观察家研究基金会-印度第五次全国家庭健康调查：儿童营养的次国家分析（英文）-2021.5-50页_5mb

Summary of The 5th National Family Health Survey of India: A Sub-National Analysis of Child Nutrition

Core Content

The 5th National Family Health Survey (NFHS 5), conducted in 2019-20, revealed a reversal in the previously decreasing trend of child stunting in 13 out of 22 states and Union Territories (UTs) of India. This is a concerning development, as child undernutrition has long been a key indicator of national health and development progress. The paper analyses the reasons behind this regression and proposes urgent interventions to address the issue.

Main Findings

• Child Stunting Increase: In NFHS 5, the stunting rate increased in 13 states and UTs, with some states like Goa and Kerala showing a 3 percentage point rise in stunting rates.
• Stunting Rates by State:
  • Meghalaya had the highest stunting rate at 46.5%.
  • Bihar had a significant decrease, from 48.3% to 42.9%.
  • Sikkim had the lowest stunting rate at 22.3%.
• Undernutrition Trends: The percentage of underweight children also increased in several states, indicating a worsening nutritional status.
• Overweight Trends: A sharp increase in the prevalence of overweight and obesity among women (15-49 years) was noted in 16 out of 22 states and UTs, which could indicate imbalanced dietary intake and poor nutritional quality.
• Under-five Mortality: Malnutrition is a key contributor to under-five child mortality, with 68% of such deaths in India linked to undernutrition.
• Impact of Malnutrition: The adverse effects of malnutrition on child development, cognitive function, and future productivity are well-documented, with stunting being largely irreversible after the first 24 months of life.

Key Determinants of Child Undernutrition

The paper identifies both immediate and underlying determinants of child undernutrition:

Immediate Determinants

• Infant and young child feeding practices
• Child health services

Underlying Determinants

• Food and nutrition security
• Women’s health and nutrition care
• Women's empowerment (decision-making, education, access to financial and communication tools)
• Water, sanitation, and hygiene (WASH) practices
• Educational attainment of girls
• Delaying the age of marriage
• Maternal health indicators (e.g., antenatal care visits, institutional deliveries)

Key Interventions and Trends

Nutrition-Sensitive Interventions

• Maternal health services: There was an increase in the percentage of women receiving antenatal care (ANC) and delivering in institutional setups.
• Women’s empowerment: Improved access to mobile phones and bank accounts was noted as a proxy for empowerment.
• Sanitation and hygiene: The percentage of households using clean fuel for cooking increased in most states.

Nutrition-Specific Interventions

• Exclusive breastfeeding increased in most states, though some showed a decline.
• Complementary feeding showed mixed results, with some states improving while others saw a decline.
• Zinc supplementation for children with diarrhoea increased in several states, indicating progress in addressing micronutrient deficiencies.

Economic and Social Implications

• Economic impact: A 1% loss in adult height due to stunting is associated with a 1.4% loss in productivity.
• Long-term consequences: Stunted children face cognitive deficits and learning challenges, and are more likely to drop out of school or repeat grades.
• Cost of malnutrition: Globally, malnutrition costs US$3.5 trillion annually, or US$500 per person.

Recommendations

• Prioritize child undernutrition in the national development agenda.
• Strengthen complementary feeding as a key component of the National Nutrition Mission (POSHAN Abhiyaan).
• Address underlying determinants such as improving women’s education, delaying marriage, and enhancing WASH practices.
• Ensure equitable access to nutrition-sensitive interventions across all states and UTs.
• Monitor and evaluate the effectiveness of existing programs to ensure they are delivering results.

Conclusion

The NFHS 5 data underscores the urgent need for targeted and sustained interventions to combat child undernutrition. While there has been progress in some areas, such as maternal health and women’s empowerment, the increase in stunting and underweight children in many states highlights the need for a more comprehensive and integrated approach to nutrition. The paper calls for multisectoral efforts to address the root causes of malnutrition and ensure that India continues to make progress towards its health and development goals.