Across the world malnutrition is a grave threat to maternal and child health. Most of the victims are in the developing nations. A balanced nutritious diet is required for proper functioning of the body. Protein Energy Malnutrition (PEM) and growth retardation are probably the most widespread health and nutritional problems of the developing countries including India followed by micro-nutrient deficiency.
Image source: dailytimes.com.pk
India has a higher level of PEM than most parts of the world, including sub-Saharan Africa. Over 75% of pre-school children suffer from iron deficiency anaemia, and 57% have subclinical Vitamin A deficiency. Deficiency of essential micronutrients such as vitamin A, iron, iodine, folic acid and zinc, constitutes a major health threat for a large number of children in India. Estimates suggest that every day, more than 6,000 under-fives die in India and more than half of these deaths are caused by malnutrition, mainly due to micronutrient deficiency. About 57 percent of preschoolers and their mothers have sub-clinical vitamin A deficiency. 26% of the country’s population is zinc deficient which contributes directly to stunting. Nearly 50,000 children are deformed every year due to folic acid deficiency. Iodine deficiency is endemic in India. The prevalence of different micronutrient deficiencies varies widely across states. India has 48% stunted, 20% wasted and 43% underweight children below 5 years of age. Poor nutrition contributes to about 5.6 million child deaths per year and more than half of the total deaths take place in India. A more serious concern is the fact that the number of children under-five who are underweight has remained almost unchanged since 1990 (UNICEF, 2006). The statistic - which means 3,000 children dying daily due to illnesses related to poor diets.
The prevalence of severe malnutrition among children in the 0-6 age group has emerged as one of the grave issues of child health in India while West Bengal is no exception. ‘Kwashiorkor’ and ‘Marasmus’ are the dangerous outcomes of PEM briefly conceived as malnutrition. The word “Kwashiorkor” was suggested by Dr. Cicely Williams in the early 1930s. It is an African word which means “the disease that occurs when the child is displaced from the breast by another child”. “Marasmus” can develop in the initial months of life and results if the mother’s milk supply is insufficient as a result of which the mother feed the baby with diluted milk of buffalo and cow. Hence the common age of occurrence is 0-2 years though can also occur at later age as well
Poverty, low birth weight, improper birth spacing, lack of inadequate nutritious diet coupled with low level of parental awareness and poor breast-feeding practices have contributed to prominent appearance of child malnutrition in the state.
Paediatric Tuberculosis is the dangerous outcome of severe malnutrition. Malnutrition during pregnancy often results into incidences of still birth, premature delivery and other complications during post-partum period.
East India emerged as the region where the state of feminine hygiene is significantly poorer. Amongst women who use cloth, over 70% in East said they feel insecure during periods and wished they knew more on the subject,’ said Bhagyashri Dengle, Executive Director, Plan India.
CAUSES OF MALNUTRITION
Malnutrition has been known to be a major health and nutrition problem in India with a high prevalence among the pre-school children. It accounts for 46% of infant mortality. The causes of malnutrition can be briefly stated below:
Low-income earner hardly can afford to procure required quality and quantity of food to meet their nutritional requirements. This deprivation adversely affects their capacity for physical work resulting in low earning and poverty. Malnutrition is thus related to the vicious cycle of poverty.
Early teenage pregnancies are dangerous not only for the health of the mother but also for the baby. Chances of maternal and infant mortality and complications at the time of pregnancy are high when a girl conceives before her body attains physical maturity.
|Low birth weight||
Malnourishment during pregnancy results high incidences of low weight (<2.5 kg) during birth. Such infants are vulnerable to face growth retardation due to poor body nutritional reserve. The mothers may also show poor lactation performance.
|Infection and diseases||
Diseases such as diarrhoea, pneumonia, measles, malaria and tuberculosis precipitate into acute malnutrition and aggravate the existing nutritional deficit.
|Poor breast-feeding practices||
A child becomes susceptible to malnutrition in absence of breast-feeding. Artificial feeding often proves to be disastrous for the baby due to the poor quality of the substitute milk, excessive dilution and use of unhygienic feeding bottles and nipples.
Repeated pregnancies, improper birth spacing, social taboos and separation of a child from parents often results into malnutrition among children.
Malnutrition increases the susceptibility and severity of infections among children. A number of other factors such as environmental, agricultural, and cultural including various other factors contributes to malnutrition. The loss on account of micronutrient deficiencies costs the nation 1% of GDP which amounts to Rs. 277.2 billion or more in terms of loss of productivity, illness, increased health care costs and death (Micronutrient Initiative, 2006). Therefore it is widely recognized that a multi-sectoral approach is necessary to tackle the problem of malnutrition.
Crib and cot deaths coupled with malnutrition is particularly high in districts of Maldah, Murshidabad, Uttar Dinajpur and South 24 Parganas. Other districts enlisted as having high proportion of malnourished children include Bankura, Barddhaman, Purba Medinipur and Paschim Medinipur. The rural areas of these districts are characterized by poverty, illiteracy, ignorance and negligence.
The condition of maternal and child health has been in a tragic state in West Bengal with some initiatives taken by the State Government in recent years. The activities of ICDS in this respect have been praiseworthy. The Anganwadi schools meant for the children of low socio-economic background has been running successfully in various municipal wards of Kolkata. The health workers have been visiting households to distribute iron tablets among pregnant women. The children in the Anganwadi schools are given nutritious food like khichdi, vegetables, boiled egg and pulses. They are also provided with medicine in case of severe malnourishment and taken to doctors for height and weight check-up at regular interval. The Government run health centers in the city conduct institutional deliveries, ante-natal check up and post-natal check up for mothers. Inspite of such initiatives worth mentioning, the coverage has not been satisfactory in various wards of the city. The pregnant women and lactating mothers of the vulnerable groups in some areas are not aware of Government initiatives and consequently they remain deprived of the benefits of the welfare programmes. Distribution of rice and wheat at very negligible price among the below poverty line (BPL) people through public distribution system has increased the food intake quantity among the mother. Kanyasri (Scholarship for teaching the girl students) reduced the rate of early marriage. Still we have to miles to go.