Pupils are given a lunchtime meal distributed by a state-run primary school in Brahimpur village, Chapra, Bihar, July 2013. Photo: Reuters / Adnan Abidi
There are several nutritional concerns in the country, and the recently published fifth phase 2 compendium of the National Family Health Survey (NFHS) (2019-2021), which spans 14 states and territories across the Union, provides an opportunity to look specifically at nutrition-related Questions to deal with indicators.
Growth retardation and underweight
According to NFHS 5, the number of children under 5 who are stunted (less height for age) in India has decreased from 38.4% to 35.5%, and the number of children who are underweight (less weight for that Age) decreased from 35.8% to 32.1%.
The cycle of malnutrition in children can begin in utero and contribute to low weight and growth retardation, which are independently linked to higher mortality and morbidity in themselves, as the children may not be able to produce essential antibodies and immune responses necessary for the child Control of infectious organisms critical are often exposed. So what would have been an asymptomatic or mild infection in an otherwise healthy child can be fatal in an undernourished child.
In addition, these children may also have reduced muscle mass, reduced cough reflex, electrolyte imbalances, and other concurrent illnesses and disorders. On the other hand, a child who develops an infection may lose appetite and may not be able to take in sufficient nutrients, leading to (further) malnutrition.
In the same age group, the number of overweight (more weight for height) children increased from 2.1 to 3.4%. It is necessary to evaluate the eating habits of children and their families. The most common dietary causes for overweight or obese children are predominantly grain- or millet-heavy diets without other nutrient-dense foods, as well as excessive consumption of sugar, junk and processed foods, and seed oils and trans fats.
Women with a body mass index (BMI) below 18.5 kg / m2 have decreased from 22.9% to 18.7%, but they are still a cause for great concern. While the BMI for women and men in Arunachal Pradesh is 5.7% and 4.9%, respectively, it is 23.1% and 17.4% in Chattisgarh. The BMI for men is 16.2 for this round, compared to 20.2 in NFHS 4. A lower BMI can increase the susceptibility to fractures and the risk of infection due to decreased immunity.
Vaccine Preventable Diseases and Diet
It is known that vaccine-preventable diseases are closely related to diet. The Universal Immunization Program (UIP) in India protects against many infections that contribute to child mortality under 5 years old.
The NFHS 5 data shows that 76.4% of children between the ages of 12 and 23 months are fully vaccinated – from 64.9% in Arunachal Pradesh to 82% in Pondicherry. Vaccine protection has been severely impacted by the ongoing COVID-19 pandemic and unplanned lockdown, particularly in hilly, remote, and tribal areas.
Vitamin A deficiency is still a leading cause of preventable child blindness in India, resulting in decreased immune function and an increased risk of death from infections, which in turn can lead to even greater vitamin A deficiency. Severe forms of this deficiency, such as keratomalacia, must be prevented as they lead to irreversible vision loss and cannot be corrected afterwards.
Food sources for vitamin A can either be preformed or provitamin A and beta-carotene – the former being superior. Preformed vitamin A is found in animal fats, eggs, liver, milk and dairy products, and fatty fish. Beta-carotene and provitamin A are found in green leafy and yellow vegetables (mango, papaya), carrots and light vegetables (bell peppers), especially when consumed with a little fat / oil, since vitamin A is a fat-soluble vitamin.
As with other nutritional interventions, the vitamin A program in India stalled during the extended lockdown and showed no signs of resumption. The NFHS 5 II phase data shows a low vitamin A coverage in the NCT of Delhi (52.9%) and in Uttarakhand (53.7%).
Breastfeeding
According to established standards, babies should be exclusively breastfed (with no additional food and drink, including water) for six months. Breast-fed children are likely to have better immunity to ear infections, diarrhea, and respiratory infections, as well as a lower risk of allergies, asthma, diabetes, and obesity, among others. Breastfeeding promotes uterine contraction and reduces the mother’s risk of breast, uterine and ovarian cancer.
In NFHS 5, the number of exclusively breastfed children under 6 months of age rose from 54.9% to 63.7% (more in rural areas at 65.1%). In Chhattisgarh it is high at 80.3%. This indicator would have been affected after the pandemic and lockdown as more women had to seek employment. The informal sector maternity benefit system needs to be properly implemented in order for women to breastfeed their babies.
The proportion of children under 3 years of age who were breast-fed within an hour of birth remains at 41.8% in India. The increasing number of caesarean sections could also delay breastfeeding. Caesarean sections have increased from 17.2% to 21.5%. While this share rose from 40.9% to 47.4% in private sector institutions, it rose from 11.9% to 14.3% in public sector institutions.
Since the ideal Caesarean section rate is usually 10-15%, there is a need to constantly monitor and regulate the private sector to avoid unnecessary Caesarean sections.
Infant feeding
From six months, semi-solid food can be included in the diet of an infant. Giving them sugary beverages, foods rich in carbohydrates, and junk or processed foods like cookies affects the child’s nutritional status and can also create a lifelong culture of poor nutrition and its complications.
Alarmingly, the proportion of children aged 6 to 23 months who receive adequate nutrition is only 11.3%, according to NFHS 5. This is dire and requires concerted and serious nutritional interventions with a breakdown of indicators based on the socio-demographic profile of the population. Lunch is a statutory right of children under the age of 14 under the National Food Security Act 2013 that should be exercised with caution.
anemia
The proportion of anemic children aged 6 to 59 months in NFHS 5 increased from 58.6% to 67.1%. The proportion of all anemic women aged 15 to 19 has increased from 54.1% to 59.1%. Anemia can lead to negative clinical outcomes such as low birth weight, neonatal mortality, and premature birth. Intra- and postpartum bleeding are the leading preventable cause of maternal death.
Also Read: Does India Know That Anemia Is Running Amok In The Country?
In India, however, it has at least one attempt – by Dr the Comprehensive National Nutrition Survey (CNNS).
Ideally, the cutoffs need to be calculated based on a sample likely to produce the best results for the given indicator and selected through a thorough process of screening, investigation, exclusions and inclusions. What is important is that it needs to be correlated with clinical outcomes, not just by juggling data on a computer. According to this criterion, the CNNS data are unsuitable for calculating cutoffs.
On the other hand, a relatively better designed study by a better designed study by H. Khusun of the University of Indonesia and others found that there was no need to develop different cutoff points for anemia and that the WHO hemoglobin cutoffs for an Indonesian population.
It is important that the Government of India study some of this dietary data and make the country’s food and nutrition security more evidence-based.
Dr. Sylvia Karpagam is a public health doctor and researcher and part of the Right to Food and Right to Health campaigns.
