NFHS 5 has a lot to say about nutrition in India. Who is listening?
Schoolchildren eat a midday meal, distributed by a government-run primary school in the village of Brahimpur, Chapra, Bihar, July 2013. Photo: Reuters / Adnan Abidi
There are several concerns regarding the state of nutrition in the country, and the recently released Fifth Phase 2 Compendium of the National Family Health Survey (NFHS) (2019-2021), covering 14 states and territories of Union, provides an opportunity to specifically address issues related to nutrition. indicators.
Stunted and underweight
According to NFHS 5, the number of children under 5 who are stunted (less height for age) in India has increased from 38.4% to 35.5% and the number of children who are underweight (less weight for age) fell from 35.8% to 32.1%.
The cycle of child malnutrition can begin in utero and contribute to low body weight and stunting, which are themselves independently associated with mortality and morbidity, as children may not be able to produce essential antibodies and immune responses crucial to fighting infectious organisms to which they are commonly exposed. Thus, what would have been an asymptomatic or mild infection in an otherwise healthy child can become fatal in a malnourished child.
Additionally, these children might also have reduced muscle mass, reduced cough reflex, electrolyte disturbances, and other coexisting illnesses and conditions. On the other hand, a child who develops an infection may lose his appetite and not be able to absorb nutrients adequately, thus worsening to (more) malnutrition.
In the same age group, the number of overweight children (more weight for height) increased from 2.1 to 3.4%. It is necessary to assess the eating habits of children and their families. The most common nutritional cause of overweight or obesity in children are diets high in grains or millet without other nutrient-dense foods, as well as excessive consumption of sugar, junk food, and sugar. processed foods, seed oils and trans fats.
Women with a body mass index (BMI) below 18.5 kg / m2 fell from 22.9% to 18.7%, but remain a serious concern. While the BMI for women and men in Arunachal Pradesh is 5.7% and 4.9% respectively, in Chattisgarh it is 23.1% and 17.4%. The BMI for men is 16.2 in this cycle, compared to 20.2 in NFHS 4. A low BMI can increase susceptibility to fractures and the risk of contracting infections due to reduced immunity.
Vaccine-preventable diseases and nutrition
It is well known that there is a close association between vaccine preventable diseases and nutrition. The Universal Immunization Program (UIP) in India protects against many infections that contribute to the mortality of children under 5 years old.
NFHS 5 data shows that 76.4% of children aged 12-23 months are fully immunized, ranging from 64.9% in Arunachal Pradesh to 82% in Pondicherry. Immunization coverage has been severely affected by the protracted COVID-19 pandemic and unplanned containment, especially in hilly, remote and tribal areas.
Vitamin A deficiency is still one of the leading causes of preventable childhood blindness in India, and leads to reduced immune function and increased risk of death from infections, which in turn can lead to even more vitamin A deficiency. Severe forms of this impairment, such as keratomalacia, should be avoided because they cause irreversible visual loss and cannot be treated retrospectively.
Dietary sources of vitamin A can be either preformed or provitamin A and beta-carotene, whichever is greater. Preformed vitamin A is found in animal fats, eggs, liver, milk, dairy products and oily fish. Beta-carotene and provitamin A are found in green and yellow leafy vegetables (mango, papaya), carrots and brightly colored vegetables (capsicum), especially if eaten with a little fat / oil, because vitamin A is a fat soluble vitamin.
As with other nutrition-related interventions, the vitamin A program in India came to a halt during the extended lockdown and showed no signs of resuming. Data from phase NFHS 5 II show low vitamin A coverage in Delhi NCT (52.9%) and Uttarakhand (53.7%).
According to established standards, babies should be exclusively breastfed for six months (without additional food or drink, including water). Breastfed children are likely to have better immunity to ear infections, diarrhea, and respiratory infections, among other conditions, and also a lower risk of allergies, asthma, diabetes, and obesity. . Breastfeeding helps the uterus to contract and also lowers the risk of breast, uterine and ovarian cancer in the mother.
In NFHS 5, the number of infants under 6 months exclusively breastfed increased from 54.9% to 63.7% (more in rural areas, to 65.1%). It is high at 80.3% in Chhattisgarh. This indicator would have been affected post-pandemic and post-containment, with more women having to seek employment. The maternity allowance scheme for the informal sector must be properly implemented to enable women to breastfeed their babies.
The percentage of children under 3 who were breastfed within one hour of birth remains around 41.8% in India. The increasing number of cesarean sections could also contribute to delaying breastfeeding. Cesarean sections fell from 17.2% to 21.5%. While this rate rose from 40.9% to 47.4% in private sector establishments, it rose from 11.9% to 14.3% in public sector establishments.
Since the ideal rate Caesarean section is usually around 10-15%, it is necessary to continuously monitor and regulate the private sector to avoid unnecessary cesarean sections.
From the age of six months, semi-solid foods can be introduced into the infant’s diet. Giving the child sugary drinks, high carbohydrate foods and junk food or processed foods like cookies will affect the child’s nutritional status and can also create a permanent culture of unhealthy eating and its subsequent complications.
Surprisingly, according to NFHS 5, the percentage of children aged 6 to 23 months receiving adequate nutrition is only 11.3%. This is lamentable and calls for concerted and serious nutritional interventions, with a breakdown of indicators according to the socio-demographic profile of the population. Midday meal is a legally mandated right of children up to the age of 14 under national food security Act 2013, and this needs to be implemented with caution.
The fraction of children aged 6 to 59 months who are anemic increased from 58.6% to 67.1% in NFHS 5. The percentage of all women aged 15 to 19 who are anemic increased from 54 , 1% to 59.1%. Anemia can lead to undesirable clinical outcomes such as low birth weight, neonatal mortality, and premature births. Intra and postpartum bleeding is the leading preventable cause of maternal death.
In India, however, rather than questioning the high levels of anemia, there has been at least one attempt – by New Delhi pediatrician Dr Harshpal Sachdeva and colleagues – to downplay concerns by hard anemia thresholds using data from the Comprehensive National Nutrition Survey (CNNS).
Ideally, thresholds should be calculated on the basis of a sample of the population likely to perform best in terms of a given indicator, and selected through a thorough process of selection, reviews, exclusions and inclusions. . Above all, it needs to be correlated with clinical outcomes, not just juggling data on a computer. According to this criterion, the CNNS data are unsuitable for calculating thresholds.
On the other hand, a relatively better-designed study by better designed study by H. Khusun, University of Indonesia, and others found that it was not necessary to develop different thresholds for anemia and that the WHO hemoglobin thresholds were valid for an Indonesian population.
It is important that the Indian government looks at some of this nutrition data and designs the country’s food and nutrition security in a more evidence-based way.
Dr Sylvia Karpagam is a doctor and public health researcher, member of the Right to Food and Right to Health campaigns.