A new survey by the Ministry of Health has found distressingly high levels of malnutrition among Indian children and adolescents. Only 6.4% of children surveyed under the age of 2 had received a minimum acceptable diet. One in five children between the ages of 5 and 9 was stunted, which means that they were at a low height for their age. One in four adolescents between the ages of 10 and 19 was thin for their age, with a low Body Mass Index.
Conducted between 2016 and 2018, the Comprehensive National Nutrition Survey collected data on the nutritional status of a representative sample of 1.1 lakh children and adolescents from the ages of 0 to 19 years from 29 states and Delhi.
It also collected data on what the children and adolescents were consuming as part of their diet.
Correlating both sets of data, Scroll.in found better nutritional outcomes among those consuming non-vegetarian diets. More significantly, there is a strong correlation between the consumption of eggs and better nutritional status in most states, particularly among younger children.
These findings are significant in light of the debate over whether eggs should be served in lunches in government schools and anganwadis. The debate resurfaced this week: after Madhya Pradesh government announced that it would serve eggs in mid-day meals, a politician belonging to the Bharatiya Janata Party said this would turn children into cannibals.
The survey measures nutritional status in several ways, but for the purpose of this exercise, the parameter of stunting was used to measure undernutrition in children. This is because stunting – or low height for age – is a measure of chronic nutritional deficiency.
Ayushi Jain, a researcher and PhD student at the Centre for Technology Alternatives in Rural Areas, IIT Bombay, said: “It is definitely possible for a child to recover from stunting, but if not given proper attention, and the child is left in the stunting bracket in initial years, then it is difficult to recover from it. So it is said that stunting is irreversible after a certain period of time.”
For adolescents, Body Mass Index for age was used to measure undernutrition. As children grow older and stop growing in height, the Body Mass Index becomes a reasonably accurate measure of malnutrition, since it takes into account both weight and height.
The study measures the nutritional status of children in three age groups: 0-4, 5-9 and 10-19. Children whose mothers were vegetarian were more likely to be stunted than children whose mothers consumed eggs or meat, in all three age groups.
The study also tracks the diets of children in these groups, but the 0-4 age group is further broken down into those below the age of two and those above, to take into account dietary differences on account of the breastfeeding of infants.
Children aged 0 to 4
The study assessed the diets of children in different age groups in different ways. For children under two years of age, the parameter measured was “minimum acceptable diet”. This is a WHO standard that is a composite of two indicators:
- Dietary diversity or whether the child ate foods from four of seven food groups in the past day
- Meal frequency or how often the child was fed in a day.
Dietary diversity was lower, at 13.9%, among children whose mothers were vegetarians. The figures were 20.8% and 22.9% for children whose mothers were vegetarians who ate eggs, and for those whose mothers were non-vegetarians respectively.
The best performing states in terms of providing a minimum adequate diet to children below the age of two are Jammu and Kashmir (71%) and Sikkim (36%), while the worst performing states are Maharashtra (2.2%) and Mizoram (2.8%).
For children over the age of 2, dietary diversity was measured by asking whether they had consumed different kinds of in the past week. A nutritionally adequate diet requires the consumption of different food groups.
A closer look at the dietary pattern of children between 2-4 years of age shows that the states performing better on nutritional outcomes have a higher consumption of eggs, meat and fish. Viewed with the nutritional outcome mappings, there is an inverse relationship between the consumption of eggs and meat and the prevalence of stunting.
Forty two percent of children in Bihar under the age of 4 are stunted. Only 6.1% of children under the age of 2 in the state had received a minimum adequate diet. While 54% of those aged 2-4 consume dairy products and 63% consume vegetables, only 4.6% consume eggs and 11.6% consume meat.
Egg consumption is lowest (2.8%) in Haryana. Thirty five percent of children under the age of 4 in the state are stunted.
Interestingly, Meghalaya has the highest consumption of eggs at 70% for children aged 0-4, but it also has 40% stunting. When asked about this anomaly, Jain said that state-specific conditions would need to be studied in greater detail, because stunting is affected by a variety of causes. Other states however, display a clear correlation between the consumption of eggs and lower stunting.
Children aged 5-9
Dietary diversity among children aged between 5-9 varies widely across states, although cereals, lentils and pulses were consumed by more than 80% of children in nearly all states.
The correlation between a higher consumption of eggs and meat and lower incidences of stunting continues to hold for children in this age group, although not as strongly as for the younger children. Children in Haryana consumed the fewest eggs at 3.6%. The rate of stunting in the state was 16.4% for children aged 5-9, which is still below the national average of 22% for children in this age group.
Tamil Nadu, which has among the highest consumption of eggs also has the lowest rate of stunting for children in this age group, at 9.7%. Such a relationship is not as clearly observable between the consumption of dairy products or vegetables and undernutrition.
It must be noted, however, that there are several other factors at play in determining rates of stunting, including the child’s area or residence, sanitation practices, the mother’s education, and the wealth of the child’s family.
Adolescents aged 10-19
As children grow older, bone growth completes and they reach the maximum height they can attain, so a better measure of malnutrition is Body Mass Index for age, since that takes into account weight, height, and age. 24.1% of adolescents have a low BMI for their age, or almost one in four.
The northeastern states have the lowest levels of undernourishment, and 30%-40% egg consumption and 40%-50% meat consumption. The state with the lowest consumption of eggs and meat, Himachal Pradesh, has the second-highest levels of undernourishment.
Taken together, malnutrition appears highly correlated with lack of consumption of eggs and meat across age groups. There are several anomalies, as would be expected, given that this is state-level data and nutrition and dietary habits vary from district to district, and these merit closer study.
A low-hanging fruit
In recent years, the supply of eggs to children in school mid-day meals and in anganwadi centres has run into opposition in several states on religious grounds. But many nutrition experts continue to advocate their inclusion in the government-run programmes.
“Egg is the best quality protein and it is cheap,” said Jain. “Children whose families already consume eggs could also be given eggs in anganwadis.”
The Comprehensive National Nutrition Survey report notes: “Malnutrition has been identiﬁed as one of the principal causes limiting India’s global economic potential.” Despite substantial economic growth, stunting still remains alarmingly high. India ranked 102 out of 117 countries on the Global Hunger Index this year.
Eradicating malnutrition altogether requires battling it on multiple fronts. The government is attempting to tackle it through the POSHAN Abhiyan which aims to improve nutrition parameters; the Swachh Bharat Abhiyaan, which tackles sanitation problems; and the National Health Mission, which seeks to improve maternal and child healthcare. But India still looks unlikely to meet its Sustainable Development Goal of achieving Zero Hunger by 2030.
In all this, the egg might just be a low-hanging fruit.
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