The Indian Council of Medical Research (ICMR) has conducted a comprehensive study into the burden of diseases resulting from child and maternal malnutrition in India between 1990 and 2017 as part of the Global Burden of Disease Study (GBD) 2017. The GBD is a complete examination of mortality and disability caused by major diseases, injuries, and risk factors, initiated in the 1990s with contributions from hundreds of experts worldwide, including those from the World Health Organization (WHO) and the World Bank.
The Problem of Child and Maternal Malnutrition
Despite reductions, child and maternal malnutrition remains a leading cause of death rate and disability in India. Deaths attributable to malnutrition in under-5 children have decreased by two-thirds from 1990 to 2017, but malnutrition still accounts for 68% of these deaths. It ranges from a high of 72.7% in Bihar to a low of 50.8% in Kerala.
The Disability-Adjusted Life Years (DALY) rate due to malnutrition varies widely among different states. For instance, there’s a 7-fold gap between Uttar Pradesh (74,782) and Kerala (11,002). Overweight is increasingly becoming a significant public health issue across all states.
Anaemia and Low Birthweight Issues
Another concern is the high prevalence of anaemia among women, standing at 54% in 2017. Low birthweight, believed to be the largest contributor to child deaths related to malnutrition, is also increasing faster than any other malnutrition indications, such as stunting, underweight, and wasting. The rate of decline for low birthweight is among the lowest, indicating stagnation in addressing this problem.
| Malnutrition Fact | Percentage |
|---|---|
| Death rate due to malnutrition in under-5 children (1990 to 2017) | 68% |
| Anaemia prevalence in women (2017) | 54% |
| Contribution of low birthweight to child deaths due to malnutrition | Largest contributor |
Possible Miss of Global Targets and Steps Towards Improvements
With the present state, India may fall short of global targets regarding malnutrition for the year 2030 as set by the WHO, UNICEF, and included in the Sustainable Development Goals (SDGs). To mitigate this, improving the overall nutritional status of girls and women during the preconception and pregnancy period as well as quality antenatal care can positively influence low birth weight indicators. Addressing basic needs such as clean drinking water, reducing rates of open defecation, improving women’s educational status, and providing food and nutrition security for the most vulnerable families is also crucial.
Initiatives Implemented
Several initiatives have been introduced to tackle this issue. The Mid-day Meal (MDM) scheme aims to improve nutritional levels among school children which also positively impacts enrolment, retention, and attendance in schools. The Pradhan Mantri Matru Vandana Yojana (PMMVY) provides direct money transfer to pregnant women’s bank accounts to encourage better delivery facilities. The POSHAN Abhiyaan launched in 2017-18, seeks to reduce stunting, undernutrition, anaemia, and low birthweight babies via synergy and convergence among different programs, enhanced monitoring, and improved community mobilisation. The National Food Security Act (NFSA), 2013, ensures food and nutrition security for the most vulnerable through its associated schemes and programs, making access to food a legal right.
Defining Malnutrition, Anaemia and DALYs
‘Malnutrition’ covers deficiencies, excesses, or imbalances in intake of energy/nutrients. It includes ‘undernutrition’—stunting, wasting, underweight, micronutrient deficiencies—or insufficiencies, overweight, obesity, and diet-related noncommunicable diseases.
‘Anaemia’ is a condition where red blood cells or their oxygen-carrying capacity doesn’t meet physiological needs, varying by age, sex, altitude, smoking, and pregnancy status. Iron deficiency is the most common cause, but folate, vitamin B12 and A deficiencies, chronic inflammation, parasitic infections, and some inherited disorders can also cause anaemia.
‘Disability-Adjusted Life Years (DALYs)’, is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury.