9.27 lakh severely acute malnourished children identified till November last year: RTI
New Delhi: More than 9.2 lakh children in India are severely acute malnourished', with the most in Uttar Pradesh followed by Bihar, according to government data, underscoring concerns that the Covid pandemic could exacerbate the health and nutrition crisis among the poorest of the poor.
An estimated 9,27,606 severely acute malnourished' children from six months to six years were identified across the country till November last year, the Women and Child Development Ministry said in response to an RTI query from PTI.
Of these, Uttar Pradesh counted for 3,98,359 and Bihar 2,79,427, according to the figures shared by the ministry. Ladakh, Lakshadweep, Nagaland, Manipur and Madhya Pradesh reported no severely malnourished children.
Except for Ladakh, none of the anganwadi centres in the other four, including Madhya Pradesh, one of India's largest states, reported any data on the matter, according to the RTI reply.
The World Health Organisation (WHO) defines severe acute malnutrition' (SAM) by very low weight-for-height or a mid-upper arm circumference less than 115 mm, or by the presence of nutritional oedema. Children suffering from SAM have very low weight for their height, and are nine times more likely to die in case of diseases due to their weakened immune system.
The Women and Child Development Ministry had last year asked all states and union territories to identify SAM children for their early referral to hospitals. The figure of 9,27,606 came following that exercise.
The worry is that the numbers could not just be an underestimation but also rise in view of the ongoing pandemic with fears that the third wave could impact children more than others.
"There is rise in unemployment, there is rise in an economic crisis which is bound to have repercussions on hunger and when there is hunger there will be malnutrition. The government has a clear cut protocol and they need to ramp that up," Enakshi Ganguly, co-founder of the HAQ Center for Child Rights, told PTI.
While Uttar Pradesh and Bihar top the list for SAM children, they are also home to the highest number of children in the country. According to 2011 census data, Uttar Pradesh has 2,97,28,235 (2.97 crore/29.72 million) children aged 0-6 years while Bihar has 1,85,82,229 (1.85 crore/18.5 million).
According to the RTI response, Maharashtra reported 70,665 SAM children followed by Gujarat at 45,749, Chhattisgarh at 37,249, Odisha at 15,595, Tamil Nadu at 12,489, Jharkhand at 12,059, Andhra Pradesh at 11,201, Telangana at 9,045, Assam at 7,218, Karnataka at 6,899, Kerala at 6,188 and Rajasthan at 5,732.
The identification of SAM children was done by over 10 lakh Anganwadi centres from across the country.
Ganguly stressed on the role of anganwadi centres in helping improve the nutrition status of the children.
"The anganwadis have to become much more functional and if the possibility of children reaching anganwadis is going to become hard because of lockdowns, then the anganwadis need to reach the children. So what are the plans for that? she asked.
Malnutrition will be a huge comorbidity if what they are saying that children will be affected more in the next wave holds true, then malnutrition will be a huge comorbidity and how are they going to address that?"
Dola Mohapatra, executive director, Rise Against Hunger India, agreed that COVID-19 could further exacerbate the situation with shrinking food diversity and low intake combined with episodes of missing food at times.
He said solutions have to be both home-based care and facility-based care.
"Since SAM has direct connection with food availability, utilisation and awareness the immediate task is to appropriately build linkages with the government systems to ensure families receive not just ration/food, but required education and support," he said.
COVID-19 has been a big impediment in organising community based interventions, so new ways/methods to disseminate info to the mothers and caregivers have to be found out," he said.
Mohapatra also stressed on the need to strengthen Nutrition Rehabilitation Centres (NRCs) which are meant to treat SAM cases
"There are studies that suggest that NRCs have not been very effective. In many cases, we have seen that SAM cases have been discharged early because either the centre could not continue to keep the same case for a continued period, or the caregivers could not stay for a longer duration at the facility, or there was simply not enough supervision by the higher ups."
He also stressed on the need for designing customised menus in consultation with experts for SAM cases and formulating guidelines.
For administrative and operational convenience, as well as for better accountability, SAM cases could be segregated into smaller units and responsibility to manage/coordinate and monitor smaller units could be handed over to independent entities such as medical colleges, local NGOs, women's collectives under the overall guidance of the District/Block health staff," Mohapatra said.
While data is not updated year on year, the last available figure of SAM children is from NFHS-4 (National Family Health Survey) in 2015-16 according to which prevalence of severe acute malnutrition among children was reported at 7.4 per cent.
NFHS-4 gathered information from 601,509 households, 699,686 women, and 112,122 men. Information on 265,653 children below age 5 has been collected in the survey
NFHS-5, released in December last year, which gave figures for 22 states and UTs also presented a grim scenario. It said malnutrition increased among children in 2019-20 from 2015-16 in 22 states and UTs.
Around 13 states and UTs out of the 22 surveyed recorded a rise in percentage of children under five years who are stunted in comparison to 2015-16; 12 states and UTs recorded a rise in percentage of children under five years who are wasted; 16 states and UTs recorded a rise in the percentage of children under five years who are severely wasted and underweight in 2019-20. The NFHS-5 was conducted on 6.1 lakh sample households.
Wasting is low weight for their height among children, reflecting acute undernutrition. Wasting is a strong predictor of mortality among children under five years of age.
To tackle high persistence of malnutrition in the country, the Centre launched the Poshan Abhiyan programme in 2018 to reduce low birth weight, stunting and undernutrition and anaemia among children, adolescent girls and women.
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Lebanese lawmakers pick billionaire Najib Mikati as new PM
Beirut, Jul 26: Lebanon's president appointed a billionaire businessman and former prime minister as the next premier-designate Monday, after Saad Hariri earlier this month gave up attempts to form a Cabinet amid an unprecedented financial meltdown roiling the country.
Najib Mikati's appointment came after he secured the majority of lawmakers' votes in binding consultations President Michel Aoun held with members of parliament.
One of the richest men in Lebanon, Mikati became a favourite for the post after he was endorsed by most of Lebanon's political parties including the powerful, Iran-backed militant Hezbollah group and the other major Shiite party, Amal, led by Parliament Speaker Nabih Berri.
Mikati was also endorsed by former Sunni prime ministers including Hariri, who abandoned efforts to form a government after failing to agree with Aoun on the Cabinet's makeup.
The political deadlock, driven by a power struggle between Aoun and Hariri over constitutional rights and powers of the president and prime minister, has worsened a crippling economic and financial crisis.
It is not clear whether Mikati - widely considered an extension of the political class that brought the country to bankruptcy - would be able to break the year-long impasse over the formation of a new government. He faces Christian opposition, including from Aoun's own bloc, now led by his son-in-law Gebran Bassil, which did not name anyone as a candidate for prime minister.
Lebanon's economic and financial crisis began in late 2019 and has steadily worsened since then. Poverty has soared in the past several months as the situation spirals out of control, with dire shortages of medicines, fuel and electricity. The currency has lost around 90% of its value to the dollar, driving hyperinflation.
Mikati's designation would be the third so far since the current caretaker government headed by Hassan Diab resigned in the wake of the massive explosion at Beirut's port last August. Since then, Diab's Cabinet has acted only in a caretaker capacity, compounding Lebanon's paralysis further.
The first to try to form a government was Lebanon's former ambassador to Germany, Mustafa Adib, who resigned last September, nearly a month after being designated prime minister. Hariri was appointed next and stepped down after 10 months.
Any new government faces the monumental task of undertaking critical needed reforms as well as resuming talks with the International Monetary Fund for a rescue package. The new Cabinet is also expected to oversee general elections scheduled for next year.
International calls have mounted for Lebanese leaders to form a new government, but the international community has refused to help Lebanon financially before wide reforms are implemented to fight widespread corruption and mismanagement.
The investigation into the August 4 port explosion - triggered by the detonation of hundreds of thousands of tons of improperly stored ammonium nitrate - has exacerbated tensions in the small nation amid accusations of political meddling in the judiciary's work. More than 200 people were killed and thousands injured in the blast, which defaced parts of the city.
Mikati, a Sunni billionaire from the northern city of Tripoli, served as prime minister in 2005 and from 2011 to 2013, when he resigned at the height of the Syrian war after a two-year stint in a government dominated by Hezbollah and its allies.
He founded the telecommunications company Investcom with his brother Taha in the 1980s and sold it in 2006 to South Africa's MTN Group for 5.5 billion.
Mikati is supported by France, the former colonial power in Lebanon, and also the United States.
