Finding sustainable solutions for childhood under-nutrition in India: an assessment of association of childhood under-nutrition with multiple factors

Authors

  • Keya Chatterjee National Centre of Excellence for SAM Management, Kalawati Saran Children’s Hospital, New Delhi, India
  • Rajesh Sinha National Centre of Excellence for SAM Management, Kalawati Saran Children’s Hospital, New Delhi, India
  • Praveen Kumar Lady Hardinge Medical College and associated Kalawati Saran Children’s Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20221243

Keywords:

Wasting, Stunting, Childhood undernutrition, Correlation

Abstract

Background: Burden of malnutrition among children is very high in India. Under-nutrition is an interplay of different factors. The present study tried to understand the correlation between child under-nutrition and different distal and proximate factors.

Methods: Correlation coefficients (r), using state wise data, were calculated to assess relationship between child nutritional status and other factors such as minimum acceptable diet, micronutrient deficiencies, IYCF, maternal nutritional factors, women agency, water and sanitation practices, HDI, food insecurity and climate change vulnerability.

Results: Minimum acceptable diet showed negative correlation with childhood wasting (-0.41) and stunting (-0.36). They were positively correlated with any form of anaemia and vitamin A deficiency. Both basic and age-appropriate immunisation was negatively correlated with wasting (r=-0.2 and -0.5 respectively) and stunting (r=-0.5 and -0.7 respectively). Maternal nutritional factors (BMI<18.5 kg/m2 and any form of maternal anaemia) were positively correlated with childhood nutritional status. Strong negative correlation of both wasting and stunting were found with households having toilet facilities (r=-0.7 in both cases). Indoor air pollution was positively correlated with wasting (r=0.6) and stunting (r=0.2). Both wasting (r=-0.50) and stunting (r=-0.70) were negatively correlated to HDI. Food insecurity and climate change vulnerability were positively correlated with both wasting (r=0.3 for both case) and stunting (r=0.6 and 0.40 respectively).

Conclusions: A synergetic programme that brings together essential nutritional interventions and those that address underlying and basic causes is required to sustainably address childhood under-nutrition in India.

References

Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. Comprehensive National Nutrition Survey (CNNS) National Report, 2019. Available at: https://nhm.gov.in/WriteReadData/l892s/1405796031571201348. Accessed on 07 March 2022.

UNICEF, & Unicef (2015)’s approach to scaling up nutrition for mothers and their children. United Nations Children’s Fund, 2015. Available at: http://www.acp.int/sites/acpsec.waw.be/files/UNICEF. Accessed on 07 March 2022.

United Nations Children's Fund. (UNICEF). Nutrition, for ... of children's right to nutrition – and partners, in scaling up policies, strategies, 2020. Available at: https://www.unicef.org/media/92031/file/UNICEF%20Nutrition%20Strategy%202020-2030. Accessed on 07 March 2022.

Sustainable Development Goals in India. Available at: Sustainable Development Goals in India. SDGs – UN India. Accessed on 07 July 2021.

India and Sustainable Development Goals: The Way Forward | RIS Work Programme On Sustainable Development Goals. Available at: ris.org.in/sd g/india/india-and-sustainable-developmen-goals-way-forward. Accessed on 07 July 2021.

POSHAN Abhiyaan - PM's Overarching Scheme for Holistic Nourishment. National Portal of India, 2018. Available at: https://www.india.gov.in/spotlight/poshan-abhiyaan-pms-overarching-scheme-holistic-nouri. Accessed on 7 July 2021.

Poshan Abhiyan, MWCD Presentation at LBSNAA course (Feb 2019) Day 1 - POSHAN Abhiyaan – MWCD. Available at: slideshare.net. Accessed on 7 July 2021.

International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.

Sub-national HDI. Subnational HDI - Global Data Lab, 2013. Available at: https://globaldatalab.org/shdi/shdi/. Accessed on 07 March 2022.

Department of Food and Public Distribution, 2013. NFSA. Available at: https://nfsa.gov.in/. Accessed on 07 March 2022.

Department of Science and Technology, Government of India and Swiss Agency for development and Cooperation SDC, Climate Vulnerable Assessment for Adapting Planning in India Using a Common Framework. Available at: https:// dst.gov.in/sites/default/files/fullreport(1).pdf. Accessed on 1 July 2021.

World Health Organization. Indicators for assessing infant and young child feeding practices: part 2: measurement, 2010. Available at: https://www.who.int/publications/i/item/9789240018389. Accessed on 07 March 2022.

United Nations Development Programme, Human Development Index, Human Development Index (HDI). Human Development Reports. Available at: undp.org. Accessed on 12 June 2021.

Bloem MW, Semba RD, Kraemer K. Castel Gandolfo Workshop: An introduction to the impact of climate change, the economic crisis, and the increase in the food prices on malnutrition. J Nut. 2020;140(1):132S-5S.

Ruel MT, Alderman H. Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?. The lancet. 2013;382(9891):536-51.

UNICEF. 10 proven nutrition interventions. 10 proven nutrition interventions. UNICEF South Asia, 2021. Available at: https://www.unicef.org/rosa/stories/10provennutrition-interventions. Accessed on 07 March 2022.

Niti Ayog, Government of India, Poshan Abhiyan Monitoring Report, 2020. Available at: POSHAN-AbhiyaanMonitoringReport22July2020.(niti.gov.in). Accessed on 22 June 2021.

Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) National Report. New Delhi. 2019;100-8.

Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) National Report. New Delhi. 2019;124.

Cigerli O, Parildar H, Unal AD, Tarcin O, Kut A, Eroglu H et al. Vitamin deficiency and insulin resistance in nondiabetic obese patients. Acta Endocrinologica (Bucharest). 2014;2(3):319.

Charmarbagwala R, Ranger M, Waddington H, White H. The determinants of child health and nutrition: a meta-analysis. 2004.

Luby SP, Rahman M, Arnold BF, Unicomb L, Ashraf S, Winch PJ. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial. The Lancet Global Health. 2018;6(3):e302-15.

Mishra V, Retherford RD. Does biofuel smoke contribute to anaemia and stunting in early childhood? International Journal of Epidemiology. 2007;36(1):117-29.

Lamichhane DK, Leem JH, Kim HC. Household air pollution and caste-ethnic differences in undernutrition among children in Nepal. Archives of environmental & occupational health. 2020;75(8):435-44.

Boy E, Bruce N, Delgado H. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environmental health perspectives. 2002;110(1):109-14.

Mishra V, Dai X, Smith KR, Mika L. Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe. Annals of epidemiology. 2004;14(10):740-7.

Choi H. Jedrychowski W, Spengler J, Camann DE, Whyatt RM, Rauh V, et al. International studies of prenatal exposure to polycyclic aromatic hydrocarbons and fetal growth. Environ Health Perspect. 2004;1(14):1744-50.

Ezzati M. Indoor air pollution and health in developing countries. The Lancet. 2004;366(9480):104-6.

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience, 2016. Available at: https://www.who.int/publications/i/item/9789241549912. Accessed on 07 March 2022.

Ackerson LK, Subramanian SV. Domestic violence and chronic malnutrition among women and children in India. American journal of epidemiology. 2008;167(10):1188-96.

Adhikari RP, Yogi S, Acharya A, Cunningham K. Intimate partner violence and nutritional status among nepalese women: an investigation of associations. BMC women's health. 2020;20(1):1-11.

Rahman M, Nakamura K, Seino K, Kizuki M. Intimate partner violence and chronic undernutrition among married Bangladeshi women of reproductive age: are the poor uniquely disadvantaged?. European journal of clinical nutrition. 2013;67(3):301-7.

Chai J, Fink G, Kaaya S, Danaei G, Fawzi W, Ezzati M et al. Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys. Bulletin of the World Health Organization. 2016;94(5):331.

Levy BS, Patz JA. Climate change, human rights, and social justice. Annals of global health. 2015;81(3):310-22.

Alderman H. Safety nets can help address the risks to nutrition from increasing climate variability. the Journal of Nutrition. 2010;140(1):148S-52S.

Darnton-Hill I, Cogill B. Maternal and young child nutrition adversely affected by external shocks such as increasing global food prices. J nutr. 2010;140(1):162S-9S.

Nelson GC, Rosegrant MW, Koo J, Robertson R, Sulser T, Zhu T et al. Climate change: Impact on agriculture and costs of adaptation. Intl Food Policy Res Inst. 2009;21.

Ruel MT, Garrett JL, Hawkes C, Cohen MJ. The food, fuel, and financial crises affect the urban and rural poor disproportionately: a review of the evidence. J Nutr. 2010;140(1):170S-6S.

Christian P. Impact of the economic crisis and increase in food prices on child mortality: exploring nutritional pathways. J nutr. 2010;140(1):177S-81S.

Department of Science and Technology, Government of India and Swiss Agency for development and Cooperation SDC, Climate Vulnerable Assessment for Adapting Planning in India Using a Common Framework. Available at: https://dst.gov.in/sites/default/files/fullreport(1) .pdf. Accessed on 1 July 2021.

India and Sustainable Development Goals: The Way Forward | RIS Work Programme On Sustainable Development Goals. Available at: ris.org.in/sdg/india/india-and-sustainable-develop men-goals-way-forward. Accessed on 22 June 2021.

UNDP. India ranks 130 on 2018 Human Development Index. UNDP in India, 2020. Available at: https://www.in.undp.org/content/india/en/home/sustainable-development/successstories/india-ranks130-on-2018-human-development-inde. Accessed on 07 March 2022.

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Published

2022-04-27

How to Cite

Chatterjee, K., Sinha, R., & Kumar, P. (2022). Finding sustainable solutions for childhood under-nutrition in India: an assessment of association of childhood under-nutrition with multiple factors. International Journal Of Community Medicine And Public Health, 9(5), 2214–2224. https://doi.org/10.18203/2394-6040.ijcmph20221243

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Original Research Articles