.<br /> <br /> • Non-cereal food contributed about 43% of calorie intake in rural India. The percentage break-up of this part of calorie intake (the part coming from non-cereal food) was: oils and fats: 22%; miscellaneous food, food products and beverages: 21%; milk and milk<br /> <br /> • Non-cereal food contributed about 52% of calorie intake in urban India. On the whole, the pattern of calorie intake from non-cereal food was similar in rural and urban areas, though the share of roots and tubers was, at 7%, somewhat lower.<br /> <br /> • The share of “milk and milk products” in calorie intake contributed by non-cereals, which was between 8% and 27% in the urban sector of all the major States, ranged from 3% to 36% in the rural sector, being 7% or less in 4 major States.<br /> <br /> • “Sugar and honey” usually had a higher contribution to calorie intake from non-cereal food in States with higher average levels of living.<br /> <br /> <strong><em>Intake of Protein and Fat (based on Schedule Type 2*) </em></strong><br /> <br /> • At the all-India level protein intake per person per day was 60.7gm in the rural sector and 60.3gm in the urban sector<br /> <br /> • The range of inter-State variation for major States was appreciably wider in the rural sector, where per capita intake per day varied from about 52gm (Chhattisgarh) to about 73gm (Haryana), than in the urban, where it varied from 55gm (Assam) to about 69gm (Haryana).<br /> <br /> • In some of the poorer States, protein intake was markedly lower in the rural sector than in the urban; examples are Jharkhand (rural: 54.7gm, urban: 60.3gm) and Chhattisgarh (rural: 51.7gm, urban: 55.8gm). On the other hand, in the States with the highest levels of protein intake, viz., Haryana, Rajasthan and Punjab, it was the rural population and not the urban that had higher protein intake (about 4-5gm higher).<br /> <br /> • Average protein intake per capita per day was seen to rise steadily with MPCE level in rural India from 43gm for the bottom 5% of population ranked by MPCE to 91gm for the top 5%, and in urban India from 44gm for the bottom 5% to about 87gm for the top 5%.<br /> <br /> • The share of cereals in protein intake was 58% for rural and 49% for urban India.<br /> <br /> • The share of milk and milk products in protein intake was 10% in rural India and 12% in urban India. It was highest in Haryana (rural: 27%; urban: 22%) and Punjab (rural and urban: 23%), and between 14% and 18% in Rajasthan and Gujarat. Among the 17 major States, these 4 States and Uttar Pradesh (rural: 11%; urban: 13%) were the only 5 States where the contribution of milk and milk products to protein intake was higher than the national average.<br /> <br /> • The share of meat, fish and egg in protein intake was only 7% in rural India and 9% in urban India. The share was 26% in both rural and urban Kerala, and was 10% or more in only 5 other major States: West Bengal, Assam, Andhra Pradesh, Tamil Nadu, and Karnataka.<br /> <br /> • The contribution of cereals to protein intake is seen to fall steadily with rise in MPCE from 72% for the bottom 5% of population to 42% for the top 5% in rural India and from 68% to 31% in urban India. On the other hand, the contribution of milk and milk products to protein intake is seen to rise from 3% for the bottom fractile class of population in the rural sector to 16% in the highest, and from 4% to 17% in the urban sector. The contribution of egg, fish and meat to protein intake, too, climbs quite noticeably across MPCE classes from 2% to 12% in rural India and from 4% to 11% in urban India.<br /> <br /> • Average fat intake for the country as a whole was about 46gm per person per day in the rural sector and 58gm in the urban sector. Considerable inter-State variation, however, existed, especially in rural India. In both sectors, per capita intake was lowest in Odisha and Assam. The States with highest fat intake were Haryana (rural: 69gm; urban: 75gm), Gujarat (rural: 62gm; urban: 73gm) and Punjab (rural: 70gm; urban: 69gm).<br /> <br /> • Urban fat intake per person per day exceeded rural intake by 9gm or more in nine of the major States and by more than 13gm in West Bengal and Jharkhand. Rural intake exceeded urban in only one major State – Punjab.<br /> <br /> • Per capita fat intake was about 100g in the top fractile class of the urban sector and about 27gm in the lowest fractile class. In the rural sector the intake of the top fractile class was 92gm while that of the bottom class was 21gm.<br /> <br /> • At all-India level, in contrast to the remarkable closeness of average protein intake across the rural-urban divide, average urban fat intake was noticeably higher than rural intake in all the fractile classes.<br /> <br /> <strong><em>Trends in Nutritional Intake (based on Schedule Type 1*) </em></strong><br /> <br /> • Comparison of estimates for India and the major States from NSS surveys between 1983 and 2011-12 shows calorie intake declining in both sectors after 1999-2000, the decline being sharper in the urban sector, but recovering again to regain a level of about 2100 Kcal per person per day in the rural sector and about 2060 Kcal in the urban in 2011-12. At the level of individual States, a rise in average calorie intake level between 2004-05 and 2011-12 is noted in rural areas of most of the major States.<br /> <br /> • The proportion of households with calorie intake under 2160 Kcal per consumer unit per day, which in both sectors increased over the period 1993-94 to 2004-05, is seen to have subsequently declined appreciably to reach about 20% in the rural sector and 23% in the urban. On the whole, the distribution of dietary energy intake appears to have experienced a reduction in dispersion since the 1990s.<br /> <br /> • Over the 18-year period from 1993-94 to 2011-12, the share of cereals in total calorie intake has declined by nearly 10 percentage points in the rural sector and nearly 7 percentage points in the urban. On the other hand, the share of oils and fats has risen by about 3½ percentage points in both sectors.<br /> <br /> • In rural India as a whole, protein intake per person per day has definitely declined since 1993-94. However, the decline at the all-India level shows signs of flattening out, being only 0.5gm less in 2011-12 compared to 2004-05. The decline in rural protein intake since 1993-94 has been prominent in Rajasthan (a fall of 11gm), Haryana (about 10gm), and Punjab (8gm). In the urban sector the decline between 1993-94 and 2011-12 is less marked than in the rural. In both sectors, all the southern States except Karnataka show slight increases in protein intake per person during this period.<br /> <br /> • An unmistakable rising trend in per capita fat intake is visible not only at all-India level but in every major State. For rural India the rise has been from 31.4gm per day in 1993-94 to 41.6gm in 2011-12 and for urban India, from 42.0gm to 52.5gm– a rise of over 10gm in both sectors over the 18-year period. In both sectors, all the major States show a rise ranging from 5-6gm to 17-18gm during this period.<br /> <br /> • Over the 18 years preceding 2011-12, the contribution of cereals to protein intake has fallen by about 7 percentage points in rural India and nearly 6 percentage points in urban India while the shares of the other major food groups have all risen slightly.<br /> <br /> <strong><em>* Note: </em></strong>The schedules of enquiry used were of two types. The two types had the same item break-up but differed in reference periods used for collection of consumption data. Schedule Type 1, as far as reference periods were concerned, was a repeat of the schedule used in most quinquennial rounds. For certain categories of relatively infrequently purchased items, including clothing and consumer durables, it collected information on consumption during the last 30 days and the last 365 days. For other categories, including all food and fuel and consumer services, it used a 30-days reference period. Schedule Type 2 used "last 365 days" (only) for the infrequently purchased categories, "last 7 days" for some categories of food items, as well as pan, tobacco and intoxicants, and "last 30 days" for other food items, fuel, and the rest. This was in line with the recommendations of an Expert Group that had been formed for the purpose of suggesting the most suitable reference period for each item of consumption.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"><br /> According to the [inside]Global Nutrition Report 2014[/inside]: Actions and Accountability to Accelerate the World's Progress on Nutrition, prepared by IFPRI (Please <a href="tinymce/uploaded/Global%20Nutrition%20Report%202014.pdf" title="Global Nutrition Report 2014">click here</a> to download):<br /> <br /> • Prevalence of stunting among children below 5 years age has reduced from 47.9% in 2005-06 (National Family Health Survey, NFHS-3) to 38.8% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by stunting has gone down from 5.82 crore in 2005-06 to 4.38 crore in 2013-14.<br /> <br /> • Prevalence of wasting among children below 5 years age has reduced from 20.0% in 2005-06 (National Family Health Survey, NFHS-3) to 15.0% in 2013-14 (Rapid Survey on Children, RSOC). As a result, the population of under-five children affected by wasting has gone down from 2.43 crore in 2005-06 to 1.69 crore in 2013-14.<br /> <br /> • The Government of India is yet to release all the findings of the 2013–2014 Rapid Survey on Children (RSOC). This 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. The Government has made preliminary estimates available for use in this Global Nutrition Report. Only data for children under age five are reported here.<br /> <br /> • The average annual rate of reduction in stunting (47.9 percent to 38.8 percent in eight years) is 2.6 percent—below India’s target rate of 3.7 percent but well above the rate of 1.7 percent estimated on the basis of previous surveys. Because India has such a large population and a high stunting prevalence, this rate of change affects the global numbers significantly. Comparisons between the two surveys (i.e 2005–2006 NFHS and 2013–2014 Rapid Survey on Children-RSOC) also show declines in wasting.<br /> <br /> • The rise in exclusive breastfeeding rates from 46.4 percent to 71.6 percent in eight years represents an average annual rate of increase of 5.5 percent—far above the rate required to meet India’s World Health Assembly (WHA) target by 2025 (1.5 percent). In fact, if the preliminary numbers hold, by 2025 India will have far surpassed its WHA exclusive breastfeeding target of 57 percent.<br /> <br /> • For India—the second-most populous country in the world—new and preliminary national data suggest it is experiencing a much faster improvement in World Health Assembly (WHA) indicators than currently assumed. For example, if the new preliminary estimates undergo no further significant adjustments, then the numbers of stunted children under the age of five in India has already declined by more than 10 million.<br /> <br /> • The Government of India has produced a new national survey on children. WHO and UNICEF have not yet reviewed the survey’s data and methodologies, and the survey results thus do not yet appear in the WHO’s Global Database on Child Growth and Malnutrition, but if the finalized rates of undernutrition are close to the preliminary reported rates, they should make us more optimistic about India's ability to meet the global World Health Assembly (WHA) goals.<br /> <br /> • 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.<br /> <br /> • 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.<br /> <br /> • The benefit to cost ratio of scaling up nutrition-specific interventions for stunting reduction in India is 34.<br /> <br /> **page**</p> <p style="text-align:justify">Please <a href="tinymce/uploaded/Lancet.pdf" title="Lancet">click here</a> to access the [inside]Executive Summary of the Lancet series on Maternal and Child Nutrition[/inside], published on 6 June, 2013</p> <p style="text-align:justify"><br /> According to the [inside]2013 UNICEF report: Improving Child Nutrition[/inside]: The achievable imperative for global progress, please <a href="tinymce/uploaded/Improving%20Child%20Nutrition%20The%20achievable%20imperative%20for%20global%20progress.pdf" title="Improving Child Nutrition The achievable imperative for global progress">click here</a> to access:<br /> <br /> • By 2011, the number of stunted children in India was 6,17,23,000 (i.e. 6.17 crore approximately) and its share in the world total of stunted children was 37.9 percent.<br /> <br /> • In South Asia, an estimated 28 per cent of infants are born with low birthweight. In South Asia, 39 percent of children are stunted. According to the NFHS-3 done in 2005-06, 48 percent of Indian children under the age 5 are stunted.<br /> <br /> • In Maharashtra, the wealthiest state in India, 39 per cent of children under age 2 were stunted in 2005–2006. But by 2012, according to a statewide nutrition survey, the prevalence of stunting had dropped to 23 percent.<br /> <br /> • In 2012, the Government of Maharashtra commissioned the first-ever statewide nutrition survey to assess progress and identify areas for future action. Results of this Comprehensive Nutrition Survey in Maharashtra indicated that prevalence of stunting in children under 2 years of age was 23 per cent in 2012 – a decrease of 16 percentage points over a seven-year period.<br /> <br /> • From 2005–2006 to 2012, the percentage of children 6 to 23 months old who were fed a required minimum number of times per day increased from 34 to 77 and the proportion of mothers who benefited from at least three antenatal visits during pregnancy increased from 75 to 90 per cent.<br /> <br /> • The provisional results of the Maharashtra survey showed that in spite of more frequent meals, only 7 per cent of children 6–23 months old received a minimal acceptable diet in 2012.<br /> <br /> • The proportion of stunted children under 5 in the poorest households compared with the proportion in the richest households ranges from nearly twice as high in sub-Saharan Africa (48 percent versus 25 per cent) to more than twice as high in South Asia (59 percent versus 25 per cent).<br /> <br /> • Recent longitudinal studies among cohorts of children from Brazil, Guatemala, India, the Philippines and South Africa confirmed the association between stunting and a reduction in schooling, and also found that stunting was a predictor of grade failure. Reduced school attendance and educational outcomes result in diminished income-earning capacity in adulthood. A 2007 study estimated an average 22 per cent loss of yearly income in adulthood.<br /> <br /> • Poor nutrition in the first 1,000 days of children’s lives can have irreversible consequences. More and more countries are scaling up their nutrition programmes to reach children during the critical period from pregnancy to the age of 2. From a life-cycle perspective, the most crucial time to meet a child’s nutritional requirements is in the 1,000 days including the period of pregnancy and ending with the child’s second birthday.<br /> <br /> • The World Health Assembly has adopted a new target of reducing the number of stunted children under the age of 5 by 40 per cent by 2025. A stunted child enters adulthood with a greater propensity for developing obesity and chronic diseases.<br /> <br /> • Globally, about one in four children under 5 years old are stunted (26 per cent in 2011). An estimated 80 per cent of the world’s 165 million stunted children live in just 14 countries.<br /> <br /> • Undernourished girls have a greater likelihood of becoming undernourished mothers who in turn have a greater chance of giving birth to low birthweight babies, perpetuating an intergenerational cycle.<br /> <br /> • More than 30 countries in Africa, Asia and Latin America have joined Scaling Up Nutrition (SUN). The present report highlights successes in scaling up nutrition and improving policies in 11 countries: Ethiopia, Haiti, India, Nepal, Peru, Rwanda, the Democratic Republic of the Congo, Sri Lanka, Kyrgyzstan, the United Republic of Tanzania and Viet Nam.<br /> <br /> • In Peru, stunting fell by a third between 2006 and 2011 following an initiative that lobbied political candidates to sign a commitment to reduce stunting in children under five by five per cent over the span of five years and to lessen inequities between urban and rural areas.<br /> <br /> • Ethiopia cut stunting from 57 per cent to 44 per cent between 2000 and 2011 by implementing a national nutrition programme, providing a safety net in the poorest areas and boosting nutrition assistance through communities.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <div style="text-align:justify">According to [inside]Report of the Comptroller and Auditor General of India on Performance Audit of Integrated Child Development Services (ICDS) Scheme[/inside], CAG Report no. 22 of 2012-13-Union Government (Ministry of Women and Child Development), <a href="http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html">http://saiindia.gov.in/english/home/Our_Products/Audit_Report/Government_Wise/union_audit/recent_reports/union_performance/2012_2013/Civil/Report_22/Report_22.html</a>:</div> <p style="text-align:justify"><br /> <strong><em>Status of Nutrition:</em></strong><br /> <br /> • Total number of ICDS Supplementary Nutrition beneficiaries had been 7.06 crore in 2006-07, 8.43 crore in 2007-08, 8.73 crore in 2008-09, 8.84 crore in 2009-10, 9.59 crore in 2010-11 and 9.72 crore in 2011-12.<br /> <br /> • Total number of ICDS Pre-school education beneficiaries had been 3.01 crore in 2006-07, 3.39 crore in 2007-08, 3.41 crore in 2008-09, 3.55 crore in 2009-10, 3.66 crore in 2010-11 and 3.58 crore in 2011-12.<br /> <br /> • Total number of malnourished children (Grade I, II, III and IV) exceeded the 40 percent mark in 10 states/ UTs (Andhra Pradesh: 49 percent, Bihar: 82 percent, Haryana: 43 percent, Jharkhand: 40 percent, Odisha: 50 percent, Rajasthan: 43 percent, UP: 41 percent, Delhi: 50 percent, Daman and Diu: 50 percent and Lakshadweep: 40 percent), as on 31 March, 2011. <br /> <br /> • The number of severely malnourished children (Grade III and IV) exceeded 1 percent of total weighed children in 8 states (Bihar: 26 percent, Chhattisgarh: 2 percent, Gujarat: 5 percent, Karnataka: 3 percent, Madhya Pradesh: 2 percent, Maharashtra: 3 percent, Uttarakhand: 1 percent and West Bengal: 4 percent) as on 31 March, 2011.<br /> <br /> • There was substantial decrease in the malnourished children in 6 states between 31 March 2007 and 31 March 2011 (Gujarat: from 71 percent to 39 percent, Karnataka: from 53 to 40 percent, Maharashtra: from 45 to 23 percent, UP: from 53 to 41 percent, Uttarakhand: 46 to 25 percent and West Bengal: 53 to 37 percent.<br /> <br /> • North-eastern states fared better in respect of the nutritional status of children, where percentage of normal children was satisfactory vis-a-vis the total weighed children as on 31 March 2011 (Arunachal Pradesh: 98 percent, Assam: 69 percent, Manipur: 86 percent, Meghalaya: 71 percent, Mizoran: 77 percent, Nagaland: 92 percent, Sikkim: 89 percent and Tripura: 63 percent).<br /> <br /> • In 5 other states/ UTs the percentage of normal children exceeded 70 percent as of 31 March 2011, viz. MP: 72 percent, Maharashtra: 77 percent, Uttarakhand: 75 percent, A & N Islands: 82 percent and Dadra & Nagar Haveli: 75 percent. <br /> <br /> <strong><em>Key findings: </em></strong></p> <p style="text-align:justify">• The CAG chose to audit the ICDS since India's status on key child development and health indicators did not compare well with its own targets as well as with the neighbouring and other regions. The Infant Mortality Rate (IMR) was 48 per 1000 live birth and the Child Mortality Rate (CMR) 63 per 1000 live birth in 2010 as against the targets of 30 and 31 respectively. These indicators (IMR and CMR) for the neighbouring countries were: China (IMR: 16, CMR: 18) and Sri Lanka (IMR: 14, CMR: 17). In industrialized countries, the IMR and CMR were as low as 5 and 6 respectively.<br /> <br /> • The performance audit covered 2730 of the test checked Anganwadi Centres (AWCs) from 273 project offices of 67 districts from 13 states (Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Meghalaya, Odisha, Rajasthan, Uttar Pradesh and West Bengal) for the period 2006-07 to 2010-11 on 3 services viz. supplementary nutrition, pre-school education and nutrition and health education under scheme. The selection of the states was made on the basis of population, funding and nutrition indicators as per the NFHS-3, 2005.<br /> <br /> • To universalize the ICDS, Hon'ble Supreme Court had directed the Central and state Governments to operationalize 14 lakh AWCs by December, 2008. The Ministry sanctioned 13.71 lakh AWCs and could operationalize 13.17 lakh. This left a shortfall of 0.54 lakh. Similarly, out of 7075 sanctioned ICDS projects, 7005 projects were operationalized.<br /> <br /> • 61 percent of the test-checked AWCs did not have their own buildings and 25 percent were functioning from semi-pucca/ kachcha buildings or open/ partially covered space. Separate space for cooking, storing food items and indoor and outdoor activities for children was not available in 40 to 65 percent of the test-checked AWCs.<br /> <br /> • Poor hygiene and sanitation were noticed in the AWCs due to the absence of toilets in 52 percent of the test checked AWCs and non-availability of drinking water facility for 32 percent of the test checked AWCs.<br /> <br /> • Functional weighing machines for babies and adults were not available in 26 and 58 percent, respectively, of the test-checked AWCs. The essential utensils required for providing supplementary nutrition to the beneficiaries were also not available in several test-checked AWCs.<br /> <br /> • Medicine kits were not available in 33 to 49 percent of the test checked AWCs due to failure of the state governments in spending the funds released to them by the Centre. <br /> <br /> • 53 percent of the test checked AWCs did not receive annual flexi-fund of Rs. 1000 from the state governments during the period 2009-2011.<br /> <br /> • There were shortages of staff and key functionaries at all levels.<br /> <br /> • The shortfall under various categories of training ranged from 19 to 58 percent of the targets fixed under the State Training Action Plan (STRAP).<br /> <br /> • The shortfall in expenditure on Supplementary Nutrition (SN) ranged between 15 percent and 36 percent of the requirements during the period 2006-2011. The average daily expenditure per beneficiary on SN was Rs. 1.52 to Rs. 2.01 against the norm of Rs. 2.06 during 2006-09 and Rs. 3.08 to Rs. 3.64 against the norm of Rs. 4.21 during 2009-2011.<br /> <br /> • 33 to 47 percent children were not weighed for monitoring their growth during 2006-07 to 2010-11. The data on nutritional status of children had discrepancies and were not based on WHO's growth standards.<br /> <br /> • There was a gap of 33 to 45 percent between the number of eligible beneficiaries identified and those receiving the SN during 2006-07 to 2010-11.<br /> <br /> • The Wheat Based Nutrition Programme suffered from lack of proper coordination among the Ministry of Women and Child Development, the Department of Food and Public Distribution and the state governments. The Ministry could allocate 78 percent of foodgrains demanded by the states. The actual take-offs by the states was merely 66 percent of total demand placed by them.<br /> <br /> • Pre-school education (PSE) kits were not available at 41 to 51 percent of the test-checked AWCs during the period 2006-11.<br /> <br /> • In 6 of the test checked states (Bihar, Haryana, Jharkhand, Madhya Pradesh, Uttar Pradesh and West Bengal) data on beneficiaries of PSE who joined mainstream education were not available. In 5 states (Andhra Pradesh, Chhattisgarh, Odisha, Rajasthan and Karnataka) shortfall in the number of children who actually joined the formal education during 2006-2011 ranged between 7 and 30 percent. <br /> <br /> • Shortfall of 40 to 100 percent was noted on the expenditure against the funds released for Information, Education and Communication (IEC) in many states.<br /> <br /> • Against the total release of Rs. 1753 crore to 13 states during 2008-09 and 15 states during 2009-2011 for meeting the expenditure on salary of ICDS functionaries, the actual expenditure was Rs. 2853 crore indicating unrealistic budgeting and consequent diversion of funds from other critical components of the scheme.<br /> <br /> • Rs. 57.82 crore were diverted to activities not permitted under the ICDS in 5 of the test-checked states and Rs. 70.11 crore were parked in civil deposits/ personal ledger accounts/ bank accounts / treasury resulting in blocking of funds.<br /> <br /> • The Central Monitoring Unit (CMU) under the ICDS failed to efficiently carry out assigned tasks, which included concurrent evaluation of the scheme, monitoring through the progress reports received from the states.<br /> <br /> • Impact assessment of the services under the SN and the PSE based on outcome indicators, such as nutritional status of the children, was not being done.<br /> <br /> • The follow-up action on internal monitoring and evaluation by the Ministry was inadequate and resulted in recurrence of shortcomings and lapses in the scheme implementation. <br /> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">The per capita per diem calorie intake is higher in the rural areas compared to urban areas, as could be deciphered from the graph below. However, both have seen a decline over the various rounds of National Sample Survey. </span></p> <p style="text-align:justify"> </p> <div style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><strong>Per capita per diem intake of Calorie (in Kcal)</strong></span></span></div> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"><img alt="Per capita per diem intake of Calorie (in Kcal)" src="tinymce/uploaded/graf1.jpg" style="height:242px; width:577px" /> </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><em><span style="font-size:small"><strong>Source: </strong>Nutritional Intake in India: 2004-2005, NSS 61st Round, July 2004- June 2005</span></em></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the [inside]2012 Global Hunger Index[/inside] - The Challenge of Hunger: Ensuring Sustainable Food Security under Land, Water, and Energy Stresses, produced by IFPRI, Concern Worldwide and Welthungerhilfe, <span style="font-size:medium">please <a href="tinymce/uploaded/2012%20Global%20Hunger%20Index.pdf" title="2012 Global Hunger Index">click here</a> to access</span> </p> <p style="text-align:justify"><a href="http://www.ifpri.org/sites/default/files/publications/ghi12.pdf">http://www.ifpri.org/sites/default/files/publications/ghi12.pdf</a> </p> <p style="text-align:justify"><a href="http://www.ifpri.org/sites/default/files/publications/ghi2012fsasia.pdf">http://www.ifpri.org/sites/default/files/publications/ghi2012fsasia.pdf</a>: </p> <p style="text-align:justify"> </p> <p style="text-align:justify">• The 2012 Global Hunger Index (GHI) is calculated for 120 developing countries and countries in transition for which data on the three indicators of hunger are available. This year’s GHI reflects data from 2005-2010—the most recent country-level data available on the three GHI measures. It is thus a snapshot of the recent past. </p> <p style="text-align:justify">• The GHI combines three equally weighted indicators into one score: the proportion of people who are undernourished, the proportion of children under five who are underweight, and the mortality rate of children younger than age five.</p> <p style="text-align:justify">• The GHI ranks countries on a 100-point scale in which zero is the best score (no hunger) and 100 the worst, although neither of these extremes is reached in practice. An increase in a country’s GHI score indicates that the hunger situation is worsening, while a decrease in the score indicates improvement in the country’s hunger situation.</p> <p style="text-align:justify">• India's 2012 GHI score is 22.9 (rank: 65) as compared to China's GHI score of 5.1 (rank: 2), Bangladesh's score of 24.0 (rank: 68), Pakistan's score of 19.7 (rank: 57), Nepal's score of 20.3 (rank: 60) and Sri Lanka's score of 14.4 (rank: 37). </p> <p style="text-align:justify">• India's GHI score has improved from 30.3 in 1990 to 24.2 in 2001 and further to 22.9 in 2012. </p> <p style="text-align:justify">• India has lagged behind in improving its GHI score despite strong economic growth. After a small increase between 1996 (GHI 22.6) and 2001 (GHI 24.2), India’s GHI score fell only slightly, and the latest GHI returned to about the 1996 level. </p> <p style="text-align:justify">• India's stagnation in GHI scores occurred during a period when India’s gross national income (GNI) per capita almost doubled, rising from about 1,460 to 2,850 constant 2005 international dollars between 1995–97 and 2008–10 (World Bank 2012).</p> <p style="text-align:justify">• In India, 43.5 percent of children under five are underweight, which accounts for almost two-thirds of the country’s alarmingly high GHI score. From 2005-2010, India ranked second to last on child underweight— below Ethiopia, Niger, Nepal, and Bangladesh. </p> <p style="text-align:justify">• Bangladesh has also closed the gender gap in education through targeted public interventions and has overtaken India on a range of social indicators, including the level and rate of reduction of child mortality.</p> <p style="text-align:justify">• In India, 43.5 percent of children under five are underweight, which accounts for almost two-thirds of the country’s alarmingly high GHI score. From 2005-2010, India ranked second to last on child underweight— below Ethiopia, Niger, Nepal, and Bangladesh. </p> <p style="text-align:justify">• Bangladesh, India, and Timor-Leste have the highest prevalence of underweight children under five, more than 40 percent in each of the three countries.</p> <p style="text-align:justify">• According to surveys during 2000–06, 36 percent of Indian women of childbearing age were underweight, compared with only 16 percent in 23 Sub-Saharan African countries (Deaton and Drèze 2009).</p> <p style="text-align:justify">• Though India has worked to improve food security and nutrition in recent years through government-operated nutrition-relevant social programs, program effectiveness remains uncertain due to the absence of up-to-date information.</p> <p style="text-align:justify">• When comparing GHI scores with GNI per capita, it must be emphasized that India’s latest GHI score is based partly on outdated data: although it includes relatively recent child mortality data from 2010, FAO’s most recent data on undernourishment are for 2006–08, and India’s latest available nationally representative data on child underweight were collected in 2005–06.</p> <p style="text-align:justify">• Given that the Government of India has failed to monitor national trends in child undernutrition for more than six years, any recent progress in the fight against child undernutrition cannot be taken into account by the 2012 GHI.</p> <p style="text-align:justify">• Home to the majority of the world’s undernourished children, India is in dire need of monitoring systems for child undernutrition and related indicators that produce data at regular intervals, in order to improve program performance and scale up impact (Kadiyala et al. 2012).</p> <p style="text-align:justify">• The 2012 world GHI fell by 26 percent from the 1990 world GHI, from a score of 19.8 to 14.7. South Asia and Sub-Saharan Africa have the highest levels of hunger with regional scores of 22.5 and 20.7, respectively. </p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">The Nutrition Barometer produced by Save the Children provides a snapshot of national governments’ commitments to addressing children’s nutrition, and the progress they have made. It looks at 36 developing countries with the highest levels of child undernutrition. The Barometer measures governments’ political and legal commitment to tackling malnutrition (eg, whether they have a national nutrition plan), as well as their financial commitment. Countries’ progress in tackling malnutrition is measured by children’s nutritional status – the proportion who are underweight, stunted or suffering from wasting – and children’s chances of survival. Countries are then ranked according to both their commitments and their nutritional and child survival outcomes.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to the report titled [inside]The Nutrition Barometer: Gauging national responses to undernutrition (2012)[/inside] by Save the Children and World Vision, please <span style="font-size:medium"><a href="tinymce/uploaded/Nutrition%20Barometer.pdf" title="Nutrition Barometer">click here</a></span> to access:<br /> <br /> • The Democratic Republic of Congo (DRC), India and Yemen show the weakest performance, with frail commitments and frail outcomes. Outcomes for India are dated as they are based on the National Family and Health Survey-3 from 2005–06. However, since the country has not had a nationally representative survey since then, these figures are still generally used.<br /> <br /> • India urgently needs a new population-based, nationally representative survey to check what has happened to nutrition since 2005–06. The fourth National Family Health Survey was about to take place in 2014.<br /> <br /> • Spectacular economic growth has not translated into better nutrition outcomes for many of India’s children. Growth has lifted millions out of poverty but it has also been largely unequal, with the benefits accruing to a small segment of the population. Many sources of data show that almost half its children are underweight and stunted, and more than 70% of women and children have serious nutritional deficiencies such as anaemia.<br /> <br /> • Children in the poorest households are more than twice as likely to be stunted as those in the richest households in India. However, even in the wealthiest 20% of the Indian population, one child in five is undernourished.<br /> <br /> • India's showing on commitments was set back by the lack of nutrition-specific commitments to Every Woman Every Child and not being a member of Scaling up Nutrition movement (SUN) as yet.<br /> <br /> • A criticism of the Integrated Child Development Services (ICDS) was its failure to target children between the ages of 0 and two years, which is the crucial growth period. One reform involves increasing the number of Anganwadi [community health] workers in the 200 districts with the highest levels of undernutrition.<br /> <br /> • In 13 of the countries (just over a third of the sample of 36 countries) the Nutrition Barometer study looked at, commitments and outcomes point in exactly the same direction. Three countries – Guatemala, Malawi and Peru–have both sound political and financial commitments and sound outcomes relative to the other countries in the group in this study.<br /> <br /> • The Barometer shows 12 countries where there are high political, legal and/or financial commitments to nutrition, yet outcomes are lower.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">The report titled [inside]A Life Free from Hunger: Tackling child malnutrition (2012)[/inside], which has been brought out by Save the Children (<span style="font-family:Arial; font-size:medium">please <a href="tinymce/uploaded/A%20Life%20Free%20from%20Hunger%20Tackling%20child%20malnutrition%202012%20Save%20the%20Children.pdf" title="A Life Free from Hunger Tackling child malnutrition 2012 Save the Children">click here</a> to access) </span>analyses the causes of malnutrition, focusing on chronic malnutrition and stunting in children. It identifies solutions that are proven to be effective in containing child malnutrition: a. direct interventions, such as exclusive breastfeeding, micronutrient supplementation and fortification; b. indirect interventions, such as introducing social protection programmes, and adapting agricultural production to meet the nutritional needs of children.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><em>Key findings of the report are as follows: </em></p> <p style="text-align:justify">• 48 percent of children in India are stunted. 450 million children around the world will be affected by stunting in the next 15 years, if current trends continue.</p> <p style="text-align:justify">• The economic losses due to undernutrition are pervasive–experimental evidence suggests that tackling malnutrition in early life can lead to as much as a 46% increase in earnings as an adult. Productivity loss due to foregone waged employment was estimated to be US$2.3 billion a year in India.</p> <p style="text-align:justify">• A study by Ravi and Engler (2009) on the impact of the Mahatma Gandhi NREGA in India, which guarantees poor households 100 days of paid employment, found the scheme increased food spending by 40% on average, and that the effect is strongest for the poorest households who participated in the scheme the longest.</p> <p style="text-align:justify">• It’s estimated that 2–3% of the national income of a country can be lost to malnutrition. Childhood malnutrition can lessen productivity – stunted children are predicted to earn an average of 20% less when they become adults</p> <p style="text-align:justify">• Staple food prices hit record highs globally in February 2011 and may have put the lives of upto 400,000 more children at risk.</p> <p style="text-align:justify">• One in four of the world’s children are stunted. In developing countries this figure is as high as one in three. That means their body and brain has failed to develop properly because of malnutrition.</p> <p style="text-align:justify">• Every hour of every day, 300 children die because of malnutrition. Malnutrition is an underlying cause of the death of 2.6 million children each year–one-third of the global total of children’s deaths.</p> <p style="text-align:justify">• Global progress on stunting has been extremely slow. The proportion of children who are stunted fell from 40 percent in 1990 to 27 percent in 2010 – an average of just 0.6 percentage points per year.</p> <p style="text-align:justify">• In 2008 the Lancet medical journal identified a package of 13 direct interventions – such as vitamin A and zinc supplements, iodised salt, and the promotion of healthy behaviour, including handwashing, exclusive breastfeeding and complementary feeding practices– that were proven to have an impact on the nutrition and health of children and mothers. This cost-effective and affordable package could prevent the deaths of almost 2 million children under five and a substantial amount of illness if it was delivered to children in the 36 countries that are home to 90% of the world’s malnourished children.</p> <p style="text-align:justify">• At a cost of just over US$1 per person per year, the World Bank has estimated that more than 4 billion people would be able to benefit from access to fortified wheat, iron, complementary food and micronutrient powders. Fortification, or the process of adding vitamins and minerals to food, is one of the most cost-effective direct interventions.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">For the report named [inside]HUNGaMA: Fighting Hunger & Malnutrition (2011)[/inside], Naandi Foundation deployed a trained team of over 1000 surveyors who interviewed 74,020 mothers and measured 109,093 children in 4 months. The HUNGaMA (Hunger and Malnutrition) survey that covered 73,670 households across 112 districts spanning nine states in India provides reliable estimates of child nutrition covering nearly 20% of Indian children. Of the 112 districts surveyed, 100 were selected from the bottom of a child development district index developed for UNICEF India in 2009, referred to as the 100 Focus Districts in this report.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><em>Key findings of the report titled: HUNGaMA: Fighting Hunger & Malnutrition (2011), </em><em><span style="font-family:Arial; font-size:medium">please <a href="tinymce/uploaded/Hungama%20Report%202011.pdf" title="Hungama Report 2011">click here</a> to access</span>, which has been prepared by the Naandi Foundation, are as follows:</em></p> <p style="text-align:justify"> </p> <p style="text-align:justify">• In the 100 Focus Districts, 42 percent of children under five are underweight and 59 percent are stunted. Of the children suffering from stunting, about half are severely stunted.</p> <p style="text-align:justify">• In the 100 Focus Districts, the prevalence of child underweight has decreased from 53 per cent (DLHS, 2004) to 42 per cent (HUNGaMA 2011); this represents a 20.3 percent decrease over a 7 year period with an average annual rate of reduction of 2.9 per cent. </p> <p style="text-align:justify">• By age 24 months, 42 percent of children are underweight and 58 percent are stunted in the 100 Focus Districts.</p> <p style="text-align:justify">• The prevalence of malnutrition is significantly higher among children from low-income families, although rates of child malnutrition are significant among middle and high income families.</p> <p style="text-align:justify">• In the 100 Focus Districts, 66 per cent mothers did not attend school; rates of child underweight and stunting are significantly higher among mothers with low levels of education; the prevalence of child underweight among mothers who cannot read is 45 percent while that among mothers with 10 or more years of education is 27 per cent.</p> <p style="text-align:justify">• In the 100 Focus Districts 51 per cent mothers did not give colostrum to the newborn soon after birth and 58 percent mothers fed water to their infants before 6 months.</p> <p style="text-align:justify">• In the 100 Focus Districts 11 percent mothers said they used soap to wash hands before a meal and 19 per cent do so after a visit to the toilet.</p> <p style="text-align:justify">• There is an Anganwadi centre in 96 percent of the villages in the 100 Focus Districts, 61 per cent of them in pucca buildings; the Anganwadi service accessed by the largest proportion of mothers (86 percent) is immunization; 61 percent of Anganwadi Centres had dried rations available and 50 percent provided food on the day of survey; only 19 percent of the mothers reported that the Anganwadi Centre provides nutrition counseling to parents.</p> <p style="text-align:justify">**page** </p> <p style="text-align:justify">According to the [inside]World Disaster Report 2011: Focus on Hunger and Malnutrition[/inside], which has been produced by International Federation of Red Cross and Red Crescent Societies, <a href="http://www.indiaenvironmentportal.org.in/files/file/WDR-2011-FINAL.pdf">http://www.indiaenvironmentportal.org.in/files/file/WDR-2011-FINAL.pdf</a>: <br /> <br /> • There has been progress in feeding more people than ever before even as the world’s population has grown by around 50 per cent since the mid-1970s. Even so, the number of undernourished people in the world was higher in 2010 – 925 million according to the Food and Agriculture Organization of the United Nations (FAO)–than in the early 1970s. There was a record peak of more than 1 billion hungry people in 2009 following dramatic food price rises in 2007–2008.<br /> <br /> • The majority of the hungry are in the Asia Pacific region, especially the Indian subcontinent, and in sub-Saharan Africa. Most of the hungry live in rural areas. A substantial and growing number of the world’s hungry also lives in urban and peri-urban areas.<br /> <br /> • In 2005 the World Bank estimated that malnutrition costs the global economy around US$ 80 billion a year. The loss to the Indian economy alone is at least US$ 10 billion a year, or 2 to 3 per cent of GDP.<br /> <br /> • The United States Department for Agriculture (USDA) reports that in 2010 about US$ 68 billion was spent through its Supplemental Nutrition Assistance Program – also known as ‘food stamps’ – to reach just over 40 million people – compared to US$ 250 million (1969 prices) in 1969 that benefited some 2.9 million people.<br /> <br /> • At least 1 billion people are undernourished and lack key vitamins and minerals, while at the same time a staggering 1.5 billion people are overweight or obese.<br /> <br /> • India’s public distribution scheme technically caters to 316 million people who are in the ‘below the poverty line’ category. Add the ‘above the poverty line’ category and the scheme is supposed to provide food to more than 900 million people. But the way the below the poverty line (which should be dubbed the ‘starvation line’) has been drawn, the distribution scheme fails to provide them with their minimal daily food intake. If the scheme had been even partially effective, there is no reason why India should be saddled with the largest population of hungry people in the world.<br /> <br /> • Despite four ministries administering 22 programmes to alleviate hunger and poverty, the budget allocation for which is enhanced almost every year, the poor still go hungry and hundreds of children die every day in India from malnourishment.<br /> <br /> • According to the recommendations of the Indian Council of Medical Research, each able-bodied adult needs a minimum of 14 kilograms (kg) of grains a month. Given that an average family comprises five members, the household allocation would be 70kg. The distribution scheme at present provides only 35kg of wheat and rice to each family, so the hungry remain perpetually hungry.<br /> <br /> • In a country that has emerged as the world’s fifth largest economy with a growth rate of almost 9 per cent, more than 700 million people remain food insecure.<br /> <br /> • One problem in India, according to the Deccan Development Society and others, is the neglect of small farmers – especially women – who are the main producers of local foods and traditional grains such as millet and sorghum. The Deccan Development Society has been working with poor, illiterate dalit (untouchable) women to help them to restore the fertility and productivity of the almost barren lands they received from the government as a result of land reforms and to have the means to communicate about their needs. It also works to get the government to include the millets and sorghums, which grow so well in drier areas such as the Deccan, into the national food distribution system and to consider actions to promote their production and consumption as a priority.<br /> <br /> • In New Delhi, India, a research project which gave thin and anaemic pregnant women a multiple micronutrient supplement in addition to their regular iron and folic acid, found a mean increase of 98 grams in the birth weight of their babies and a 50 per cent reduction in illness among the newborns compared to a placebo.<br /> <br /> • India has been a net exporter of agricultural and food products since 1995. It is also a net exporter of meat and dairy products. India, Pakistan, Thailand, the US and Viet Nam represent 80 per cent of world rice exports.<br /> <br /> • In countries with public procurement systems in place, such as Bangladesh and India, the governments were able to support farmers by procuring rice at a higher price and providing subsidies to poor and marginal farmers to mitigate higher costs of production for irrigation and fertilizer.<br /> <br /> • Evidence from India and elsewhere in Asia shows that smallholders consistently produce higher yields than larger capital-intensive farms. Small farmers generally use their land more intensively than larger operations, because they utilize every scrap and corner. Most importantly, there is an inverse relationship in low- and middle-income countries’ economies between farm area and both labour and output per hectare, because smallholders aim to maximize food production.<br /> <br /> • The Indian dairy industry has gone from being the 78th largest in the world to number one in just a few decades, almost entirely on the basis of cooperative dairies collecting milk from small farmers whose small herds are fed with home-grown fodder crops.<br /> <br /> • Globally, human nutrition has come to depend upon very few crops as its staples. Just three crops–rice, wheat and maize–account for more than half the energy intake from plants. Another six–sorghum, millet, potatoes, sweet potatoes, soybean and sugar–take the total to more than 75 per cent, while 90 per cent of humanity’scalorie intake comes from just 30 crops.<br /> <br /> • From 1988 to 1997, foreign direct investment in the food industry increased from US$743 million to more than US$2.1 billion in Asia and from US$222 million to US$3.3 billion in Latin America, significantly outstripping the level of investments in agriculture. At the same time, sales through supermarkets grew as much as they had in the United States over 50 years.<br /> <br /> • Much development policy has focused on industrialization and has neglected rural and agricultural development over the last 30 years. Attention has shifted away from agriculture in the big development agencies, such as the World Bank, which lent about 26 per cent of its total budget to agriculture in the 1980s but only 10 per cent in 2000.<br /> <br /> • Every year some 9 million children across the world die before they reach their fifth birthday, and about one-third of these untimely deaths is attributed to undernutrition.<br /> <br /> • Some 178 million children under the age of 5 suffer from stunted growth as a result of undernutrition. About 55 million under 5 years of age are acutely undernourished, which means that their bodies are wasted – they are underweight for their height – and 19 million of these children are severely wasted.<br /> <br /> • Anaemia in children has only relatively recently been recognized as a widespread problem, and there are almost no data before 1995. Haemoglobin is now one of the elements measured in demographic and health surveys, and they show that in sub-Saharan Africa around 60 per cent of children are anaemic compared with a global average of nearly half of all preschool-age children. Some 40 per cent of women in low- and middle-income countries are believed to suffer from anaemia, which affects a total of around 2 billion people worldwide.<br /> <br /> • Vitamin A deficiency, which is the most common cause of blindness in low- and middle-income countries, affects around 30 per cent – some 163 million – of children in poor countries. Two-thirds of affected children are in South and central Asia, which along with West Africa have the highest prevalence of childhood vitamin A deficiency, at more than 40 per cent. Latin America and the Caribbean have the lowest prevalence, at 10 per cent. Nearly 14 million children with the condition have some degree of visual loss, and 250,000 to 500,000 are blinded every year, half of them dying within 12 months of losing their sight.<br /> <br /> • More than 1.7 billion of the world’s people (of whom 1.3 billion live in Asia) suffer from iodine deficiency , which can lead to stunted growth and other developmental abnormalities and which is one of the commonest causes of mental impairment and retardation in children worldwide.<br /> <br /> • More than 3 billion people, or 31 per cent of the world’s population, are deficient in zinc, which increases the risk for children of diarrhoea, pneumonia and malaria, and is thought to contribute to more than 450,000 child deaths annually worldwide.<br /> <br /> • According to Save the Children, deficiency in vitamin A and zinc could be prevented with supplements costing just 6 US cents and US$ 1.6 per child per year respectively.<br /> <br /> • A multi-country study reported in The Lancet in 2007 found that for every 10 per cent increase in the prevalence of stunting in the population, the proportion of children reaching the final grade of school fell by 8 per cent.<br /> <br /> • The causes of hunger and undernutrition are complex and include structural factors such as lack of investment in agriculture, climate change, volatile fuel prices, commodity speculation and the ebb and flow of global market forces<br /> <br /> • About one-fifth of the world’s 185 million undernourished people live in towns and cities and the root cause of their hunger is overwhelmingly poverty.<br /> <br /> • Families in many countries consider their girls an economic burden and marry them off young, occasionally even before puberty. The practice is most common in sub-Saharan Africa and South Asia. Girls who become pregnant in their teens stop developing physically themselves and are at increased risk of delivering low birth weight babies, thus setting in motion the cycle of deprivation described earlier. In India, where 40 per cent of the world’s low birth weight babies are born, 8 per cent of women aged 20–24 years in 2006 had given birth to her first child before she was 16 years old.<br /> <br /> •<span style="font-size:medium"><span style="font-family:Arial"> </span></span>Save the Children estimated that in 2008 alone, a minimum of 4.3 million (and potentially as many as 10.4 million) additional children in low- and middle-income countries may have become malnourished as a result of food price rises.</p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify">According to [inside]Common Wealth or Common Hunger? Malnutrition and its impact on Child Survival in the Commonwealth (2010)[/inside], Save the Children,</p> <p style="text-align:justify"><a href="http://www.savethechildren.in/custom/recent-publication/Report--Common_Wealth_or_Common_Hunger(2).pdf">http://www.savethechildren.in/custom/recent-publication/Report--Common_Wealth_or_Common_Hunger%282%29.pdf</a>: </p> <p style="text-align:justify">• India, host to the 2010 Commonwealth Games, has both the highest number and the highest proportion of malnourished children in the world. Nearly half of all under-fives in India–55 million children–are malnourished, almost 7 million of them with severe acute malnutrition.</p> <p style="text-align:justify">• The estimated number of severe acute malnutrition (SAM) children in India is 6941387, which is roughly 6 percent of total children in the age group 6-59 months. The prevalence of SAM among children in the age group 6-59 months is 6 percent in Pakistan and 3 percent in Bangladesh. </p> <p style="text-align:justify">• In Chhattisgarh, a ‘child protection month’ is celebrated twice a year (April and October) and delivers a package of services to more than 85% of children.The services include vitamin A supplementation, deworming, growth monitoring, immunisation focused on children never or only partially vaccinated, and salt testing for iodine content in households and community feeding centres.</p> <p style="text-align:justify">• There are three measures of child malnutrition:</p> <p style="text-align:justify">* Chronic, long-term malnutrition can result in children being too short for their age (stunted).</p> <p style="text-align:justify">* Acute, fast-onset malnutrition results in a child being dangerously thin for their height (wasted).</p> <p style="text-align:justify">* An underweight child has a low weight for their age and could be chronically and/or acutely malnourished. It is also the key indicator for MDG 1.</p> <p style="text-align:justify">• More than two-thirds of stunted children (88.5 million, 68.6%) and nearly half of those who are underweight (95 million, 48.7%) live in just seven Commonwealth countries–India, Bangladesh, Pakistan, Nigeria, Tanzania, Kenya and Uganda. India, alone, has 55.5 million underweight children.</p> <p style="text-align:justify">• A major cause of malnutrition is a poor diet, which makes newborn babies and infants more vulnerable to infection and less able to recover from common childhood illnesses such as pneumonia and diarrhoea. Poverty; household food insecurity; the low status of women; poor hygiene, sanitation and access to clean water; and inadequate public health services all contribute to malnutrition and are a threat to children’s survival.</p> <p style="text-align:justify">• Bangladesh and Pakistan have high rates of malnourished children – 41% and 31% respectively.</p> <p style="text-align:justify">• In India, 36% of women are malnourished with a body mass index of less than 18.5 kg/m2 compared with 12% in Nigeria. Malnourished mothers often give birth to smaller children. India, Pakistan and Bangladesh all have significantly higher levels of children being born at low birth weight than developing countries in other parts of the world. In these three countries, between 22% and 32% of babies are born weighing less than 2.5kg. They begin life already malnourished and at a disadvantage. Many are unable to catch up and therefore remain underweight.</p> <p style="text-align:justify">• Breast milk provides all the energy and nutrients an infant needs during the first six months of life. Rates of exclusive breastfeeding (children below 6 months) are poor at 37%, 43% and 46% in Pakistan, Bangladesh and India respectively, but are even lower in Nigeria and at 13%.</p> <p style="text-align:justify">• An estimated one third of children under five years old in the developing world are stunted–that’s 195 million–and 129 million are underweight.</p> <p style="text-align:justify">• Globally, more than 3 million children die every year from undernutrition related causes.</p> <p style="text-align:justify">• An estimated one-third of children under five years old in the developing world are stunted–that’s 195 million children–and 129 million are underweight.</p> <p style="text-align:justify">• The critical period, when malnutrition can have the most irrevocable impact, is during the 33 months from conception to a child’s second birthday – the first 1,000 days. After two years of age, it is much harder to reverse the effects of chronic malnutrition, particularly its impact on the development of the brain.</p> <p style="text-align:justify">• Thirty per cent of the world’s population lives in the 54 diverse countries that make up the Commonwealth–and at least 64% of the world’s underweight children.</p> <p style="text-align:justify">• Malnutrition is also an underlying cause in 35% of all preventable deaths in children under five each year. Even those who survive are likely to suffer from recurring sickness, impaired physical and mental development, and reduced productivity.</p> <p style="text-align:justify">• The success of vitamin A supplementation programmes targeting children 6–59 months of age has been proven, with an estimated 24% reduction in all-cause mortality.</p> <p style="text-align:justify">• In May 2008, the Copenhagen Consensus, a panel of top economists, determined that providing micronutrients in the form of iodised salt, vitamin A capsules and iron-fortified flour for 80% of the world’s malnourished children would cost US$347 million a year and yield US$5 billion from avoided deaths, improved earnings and reduced healthcare spending.</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium">According to [inside]Investing in the future: A United Call to Action on Vitamin and Mineral Deficiencies-Global Report 2009[/inside], </span><br /> <a href="http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf"><span style="font-size:medium">http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf</span></a><span style="font-size:medium">: </span></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Vitamin A, iodine, iron, zinc and folate play pivotal roles in maintaining healthy and productive populations.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Approximately one third of the developing world’s children under the age of five are vitamin A-deficient, and therefore ill-equipped for survival.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron deficiency anaemia during pregnancy is associated with 115,000 deaths each year, accounting for one fifth of total maternal deaths.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Research has shown that, where a population is at risk of vitamin A deficiency, vitamin A supplementation reduces mortality in children between six months and five years of age by an average of 23%. Global efforts to provide young children with twice-yearly supplements have involved 103 countries. In 1999, just 16% of children in these countries received full supplementation. By 2007, that number had more than quadrupled to 72%.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In communities where iodine intake is sufficient, average IQ is shown to be on average 13 points higher than in iodine-deficient communities. Between 1993 and 2007, the number of countries in which iodine-deficiency disorders were a public health concern was reduced by more than half, from 110 to 47.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 2008, the Copenhagen Consensus panel determined that vitamin A and zinc supplementation for children provided the very best return on investment across all global development efforts.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron supplementation during pregnancy lowers the risk of maternal mortality due to haemorrhage, the cause of more than 130,000 maternal deaths each year.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Eliminating anaemia in adults can result in productivity increases of up to 17%. These increases are equivalent to 2% of GDP in the worst affected countries.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron-deficiency anaemia during pregnancy is associated with 115,000 women’s deaths each year, which account for one fifth of total maternal deaths</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Deficiencies in vitamin A and zinc are particularly dangerous for children who are fighting measles, diarrhoea and malaria.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron-deficiency anaemia is also estimated to cause almost 600,000 stillbirths or deaths of babies within their first week of life.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In developing countries, 38 million newborns each year are at risk of iodine deficiency.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 2006, approximately 1.62 billion people had anaemia.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In China, vitamin and mineral deficiencies represent an annual GDP loss of US$ 2.5-5 billion. In India, they may be costing the country US$ 2.5 billion annually – equivalent to approximately 0.4% of GDP.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page**</p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to [inside]Tracking Progress on Child and Maternal Nutrition: A survival and development priority[/inside], UNICEF (2009),</span><br /> <a href="http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf</span></a><span style="font-family:arial,helvetica,sans-serif; font-size:medium">: </span></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A child’s future nutrition status is affected before conception and is greatly dependent on the mother’s nutrition status prior to and during pregnancy. A chronically undernourished woman will give birth to a baby who is likely to be undernourished as a child, causing the cycle of undernutrition to be repeated over generations.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Children with iron and iodine deficiencies do not perform as well in school as their well-nourished peers, and when they grow up they may be less productive than other adults.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In the developing world the number of children under 5 years old who are stunted is close to 200 million, while the number of children under 5 who are underweight is about 130 million.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In Africa and Asia, stunting rates are particularly high, at 40 per cent and 36 per cent respectively. More than 90 per cent of the developing world’s stunted children live in Africa and Asia.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The level of child and maternal undernutrition remains unacceptable throughout the world, with 90 per cent of the developing world’s chronically undernourished (stunted) children living in Asia and Africa.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Low birthweight is related to maternal undernutrition; it contributes to infections and asphyxia, which together account for 60 per cent of neonatal deaths. An infant born weighing between 1,500 and 2,000 grams is eight times more likely to die than an infant born with an adequate weight of at least 2,500 grams. Low birthweight causes an estimated 3.3 per cent of overall child deaths.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Supplementation of micronutrient can reduce the risk of child mortality from all causes by about 23 per cent.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Children from communities that are iodine deficient can lose 13.5 IQ points on average compared with children from communities that are non-deficient</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Stunting affects approximately 195 million children under 5 years old in the developing world, or about one in three. Africa and Asia have high stunting rates – 40 per cent and 36 per cent, respectively – and more than 90 per cent of the world’s stunted children live on these two continents.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Of the 10 countries that contribute most to the global burden of stunting among children, 6 are in Asia. These countries all have relatively large populations: Bangladesh, China, India, Indonesia, Pakistan and the Philippines.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Due to the high prevalence of stunting (48 per cent) in combination with a large population, India alone has an estimated 61 million stunted children, accounting for more than 3 out of every 10 stunted children in the developing world.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Of countries with available data, Afghanistan and Yemen have the highest stunting rates: 59 per cent and 58 per cent, respectively.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Since 1990, stunting prevalence in the developing world has declined from 40 per cent to 29 per cent, a relative reduction of 28 per cent. Progress has been particularly notable in Asia, where prevalence dropped from 44 per cent around 1990 to 30 per cent around 2008. This reduction is influenced by marked declines in China.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• An estimated 129 million children under 5 years old in the developing world are underweight – nearly one in four. Ten per cent of children in the developing world are severely underweight. The prevalence of underweight among children is higher in Asia than in Africa, with rates of 27 per cent and 21 per cent, respectively.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In 17 countries, underweight prevalence among children under 5 years old is greater than 30 per cent. The rates are highest in Bangladesh, India, Timor-Leste and Yemen, with more than 40 per cent of children underweight.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Progress towards the reduction of underweight prevalence has been limited in Africa, with 28 per cent of children under 5 years old being underweight around 1990, compared with 25 per cent around 2008. Progress has been slightly better in Asia, with 37 per cent underweight prevalence around 1990 and 31 per cent around 2008.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• 13 per cent of children under 5 years old in the developing world are wasted, and 5 per cent are severely wasted (an estimated 26 million children).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A number of African and Asian countries have wasting rates that exceed 15 per cent, including Bangladesh (17 per cent), India (20 per cent) and the Sudan (16 per cent). The country with the highest prevalence of wasting in the world is Timor-Leste, where 25 per cent of children under 5 years old are wasted (8 per cent severely).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Although being overweight is a problem most often associated with industrialized countries, some developing countries and countries in transition also have high prevalence of overweight children. In Georgia, Guinea-Bissau, Iraq, Kazakhstan, Sao Tome and Principe, and the Syrian Arab Republic, for example, 15 per cent or more of children under 5 years old are overweight.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Some countries are experiencing a ‘double burden’ of malnutrition, having high rates of both stunting and overweight. In Guinea-Bissau and Malawi, for example, more than 10 per cent of children are overweight, while around half are stunted.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In developing countries, 16 per cent of infants, or 1 in 6, weigh less than 2,500 grams at birth. Asia has the highest incidence of low birthweight by far, with 18 per cent of all infants weighing less than 2,500 grams at birth. Mauritania, Pakistan, the Sudan and Yemen all have an estimated low birthweight incidence of more than 30 per cent.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• A total of 19 million newborns per year in the developing world are born with low birthweight, and India has the highest number of low birthweight babies per year: 7.4 million.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Iron deficiency affects about 25 per cent of the world’s population, most of them children of preschool-age and women. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Vitamin A deficiency is widespread throughout India, but particularly so in rural India, where up to 62 per cent of preschool-age children are deficient, according to the latest estimates. Moreover, the high prevalence of wasting (20 per cent), stunting (48 per cent) and anaemia (70 per cent) in children under 5 years old indicates widespread nutritional deprivation.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify">**page** </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><em><span style="font-size:medium">According to The State of Food Insecurity in the World Report 2009: Economic Crises-Impacts and Lessons Learnt, </span><a href="http://www.fao.org/docrep/012/i0876e/i0876e00.htm"><span style="font-size:medium">http://www.fao.org/docrep/012/i0876e/i0876e00.htm</span></a><span style="font-size:medium">: </span> </em></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In the case of India, proportion of undernourished in the total population has increased from 21% in 2000-02 to 22% in 2004-06. The number of undernourished people in India has increased from 223.0 million in 2000-02 to 251.5 million in 2004-06. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The economic turmoil sweeping the globe has led to a sharp spike in hunger affecting the world’s poorest, uncovering a fragile global food system requiring urgent reform. The combination of the food and economic crises have pushed more people into hunger, with the number of hungry expected to top 1 billion this year</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The World Food Summit target of reducing the number of undernourished people by half to no more than 420 million by 2015 will not be reached if the trends that prevailed before those crises continue.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Strides in improving access to food were made in the 1980s and early 1990s, thanks to stepped up agricultural investment after the global food crisis of the early 1970s. However, official development assistance (ODA) fell between 1995-1997 and 2004-2006, resulting in surges in the number of undernourished in most regions. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The increase in the number of the world’s hungry in times of both low prices and economic prosperity as well as periods of price spikes and recessions shows how weak the global food security governance system is</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Even before the consecutive food and economic crises, the number of undernourished people in the world had been increasing slowly but steadily for a decade. The most recent FAO undernourishment data covering all countries in the world show that this trend continued into 2004–06.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The number of hungry people increased between 1995–97 and 2004–06 in all regions except Latin America and the Caribbean. Even in this region, however, the downward trend was reversed because of the food and economic crises. While the proportion of undernourished continually declined from 1990–92 to 2004–06, the decline was much slower than the pace needed to meet the hungerreduction target of the first Millennium Development Goal (MDG).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The current economic crisis emerged immediately following the food and fuel crisis of 2006–08. While food commodity prices in world markets declined substantially in the wake of the financial crisis, they remained high by recent historical standards. Also, food prices in domestic markets came down more slowly, partly because the US dollar, in which most imports are priced, continued to appreciate for some time, but also, more importantly, because of lags in price transmission from world markets to domestic markets. At the end of 2008, domestic prices for staple foods remained, on average, 17 percent higher in real terms than two years earlier. This represented a considerable reduction in the effective purchasing power of poor consumers, who spend a substantial share of their income (often 40 percent) on staple foods.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The number of undernourished in the world will have risen to 1.02 billion people during 2009, even though international food commodity prices have declined from their earlier peaks. If these projections are realized, this will represent the highest level of chronically hungry people since 1970.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• During the 1990s and the current decade, however, the number of undernourished has risen, despite the benefit of slower population growth, and the proportion of undernourished increased in 2008.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Because the world energy market is so much larger than the world grain market, grain prices may be determined by oil prices in the energy market as opposed to being determined by grain supply.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Although domestic prices for most countries declined somewhat during the second half of 2008, in the vast majority of cases, and in all regions, their decline did not keep pace with that of international food commodity prices. At the end of 2008, domestic staple food prices were still 17 percent higher in real terms than two years earlier, and this was true across a range of important foodstuffs.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• India will be less affected than many other Asian countries because its cautious financial policies have reduced the country’s exposure to external financial shocks. In addition, continuing government support to the agriculture sector has transformed India from a net importer of grains to a net exporter.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Investing in agriculture in developing countries is key as a healthy agricultural sector is essential not only to overcome hunger and poverty, but also to ensure overall economic growth and peace and stability in the world.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium">According to the [inside]Nutritional Intake in India: 2004-2005[/inside], NSS 61st Round, July 2004- June 2005: </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> The consumer expenditure survey shows that the percentage share of food expenditure in total expenditure by Indian population was 55.0% in the rural areas and 42.5% in the urban areas. Relative to the comparable survey results for 1993-94, the share of food expenditure has dropped by 8.2 and 12.2 percentage points in rural and urban areas, respectively. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Average daily intake of calories by rural population has dropped by 106 kcal (4.9 percent) from 2153 kcal to 2047 Kcal from 1993-94 to 2004-05 and by 51 Kcal (2.5 percent) from 2071 to 2020 Kcal in the urban area.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Population reporting a calorie intake level of “less than 100%” of the norm of 2700 kcal, formed 66 percent of the total in rural areas and 70 percent of the total in urban areas. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Some states at the higher end of the average intake of calorie per consumer unit per diem were Punjab (2763), Uttar Pradesh (2743) and Rajasthan (2714) in the rural areas and Jharkhand (3013), Bihar (2683) and Punjab (2614) in the urban areas. On the other hand, Karnataka (2276) and Tamil Nadu (2294) in the rural areas and Maharashtra (2261), Karnataka (2385) and Tamil Nadu (2394) in the urban areas were found to have much lower intake of calorie than the Indian average. In terms of per capita calorie intake, Assam, Bihar, Haryana, Punjub, Rajasthan, West Bengal and Uttar Pradesh were higher than the national average of 2047 Kcal.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> In the rural areas, the people of Orissa (79%), Chhatisgarh (78%) and Jharkhand (75%) reportedly derived around 75% of actual intake of calorie from cereals. On the other hand, people of Punjab (50%), Haryana (54%) and Kerala (54%) reported a smaller percentage of calorie intake from cereals</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Average daily intake of protein by the Indian population has decreased from 60.2 to 57 grams in the rural area between 1993-94 and 2004-05 and remained stable around 57 grams in the urban area during the same period. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> While the intake of calorie was observed to be lower, the level of protein and fat consumption was considerably higher than the standard minimum requirement per diem per consumer unit in both the sectors. A higher intake of calorie and protein was observed in the rural India (2540 kcal and 70.8 gms.) as compared to urban India (2475 kcal & 69.9 gms.) whereas, the consumption of fat was relatively much lower in rural areas (44.0 gms.) compared to that in urban areas (58.2 gms.).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> A significant rise in per capita daily average intake of fat is observed during the decades (1993-94 to2004-05) in both rural and urban areas. It has increased from 31.4 gms. to 35.5 gms. (13.1 percent) in rural areas and from 42 gms. to 47.5 gms. (13 percent) in urban areas.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> At national level, the number of meals taken at home had decreased by 0.57%, major states having undergone similar declines were Karnataka (-13.0%), Gujarat (-75%), Andhra Pradesh (-7.37%) whereas in West Bengal it remained unchanged in the rural India. In the urban India, prevalence of home-cooked meals had gone down by 1.66% over last eleven years. The leading contributors were Karnataka (-13.2%), Andhra Pradesh (-9.35%), Assam (-8.56%) whereas the it had increased for states like Haryana (8.81%), Gujarat (1.46%) and West Bengal (0.42%).</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> At the national level, the number of meals eaten at home by household members had decreased by 0.57% in the rural areas between 1993-94 and 2004-05. In urban India popularity of home kitchen had declined by 1.66% over last ten years. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> Meals taken outside home were mainly concentrated among the age group 5-9 and 10-14 years for both the sex in all the sectors. Among the meals taken outside home in these age groups, most were from schools or Balwadi, might be in the form of ‘Mid-day Meals’. Both in rural and urban area, meals taken on payment were a rare phenomenon. </span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:small"><strong><em>Notes </em></strong></span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif"><span style="font-size:medium"><span style="font-size:small"><em><strong>Consumer unit: </strong>Consumer unit is the rate of equivalence of a normal person determined on the basis of age-sex composition of a person. It is usual to assess the calorie needs of men, women and children in terms of those of the average man by applying various coefficients to the different age-sex groups. Consumer unit of a normal male person doing sedentary work and belonging to the age group 20-39 is taken as one unit and the other coefficients are worked out on the basis of calorie requirements. Alternatively consumer unit is a normative rate of equivalence of a given age-sex specific person in relation to a ‘standard’ male person aged 20-39 years and doing sedentary work who is taken to be equivalent to one consumer unit. Nutritionists, attempting to assess calorie requirements per consumer unit, differ in their approaches to the problem, some specifying calorie requirement as function of body weight, while others assign requirements depending on nature of work (sedentary/moderate/heavy). From the 26th round, the NSS has been using a level to the tune of 2700 calories per consumer unit per day as a standard and measure of actual intake may be compared with it. This level (2700 calories per consumer unit per day) is referred to & reported as the "norm" level of calorie intake.<br /> <br /> <strong>Monthly per capita consumer expenditure (MPCE): </strong>For a household, this is the total consumer expenditure over all items divided by its size and expressed on a per month (30 days) basis. A person’s MPCE is understood as that of the household to which he or she belongs.</em></span></span></span><br /> <br /> <em><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span></em></p> <p style="text-align:justify"><em><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to the World Bank:</span><br /> <a href="http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20917151~pagePK:64257043~piPK:437376~theSitePK:4607,00.html"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20917151~pagePK:64257043~piPK:437376~theSitePK:4607,00.html</span></a></em><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span><span style="font-family:arial,helvetica,sans-serif; font-size:medium"> </span></p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">• The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa, the report says.. It also observes that malnutrition in India is a concentrated phenomenon. A relatively small number of states, districts, and villages account for a large share of the burden - 5 states and 50 percent of villages account for about 80 percent of the malnutrition cases.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Reductions in the prevalence of malnutrition over the last decade have been small – the prevalence of underweight has only fallen from 53 percent to 47 percent between 1992/93 and 1998/99</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• More than 75 percent of preschool children suffer from iron deficiency anemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD). Iodine deficiency is endemic in 85 percent of districts.<br /> <br /> • Child malnutrition is a leading cause of child and adult morbidity, mortality, and cognitive and motor development. Malnutrition is estimated to play a role in about 50 percent of all child deaths, and more than half of child deaths from malaria (57 percent), diarrhea (61 percent) and pneumonia (52 percent). Overall, child malnutrition is a risk factor for 22.4 percent of India’s total burden of disease.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• In India, child malnutrition is responsible for 22 percent of the country’s burden of disease. Undernutrition also affects cognitive and motor development and undermines educational attainment; and, ultimately impacts on productivity at work and at home, with adverse implications for income and economic growth. Micronutrient deficiencies alone may cost India US$2.5 billion annually.<br /> <br /> • In India, child malnutrition is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding and caring practices, and has its origins almost entirely during the first two to three years of life. However, the commonly held assumption is that food insecurity is the primary or even sole cause of malnutrition. Consequently, the existing response to malnutrition in India has been skewed towards food-based interventions and has placed little emphasis on schemes addressing the other determinants of malnutrition.</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• States with the highest levels of malnutrition have the lowest levels of ICDS program funding and a smaller percentage of their villages covered by ICDS centers than states with less malnutrition - The five states with the highest underweight prevalence, namely Rajasthan, Uttar Pradesh, Bihar, Orissa and Madhya Pradesh, all rank in the bottom ten in terms of ICDS coverage</span></p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Underweight prevalence during NFHS-II was higher in rural areas (50 percent) than in urban areas (38 percent); higher among girls (48.9 percent) than among boys (45.5 percent); higher among scheduled castes (53.2 percent) and scheduled tribes (56.2 percent) than among other castes (44.1 percent); and, although underweight is pervasive throughout the wealth distribution, the prevalence of underweight reaches as high as 60 percent in the lowest wealth quintile. Moreover, during the 1990s, urban-rural, inter-caste, male-female and inter-quintile inequalities in nutritional status widened.</span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">According to the [inside]National Family Health Survey-III (2005-06)[/inside], </span><a href="http://www.nfhsindia.org"><span style="font-family:arial,helvetica,sans-serif; font-size:medium">http://www.nfhsindia.org</span></a><span style="font-family:arial,helvetica,sans-serif; font-size:medium">:</span></p> <p style="text-align:justify"><br /> <span style="font-family:arial,helvetica,sans-serif; font-size:medium">• Percentage of children (under 3 years) who are stunted declined from 45.5 during NFHS-II (1998-99) to 38.4 during NFHS-III at the all-India level. The prevalence of stuntedness (during NFHS-III) among children below 3 years was highest in Uttar Pradesh (46.0%), to be followed by Chattisgarh (45.4%) and Gujarat (42.4%). </span></p> <p style="text-align:justify">• Percentage of children (under 3 years) who are wasted increased from 15.5 during NFHS-II to 19.1 during NFHS-III at the all-India level. The prevalence of wastedness (during NFHS-III) among children below 3 years was highest in Madhya Pradesh (33.3%), to be followed by Jharkhand (31.1%), Meghalaya (28.2%) and Bihar (27.7%). </p> <p style="text-align:justify">• Percentage of children (under 3 years) who are underweight declined meagerly from 47.0 during NFHS-II to 45.9 during NFHS-III at the all-India level. The prevalence of underweightedness (during NFHS-III) among children below 3 years was highest in Madhya Pradesh (60.3%), to be followed by Jharkhand (59.2%), Bihar (58.4%), Gujarat (47.4%) and Uttar Pradesh (47.3%). </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><strong>Life cycle approach to inter-generational malnutrition</strong></p> <p style="text-align:justify"><img alt="life cycle nutrition" src="tinymce/uploaded/Life%20cycle%20nutrition.JPG" style="height:460px; width:700px" title="life cycle nutrition" /></p> <p style="text-align:justify"><span style="font-size:small"><em><strong>Source: </strong>ncbi.nlm.nih.gov </em></span> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"><br /> According to [inside]Facilitating Improved Nutrition for Pregnant and Lactating Women, and Children 0–5 Years of Age[/inside] by Kathryn G. Dewey (2003), PhD, University of California, Davis, USA, <a href="http://www.enfant-encyclopedie.com/Pages/PDF/DeweyANGxp.pdf">http://www.enfant-encyclopedie.com/Pages/PDF/DeweyANGxp.pdf</a>:<br /> </p> <p style="text-align:justify">* Nutrition during childhood and adolescence influence a woman’s pre-conceptional nutritional status, which subsequently influences the outcome of pregnancy and the health of her child. Malnutrition is perpetuated across generations via this cycle. For this reason, programs to improve the nutrition of women and children must be comprehensive, targeting all stages of the life cycle.</p> <p style="text-align:justify">* Why are maternal and child nutrition important in the context of early childhood development? There are numerous linkages between adequate prenatal and postnatal nutrition and a child’s physical, cognitive, emotional, and motor development. For example, low birthweight resulting from intrauterine malnutrition is a key predictor of developmental delay, among other adverse outcomes. Duration of breastfeeding has been positively associated with a child’s cognitive and motor development. Maternal nutritional status, such as iron-deficiency anaemia, may affect the degree and quality of child caregiving. Lastly, maternal dietary practices and weight status are strongly related to a child’s risk of being overweight, a condition that can have lasting consequences on emotional and physical development.</p> <p style="text-align:justify">* Ensuring adequate diets prior to pregnancy, during pregnancy and lactation, and during early childhood (particularly the first two years) is essential. Such interventions have the potential to substantially enhance child development, as well as the general health of women and children.</p> ', 'credit_writer' => 'Rural Expert', 'article_img' => '', 'article_img_thumb' => '', 'status' => (int) 1, 'show_on_home' => (int) 1, 'lang' => 'EN', 'category_id' => (int) 10, 'tag_keyword' => '', 'seo_url' => 'malnutrition-41', 'meta_title' => '', 'meta_keywords' => '', 'meta_description' => '', 'noindex' => (int) 0, 'publish_date' => object(Cake\I18n\FrozenDate) {}, 'most_visit_section_id' => null, 'article_big_img' => null, 'liveid' => (int) 41, 'created' => object(Cake\I18n\FrozenTime) {}, 'modified' => object(Cake\I18n\FrozenTime) {}, 'edate' => '', 'category' => object(App\Model\Entity\Category) {}, '[new]' => false, '[accessible]' => [ '*' => true, 'id' => false ], '[dirty]' => [], '[original]' => [], '[virtual]' => [], '[hasErrors]' => false, '[errors]' => [], '[invalid]' => [], '[repository]' => 'Articles' } $imgtag = false $imgURL = '#' $titleText = null $descText = 'KEY TRENDS • According to The State of the World's Children 2019 report, the proportion of children under 5 years who are either stunted, wasted or overweight was 54 percent for India in 2015, 49 percent for Afganistan, 46 percent for Bangladesh in 2014, 43 percent for Nepal in 2016, 43 percent for Pakistan in 2018, 40 percent for Bhutan in 2010, 32 percent for Maldives in 2009, 28 percent for Sri Lanka and 50...' $foundposition = false $startp = (int) 0 $endp = (int) 200preg_replace - [internal], line ?? include - APP/Template/SearchResult/index.ctp, line 35 Cake\View\View::_evaluate() - CORE/src/View/View.php, line 1413 Cake\View\View::_render() - CORE/src/View/View.php, line 1374 Cake\View\View::render() - CORE/src/View/View.php, line 880 Cake\Controller\Controller::render() - CORE/src/Controller/Controller.php, line 791 Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 126 Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94 Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235 Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65 Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162 Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65 Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 88 Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65 Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96 Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65 Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
