Challenges in addressing undernutrition in India (original) (raw)

2015

Abstract

A major gap in India’s capacity to address undernutrition in India is the absence of programmes to both prevent and treat cases of childhood SAM. Energy dense food that is soft or crushable, palatable and easy for children to eat through community based management of acute malnutrition (CMAM) need rapid scaling up in India. Operations research using energy dense food fortified with Type 2 micronutrients (magnesium, phosphorus, sulphur, lysine) is needed. Reductions in stunting are better achieved through interventions such as IYCF micronutrient supplementation for vulnerable children; access to high quality food; health care; safe water sources and basic sanitation. IYCF and CMAM should be conceptualised and planned as two integral parts of a single programme to prevent and treat undernutrition in its range of forms. Quantifying need and determining impact of interventions is critical. However, in India, tracking programme performance over time is compromised by surveys that gather data on different child age groups. For example, CNSM (2012-13) collects data for children under 2 years of age, whilst NFHS 3 (2005-06) and DLHS 4 (2012- 13) collected data for under-fives. DLHS 3 was conducted in almost the same reference period (2007-08) as 33 that of NFHS 3 (2005-06), but DLHS-3 did not give information on any of the three indicators of malnutrition. DLHS 4 and CNSM are also of the same time reference period (2012-13), but the age group of children covered is different. As a result tracking change (improvement or decline) is hugely challenging. Early identification and treatment of wasting may play a role in prevention of stunting in particular contexts. Programmes could be designed and directed to reduce wasting and stunting with preventive food based approaches. Policy, programme and finance should address the issue of wasting and stunting in an integrated way and attempt to bridge the divide between the two categories; it is unfortunate that neither the Ministry of Women and Child Development (WCD) nor the Health Department records length/height of children during growth monitoring promotion (GMP). The continuum of care has to be established and encompass preconception, during conception, natal and post-natal management of small for gestational age (SGA) babies, IYCF, complementary feeding, early detection of severe undernutrition by growth monitoring, disease prevention and treatment and care practices. Improvement in Maternal Health is also a priority action. Mid upper arm circumference (MUAC) standards appropriate for Indian children, should be used in community screening. Considering the high rate of small for gestational age (SGA) and preterm babies, there is an increased risk of children growing with Metabolic Syndrome, which is likely to triple the burden of malnutrition in future generations. Finding solutions to malnutrition requires traversing many pathways and integrating interventions in multiple sectors including agriculture, food distributions, feeding and care practices, disease control, hygiene and sanitation and public health programmes for disease control. In India, these interventions and pathways fall under the portfolios of at least seven different ministries, e.g. Ministry of Agriculture, Ministry of Food and Public Distribution, Ministry of WCD, Ministry of Health and Family Welfare, Ministry of Water and Sanitation, Ministry of Rural Development, Ministry of Urban Development and Poverty Alleviation. Specific attention to socially marginalised groups comes within the remit of three more separate ministries, i.e. Ministry of Social Justice and Empowerment, Ministry of Tribal Affairs and Ministry of Minority Affairs. This requires a tremendous effort at coordination. Achieving positive nutrition outcomes is therefore contingent upon effective coordination between these ministries. In order for nutrition problems to be addressed effectively, India may well need a Nutrition Mission that has the authority and system to coordinate an integrated approach between the myriad of actors implementing nutrition-specific and nutrition-sensitive programming and holds various stakeholders, including government, to account for actions and inaction.

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