Malnutrition

Malnutrition refers to a condition in which a person’s diet is deficient or in excess of energy (calories) or nutrients or both. Malnutrition can be classified into three broad categories: undernutrition, micronutrient deficiency or hidden hunger and obesity and overweight. Malnutrition in children affects their physical growth and makes them susceptible to other diseases due to a weak immune system. Malnutrition also affects the mental and cognitive functions of a person. Malnutrition is a condition that affects children and the poor the most, but it can affect other sections too. Sustainable Development Goal 2, SDG 2, which aims at zero hunger and improved nutrition, has a target 2.2 of ending malnutrition in all its forms. To combat malnutrition, the government is running various programmes that target various manifestations of malnutrition at different levels. These programmes are POSHAN Abhiyan, the Integrated Child Development Scheme, Public Distribution System and the National Food Security Act, etc. India has shown improvement in its nutritional status, as evidenced by the National Family Health Survey-5 (NFHS-5). NFHS-5 data has shown that there is an improvement in child malnutrition and adult nutritional status. Although the results are encouraging, there is a lot of work to be done to achieve SDG-2.

Some important definitions:

Hunger: It is a situation of distress in which a person is not able to meet the basic nutritional needs for a prolonged period of time.

Child Mortality: One of the major reasons for child mortality is infectious disease, diarrhoea, malaria, birth related complications, etc. Among other interventions such as vaccination, breastfeeding, institutional delivery, etc, adequate nutrition is very important. SDG Target 3.2 is to end preventable deaths of newborns and children under 5 years of age.

• Neonatal Mortality Rate (NNMR): It refers to the number of deaths in total live births during the first 28 days of life. It is expressed in deaths per thousand live births. According to NFHS-5, NNMR has been reduced to 24.9 from 29.5 in the NFHS-4.
• Infant Mortality Rate (IMR): It refers to the number of infant deaths before their first birthday. It is expressed in deaths per thousand live births. According to the NFHS-5, IMR has been reduced to 35.2 from 40.7 in the NFHS-4.
• Under 5 Mortality Rate (U5MR): It refers to the probability that a child born in a specific year or a period will die before reaching the age of five. It is measured in deaths per thousand live births. According to the NFHS-5, it has reduced from 49.7 in the NFHS-4 to 41.9.

Malnutrition: According to the World Health Organisation (WHO), malnutrition refers todeficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. It can be broadly classified into three categories:

• Undernutrition: this is a condition that occurs due to insufficient calorie or nutrient intake. There are three sub-forms:
  • Wasting: low weight for height
  • Stunting: low height for age
  • Underweight: low weight for age

  Children under 5 years of age (in %)	NFHS-5	NFHS-4	Trend
  Wasting	19.3	21	Decreasing
  Severely Wasted	7.7	7.5	Increasing
  Stunting	35.5	38.4	Decreasing
  Underweight	32.1	35.8	Decreasing
  Overweight	3.4	2.1	Increasing

• Overweight: this condition occurs when there is an excess intake of calories and other nutrients. This includes both overweight and obesity.
• Micronutrient Deficiency: In this condition, there is a deficiency of essential micronutrients, i.e. vitamins and minerals. A person might look healthy but may be suffering from this deficiency. It is also referred to as hidden hunger.

WHO considers malnutrition one of the biggest threats to the world’s health. The following are some of the consequences of malnutrition:

• Poverty and Unemployment: Unemployment pushes people into poverty. A family suffering from abject poverty does not have enough resources to have nutritional food. Hence, people in poverty are trapped in a cycle of malnutrition, unemployment, and poverty.
• Lack of awareness: Micronutrient deficiency or hidden hunger, is caused by a lack of awareness of essential nutrients that a human body requires.
• Societal causes: Due to some ingrained social norms, women do not have access to enough food and nutrition as compared to men. For example, in many families, women are the last ones to have a meal.
• Improper sanitation and hygiene: such conditions are breeding grounds for many pathogens and parasites, which cause many diseases. These diseases make the body weak, which leads to improper absorption of nutrients in the body. For example, recurring diarrhoea in children aggravates malnutrition conditions.
• Maternal health: women who are malnourished give birth to malnourished children. Also, lack of proper breastfeeding practices is the major cause of malnutrition in infants and children under 5 years.
• Unsafe drinking water also exposes people to water-borne diseases that make the human body susceptible to malnutrition.
• Climate change: extreme weather events caused by climate change like frequent floods, draughts, and other disasters disrupt food supply and production. It can threaten food production and food security.
• Improper implementation of government schemes leads to the exclusion of targeted beneficiaries.

• Poverty alleviation programs: coordinated efforts must be made to generate meaningful employment and reduce poverty. This can break the vicious cycle of poverty and malnutrition. For example, empowering Self Help Groups (SHGs) will not only reduce poverty and unemployment but also achieve better nutritional status for women and children.
• Promotion of diversified food consumption: one size fits all approach may not work in addressing malnutrition. Therefore, a diverse food diet based on the region must be promoted that is most suitable and offers complete nutrition.
• Better identification of malnutrition in children: Malnourished children must be identified at an early stage and given adequate means for proper nutrition. There should be proper monitoring and regular checkups for such cases.
• Fortification of staple food: micronutrient deficiency or hidden hunger can be tackled with the fortification of staple foods such as flour, milk, rice, etc with essential micronutrients and minerals like iron, zinc, Vitamins, etc.
• Focus on maternal and child health: intergenerational transfer of malnutrition from mother to child can be stopped by focusing on maternal health. For this, primary health care must be improved.
• Better implementation of existing government schemes and fixing accountability of public officials: implementation of government schemes depends on the efficient working of the ground worker. But it is often seen that there is laxity on the part of government officials. Such officials must be held accountable for their inefficient work.
• Better policy environment: policies must reflect ground realities and consider the diversity of the country. Policies must be based on evidence based studies to ensure better implementation.
• Community participation and empowerment: Government interventions often suffer from a few problems such as inefficiency, improper service delivery, leakages, etc. To address this, the community as a whole should be made aware of their rights and entitlements. Community participation will ensure that there is accountability of public officials and effective implementation of government programs.
• IEC campaign: An Information, Education and Communication (IEC) strategy must be adopted to spread awareness regarding food habits, nutrient requirements, maternal and child health, etc.

India is currently suffering from a triple burden of malnutrition, i.e., undernutrition, hidden hunger, and obesity. To achieve sustainable and inclusive development, the health and well-being of people should be of paramount importance. Malnutrition not only leads to an increase in health costs but also dents the potential of the demographic dividend. To ensure Sabka Sath Sabka Vikas, this issue must be treated as the utmost priority, and all the stakeholders must work together to reduce the triple burden.