Malnutrition in India’s north-eastern states

There has been a significant increase in the number of malnourished children in India between the National Family Health Survey (NFHS)-4 (2015-16) and the fifth round (2019-2020), and the progress made during the first half of the decade appears to have been undone. Malnutrition in India’s north-eastern states is worse than the national average.

What exactly is malnutrition?

  • Malnutrition is defined as a person’s intake of energy and/or nutrients being deficient, excessive, or imbalanced.
  • Malnutrition has long-term consequences for a child’s motor, sensory, cognitive, social, and emotional development. It stifles productivity and academic advancement.

The term malnutrition covers two broad groups of conditions

  • Stunting (low height for age), wasting (low weight for height), underweight (lowweight for age), and micronutrient deficiencies or insufficiencies are all examples of undernutrition (a lack of important vitamins and minerals).
  • Overnutrition: The other is overweight, obesity, and noncommunicable diet-related diseases (such as heart disease, stroke, diabetes, and cancer).

North East India suffers from malnutrition.

  • Stunting among children under the age of five has increased in four Northeastern states: Meghalaya, Mizoram, Nagaland, and Tripura. Meghalaya has the highest rate of stunting at 46.8%, followed by Nagaland (32.7%), Tripura (32.3%), and Mizoram (28.9%). The proportion of children who are stunted, wasting, underweight, or overweight has increased in Mizoram, Nagaland, and Tripura.
  • Stunting levels in Assam have decreased: According to the NFHS-5, stunting levels have decreased in Assam, Manipur, and Sikkim. In Assam, stunting has decreased by nearly one percentage point, despite increases in overweight (2.3% to 4.9%), underweight (29.8% to 32.8%), and stunting (17% to 21.7%), while wasting and underweight have decreased by more than 2% in each case.
  • Sikkim outperforms other NE states: As the number of stunted, wasting, and underweight children have decreased, Sikkim has outperformed other NE states, as has Manipur, with a drop in wasting from 6.8% to 9.9% in under-five children.
  • Increase in the number of overweight people in every Northeast state: Every state in the Northeast saw an increase in the number of overweight people, adding to the states’ growing double burden of malnutrition.

Appropriate foods and feeding practices show Higher immunity

  • Only Meghalaya and Tripura have adequate feeding practises: The percentages of breastfeeding children receiving adequate complementary foods have improved only in Meghalaya and Tripura. Early breastfeeding initiation is declining in six of the eight northeastern states, with the highest rates in Sikkim (33.5%) and Assam (15.3%).
  • Reduction in exclusive breastfeeding rates (EBF): Sikkim, Tripura, and Manipur all have significant reductions in EBF rates. Sikkim has the lowest EBF at 28.3 percent, far below the national average of 63.7 percent. Tripura increased its practise of timely introduction of semi-solid food by 39.5 percentage points, while Meghalaya, Mizoram, Nagaland, Sikkim, and Arunachal Pradesh decreased slightly.
  • Except for Assam, all NE states performed well in terms of diet adequacy: The Minimum Adequate Diet (or diet adequacy) is a metric that combines feeding frequency and diet variety. There is a significant range in the northeastern states, ranging from 8% to 29.8%. With the exception of Assam, all states have outperformed the country on this metric.
  • Obesity is a more complicated problem: Only Meghalaya and Nagaland have experienced decreases, while the remaining six states have experienced increases. It is encouraging to see a downward trend in underweight women (BMI 18.5) across all eight northeastern states.
  • Anaemia is on the rise: Anaemia among women of reproductive age has increased in six of the eight northeastern states, with Tripura having the highest rate at 67.2% and Assam having the lowest at 65.9%.

How can malnutrition be addressed in the Northeast?

  • Identifying the causes: Stunting is caused by a variety of factors in the Northeast, including poor maternal health, a lack of antenatal care, inadequate infrastructure and healthcare facilities, inadequate feeding and nutrition for women, and limited access to education, clean drinking water, and sanitary facilities.
  • According to a 2015 study on indigenous peoples in the Northeast, a lack of toilets, drinking water, and cooking fuels in the home environment has an impact on child malnutrition.
  • Improving maternal nutrition: In most measures, Manipur, Mizoram, and Sikkim outperform the national average. Better maternal nutrition before conception, during pregnancy, and after delivery reduces newborns’ chances of being stunted. The risk of stunting decreases as the number of underweight mothers decreases, according to data from Sikkim, Manipur, and Mizoram.
  • Improving service accessibility: The use of supplementary food at anganwadi centres (ANC) varies greatly across the northeastern states, ranging from about 35% in Arunachal Pradesh to 70% in Tripura. ANC coverage in the Northeast ranges from 20.7% in Nagaland to 79.4% in Manipur.
  • Improving Iron and Folic Acid Requirements: All states have lower percentages of iron and folic acid (IFA) intake than the national average of 26%, with the exception of Manipur, where 30.3% of pregnant women completed the entire 180-day course of IFA tablets. Nagaland has the lowest rate, which is only 4.1%. Overall, service availability and uptake vary greatly across the NE states.
  • Nutrition gardens: The Assam government, for example, encouraged women in rural communities to create “nutrition gardens” where they could grow vegetables.
  • “Kan Sikul, Kan Huan” (My School, My Farm) programme in Mizoram’s most impoverished and disaster-prone area-Lawngtlai.
  • Lunchbox exchange: The “dibbi adaan pradaan (lunchbox exchange)” initiative in Assam’s Hailakandi district to promote better nutrition and menu variety.

@the end

To close the nutrition gap in the Northeast, malnutrition must be addressed holistically by scaling up direct nutrition interventions and coupling them with nutrition-sensitive measures. Building on the POSHAN Abhiyaan and health projects, it may be beneficial in the long run to improve monitoring and evaluation of current interventions.

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