Status of micronutrient malnutrition in India and intervention strategies to combat them.

Abstract

During the last fifty-five years, a significant improvement in the health and nutritional status of population in the country, particularly in relation to micronutrient malnutrition, has taken place in the country. The florid clinical manifestations of micronutrient deficiencies such as beriberi, scurvy and pellagra which used to be major public health problems in the 1950s and early 60s, have now declined or disappeared. Keratomalacia, a major cause of nutritional blindness in children till the 1960s, is now distinctly uncommon. One of the most important achievements in the country- in the field of nutrition has been the banishment of the acute food shortages and famines. This has been mainly due to improvement in agricultural production, availability of all weather road to difficult and drought and flood prone areas, expansion of irrigation facilities and maintenance of adequate buffer stocks. A few pockets of acute hunger may still emerge, especially when there is poor rainfall in the area but these are efficiently managed by the public distribution system and similar government initiatives. The "Green Revolution" has been boon to our population. The major nutritional problems that elude solution despite the increase in food availability and implementation of control programs are protein energy malnutrition (PEM), iron deficiency anemia (IDA), iodine deficiency disorders (IDD) and vitamin A deficiency (VAD). These may not be overtly life threatening but they have serious functional consequences and implications for human resource development in India. In this communication we discuss the current scenario, suggest what can be done to consolidate the gains achieved so far and propose future initiatives that may be undertaken. Protein Energy Malnutrition PEM is the most widely prevalent form of malnutrition among children. It is an underlying cause of high child morbidity and mortality in underprivileged communities. PEM in young age is associated with irrreversible effects on motor and cognitive development. According to NNMB data there has been a decline in the prevalence of severe forms of PEM, i.e., Marasmus from 1.3 to 0.6% and Kwashiorkor from 0.4 to 0.1% between 1975-79 to 198890.1 However, the moderate forms of PEM continue to be high. According to NFHS-2 survey report (1998-99), almost half of children under three years of age (47%) are underweight, and a similar percentage (46%) is stunted. Wasting is less prevalent affecting 16% of children under three years of age. 2