Malnutrition and Covid-19 | 10 Oct 2020

While malnutrition already remains as the predominant risk factor for child deaths and total disability- adjusted life years, the COVID-19 has pushed back our efforts on ending malnutrition, which plagues India's children.

There is a real risk that, as nations strive to control the virus, the gains made in reducing hunger and malnutrition will be lost. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.

Malnutrition

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition addresses 3 broad groups of conditions:

• Undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age).
• Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess;
• Overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and some cancers).

Globally, at least 1 in 3 children under 5 is undernourished or overweight and at least 1 in 2 children suffer from hidden hunger.

Causes of Malnutrition

• Food & nutrition insecurity: Increased food and nutrition insecurity has severely weakened the immune system of people contributing to poor growth & intellectual impairment and has lowered human capital and development prospects
• Inequity: Inequity is a cause of malnutrition — both under-nutrition and overweight, obesity and other diet-related chronic diseases.
  • Inequities in food and health systems exacerbate inequalities in nutrition outcomes.
• Inadequate Dietary Intake: Inadequate dietary intake and disease are directly responsible for undernutrition, but multiple indirect determinants exacerbate these causes. These include-
  • Food insecurity
  • Inadequate childcare practices
  • Low maternal education
  • Poor access to health services
  • Lack of access to clean water and sanitation
  • Poor hygiene practices

Covid-19 and Malnutrition

• The nationwide lockdown has disrupted access to essential services, including Mid-Day Meals, which are not only a nutritional measure to supplement some portion of a child’s calorie needs but is also a tool to access education.
• Through a concurrent rapid needs assessment, Save the Children found that around 40% of eligible children have not received mid-day meal during the lockdown.

Malnutrition and India

• Global Nutrition Report-2020: As per the Global Nutrition Report 2020, India is among 88 countries that are likely to miss global nutrition targets by 2025.
• Malnourished children in India: Malnutrition in India accounts for 68% of total under-five deaths and 17% of the total disability- adjusted life years.
  • India is home to about 30% of the world’s stunted children and nearly 50 per cent of severely wasted children under the age of five.
• FAO estimates: The Food and Agriculture Organization (FAO) estimates that 194.4 million people in India (about 14.5% of the total population) are undernourished.
• Global Hunger Index-2019: India ranks 102 out of 117 countries in the Global Hunger Index 2019.
• Wasting rate: India’s wasting rate is extremely high at 20.8% — the highest wasting rate of any country.
• Nutrition interventions: They are not sufficient to tackle the problem of undernutrition: Even at 90% coverage, the core set of proven nutrition-specific interventions would only decrease stunting by 20 per cent.
• Covid-19: Covid-19 has posed serious threats to children and their health and nutritional rights.
  • According to recent estimates, even in the best possible scenario and accounting for changes in the provision of essential health and nutrition services due to COVID-19, India could have around additional 60,000 child deaths (around 3,00,000 in the worst-case scenario) in the next six months.

Measures Taken

• World Food Day: it is observed annually on October 16 to address the problem of global hunger.
• POSHAN Abhiyaan: The government of India had 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: 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: 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: launched in 1975, 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.

Steps That Can Be Taken

• There is a need to explore possible solutions and put forward key policy and programme proposals for the integrated management of acute malnutrition and mitigating the impact of Covid-19.
• For easy and sustained access to nutritious food, the spotlight back should be brought back on locally-available, low-cost nutritious food.
  • Also more encouragement should be given to maternal, infant and young child nutrition actions.
• Strategies like ‘take-home ration’ and ‘mid-day meal service’ to ensure the continuation of services and coverage of the most vulnerable communities, especially in urban areas. Child-sensitive social protection schemes, like Pradhan Mantri Matru Vandana Yojna (PMMVY), need to be implemented in a way so that they reach the last child.
• Strict measures are needed to ensure that the Public Distribution System (PDS) is accessible to all, especially the vulnerable population.
• The use of newer technologies in service delivery, data management, evidence generation and real-time monitoring should be encouraged for maximum use in these processes.

Conclusion

• Nutrition is not a peripheral concern rather a central to our existence; a pro-equity agenda that mainstreams nutrition into food systems and health systems, supported by strong financing and accountability is the greatest need.
• Only five years are left to meet the 2025 global nutrition targets, while the time is running out, the focus should be on an action that provides the maximum impact.
• Given the range of drivers of nutrition, spanning multiple sectors of agriculture, social protection, health and education, tackling undernutrition demands a multi-sectoral response.

This editorial is based on Trouble in the Air which was published in the ‘Business Standard’ on October 08, 2020. Now watch this on our youtube channel.