The recently released National Health Family Survey throws up an interesting conundrum on childhood nutrition. More children below the age of five have reached an acceptable height for their age as per World Health Organisation standards. But children’s weights have not shown a similar improvement for the past decade.

National Family Health Survey data is based on survey conducted between 2015 and 2016. The large-scale survey, the last of which was in 2005-’06, is conducted on a representative sample of households.

Forty eight per cent of children in the 2005-’06 survey were found stunted, which means that their height was lower than what it should be at the age they are at. The latest data shows that stunting has reduced to 38.4% of children surveyed, though even this is unacceptably high. Stunted growth reflects poor intake of food, often starvation, over a long period of time.

Wasting among children has increased since the last survey 10 years ago. Wasting is low weight for height and is associated with acute starvation.

In 2005-’06, almost 20% of children surveyed were wasted, while more than 6% were severely wasted. In 2015-16, the proportion of wasted children has increased to 21% and the severely wasted to 7.5%. Wasting is a strong predictor of mortality below five years, according to the WHO.

Wasted- low weight to height by 2 standard deviations below WHO child growth standards; Severely wasted - low weight to height by 3 standard deviations below WHO child growth standards; Stunted - low height to age; Underweight - low weight to age

Nutritional shocks

Amit Sengupta, associate global coordinator of the People’s Health Movement, said that the data indicates significant periods of nutritional distress in children. “Wasting indicates nutritional shocks that have occurred in the recent past,” he said.

Dr Rajib Dasgupta, from the community medicine department at Jawaharlal Nehru University in Delhi has observed a similar trend of an increase in wasting and decrease in stunting in earlier surveys like the Rapid Survey of Children 2013-’14 conducted by the Ministry of Women and Child Development compared with National Health Family Survey data of 2005-’06.

“When stunting decreases, it means that the situation has improved somewhat,” said Dasgupta. “It indicates that the chronic nutritional distress is not as bad.”

A child that lacks proper nutrition first stops growing in height. The the lack of nutrition is prolonged the child starts losing weight too. With a little more food, the child starts growing in height again, and only then starts putting on the required weight. The data from the health survey reflects this nutritional phenomenon as it shows that children, now eating more than they did earlier, are catching up faster with normal height for their age than they are catching up with their normal weight for height.

Gujarat is one of the states with nutrition indicators below the national average.

“If children are fed reasonably well during the first two years of their lives, and later during the growth phase, they shoot in height and even look spindly thin,” said Dr Veena Shatrugna, former deputy director of National Institute of Nutrition in Hyderabad. “But if there is no food, they do not put on enough weight for height.”

The data indicates children’s diets have to improve in both quality and quantity if they have to put on weight. “For this they do not only need rice and wheat but also milk, eggs, fruits, nuts, and vegetables,” said Shatrugna.

Government supplementary food programme under the Integrated Child Development Scheme lack the necessary food diversity of healthy diets.

“The whole idea is that the food should be something that the children are used to and should be sourced locally,” said Sylvia Karpakam, a public health activist in Bengaluru. “But many states offer packaged food. The idea of locally cooked food, which the children can smell being cooked is lost.”

Madhya Pradesh is one of the states where the malnutrition indicators have improved

Still too much stunting

Fewer of India’s children may now be stunted, as compared to 10 years ago, but their numbers are still pretty dismal. Less than 15% of Sri Lanka’s children below five years are stunted – that is less than half the proportion in India.

The effects of stunting including delayed motor development including impaired cognitive function that leads to poor school performance, are largely irreversible. Stunting is also associated with higher mortality among children.

“The improvement of nutrition indicators over a period of ten years is very sluggish,” said Shatrugna. “The changes are minimal.”