Malnutrition in India

Introduction :-

Malnutrition is found to be a leading killer through out the world, with under nutrition in the developing world the main nutrition problem. The World Bank Estimate that India is ranked 2nd in the world of the number of children suffering from malnutrition after Bangladesh (1998), where 47% of the Children exhibit a degree of malnutrition. India is one of the fastest growing country in terms of population and economic growth rate , sitting at a population of near about 1200 million (December 2010) and economy growing by 9% GDP growth rate from 2007-2008.

Since independence Indian economy considered as low income country with majority of population at or below the poverty line which is lead to problems of malnutrition, hunger etc. the combination of people leaving in poverty and the recent economic growth of India (as well as Maharashtra)has led to the co-emergence of two type of malnutrition:

1) Undernutrition
2) Overnutrition.

The National Family Healthy survey 2005-2006 shows that, while Maharashtra is one of the most developed State among the country, It has also problem of Malnutrition exists, but nutrition situation in Maharashtra is slightly better than the national average.

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National Nutrition Monitoring Bureau (NNMB) study quoted that more than 40 lakh children were affected with grade 2 to 4 malnutrition in Maharashtra. This indicate the seriousness of the problem of malnutrition.

Definition of the Term Malnutrition

Malnutrition carries different connotations to different people. To some, malnutrition means undernourishment, while to others it means starvation. Some confuse malnutrition with hunger while others consider malnutrition as undernutrition. The writer would like to define the term malnutrition in the following pages and differentiate it from the other similar terms.

Malnutrition

The word malnutrition might best be reserved to indicate the state of ill-health of a population or of any group of people in so far as that condition is caused either by malnourishment or undernourishment. It is thus, to an extent, a medical term or a term for public health purposes. The students of public health are showing a tendency to use that term in such a sense more consistently. The existence of malnutrition is revealed in various morbid conditions and it is measurable in terms of indices which are medical, anthropological, or biostatistical (such as height, weight, and special diseases, etc. )

Malnutrition is the condition that develops when the body does not get right amount of Vitamins, Minerals and other nutrition’s (Proteins) is needs to maintains healthy tissues and organ function.”

Malnutrition occurs in people who are either undernourished or over nourished. Undernutrition is a consequence of consuming too few essential nutrients or excreting them more rapidly than they can be replaced. Infants, teenagers, young children, pregnant and breastfeeding women require additional nutrients. Overnutrition results from eating too much; eating too many of the wrong things, not exercising enough or taking too many vitamins or other dietary replacement

Malnourishment

Refers to an actual condition of diets in which not the quantity, but the quality of the food stuff is also involved. According to the present knowledge, a diet must supply some 30 or more nutrients in order to provide the proteins of high quality, as well as energy yielding food. A population is malnourished, even if it is able to use and is in the habit of using a quantity of energy yielding food stuffs, but if the people are either unable or unaccustomed to maintain a balanced diet including all the proper nutritive elements in correct proportion, is still suffering from malnourishment

Undernourishment

"Expresses a dietary condition largely among the working people in which there is an actual insufficiency both in quantity and in quality of nutritive elements needed for health and well-being."-

Objectives of the study:

We have attempted to discuss the crucial issue child malnutrition in Maharashtra State. Therefore we look at the following objectives regarding malnutrition study in the state.

1. To discuss the status of child malnutrition in the state.

2. To find out the major causes of malnutrition.

3. To find out the effects / incidence of malnutrition problem.

4. To address the way to eradicate the malnutrition problems. Methodology:
In this research paper we mostly used the secondary kind of data for analysis the issue. Researchers used macro-analysis method for analyze the malnutrition in the country as well as Maharashtra State.

Types of Malnutrition:
Each form of malnutrition depends on what nutrients are missing in the diet, for how long and what age.

A) Proteins Energy Malnutrition (PEM):
This is the most basic kind of malnutrition, results from a diet lacking in energy and Protein because of a deficit in all major macro nutrients such as carbohydrates, fats and Proteins.

B) Micronutrients deficiencies:

Micronutrients deficiencies are also a widespread problem in India. More than 75% of preschool children suffer from iron deficiency anemia (IDA) and 57% preschool children have subclinical vitamin A deficiency (VAD). Iodine deficiency is endemic in 85% districts (In India) mostly due to the lack of iodized salt. The prevalence of deferent micro nutrients deficiency varies widely across states.

Degrees of Malnutrition:

Classification of Protein Energy Malnutrition (PEM) is done by Gomez. Degree of PEM % of desired body weight for age and sex.

1. Mild Malnutrition (Grade I )

90% -100%

2. Moderate Malnutrition (Grade II)

75% - 89%

3. Severe Malnutrition (Grade III)

< 60%

Status of Malnutrition in Maharashtra :-

As far as Maharashtra State is concern, deaths regarding to the malnutrition seems high in tribal dominated districts e.g. Gadchiroli, Amravati, Yewatmal, Chandrapur, Bhandara and Melghat etc. Dr. Abhay Bang committee (2004) reported that between 1.20 lakh and 1.75 lakh children diet every year in the state for medical reasons. The report blamed an Insensitive bureaucracy for the plight of nearly 8 lakh children whose lives were threatened by grade 3 or 4 malnutrition. According to the report during 1988 to 2002 the percentage of affected by grade 3 or 4 malnutrition had fallen by mere 0.6% only which is found little improvements.

According to National Nutrition Monitoring Bureau (NNMB) study quoted that more than 40lakh children were affected with grade 2 to 4 malnutrition in Maharashtra. It estimated that 82000 children died every Year in rural area’s of the state 23, 500 in the tribal area’s and 56000 in urban slums.

According to the government statistics in the entire Maharashtra state child death were estimated 45,000 (during July 2004 to June 2005) due to the malnutrition out of these 12,000 fall prey to severe malnutrition and the remaining 33,000 children died due to the mild or moderate malnutrition. The malnutrition is also the underlying cause in about 480 of the 2850 maternal deaths each year in the state.

Child Death And Action Group (CDSAG) study found that 10.4% child death are recorded on an account of malnutrition in the state. Tribal Dominated Districts of Amravati, Yewatmal, Gadchiroli, Chandrapur and Bhandara in Vidarbh region as well as Melghat in North Maharashtra region were affected worsely by malnutrition problem.

Ø Almost 38% of children under age three are stunted (India – 38.4%)

Ø Almost 40% are underweight (India – 45.9%)

Ø There is a strong correlation between child malnutrition and the level of maternal education.

Ø There are significance differences between rural and urban area’s, where the rural area’s being more affected by malnutrition.

Ø The prevalence of overweight and obesity in Maharashtra is higher than the national average for both male and female.

Causes of Malnutrition:

1. The economist Amartya Sen observed that poverty is major cause of malnutrition and famine has always a problem of poverty and unbalanced distribution of food.

2. Hike in food prices or food inflation.

3. Insufficient food production (availability)

4. Changes in climate threaten the food security.

5. People with drug or alcohol dependencies are also at increased risk of malnutrition.

Effect of Malnutrition:

Malnutrition including both protein energy malnutrition and micro nutrient deficiencies not only affect physical appearance and energy level, but also directly affects many aspects of the children mental functions, growth and development.

Ø According to the Jean Ziegler UN special report on the right to food (for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006. One in twelve people world wide is malnourished.

Ø WHO, also indicate that malnutrition is the biggest contributor to child mortality.

Ø Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller.

Ø Malnutrition increases the risk of infection and infectious disease.

Ø Malnutrition affects adversely physically as well as psychologically. Malnutrition in the form of ioden deficiency is most common preventable cause of mental impairment worldwide.

Ø Ioden deficiency specially in pregnant women and infants, lowered intelligence by 10 to 15 I.Q. points.

Ø Malnutrition can also be a consequence of other health issues such as diarrheal disease or chronic illness specially disease of intestinal tract, Kidney’s and liver.

Programs to address eradicate the Malnutrition
The government of India has launched several programs to converge the growing malnutrition problems in the country. They include ICDS, NCF, National health mission.

1. Integrate child development scheme (ICDS):-
Indian government has starter this ICDS program in the year 1975 for improving the health of mothers and children development program is on of largest in the world. It reaches more than 34 million children aged 0-6 years and 7 million pregnant and getting mothers.

2. National Children Fund (NCF):-
This Fund was created during the international year of the child in 1979. This Fund provides support to the voluntary organizations that help the welfare of children.

3. United Nations Children Fund (UNCF):-
UNISEF has been supporting India from last six decade in a number of sectors like child development, women development support for community based converged services health, education, nutrition, water and sanitation, childhood disability, children in especially difficult circumstances.

National Rural Health Mission:
This mission was created for the years 2005-2012 and its goal is to “Improve the availability of and access to quality health care by people, especially for those residing in rural area, the poor women and children.”

1. Objective of the mission are:-
Ø Reduce Infant Mortality Rate (IMR).

Ø Provide access to integrated compressive primary health care.

Ø Revitalize local health tradition and mainstream AYUSH. (This mission has set up strategies and action plan to meet all of its goals.)

2. The best wa y to prevent the condition is to eat a healthy balanced diet that contains food from all the major groups like carbohydrates, fruits and vegetable, Protein, dairy and fats.

3. As well as eating healthy, you should aim to drink at least 1.2 liters of fluid a day.

45,000 die of malnutrition every year in MaharashtraDespite being among the wealthiest states in the country, almost half Maharashtra’s children are undernourished and one-third of adults are underweight, says a recent report by the NGO SATHI. Forty-five-thousand children die of malnutrition every year in the state, according to ‘A report on nutritional crisis in Maharashtra’ by the Pune-based SATHI (Support for Advocacy and Training to Health Initiatives). One-third of adults are underweight, and 15% severely underweight.The two major schemes for children meant to prevent such deaths are the midday meal scheme and the Integrated Child Development Scheme (ICDS). But the state government spends just 0.8% of its gross domestic product on these schemes, the report states. More children die of mild or moderate malnutrition (33,000) than of severe malnutrition (12,000). Malnutrition is also the underlying cause of death of 480 of the 2,850 malnutrition deaths in the state every year. “A large number of people in Maharashtra do not get enough to eat and are suffering from serious nutritional deficiencies,” said the coordinator of SATHI, Abhay Shukla, at a press conference to release the report on February 3, 2010.

The report takes into account the findings of the National Family Health Survey-3 and the National Sample Survey. The report points out that chronic hunger is not confined to rural areas, as is popularly believed; urban populations in coastal regions, including the city of Mumbai, have the highest prevalence of calorie deficiency (43%) in the state. Calculations made using the per-consumer-unit-calories norm of 2,400 in rural areas and 2,100 in urban areas reveals that the incidence of calories-based poverty is 54% in rural areas and 39.5% in urban areas. The report is critical of government schemes like the ICDS. Grade 3 and 4 malnutrition is grossly underreported under the scheme as workers lack the skills and equipment to accurately weigh and classify children. Severe malnutrition is often underreported as it points to a failure of the programme. The midday meal scheme too has been underperforming, according to the report.

Only 12% of schools surveyed provided midday meals, and many gave only one component of the meal. Moreover, not a single school provided the stipulated 300 calories and 8-12 grams of protein. India’s performance on the nutrition front is poor overall. According to the National Family Health Survey-3 (up to 2005-06), almost half of children under 5 years of age (48%) are stunted, that is, too short for their age, an indicator of chronic malnutrition; 43% are underweight. The proportion of severely undernourished children is also notable -- 24% are severely stunted and 16% are severely underweight. The 2009 annual budget earmarked just 4.15% for children when the population under 18 years of age is 447 million. Maharashtra’s poor performance on the health front comes despite it being one of the high GDP states. Though the country as a whole has seen GDP grow by 3.95% per year, between 1980 and 2005, the percentage of underweight children under 3 went down by just 6%, from 52% to 46% between 1992 and 2005.

For every 3-4% increase in per capita income, the underweight rate should decline by 1%. This has not happened in India, pointing to the need for more inclusive growth and better delivery and distribution of schemes targeted at malnutrition. Malnutrition among Maharashtra’s tribalsMore than 98 children died in three months of 2005, in Akkalkuwa block of Nandurbar district. Of these, 71 children were found to be severely malnourished.A survey by the Punarvasan Sangharsh Samiti revealed that the government is unaware of the scale of malnutrition in the area. Only 10% of malnourished children figure in the government records. The survey also showed that not only were the children malnourished, their mothers were too. The weight of adult mothers ranged between 40-45 kg.Girls constituted around half the total number of malnourished children, indicating the precarious condition of these 'future mothers'.

The survey also revealed that although generations of malnourished children are born in this region, the government still does not look beyond the singular health aspect of the problem, on the basis of which mitigation measures are designed. Unless the issue of malnutrition is addressed comprehensively, the tribal community in this part of the country is headed for extinction.These and other startling revelations form part of a report brought out by the Punarvasan Sangharsh Samiti, which has been actively mobilising the tribal population of Nandurbar district for the last decade. The report, titled 'Maranatach He Jag Jagate', is based on the survey which was carried out in 22 villages. And information obtained through the Right to Information Act.The tribals of Nandurbar are engaged in a continuous struggle for existence. Malnutrition and child mortality is part of their everyday lives, even as issues related to rights over natural resources and means of livelihood gain greater urgency with each passing year.Attempts to remedy malnutrition and child mortality by singling it out will not deliver the desired results.

'Maranatach He Jag Jagate' attempts to take stock of the situation and get at the root of the problem. The report analyses the situation on the ground and suggests ways to tackle the problem head-on. Obviously there is the need for firm action by the government and the active involvement of society at large.Some basic facts about the survey: * The survey was undertaken in 22 villages of Akkalkuwa block, Nandurbar district. The weights of mothers in seven villages and two rehabilitation and resettlement sites of the Sardar Sarovar Project were recorded. The facts that emerged from the survey were shocking. In April, May and June 2005, 98 children died in Akkalkuwa block alone and of these 71 children were malnourished. Of the malnourished children, 45 were found to be in the second stage of malnutrition. Meanwhile, the government refuses to accept that the children died from malnutrition. * Punarvasan Sangharsh Samiti recorded the weights of children in 22 villages and compared this data with that of the government.

The comparison showed that the government has only 10% of the facts related to malnutrition. In effect, it is unaware of 90% of malnutrition cases. According to the survey, the number of third-grade malnutrition among children in April was 127, in May 135 and in June 104; the government records showed only 14, 42 and 17 children as malnourished in this grade respectively. The survey figures for fourth-grade malnutrition, during these months, were 61, 50 and 35; the government figures were 6, 6 and 3 respectively. (The figures quoted here were obtained from the government under the Right to Information Act). * Of the 22 villages in the survey, six have been declared 'hyper-sensitive' by the government. The survey showed that the combined number of third and fourth-grade malnutrition among children in April, May and June stood at 100, 104 and 72; the government records showed only six children were malnourished. * Of the total number of malnourished children, half were girls. This raises a serious question about the next generation.

* With this question in mind, the Punarvasan Sangharsh Samiti conducted a survey in six villages and two rehabilitation and resettlement sites in which the weights of fully-grown mothers were assessed. The survey showed that the weights ranged between 40-45 kg. This emphasises the need for a comprehensive study of the ages of young mothers, stage of motherhood and its link with malnutrition. It also suggests that the process of malnutrition begins in the womb itself. * The root of the problem is lack of livelihoods. Measures in the areas of health, education, employment and supply do not create sustainable livelihood sources and therefore cannot, in themselves, be decisive remedies to the problem of malnutrition. Let's take a closer look at the villages covered in the survey.The 22 villages are spread out in the plains as well as in hilly regions of the Satpudas. Of the villages, Khai, Andharbari, Ohwa, Kaulavimal, Toknapimpri, Maliamba, Kondvapada, Thana and Beti have been declared 'hyper-sensitive' villages under the Navsanjivani Scheme, which is touted as the answer to the malnutrition problem.

Of the 22 villages, seven villages -- Khai, Andharbari, Ohwa, Kaulavimal, Miryabari, Valamba and Pimpalgaon -- do not have a yearlong motorable road and are therefore inaccessible. After a point one has to walk to get to the village. Four villages -- Thanavihir, Guliamba, Amali and Pimpalgaon -- are within a periphery of 12 km from the block headquarters of Akkalkuwa, but they are connected to a remote primary health centre (PHC) in Dab, situated deep in the third range of the Satpudas. One has to pay Rs 15 to get to the PHC by jeep; to reach Akkalkuwa one has to pay Rs 5.Other examples are Ambabri, Andharbari, Bharadipadar and Khai. These villages are connected to the Moramba PHC. To reach Moramba by car one has to travel via Khapar, covering a distance of 17-18 km. Although there is a primary health centre in Khapar, villagers from these four villages have to bypass it and go on to Moramba. The other option to get to Moramba directly is to walk through the hills of the Satpudas for around 7-8 km.

This shows up a serious flaw in the state government's policy with regard to the location and coverage of primary health centres. The village of Ohwa is connected to the Horaphali PHC, which is 22 km away. There is no road connecting the village with the centre; people have to walk through the Satpuda hills to get to it. To correct the situation the government sanctioned a health centre for Ohwa in 2004. But, although the tribal development department made provision to build the primary health centre, the health department still has to sanction the plan.Seven villages -- Andharbari, Kaulavi, Bari, Pimpalgaon, Valamba, Maliamba and Kondvapada -- do not have a public distribution system (PDS) outlet. Tribals from these villages are forced to walk 3-4 km to reach a PDS outlet.

Of the 22 surveyed villages, 11 do not have a single job-creation opportunity under the state's well-known Employment Guarantee Scheme (EGS). The residents of seven villages did receive some form of employment but only for a period of around a month.The survey also covered two rehabilitation and resettlement (R&R) sites of the Sardar Sarovar Project. Although the government claims to have carried out its R&R duties satisfactorily, the situation on the ground is quite the opposite. Of the 634 children surveyed, 378 were found to be malnourished and the number of girls among them was as high as 60%. Of the total number of malnourished children, 119 were in the third and fourth stages.

The two sites have separate PHCs, PDS outlets, gram panchayats and four anganwadis each. All the children were in the 0-6 age-group. This shows that they were born after their families were resettled. What conditions are like in the other six sites is a question open for study.What is clearly needed is a debate on the findings of this survey, from the social, economic, political, cultural and medico-anthropological perspective. Especially, vis-Ã -vis the government's information on the subject. The report is being made public to facilitate just such a debate.India's malnutrition problem is a systemic issue | |

Girls in India are more malnourished as "inadequate resources of families are divided preferentially among men". "The problem of malnourishment in India is a reflection on its deeply entrenched poverty and a lack of functionality of its systems," says author [EPA]| India's growing riches have been the subject of many global discussions. In the past few years, India has responded to international emergencies by reaching out with support in cash and kind. However, India has still not managed to get a grip on the problem of malnutrition its children face, a fact that India's prime minister this year called a "national shame".The facts are daunting - as many as nearly half of India's children below five years are malnourished. Girls are even more malnourished as inadequate resources of families are divided preferentially among men.

India's nutrition problem shows among women as well - the malnourished girls grow up to be anaemic, deliver underweight babies who face an increased risk of dying and being sick right after their birth. India ranks 76 among 80 middle-income countries rated for the "best place to be a mother" according to the Save the Children's Mothers' Index released in May 2012.'Anganwadi' centresThe problem of malnourishment in India is a reflection on its deeply entrenched poverty and a lack of functionality of its systems. Policymakers from the comfort of their oversized public-funded accommodation while examining the failure of their policies often argue that a country of India's size - both in terms of geography as well as population - is difficult to administer.

What they admit a little reluctantly is that the government-supported institutions are neither effective nor accountable to the people, and that the budget allocations in sectors critical for people's well-being are still abysmally low. India's wealth - no longer so new-found - has so far not filtered down to the areas which would make considerable difference to the lives of its common people.A question often asked in India is about the co-existence of hunger and malnutrition alongside the problem of plenty - of thousands of tonnes of food grains rotting due to poor storage in government stores while the poor go to bed hungry. Clearly, the problem is not of a lack of resources but of systems that ensure that the country's opportunities and resources are more equitably and equally divided.India's response to its massive problem of malnutrition has been largely through the Integrated Child Development Services, or ICDS as it is known.

The ICDS runs preparatory schools-cum-health institutions called anganwadi centres where pregnant and lactating women and children below five years receive supplementary nutrition while children are also taught to take first steps towards learning letters and numbers. Many states have further equipped their anganwadi centres to enable them to treat the common ailments of children.Considering the critical role of anganwadi centres in helping children remain healthy, they should have been universalised decades ago but they have not. Anganwadi centres cover only 50 per cent of India's children. However, data as well as anecdotal evidence appearing in the form of newspaper reports points out that anganwadi centres do not function at their optimum capacity and efficiency. Their staff are not accountable to the people of the village, and being "influential" (some of them are known to be relatives of village headmen and other important members of the village) are not susceptible to punitive action when they fail to perform their duty.

Poverty and malnourishmentThat is a typical Indian situation - one can get away without being punished for one's wrongdoings if one has the right connections. This is the bane of most of India's institutions and facilities which are meant to serve the people but become, instead, means of employment and influence for a few. "Nearly half of India’s children below five years are malnourished."| Under the patronage of this protection, doctors in government hospitals may remain absent from work without a note on the attendance register for days, teachers may not teach, clerks in offices may demand a bribe to perform a task which is the right of a citizen. The impact of dysfunctional systems on the lives of the poor and the marginalised is devastating as they have no alternatives. The poor die of common illnesses if they do not get treated at government hospitals, or they go borrow money to access a private hospital and go into debt.

In fact, the WHO has said that 3.2 per cent Indians would fall below the poverty line because of high medical bills with about 70 per cent of Indians spending their entire income on healthcare and purchasing drugs. The Planning Commission also accepts that out of pocket expense to pay for healthcare costs is a growing problem in India. It says 39 million Indians are pushed to poverty because of ill health every year. Around 30 per cent in rural India didn't go for any treatment for financial constraints in 2004. In urban areas, 20 per cent of ailments were untreated for financial problems the same year, said a recent study in the Lancet. The government needs to look at health and education as critically important sectors in the development paradigm. If India is to reap its demographic dividend, it cannot do so with half of its children malnourished and not reaching their full potential|

Overview of Malnutrition Situation in Maharashtra

Maharashtra: The data below are from the National Family Healthy Survey 2005-2006. Highlights: The nutrition situation in Maharashtra is slightly better than the national average with improvements from 1998-99 and 1992-93 except for an increase of anaemia prevalence among pregnant women. The feeding practice for children aged 6-9 months shows an alarming pattern with only 48% of children aged 6-9 months receiving solid or semisolid food and breast milk. This is significantly lower than the national average of almost 56%. Furthermore, the prevalence drops to 40% for rural areas compared with the national average of 54% and as low as 23.3% for non-educated mothers compared with the national average of 49%. The prevalence of overweight and obesity in Maharashtra is higher than the national average for both female and male with Mumbai reaching almost 35% of obesity among the female population. Within Maharashtra, there are significant differences between rural and urban areas with the rural areas being more affected by malnutrition. However, the most outstanding gap in all indicators is between non-educated and well-educated respondents.

Malnutrition and Anaemia Rates Are High among Children

* Almost 38% of children under age three are stunted (India - 38.4%) and almost 40% are underweight (India 45.9%). Both indicators have slightly improved from 1998-99 and 1992-93.
* Wasting affects 14.6% of children under age (India 19%) with a steady improvement from 1998-99 and 1992-93.
* Compared with urban areas, under-nutrition is higher in rural areas and in Mumbai. Similar to the national picture, there is a strong correlation between child malnutrition and the level of maternal education showing a two-fold difference between non-educated and well-educated mothers. The stunting and underweight prevalence for children with illiterate mothers is 52.9% and 53.1% respectively contrasted with 22.9% and 25.9% for children with well educated mothers. The stark difference may be linked to access to nutritious diet and complementary feeding at 6-9 months.

* Almost 72% of children under age three are anaemic (India 79.2). There is a significant urban-rural divide with Mumbai having the lowest prevalence with 59.5% compared with 76.8% in rural areas. The non-educated versus educated mothers difference is not as strong with 75% and 71% relatively. This may be linked to a more general poor quality of nutrition and hygiene conditions and limited access to iron supplementation.

Improvements Needed in Infant and Child Feeding especially for the age 6-9 months * 53% of children are fed only breast milk for the first 6 months (India 46%). Exclusive breastfeeding is significantly higher among the non-educated mothers, in rural areas and in Mumbai. Work factor and access to breast milk substitutes may have an impact among urban and better educated mothers. The positive deviance in Mumbai may be associated with an increased awareness among the female working class and better baby-friendly employment conditions.

* 51.8% of children under three years are breastfed within one hour of birth (India 23.4%) with no significant difference between urban and rural areas and between well-educated and non-educated mothers.

* Only 47.8% of children aged 6-9 months receive solid or semisolid food and breast milk. This is significantly lower than the national average of almost 56%. The prevalence drops as low as 40% in rural areas (India rural 54%) and 23.3% among non-educated mothers (India non-educated 49%) showing a high-priority gap. The prevalence in urban areas and in Mumbai is 58% and 56.6% respectively (India urban 62.1%).

* 32% of children age 12-35 months received vitamin A supplements in the six months before the survey (India 23%) with the highest prevalence in urban areas (34.2%) followed by rural areas (29.9%) and Mumbai (27%) with a significant difference between non-educated (26.2%) and well-educated mothers (32.2%).

A significant percentage of Women and Men Are Either Too Thin or Too Fat * 32.6% of married women (India 33%) and almost 30% of men (India 28%) are too thin, according to the body mass index (BMI). Underweight is strikingly most common among the non-educated and the rural population compared with Mumbai and urban areas that show a similar prevalence.

* Overweight and obesity affects 17% of women (India 14.8%) and almost 16% of men (India 12%). Overweight and obesity are strikingly most common in urban areas and among the well-educated with Mumbai reaching almost 35% of obesity among the female population as compared with the national urban average of 29%.

Anaemia is Widespread

* 49% of women (India 56.2%) and 16.2% of men (India 24.3) suffer from anaemia. Among pregnant women, anaemia has increased from 52.6% to almost 58%.
* Only 30.5% of pregnant women consume Iron and Folic Acid supplementation for 90 days (India 22.3%) with 16.4% among the non-educated women compared to 45.2% among the well-educated ones. Rural and urban areas have the same prevalence of 30.5% with Mumbai reaching only 27.5% (India urban 34.5% respectively) The bleakest numbers* at a glance:*(NOTE: Figures have been rounded to the closest zero for easier understanding of the ratio) 1. For every ten children aged three or less, born to illiterate mothers, five children are stunted - too short for their age. This is a sign of chronic malnutrition. 2. For every ten children aged three or less, born to illiterate mothers, five children are underweight - too thin for their age. This is a sign of acute and chronic malnutrition.

3. For every ten children aged three or less, born to illiterate mothers, two children are wasted - too thin for his/her age. This is a sign of acute malnutrition. Wasted children are at highest risk of dying from malnutrition or from any common child diseases like diarrhoea or respiratory infections. 4. For every ten children aged 6-9 months, born to illiterate mothers, only two receive solid or semi-solid foods in addition to Breast-milk as recommended. This jeopardizes their chances of survival and irreversibly impairs their future growth and development.

5. For every ten children aged one to three years, born to illiterate mothers, only three children received Vitamin A supplementation in the last six months prior the survey. 6. For every ten illiterate women aged 15-49 years, four are too thin. 7. For every ten pregnant illiterate women, six are anaemic but only two take Iron and Folic Acid supplementation for 90 days as recommended. The higher the education of the mother, the better the nutrition status of themselves and their child.NOTE: In Maharashtra, for every ten women, 2 women are illiterate and 8 are educatedAmong the educated women, 3 are well-educated (10 years complete and above), 2 have 8-9 years complete and 3 have less than 8 years complete.