Patterns and Trends - World Bank

1 51 Reduction in childmalnutrition is another MDGrelated to an improvement in child significantlyincreases the risk of infant andchild death, with someestimates suggesting that childmalnutrition is responsible forhalf or more of child deaths inthe developing data analyzed in theprevious chapter showed astrong relationship betweenunder-five child mortality ratesand child underweight ratesacross the various regions ofIndia (see Figure inChapter II). There is also a large body of evidence from around the World relating under-nutrition inchildhood to lower levels ofschool performance, cognitivedevelopment, health, and,ultimately, to lower levelsof labor productivity inadulthood.

2 Thus, the econo-mic and human costs of childmalnutrition in India are likelyto be very millennium develop-ment goal is to reduce thepercentage of underweightchildren by one-half between1990 and India,this would imply a reduction inthe child underweight ratefrom in 1990 to and TrendsLevelsChild malnutrition rates inIndia are extraordinarily NFHS-2, which is themost recent household surveycontaining information onchild nutrition, indicates thatnearly one-half of children aged0-35 months are underweightor stunted,49 which translatesinto approximately 37 millionmalnourished children. About18-23 percent of children areseverely underweight or stuntedin the sense of being more thanthree standard deviations belowthe relevant NCHS suggests that Indianchildren suffer from shortterm,acute food deficits (as reflectedin low weight-for-age) as well asfrom longer-term, chronicunder-nutrition (as manifestedin high rates of stunting).

3 50 TrendsBoth the NFHS-1,conducted in 1992-93, and theNFHS-2, conducted in 1998- child Malnutrition44 Another important form of malnutrition that is not pursued in this report is inadequate consumption of micronutrients, such as Vitamin A,iron and iodine. 45 For instance, based on worldwide evidence, Pelletier and Frongillo (2002) estimate that a 5 percentage point reduction in the prevalence oflow weight-for-age could reduce child mortality by about 30% and under-5 mortality by 13%.46 The World Bank (1998) suggests that the cost of undernutrition in India is at least US$10 billion annually in terms of lost productivity,morbidity and mortality. 47 While the nutrition MDG is based on the weight-for-age indicator, it should be recognized that there are other important indicators of childmalnutrition.

4 Weight-for-age is an indicator of both short- and long-term malnutrition . Height-for-age or stunting is a better indicator oflong-term (cumulative) malnutrition , while weight-for-height or wasting is generally considered the appropriate indicator for tracking short-term fluctuations in nutritional The most reliable estimate is available from the NFHS-1 for 1992-93. The rate shown for 1990 is projected from the change observed between1992-93 and As in the literature, a child is considered underweight when his or her weight-for-age is more than two standard deviations below the NCHS reference weight. A child is stunted when his or her height-for-age is more than two standard deviations below the NCHS reference. Severeunderweight and stunting occur when the relevant nutrition indicator is more than three standard deviations below the NCHS reference.

5 50 Wasting rates ( , low weight-for-height) are significantly lower than underweight or stunting rates, but this is typically the case in most low-income the Millennium Development Goals in India99, obtained information onchild anthropo-metry. Acomparison of the estimates ofthese two surveys indicates amodest decline of about 11%(from a rate of to 47%)during the 6-year period amounting to an annual rate ofdecline of In contrast,underweight rates in neighbor-ing Bangladesh fell from 68%in 1992 to 51% in 2000 anannual rate of decline of ( World Bank 2003). In Vietnam, the childunderweight rate fell from49% in 1993 to 36% in 1998 an annual rate of decline ( World Bank 1999)!India thus appears to be an under-performer inreducingchild malnutrition during the variationsAn average child under-weight rate of 47% masks widevariations in child malnutri-tion across states.

6 child under-weight rates vary from a low of24-28% in the Northeasternstates and Kerala to 51-55% inthe states of Bihar, Rajasthan,Uttar Pradesh, MadhyaPradesh and Orissa ( ). Likewise, the decline inchild underweight rates overtime has also varied greatlyacross states. In Punjab, forinstance, the child under-weight rate fell at an annualrate of between 1992-93and 1998-99, while Rajasthansaw an increase of 2% per annum in the childunderweight rate during thesame period. Based on 1992-93 and 1998-99 values, shows the 2015 MDgoals for each of the the proportion ofchildren aged 0-3 years in Indiawho were under-weightdeclined from in 1992-93 to 47% in 1998-99,the absolute number ofunderweight children hardlychanged over this periodbecause of a large increase inthe population of children aged0-3.

7 Indeed, only about aquarter million fewer Indianchildren aged 0-3 wereunderweight in 1998-99 ascompared to 1992-93. Therewere wide variations in theabsolute decline in the numberof underweight children acrossstates. Tamil Nadu and AndhraPradesh each saw declines inthe absolute number ofunderweight children of about202530354045505560 NagalandArunachal PradeshKeralaManipurMizoramGoaPunjabJamm u & KashmirHary anaDelhiAssamTamil NaduAndhra PradeshMeghalayaHimachal PradeshKarnatakaGujaratIndiaWest BengalMaharashtraRajasthanUttar PradeshBiharOrissaMadhya Pradesh% of children underw eight in 1998-99-10-8-6-4-2024A nnual rate of change in child underweight rate(%), 1992-98 child underweight rate (%), 1998-99 Annual rate of change (%), 1992-98 Figure.

8 Percent of children aged 0-35 months who areunderweight, 1998-99, and annual % change in this rate between1992-93 and 1998-99, by state05101520253035 ManipurKeralaNagalandMizoramGoaHaryanaAr unachal PradeshDelhiJammu & KashmirMeghalayaRajasthanHimachal PradeshPunjabTamil NaduAndhra PradeshGujaratAssamKarnatakaMaharashtraI ndiaOrissaWest BengalUttar PradeshMadhya PradeshBiharFigure : child underweight rate MDGs by state, 2015(% of children 0-35 months underweight) million, but Rajasthan andBihar saw an increaseof each in the number ofunderweight 0-3 year olds(Figure ). Uttar Pradeshand Madhya Pradesh eachrecorded an increase of million underweightchildren aged 0-3 during thesame suggests thatthere is no systematicassociation between the initial level of childmalnutrition in 1992-93 andthe rate of decline inmalnutrition between 1992-93and 1998-99.

9 Nagaland, whichhad a child underweight rate ofonly in 1992-93,experienced an annual rate ofdecline of over thefollowing 6 years the samerate of decline experienced byBihar, which began with a much higher childunderweight rate of in child malnutrition relatedto living standards? The cross-state data suggest an inverse,albeit not perfect, associationbetween the child underweightrate and gross state domesticproduct per capita ( ). That Kerala emerges as apositive outlier having amuch lower child underweightrate than would be suggestedby its per capita income is nobig surprise, but the fact thatGujarat and Maharashtra havesignificantly higher childunderweight rates relative totheir per capita income issurprising.

10 On the other hand,Andhra Pradesh, which is amiddle-income state, has alower child underweight ratethan would be predicted by itsgross state domestic productper capita. This suggests thatcultural and social not justeconomic factors have animportant role to play indetermining child malnutritionin Spending onNutritionMuch of the publicspending on child nutrition inIndia takes place on theIntegrated child Develop-ment Services program. This program consists ofanganwadicenters (AWCs) ineach village, typically staffedby a village woman with 5-8years of schooling and an53 child malnutrition -539-520-319-289-175-153-58- 5176107182196248461571-2-5-6-84220-600-4 00-2000200400600 Tamil NaduAndhra PradeshWest BengalPunjabAssamKarnatakaHary anaGujaratArunachalPradeshNew DelhiHim ac hal Prades hMizoramGoaNagalandMeghalayaManipurOriss aKeralaU ttar Prades hMadhya PradeshMaharashtraRajasthanBiharFigure : Change in absolute number of underweight children 0-35months of age between 1992-93 & 1998-99, by state ( '000 children )-8-7-6-5-4-3-2-1012253035404550556065% of children 0-35 months who were underweight in 1992-93A nnual rate of decline in child underweightrate,1992-98 Figure.