Highlighting a key gap in child nutrition, the recently released National Family Health Survey (NFHS-5) has found that 89 per cent of children between the formative ages of 6-23 months do not receive a “minimum acceptable diet’’. This is only marginally better than the 90.4 per cent recorded in NFHS-4.
The NFHS report looked at adequate diet for both breastfeeding and non-breastfeeding children till they reached two years.
It found that 88.9 per cent of children between 6-23 months, who are breastfeeding, did not receive adequate diet in 2019-2020 — a slight improvement from 91.3 per cent in 2015-16. And that 87.3 per cent of non-breastfeeding children in this category did not receive adequate nutrition in 2019-21, up from 85.7 per cent in 2015-16.
Alert on malnutrition
Deficiency in diet in a child’s formative years has a direct bearing on malnutrition, with India having one of the highest malnutrition burdens in the world.
Among all states and Union Territories, the proportion of children aged 6-23 months who received a minimum acceptable diet was highest in Meghalaya (28.5 per cent) and the lowest in UP and Gujarat (5.9 per cent each). In 2015-16, the proportion of children in this category stood at 5.2 per cent in Gujarat and 6.1 per cent in UP.
Apart from Gujarat and UP, 10 other states — Assam (7.2 per cent), Rajasthan (8.3 per cent), Maharashtra (8.9 per cent), Andhra Pradesh (9 per cent), MP (9 per cent), Telangana (9 per cent), Chhattisgarh (9.1 per cent), Jharkhand (10 per cent), Dadra & Nagar Haveli and Daman & Diu (10.2 per cent) and Bihar (10.8 per cent) — recorded a lower than national-level proportion (11 per cent) of children receiving adequate diet.
Among the top-five states where the percentage of children fom 6-23 months receiving adequate diet was highest, Meghalaya was followed by Sikkim (23.8 per cent), Kerala (23.3 per cent), Ladakh (23.1 per cent) and Puducherry (22.9 per cent).
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“Infants and young children should be fed a minimum acceptable diet to ensure appropriate growth and development… Without adequate diversity and meal frequency, infants and young children are vulnerable to undernutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality,” the report said.
“The minimum acceptable diet is a composite of two main things: breastfeeding and its frequency up to two years, and dietary diversity. A child needs at least four of the food groups indicated by the WHO every day to have a minimum acceptable diet. Only 25 per cent of children receive this dietary diversity while 35 per cent of children receive adequate milk frequency,” said Antaryami Dash, acting deputy director (nutrition and health), Save the Children.
“This indicator has not improved as much as we had expected between the two surveys. This is the most direct indicator of child malnutrition — stunting, wasting and underweight children — and India has one of the highest malnutrition burdens in the world,’’ Dash said.
The proportion of children aged 6-23 months who received a minimum acceptable diet was highest in Meghalaya (28.5 per cent) and the lowest in UP and Gujarat (5.9 per cent each).
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Dr Basanta Kar, chief advisor, The Coalition for Food and Nutrition Security, said there are a number of reasons for deficient diet — poverty, lack of access to nutrition (cereals, fruits, vegetables, eggs, etc), lack of awareness and low education, among others.
The NFHS found that access to minimum acceptable diet in this category of children is higher in urban areas (12.1 per cent) than rural areas (10.7 per cent).
According to Kar, a deficient diet in the first 1000 days (from conception to 2 years) has huge effects on cognitive ability, including sensory and language capabilities.
“Key cognitive development takes place at this stage, affecting the child’s IQ later on and cognitive development, with 80 per cent brain growth taking place by two years. If children don’t get an adequate diet, there is growth faltering and height is affected as well. It can also have an impact on increased anaemia,” Kar said.
Sixty-seven per cent of children age 6-59 months have anaemia, which is higher than the NFHS-4 estimate of 59 per cent. Thirty-six per cent of children under age five years are stunted (short for their age); 19 per cent are wasted (thin for their height); 32 per cent are underweight (thin for their age).
The WHO has defined ten essential food groups — cereals and millets, pulses, milk and milk products, roots and tubers, green leafy vegetables, other vegetables, fruits, fat or oil, fish, egg and other meats and sugar — out of which 4-5 every day are required for a child to prevent malnutrition.