Divergence in time trends between nutrition and health status of Indian children: an enigma?
Main Article Content
Prema Ramachandran
http://orcid.org/0000-0003-1974-8281
K Kalaivani
http://orcid.org/0000-0002-9582-4488
http://orcid.org/0000-0003-1974-8281
K Kalaivani
http://orcid.org/0000-0002-9582-4488
Abstract
India has been food secure and children had access to essential health and nutrition services for four decades but under-nutrition rates in children continue to be high. Despite the high prevalence of low birthweight (LBW) and under-nutrition, under-five mortality rates are relatively low: the ‘South Asian enigma’.
Data from research studies and large-scale nutrition and health surveys were analysed and reviewed to assess:
- dimensions, determinants and time trends of under-nutrition in under-five children,
- functional decompensations associated with LBW and under-nutrition,
- factors responsible for ‘South Asian enigma’, and
- progress towards Sustainable Development Goals (SDG) for child nutrition and health.
Neonates born with low weight and length, follow a lower trajectory of growth throughout childhood; this was the major factor responsible for the high under-nutrition rates in children. Breast feeding was nearly universal; about 2/3rd of infants were solely breast-fed at 5 months; but both complementary feeds and adult food given to children were inadequate and lacked diversity. This resulted in a rise in under-nutrition rates between 12-23 months. In 24-59 months there was no further rise in under-nutrition rates. Moderate under-nutrition is not associated with increase in risk of infections; health care for infection was available and utilised; therefore, mortality rates were low.
India will not be able to achieve the SDG targets for reduction in low birthweight or under-nutrition but is likely to achieve the targets for reduction in food insecurity and under-five mortality.
Keywords:
under-five children, under-nutrition, growth monitoring, India, nutrition and morbidity, nutrition and mortality, nutritional status
Article Details
How to Cite
RAMACHANDRAN, Prema; KALAIVANI, K.
Divergence in time trends between nutrition and health status of Indian children: an enigma?.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4850>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i12.4850.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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42. Kramer MS Does one size fit all? Should India Adopt the New INTERGROWTH-21 “Prescriptive” Standard for Fetal Growth? Bulletin of the Nutrition Foundation of India 2015 36 (3)
43. Bhilwar M, Upadhyay RP, Yadav K, Kumar R, Chinnakali P, Sinha S, Kant S. Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India. Natl Med J India. 2016 :29(2):73-81.
44. Khan N, Mozumdar A, Kaur S: Determinants of low birth weight in India: An investigation from the National Family Health Survey. Am J Hum Biol. 2020,32:e23355. 10.1002/ajhb.23355
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46. AL Thompson What is normal, healthy growth? Global health, human biology, and parental perspectives 2021 Accessed November 01 2023 https://doi.org/10.1002/ajhb.23597
47. Habicht JP, Yarbrough C, Martorell R, Malina R, Klein R. Height and weight standards for preschool children: how relevant are ethnic differences in growth potential?. Lancet. 1974 Apr 6;303(7858):611-5
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57. Ministry of women and child development (GOI): Protocol for management of malnutrition Accessed November 1 2023 https://wcd.nic.in/sites/default/files/CMAM-Book-10-10-2023%20%281%29.pdf
2. Ramachandran P. Food & nutrition security: Challenges in the new millennium. The Indian J Med Res. 2013: 138(3):373-82.
3. Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity: an overview. The American J Clin Nutr. 1997:66 (2):464S-77S.
4. Reddy V, Jagadeesan V, Ragharamulu N, Bhaskaram C, Srikantia SG. Functional significance of growth retardation in malnutrition. American J Clin Nutr. 1976:29(1):3-7.
5. Bhaskaram P. Infections and malnutrition among poor children. The Indian J Ped. 1987: 54(4):535-45.
6. Ramachandran P. Nutrition and child survival in India. Indian J of Ped. 2010:77 (3):301-5.
7. Ramachandran P (2006) The Double Burden of Malnutrition in India Accessed November 01 2023 ftp://ftp.fao.org/docrep/fao/009/a0442e/a0442e01.pdf.
8. Ramachandran P Research in nutrition & health interactions: achievements & challenges Indian J Med Res 2023 158 97-100
9. Ramachandran P, Kalaivani K. Nutrition Transition in India: Challenges in achieving Global Targets Proc Indian Natn Sci Acad 2018 84(4) 821-833
10. National Food Security Portal. Department of Food & Public Distribution, Government of India. National food security act, 2013. Accessed November 01 2023 https://nfsa.gov.in/portal/nfsa-act
11. Ramalingaswami V, Jonsson U, Rhode J. Malnutrition: a south Asian enigma. Malnutrition in South Asia: a regional profile. UNICEF Regional Office for South Asia. 1997:11-22
12. Department of agriculture and farmers welfare: agricultural statistics at a glance
Accessed on 1.12.2023 https://agricoop.gov.in/en/Agricultural_Statistics_at_a_Glance
13. Ministry of statistics and programme implementation Consumer Expenditure surveys Accessed on 1.12.2023
https://mospi.gov.in/98-consumption-surveys-and-levels-living
14. National Institute of Nutrition (NIN) National Nutrition Monitoring Bureau (NNMB) Accessed on 1.12.2023 https://www.nin.res.in/downloads/NNMB
15. Registrar General of India (RGI) Sample registration system (SRS)-Bulletin Accessed on 1.12.2023https://censusindia.gov.in/census.website/data/SRSB
16. International institute of Population Sciences (IIPS): National Family Health surveys Accessed on 1.12.2023 https://rchiips.org/nfhs/
17. IIPS District level household and facility survey Accessed on 1.12.2023 https://data.gov.in/.../district-levelhousehold-and-facility-survey-dlhs-
18. RGI Clinical anthropometric and biochemical component of Annual health survey Accessed on November1 2023 http://www.censusindia.gov.in/2011census/hh-series/cab.html
19. ICMR-NIN Expert Group. Nutrient Requirements for Indians, Recommended Dietary Allowances (RDA) and Estimated Average Requirements (EAR). (2020). National Institute of Nutrition, Hyderabad, India
20. IIPS District Level Household and Facility Survey (DLHS-4). Accessed November 1 2023 https://data.gov.in/.../district-levelhousehold-and-facility-survey-dlhs-4
21. IIPS Nutrition in India NFHS 3; 2011. Accessed November 1 2023 http://rchiips.org/nfhs/nutrition_report_for_website_18sep09.pdf
22. Kumari H, Kalaivani K, Ramachandran P. Intra-family differences in nutritional status between pre-school children and women. Int J Comm Med Pub Health. 2020;7(7):2580-7
23. Kumari H, Kalaivani K, Ramachandran P. Nutritional Status of Parents and their Pre-School Children. Indian J Nutr Diet. 2020;58(4):489– 500.
24. Kumari H, Kalaivani K, Ramachandran P. Food Consumption and Nutritional Status of Urban Low Middle-Income Families The Indian. J Nutrition Diet. 2022: 59 (3):357–68.
25. Kumari H, Kalaivani K, Ramachandran P. Intrafamily differences in nutritional status of preschool children. IP J Paediatr Nurs Sci 2023;6(3):1-8
26. Ghosh S, Bhargahava S K, Madhavan S, Taskar A D, Bharghava V and Nigam S K Intrauterine growth of north Indian babies Paediatrics 1971: 47 826-830
27. Ghosh S, Bharghava S K and Moriyamma I W Longitudinal study of survival and outcomes of a birth cohort Report of the research project (1968) 01-658-2 NCHS Maryland USA
28. FAO. State of Food Insecurity in the World 2013. Accessed November 1 2023 http://www.fao.org/publications/sofi/en/
29. Gopalan C, Ramalingaswami V. Kwashiorkor in India. Indian J Med Res. 1955:43(4):751-73.
30. IIPS ‘National Family Health Survey-5 Fact sheet Accessed November 1 2023 http://rchiips.org/nfhs/pub_nfhs-5.shtml
31. Ramachandran P, Gopalan HS. Undernutrition & risk of infections in preschool children. Indian J Med Res 2009; 130 (5): 579-83.
32. Lakshmi RV, Subapriya MS, Kalaivani K, Ramachandran P. Morbidity due to infections in preschool children from urban low income households. Indian J Nutr Diet 2018; 55: 488-99
33. Ramachandran P, Kalaivani K, Lakshmi RV, Kalaivani M, Pandey RM, Subapriya MS Nutrition morbidity interactions in pre-school children Indian J Med Res 2023 157 (5), 460-469
34. Kumar, P., Sinha, R.K., Daniel, A. et al. Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6–59 months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study. BMC Nutr 2021. Accessed November 1 2023 https://doi.org/10.1186/s40795-021-00489-1
35 Sachdev HS, Sinha S, Sareen N, Pandey RM, Kapil U. Survival and Recovery in Severely Wasted Under-five Children Without Community Management of Acute Malnutrition Programme. Indian Pediatr. 2017 Oct 15;54(10):817-824.
36. Bhandari N, Mohan SB, Bose A, Iyengar SD, Taneja S, Mazumdar S, et al. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India. Accessed November 1 2023 BMJ Glob Health. 2016;1:e000144
37. World Bank Indicator database Accessed November 01 2023 https://data.worldbank.org/indicator/
38. World Scientific Publishing Company. Fifty years of green revolution: An anthology of research papers. World Scientific Publishing Co Pvt Ltd Chennai: India; 2017.
39. Kramer MS: Determinants of low birth weight: Methodological assessment and meta-analysis Bull World Health Organ. 1987, 65:663-737.
40. WHO Low Birth Weight Policy Brief - World Health Organization 2012 Accessed November 01 2023 http://www.who.int/nutrition/topics/globaltargets_lowbirthweight_policybrief.pdf
41. Gopalan S Low Birth Weight - Causes, consequences and interventions to achieve reduction Proc Indian Natn Sci Acad 2018: 84.( 4 ) 843-851
42. Kramer MS Does one size fit all? Should India Adopt the New INTERGROWTH-21 “Prescriptive” Standard for Fetal Growth? Bulletin of the Nutrition Foundation of India 2015 36 (3)
43. Bhilwar M, Upadhyay RP, Yadav K, Kumar R, Chinnakali P, Sinha S, Kant S. Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India. Natl Med J India. 2016 :29(2):73-81.
44. Khan N, Mozumdar A, Kaur S: Determinants of low birth weight in India: An investigation from the National Family Health Survey. Am J Hum Biol. 2020,32:e23355. 10.1002/ajhb.23355
45. Girotra S, Mohan N, Malik M, et al. (March 26, 2023) Prevalence and Determinants of Low Birth Weight in India: Findings From a Nationally Representative Cross-Sectional Survey (2019-21). 2023 Cureus 15(3): e36717. DOI 10.7759/cureus. 36717
46. AL Thompson What is normal, healthy growth? Global health, human biology, and parental perspectives 2021 Accessed November 01 2023 https://doi.org/10.1002/ajhb.23597
47. Habicht JP, Yarbrough C, Martorell R, Malina R, Klein R. Height and weight standards for preschool children: how relevant are ethnic differences in growth potential?. Lancet. 1974 Apr 6;303(7858):611-5
48. Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL. Development of normalized curves for the international growth reference: historical and technical considerations. American J Clin Nutr. 1987;46(5):736-48.
49. WHO child growth standards: length/height-for-age, weight-for-age, weight -for-length, weight-for-height and body mass index-for-age: methods and development (2006) Accessed November 01 2023 https://www.who.int/publications/i/item/924154693XMGRSstandards
50. Prabhakar K, Kowsalya, S., Kalaivani, K. Ramachandran P Growth Monitoring in Under-Three Children Using the Mother Child Protection Card Indian J of Nutr and Diet , 2020: 57 (4), 368-386
51. FAO State of food security and nutrition in the world 2023 Accessed November 1 2023 https://www.fao.org/documents/card/en?details=cc3017en
52. Bhargava SK, Sachdev HPS, Fall C, Osmond C, Lakshmy R, Barker DJP, et al. Relation of serial changes in childhood body mass index to impaired glucose tolerance in young adulthood. N Engl J Med. 2004: 350:865-75.
53. WHO Management of severe malnutrition: a manual for physicians and other senior health workers WHO 1999 Accessed November 1 2023 https://www.who.int/publications/i/item/9241545119
54. WHO, WFP, UNSCN, UNICEF. Community-based management of severe acute malnutrition: A joint statement by the WHO, WFP, UNSCN, UNICEF 2007. Accessed November 1 2023 http://www.who.int/maternal_child_adolescent/documents/a91065/en/
55. WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization. 2013 Accessed November 1 2023 https://iris.who.int/bitstream/handle/10665/95584/9789241506328_eng.pdf?sequence=1
56. WHO: Guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years (magicapp.org) Accessed December 1 2023 https://www.childwasting.org/_files/ugd/2b7a06_643a6617b6a54190933d860b7b2c769b.pdf
57. Ministry of women and child development (GOI): Protocol for management of malnutrition Accessed November 1 2023 https://wcd.nic.in/sites/default/files/CMAM-Book-10-10-2023%20%281%29.pdf