People often ask me about the biggest health problem I faced while working for Deep Griha in slums of Pune. Without doubt, the answer is malnutrition. Sure, many kids had other problems, but malnutrition, and complaints secondary to malnutrition, outnumbered all other problems.
This week’s Economists article on malnutrition in India
Today I read an article in The Economist, great reading btw, about malnutrition in India. To no surprise of mine, the article expressed its worries about the nutritional status of India’s population. It quotes Mr Lawrence Haddad, the director of the institute of development studies at Sussex University, as calling India an “economic powerhouse, but nutritional weakling”.
Despite India’s impressive economic growth in the last two decades, Indians have not started eating any better. Recent figures show that nearly have of the children under three, weigh less than they should. Given the increase in wealth, an increase in the nutritional status would have been the expected course. While the dalits (former untouchables) and tribal peoples carry the heaviest burden, even socioeconomically better of children are not necessarily on their target weight. The economist reports that a third, of the wealthiest 20% of Indian children, are malnourished. Although it leaves me to wonder what the figures would look like for the 10 or even 5% wealthiest children; this, together with the fact that the corruption and slower agricultural growth alone do not explain why nutrition hasn’t been able to progress, suggest that other factors play an important role. The economist suggests that the low status of woman and habits might be amongst them (1).
Malnutrition of Deep Griha’s children
During my time in with Deep Griha, with the enthusiastic help of another volunteer, I collected some information about the nutritional status of children involved with the organization. Deep Griha uses a weight for age chart to monitor the children’s weight. The results of our very modest effort speak for them self, keep in mind that all these kids receive at least one meal per day on days they go to the crèche/balwadi.
Data was collected of all children of six years or younger who attend a Balwadi or Crèche in Deep Griha and who had a personal health card. In total 305 children and their records were found. Of those, 30 children were excluded from analyses because their date of birth was unknown and 2 were excluded because there was no weight recorded in the last 6 months. In the occasion a child was weighted more than once in the 6 months prior to the date of information gathering, the most recent weight was used for analyses. Of the remaining 273 children, only 112 had a normal weight, less than 50%! 91 Children are slightly underweight (1st percentile), 48 moderately underweight (2nd percentile) and 22 children severely underweight (3th percentile).
Deep Griha uses a slightly out-dated weight for age chart with the consequence that some children who are now considered slightly underweight would in reality have a normal weight. On the other hand the some children who currently fall in the moderately underweight group are in reality severely underweight. Despite this issue I think these numbers are a ‘good’ illustration to the article from the Economist.
Behind the numbers
Behind all those numbers is a personal story; a child that does not develop to his or her full potential because he or she needs more nutrients and energy to stay healthy to grow and to ripen their brain. A mother who knows her child needs to eat more, but she simply cannot afford to feed her child properly. They are not the ‘hunger bellies’ and ‘hollow eyes’ people associate with malnutrition. The symptoms are often a lot more subtle; however, the consequences are none the less present, and very much so.
Nutritional standards
Nutrition is so simple, yet the solution to malnutrition is so hard. I am sure though, that obesity is not the solution. Despite the estimated one-third underweight kids of the so called 20% ‘well to do’, I’ve unfortunately seen a lot of obese ‘rich’ kids. I think that while malnutrition deserves all the attention it gets, and more, obesity should not be overlooked. While it is far less of a problem now that malnutrition is, it should not be ignored. At the present time, being fat seems a bit of a status symbol of wealth. No one will benefit if obesity is going to replace malnutrition as a health concern, especially not so with the natural predisposition of Diabetes Mellitus in the Indian population.
While I was in India I did encounter a lot of misunderstandings about proper nutrition. Although I am not suggesting to have a solution, I do think that nutritional education should be part of it. What, and how much, makes a healthy diet?
Food for thinking 
