Context

• Between the National Family Health Survey (N
  

  

  FHS)-4 (2015–16) and the fifth round (2019–2020), there has been a considerable increase in the number of malnourished children in India, and the progress made during the first half of the decade appears to have been undone. Malnutrition in the North-eastern states of India is worse than the country average.

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What is malnutrition?

• Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
• For a child’s motor, sensory, cognitive, social, and emotional development, malnutrition has substantial long-term effects. It impedes productivity and academic progress.

The term malnutrition covers two broad groups of conditions

• Undernutrition: Undernutrition includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
• Overnutition: The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer).

Did you know?

• Stunting, or low height for age, is a recognized risk factor for children’s delayed development.
• According to a study, a 1% reduction in adult height as a result of childhood stunting is linked to a 1.4% reduction in economic productivity.
• Children who are stunted, earn 20% less as adults.

Malnutrition in North East India

• Upsurge in stunting: Four states in the Northeast Meghalaya, Mizoram, Nagaland and Tripura have seen an upsurge in stunting among children under the age of five. Stunting is highest in Meghalaya at 46.8 %, followed by Nagaland (32.7%), Tripura (32.3 %), and Mizoram (28.9%). In Mizoram, Nagaland, and Tripura, the percentage of kids who are stunted, wasting, underweight, or overweight has increased
• Levels of stunting decreased in Assam: The NFHS-5 shows Assam, Manipur and Sikkim have shown a drop in stunting levels. In Assam, stunting has decreased by almost one percentage point, although rates of overweight (2.3% to 4.9%), underweight (29.8% to 32.8%), and stunting (17% to 21.7%) have all increased, whereas that of wasting and underweight have decreased by more than 2% in each instance.
• Sikkim performs better than other NE states: As the number of stunted, wasting, and underweight children has dropped, Sikkim has done considerably better than other NE states so has Manipur, with a decrease in wasting from 6.8% to 9.9% in under-five children.
• Increase in no of overweight people in every NE state: Every state in the Northeast saw an increase in the number of overweight people, which amplifies the growing double burden of malnutrition in the states.

Appropriate foods and feeding practices show Higher immunity

• Feeding practices adequate only in Meghalaya and Tripura:  The percentages of breastfeeding children receiving adequate complementary foods have improved only in Meghalaya and Tripura. Early initiation of breastfeeding is on the decline in six out of the eight northeastern states, with highest levels in Sikkim (33.5%) and Assam (15.3%).
• Reduction in exclusive breastfeeding rates (EBF): Sikkim, Tripura, and Manipur all exhibit a notable reduction in exclusive breastfeeding (EBF) rates. EBF in Sikkim is the lowest at 28.3 percent, far lower than the national average of 63.7 percent. Tripura demonstrated a gain of 39.5 percentage points in the practice of timely introduction of semi-solid food, whereas Meghalaya, Mizoram, Nagaland, Sikkim, and Arunachal Pradesh showed a slight fall.
• All NE states except Assam performed well on diet adequacy: Minimum Adequate Diet (or diet adequacy) is a combined indicator of feeding frequency and diet variety. From 8% to 29.8%, there is a significant range throughout the northeastern states. All states, with the exception of Assam, have performed better on this measure than the nation as a whole.
• The situation with obesity is more complicated: Only Meghalaya and Nagaland have seen decreases, while the other six states have seen increases. It is heartening to see a declining trend in underweight women (BMI < 18.5) in all eight northeastern states.
• Anaemia is increased: In six of the eight northeastern states, anaemia among women of reproductive age has increased, with Tripura worst at 67.2%, and Assam at 65.9%.

How malnutrition can be tackled in NE?

• Finding out the causes: Stunting among children in the Northeast is caused by a number of factors, including poor maternal health, a lack of antenatal care, inadequate infrastructure and healthcare facilities, inadequate feeding and nutrition for women, and limited access to education, clean drinking water, and sanitary facilities.
• For instance: Lack of toilets, drinking water and cooking fuels in the home environment have an impact on child malnutrition, according to a 2015 study on indigenous peoples in the Northeast.
• Improving the maternal nutrition: Manipur, Mizoram, and Sikkim fare better than the national average in most measures. Newborns’ chances of being stunted are decreased by better maternal nutrition prior to conception, throughout pregnancy, and after delivery. According to data for Sikkim, Manipur, and Mizoram, the risk of stunting decreases as the number of underweight mothers decreases.
• Upgrading the service availability: In the northeastern states, the use of supplementary food at the anganwadi centres (ANC) varies greatly, from about 35% in Arunachal Pradesh to 70% in Tripura. A low of 20.7% in Nagaland and a high of 79.4% in Manipur is the ANC coverage across the Northeast.
• Improving the required intake of Iron and Folic acid: All states have lower percentages of iron and folic acid (IFA) intake than the national average of 26%, with the exception of Manipur where 30.3% of pregnant women completed the full 180-day course of IFA tablets. Nagaland has the lowest rate, at just 4.1%. Overall, the NE states show a wide variation in service availability and uptake.

Note it down: The innovative programmes to enhance mother and child health

• Nutrition gardens: For example, the Assam government encouraged women in rural communities to develop “nutrition gardens” where they could grow vegetables.
• My school my Farm: “Kan Sikul, Kan Huan (My School, My Farm)” programme in the most impoverished and disaster-prone area in Mizoram-Lawngtlai.
• Lunchbox exchange: The “dibbi adaan pradaan (lunchbox exchange)” initiative in Hailakandi district of Assam for promoting better nutrition and variety in menu.

Conclusion

• Malnutrition in the Northeast has to be addressed holistically through the scaling up of direct nutrition interventions and the coupling of them with nutrition-sensitive measures to close the nutrition gap. In the long run, it could be beneficial to improve the monitoring and evaluation of current interventions by building on the POSHAN Abhiyaan and health projects.

Mains question

Q. What is Malnutrition? Malnutrition in the North-eastern states of India is worse than the country average. Discuss.

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