A study, published by Lancet Child & Adoloscent Health, stated that Rajasthan, Uttar Pradesh (UP), Bihar and Assam have the highest malnutrition levels in the country, despite the substantial drop in disease burden and death rate.

Disease burden and death rate are attributable to poor nutritional intake.

The study comprehensively estimated the disease burden, due to child and maternal malnutrition, in every Indian state from 1990 by the India State-Level Disease Burden Initiative. This is a consortium of experts and stakeholders associated with over 100 Indian institutions, including the Indian Council of Medical Research (ICMR), the Public Health Foundation of India and Institute for Health Metrics and Evaluation, an independent global health research centre at the University of Washington.

Among the malnutrition indicators, low birth weight is the biggest contributor to disease burden followed by child growth failure which includes stunting, underweight and wasting. The prevalence of malnutrition indicators and their rates of improvement vary substantially between different Indian states. The performance of different states was measured using disability-adjusted life-years (DALYs) per 100,000 lost due to child and maternal malnutrition.

What does the study show?

The study showed that the disease burden rate, attributable to malnutrition in children, varies seven-fold between the states. States like Rajasthan, UP, Bihar and Assam top the list while Kerala and Tamil Nadu have the lowest disease burden.

While the four worst-performing states have DALYs of more than 60,000, Madhya Pradesh (MP), Chhattisgarh, Odisha, Nagaland and Tripura too figure among the second set of poor-performing states that have DALYs between 50,000 and 59,999, the Lancet study said.

“The findings reported in the paper highlight that there are wide variations in the malnutrition status between the States. It is important therefore to plan the reduction in malnutrition in a manner that is suitable for the trends and context of each State,” said Balram Bhargava, ICMR Director General.

“The study reveals that while it is important to address the gaps in all malnutrition indicators, low birth weight needs particular policy attention in India as it is the biggest contributor to child death among all malnutrition indications and its rate of decline is among the lowest. Another important revelation is that overweight among a subset of children is becoming a significant public health problem as it is increasing rapidly across all states of India,” said Lalit Dandona, who heads the consortium.

The death rate attributable to malnutrition among children, below five-years-old, in India has dropped by two-thirds from 1990 to 2017. Malnutrition is, however, still the underlying risk factor for 68 per cent of the deaths among these children. It is also the leading risk factor for disease burden in persons of all ages considered together, contributing 17 per cent of the total DALYs.

Incidence of low birth weight

The prevalence of low birth weight was 21 per cent in India in 2017, ranging from 9 per cent in Mizoram to 24 per cent in UP. The annual rate of reduction was 1.1 per cent in India between 1990 and 2017, ranging from 3.8 per cent in Sikkim to 0.3 per cent in Delhi.

Incidence of child stunting

Incidences of stunting among children was 39 per cent in India in 2017. This ranged from 21 per cent in Goa to 49 per cent in UP, and was generally the highest among socio-economically backward states of Bihar, Chhattisgarh, Jharkhand, Odisha, Rajasthan, MP and UP.

The annual rate of reduction was 2.6 per cent in India between 1990 and 2017, which varied from 4 per cent in Kerala to 1.2 per cent in Meghalaya.

Incidence of children being underweight

In 2017, 33 per cent of the children in India were reportedly underweight, ranging from 16 per cent in Manipur to 42 per cent in Jharkhand. The annual rate of reduction was 3.2 per cent in India between 1990 and 2017, ranging from 5.4 per cent in Meghalaya to 1.8 per cent in Delhi.

Anaemia among children

The incidences of anaemia among children, on other other hand, was 60 per cent in India in 2017, ranging from 21 per cent in Mizoram to 74 per cent in Haryana. The annual rate of reduction was 1.8 per cent in India between 1990 and 2017, which varied from 8.3 per cent in Mizoram to no significant reduction in Goa.