Presentation on theme: "Malnutrition among Indian children August 25 th, 2007."— Presentation transcript:
Malnutrition among Indian children August 25 th, 2007
What is Malnutrition? Both protein-energy malnutrition (underweight etc.) and micronutrient deficiencies Retards physical and cognitive growth; increases susceptibility to infections Cause of half of all child deaths, and more than half of deaths due to major diseases (malaria, diarrhea, pneumonia, measles) Cause of 22% of disease burden of country Implications on productivity - 2.5 B USD annually
Underweight Prevalence of underweight children is highest in the world, double of sub-Saharan Africa, more than a third of undernourished kids of the world live in India. Most retardation occurs by age 2 (30% low birth weight) In 1998-99, 73% of children underweight (of which 18% severe, 26% mild) 46% stunted (long term), 16% wasted (short term) Total of 37M kids under 3
"South Asian Enigma" People puzzled that south Asian countries have worse incidence of malnutrition than Africa. Characteristics of south Asia: low birth weight, less powerful women, poor sanitation.
Distribution by demographics or socio-economic factors Rural (50%) vs. urban (38%) Girls (48.9%) vs. boys (45.5%) SC/ST (53-56%) vs. others (44%) 60% in lowest wealth quartile. Interestingly, spread among all quartiles. These differences widened in 1990s
Distribution by demographics or socio-economic factors (contd.) It is concentrated in pockets One in 2 children underwieght in: Maharashtra, Orissa, Bihar, Madhya Pradesh, UP and Rajasthan. Last 4 account for 43% of underweight children. 10% of villages account for 28% of underweight children
Micronutrient deficiencies Preschool children: 75% (iron) 57% (Vit.A) 87% of pregnant women have anemia Distribution across demographic and socio-economic factors similar to underweight
Has there been improvement? Reduction not good enough 11% between 92-93 and 98-99, but not comparable to countries with similar socio-economic factors
ICDS (Integrated Child Development Services) World's largest early child development program Multi-sectoral approach. Anganwadi centers Supplementary feeding, immunization, health checkups, health and nutrition education to adult women, micronutrient supplements, pre-school education, growth monitoring By 2004 6lakhs AWC workers, 33M children and 6M women
Impact of ICDS No statisticaly significant relationship between presence of anganwdi center and nutritional status! Covers 90% of administrative blocks Does not cover states where underweight is most prevalent (or is it other way around?) Growth rate higher in poorer villages Poorer states have lower coverage of ICDS A whole bunch of studies, some say it has helped, some say not. Another paper said it helped younger kids more than 4-6 kids.
Bright spots of ICDS Doing well in a bunch of states Synergizing with RCH (Reproductive and Child Health program) Different states adopt different flavors of the ICDS program Promoting community participation: Mothers committees, self help groups etc. are working together with the anganwadi workers in many places. Having more volunteers (change agents)
ICDS Problems Food and supplements delivery not proper - leakage to non-targeted individuals, irregularity, mis- communication with parents More focus on expanding coverage than distributing food; instead, should be on nutritional and family- based feeding/caring and educating people. Does not target kids nder 3, or preferentially target girls/lower income groups Not in proportion to magnitude of problem Operational challenges: workers overburdened in providing primary education also to kids aged 4-6
Determinants of nutritional status Food security Access to health resources Appropriate child care behavior
How to overcome these problems Refocus objectives: either pre-school education or malnutrition Emphasis on educating to improve feeding pratices, better overall health and sanitation, how to cook nutritious food in a low budget Work with health sector more Redirected to vulnerable groups (kids < 3, pregnant women, neglected states and castes). Mini anganwadi centres;split work into 2 roles - one for health and one for preschool education Improve food procurement; make it decentralized or contract More community based; tailored to local needs