Severe Acute Malnutrition (SAM) is high among children (under the age of five) at 8% in Tamil Nadu, according to National Family Health Survey-4 (NFHS) data released in 2017.
Defined by a very low weight-for-height and by visible severe wasting, or by the presence of nutritional oedema (swelling of feet, for example), according to the World Health Organisation, SAM incidence in the State is higher than the national average.
Job Zachariah, chief of Unicef for Tamil Nadu and Kerala, told The Hindu that there was need for a detailed State-level study of this phenomenon as the NFHS data was inadequate. But, the Integrated Child Development Scheme (ICDS) in the State was not equipped currently to carry out weight-for-height measurements of under-5 children.
“We have taken up the matter of addressing SAM with the State government. Since measuring height for small children is tricky, this could be done using a mid-upper-arm-circumference tape.
“If the measurement is below 11.5 cm, it confirms that the child is severely malnourished. Anganwadi workers alone identify underweight children, so nobody else knows the number. That is why measuring height is crucial as SAM children have a higher probability of dying, over 10 times, compared to normal children,” Mr. Zachariah said.
Anaemic women
R. Kannan, director of the ICDS in the State, said prevalence of severe malnutrition among children was the result of a vicious cycle starting from unhealthy mothers.
In Tamil Nadu, half of the women in child-bearing age are found to be anaemic, NFHS-4 data shows. “Our target is to reduce malnutrition in women by 2% every year,” Mr. Kannan said.
Lack of sanitation could also play a role in influencing anaemia in women, he added.
K. Kolandaswamy, Director of Public Health, said that poor sanitation facilities and open defecation also posed serious challenges causing malnutrition in the State. "Open defecation could expose child-bearing women and young children to worms that resulted in anaemia or loss of nutrition," he said.
Mr. Zachariah also explained that genetic factors had a limited role to play in determining height or weight milestones to be met by under-5 children. “At this stage it is the quality of nutrition, maternal health and sanitation that play a more crucial role,” he said, adding that more than genetics, environmental factors and nutrition played a greater role in determining the height and weight of children as it has been observed that healthy children often grew taller than their parents.
Dr. Kumuda Jayaraman, an experienced paediatrician who recently retired from the Institute of Child Health, Chennai, concurred and said, “It is only during the complete growth phase of a child that pediatricians see whether mid-parental height (sum of parental height divided by two) is attained or not, which is determined by genetics. But the weight of a child at any phase of growth should be in proportion to its height and meet the standards laid down by WHO,” she said.
Though the Mother-Child Protection (MCP) cards used by health workers currently only talk about weighing small children to measure their growth, she said changes were now being introduced in line with the WHO guidelines.
Multi-sectoral approach
At a meeting organised by the M.S. Swaminathan Research Foundation on Tuesday, experts emphasised the need to follow an integrated approach to addressing the problem of malnutrition in the State. Since different departments, from health to nutrition to sanitation departments influenced outcomes, experts said that only a multi-sectoral approach could address the issue.
Professor M.S. Swaminathan also emphasised the need for nutrition security. “The first 1,000 days of a child’s nutrition is very important. Similarly, for adults it is not only rice or wheat but a diversified diet that would address nutrition concerns. The Food Security Act talks about 5 kg of foodgrains per person per month. But that is not going to be enough. We need to move from food security to nutrition security,” he said.
