The World Nutrition Report 2018, published by the World Health Organization (WHO), points out that malnutrition is a universal concern. Among the children below five years, 150.8 million are stunted (low height for age), 50.5 million are wasted (low weight for height), and 38.3 million are overweight (body fat rather than optimally healthy).
Of the total population of stunted children, 46.6 million, and of the wasted children, more than 50%, are in India. This is indeed a cause for alarm.
Stunting, wasting and underweight in children are indicators of malnutrition and under-nutrition among the children. Recognising the importance of nutrition in human development, the member states of the United Nations have adopted a target to eradicate malnutrition in all forms by 2030 as part of Sustainable Development Goals (SDGs). The UN decade of action on nutrition 2016–25 targets to reduce the number of stunted children by 40%.
The Union Ministry of Health and Family Welfare along with UNICEF and Population Council have conducted a Comprehensive National Nutrition Survey (CNNS), the first ever in India covering 30 states and the report has been published. The report was prepared after interviewing 1,12,316 children and adolescents and grouping them into three: (i) pre-school children of 0-4 years, (ii) school age children of 5–9 years, and (iii) adolescents of 10–19 years.
The report analyses the data based on the rural and urban areas, food habits, literacy level of mothers, religion and income of the families. Across the groups, 75% of participants came from rural areas. In terms of religion, 80% were Hindus, 16% Muslims, 2% Christians and the remaining are from Sikh and other religions. This is proportionate to their respective share in the total population. It is found that 55% children and adolescents eat vegetarian food (without eggs), 36 to 40% follow non-vegetarian diet and the remaining consumed egg along with a vegetarian diet.
The key findings of the survey reveal that, at the national level, 35% of children under five years of age are stunted, 17% are wasted and 33% are underweight. It also shows that at the national level, 11% of children are malnourished and 5% are acutely malnourished. Among the school going children of five to nine years, 22% are stunted and 10% are underweight at the national level. The nutrition status of all the BIMARU states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh are behind the national average.
All of them have a high stunting rate of between 37 and 42%. At the national level, 27% of children in urban areas are stunted and in rural areas, it is 10% higher. Among the BIMARU states, Bihar has the highest percentage of children stunted and it works out at 42% whereas in Rajasthan it is 36.8%. Gujarat and Meghalaya are the other two states with lower nutritional status as in the BIMARU states. Among the 100 poor performing districts where stunting is very high, 72 are from the BIMARU.
According to the Survey, among preschool children, 32.5% are stunted in Karnataka. The state, being the highest in the prevalence of stunting, is placed in the eleventh position nationally. According to the report of the NITI Aayog (Nourishing India: National Nutrition Strategy), five districts in Karnataka - Ballari, Bagalkot, Kopal, Kalaburagi and Yadgir are located among the 100 poor performing districts with very high levels of stunting.
These districts of Karnataka can also be equated with the BIMARU state of Rajasthan where five districts have high levels of stunting. Moreover, while comparing the five poorly performing districts of Karnataka with the 72 districts from the BIMARU states also, no major difference is visible. Surprisingly, a higher level of stunting is seen in some of the districts of Karnataka than in some districts of BIMARU states.
In the case of wasting, Karnataka is in the seventh position. It is 19% in Karnataka whereas the national average is only 17%. In the state, 32% of the children are underweight and it scores the ninth position in the prevalence of underweight.
Among the underweight school going children, the national average is 35.2 and the situation in Karnataka is worse than the national average by 4.3 points. In the case of overweight among adolescents, the national average is 4.8, which is more acute in Karnataka by 2.4 points.
The survey also analyses the deficiency of micronutrients such as iron, zinc, folate and vitamins. Among the preschool children surveyed, half of them are iron deficient in Karnataka, while the national average is 31.9%. Karnataka stands in the fifth position in the case of highest iron deficiency states among preschool children. In the school-going age group also the position of Karnataka is stark.
It has an iron deficiency of 31.2% while the national average is only 17. Again, around one-third of adolescents in the state are also iron deficient, placing the state in the seventh position against the national average of 21.5%. In all the age groups, the children from Karnataka are facing serious iron deficiency when compared to their counterparts in other states.
All these findings point out that concerted efforts have to be made by the various stakeholders in the state to fight malnutrition and its consequences. Active awareness programmes have to be undertaken on hygiene and sanitation since access to improved sanitation is frequently associated with reduced stunting risk. Anganwadi feeding and mid-day meal programmes in schools are to be improved based on the Comprehensive National Nutrition Survey. Karnataka’s children need new tenets of nutrition and nutritious diet.
Since the severity of malnutrition varies from region to region and districts to districts, a paradigm shift in governance on matters relating to hygiene, sanitation, drinking water, Anganwadi feeding, mid-day meal programme and public distribution system that reckon with these regional variations is called for. The local governments may be encouraged to give priority to address malnutrition, hygiene and sanitation under the Namma Grama Namma Yojana.
(The writer is Professor, Sri Ramakrishna Hegde Chair on Decentralisation and Development, Institute for Social and Economic Change, Bengaluru)