Closing Diet Gaps for Children Under 5 in India

From Siddhi Jaina

New Delhi, July 5th (IANSlife): 68 percent of child mortality under 5 in India is related to malnutrition, and over a third of children under 5 in the country are chronically malnourished or stunted. An insight into the nutritional situation and determinants of child nutrition obtained from the fifth National Family Health Survey (NFHS-5) 2019-20 for 22 states and Union territories is extremely worrying, according to experts.

A rapid trend analysis report published by the Observer Research Foundation compares results from NFHS-4 (2015-16) and NFHS-5. Written by Sheila C. Vir and Shoba Suri, the report finds a reversal in progress on some of the country’s key nutritional indicators. These include an increasing trend in chronic malnutrition (measured as stunted growth or height for age) in 13 states and an increasing trend in the proportion of overweight children under 5 years of age in all states except one UT. The unexpectedly growing trend of malnutrition in states like Kerala, Goa and Himachal Pradesh, where over 60 percent of women are reported to have completed at least 10 years of education, is fascinating.

Child malnutrition is largely determined by underlying and immediate factors. The data show that the underlying determinants most important for preventing chronic malnutrition or stunted growth in children are women’s education, height of at least 145 cm and the correct age of conception, as well as improved prenatal care and health Water hygiene (WASH) are. Percentage coverage of nutrition-sensitive interventions that focus on the underlying determinants – including women’s empowerment status, women’s health care and WASH practices – has increased positively over the four-year period between 2015 and 2019.

According to the latest NFHS-5 data, relatively more women today have access to safe and clean sanitation, maternal health services and institutional supplies, have their own mobile phone and bank account, and can stay in school longer and with delayed conception until after they are 18 years old . Women who own cell phones and have bank accounts and access to clean fuel, which the authors view as proxy indicators of women’s empowerment, show unusually high coverage of over 60 percent on UTs in more than half of the states, and 9 States report over 80 percent.

Why don’t children’s nutrition indicators reflect this progress?

Advances in underlying determinants alone are insufficient to address malnutrition problems. While they have an indirect impact on the immediate determinants, it is imperative that the scope of the interventions be simultaneously addressed and expanded to address the immediate determinants directly. The latter include Adequate Nutrition and Infant and Young Child Nutrition (IYCF) practices and child health services. IYCF includes breastfeeding and supplementary nutrition (CF). CF refers to the transition from exclusively breastfeeding in the first six months of life to introducing semi-solid foods in a child along with continued breastfeeding.

Adequate CF involves choosing the right foods from at least 4 different food groups, combined with continued breastfeeding and feeding adequate amounts of food 3-4 times a day. The ORF report highlights that CF practices remain inadequate and may contribute to children’s malnutrition. Pricelessness doesn’t seem to be the only reason for bad CF practices. This is supported by the fact that according to NFHS-4 results, 20 percent of children in the highest wealth index were also reported as stunted. A lack of awareness of choosing the right foods from appropriately different food groups and caregivers not having enough time to follow recommended feeding practices and the incentive to use meager resources in commercially attractively packaged foods are becoming the leading cause of child malnutrition viewed.

A family will only prioritize adequate CF if they are aware of the grave consequences, that is, largely irreversible effects not only on physical growth but also on brain development. In addition, raising awareness of the widespread misconception that an undernourished child looks emaciated is critical to ensuring that the “invisible” but harmful problem of chronic malnutrition is not overlooked.

What are the political needs?

The first 1000 days of life (from conception to the first 24 months) are identified by experts as crucial for optimal growth. Eighty percent of brain development occurs in this window, which offers the most favorable timeframe for investing in child nutrition, they argue. Any family with a pregnant woman or child aged 0-24 months should be considered a family at high risk of child malnutrition. Timely efforts must be directed specifically to these families. Although several nutrition-sensitive interventions and health services for mother and child, and to some extent breastfeeding practices, have improved, CF practices remain largely neglected. Both feeding and feeding practices are important. The authors also advocate mapping at the community level of households with pregnant or newly married women and children between 0 and 24 months.

The ORF report identifies the need for effective social and behavioral change (SBCC) communication to combat misinformation and empower women and families to choose the right affordable and locally applicable foods to address all three of the main problems of child malnutrition – malnutrition , Overweight or obesity and micronutrient deficiency.

It is known that malnutrition affects the cognitive development and future income potential of children. In order to ensure a reduction in chronic child malnutrition (disease) and prevent negative effects on the growth and lifelong development of a child, the report calls for serious efforts to step up measures to improve meaningful multi-sectoral convergence at the family level of children under two years of age coupled child nutrition practices with maternal nutrition, as well as food security measures and WASH services, and community involvement in appropriate complementary feeding practices.