Malnutrition and RSoC
World Health Organization definition:
The term is used to refer to a number of diseases, each with a specific cause related to one or more nutrients (for example, protein, iodine or iron) and each characterized by cellular imbalance between the supply of nutrients and energy on the one hand, and the body’s demand for them to ensure growth, maintenance, and specific functions, on the other.
Types of malnutrition are:
- nutrients like proteins, calories, fats, carbohydrates, vitamins or minerals are not provided in proper level.
- may to lead to stunted growth and will hinder growing capacity of the body.
- Malnutrition is generally considered as Under-nutrition only.
- If under-nutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development.
- nutrients is oversupplied.
- nutrients exceeds the amount required for normal growth, development, and metabolism.
- occurs when the intake is not balanced and a person in consuming only a particular nutrient in its diet and neglecting other nutrients.
- can cause obesity further leading to different health issues like heart disorder, joint pains etc.
- underweight=low in weight for their age
- wasted=low weight for their height
- stunted=low in height for age
Rapid Survey on Children (RSoC)
- conducted by the ministry of women and child development with technical support from Unicef.
- RSoC(Rapid Survey on Children ) was keenly awaited as it provides a nationwide assessment after the third round of the National Family Health Survey (NFHS-3), which is nearly a decade old now.
- The RSoC data significant due to Sustainable Development Goals.
- One of the goals of SDG seeks to end all forms of malnutrition by 2030, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children less than five years of age.
Though the graph seems to suggest the improvement in RSoC( done in 2013-14) as compared to NFHS-3 but in absolute terms, the current levels of underweight and stunted children are abysmally high and former Prime Minister Manmohan Singh’s assertion that malnutrition is a “national shame” is still valid.
SAM and SCM
Current mainstream global notions draw upon African experiences, where severe acute malnutrition (SAM) has been triggered by acute crises, such as drought, crop failure and civil wars.
Classical Severe Acute Malnutrition:
- is a medical emergency
- carries with it a high risk of mortality
- requires not just therapeutic feeding but other medical inputs
Situation in India
- SAM’s global wisdom was bought off-the-shelf by national experts and Indian strategies and guidelines continue to be largely clinical, essentially seeking to treat malnutrition.
- The predominant form of malnutrition in India SCM and standardised protocols for treatment are not as effective in the Indian context, where longer durations are required for achieving targeted weight gains(high levels of underlying stunting).
- Stunting signifies chronic undernutrition and has no scope for “cure” in a therapeutic mode.
- Its levels in India are higher than in Africa, and exceedingly so among chronically poor populations.
Severe chronic malnutrition (SCM)
- stunted growth
- potentially less serious but continual form of malnutrition.
- generally an outcome of latent poverty, chronic food insecurity, poor feeding practices and protracted morbidities, but rarely a direct cause of mortality.
- In short, stunted children are hungry but not sick.
Existing Government Interventions
Strategy to be adopted
- SCM requires a far wider spectrum of programmatic interventions beyond clinical management.
- Multi-sectoral actions are needed to combat multi-dimensional deprivations.
- Simultaneously, there is an urgent need for promoting practices to
- improve the quality of local diets
- improving child-feeding practices
- reducing exposure to illnesses
- paediatric care services.
This would need a broad-based commitment of resources as well as the creation and nurturing of local capacities and leaderships.
- Household food security and livelihood
- Need for food supplementation programmes and Health care
- Strengthening & Restructuring of ICDS
- Addressing the intergenerational cycle of adolescent, maternal and child undernutrition
- Policy, coordination and convergence of, nutrition related sectors including health services and hygienic interventions
- Monitoring nutrition interventions
- Capacity building
Despite recent gains, malnutrition continues to be a national emergency; though not a medical one.
The National Nutrition Mission (a multi-sectoral programme earmarked for 200 high-burden districts) has not taken off in any meaningful manner.
The way forward requires
- a reorientation of Indian research to inform policy and practice
- change the current tenor of policy discussions.
The Make in India call should apply no less to research and practice.