Health

Gujarat's estimate of malnourished children lower than national survey: CAG

Gujarat government considered only underweight children to assess malnutrition levels and not stunting and wastage

By Kundan Pandey
Last Updated: Friday 21 September 2018
Malnourished kids in India
Credit: Kumar Sambhav Shrivastava Credit: Kumar Sambhav Shrivastava

On Wednesday, Comptroller and Auditor General of India tabled a report in the state Assembly saying that the low numbers of malnourished children in the state government is because of different methodologies, generally not used by the World Health Organization (WHO) or even in National Family Health Survey (NFHS).

In the recent past, the measurement of malnutrition in Gujarat has been a controversial issue. In 2012, the then Chief Minister Narendra Modi attributed figure-conscious girls to the high rate of malnutrition in Gujarat. Later, a UNICEF report, Rapid Survey on Children (RSOC) said that Gujarat is only developed state which has worst malnutrition than national average. After delaying publishing the survey results, the government was forced to make the data public in 2015 when the international media highlighted the survey.

There are only 4.85 per cent malnourished children in state in 2015-16 and also 0.65 percent severely malnourished children, according to the state government. However, according to the NFHS-4, 38 per cent children in the state are stunted, 26 per cent are wasted, 39 per cent are underweight and 9.5 per cent are severely wasted.

The CAG report slams the Gujarat government saying their claim is not consistent with the NFHS findings.

According to media reports, the CAG has indicated towards a worsening situation of malnutrition in the state saying that the percentage of wasted children (under five years) in the state increased from 18 per cent (as per NFHS-3, 2006-05) to 26 per cent (NFHS-4, 2015-2016).

The reason behind the gap is the difference in methodology used by the state. The state government has just considered underweight children to assess malnutrition levels but the WHO considers stunting and wastage as well.

WHO’S STANDARD
 
It is based on children from well-off background

In 2006, the world adopted a growth standard developed by WHO to measure malnutrition. These standards were prepared after measuring the growth of 8,500 children from six countries—Brazil, Ghana, India, Norway, Oman and the United States—for two years. Selection of the children was made on the following conditions: 

  • Good economic condition of parents
  • Access to safe drinking water and sanitation
  • Low mobility of mother so that children receive regular care
  • Mothers adhering to breast feeding and other recommended diet patterns
  • Access to nearby hospitals and total immunisation
  • Use of micronutrient supplements
  • One of the parents must have 17 years of education
  • Mother must be non-smoker

In India, the sample was drawn from 58 affluent families in South Delhi, a plush area of the capital city. In the late 1990s, WHO conducted two surveys of the region to identify 1,000 pregnant women from 111,084 households. WHO officials monitored the growth of their children for close to two years. 

At the global level, the survey began with the enrollment of the first newborn in Pelotas, Brazil, on July 1, 1997, and ended in November 2003.

During the survey, WHO officials measured height, weight, and circumference of the head and the mid-upper arm is proportion to the age of under-five children. Based on the survey findings, WHO created the growth chart.

Though these standards show how a child is growing, countries use it as a standard to check malnutrition. Countries measure the growth of children against this WHO chart to identify if a child is malnourished. A child is categorised as underweight (low weight for age or less than 2.5 kg at birth), wasted (low weight for height) and stunted (low height for age). Stunting is an indicator of chronic under nutrition, especially protein-energy malnutrition, and is caused due to prolonged food deprivation and/or disease or illness. Wasting is an indicator of acute under nutrition and is the result of more recent food deprivation or illness. Underweight is used as a composite indicator to reflect both acute and chronic under nutrition.

 

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