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At a time when the world thinks of India as a major economic power in the making, malnutrition still is a major problem which contributes to the poor human development situation in our country. The figures are deeply disturbing: the prevalence of underweight children in India is among the highest in the world, nearly double that of Sub-Saharan Africa. The UN estimates that 2.1 million children die every year before they reach the age of five. Though India has many programs to tackle malnutrition, not much headway has been made in the fight against malnutrition.
Malnutrition is identified into two constituents: protein-energy malnutrition (this is widely prevalent in India and other developing countries) and micronutrient deficiencies. Physical findings help in early identification of malnutrition, which is useful in early rehabilitation. Gomez classified protein-energy malnutrition (PEM) into three degrees: Grade 1 which is severe malnutrition (90-100% degree of PEM), Grade 2, moderate malnutrition (75-89% degree of PEM) and Grade 3, mild malnutrition with less than 60% degree of PEM.
Malnutrition is widely prevalent in rural areas, with tribal areas having the poorest nutritional status. We take the figures in Gondia district of Maharashtra, where there are 1, 02,692 children between the ages of zero and six. Of this, 779 are in the severe malnutrition category and 3,411 in the moderate malnutrition category. From April till July this year, 118 infants did not reach the age of one. Of the children between the ages of zero and six, 22% are underweight and roughly 3% are severely underweight. The weaker children are identified by anganwadi workers or Accredited Social Health Activists under the National Rural Health Mission and brought to the Nutritional Rehabilitation Center (NRC). Shockingly, the NRC in Gondia district opened only on August 15 this year.
The situation in nearby Gadchiroli district (with a tribal population of more than 50%) is not much different. Of a total of 93,983 children aged between zero and six, only 63% are of normal weight.
Among the various states of India, Madhya Pradesh, Jharkhand and Bihar have very high rates of under-nutrition. Even states like Mizoram, Sikkim, Manipur, Kerala, Punjab and Goa, where the numbers are lower, the rate of malnutrition is greatly higher than that of developed countries. Further, anemia is found in over 70% of individuals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, Karnataka, Haryana, and Jharkhand.
REASONS FOR HIGH RATE OF MALNUTRITION
People in the far-flung villages were reluctant to bring weak children to the NRC or even seek medical attention, she adds. Poverty was one of the main reasons and the parents mostly worked as agricultural labourers and found it difficult to stay in hospitals and look after their children. In addition to this, scattered population makes access to good health care facilities very difficult. Infants are neglected after birth and do not get proper nutritional supplements. Many villages are in inaccessible areas. Poor nutrition is also reflected at birth with 20 per cent of infants having low birth weight. Malaria and other diseases compound the health situation even more. In addition to this, many anganwadi workers (or Accredited Social Health Activists) do not turn up in many centers. 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)
PROGRAMS TO ADDRESS MALNUTRITION
The Government has introduced many programs to tackle malnutrition. The most famous among these are the Integrated Child Development Scheme (ICDS) set up in 1975 and the National Rural Health Mission (NRHM). 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. NRHM, created for the years 2005-2012, seeks 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 ICDS’ emphasis on older children has meant that infants under the age of two and pregnant women barely get covered. After the age of 2, growth retardation is irreversible. Thus, this program has failed.
Another program for tackling malnutrition is the Public Distribution System and the Mid-day meal schemes in Indian schools. The Mid-day meal scheme, set up by the Akshaya Patra Foundation, 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.
Like many government programs, the challenge for all these programs and schemes is how to increase efficiency, impact and coverage. Corruption is also a huge problem.
As we have seen, malnutrition is a huge problem in our country, with millions of children dying before they reach the age of six. Malnutrition amounts to a massive human development crisis, where the state is unable to provide the most basic facilities to so many of its people. It is now estimated that India will be unable to meet its Millennium Development Goals of halving malnutrition by 2015. On the contrary, disparities are growing. Even though GDP growth is impressive, malnutrition is decreasing by only a few percentage points. Malnutrition has an effect on productivity: it is estimated that physical impediments caused by malnutrition knock off 3% of GDP. One solution for the problem is fortifying food handed out by the Public Distribution System (PDS) to lower rates of anemia and decrease nutrition. A long term solution, which needs urgent emphasis, is redirecting our energies towards pregnant women and infants under the age of two. Unless we do this on a priority basis, malnutrition will continue to be a huge problem for our country. India has missed a huge window of opportunity; we cannot afford to do so any longer. The future of our children is at stake. We must act now.