Micronutrient deficiency and Severe Acute Malnutrition (SAM) are important public health challenges and need to be addressed in right earnest. Micronutrients are not only important for development and growth but also for maintaining the immunity standards, said experts at a webinar organised by industry chamber ASSOCHAM in collaboration with CMAM Association of India recently. The webinar witnessed participation of all important stakeholders from the Government, Civil Society and Industry.
ASSOCHAM – CMAM Association Webinar
Speaking on the occasion, Dr. Sumita Ghosh (Additional Commissioner, In-charge Child Health, Ministry of Health & Family Welfare, Government of India) stated that nutrition was not merely consuming an adequate amount of food but also getting adequate macro and micronutrients. Macro and micronutrients were important not just for the survival of the child but also for a child to develop normally.
According to her, the improvements in National Family Health Survey-5 (NFHS-5) were unfortunately marginal and not on the expected lines. The levels of Micro nutrient deficiency were alarming with 67% of children at the national level being anaemic and that’s a big challenge to meet.
Malnutrition and infection are part of a vicious cycle. 70% of child mortality is indirectly caused by lack of nutrition. Malnutrition in children takes several forms – underweight, stunted or wasted. Severe Acute Malnutrition is an intergenerational problem. Women who are undernourished during pregnancy have low birth weight (LBW) babies. Nutrition of girl child during and after pregnancy is the key, she added.
Dr. Sujeet Ranjan of Tata Trusts stated that malnutrition remained a major threat to the survival, growth and development of children in India. Micronutrient deficiencies or hidden hunger and the negative consequences of a diet lacking in essential vitamins and minerals/ trace elements continued to pose significant public health challenges.
Despite the fact that ICDS, the community based program of the Government, was the largest platform in the world for delivery of supplementary nutrition through ready to eat meals, there were over 8 million SAM children in India.
According to him, Community based Management of Acute Malnutrition (CMAM) was the globally recommended approach for SAM. Unfortunately, Community Management of Acute Malnutrition was yet to be adopted as a routine part of the government system since there wasn’t enough evidence with the policy makers and therefore there was no national policy around it yet.
Representing CMAM Association of India, Shilpee Bachhalsa stated that the Government needed to be complimented for its efforts towards improving nutrition levels through the PDS, Mid-Day meals, Take Home Rations and Hot Cooked Meals etc. Government is also seized of the fact that the absence of micronutrients and energy content in the dietary practices was a matter of concern and needed focussed intervention.
Severe Acute Malnutrition is the most extreme and visible form of malnutrition. SAM children require specific micronutrient and energy dense foods and supplements. While various initiatives, including facility based management of SAM children have been taken up by the government, there are only 1200 Nutrition Rehabilitation Centre (NRCs) in India which can cater to less than 5% of SAM children, she added.
According to her, 90% of the SAM children without complications do not require treatment at NRCs and can be treated at the community level itself. There is a need for national CMAM guidelines in handholding states in their efforts towards treating SAM. The CMAM guidelines should incorporate best practices from the various state programs run successfully. Rajasthan executed one of the most successful CMAM programs within which Ready-to-Use Therapeutic Foods were given to children.
The industry can bring manufacturing expertise, research and development and scale to the table for manufacturing products that the government determines, she added
A Laxmaiah (National Institute of Nutrition), Dr. Alka Jadhav (Sion Hospital) and Harish Chand (World Vision India) also put forth their expert views on the subject.
According to Dr. Alka Jadhav, SAM was a major public health challenge. In the Sion Hospital, they used self-developed Energy Dense Nutrition Supplements which contained 21 micronutrients (Type 1 and 2) to treat SAM children. It is the first of its kind project in India and has been going on for the last 10 years, she said.