Every second child under the age of 5 in Muzaffarpur district of Bihar is stunted. (Photo: Getty Images. Photo for representational purpose.)

If you think some of the poorest countries in Africa (and the world) are the worst places for a child to be born in, you are mistaken. Data suggest that most of them are better places than Muzaffarpur district of Bihar.

This week, Muzaffarpur has hogged national and international headlines for something its residents would wish never happened. More than 100 children have died due to acute encephalitis syndrome (AES) in the past fortnight and many more are feared infected.

Caught unaware and grossly underprepared for this outbreak, the state and central governments have now launched an all-out effort to control the it, even as children continue to be brought to hospitals.

While the central and state health teams are battling the encephalitis outbreak in Muzaffarpur, official data suggest that the Bihar government has been indifferent towards improving child nutrition and healthcare in this district, thus making the district a petri dish cultivating the present tragedy.

This is despite the fact that encephalitis outbreak is not new to this region -- North Bihar-Eastern Uttar Pradesh - which has seen thousands of encephalitis-related deaths in the past few decades. Just two years ago, more than 500 children died due to encephalitis in Gorakhpur district of Uttar Pradesh that falls in the same region and has similar geographic conditions as Muzaffarpur.

Data suggest Bihar govt has been indifferent towards improving child nutrition and healthcare in Muzaffarpur district, thus making it a petri dish cultivating the present tragedy.

Between 2016 and 2018, at least 228 cases of Japanese encephalitis were reported in Bihar alone, claiming 46 lives.

Data analysis of reports of World Health Organisation (WHO), World Bank and Unicef, and its comparison with statistics for Muzaffarpur district shows that when it comes to nutrition of child and mother, most African countries perform better than Muzaffarpur.

For this analysis we compared figures from Muzaffarpur and Africa for child nutrition (stunted, wasted and underweight children), adequate diet, breastfeeding, anaemia among others.

Hundreds of children with symptoms of acute encephalitis syndrome (AES) have been brought to Sri Krishna Medical College Hospital in Muzaffarpur, Bihar. (Photo: Associated Press)

MUZAFFARPUR STUNS AFRICA IN CHILD NUTRITION

The National Family Health Survey (NFHS)-4, India's biggest survey on the status of health, shows Muzaffarpur district has abysmal records of child nutrition.

Nearly 48 per cent children under the age of 5 are stunted (short for their height), 17.5 per cent are wasted (too thin for their height), while 42 per cent are underweight--a glaring sign of chronic undernutrition.

Overall, Bihar does not fare any better than this district and is today the state with highest prevalence of stunting in India. (The national figure for stunted and underweight children stands at 38 and 36 per cent, respectively.)

Nearly 48% children (under 5) are stunted (short for their height), 17.5 per cent are wasted (too thin for their height), while 42 per cent are underweight--a glaring sign of chronic undernutrition.

In comparison to this, only 31.3 per cent children in Africa are found to be stunted. WHO reports for its Africa region show that 43 African countries have lower prevalence of stunted children than Muzaffarpur. This includes countries like Ghana (18.8 per cent), Sierra Leone (28.8 per cent), South Sudan (31.1 per cent), Nigeria (32.9 per cent), Uganda (34.2 per cent), Rwanda (37.9 per cent), among others.

Not just this, Africa outperforms Muzaffarpur even in checking the prevalence of wasting (being too thin for their height) among children.

On an average, only 6.3 per cent children in Africa are wasted as against 17.5 per cent in Muzaffarpur. With 22.7 per cent children wasted, South Sudan is the only African country that fares poorer than Muzaffarpur.

PREVALENCE OF STUNTING

Source: Unicef

CHILDREN HARDLY GET ADEQUATE DIET

The World Health Organisation estimates that every year nearly 2.7 million children die due to undernutrition globally. This is about 44 per cent of all child deaths in the world.

Over the years scientific research into healthcare has established that proper diet during infancy, especially just after birth, can help in boosting a child's immunity and overall growth.

Despite this, when it comes to adequate diet, just 7.8 per cent children (aged 6-23 months) receive an adequate diet in Muzaffarpur district of Bihar.

In contrast, a 2017 WHO report on the status of nutrition in Africa shows that at least 20 African countries have greater percentage of children who get adequate diet during their infancy. These countries include Kenya, Rwanda, Ghana, Nigeria among others.

BREASTFEEDING: MUZAFFARPUR BETTER THAN AFRICA BUT NO REASON TO CHEER

Breastfeeding has proved to very effective in boosting an infant's immunity. WHO recommends that exclusive breastfeeding should start within one hour of birth and must continue until the baby is six months old.

It is estimated that globally, optimal breastfeeding could save over 8,20,000 children (below 5 years) every year.

Exclusive breastfeeding among infants less than six months is one parameter where Muzaffarpur scores better than Africa. Nearly 79 per cent children (aged less than 6 months) receive exclusive breastfeeding in this district. This is higher than all African countries except Rwanda (87.3 per cent).

But this is also where the good news ends.

While Muzaffarpur district is performing well in breastfeeding in the longer duration, but when it comes to the critical first hour after birth, the tall figure of 79 per cent falls flat.

NFHS-4 data show that 63 per cent newborns in Muzaffarpur are not breastfed within the first hour of birth.

Initiating breastfeeding within one hour of birth is important because it boosts immunity, protects the baby from acquiring infections and reduces newborn mortality.

WHO says that the risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all.

"Breast milk is a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished," the WHO says, adding that children who are breastfed within the first hour after birth go on to have better IQ than those who aren't.

63% newborns in Muzaffarpur are not breastfed within the first hour of birth.

But, when it comes to Muzaffarpur these findings, which were gathered after years of laborious scientific research, go for a toss. Neither the common people nor health officials seem to care about them.

Overall, 58 per cent newborns in India aren't given Colostrum, the nutritiously rich yellowish breast milk, within the first hour of birth. This is despite the fact that Colostrum is recommended to be the perfect food for newborns.

ANAEMIA: DISEASE THAT ATTACKS MOTHER AND CHILD ALIKE

Another indicator of poor dietary status among children in Muzaffarpur is the high prevalence of anaemia. Every three among five children (58.5 per cent) aged 6-59 months in Muzaffarpur is anaemic.

Not just children, high prevalence of anaemia (52.4 per cent) are seen even among women (15-49 years). This prevalence increases to nearly 56 per cent when it comes to pregnant women in this age group.

For Africa, based on national nutrition data for 30 countries WHO has estimated that on an average 47.3 per cent pregnant women suffer anaemia. This is 8.7 percentage points lower than Muzaffarpur.

In a country-wise break down of the WHO data, we find that Muzaffarpur fares better than 20 African countries but poorer than 10.

POOR BMI AMONG WOMEN: ANOTHER THORN FOR MUZAFFARPUR

Every third women (15-49 years) in Muzaffarpur district is malnourished, having body mass index (BMI) below the normal level (18kg/m2). Government reports show that 33 per cent women in this age group in Muzaffarpur district are underweight.

These figures are disturbing because this is the age group that represents lactating mothers, thus indicating that 33 per cent women in the childbearing age are underweight.

Controlling maternal underweight is vital not only for the mother but also for the baby because it directly contributes to low birth weight (LBW) and undernourishment of the child right from the time it is in the womb.

In Africa, except Eritrea, all countries have a lower percentage of women who are underweight. The average figure of underweight women in Africa is 10.9 per cent.

With hundreds of children dying every year due to encephalitis, malaria, chikungunya among others, the state and central government would thus serve better by focusing on strengthening preventive measures to tackle diseases and outbreaks like the one in Muzaffarpur.

Emphasis on child and mother nutrition is a vital cog in this battle against preventable deaths. If some of the poorest economies in the world can do it, there is no reason why the same can't be done in Muzaffarpur district of Bihar.

The author tweets at @mukeshrawat705 and can also be reached out on Facebook.

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