Making sense of undernutrition

None of us in India are a stranger to hunger. Living in a country which houses a quarter of all undernourished people across the world, we frequently see the pinched, gaunt faces of hungry men, women and heartbreakingly, the children. Today hunger among children is a very real problem in India; one that the Government, NGOs, corporates and community members have joined forces to fight every day. But in order to tackle the problem, it’s important to first understand it.

Hunger is a state of daily undernourishment where its victims live on less than the number of kilocalories needed a day to meet their energy requirements. As of 2014, one in nine people across the world suffer from undernourishment. Hunger can have devastating effects both physically and mentally, like poor energy levels, lower immunity against diseases, poor concentration and assimilation and much more.

One of the consequences of chronic hunger can be malnutrition, although malnutrition can be found even in the absence of hunger. Malnutrition includes both undernutrition and overnutrition.

Undernutrition, which is deficiencies in energy, protein and/or micronutrients, predominantly manifests in three ways. These are stunting (low height for age), wasting (low weight for height) and micronutrient deficiency (lacking required micronutrients – vitamins and minerals). All of these forms of under nutrition are found to different degrees in children across India.

Stunting in children is more than being too short for their age; it also includes suffering from reduced brain development and cognitive capacity. This has a lasting impact on the child’s life, and on the nation. Children who suffer from stunting have experienced chronic under nutrition during the first two years of their life, which is a critical timeframe for their growth and development. Stunting can occur in children as a result of a malnutrition cycle where an already under nourished adolescent girl later becomes an undernourished mother who gives birth to a low birth weight baby. The situation is exacerbated by continued lack of access to proper nutrition post birth.

Maternal health is huge concern in preventing stunting in children. Inadequate nutrition in mothers before conception and during pregnancy plays a big role in foetal stunting. In fact, fifty per cent of the growth failure in children that happens by the age of two years occurs in the womb due to the poor nutritional status of mothers.

Post-delivery feeding practices for infants are central to their healthy development too. Breastfeeding within the first hour of the baby’s birth is critical to the baby’s survival. Six months of exclusive breastfeeding, with a combination of breastfeeding and nutritious, age appropriate complementary foods in the following months till two years of age or more are critical to preventing stunting in infancy and early childhood.

Although stunting is prevalent in the country, India is making good progress in addressing the issue today. Between 2005-06 and 2013-14 India has achieved a 9.1 percentage point reduction in stunting among children below the age of five, dropping from 47.9 to 38.8 per cent. This has been complimented by a similar improvement in breastfeeding practices in the country with the number of infants below six months of age who are exclusively breastfed increasing from 46.6 to 71.6 per cent in the same time frame.

Wasting or thinness, signified by a low weight to height ratio, is usually the result of extreme starvation or serious disease (either in the short or long term). Typically, wasting becomes evident in the second year of an infant’s life. Wasting can be treated with supplementary foods. In cases of extreme wasting, children can develop Severe Acute Malnutrition (SAM), which can be treated with a carefully blended combination of proteins, fat, sugar and micronutrients, as prescribed by the World Health Organisation.

On the severity scale a national prevalence of wasting between 10-14 per cent is considered a serious problem, while 15 per cent or above is critical. In 2005-06 India had a dire problem with wasting, with 20 per cent of children under the age of five suffering from this affliction. Though the situation has improved slightly according to the 2013-14 figures which show a five percentage point drop to 15 per cent, India’s wasting figures remain critical.

Micronutrient deficiency or ‘Hidden Hunger’ is also an extremely prevalent form of under nutrition. Referred to as Hidden Hunger because it is not visibly apparent, it occurs when people eat food that doesn’t supply them with the right amount of micronutrients (vitamins and minerals) that they need every day. Hidden Hunger has serious negative consequences on a person’s physical and mental health, especially for pregnant women and children. Over 2 billion people across the world suffer from this deficiency.

Although they are needed in very small quantities, micronutrients allow the body to produce enzymes, hormones and other substances that are crucial for normal functioning. The absence of these micronutrients, especially Iodine, Vitamin A Folate and Iron, can cause severe ailments and even death.

In India the 2006 National Family Health Survey showed that micronutrient deficiency was alarmingly bad with only 25 per cent of children under the age of five receiving Vitamin A supplementation. However, the same year the Government implemented a biannual supplementation programme, over time increasing the coverage to two-thirds by 2011.

Micronutrient deficiency is a serious issue, but can be tackled by providing access to supplements, fortifying complementary foods for infants between six months to two years of age, and fortifying staples and condiments in the household.

This article aims to bring about an understanding of undernutrition. It’s a messy, complex issue that countries all across the world struggle with. But the right understanding of the issue, combined with resources to tackle it, can help us end the problem once and for all.