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RSTV: THE BIG PICTURE- FIGHT AGAINST MALNUTRITION


RSTV: THE BIG PICTURE- FIGHT AGAINST MALNUTRITION


Introduction:

            In a bid to tackle malnutrition, government is developing an Atlas to map the crops and food grains grown in different regions of the country so that nutritious protein rich food in local areas can be promoted. The ministry of Women and Child Development in association with the Bill & Melinda Gates Foundation and Deendayal Research Institute is developing a POSHAN atlas under POSHAN abhiyan, government’s multi-ministerial convergence mission with the vision to ensure attainment of malnutrition free India by 2022. According to the World Bank Global Nutrition Report – 2018, malnutrition costs India at least $10 billion annually in terms of lost productivity, illness and death and is seriously retarding improvements in human development and further reduction of childhood mortality. POSHAN abhiyan is focusing on ensuring the nutrition of children, women, and pregnant mothers in impoverished areas and the government seems to be looking at community management of the problem.         

 

What is malnutrition?

  • Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
  • The term malnutrition covers 2 broad groups of conditions.
  • One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
  • The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer).

 

Causes for malnutrition:

  • Mother’s health:
    • Scientists say the initial 1,000 days of an individual’s lifespan, from the day of conception till he or she turns two, is crucial for physical and cognitive development.
    • But more than half the women of childbearing age are anaemic and 33 per cent are undernourished, according to NFHS 2006. A malnourished mother is more likely to give birth to malnourished children.
  • Social inequality:
    • For example, girl children are more likely to be malnourished than boys, and low-caste children than upper-caste children.
  • Sanitation:
    • Most children in rural areas and urban slums still lack sanitation. This makes them vulnerable to the kinds of chronic intestinal diseases that prevent bodies from making good use of nutrients in food, and they become malnourished.
    • Lack of sanitation and clean drinking water are the reasons high levels of malnutrition persists in India despite improvement in food availability.
  • Lack of diversified food:
    • With the increase in diversity in food intake malnutrition (stunted/underweight) status declines. Only 12% of children are likely to be stunted and underweight in areas where diversity in food intake is high, while around 50% children are stunted if they consume less than three food items.
  • Lack of food security:
    • The dismal health of Indian women and children is primarily due to lack of food security.
    • Nearly one-third of adults in the country have a body mass index (BMI) below normal just because they do not have enough food to eat.
  • Failure of government approaches:
    • India already has two robust national programmes addressing malnutrition the Integrated Child Development Service (ICDS) and the National Health Mission but these do not yet reach enough people.
    • The delivery system is also inadequate and plagued by inefficiency and corruption. Some analysts estimate that 40 per cent of the subsidised food never reaches the intended recipients
  • Disease spread:
    • Most child deaths in India occur from treatable diseases like pneumonia, diarrhoea, malaria and complications at birth. The child may eventually die of a disease, but that disease becomes lethal because the child is malnourished and unable to put up resistance to it.
  • Poverty:
    • The staff of ICDS places part of the blame of malnutrition on parents being inattentive to the needs of their children, but crushing poverty forces most women to leave their young children at home and work in the fields during the agricultural seasons.
    • Regional disparities in the availability of food and varying food habits lead to the differential status of under-nutrition which is substantially higher in rural than in urban areas. This demands a region-specific action plan with significant investments in human resources with critical health investments at the local levels.
  • Lack of nutrition:
    • Significant cause of malnutrition is also the deliberate failure of malnourished people to choose nutritious food.
    • An international study found that the poor in developing countries had enough money to increase their food spending by as much as 30 per cent but that this money was spent on alcohol, tobacco and festivals instead.

 

Measures needed:

  • Anganwadis system is the backbone of India’s nutrition target effort and we really have to improve it.
  • Primary health infrastructure is not strong so proper steps needs to be taken in this regard.
  • Farmers should be encouraged and incentivised for agricultural diversification.
  • Innovative and low-cost farming technologies, increase in the irrigation coverage and enhancing knowledge of farmers in areas such as appropriate use of land and water should be encouraged to improve the sustainability of food productivity.
  • Public Health Management Cadre.
  • The government should improve policy support for improving agricultural produce of traditional crops in the country.
  • Improve ICDS
  • The targeting efficiency of all food safety nets should be improved, especially that of the Targeted Public Distribution System (TPDS), to ensure that the poorest are included.
  • In addition, fortification of government-approved commodities within the social safety net programmes can improve nutritional outcomes.
  • Child feeding practices should be improved in the country, especially at the critical ages when solid foods are introduced to the diet.
  • Fortification, diversification and supplementation may be used as simultaneous strategies to address micro and macronutrient deficiencies.
  • Storage capacity should be improved to prevent post-harvest losses.
  • There is a need for more robust measures that can take cognizance of all aspects of SDG 2.
  • All the major welfare programmes need to be gender sensitive.
  • The inherited dehumanising poverty explains the persistence of malnutrition on a large scale.
  • Children born in impecunious circumstances suffer the most from malnutrition. It is all the more reason for governments to intervene to provide adequate nutrition to all.
  • Taking medical services to the door step of villages
  • Funds for food to all yield great returns and help in unlocking the full potential of citizens besides strengthening the workforce.
  • Focus to improve the hygiene and cleanliness of our surrounding.
  • Real time delivery of such schemes to the targeted beneficiaries.
  • Schools kids and their parents should be made aware about the various government programmes.

 

Initiatives taken by government:

  • ICDS:-
    • High priority was accorded to reducing undernutrition in preschool children. The Integrated Child Development Scheme (ICDS) was aimed at providing food supplements to children from poor and marginalised sections to bridge the gap between requirement and actual dietary intake. 
    • Another component of ICDS programme was weighing children for early detection of growth faltering and undernutrition.
  • Universal Salt Iodisation:-
    • National Iodine Deficiency Control Programme (NIDDCP) was initiated in 1992 with the goal that all salt for human consumption will be iodised to ensure universal household access to iodised salt. 
  • There are a number of existing programmes targeting nutrition outcomes, directly or indirectly. These include the National Health Mission – Janani Suraksha Yojana, the National Rural Drinking Water Programme, Matritva Sahyog Yojana, SABLA for adolescent girls, Mid-day Meal Scheme, Targeted Public Distribution System, National Food Security Mission, MGNREGA and the National Rural Livelihoods Mission among others.
  • National Nutrition Mission :-
    • NNM has introduced a central nodal agency with extensive financial resources to coordinate various central and state government schemes and imbue them with additional financial resources.
    • The programme will  cover all states and districts in a phased manner.
    • The core strategy of the mission is to create decentralised governance systems with flexibility given to states, districts and local level with robust monitoring, accountability and incentive frameworks that will encourage local solutions. 
    • More than 10 crore people are likely to be benefitted by this programme. 
  • POSHAN Abhiyaan -PM’s Overarching Scheme for Holistic Nourishment from Jhunjhunu in Rajasthan.
    • The programme through the use of technology, a targeted approach and convergence strives to reduce the level of stunting, undernutrition, anemia and low birthweight in children, as also, focus on adolescent girls, pregnant women and lactating mothers, thus holistically addressing malnutrition. 
    • The programme aims to ensure service delivery and interventions by use of technology, behavioural change through convergence and lays-down specific targets to be achieved across different monitoring parameters  over the next few years. 
  • POSHAN Atlas: To map the crops and food grains grown in different regions of the country so that nutritious protein rich food in local areas can be promoted.
  • Indian Government has taken important steps, such as the release of fortification standards for five staples by the Food Safety and Standards Authority of India (FSSAI) to fight micronutrient malnutrition, release of food composition tables by the National Institute of Nutrition to increase focus on dietary diversity, and now, the release of nutrition data to address the issue of malnutrition more holistically.
  • The Sustainable Development Goal (SDG)-2 goal, which aims to “end hunger, achieve food security and improved nutrition and promote sustainable agriculture”, is a priority area for India, which can offer key solutions for hunger and poverty eradication and also tackle the issue of malnutrition and undernourishment in the country. 

Conclusion:

  • Malnutrition is a complex and multi-dimensional issue.
  • Before 2015, the coverage was used to be about 1%, however, the Mission Indradhanush, introduced in 2015, sets the target to achieve child vaccine coverage by 5% every year and aims to achieve target of full coverage by 2020. Currently, as a result of Mission Indradhanush, the current rate of vaccination is 7% per year.
  • It is primarily caused by several factors, including poverty, inadequate food consumption, inequitable food distribution, improper maternal, infant and child feeding, and care practices, inequity and gender imbalances, poor sanitary and environmental conditions, and restricted access to quality health, education and social care services.
  • National Family Health Survey – 4 says the decrease in underweight children was only 10%. Moreover, wasting increased by 3% (from 19.4% % 21%).
  • It once again forces us to ask why despite rapid economic growth, declining levels of poverty, enough food to export, and a multiplicity of government programmes, malnutrition amongst the poorest remains high.
  • Governance can be termed ‘good’ only when it banishes hunger and starvation. The poor must also be valued like the rest of the population since attaching less value to their lives is one unstated reason why their nutritional needs are not taken care of as they should be.

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