Poor diet: Malnutrition is still the leading risk factor for death in children under five years.   | Photo Credit: K.K. Mustafah

Two-thirds of the 1.04 million deaths in children under five years in India are still attributable to malnutrition, according to the first comprehensive estimate of disease burden due to child and maternal malnutrition and the trends of its indicators in every State from 1990.

The report states that the disability-adjusted life year (DALY) rate attributable to malnutrition in children varies 7-fold among the States and is highest in Rajasthan, Uttar Pradesh, Bihar and Assam, followed by Madhya Pradesh, Chhattisgarh, Odisha, Nagaland and Tripura.

The report was published on Wednesday in The Lancet Child & Adolescent Health by the India State-Level Disease Burden Initiative. The report says the overall under-five death rate and the death rate due to malnutrition has decreased substantially from 1990 to 2017, but malnutrition is still the leading risk factor for death in children under five years, and is also the leading risk factor for disease burden for all ages considered together in most States.

The malnutrition trends over about three decades reported in this paper utilised all available data sources from India, which enable more robust estimates than the estimates based on single sources that may have more biases.

The India State-Level Disease Burden Initiative is a joint initiative of the Indian Council of Medical Research (ICMR), Public Health Foundation of India, and Institute for Health Metrics and Evaluation in collaboration with the Ministry of Health and Family Welfare along with experts and stakeholders associated with over 100 Indian institutions, involving many leading health scientists and policy makers from India.

Vinod K. Paul, member, NITI Aayog, said that the government is now intensifying its efforts to address the issue of malnutrition across the country. “State governments are being encouraged to intensify efforts to reduce malnutrition and undertake robust monitoring to track the progress,” he said.

Balram Bhargava, Director General, ICMR said: “The National Institute of Nutrition, an ICMR institute, and other partners are setting in place mechanisms to ensure that there is more data available on malnutrition in the various States which will help monitor progress. The findings reported in the paper published today highlight that there are wide variations in the malnutrition status between the States. It is important therefore to plan the reduction in malnutrition in a manner that is suitable for the trends and context of each State.”

Senior author of the paper Lalit Dandona, also director of the India State-Level Disease Burden Initiative, explained that the study reports that malnutrition has reduced in India, but continues to be the predominant risk factor for child deaths, underscoring it importance in addressing child mortality. “It reveals that while it is important to address the gaps in all malnutrition indicators, low birth weight needs particular policy attention in India as it is the biggest contributor to child death among all malnutrition indications and its rate of decline is among the lowest. Another important revelation is that overweight among a subset of children is becoming a significant public health problem as it is increasing rapidly across all States,” he said.

Soumya Swaminathan, chief scientist at the World Health Organisation and first author on this paper, noted that the study findings have highlighted where efforts need to be intensified.

“For substantial improvements across the malnutrition indicators, States will need to implement an integrated nutrition policy to effectively address the broader determinants of under-nutrition across the life cycle. Focus will be needed on major determinants like provision of clean drinking water, reducing rates of open defecation, improving women’s educational status, and food and nutrition security for the most vulnerable families,” she explained.

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