MALNUTRITION IN UNDER-5 CHILDREN

A recent report published in The Lancet Child & Adolescent Health gives comprehensive estimates of disease burden due to child and maternal malnutrition and the trends of its indicators in every state of India from 1990 to 2017.

Malnutrition continues to be the leading cause for death among Indian children under the age of five, according to a study ICMR.

The death rate due to malnutrition in children under five years of age in India has dropped by two-thirds between 1990 and 2017, but still accounts for 68% of deaths in children of the age group, according to ICMR’s comprehensive estimates of disease burden caused by child and maternal malnutrition.

The disease burden—the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators attributed to malnutrition in children varies across states by as much as seven times, the study highlighted.

Rajasthan, Uttar Pradesh, Bihar, and Assam top the list, followed by Madhya Pradesh, Chhattisgarh, Odisha, Nagaland, and Tripura.

Among malnutrition indicators, low birth weight is the biggest contributor to the disease burden, followed by child growth failure, including stunting, underweight and wasting.

The estimates, which are part of the Global Burden of Disease Study 1990–2017, were also published in The Lancet Child and Adolescent Health on Wednesday.

The study was conducted by the India State-Level Disease Burden Initiative, a joint initiative by the ICMR, Public Health Foundation of India, and Institute for Health Metrics and Evaluation, in collaboration with the ministry of health and family welfare.

“Efforts are needed in each state to control malnutrition. State governments are being encouraged to intensify efforts to reduce malnutrition and undertake robust monitoring to track progress,” said NITI Aayog’s Vinod K. Paul.

The National Institute of Nutrition, an ICMR institute, and other partners are setting in place mechanisms to ensure there is more data on malnutrition in the various states, which will help monitor progress.

The prevalence of low birth weight in 2017 was 21%, and varied across states, ranging from 9% in Mizoram to 24% in Uttar Pradesh, the study showed.

The prevalence of child stunting was 39%, ranging from 21% in Goa to 49% in Uttar Pradesh. The trend was the highest in the Empowered Action Group States, which includes Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Odisha, and Rajasthan.

The prevalence of child underweight was at 33% and child anaemia cases was at 60%, ranging from 21% in Mizoram to 74% in Haryana.

The study also found that the prevalence of anaemia in women was at 54% in 2017.

“While it is important to address the gaps in all malnutrition indicators, low birth weight needs particular policy attention as it is the biggest contributor to child death among all malnutrition indications and its rate of decline is among the lowest,” said Lalit Dandona, director, India State-Level Disease Burden Initiative.

“Focus on improving the overall nutritional status of girls and women during the preconception and pregnancy period and providing quality antenatal care will positively influence low birth weight indicators and extend the benefits to next generation,” Paul said.

“For substantial improvements across all malnutrition indicators, states will have to implement an integrated nutrition policy to effectively address broader determinants of under nutrition across the life cycle,” said Soumya Swaminathan, chief scientist, World Health Organization, and the first author of the research paper.

Key findings include:

The death rate attributable to malnutrition in under-5 children in India has dropped by two-thirds from 1990 to 2017. Malnutrition is, however, still the underlying risk factor for 68% of the deaths in under-five children in India.
The Disability-Adjusted Life Years (DALY) rate attributable to malnutrition in children varies 7-fold among the states — a gap between a high of 74,782 in Uttar Pradesh and a low of 11,002 in Kerala.
The proportion of under-5 deaths attributable to malnutrition, which is 68.2% across India, ranges between a high of 72.7% in Bihar and a low of 50.8% in Kerala.
Among the malnutrition indicators, low birth weight is the largest contributor to child deaths in India, followed by child growth failure which includes stunting, underweight, and wasting.
The prevalence of low birth weight was 21 per cent in India in 2017, ranging from 9 per cent in Mizoram to 24 per cent in UP.
Incidences of stunting among children was 39 per cent in India in 2017. This ranged from 21 per cent in Goa to 49 per cent in UP.
In 2017, 33 per cent of the children in India were reportedly underweight, ranging from 16 per cent in Manipur to 42 per cent in Jharkhand.
The incidences of anaemia among children, on other other hand, was 60 per cent in India in 2017, ranging from 21 per cent in Mizoram to 74 per cent in Haryana.