One of the greatest
threats to the
DEFINITION OF MALNUTRITION
• ”People are malnourished if
their diet does not provide
adequate calories and
protein for growth and
maintenance or they are
unable to fully utilize the
food they eat due to illness
(undernutrition). They are
also malnourished if they
consume too many calories
TOP MOST MALNOURISHED
NATIONS IN THE WORLD
• India ranks among the
top 6 MALNOURISHED
nations in the world.
• ASIA-PACIFIC region
consists of maximum
number of malnourished
nations. Among which
INDIA is the most
country due to it’s dense
CONDITION OF INDIAN STATES
IN TERMS OF MALNUTRITION
POLITICAL AND ECONOMIC
INADEQUATE DIETARY INTAKE
THE EVIL CYCLE OF
What are the Reasons for High Levels of
Undernourishment and Child Malnutrition?
• Low per capita income. Cross-section data –the
percentage decline in malnutrition is roughly half the
rate at which GNP per capita grows.
• Thus economic growth alone can not reduce
malnutrition. For example, in India, GDP growth was
6 to 7% per annum during 1992-93 to 2005-06.
• But child malnutrition declined from 52% to 47% --0.5
percentage points per annum.
• In fact, the per cent of underweight children in India
declined only one percentage point from 47% in 1998-
99 to 46% in 2005-06 inspite of high economic
Reasons for high Levels of
• Income poverty is another reason.
• However, studies have shown that malnutrition
exists even after removal of poverty.
• For example income poverty in India is 26%
while child malnutrition is 46%.
• The data for India, Bangladesh and some other
countries show that malnutrition levels are
surprisingly high even in rich income quintiles.
• Thus, reduction in malnutrition is going to be a
bigger challenge than income poverty.
Reasons for high Levels
• Therefore, one has to look beyond economic growth,
income poverty and food availability
• Adequate nutrition during pregnancy and first
six months of life are critical because of the impact on
• Thus, the problems often start before, during and
after pregnancy as malnourished mothers are more
likely to produce low birth weight babies.
• Poor nutritional status at birth is perpetuated
by inadequate breastfeeding and
supplementary feeding habits.
• Subsequently in the first two years, they do not give
sufficient quality food –particularly mothers with
Reasons for High Levels
• Similarly, public health services are poor in South
• Health sector performance in some of the Asian
countries show that there are basically six problems
--low levels of health indicators
--slow progress in these indicators
--significant regional, social and gender
--poor quality delivery systems in health
--privatization of health services
• Low standards of health and hygeine play important
part since sick children are able to absorb essential
Reasons for high levels
• Micro nutrient deficiency is another reason
• Age-specific interventions upto five years are important.
But, lack of institutional arrangements for age-specific
nutritional programs is another problem.
• To conclude, there is a strong association between child
malnutrition and women’s health/well being.
• For example, one third of Indian women suffer from
Chronic Energy Deficiency and BMI of less than 18.5kg
• 58% of pregnant women in India suffer from anemia
• About 68% of pregnant women make first ANC visit after
4th Month of pregnancy.
• One third of them visit after sixth month of pregnancy
• About half of the deliveries take place at home
The Challenge: Accelerating progress in
reducing child malnutrition in India:
• India has many nutrition and social safety net
programs, some of which (such as Integrated
Child Development Services [ICDS] and the
Public Distribution System [PDS]) have had
success in several states in
addressing the needs of poor households. All
of these programs have potential, but they
do not form a comprehensive nutrition
strategy, and they have not addressed the
nutrition problem effectively so far.
Policies and Actions
• Sector Specific Policies: Economic growth is not enough.
Sector specific policies are needed.
• For example, a package consisting of expanded child and
maternal immunization, antenatal care coverage,
• nutritional supplementation (including breast feeding)
and home based neo-natal services (including treatment
of pneumonia) bring about significant reduction in both
infant mortality and child malnutrition .
• In other words, basic health services have to be
• Women’s Health and Well Being: Malnutrition can be
reduced by enhancing women’s health, promoting gender
equality and, empowerment of women including female
Essential Interventions to
(A)Direct interventions –
Related to the consumption and absorption of adequate protein calorie/micro-
nutrient rich foods essential to combat malnutrition, namely:
1. Weight measurement of child within 6 hours of birth and thereafter at monthly
2. Timely initiation of breastfeeding within one hour of birth, and feeding of
colostrums to the infant.
3. Exclusive breastfeeding during the first six months of life.
4. Timely introduction of complementary foods at six months and adequate intake of
the same, in terms of quantity, quality and frequency for children between 6-24
5. Dietary supplements of all children between 6 months – 72 months through energy
dense foods made by SHGs from locally available food material to bridge the
protein calorie gap.
6. Safe handling of complementary foods and hygienic complementary feeding
7. Complete immunization and Vit. A supplementation.
8. De-worming of all family members bi-annually.
Essential Interventions to Combat
9. Frequent, appropriate, and active feeding for children during and after
illness, including oral rehydration with Zinc supplementation during
10. Timely and quality therapeutic feeding and care for all children with
severe and acute malnutrition.
11. Dietary supplements of iron – rich, energy dense foods made from locally
available food material prepared by women SHGs for adolescent girls
and women, especially during growth periods and pregnancy to fill the
protein calorie gap and ensure optimal weight gain during pregnancy.
12. Anemia screening for children, adolescent girls and women.
13. Weight monitoring of all adolescent girls and pregnant women.
14. Prevention and management of Micro-Nutrient deficiencies, especially
through IFA supplementation to prevent anaemia in adolescent girls and
15. Making available low cost energy foods for the general population.
16. Fortification of common foods.
Essential Interventions to
(B)Indirect Interventions –
Related to issues of health, safe drinking water, hygienic sanitation and
socio-cultural factors such as early marriage and pregnancy of girls,
female literacy and poverty reduction, to eradicate malnutrition on a
long term, sustainable basis.
1. Access to safe drinking water (treatment, storage, handling and
transport), sanitation and hygiene.
2. Increased female education and completion of secondary schooling for
the girl child.
3. Increased access to basic health services by women.
4. Expanded and improved nutrition education and involvement at
Panchayat and community level to create demand.
5. Increased gender equity.
6. Promotion of nutrition best practices especially for girls and women.
Highly cost-effective maternal and
child nutrition interventions
• Behavior change interventions
• 1.Breastfeeding promotion
• 2.Complementary-feeding promotion
• 3.Handwashing with soap and promotion of hygiene behaviors
• Micronutrient and deworming interventions
• 4.Vitamin A supplementation
• 5.Therapeutic zinc supplements
• 6.Multiple micronutrient powders
• 8.Iron-folic acid supplements for pregnant women
• 9.Iron fortification of staples
• 10.Salt iodization
• 11.Iodine supplements
• Complementary and therapeutic feeding interventions
• 12.Prevention or treatment of moderate malnutrition in children aged 6–23 months
• 13.Treatment of severe acute malnutrition
Comprehensive Services for Children
• 'Universalisation with quality' of the ICDS
• Crèches and day care facilities
• Maternity entitlements
• Support for “infant and young child feeding”
(IYCF), particularly breastfeeding
• Prevention of interference of commercial
interests through 'packaged' or 'ready to eat'
food or 'public private partnerships' in
government programmes for child health and
Strategic choices for improved child
• India lacks a comprehensive nutrition strategy. Various
choices for nutrition strategies can be considered. A review
of some of the more successful country experiences suggests
that all of them implemented complex,
multisectoral actions with more or less emphasis on service-
oriented nutrition policies (as in Indonesia), incentive-
oriented nutrition policies linked to community or
household participation and performance (as
in Mexico), or mobilization-oriented nutrition policies (as in
These choices are not mutually exclusive. India now has the
opportunity to “leapfrog” toward innovative nutritional
improvement based on the experiences of other countries
and on experiences within India itself.
Cooperation for policy actions:
• To accelerate progress in reducing child malnutrition, India
should focus on the following four cross-cutting
• Ensuring that economic growth and poverty reduction
policies reach the poor;
• Redesigning nutrition and health policies and programs by
drawing on science and technology for nutritional
improvement, strengthening their implementation, and
increasing their coverage;
• Increasing investments and actions in nutrition services for
communities with the highest concentration
of poor; and
• Focusing programs on girls’ and women’s health and
Cooperation for policy actions:
• Ensure equitable distribution of food through,
inter alia, well-functioning public distribution
systems and school meal programmes.
• Knowledge, research, education/training and
public assessment systems must empower
women food providers and strengthen their
capacities to participate in policy formulation and
decision-making about food and agricultural
Cooperation for policy actions:
• Governments should ensure full transparency
for consumers on the quality and nutritional
values of food, Instead of making the poor
and ordinary people pay for resolving the
crisis, those who own most of the capital, who
triggered the crisis and who benefit from it
must cover the losses through specific taxes on
capital and taxes on foreign exchange
” All children,
when their needs
Growth of Children <5 years