Study Finds Severe Malnutrition Spiked in Half of India in 5 Years

An analysis of district-level data published in a reputed health journal shows a worrying rise in severe wasting in almost half of Indian districts even as the National Family Health Survey (NFHS)-5 showed only an overall marginal increase in levels of severe acute malnutrition among children in the country.

According to the analysis, titled ‘Acute level of severe malnutrition in Indian districts’, between 2016 and 2021, severe wasting, or severe acute malnutrition (SAM) in preschool children (aged 0-59 months) increased in 341 districts out of 707 across 36 states and Union Territories.

The analysis, done by Sabu Kochupurackal Ulahannan, Alby Wilson, Deepshikha Chhetri, Biju Soman and NS Prashanth, was published by BMJ Global Health, an online peer-reviewed journal that publishes all aspects of global health.

The paper is based on the study of district-level data of NFHS-5. “Although the prevalence trend in SAM between NFHS-4 and NFHS-5 shows an almost stagnant position at the national level, the national average hides the worsening of SAM at several individual districts due to the improvement in other districts,” the analysis states.

Between NFHS-4 (2015-2016) and NFHS-5, the overall increase in severe acute malnourishment was a marginal 0.2%. In 2015-2016, the level of SAM was 7.5%, which increased to 7.7% in 2019-2021. The level of severe wasting among kids has been on a consistent rise in the last two decades. It was 6.6% in 2005-2006, as per NFHS-4 data.  

In the latest NFHS, Assam’s Karimganj district reported the highest increase (24.4%) and most critical level (30.5%) of SAM. Other districts with critical and increased levels are Dang (22.2%), Gujarat; Sheohar (21.4%), Bihar; Saraikela Kharsawan (23%), Jharkhand; Chandrapur (21.8%) and Nagpur (20%), Maharashtra; and Panchmahal (19.4%), Gujarat. 

The paper further identifies as many as 115 districts where levels of SAM have increased manifold. These districts include Ranchi, Kolkata, Darjeeling, Pune, Aurangabad, Khargone, Ajmer and Saharanpur, among several others. Prime Minister Narendra Modi’s constituency Varanasi and Uttar Pradesh’s chief minister Yogi Adityanath’s constituency Gorakhpur also reported an alarming level of increase in severe wasting levels. Maharashtra had the most number of districts, 16, with high and increased levels, followed by Gujarat and Uttar Pradesh (both 14), Madhya Pradesh (10), and Bihar(9).

The case mortality rate among severely malnourished children receiving inpatient treatment based on World Health Organisation protocol ranged from 3.4% to 35%, the paper further states. “According to the current estimates, over 1 crore children in India are severely malnourished. Case mortality rate of 35% means that around 35 lakh children in our country are at ahigh-risk mortality,” said Ulahanna, the main author of the paper and a health and system researcher, Institute of Public Health (Bengaluru).

Malnourishment does not get adequate attention from the government, Ulahanna said. “Even though we have invested a lot in schemes and missions such as Poshan Abhiyaan, we are yet to see any positive signs. The Poshan Abhiyaan focusses more on information disbursal and gives limited attention to food security.” According to him, the Poshan Abhiyaan should engage with authorities at the Panchayat level but such decentralised planning and implementation are yet to be seen.

“The Poshan Abhiyaan mission also needs to develop operational guidelines for an intersectional approach and collaborate with other entities. For example, we need active participation from Swachh Bharat Mission, agriculture department, National Rural Livelihoods Mission, etc., to address the social determinants of SAM,” Ulahanna said. 

The NFHS-5 data were largely collected before COVID-19 hit the country. The pandemic is expected to have worsened malnourishment levels. Another cause for worry for health experts is the rising inflation. “It is no secret that high inflation and price rise affect people’s capability to consume more and nutritious food. Rising inflation will affect the poor and marginalised communities even more,” said Ulahanna.

The Consumer Price Index, or retail inflation, was at an eight-year high of 7.79% in April. A recent report by the Centre for Science and Environment and Down to Earth magazine showed that 71% of Indians cannot afford a nutritious meal and more than 17 lakh people die annually because of diseases attributable to poor diet.

The NFHS-5 data also highlighted a very high increase in anaemia (caused by unhealthy food habits) levels. According to the survey, 67.1% of children aged 6-59 months were anaemic in 2021 against 58.6% in 2016. Anaemia was also found prevalent in, at least, 57% of women.

The writer is a Delhi-based independent researcher.