Malnutrition in India

Malnutrition in INDIA

Presentation by:Pattan Imran Khan

P401115FGS270M.TECH GIS

NIIT University

What is Malnutrition?

WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth,

maintenance, and specific functions.“

Malnutrition refers to the situation where there is an unbalanced diet in which some nutrients are in excess, lacking or wrong proportion which causes measurable adverse effects on tissue / body form (body shape, size and composition) and function and clinical outcome.

The term malnutrition covers 2 broad groups of conditions. One is ‘Undernutrition’—which 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).

Image Source: Google Images

The other is Overnutrition, obesity and diet-related non-communicable diseases (cardiovascular diseases, diabetes, cancers and chronic respiratory diseases).


Malnutrition in INDIA

Malnutrition is a matter of national shame: PM(The Hindu, Jan 10, 2012)

“…the problem of malnutrition is a matter of national shame. Despite impressive growth in our GDP, the level of under-nutrition in the country is unacceptably high,…..” - Dr. Manmohan Singh, Ex-Prime Minister

“Malnutrition has been one of the enduring enigmas of Contemporary India” The World Bank estimates that India is one of the highest ranking countries in the

world for the number of children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world,

and is nearly double that of Sub Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.

The 2015 Global Hunger Index (GHI) Report ranked India 20th amongst leading countries with a serious hunger situation.

Amongst South Asian nations, it ranks third behind only Afghanistan and Pakistan with a GHI score of 29.0 ("serious situation").

India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1.34 billion and growing at 1.5%–1.7% annually.

India's Gross Domestic Product growth was 9.0% from 2007 to 2008; since Independence in 1947, its economic status has been classified as a low-income country with majority of the population at or below the poverty line.

Though most of the population is still living below the National Poverty Line, its economic growth indicates new opportunities and a movement towards increase in the prevalence of chronic diseases which is observed in at high rates in developed countries such as United States, Canada and Australia.

The combination of people living in poverty and the recent economic growth of India has led to the co-emergence of two types of malnutrition: Undernutrition and Overnutrition.


Despite India's 50% increase in GDP since 1991, more than one third of the world's malnourished children live in India. Among these, half of them under 3 are underweight and a third of wealthiest children are over-nutriented.

Deficiencies in nutrition inflict long-term damage to both individuals and society. On the other hand, over-nutrition also has severe consequences.


India, a country which is often associated with poverty, hunger and malnutrition, has found itself placed amongst the ten most obese countries in the world! In fact, India stands third, after United States and China, in terms of the number of obese and overweight people.

In India national obesity rates in 2010 were 14% for women and 18% for men with some urban areas having rates as high as 40%.

It is an irony that in a country where approximately forty-five percent of children are believed to be stunted, obesity is so highly prevalent.

On one hand, studies show that one in every five Indian men and women is overweight.

On the other, malnutrition is the leading death risk-factor in children under five. Such a contrasting scenario is worrisome and a double burden borne by our country.

Uttar PradeshBihar

Meghalaya

Chhattisgarh

Gujarat

Madhya Pradesh

JharkhandINDIAAssam

Maharashtra

Haryana

West Bengal

Odisha

Uttarakhand

Rajasthan

Karnataka

Arunachal Pradesh

Andhra PradeshDelhi

Mizoram

Nagaland

Himachal PradeshSikkimPunjab

Tripura

Manipur

Jammu and Kashmir

Tamil NaduGoaKerala

0

10

20

30

40

50

6057 56 55 53 52 50 50 48 47 46 46 45 45 44 44 44 43 43 42 40 39 39 38 37 36 36 35

3126 25

Stunting rates in 2005–2006 IN 29 Indian states

2005-2006

Indian State

Stun

ting

Rate

(%)

Data Source: NFHS 2005-2006

Uttar PradeshBihar

Meghalaya

Chhattisgarh

Gujarat

Madhya Pradesh

JharkhandINDIAAssam

Maharashtra

Haryana

West Bengal

Odisha

Uttarakhand

Rajasthan

Karnataka

Arunachal Pradesh

Andhra PradeshDelhi

Mizoram

Nagaland


Tripura

Manipur

Jammu and Kashmir

Tamil NaduGoaKerala

05101520253035404550

50 49

43 43 42 4247

39 41

35 37 3538

34 36 34

28

35

29 27 2934

2831 31 33 32

23 21 19

Stunting rates in 2013–2014 in 29 Indian states

2013-2014

Indian State

Stun

ting

Rate

(%)


Uttar PradeshBihar

Meghalaya

Chhattisgarh

Gujarat

Madhya Pradesh

JharkhandINDIAAssam

Maharashtra

Haryana

West Bengal

Odisha

Uttarakhand

Rajasthan

Karnataka

Arunachal Pradesh

Andhra PradeshDelhi

Mizoram

Nagaland


Tripura

Manipur

Jammu and Kashmir

Tamil NaduGoaKerala

0

10

20

30

40

50

6057 56 55 53 52 50 50 48 47 46 46 45 45 44 44 44 43 43 42 40 39 39 38 37 36 36 35

3126 25

50 4943 43 42 42

47

39 4135 37 35

3834 36 34

28

3529 27 29

3428

31 31 33 32

23 21 19

Stunting rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State

Stun

ting

Rate

(%)

Data Source: NFHS 2005-2006 & 2013-2014

Uttar Pradesh

Bihar

Meghalaya

Chhattisgarh

Gujarat

Madhya Pradesh

Jharkhand

INDIA

Assam

Maharashtra

Haryana

West Bengal

Odisha

Uttarakhand

Rajasthan

Karnataka

Arunachal Pradesh

Andhra Pradesh

Delhi

Mizoram

Nagaland

Himachal PradeshSikkim

Punjab

Tripura

Manipur

Jammu and Kashmir

Tamil Nadu

GoaKerala

0

10

20

30

40

50

60

Stunting rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State

Stunting Rate (%)

Data Source: NFHS 2005-2006 & 2013-2014

Madhya Pradesh

Jharkhand

MeghalayaBihar

Tripura

Tamil Nadu

RajasthanINDIAOdisha

Chhattisgarh

Himachal Pradesh

Haryana

Uttarakhand

Gujarat

Karnataka

West Bengal

MaharashtraKeralaDelhi

Arunachal Pradesh

Uttar Pradesh

Jammu and Kashmir

GoaAssam

Nagaland

Andhra PradeshSikkimPunjab

Mizoram

Manipur

0

5

10

15

20

25

30

3535

32 31

2725

2220 20 20 20 19 19 19 19 18 17 17 16 15 15 15 15 14 14 13 12

10 9 9 9

Wasting rates in 2005–2006 in 29 Indian states

2005-2006

Indian State

Was

ting

Rate

(%)


Madhya Pradesh

Jharkhand

MeghalayaBihar

Tripura

Tamil Nadu


Chhattisgarh

Himachal Pradesh

Haryana

Uttarakhand

Gujarat

Karnataka

West Bengal


Arunachal Pradesh

Uttar Pradesh

Jammu and Kashmir

GoaAssam

Nagaland


Mizoram

Manipur

0

2

4

6

8

10

12

14

16

18

20 18

16

13 13

17

19

1415

18

13

109 9

19

17

15

19

16

14

17

10

7

15

10

12

19

5

9

14

7

Wasting rates in 2013–2014 in 29 Indian states

2013-2014

Indian State

Was

ting

Rate

(%)


Madhya Pradesh

Jharkhand

MeghalayaBihar

Tripura

Tamil Nadu


Chhattisgarh

Himachal Pradesh

Haryana

Uttarakhand

Gujarat

Karnataka

West Bengal


Arunachal Pradesh

Uttar Pradesh

Jammu and Kashmir

GoaAssam

Nagaland


Mizoram

Manipur

0

5

10

15

20

25

30

3535

32 31

2725

2220 20 20 20 19 19 19 19 18 17 17 16 15 15 15 15 14 14 13 12

10 9 9 9

1816

13 13

1719

14 1518

1310 9 9

1917

15

1916

1417

107

15

1012

19

5

9

14

7

Wasting rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State

Was

ting

Rate

(%)

Data Source: NFHS 2005-2006 & 2013-2014

Madhya Pradesh

Jharkhand

Meghalaya

Bihar

Tripura

Tamil Nadu

Rajasthan

INDIA

Odisha

Chhattisgarh

Himachal Pradesh

Haryana

Uttarakhand

Gujarat

Karnataka

West Bengal

MaharashtraKerala

Delhi

Arunachal Pradesh

Uttar Pradesh

Jammu and Kashmir

GoaAssam

Nagaland

Andhra Pradesh

Sikkim

Punjab

Mizoram

Manipur

0

5

10

15

20

25

30

35

40

Wasting rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State

Was

ting

Rate

(%)

Data Source: NFHS 2005-2006 & 2013-2014

India0

1

2

3

4

5

6

4

4.9

Prevalence of obesity in 2010 and 2014

2010 2014

Country

Obe

sity

Rat

e (%

)

Data Source: Global Nutrition Report 2015

India0

0.5

1

1.5

2

2.5

3

3.5

2.5

3.2

Prevalence of obesity in 2010 and 2014 (only male)

2010 2014

Obe

sity

Rat

e (%

)


India5

5.2

5.4

5.6

5.8

6

6.2

6.4

6.6

6.8

5.6

6.7

Prevalence of obesity in 2010 and 2014 (only female)

2010 2014

Obesity Rate (%)


Factors affecting Nutrition/Nutritional status

Many factors, including region, religion, and caste affect the nutritional status of Indians. Living in rural areas also contribute to nutritional status. Some other factors which influence nutritional status are:

Agro-Climatic Factors Food Production Land ownership Type of land Rainfall Geographic conditions Agricultural techniques Use of hybrid seeds Use of Fertilizers

Demographic Factors Population Family Size Urbanization

Socio-economic Factors Religion Community Occupation Income

Socio-cultural Factors Illiteracy Ignorance Taboos

Physiological Factors Pregnancy Lactation Breast feeding practices Infant & Child feeding practices

Environmental Factors Sanitation Personal Hygiene Safe Drinking Water

Disasters Droughts/Floods Wars

Haryana Go

a

Madhya Pradesh

Meghalaya

Himachal Pradesh

Bihar

Nagaland

Uttarakhand

Rajasthan

Tamil Nadu

Delhi

Punjab

Tripura

Sikkim

Jammu and Kashmir

Mizoram IND

IA

Gujarat

Odisha

Uttar Pradesh

MaharashtraKerala

Jharkhand

Karnataka

West Bengal

Arunachal Pradesh

Manipur

Andhra Pradesh

Assam

Chhattisgarh

0

10

20

30

40

50

60

70

80

90

17 1822

26 27 28 30 31 33 34 35 36 36 3742

46 46 4851 51 53

56 58 59 59 60 62 63 63

82

Exclusive Breastfeeding rates in 2005–2006 in 29 Indian states

2005-2006

Indian State

Breastfeeding rate (%)


Haryana Go

a

Madhya Pradesh

Meghalaya

Himachal Pradesh

Bihar

Nagaland

Uttarakhand

Rajasthan

Tamil Nadu

Delhi

Punjab

Tripura

Sikkim

Jammu and Kashmir

Mizoram IND

IA

Gujarat

Odisha

Uttar Pradesh

MaharashtraKerala

Jharkhand

Karnataka

West Bengal

Arunachal Pradesh

Manipur

Andhra Pradesh

Assam

Chhattisgarh

0

10

20

30

40

50

60

70

80

90

54

63

75

55 55

71

58

48 50

57

68

60 5863

60

45

65

7469

62

73

5964

5559 60

67 6965

82

Exclusive Breastfeeding rates in 2013–2014 in 29 Indian states

2013-2014

Indian State



Haryana Go

a

Madhya Pradesh

Meghalaya

Himachal Pradesh

Bihar

Nagaland

Uttarakhand

Rajasthan

Tamil Nadu

Delhi

Punjab

Tripura

Sikkim

Jammu and Kashmir

Mizoram IND

IA

Gujarat

Odisha

Uttar Pradesh

MaharashtraKerala

Jharkhand

Karnataka

West Bengal

Arunachal Pradesh

Manipur

Andhra Pradesh

Assam

Chhattisgarh

0

10

20

30

40

50

60

70

80

90

17 1822

26 27 28 30 31 33 34 35 36 36 3742

46 46 4851 51 53

56 58 59 59 60 62 63 63

82

54

63

75

55 55

71

58

48 50

57

68

60 5863

60

45

65

7469

62

73

5964

5559 60

67 6965

82

Exclusive Breastfeeding rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State


Data Source: NFHS 2005-2006 & 2013-2014

Haryana Go

a

Madhya Pradesh

Meghalaya

Himachal Pradesh

Bihar

Nagaland

Uttarakhand

Rajasthan

Tamil Nadu

Delhi

Punjab

Tripura

Sikkim

Jammu and Kashmir

Mizoram IND

IA

Gujarat

Odisha

Uttar Pradesh

Maharashtra

Kerala

Jharkhand

Karnataka

West Bengal

Arunachal Pradesh

Manipur

Andhra Pradesh

Assam

Chhattisgarh

0

10

20

30

40

50

60

70

80

90

Exclusive Breastfeeding rates in 2005–2006 and 2013–2014 in 29 Indian states

2005-2006 2013-2014

Indian State

Breastfeeding Rate (%)

Data Source: NFHS 2005-2006 & 2013-2014

Pathological conditions Infections

• Diarrhoea• Respiratory Infections• Malaria• Others

Infestations• Hook worms• Round worms & Giardiasis etc.,

Availability of & Participation in developmental programmes Rural Developmental programmes Employment generation programmes

High Illiteracy

Poor EnvironmentPoor Utilization of services

Poor coverage of Immunization Improper Health services

Poor InfrastructureLack of resources

Morbidity Absorption of nutrients

Low production of food grains

Low procurement of

foods

MalnutritionReduced work output

Low Appetite

Low availability of foodsHigh Cost

Inadequate IntakesFalse food beliefs

IgnoranceLow purchasing power

Unemployment/Underemployment

High dependence rate

Large Families

Effects of Malnutrition

Major Nutrition problems of India can be classified as: Protein Energy Malnutrition (PEM) Nutritional Anemia Iodine Deficiency Disorder Vitamin A Deficiency & other Hypovitaminoses Low Birth Weight Endemic Fluorosis – Dental & Skeletal Obesity etc.,

Direct effects :

are the occurrence of frank and subclinical nutrition deficiency

diseases such as Kwashiorkor, Marasmus, vitamin and mineral

deficiency diseases.

Indirect effects :

a high morbidity and mortality among young children,

retarded physical and mental growth and development (which may be permanent) &

lowered vitality of the people leading to lowered productivity and reduced life expectancy.


Severe Malnourish

ment

Increased metabolic

rate & tissue damage.

Low Immunity

Need for extra

nutrients and also reduced Appetite

In GI Infections nutrient

absorption diminished

Nutrients: Extra need

& poor supply

Fig. The Vicious cycle of Malnutrition &

Infections

Deficiencies in nutrition inflict long-term damage to both individuals and society.

Compared with their better-fed peers, nutrition-deficient individuals are more likely to have infectious diseases such as pneumonia and tuberculosis, which lead to a higher mortality rate.

In addition, nutrition-deficient individuals are less productive at work. Low productivity not only gives them low pay that traps them in a

vicious circle of under-nutrition, but also brings inefficiency to the society, especially in India where labour is a major input factor for economic production.

On the other hand, over-nutrition also has severe consequences. Obesity causes several non-communicable diseases such as

cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.


The Government of India has launched several programs to converge the growing rate of under nutrition children. They include:

Midday meal scheme in Indian schools Integrated child development scheme National Children's Fund National Plan of Action for Children United Nations Children's Fund National Health Mission

The subset of goals under these programs are: Reduce infant mortality rate (IMR) and maternal mortality ratio (MMR) Provide universal access to public health services Prevent and control both communicable and non-communicable

diseases, including locally endemic diseases Provide access to integrated comprehensive primary healthcare Create population stabilization, as well as gender and demographic

balance Finally, to promote healthy life styles

Conclusion

“Global Nutrition Report 2016” once again demonstrates India’s slow overall progress in addressing chronic malnutrition, manifest in stunting (low weight for

age), wasting (low weight for height), micronutrient deficiencies and over-weight.

The overall nutritional problems are still prevailing in India, despite all efforts by government. These nutritional problems, especially in youth, need to be address immediately, for the betterment of people and as well for making India's economy strong with significant role of its human resources.

According to NFHS nearly all states in India showed significant declines in child stunting between 2006 and 2014. However three states with very high rates in 2006 - Bihar, Jharkhand & Uttar Pradesh – showed some of the slowest declines. Changes in wasting rates are more variable across states.

REASONS FOR SLOW PROGRESS – The poor nutritional status of adolescent girls, who mostly married before 18 and

give child births even before their own body is ready, which ultimately led to children born with many deficiencies.

Lack of awareness regarding nutritional importance among uneducated families especially mothers who has foremost duty for overall nutritional development of child. The problem of over weight is also due to negligence on part of families.

Most of the sections of society are economically deprived especially scheduled tribes which led to the poverty and hence, these people not able to have essential nutritional food.

The ongoing schemes such as ICDS, Mid-day meal schemes need to be re-design to eliminate the short-comings. And, need to be implemented in better manner.

WAY AHEAD – Create and launch a national nutrition mission to curb the nutritional problems

which the more systematic development approach. A national campaign should be started to impart awareness among people

especially mothers regarding basic nutritional, sanitation and health needs. For this, help of NGOs, gram panchayats, anganwadi workers can be taken.

Improve mid-day meal scheme by including diverse nutritional diets and micro-nutrients. Mid- day meal schemes should be directly supervised by district collector so that no mischief can be done by food supply contractors.

Free nutritional essentials, vitamins & calcium medicines and health check-ups to pregnant women of economically deprived section.

Revamping of nutritional schemes with the clear goals and timelines. And better resources allocation.

India has to go a long way to achieve it's aim to eliminate malnutrition by 2030. We all should do our bit to give the basic right of nutritional diet to a

child.

References:

http://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition https://en.wikipedia.org/wiki/Malnutrition_in_India http://iap.healthphone.org/the-cycle-of-undernutrition.html http://

www.rappler.com/move-ph/issues/hunger/84126-double-burden-malnutrition-obesity-urbanization

https://www.myindiandream.in/Thoughts%2CIndia%40Heart/Obesity+and+Malnutrition+in+India

https://globalnutritionreport.org/the-report/the-report-2015/

http://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition

http://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition

https://en.wikipedia.org/wiki/Malnutrition_in_India

https://en.wikipedia.org/wiki/Malnutrition_in_India

http://iap.healthphone.org/the-cycle-of-undernutrition.html

http://iap.healthphone.org/the-cycle-of-undernutrition.html

http://www.rappler.com/move-ph/issues/hunger/84126-double-burden-malnutrition-obesity-urbanization



https://www.myindiandream.in/Thoughts,India@Heart/Obesity+and+Malnutrition+in+India

https://www.myindiandream.in/Thoughts,India@Heart/Obesity+and+Malnutrition+in+India



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Malnutrition in India