Malnutrition is not a direct cause of death among children under five years of age, but it raises chances of diseases and death by reducing resistance to infections, minister of state for health and family welfare Ashwini Kumar Choubey said in the Lok Sabha on Friday.

Malnutrition is a vicious cycle. Malnutrition begins from womb as baby born with an intra-uterine growth retardation is more likely to become a stunted child and unable to attain full growth potential,” he said, listing mother’s poor health and undernutrition, low birth-weight, faulty and sub-optimal infant and child feeding practices, and repeated episodes of childhood illnesses such as diarrhoea, pneumonia and worm infestation (soil-transmitted helminths) has the leading causes of malnutrition.

This health ministry’s position negates claims by some states that try to blame malnutrition deaths on diarrhoea, pneumonia and tuberculosis, which are the infections that hungry children with low immunity usually succumb to.

No urban-rural bias

Undernourishment starts young and is shockingly high in children in both rural and urban India, with close to nine in 10 children in the age group six to 23 months not getting “adequate” age-appropriate diet, shows data from the National Family Health Survey 4 (2015-’16). Only 11.6% urban and 8.8% rural children have adequate diet that includes four or more food groups, excluding milk.

One in three children under five yeras are underweight, including 29% in urban India. Around 70% adolescent girls are anaemic and 50% are underweight. India is also home to the largest number of stunted children in the world, with close to two in five (38.4%) children under five being too short for their age. Stunting lowers learning capacity, raises the risk of infections leads to chronic diseases, such as diabetes, hypertension, obesity and heart disease, in later life.

Socio-economic determinants such as the mother’s poor nutritional health, large family sizes that deprive the mother and younger children of food, and poor hygiene and sanitation practices add to malnutrition and under-five mortality, which remains an unacceptably high 39 deaths per 1,000 live births even after reducing substantially from 45 in 2014, according to Sample Registration System (SRS) 2016 report of Registrar General of India.

On average, boys get better nutrition and care, including medical care, which improves male child survival in the first five years of life. The bias against girls in under-five death rates, however, has reduced to 11%, from 17% in 2014, but there is a four point difference between genders. Under-five mortality was 37 per live births 1,000 for boys in 2016, and 41 for girls.

Some states have shown that bias can end. Amongst the bigger states, Chattisgarh, Delhi, Gujarat, MP, Odisha, Tamil Nadu and Telangana reversed the gender gap in girl child survival, while Madhya Pradesh, Chhattisgarh, Gujarat and Tamil Nadu reversed the gender gap for under-five survival.
Information gaps

Despite preventive vaccines and available treatment, diarrhoea and pneumonia continue to be the leading causes of death in children under five. Diarrhoea alone accounts for 9% of the around 900,000 under-five occur in India, which makes the World Health Organisation (WHO)’s inclusion of co-packaged oral rehydration salts (ORS) and zinc sulfate in the new listing of its Model List of Essential Medicines for children significant. Called the most important medical advances of the 20th century by The Lancet, ORS is a mixture of sugar, salt, water, and zinc that reduces the duration and severity of diarrhoea.

The government, on its part, is running several programmes to reduce malnutrition. The integrated child development scheme (ICDS) provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years; supplementary nutrition programme is provided under anganwadi services; Poshan Abhiyaan promotes nutrition, breastfeeding, complementary feeding and supplementation’ while National Health Mission focuses on strengthening the public health systems through services like institutional deliveries, promoting early breastfeeding, treating sick newborns, increasing full immunisation, providing micronutrient supplementation for children and mothers, including nutritional support for pregnant women and children Janani Shishu Suraksha Karyakram.
Given the high rates of child under-nutrition in urban and rural areas, this is clearly not enough.

Correct information needs to be shared and governments, both states and Centre, need to use all the communication tools they have to provide services when and where people need it.