7-Dec-2022: Nutrition indicators for children under 5 years improve
The Ministry of Women and Child Development is developing a National Nutrition Index to measure the annual national performance and the performance of States and Union Territories (UTs) on a select set of relevant indicators categorized in the domains of (i) Nutrition Outcomes, (ii) Service Coverage and (iii) Resources and Inputs. The National Nutrition Index will rank the States/UTs and help them identify specific areas of improvement.
The estimated number of underweight, malnourished and severely malnourished children under 5 years of age is obtained under National Family Health Survey (NFHS) conducted by the Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, Wasting has reduced from 21.0% to 19.3% and Underweight prevalence has reduced from 35.8% to 32.1%.
The efforts under the Supplementary Nutrition Programme under Anganwadi Services and POSHAN Abhiyaan have been aligned under ‘Saksham Anganwadi and POSHAN 2.0’ (Mission Poshan 2.0) which seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity. Technology has been leveraged under the 'Poshan Tracker', a robust ICT enabled platform to improve governance with regard to real time monitoring of provisioning of supplementary nutrition for prompt supervision and management of services.
Government has released Streamlined Guidelines dated 13.1.2021 for greater transparency, accountability and quality in the nutrition support programme and service delivery. The Streamlined Guidelines provides for involvement of AWC level management committees, village communities, Mothers Groups and Panchayati Raj institutions (Gram Panchayats) to bring about community ownership and encourage accountability in the local anganwadi programme.
The scheme guidelines of Mission Poshan 2.0 focuses on converting the agenda of improving nutrition into a Jan Andolan through involvement of Panchayati Raj Institutions/Village Organizations/SHGs/volunteers etc. and ensuring wide public participation. Under the guidelines, the Gram/Poshan Panchayat and VHSNC shall meet once a month at least to discuss specific reasons for malnutrition specific to their jurisdiction and facilitate necessary community/social support mechanism. The meetings of the Gram/Poshan Panchayat shall be attended by local stakeholders, including Mothers Groups’, SHGs, AWWs, AWHs, Lady Supervisor and the CDPO. The quarterly reports of the Poshan Panchayats shall be made available to the CDPO and DPO. If required, the Poshan Panchayats shall present these reports in the meetings of the District Nutrition Committee chaired by the DM/Collector.
Poshan Panchayats, with mandatory representation of vulnerable communities shall thus act as facilitators for “Peoples Audit” to improve bottom-up accountability of service delivery at Anganwadi Centres.
Besides ensuring uptake of nutrition seeking behaviors and disseminating information on access to good health and nutrition services, it is envisaged that the Panchayat level committees will undertake spot checks to check provision of THR and other nutrition services at the Anganwadi Center. The Gram /Poshan Panchayat has been assigned the mandate of oversight services with regard to receipt of Take Home Ration (not raw ration), quality thereof and distribution to all beneficiaries.
1-Oct-2019: First National Nutrition Survey
The Ministry of Health and Family Welfare organized first National Nutrition Survey. The ministry took help from UNICEF to complete the survey. The survey was conducted between 2016 and 2018.
In India, for the first time the ministry measured malnutrition that included micro nutrient deficiencies. It was done by collecting urine samples and blood samples. Apart from this, details of non – communicable diseases like hypertension, diabetes, cholesterol, kidney function in children were also collected during the survey.
Key findings of the survey
- Around 10% of children in the age group of 5 to 9 years and adolescents in the age group 10 to 19 years are pre – diabetic. 5% of them were overweight and 5% suffered from blood pressure.
- The survey for the first time proved the coexistence of obesity and under nutrition.
- One in five children in the age group 5 to 9 years were stunted.
- Tamil Nadu and Goa had the highest number of adolescents who were obese or overweight.
The survey covered more than 1,20,000 children and adolescents in rural and urban area. It aims to assess the following
- Micro nutrient deficiencies
- Sub clinical inflammation
- Worm infestation.
- Overweight or obesity
- Cardio – metabolic risks
- CDSA – Clinical Development Services Agency was selected as the monitoring agency.
Recently India marked the National Nutrition Week between September 1 and September 7, 2019 and marked September as Poshan month. It is important to encourage such measures as the country has around 194.4 million undernourished people. According to Food and Agriculture Organization, they constitute 14.5% of the total Indian population.
Global Hunger Index, 2018 ranked India at 103 out of 119 countries based on the following factors
- Prevalence of stunting and wasting
- Child mortality rate
- Undernourishment
According to the index, India is suffering from serious problem of malnutrition
Global Nutrition Report, 2018: The Global Nutrition Report 2018, prepared by WHO, states that India is home to 46.6 million stunted children out of 150.8 million stunted children all over the world. The report also says that
- Out of 50.5 million children who are wasted globally, 25.5 million are in India.
- India is the third most obese nation in the world. WHO states India as Diabetes capital with 69.2 million suffering from diabetes.
- India might lose 46 billion USD to malnutrition by 2030.
Steps taken by the Government of India to combat malnutrition
- Poshan Abhiyan – It was launched in 2017 – 18 to reduce anemia, stunting, under – nutrition.
- National Food Security act, 2013 – The act made food a legal right of the citizens. It aims to ensure food and nutrition security to the vulnerable.
- Mid – day meal scheme
- Pradhan Mantri Matru Vandana Yojana – Under the scheme, Rs 6,000 is transferred directly to bank accounts of pregnant women to avail facilities for their delivery.
What is malnutrition and under nutrition?
- Malnutrition refers to the imbalanced in a person’s intake of nutrients or energy.
- Under nutrition includes
- Stunting – Low height for age
- Wasting – low weight for age
- Underweight – Low weight for age
- Micro nutrient deficiencies – lack of vitamins and minerals
- Obesity includes overweight and non – communicable diseases like diabetes, stroke, cancer, etc.
16-Dec-2022: Steps taken to reduce Non-Communicable Diseases
Indian Council of Medical Research - National Institute of Epidemiology (ICMR- NIE) conducted a mortality survey among persons older than 15 years during 2015-18 in 12 (8 North-East and 4 from the rest of the country) tribal districts which found that 66% of the total deaths were caused by non-communicable diseases (NCDs). The top NCD causes of death were cardiovascular diseases (heart diseases-24%), followed by cancers (11%). The study indicates that NCDs have replaced other causes of death (such as infectious diseases), even among tribal population.
The Department of Health & Family Welfare, Government of India provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), as part of National Health Mission (NHM), based on the proposals received from the States/UTs and subject to the resource envelope. The programme focuses on strengthening infrastructure, human resource development, health promotion & awareness generation for Cancer prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the Non-Communicable Diseases (NCDs), including Cancer. Under NPCDCS, 707 District NCD Clinics, 268 District Day Care Centres, and 5541 Community Health Center NCD Clinics have been set up.
A population-based initiative for prevention, control and screening for common NCDs i.e. diabetes, hypertension and common cancers has been rolled out in the country under NHM and also as a part of Comprehensive Primary Health Care. Under the initiative, persons more than 30 years of age are targeted for their screening for the three common cancers i.e. oral, breast and cervical. Screening of these common cancers is an integral part of service delivery under Ayushman Bharat – Health and Wellness Centres.
Preventive aspect of Cancer is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about Cancer and for promotion of healthy lifestyle includes observation of National Cancer Awareness Day& World Cancer Day and use of print, electronic and social media for continued community awareness. Furthermore, healthy eating is also promoted through Food Safety and Standards Authority of India (FSSAI). Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by Ministry of AYUSH. In addition, NPCDCS gives financial support under NHM for awareness generation (IEC) activities for Cancer to be taken by the States/UTs as per their Programme Implementation Plans (PIPs).
The Central Government implements Strengthening of Tertiary Cancer Care Centres Facilities Scheme in order to enhance the facilities for tertiary care of cancer. 19 State Cancer Institutes (SCIs) and 20 Tertiary Cancer Care Centres (TCCCs) have been approved under the said scheme.
8-Feb-2022: Status of Non-Communicable Diseases (NCDs) in India
According to the study report “India: Health of the Nation's States”- The India State-Level Disease Burden Initiative in 2017 by Indian Council of Medical Research (ICMR), it is estimated that the proportion of deaths due to Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016. The four major NCDs are cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes which share four behavioral risk factors –unhealthy diet, lack of physical activity, and use of tobacco and alcohol.
The detailed proportion changes in Disability Adjusted Life Years (DALYs) number for the leading individual causes of these NCDs among women from 1990 to 2016 are given in the table below:
|
Name of NCD |
Proportion of changes in DALYs number |
|
|
1990 |
2016 |
|
|
Cardiovascular diseases(IHD) |
2.9% |
6.6% |
|
Chronic respiratory diseases (CRDs) |
2.7% |
4.4% |
|
Diabetes |
0.7% |
2.2% |
|
Cancer (Breast) |
0.7% |
0.9% |
Health is a state subject. The Department of Health & Family Welfare, Government of India, however, provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), (launched in 2010) as part of National Health Mission (NHM), based on the proposals received from the States/UTs and subject to the resource envelope. The programme focuses on strengthening infrastructure, human resource development, health promotion & awareness generation for prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the Non-Communicable Diseases (NCDs).
Under NPCDCS, 677 NCD clinics at District level, 187 District Cardiac Care Units, 266 District Day Care Centres and 5392 NCD clinics at Community Health Centre level have been set up to ensure the treatment of common NCDs.
A population-based initiative for prevention, control and screening for common Non-Communicable Diseases (NCDs) i.e. diabetes, hypertension and common cancers has been rolled out in the country under NHM and also as a part of Comprehensive Primary Health Care. Under the initiative, persons more than 30 years of age are targeted for their screening for the common NCDs, in which there is focus on screening of breast cancer and cervical cancer among women. Screening of these common NCDs is an integral part of service delivery under Ayushman Bharat – Health and Wellness Centres.
Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about NCDs and for promotion of healthy lifestyle includes observation of National & International Health Days and use of print, electronic and social media for continued community awareness. Furthermore, healthy eating is also promoted through FSSAI. Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by Ministry of AYUSH. In addition, NPCDCS gives financial support under NHM for awareness generation (IEC) activities for NCDs to be undertaken by the States/UTs as per their Programme Implementation Plans (PIPs).