Mapping child malnutrition levels across India’s assembly constituencies

As many social scientists have pointed out, India is in a perennial state of electioneering. Every year, some corner of the country queues up for some kind of polling. But amid the shrill of campaigning is lost a scary fact: Malnutrition is responsible for three in every four child deaths in India.

Malnutrition is the biggest threat to children under five years in India. But it is hardly an electoral issue. India Today Data Intelligence Unit (DIU) analyses Harvard University’s latest project, where for the first time, anyone can monitor the extent of child malnutrition in their assembly constituency.

What they found

Despite the progress in the last 15 years, food systems have overlooked needy children, mainly in the North Indian states of Uttar Pradesh, Bihar and Jharkhand.

“Lower levels of socio-economic development, literacy and sub-optimal governance are some aspects why many indicators – and not just indicators of under-nutrition – lag behind in this region. When we analyse data at the finer geographic resolution, we also find pockets that are doing well. And this should be leveraged for learning and replication,” S (Subu) V Subramanian, professor of Population Health and Geography at the Geographic Insights Lab, Harvard University, told DIU.

The indicators

Four indicators – stunting, underweight, anaemic and wasting – were defined, according to the World Health Organization Child Growth Standards, to monitor assembly-wise burden of child malnutrition.

Stunting is a prime indicator that impairs growth and development, and more than one-third of children are estimated to have stunted growth in India.

“This cross-sectional study included children younger than five years who participated in the fourth National Family and Health Survey (NFHS-4), conducted between January 2015 and December 2016. Participants lived in 36 states and union territories and 640 districts in India,” the study published by Journal of the American Medical Association (JAMA) Network Open said.

“Children who had good weight and height measures were selected for stunting, underweight, and wasting analysis, and children between ages 6 and 59 months with valid blood haemoglobin concentration levels were included in the anaemia analysis sample,” the study added.

Underweight is the second metric, which is defined as weight-for-age below WHO standard. Similarly, wasting is defined as lower weight-for-height than the WHO standard.

Childhood wasting was less widespread (19%) than stunting (34%) and underweight (31%). However, anaemia, defined as having a haemoglobin concentration less than WHO standard (11.0 g/dL), is more prevalent (~56%).

The government uses these indicators to monitor malnutrition and eradication programmes such as National Nutrition Mission (or POSHAN Abhiyaan).

In numbers

Between 2000 and 2017, estimated childhood stunting has dropped in most lower middle-income countries, including India, from 37 per cent to 27 per cent.

In absolute numbers, India is home to over five crore stunted children in 2017, according to “Nature” magazine.

Stunted children under five are unequally distributed across assembly constituencies. For instance, UP, Bihar and Jharkhand have high prevalence of malnourished populations. Bihar ranked the highest in stunting (49%), followed by UP (44%); while Jharkhand ranked highest for underweight (45%), followed by Bihar (45%).

Though the latest NHFS-5 shows some improvement on the above parameters, but detailed data is awaited.

What next

Rising costs of healthy diets and high poverty keep healthy diets out of reach for around 3 billion people on this planet. Under the shadow of the Covid-19 pandemic, all progress over malnutrition is under threat.

The situation could have been worsened without governments’ responses. Geographic targeting of public health interventions is needed to push a mainstream political agenda.

“In line with the ideals of India’s Constitution, this research will help public representatives at the middle and primary levels of governance lead united efforts in their constituencies to raise the nutritional status of children and women,” Dr Rajiv Kumar, vice-chairman of NITI Aayog, commented over the geographic interpolation of malnutrition data.

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