DrPH 8400, Epidemiological Issues in Urban and Rural Health
Professor: Dr. Janice Williams
Scope of the problem The problem of malnutrition is a complex and difficult in rural Maharashtra, India. Malnutrition is caused by mechanisms traversing the social, political and economic arenas. Addressing the problem in a systematic way requires understanding the complex causes malnutrition. The principle ones are lack of access to clean water and poor sanitation leading to high frequency of avoidable diseases, lack of access to pre-natal and postnatal care, socio-cultural causes related to the low status of women in many communities. This results in lack of opportunity for women to gain access to education, knowledge and economic opportunity, inadequate access to food resulting from seasonal shortages, and poverty and lack of access to resources such as land, irrigation, and forest (Sandosham & Winder, 2008). Food security, feeding and health seeking practices, the status of women, and availability of health care are only some of the factors that determine the nutritional status. Besides malnutrition spans generations, a low weight baby girl grows into a malnourished mother who delivers a low birth weight baby. Reduction of malnutrition thus needs to be tackled at various levels. It needs political commitment at the highest level. It needs convergence of various government departments and the institution of various proven interventions that have shown to reduce malnutrition. The term malnutrition encompasses both overnutrition and undernutrition. The term malnutrition is applied to undernutrition which includes both macronutrient and micronutrient malnutrition leading to overall undernutrition in terms of low weight-for-age, low height-for-age and low weight-for-height of children as compared with the reference standards (WHO, 2006). Undernutrition in children can manifest itself in several ways, and it is most commonly assessed through the measurement of weight and height. A child can be too short for his or her age stunted, have low weight for his or her height wasted, or have low weight for his or her age underweight. A child who is underweight can also be stunted or wasted or both. Each of these indicators captures a certain aspect of the problem. Weight is known to be a sensitive indicator of acute deficiencies, whereas height captures more chronic exposure to deficiencies and infections. Wasting is used as a way to identify severe acute malnutrition. Child undernutrition happens very early in life. The mean weight and height of Indian children at birth is already below the expected mean weight and height in a healthy and well-nourished population. The nutrition situation of children deteriorates progressively through the first two years of life. There is a critical window of opportunity to prevent undernutrition from before pregnancy to the first two years of life. Therefore, the first 1,000 days comprising the prenatal period and the first two years of life are crucial to make a lifelong lasting difference by breaking the intergenerational cycle of undernutrition (UNICEF, 2009).
Reduction of child malnutrition is one of the prime challenges that India faces. The burden of malnourished children in India is amongst the highest in the world. India ranked 96 out of 119 countries in the Global Hunger Index (GHI) developed by the International Food Policy Research Institute (IFPRI) in 2006, and where child malnutrition is concerned, it ranked 117 among 119 countries (Braun, Ruel, & Gulati, 2008). That malnutrition undermines economic growth and perpetuates the vicious circle of poverty has been well established. This occurs due to multiphasic loss, that is, direct loss to productivity because of weak physical status, indirect loss from