Prime indicator: Underweight is highly correlated with child morbidity and reflects the nutritional status.   | Photo Credit: Sanjit Das/Bloomberg

Globally over 200 million children below five years of age are chronically malnourished causing persistent problem in middle- and low-income countries. Though India’s National Family Health Surveys (NFHS) show that there has been a decline in child malnutrition numbers in the country, various studies show that the rate of decline is very slow, and India is still fighting a tough battle.

Now, a team from Harvard and Cambridge University has assessed district-level trends in the prevalence of malnutrition and how wealth disparity plays a role in five important malnutrition indicators such as stunting, underweight, wasting, low birth weight, and anaemia. The researchers analysed the NFHS-4 data of 2015-16 and noted that among the four indicators, anaemia was highly prevalent at 54.6%, across the poorest of the poor in Rajasthan, Gujarat, Madhya Pradesh and Telangana.

The team also placed each district under four categories — disparity, pitfall, intensity or prosperity — based on the overall burden and wealth disparity.

Wealth disparities in underweight children were seen across all districts with Gujarat, Jharkhand and Bihar having the worst disparities and Mizoram, Nagaland and Manipur having the least. “Underweight is highly correlated with child morbidity and is reflective of the current environmental and nutritional status of the child. Hence, underweight is arguably a more relevant and straightforward indicator to monitor for progress in child malnutrition,” explains Dr. Rockli Kim from the Harvard Center for Population and Development Studies, U.S. in an email to The Hindu. She is the corresponding author of the paper recently published in SSM- Population Health.

The paper adds that for stunting and underweight, the north and central region of India which includes Uttar Pradesh, Bihar and Jharkhand were composed primarily of “pitfall” and “intensity” districts.

The team explains that though the Government of India’s new initiative National Nutrition Mission (NNM) has led to a progressive decline in child malnutrition, the decline has been slow and the improvements have not been equally distributed across the population. “Our work provides estimates to inform policies and interventions to target areas with the highest overall burden and the worst wealth disparity in child nutritional status. Even within well-performing districts, there can be gross inegalitarian malnutrition outcomes,” explains S.V. Subramanian from the Department of Population Health and Geography at Harvard University in an email to The Hindu. He is one of the authors of the paper.

“Districts where the prevalence of malnutrition is uniformly high likely require a different intervention strategy compared with districts where prevalence is high but disproportionately shouldered amongst poorer households within the district. It is important to make sure progress on child nutrition is made both effectively and equitably,” he adds.

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