Progress in combating malnutrition remains ‘sluggish’
Malnutrition is a significant contributor to the disease burden in India. The United Nations Sustainable Development Goals (SDGs) have an ambitious target of eradicating malnutrition by 2030, prompting the World Health Organisation (WHO) to designate 2016– 2025 as the decade of nutrition. Despite strides made in reducing undernutrition indicators through national nutrition programmes, progress in India has been sluggish. A study by the Indian Institute of Public Health (IIPH) Hyderabad examined undernutrition across the nation and evaluated the distribution of nutritional indicators among children under three at the state level, utilising data from the National Family Health Surveys (NFHS).
This study published in the Clinical Epidemiology and Global Health journal centred on children below the ages of three and explored the prevalence and trajectory of undernutrition indicators across India, both nationally and at the state level. The analysis aimed to assess changes over a decade to understand the extent of the issue. Undernutrition can lead to vision impairment, weakened bones, protein deficiency, and gastrointestinal ailments in children.
“We firmly grasped the importance of comprehending the epidemiology of the condition before advocating for policy changes or interventions. It’s crucial to know who is affected, their locations, and how these factors evolve over time. Armed with this comprehensive understanding, we can aptly tailor existing policies and implement precise nutritional interventions,” said Sirshendu Chaudhari, Yashaswini Kumar, AY Nirupama, and Varun Agiwal, authors of the study.
Education and gender
Comparing data from NFHS1 (1992–93) to NFHS5 (2019–20), the study found that while the prevalence of wasting (low weight for height) increased marginally from 19.9% to 20.5%, stunting (impaired growth) and the incidence of underweight decreased from 51.9% and 34.1% to 45.8% and 29.4%, respectively. Wasting exhibited a slight increase of 0.21%. The study identified significant factors affecting children’s nutritional status, including maternal education and the child’s gender. According to the study, all States and Union territories mirrored the national trend of decreasing rates of stunting and underweight among children, though no consistent trend was observed for wasting prevalence.
In the NFHS1 survey, stunting prevalence ranged from 33.2% (lowest) in Nagaland to 63.8% (highest) in Bihar. By NFHS5, this range decreased from 23.1% (lowest) in Manipur to 41.6% (highest) in Meghalaya. Similarly, underweight prevalence in NFHS1 varied from 19.7% in Mizoram to 60.2% in Bihar, but in NFHS5, it ranged from the lowest of 11.6% in Manipur to the highest of 39.7% in Bihar. In NFHS1, wasting prevalence spanned from 4.5% in Mizoram to 26.8% in Rajasthan. However, in the 2019–2021 survey, these figures shifted, with the lowest wasting prevalence at 11.4% in Punjab and the highest at 27.7% in Maharashtra. In Chhattisgarh, Jharkhand, and Uttarakhand, stunting, underweight, and wasting rates have consistently decreased over time.
Children in urban areas face an increased risk of stunting, underweight, and wasting over the years, although the statistical significance has remained relatively stable. Male children exhibited a higher likelihood of experiencing stunting, being underweight, and wasting compared to their female counterparts, although this trend did not consistently emerge across all NFHS surveys. Maternal education emerged as a highly significant factor influencing children’s susceptibility to undernutrition. Children whose mothers had either no education or only primary education were at double the risk, while those with mothers having secondary education faced a 1.5 times higher risk of developing stunting and being underweight, although this risk decreased from NFHS1 to NFHS5.
Valuable insights
The findings of this study highlight the evolving trends in various malnutrition indicators, providing valuable insights into the necessary action to be taken at the State level and their correlation with sociodemographic factors. Looking ahead globally, if the trends observed in NFHS 5 persist, India may fall short of meeting the WHO and SDG2 targets by 2030, further exacerbated by a potential decline in the Global Hunger Index ranking.
Speaking about the study, one of the authors and also Associate Professor at IIPH Hyderabad, Sirshendu Chaudhari, said, “Enhancing overall nutrition presents a significant hurdle, but one that India has the capacity to conquer. The country boasts numerous initiatives directly or indirectly combating undernutrition. While the government shoulders a substantial part of this responsibility through initiatives like Mission Indradhanush, the onus also falls on parents, caregivers, and educators at the preschool level to identify and address this issue.”