Fight against malnutrition IASToppers
Video Summary

[RSTV The Big Picture] Fight against malnutrition

In India, malnutrition contributed to 68.2 per cent of deaths of children under the age of five years of age in 2017. According to the recent findings of the India State Level Disease Burden Initiative, if trends upto 2017 continues, the health targets of Poshan Abhinya (2022) and WHO and UNICEF targets of 2030 will not be achieved in most Indian states.
By IT's Video Summary Team
October 16, 2019

Contents

  • Introduction
  • About Poshan Abhiyan
  • Need for Poshan Atlas
  • Is it really possible to achieve Malnutrition free India by 2022?
  • About Comprehensive National Nutrition Survey (CNNS)
  • Challenges
  • Suggestions
  • Way Forward

[RSTV The Big Picture] Fight against malnutrition

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Introduction

  • The ministry of Women and Child Development in association with the Bill & Melinda Gates Foundation and Deendayal Research Institute is developing a POSHAN atlas under POSHAN abhiyan.
  • Poshan Abhinya is a government’s multi-ministerial convergence mission to ensure attainment of malnutrition free India by 2022.
  • The Atlas will map the crops and food grains grown in different regions of the country so that nutritious protein rich food in local areas can be promoted.
  • According to the World Bank Global Nutrition Report (2018), malnutrition costs India at least $10 billion annually in terms of lost productivity, illness and death and is seriously retarding improvements in human development and further reduction of childhood mortality.

About Poshan Abhiyan

  • POSHAN Abhiyaan was launched on International Women’s day (March 8) in 2018 to boost nutrition among children and women.
  • It is a multi-ministerial convergence missionwith the vision to ensure attainment of malnutrition free India by 2022.
  • Its aim to ensure holistic development and adequate nutrition for pregnant women, mothers and children.
  • Its large component involves gradual scaling-up of interventions supported by on-going World Bank assisted ‘Integrated Child Development Services (ICDS) Systems Strengthening and Nutrition Improvement Project’ (ISSNIP)to all districts in the country by 2022.
  • Under Poshan Abhiyan, Government announced entire month of September 2019 to be ‘Rashtriya Poshan Maah’ with the theme of ‘Complimentary Feeding’.

Target under the mission

  • The target of the mission is to bring down stunting among children in the age group 0-6 years from 38 % to 25% by 2022.

Other Targets

Other Targets iastoppers

  • Prevent and reduce stunting in children (0-6 years): By 6 % at 2% per annum (p.a.).
  • Prevent and reduce under-nutrition (underweight prevalence) in children (0-6 years): By 6% at 2% p.a.
  • Reduce the prevalence of anemia among young Children, Women and Adolescent Girls: By 9% at 3% p.a.
  • Reduce Low Birth Weight (LBW): By 6% at 2% p.a

 Significance of the project

  • The project will include investments in improving the skills and capacities of ICDS staff and community nutrition workers.
  • It aims at strengthening systems of citizen engagement and grievance redressand establishing mobile technology based tools for improved monitoring of services.
  • The project ensure convergence of all nutrition related schemesand provide performance based incentives to states and community nutrition and health workers.

Need for Poshan Atlas

  • Due to the different cropping patterns across India, it is difficult to come out with a single common solution to address malnutrition. Hence, to tackle malnutrition, Poshan Atlas will be promoting regional cropping patterns and embracing local food that are rich in protein.

Is it really possible to achieve Malnutrition free India by 2022?

Positive aspects:

  • Before 2015, the coverage of child vaccine across India was used to be about 1%. However, the Mission Indradhanush, introduced in 2015, sets the target to achieve child vaccine coverage by 5% every year and aims to achieve target of full coverage by 2020. Currently, as a result of Mission Indradhanush, the current rate of vaccination is 7% per year.
  • Specifically, two ministries: Ministry of Health and Ministry of women and Child development are working closely with Poshan Abhiyan. Ministry of women and Child development handles a big part of supplementary nutrition for children under Integrated Child Development Services (ICDS). Currently, Anganwadi, a rural child care centre started by the Indian government in 1975 as part of the Integrated Child Development Services program to combat child hunger and malnutrition, handles 0-6 years of children. Anganwadis are the backbone of India’s nutrition target effort.
  • In India, at village level, Doctors are sent to manage the Public health facilities. However, doctors are meant for dispensing medicines and not meant to manage such facilities. Hence, Government is planning to create a dedicated Public Health Management Carde.

Negative aspects:

  • In many of the places in India, children are not getting adequate food diversity. These children might get calories but are not getting enough micro-nutrient.
  • As per the National Family Health Survey – 4 (2005 to 2015), the decrease in underweight children was only 10%. Moreover, wasting (low birth weight with respect to height), increased by 3% (from 19.4% % 21%). In fact, the food surplus state of Punjab recorded the highest number of wasted children across India.
  • The survey also shows that the stunting (low height for age caused by long-term insufficient nutrient intake) also decreased only by 7 % across India.

About Comprehensive National Nutrition Survey (CNNS)

  • Recently, the government published the largest ever micronutrient survey for 2016-18 named ‘Comprehensive National Nutrition Survey (CNNS).
  • It was conducted for the first time in Asia by UNICEF and Ministry of Health. The uniqueness of the survey is that it not only measured the height and weight of children (anthropometric assessment), it also collected and analyzed the blood samples of children to know more about hidden level of under nutrition.
  • This survey analyzed the macro as well micro nutrient gaps in India. Undernutrition is categories as macro nutrient deficiency (calorie gap) and micro nutrient deficiency (also vitamins and minerals gap, also called Hidden Hunger).

Highlights of CNNS

Positive results

  • India is running Universal Vitamin A supplementation programme since many years. For the first time, there is a decrease in Vitamin A deficiencies in children.
  • It was also found that the there is significant level of decline in the Iodine deficiencies level in children. Also, the consumption of iodized salt is more than 85-90% across India.
  • There is iron deficiencies in children was low, which was found by measuring the anemia level and serum ferritin level which is indication of iron intake. More than 30% of population are not taking adequate iron, especially in states like Haryana, Punjab, Gujarat etc.
  • The stunting level in India has gone down from 38 % in 2015 to 34% in 2018. Moreover, the prevalence of underweight was also decreased from 34% to around 32-33%.

Negative results

Negative results 1

Negative results 2

  • In this report, it was found that not only children are undernutrition but over-nutritioned (obese children) as well.
  • 40% percent of pre-schoolers and 24% of school-age children are anaemic. Female adolescents had a higher prevalence of anaemia (40%) compared to their male counterparts (18%).
  • There are some states such as Rajasthan, Madhya Pradesh where the under nutrition level is high.

Challenges

Infections from parasite

  • Infections such as parasite (worms) infection. These worm reduces the ability of body to intake food and reduces ability to absorb nutrients. India has a National Deworming Programme being implemented at school levels. Due to increasing infection, government is now thinking to extend such programme to community level.

High level of diseases

  • The under nutrition data revels that children are not getting treatment even for simple diseases such as measles.

Poor primary health infrastructure

  • India’s primary health infrastructure is not strong enough as India’s focus was on secondary and tertiary treatment However, the National Policy on healthcare 2017, for the first time, dedicated itself for the primary health care.
  • Health and wellness center, which are primary health care centers, are being set up under Ayushman Bharat Yojana. This centers are key for the achieving major targets of Indian health sectors because many of the countries which has strong health infrastructures such as UK, Sweden and Brazil, they invest most of their health budget in Primary health sectors.

Future diseases

Future diseases iastoppers

  • Another problem will arise when such malnourished children will grow up. They can end up having different kinds of diseases including communicable and non-communicable diseases. 

Other challenges include lack of awareness and lack of diversified food.

Suggestions

  • There is need to improve ICDS because as per the survey by Comptroller and Auditor General of India, a lot of Anganwadi do not have even weighing machines to measure the weight of a child.
  • Though India has various scheme to tackle malnutrition such as Mid-day meal scheme, there is need to monitor the progress of such scheme and augmented real time delivery of such schemes to the targeted beneficiaries.
  • In order to reduce diseases and, in turn, malnutrition level, Government should provide medical services to the door step of villages as most of the village population even don’t about the kind of malnutrition their children have. Hence, the people led awareness campaign is the key for any successful implementation of any government health programmes.
  • The awareness level in villages about under/over nourishment have to be increase as villages often ignore the connection between under/over nourishment with the thinness and obesity of a child. This can be done through ASHA or Auxiliary nurse midwife (ANM).
  • Schools can be a major source to make kids and their parents aware about the various government programme though meetings.
  • The adolescent girls, who will become mothers, will have to be educated about health hygiene and other aspects. Hence, they will not only take care about their health but will also take care of the health of future family as well.
  • Government should use every opportunity available to fill the loopholes in the health care systems. For example, earlier, it was noticed that after giving blood samples for anemia testing, many of the people do not care/know about their report. Hence, under Anemia Mukt Bharat Programme, government applied 3 T (Test, Treat and Talk) Principe in which the patient is tested and given medicine on the spot.
  • There is also need to improve the hygiene and cleanliness of our surrounding,

Way Forward

  • The best way forward is to improve the child feeding practices across India as in India, breastfeeding is inadequate as only 55% of babies (0-6 months) are exclusively breastfed. Less than 10% of the children get right amount of food at age of 6 months.
  • Hence, there is need for an awareness campaign to make people aware about calorie gap due to poor complementary feeding practices and about low birth weight as 20-25% children are born with low birth weight.
  • If India can manage the low birth weight, by addressing issue in adolescent period, that can make really a major difference in countering malnutrition levels in India.

IT’s Input

Why addressing Malnutrition is necessary?

Why addressing Malnutrition is necessary1

Why addressing Malnutrition is necessary2

Why addressing Malnutrition is necessary3

Causes and Effects of Anemia

[RSTV The Big Picture] Fight against malnutrition IASToppers

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