NUTRITIONAL STATUS OF CHILDREN IN ODISHA
Almost half of the children under five in Odisha are stunted or chronically malnourished (45%) and Underweight (40.7%). About 19.5% children are wasting or acutely malnourished.
Against 46.5% chronically malnourished children in rural areas, only 34.9% are observed in urban areas.
Similarly 42.3% underweight and 20.5% acutely malnourished children are found in rural areas as compared to 29.7% and 13.4% in urban areas respectively.
Very high percentages of children belonging to ST and SC communities are malnourished. Particularly, the higher incidence of wasting or acutely malnourished in STs (27.6%) is of major concern.
Wealth quintile wise distribution of malnourished children clearly endorses the fact that children belonging to lower wealth quintiles have poor nutritional status as about 59.6% children are chronically malnourished, 24% are acutely malnourished and 53.3% are under weight.
About 55.9% men and 44.9% women in the age group of 15‐19 years are thin. Then after 19 years of age, the percentage of thin men and women starts dropping.
However, the percentage of women adults enjoying better nutritional status with the age improves in a very sluggish rate as compared to men. The percentage of thin men drops from 55.9% in the age group of 15‐19 years and settles at 30.9% by the time they reach 40‐49 years age group. There is a 15% decline in the percentage of thin men observed where as only 5 % decline is observed incase of women reached from the age of 15 to 49 years which make women more vulnerable to men as far as nutritional status is concerned.
The percentage of thin men and women are highest among the SCs and STs. Like children under five, the adult men and women in the lowest and second wealth quintile enjoy poor nutritional status.
Among young children, the anaemia percentage of Orissa (65.0%) is just below the national average (69.5%) but far from states like Goa (38.2%), Manipur (41.1%) and Kerala (44.5%). Within Orissa, the percentage of young children with anaemia is quite high among STs (80.1%) and especially among those who are in the lowest wealth quintiles (75.0%).
Gender wise more percentage of female children (66.6%) is anaemic as compared to male children (63.5%). The 1.6% children who are severely Anaemia are more susceptible to a high degree of morbidity and mortality among young children. Against 33.9% of men almost double i.e. 61.2% women are anaemic.
As compared to other caste groups, the percentage of anaemia among ST adults is highest i.e. 53.6%. Wealth quintiles wise, 49.6% adults belong to the lowest wealth quintile are anaemic as compared to only19.5% in case of highest wealth quintiles. In rural areas around 10% more anaemic adults live as compared to urban areas.
Nutrition and Malnutrition are two commonly used words in our day-to-day life, but these are considerable less known subject. While the former, in adequate, is essential for children to grow and be healthy; the later is a poor condition of health caused by a lack of food or a lack of the right type of food. Nutrition status is a gigantic determinant of health and well being of children, where as malnutrition denotes impoverished economy and poor health care system of a State. Malnutrition among children occurs in first two years of life and virtually irreversible after that. Neuroscience has confirmed that 90% of brain actually develops during first two years of life.
Hence malnutrition impairs Cognitive development, intelligence, strength, energy and productivity. To add this woe, malnourished children are always vulnerable to infections and communicable diseases. In short, malnutrition is a negation to social development. Although the word ‘undernourished’ and ‘malnourished’ have been used interchangeably, yet there is a Difference between two in the context of health science. Children who are more than two standard deviation units below the reference median are considered to be undernourished. And those are more than three standards deviations below the reference median are considered to be malnourished.
There are three indices of under nutrition- underweight, stunting and wasting. Underweight children are low in weight-forage. Stunted children are those who are short for their age and height for the age. Wasted children are those whose weight –for-height is lower than the standard reference of population.
Recognising the report of National Family Health Survey –II (1998-1999), in India 47.0%of children below the age of 3 is underweight, 45.5% are stunted and 15.5% of children are wasted. The prevalence of malnutrition varies across States, with Madhya Pradesh recording the highest rate (55%) and Kerala among the lowest (27%).
An article published in a widely circulated journal highlights that over 53% of children under the age of 4 years are malnourished and underweight, 30% of the children of this age group are stunted and about 17% of them are wasted.
The level and determinants of malnutrition is grimmer and alarming in Orissa. As per NFHS-II Survey, 54.4% children under 3 years of age are underweight, 44.0% are stunted and 24.3% children in the same agegroup are wasted.
According to the estimation of NFHS-2, 48% of Women in Orissa suffer from nutritional deficiency. The percentage is much higher in the case of illiterate women (54.60 percent), schedule tribes (55.5 percent) and those women with low standard of living (55.2 percent).
Nutritional and health status of mother have direct link on the health and nutrition of the child. As per NFHS-II, 63.0% of females in Odisha are anaemic. Children born to anaemic mother are most likely to be underweight at the time of birth. Commensurate with in incidence of malnourishment among women in Orissa, almost half of total babies born weigh significantly low. Some low weight babies either dies or malnourished, if they survive. Child Malnutrition has life long implications and it is more among girls. “A stunted girl is most likely to become a stunted adolescent and later a stunted woman. Apart from direct effects on health and productivity, adult stunting and underweight increase the chance that her children will be born with low birth weight. And so the cycle continues”
The malnutrition among the children begins from the mother’s womb and becomes acute due to inappropriate childcare and feeding practice, lack of nutritious food, inadequate access to primary health care and poor environmental sanitation. The State of Orissa is characterised by high infant mortality and Under-5 Mortality, large concentration of child malnutrition and wide prevalence of anaemic and malnutrition among adolescent girls and women.
As per the SRS Estimates for the year 2003, the IMR in the State stood at 83, which is the highest among all the States of the country.
The Annual Report (2004-2005) of Women and Child Development Department, Government of Orissa, has confirmed that for the 0-3 years of age group, 19 districts come under the ‘high and very high’ prevalent zone of malnutrition. The district include Angul, Balasore, Bhadrak, Bolangir, Deogarh, Gajpati, Jajpur, Jharsuguda, Kalahandi, Kandhamal, Keonjhar, Koraput, Malkanagiri, Nawarangpur, Nuapada, Rayagada,Sambalpur, Subarnapur and Sundargarh.
In the 3-6 years of age group these districts along with the district of Kendrapara fall in the category of ‘high and very high prevalent zone’ of malnutrition among children. The report has also indicated that only 3 districts namely Puri, Khurda and Jagatsinghpur fall under the low prevalent zone of malnutrition among 0-3 years aged children. In the 3-6 years aged group, these 3 districts along with Boudh and Nayagarh fall under the ‘low prevalent zone category’. All in all, 0-3 years aged group children in 27 districts suffer from either type of malnutrition and among 3-6 aged children the incidence and proportion of malnutrition continues to be more in 25 district of Odisha.
It is a common understanding and needs to be reckoned that the incidence of malnutrition among children is more in the KBK region in comparison to other districts of Orissa. The KBK region consists of 8 districts namely, Kalahandi & Nuapada forming in the part of undivided Kalahandi; Balangir & Subaranpur constituting the part of undivided Balangir and Koraput, Malkanagiri, Nawarangpur and Raygada forming the part of Koraput. The extent of malnutrition has not reduced even to substantial rate between Nov.-2002 to Oct.-2003.
The fact needs to be re-emphasised that State of Orissa characterized by high percentage of Malnutrition and Infant Mortality. The health science believes that incidence of diarrhoea is 14 times less in breast fed baby than those given infant milk substitutes. Breast fed baby are also less likely vulnerable to respiratory infections. But the shocking aspect is that 43.0% of child deaths in Orissa occurs due to diarrhoea or acute respiratory infections despite the fact that the rate of exclusive breast-feeding is better in Orissa than that of at national level. As per the SRS –Bulletin, April-2005 that in Orissa the infant mortality rate is 83 per 100 live birth for the year 2005. The IMR is 86 in rural areas and 55 in urban areas. In Orissa 64.0% of infant mortality rate is accounted for neo-natal mortality (i.e., death within 28 days of birth). Neo-natal mortality rate is highly co-related with low birth weight. Incidentally, 54.4% of children born in Orissa are underweight, as revealed in NFHS Report.
In Odisha 1.06 million children under the age of 3 years suffers from any kind ofnutritional deficiency of Grade-I to Grade-IV. The proportion of children suffering from malnutrition or under-nutrition is Computed to be 61.71% of children (0-3years) weighed. Malnutrition in youngchildren is not the problem exclusivelyrelated to non-availability of food, althoughthe factor is relatively concerned with thenutritional status of pregnant women and lactating mothers. One indicator of nutritional status of women inOrissa is the prevalence of iron deficiency. The anaemic women are of plenty.
The Tenth five years plan (2002-07) has considered infant feeding is the most critical to reduce theprevalence of under -nutrition and malnutrition. In the plan Govt. of India has set a target to increase rateexclusively breastfeeding to 80% from the current level of 41.2% and rate complementary feeding to 75%from the current level of 33.5%. For the State of Orissa, The 10th Five Year Plan is also aimed at to increaseexclusively breastfeeding during the first six months to 84.1% from the current level of 58.0% and the rate ofcomplementary feeding from 30.1% to 67.4%. The Strategy of plan is “inappropriate feeding practices andtheir consequences are the major obstacles to sustainable socio-economic development and povertyreduction. Governments will be un-successful in the efforts to accelerate economic development in anysignificant long-term sense until child growth and development, especially through appropriate practices, is ensured.
Malnutrition and child deaths are the tragic culmination of poor socio-economic development, lack of healthliteracy among parents, administrative lapses and poor monitoring of the operational schemes. Thus, government is culprit of two things – inability to check malnutrition and inaccurate maintenance of children’s death records.
Malnutrition, like poverty, has been pervasive and interwoven with food insecurity, hunger and starvation. The inter-dependent problem of malnutrition cannot be tackled in isolated and single-sectoral nutritional interventions like SNP or EFP. Direct intervention to combat deep rooted problems like malnutrition has not yet paid dividend and shall not usher the purpose unless attention is paid for multi sectoral development like education, health literacy, healthcare system, food, employment, social welfare, transport and communication.
President & CED,
Rural Life Development Society