India bears double burden of malnutrition: study

Global Nutrition Report 2020 calls for integrating nutrition into universal healthcare

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Geetanjali Minhas | May 14, 2020 | Mumbai


#malnutrition   #healthcare   #Nutrition   #Global Nutrition Report 2020   #obesity  
(GN photo)
(GN photo)

One in three children under five years of age in India is stunted and one in five children under five years is wasted. Stunting prevalence of10.1% is higher in rural than in urban areas. India experiences a malnutrition burden among its under-five population. One in two women (51.4% ) in reproductive age have anaemia.

The national prevalence of under-five overweight at 2.4% as of 2015 has increased from 1.9% in 2006. The national prevalence of under-five stunting is 37.9% which is greater than the developing country average of 25%. India's under-five wasting prevalence of 20.8% is also greater than the developing country average of 8.9%. In India, 54.9% of infants under 6 months are exclusively breastfed.

The 2020 Global Nutrition Report (GNR2020) ‘Action on Equity to end Malnutrition’, released on May 12, says that India is ‘off course’ to meet the global targets for all indicators analyzed with adequate data.

The report says that there is insufficient target data to assess India's progress for under-five overweight, infant exclusive breastfeeding and low birth weight. India's adult population also faces a malnutrition burden. 9.1% of adult men and 8.3% of women have diabetes. 20.7% adult women and 18.9% adult men are overweight. With this coexistence of under-nutrition and overweight or obesity India faces the double burden of malnutrition.

The report mentions that Transformation of Aspirational Districts Programme, popularly known as Poshan Abhiyan (National Nutrition Mission), launched in January 2018, is a unique programme that focuses policy attention towards addressing inequity and social injustice in 115 ‘aspirational districts’ in 28 states. “It has shown encouraging progress in health and nutrition outcomes. This progress can be attributed to an inclusive approach with firm appreciation of ground realities which ensures the district is kept at the locus of inclusive development. Key innovation within this programme was to introduce six-monthly household surveys to gauge the coverage and quality of the interventions. Improved programme delivery is spurred by competition based on outcomes and sustained targeted efforts of the state and local governments. District implementation teams are also provided with small-area estimates derived from sophisticated statistical analysis of the household data providing ‘development intelligence’ to direct field action,” it says.

Although the 2020 Global Nutrition Report was drafted before the coronavirus pandemic, the deadly gaps in healthcare have exposed heightened risk to Covid-19.  The report cautions, “There is a real risk that as nations strive to control the virus the gains they have made in reducing hunger and malnutrition will be lost. These gains must be protected through increased and well-targeted official development assistance as well as domestic resource allocations focused on nutritional wellbeing. Beyond the present pandemic emergency there is a need for well functioning, well-funded and coordinated preventive public health strategies that pay attention to food, nutrition, health and social protection.”

In global perspective, the report says progress is too slow to meet the targets. One in every nine people in the world is hungry and one in every three is overweight. More and more countries experience the double burden of malnutrition where under-nutrition coexists with overweight, obesity and other diet-related non-communicable diseases (NCDs). Not one country is on course to meet all ten of the 2025 global nutrition targets and just 8 of 194 countries are on track to meet four targets. Malnutrition persists at unacceptably high levels on global scale despite some progress in select nutrition indicators progress is insufficient to meet 2025 global nutrition targets. Worldwide, only about one-quarter of the 16.6 million children under 5 with severe acute malnutrition received treatment in 2017. Among children under 5 years of age 149 million are stunted 49.5 million are wasted are 40.1 million are overweight there are 677.6 million obese adults with no signs of slowing.
 
Malnutrition in all its forms has become the leading cause of ill health and death and the rapid rise of diet-related NCDs is putting an intolerable strain on health systems. Yet most people cannot access or afford quality nutrition care for prevention or treatment. There is need for multifaceted equitable nutrition action which is crucial to achieving the 2025 global nutrition targets.

Looking at the MIYCN targets it says that the world is ‘off course’ to meet the anaemia target, with 613.2 million (32.8% prevalence) adolescent girls and women aged 15 to 49 years being affected. Anaemia prevalence is substantially higher in pregnant (35.3 million, 40.1%) than non-pregnant (577.9 million, 32.5%) adolescent girls and women. There has been some progress towards achieving the exclusive breastfeeding target, with 42.2% of infants under 6 months being exclusively breastfed; yet, accelerated improvements would be needed to reach the 2025 target. Globally, 20.5 million newborns (14.6%) have a low birth weight, with levels of progress well below those required to achieve the 2025 target.

Stunting still affects 149.0 million (21.9%) children under 5 years of age, and wasting affects 49.5 million (7.3%) children under 5 years of age. Progress is far too slow to achieve any of those targets.

The report has raised concerns on lack of proper data and points that there are striking data gaps for certain nutrition indicators, sub-national locations and key population characteristics such as ethnicity and disability. “These data gaps prevent improved understanding of nutrition in equalities and informed priority setting.”

It further says that when nutrition actions represent only a tiny portion of national health budgets, in the long run they can reduce health spending and can be highly cost-effective. It calls for delivery of nutrition actions by skilled nutrition professionals, which is rarely done and largely focused on under nutrition. It also calls optimizing health records and checks to screen, monitor and treat malnutrition through assessments of diet quality and food security.
 
GNR 2020  recommends integrating nutrition into universal health coverage as an indispensable prerequisite for improving diets, saving lives and reducing healthcare, intensified efforts and actions to address the persistent and unacceptably high levels of malnutrition, equity sensitive interventions to food approach, policies and prevention initiatives, targeting and expanding resources particularly for areas or population groups disproportionally burdened by malnutrition, investment in high-quality systematically collected granular nutrition data disaggregated to the local level and information systems with a  global commitment to and invest in the routine collection of equity sensitive nutrition data and involvement  and mobility of all sectors to act.

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