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Malnutrition in Children on the rise in Meghalaya

Among the Northeastern States, Assam, Sikkim, Arunachal Pradesh, and Nagaland witnessed a notable reduction in infant and child mortality rates

· Mizoram, Nagaland, Manipur, and Assam witnessed a rise in wasting among under-five children.

· Tripura recorded sharp rises across all indicators for child mortality, stunting, and anaemia in under-five children and women of reproductive age

· The percentage of underweight children has been declining across all the eight northeastern states between NFHS-4 and NFHS-5, and, in every case, has fallen below the national average

· Factors such as poor maternal health, lack of antenatal care facilities, poor feeding, insufficient infrastructure and healthcare facilities, lower uptake of nutritional programmes, and remoteness of the region contributed to the statistics

New Delhi, Nov 10: India’s northeast region, home to over 220 ethnic groups and large tribal populations spread sparsely across remote areas, presents a challenge in terms of healthcare delivery, finds the study titled, ‘The Uphill Climb to Maternal and Child Nutrition in Northeast India’. The Occasional Paper by Vitamin Angels India (VAI) and Observer Research Foundation (ORF) makes several critical recommendations given the large inter-State and inter-district variations in the status of malnutrition among children and women in the region, as well as the region’s performance compared to the national average. The paper calls for a holistic approach to malnutrition in the Northeast to fill gaps in healthcare and nutrition, while leveraging the region’s agro biodiversity and traditional knowledge of its tribal populations.

The paper, authored by Shoba Suri (Senior Fellow, ORF), Priya Rampal (Consultant, Oxford Policy Management), and Shruti Menon (National Program Manager, VAI), builds on data from National Family Health Surveys; the Comprehensive National Nutrition Survey; India SRS Special Bulletin on Maternal Mortality; and reports from organisations such as FAO, UNICEF, WHO, World Bank, and more. The paper also explores the dietary practices of women and children, with a special focus on the region’s tribal populations.

Speaking on the relevance of the study, Shruti Menon, National Program Manager, VA, stated, “The in-depth analysis of the statistics on the key nutrition indicators in the northeast region show high degrees of inter-State and inter-district variations. To effectively combat malnutrition in the region, we need a holistic approach that focuses on strengthening existing health projects under POSHAN Abhiyan and optimising delivery mechanisms of nutrition interventions, especially among hard-to-reach, vulnerable populations. A greater emphasis should be placed on tribal communities, including disaggregated data on their health and nutrition performance, as well as documenting and leveraging traditional food systems. Civil society groups across the Northeast have historically played a crucial role in peace building and development — this active and thriving society must be leveraged to maximise the impact of health and nutrition interventions, particularly in strengthening last mile delivery of services.”

“There is an urgent need to address malnutrition in the north-eastern States by scaling up direct nutrition interventions and coupling them with nutrition-sensitive approaches to bridge the nutrition gap,” states Shoba Suri. “Creating synergies to strengthen inter-sectoral coordination and multi-stakeholder collaborations and convergence can be key to improving maternal and child nutrition in the northeast region of India. To quote from Lancet, ‘It is the juxtaposition of coverage and efficacy that explains progress in reducing malnutrition or its absence.’”

As per the study, among the 13 States and Union Territories across India that witnessed a rise in the percentage of stunted under-five children from 2015-16 to 2019-20, four states (Meghalaya, Mizoram, Nagaland, and Tripura) were from the Northeast. Out of the eight States in the region, four States (Mizoram, Nagaland, Manipur, and Assam) also witnessed a rise in wasting among children. In terms of micronutrient deficiency, the study raises concerns about the increasing prevalence of anaemia among children and women. For instance, Assam (68.4%) and Tripura (64.3%) have a high prevalence of anaemia among children aged 6-59 months. Factors such as poor maternal health, lack of antenatal care facilities, poor feeding, insufficient infrastructure and healthcare facilities, lower uptake of nutritional programmes, and remoteness of the region were some of the reasons cited.

However, it’s not all bad news. The prevalence of underweight children in the region was found to be lower than the all-India average of 35.8%. The study found a satisfactory nutritional status for under-five children, with stunting at 22%, underweight at 14%, and wasting at 7%. Four Northeast States (Assam, Sikkim, Arunachal Pradesh, and Nagaland) witnessed a notable reduction in neonatal mortality, infant mortality, and under-5 mortality from NFHS-4 to NFHS-5. Sikkim recorded the lowest infant and child mortality rates, performing better than the all-India figures. During the COVID-19 pandemic, the North-eastern States saw a mixed record in the implementation of the take-home rations (THR) scheme. During the lockdown, while beneficiaries found it difficult to collect their THRs, Nagaland was the only State that delivered the rations daily, while Assam provided it weekly and fortnightly. Sikkim, Tripura, Manipur, and Mizoram delivered THR in bulk only once a month or once in two months. In Meghalaya, the beneficiaries had to continue to collect THR directly from Anganwadi centres.

Harnessing the rich biodiversity of the Northeast to improve access to, and utilise locally available, sustainable, low-cost, nutritionally dense wild and cultivated foods can go a long way in nutrition equity, according to the study. About 10%–15% of the wild foods from forests are known to reduce malnutrition and improve food security. For instance, the Chakhesang Naga tribe in Nagaland showed wide food diversity with high consumption of cereals and millets, green leafy vegetables, and fruits, contributing to a healthier diet. Therefore, the study called for efforts towards documenting locally available food and mobilising their use among larger communities, potentially leading to self-sustainability.

About Vitamin Angels India

Founded in 1994, Vitamin Angels (VA) is a public health non-profit working to improve nutrition and health outcomes in low-resource settings worldwide. We strengthen, extend, and amplify the impact of our partner organizations working to reach the most nutritionally vulnerable groups – pregnant women, infants, and children – who are underserved by existing systems. VA’s work in India began in 2010, with the goal of reducing nutrition inequity by delivering evidence-based nutrition interventions (EBNIs) and offering technical assistance to ensure program quality, scale, and impact. By working with multiple stakeholders, we seek to support initiatives that are complementary to and coordinated with existing national health services, focusing specifically on improving coverage at the last mile. Over the last decade, VA has worked with a network of over 1,800 program partners across India, including governments, to reach over 20 million under-five children. We have helped bridge coverage gaps for vitamin A in the states of Maharashtra, Tripura, Jammu and Kashmir, Nagaland, Ladakh, Mizoram, Manipur, Sikkim, Arunachal Pradesh, Uttarakhand, Meghalaya, among others.

About Observer Research Foundation (ORF)

Set up in 1990, ORF seeks to lead and aid policy thinking towards building a strong and prosperous India in a fair and equitable world. It helps discover and inform India’s choices, and carries Indian voices and ideas to forums shaping global debates. ORF provides non-partisan, independent analyses and inputs on matters of security, strategy, economy, development, energy, resources and global governance to diverse decision-makers (governments, business communities, academia, civil society). ORF’s mandate is to conduct in-depth research, provide inclusive platforms and invest in tomorrow’s thought leaders today.

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