Severe Acute Malnutrition in India

• 31 Jul 2021

Why in News

According to the Women and Child Development Ministry, more than 9.2 lakh children (from six months to six years) in India were ‘severely acute malnourished’ till November, 2020.

• It underscores concerns that the Covid-19 pandemic could exacerbate the health and nutrition crisis among the poorest of the poor.

Key Points

• About Severe Acute Malnutrition (SAM) :
  
  • WHO’s Definition: The World Health Organisation (WHO) defines ‘severe acute malnutrition’ (SAM) by very low weight-for-height or a mid-upper arm circumference less than 115 mm, or by the presence of nutritional oedema.
    
    • Children suffering from SAM are nine times more likely to die in case of diseases due to their weakened immune system.
    • Nutritional oedema: Abnormal fluid retention in the tissues (oedema) resulting especially from lack of protein in states of starvation or malnutrition.
      
      • Oedema can, however, occur in starvation even if the blood levels of albumin are not lowered.
• Related Findings:
  
  • Number of SAM Children (National scenario): An estimated 9,27,606 ‘severely acute malnourished’ children from six months to six years were identified across the country till November 2020.
  • States with SAM Children:
    
    • The most in Uttar Pradesh (3,98,359 ) followed by Bihar (2,79,427).
      
      • Uttar Pradesh and Bihar are also home to the highest number of children in the country.
    • Maharashtra (70,665) > Gujarat (45,749) > Chhattisgarh (37,249) > Odisha (15,595) > Tamil Nadu (12,489) > Jharkhand (12,059) > Andhra Pradesh (11,201) > Telangana (9,045) > Assam (7,218) > Karnataka (6,899) > Kerala (6,188) > Rajasthan (5,732).
  • States with No Severely Malnourished Children: Ladakh, Lakshadweep, Nagaland, Manipur and Madhya Pradesh reported no severely malnourished children.
• National Family Health Survey Findings:
  
  • The National Family Health Survey-4 (NFHS-4), 2015-16 suggests that prevalence of severe acute malnutrition among children was at 7.4%.
  • NFHS-5 suggests that malnutrition increased among children in 2019-20 from 2015-16 in 22 states and UTs.
    
    • Stunted: Around 13 states and UTs out of the 22 surveyed recorded a rise in percentage of children under five years who are stunted in comparison to 2015-16.
      
      • Stunting is when a child has a low height for their age, usually due to malnutrition, repeated infections, and/or poor social stimulation
    • Wasted: 12 states and UTs recorded a rise in the percentage of children under five years who are wasted.
      
      • Wasting is low weight for their height among children, reflecting acute undernutrition. It is a strong predictor of mortality among children under five years of age.
    • Severely wasted and underweight: 16 states and UTs recorded a rise in the percentage of children under five years who are severely wasted and underweight in 2019-20.
• Impact of Covid-19:
  
  • Covid-19 is pushing millions into poverty, reducing incomes of many more and disproportionately affecting the economically disadvantaged, who are also most vulnerable to malnutrition and food insecurities.
  • The pandemic-prompted lockdowns disrupted essential services, such as supplementary feeding under Anganwadi centres, mid-day meals, immunisation, and micro-nutrient supplementation which exacerbated malnutrition.

Steps Taken by Government

• POSHAN Abhiyaan: The government of India has launched the National Nutrition Mission (NNM) or POSHAN Abhiyaan to ensure a “Malnutrition Free India” by 2022.
• Anemia Mukt Bharat Abhiyan: Launched in 2018, the mission aims at accelerating the annual rate of decline of anaemia from one to three percentage points.
• Mid-day Meal (MDM) scheme: It aims to improve nutritional levels among school children which also has a direct and positive impact on enrolment, retention and attendance in schools.
• The National Food Security Act (NFSA), 2013: It aims to ensure food and nutrition security for the most vulnerables through its associated schemes and programmes, making access to food a legal right.
• Pradhan Mantri Matru Vandana Yojana (PMMVY): Rs.6,000 is transferred directly to the bank accounts of pregnant women for availing better facilities for their delivery.
• Integrated Child Development Services (ICDS) Scheme: It was launched in 1975 and the scheme aims at providing food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.

Note: The Sustainable Development Goal (SDG 2: Zero hunger) aims to end all forms of hunger and malnutrition by 2030, making sure all people – especially children – have access to sufficient and nutritious food all year round.

Way Forward

• Home Based and Facility Based Care: Covid-19 could further exacerbate the situation with shrinking food diversity and low intake combined with episodes of missing food at times. The solutions have to be both home-based care and facility-based care.
• Build Linkages: The severe Acute Malnutrition has a direct connection with food availability, utilisation and awareness, the immediate task is to appropriately build linkages with the government systems to ensure families receive not just ration/food, but required education and support.
• Strengthen Nutrition Rehabilitation Centres (NRCs): The need to strengthen Nutrition Rehabilitation Centres (NRCs) which are meant to treat SAM cases.
  
  • There are studies that suggest that NRCs have not been very effective.
  • In many cases, it has been seen that SAM cases have been discharged early because either the centre could not continue to keep the same case for a continued period, or the caregivers could not stay for a longer duration at the facility, or there was simply not enough supervision by the higher ups.
• Designing Customised Menus: There is the need for designing customised menus in consultation with experts for SAM cases and formulating guidelines.
• Segregation of SAM Cases: For administrative and operational convenience, as well as for better accountability, SAM cases could be segregated into smaller units.
  
  • The responsibility to manage/coordinate and monitor smaller units could be handed over to independent entities such as medical colleges, local NGOs, women’s collectives – under the overall guidance of the District/Block health staff.
• Role of Anganwadi Centres: The identification of SAM children was done by over 10 lakh Anganwadi centres from across the country.
  
  • The anganwadis have to become much more functional and if the possibility of children reaching anganwadis is going to become hard because of lockdowns, then the anganwadis need to reach the children.

Source: TH