MALNUTRITION

What is Malnutrition?
A malnourished person finds that their body has difficulty doing normal things such
as growing and resisting disease. Physical work becomes problematic and even
learning abilities can be diminished. For women, pregnancy becomes risky and they
cannot be sure of producing nourishing breast milk. When a person is not getting
enough food or not getting the right sort of food, malnutrition is just around the
corner. Even if people get enough to eat, they will become malnourished if the food
they eat does not provide the proper amounts of micronutrients - vitamins and
minerals - to meet daily nutritional requirements.
Disease and malnutrition are closely linked. Sometimes disease is the result of
malnutrition, sometimes it is a contributing cause. In fact, malnutrition is the largest
single contributor to disease in the world, according to the UN's Standing
Committee on Nutrition (SCN). Malnutrition at an early age leads to reduced
physical and mental development during childhood. Stunting, for example, affects
more than 147 million pre-schoolers in developing countries, according to SCN's
World Nutrition Situation 5th report. Iodine deficiency, the same report shows, is the
world's greatest single cause of mental retardation and brain damage.
Undernutrition affects school performance and studies have shown it often leads to
a lower income as an adult. It also causes women to give birth to low birth-weight
babies.

Symptoms of malnutrition
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Edema on legs (below the knees)

Graying of hair
Lethargy and tiredness
Dry skin
Reduction in weight
Cold and fever

Child Malnutrition in India

Child malnutrition rates in India are extraordinarily high among the highest
in the world, with nearly one-half of all children under 3 years old being either
underweight or stunted.

Child malnutrition rates are higher in India than in many countries of subSaharan Africa, even though income levels are significantly higher and
levels of infant and child mortality are lower in India. This phenomenon,
which is true more generally of the entire South Asian region, is often referred
to as the Asian enigma.
Referred to as a national shame, Malnutrition sets in very early in the life of
an Indian child. Nearly a quarter of all children are born with a major
nutritional disadvantage low birth-weight, meaning that they weigh less
than 2.5kg at birth.

Why are Malnutrition levels in India so high?

Early marriage and underweight births: More than 20% women in India are
married below the legal age. Early marriage in adolescent girls, who are
malnourished themselves and have not yet, attained physical and mental
maturity, leads to early pregnancy and birth of undernourished children.

Maternal Anemia: High proportion of mothers themselves are underweight

(one-third of all pregnant women have a body mass index (BMI) of less than
18.5) and who suffer from anemia or iron deficiency (nearly 60% of pregnant
women suffer from anemia).

Lack of public health facilitieso

Only 44% children aged 12-23 months were fully immunized during
2005-06

Only 26% children with diarrhea were provided oral rehydration salt
(ORS)

Less than 64% children suffering from ARI or fever taken to health
facility

Barely half of pregnant women receive at least 3 ANCs

Only 48% of births attended by a TBA

Breast feeding- Only 23% children breast fed within one hour of birth and
only 56% breast fed exclusively up to 6 months

Sanitation- One out of every three Indian does not have access to a toilet in
India

Low social status of women relative to men- Common practices such as

allowing all the males of the household to eat first goes some way to
explaining 83% iron deficiency anemia among Indian women (compared to
40% in Sub-Saharan Africa)

Mens control over resources within the household Numerous studies have
shown that income or assets controlled by women are more likely to be spent
on items that benefit children

High Illiteracy level among women- Malnutrition among Indian children below
the age of 3 born to illiterate mothers (55%) is more than twice the level
(26%) reported among mothers who have completed more than 10 years of
schooling

Teaching of malnutrition is grossly inadequate in medical and nursing schools

Low Birth Weight- Birth weight below 2,500 grams has been found to be very
closely associated with poor growth not only during infancy but throughout
childhood. Estimates for India reveal that 20 to 30 per cent of babies fall into
this category
Shortfall in funding for child Nutrition

What can be done?

Preventive

Not only work on increasing coverage but also quality of food provided
through ICDS

Provide training to health service providers on child nutrition

Introduce child tracking system in areas with incidence of malnutrition

Provide training to grass root health and ICDS workers on household

nutrition counseling

Provide training to medical practioners in early detection of

malnutrition cases

Advocacy on delaying age of marriage

Develop and implement communication strategy to fight malnutrition

Strengthening implementation of adolescent health programme

Advocacy for increasing budget for child health and nutrition

Curative

Set-up Malnutrition Treatment Centers (MTCs) in areas with incidence

of chronic and severe malnutrition

Steps taken
During the 2012 World Health Assembly (WHA), a 13-year comprehensive
implementation plan (2012-2025) to address maternal, infant and child nutrition
was endorsed. The aim of the plan is to alleviate the double burden of malnutrition
in children, starting from the earliest ages. The plan includes six global nutrition
targets: child stunting, wasting, and overweight; anemia in women of reproductive
age; low birth weight; and exclusive breastfeeding.

Case Study
Project Prayatn is situated in one of the remotest
districts of
Rajasthan with historically marginalized
community. Access, unavailability of basic amenities
and discrimination are some of the key factors leading
to the many issues faced by the people. Sharing below
the some of the ground realities in the project and the
work CRY is doing towards bringing about a change
that is sustainable.

Project PRAYATN
Location: 30 villages in
Shahbad block of Baran
district, Rajasthan
Key Issues: Food
insecurity, geographical
isolation, lack of adequate
health facilities, extreme
poverty, inappropriate
development schemes

CRY supported project Prayatn is working in 30

villages/hamlets of the Shahbad block of Baran district
in Rajasthan. The project is working with one of the
most primitive tribes called Sahariya. The villages are Focus Areas for 2015-16
covered by thick degraded forests and small rivers
27 ICDS centers
criss-cross the blocks making transportation and
32 Maa badi centers
communication extremely difficult. In fact some of the
1 MTC
villages are still not connected by road. The community
Growth monitoring
is economically impoverished as they are landless and
of all children in
ages 0-6years
socially recluse. The district has been designated as

Linking of all
food insecure by the government. Owing to the
geographical isolation there is lack of food supply and adequate healthcare facilities
which make the community immensely prone to malnutrition. Children are the most
affected with hardly any development opportunities owing to extreme poverty,
exclusion, food insecurity and inappropriate development schemes.
While there are 19 Aanganwadi centers and 8 mini Aanganwadi canters running in
the area with approximately 1700 children enrolled, the study conducted by the
team at project Prayatn revealed that around 1900 children are eligible for
enrollment and this difference of 200 children indicates that 15% of children from

Saharia community are still not enrolled in the Aanganwadi canters. The growth
monitoring conducted by the team reflected 143 cases of Severely Acute
Malnourished children (SAM) and 240 cases of Moderately Acute Malnourished
children (MAM). Out of these 101 cases have been referred to MTCs and several
SAM cases have been followed at family level. The community based malnutrition
management approach as well as the referral to MTCs has ensured that 15 SAM
children are brought back to normal category.
But there is still a lot of ground to be covered before we ensure child rights. In the
coming year some of the major areas of focus will be growth monitoring of all
children in the age of 0-6 years across all 30 villages, linking all children in the age
of 0-6 years to ICDS center, activation of 27 ICDS centers, 32 Maa-Badis and 1 MTC
in the intervention area, And all this with a focus on reducing the infant and child
deaths in the area and improving the overall well being of children.

Annexure