Malnutrition in India
Encyclopedia
The World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...

 estimates that India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

 is ranked 2nd in the world of the number of children suffering from malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

, after Bangladesh
Bangladesh
Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

 (in 1998), where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...

 with dire consequences for mobility, mortality, productivity and economic growth. The UN estimates that 2.1 million Indian children die before reaching the age of 5 every year – four every minute – mostly from preventable illnesses such as diarrhoea, typhoid, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

, measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...

 and pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

. Every day, 1,000 Indian children die because of diarrhoea alone. According to the 1991 census of India, it has around 150 million children, constituting 17.5% of India's population, who are below the age of 6 years.

The 2011 Global Hunger Index
Global Hunger Index
The Global Hunger Index is a multidimensional statistical tool used to describe the state of countries’ hunger situation. The GHI measures progress and failures in the global fight against hunger...

 (GHI) Report ranked India 15th, amongst leading countries with hunger
Hunger
Hunger is the most commonly used term to describe the social condition of people who frequently experience the physical sensation of desiring food.-Malnutrition, famine, starvation:...

 situation. It also places India amongst the three countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7, while 78 out of the 81 developing countries studied, including Pakistan, Nepal, Bangladesh, Vietnam, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe and Malawi, succeeded in improving hunger condition.

Introduction

India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1,139.96 million (2009) and growing at 10–14% annually (from 2001–2007). India's Gross Domestic Product growth was 9.0% from 2007 to 2008; since Independence in 1947, its economic status has been classified as a low-income country with majority of the population at or below the poverty line. Though most of the population is still living below the National Poverty Line, its economic growth indicates new opportunities and a movement towards increase in the prevalence
Prevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...

 of chronic diseases which is observed in at high rates in developed countries such as United States, Canada and Australia. The combination of people living in poverty and the recent economic growth of India has led to the co-emergence of two types of malnutrition: undernutrition and overnutrition
Overnutrition
Overnutrition is a form of malnutrition in which nutrients are oversupplied relative to the amounts required for normal growth, development, and metabolism...

. The implications of both overnutrition and undernutrition indicates that a country can exert rates of infectious diseases and chronic diseases simultaneously: A situation that has not been observed before in history. This new phenomenon of the rising incidence of chronic diseases such as heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

, cancer and type II diabetes along with the presence of infectious diseases such as pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, and tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 is mainly attributed to rapid population growth and the increase in the country's economy. The increase in income has made it possible for people living in urban areas to have access to a wider range of food outlets, to afford transportation and other luxuries of western society that have led to an increase in fast food consumption and a more sedentary lifestyle.

Undernutrition

According to the World Food Program and the M.S. Swaminathan Research Foundation (MSSRF) , over the past decade there has been a decrease in stunting among children in rural India, but inadequate calorie intake and chronic energy deficiency levels remain steady.

Today child malnutrition is prevalent in 7 percent of children under the age of 5 in China and 28 percent in sub-Saharan African compared to a prevalence of 43 percent in India. Undernutrition is found mostly in rural areas and is concentrated in a relatively small number of districts and villages with 10 percent of villages and districts accounting for 27–28 percent of all underweight children.

Undernutrition includes both protein-energy malnutrition and micronutrient deficiencies. Undernourishment not only affects physical appearance and energy levels, but also directly affects many aspects of the children’s mental functions, growth and development which has adverse effects on children’s ability to learn and process information and grow into adults that are able to be productive and contributing members of society. Undernourishment also impairs immune function leaving them more susceptible to infection. Children with infections are more susceptible to malnutrition and the cycle of poverty and malnutrition continues. Child malnutrition is responsible for 22 percent of India’s burden of disease..

Micronutrient deficiencies are also a widespread problem in India. The prevalence of micronutrient deficiencies varies in different states, More than 75 percent of preschool children suffer from iron deficiency anaemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency
Vitamin A deficiency
Vitamin A deficiency is a lack of vitamin A in humans. It is common in developing countries but rarely seen in developed countries. Night blindness is one of the first signs of vitamin A deficiency. Xerophthalmia and complete blindness can also occur since Vitamin A has a major role in...

 (VAD). Iodine deficiency is endemic in 85 percent of districts, mostly due to the lack of iodized salt that is common in the developed world. Progress in reducing the prevalence of micronutrient deficiencies in India has been slow. The prevalence of different micronutrient deficiencies varies widely across states.

Most growth retardation occurs by the age of two, and most damage is irreversible. The prevalence of underweight in rural areas 50 percent versus 38 percent in urban areas and higher among girls (48.9 percent) than among boys (45.5 percent).

Overnutrition

At the same time as a large number of population suffers from malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....

, more than 100 million people (11% of Indian population) in India are over-nourished. Over-nutrition can be defined as consuming either too much calories or the wrong types of calories such as saturated fat, trans fat or highly refined sugar which leads to obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

 and many other chronic diseases. For example, there are over 30 million people with diabetics in 1985 and by next year (2010) India is projected to have 50.8 million diabetics. India is hence considered as the country with the largest population of diabetics. This diabetes (diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...

) is one of the diseases closely associated with overweight. The direct cause of overweight in India would be lack of physical activity due to sedentary life style, loss of traditional diet, faulty diet, high stress etc. Over-nutrition is most prevalent in the cities among affluences from demographic transition due to sudden economic growth in India. This tells that indirect, underlying cause of over-nutrition would be significantly high rate of economic growth.

Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in india

A Study done by S V Subramanian and George Davey Smith, investigated the effect of socioeconomic status and nutrition in India. The study was based on a nationally representative sample involving 77,220 women from different socioeconomic status backgrounds, and with varying body mass indices.

The results of the study found that being underweight had an inverse relationship with socioeconomic position, meaning that as socioeconomic position increased, the chances of being underweight decreased. A positive correlation, however, was found between socioeconomic position and being pre-overweight, overweight, and obese.

The study concluded that undernutrition and overnutrition were epidemics of the impoverished and the affluent in India.

MSU study

A study done by experts in the food and nutrition department of Maharaja Sayajirao University of Baroda
Maharaja Sayajirao University of Baroda
The Maharaja Sayajirao University of Baroda, commonly referred as M. S. University , is a university in the city of Vadodara, in Gujarat state, India...

 (MSU), found that there was a big divide in the children aged six to fourteen of the urban and rural areas of the Vadodara district. The study found that 75% of 3,000 children in the rural areas of this district were malnourished, whereas 15% of the 23,000 children studied in the urban areas were overweight.

The study used anthropometrical surveys to calculate these numbers, focusing on the Body Mass Index
Body mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...

 (BMI) as the main indicator of nutrition.

Nutritional trends of various demographic groups

Many factors, including region, religion, and caste affect the nutritional status of Indians. Living in rural areas also contribute to nutritional status.

Gender

Women tend to be at higher risk of both under and over-nutrition than men. Nearly 50% of females aged 15 – 19 face under-nutrition, with a very low percentage of over-nutrition, however this trend reverses with age. As women get older, they are more at risk for over-nutrition and less for under-nutrition. Women are also at higher risk of developing anaemia than men.

Socio-economic status

In general, those who are poor are at risk for under-nutrition, while those who have high socio-economic status are relatively more likely to be over-nourished. Anaemia is negatively correlated with wealth.

Region

Under-nutrition is more prevalent in rural areas, again mainly due to low socio-economic status. Anaemia for both men and women is only slightly higher in rural areas than in urban areas. For example, in 2005, 40% of women in rural areas, and 36% of women in urban areas were found to have mild anaemia.

In urban areas, overweight status and obesity are over three times as high as rural areas.

In terms of geographical regions, Madhya Pradesh, Jharkhand, and Bihar have very high rates of under-nutrition. States with lowest percentage of under-nutrition include Mizoram, Sikkim, Manipur, Kerala, Punjab, and Goa, although the rate is still considerably higher than that of developed nations. Further, anaemia is found in over 70% of individuals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, Karnataka, Haryana, and Jharkhand. Less than 50% of individuals in Goa, Manipur, Mizoram, and Kerala have anaemia.

Punjab, Kerala, and Delhi also face the highest rate of overweight and obese individuals.

Religion

Studies show that individuals belonging to Hindu or Muslim backgrounds in India tend to be more malnourished than those from Sikh, Christian, or Jain backgrounds.

Caste

Those belonging to scheduled castes, schedules tribes, or other backwards castes are also at increased risk of malnutrition. In particular, children of scheduled tribes have the poorest nutritional status and the highest wasting.

Identifying malnutrition

Malnutrition can be identified into two constituents, protein-energy malnutrition and micronutrient deficiencies, where protein-energy malnutrition is clearly observed in India and other developing countries There are different methods of identifying malnutrition; physical findings generally help in the diagnosis of advanced malnutrition. In identifying it early in the development malnutrition, it is of advantage to allowing early rehabilitation One of the classification of protein-energy malnutrition is done by Gomez, which uses anthropometric indices.

Degrees of malnutrition

Gomez classification of PEM:

Degree of PEM % of desired body wt. for age and sex
  • Grade I. Severe Malnutrition
  • 90%-100%
    • Grade II. Moderate Malnutrition
  • 75%-89%
    • Grade III. Mild Malnutrition
  • <60%

Protein-energy malnutrition can also be classified as marasmus
Marasmus
Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency.A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height . Marasmus occurrence increases prior to age 1, whereas kwashiorkor...

, kwashiorkor
Kwashiorkor
Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The presence of edema caused by poor nutrition defines kwashiorkor...

, or a combination of both. In marasmus conditions are characterised by extreme wasting of the muscles and a daunt expression; where kwashiorkor is identified as swelling of the extremities and belly, which is deceiving to their actual nutritional status.

Programs to address the causes of malnutrition in india

The Government of India has launched several programs to converge the growing rate of undernution children. They include ICDS, NCF, National Health Mission.

Mid-day meal scheme in Indian schools

The Akshaya Patra Foundation
Akshaya Patra Foundation
Akshaya Patra Foundation is a not-for-profit organization providing hot, nutritious freshly cooked classroom lunches for nearly 1.3 million underprivileged children in India. It is a Non-Governmental Organization in India...

 runs the world's largest NGO-run midday meal programme serving freshly cooked meals to over 1.2 million hungry school children in government and government-aided schools in India. This programme is conducted with part subsidies from the Government and partly with donations from individuals and corporate. The meals served by Akshaya Patra complies with the nutritional norms given by the government of India and aims to eradicate malnutrition among children in India.

Integrated child development scheme

The Government of India has started a program called Integrated Child Development Services (ICDS) in the year 1975. ICDS has been instrumental in improving the health of mothers and children under age 6 by providing health and nutrition education, health services, supplementary food, and pre-school education.The ICDS national development program is one of the largest in the world. It reaches more than 34 million children aged 0–6 years and 7 million pregnant and lactating mothers. Other programs impacting on under-nutrition include the National Mid-day Meal Scheme, the National Rural Health Mission, and the Public Distribution System
Public Distribution System
Public Distribution System is an Indian food security system. Established by the Government of India under Ministry of Consumer Affairs, Food, and Public Distribution and managed jointly with state governments in India, it distributes subsidised food and non-food items to India's poor...

 (PDS). The challenge for all these programs and schemes is how to increase efficiency, impact and coverage.

National Children's Fund

The National Children's Fund was created during the International Year of the Child in 1979 under the Charitable Endowment Fund Act, 1890. This Fund Provides support to the voluntary organisations that help the welfare of children.

National Plan of Action for Children

India is a signatory to the 27 survival and development goals laid down by the World Summit on children 1990. In order to implement these goals, the Department of Women & Child Development has formulated a National Plan of Action on Children. Each concerned Central Ministries/Departments, State Governments/U.Ts. and Voluntary Organisations dealing with women and children have been asked to take up appropriate measures to implement the Action Plan. These goals have been integrated into National Development Plans. A Monitoring Committee under the Chairpersonship of Secretary (Women & Child Development) reviews the achievement of goals set in the National Plan of Action. All concerned Central Ministries/Departments are represented on the Committee.

15 State Govts. have prepared State Plan of Action on the lines of National Plan of Action specifying targets for 1995 as well as for 2000 and spelling out strategies for holistic child development.

United Nations Children's Fund

Department of Women and Child Development is the nodal department for UNICEF. India is associated with UNICEF since 1949 and is now in the fifth decade of cooperation for assisting most disadvantaged children and their mothers. Traditionally, UNICEF has been supporting India in a number of sectors like child development, women's development, urban basic services, support for community based convergent services, health, education, nutrition, water & sanitation, childhood disability, children in especially difficult circumstances, information and communication, planning and programme support. India is presently a member on the UNICEF Executive Board till 31 December 1997. The board has 3 regular sessions and one annual session in a year. Strategies and other important matters relating to UNICEF are discussed in those meetings. A meeting of Government of India and UNICEF officials was concurred on 12 November 1997 to finalise the strategy and areas for programme of cooperation for the next Master Plan of operations 1999–2002 which is to synchronise with the Ninth Plan of Government of India.

National Rural Health Mission

The National Rural Health Mission of India
National Rural Health Mission of India
National Rural Health Mission of India is a program and scheme run by the ministry of health under government of India. The mission was launched on 5th April 2005 for period of 7 years . The mission helps and seeks to improve the health care delivery system...

 mission was created for the years 2005–2012, and its goal is to "improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women, and children."

The subset of goals under this mission are:
  • Reduce infant mortality rate (IMR) and maternal mortality ratio (MMR)
  • Provide universal access to public health services
  • Prevent and control both communicable and non-communicable diseases, including locally endemic diseases
  • Provide access to integrated comprehensive primary healthcare
  • Create population stabilisation, as well as gender and demographic balance
  • Revitalize local health traditions and mainstream AYUSH
    AYUSH
    The Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy is a part of the Ministry of Health & Family Welfare of the Government of India....

  • Finally, to promote healthy life styles


The mission has set up strategies and action plan to meet all of its goals.

See also

  • Below Poverty Line
    Below Poverty Line
    Below Poverty Line is an economic benchmark and poverty threshold used by the government of India to indicate economic disadvantage and to identify individuals and households in need of government assistance and aid. It is determined using various parameters which vary from state to state and...

  • Famine in India
    Famine in India
    Famine has been a recurrent feature of life in the Indian sub-continental countries of India, Pakistan and Bangladesh, and reached its numerically deadliest peak in the late eighteenth and nineteenth centuries. Historical and legendary evidence names some 90 famines in 2,500 years of history. There...

  • India State Hunger Index
    India State Hunger Index
    The India State Hunger Index is a tool to calculate hunger and malnutrition at the regional level in India. It is constructed in the same fashion as the Global Hunger Index 2008 and was calculated for 17 states in India, covering more than 95 percent of the population.The ISHI was developed by...

  • Poverty in India
    Poverty in India
    Poverty is widespread in India, with the nation estimated to have a third of the world's poor. According to a 2005 World Bank estimate, 41.6% of the total Indian population falls below the international poverty line of 1.25 a day...


External links

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