Top Highlights Of NFHS-5 Report: Malnutrition And Anaemia Have Increased In The State Of Gujarat Since 2015

New Delhi: Gujarat is one of India’s most urbanised states in India, with 43 percent of the population living in urban areas, according to the state government. The state is home to more than 60 million people (5 percent of the population of India as per the population census of India, 2011). But, according to the recently released report – National Family and Health Survey (NFHS-5), Gujarat is also known as one of the states facing huge challenges in dealing with malnutrition and anaemia. As per the report, malnutrition parameters such as stunting (that refers to low height for age) and wasting (that refers to low weight for age) have shown a spike when compared to the earlier edition of the NFHS report from 2015-16. Along with malnutrition trend, as per the latest report, the state is also tagged as one of the poor performing state in the country when it comes to anaemia in children under five years age.

Here’s a quick look at Gujarat’s performance in terms of health parameters from NFHS-5 report:

Also Read: Policy Makers Need To Focus On The First 1,000 Days Of Life: Experts React To NFHS-5 Survey Trends

Malnutrition: Gains Made In NFHS-4 Reversed In NHFS-5

According to the report, the proportion of the children under five years of age, among those surveyed, who are malnourished increased in Gujarat in 2019-20 as compared to 2015-16 data. NFHS-4 had reported an improvement in the proportion of children who were stunted or had low-height-for-age as it declined by 12.6 per cent from 51.1 in NFHS-3 (2005-06) to 38.5 per cent. However, in 2019-20, stunting, which has prolonged adverse effect on child health affecting physical and cognitive development has seen a marginal increase of 0.5 per cent in children under 5 years – from 38.5 per cent in 2015-16 to 39 per cent in 2019-20.

Child severe wasting reflects acute undernutrition and refers to children who have low weight for their height. This parameter has also shown an increasing trend in the state. The proportion of severely wasted children has increased by 1.1 per cent – from 9.5 per cent in 2015-16 to 10.6 per cent in 2019-20.

When it comes to the proportion of underweight & overweight children, Gujarat has again seen an increase. While about 39.3 per cent of the children surveyed were underweight in 2015-16 which was an improvement from the NFHS-3 figure of 44.2 per cents, the proportion increased to 39.7 per cent in 2019-20, showing an increase of 0.4 per cent in five years.

Obesity among children has also doubled from 1.9 per cent in 2015-16 to 3.9 per cent in 2019-20, according to NFHS 5.

Malnutrition trends in the state of Gujarat in last five years

The irony is that despite numerous schemes and policies in place, the state has still not able to decrease instances of malnutrition. Last year, in the month of September which is also celebrated as Poshan Month (Nutrition Month) by the government of India, Gujarat Chief Minister Vijay Rupani launched ‘Purna’ project in the state with an aim to eliminate malnutrition among girls in the age group of 14 to 18. This year, during the Poshan Abhiyan month, the state Launched ‘Gujarat Poshan Abhiyan 2020-22’, and made a resolution to end malnutrition completely in the state. 

Back then Chief Minister Vijay Rupani had also announced a cash reward of Rs 12,000 for anganwadi workers and said, 

The anganwadi which will help achieve best results and will do their best to eradicate malnutrition in the coming years from the state, according to parameters and norms set as per third party assessment, will be awarded at the end of the year with a cash prize of Rs 12,000. Apart from their salaries, the anganwadi worker, ASHA worker and the ANM worker will each get this reward money.

Apart from the schemes and programmes aimed at tackling malnutrition, the government earlier this year had also decided to include toor dal (Pigeon Pea), a source of protein and other nutrients in the list of groceries that are sold at subsidised rates through the Public Distribution System (PDS) under the National Food Security Act, 2013. The decision was taken while presenting the state budget for the financial year 2020-21 in A bid to combat the problem of malnutrition in the state.

Talking about the inability to reverse the trend in the state of increasing instances of malnutrition, Dr. Sujeet Ranjan, Executive Director, Centre for Food and Nutrition Security (CFNS) told NDTV,

In Gujarat, trends have indicated a slight decline in wasting while an increase has been reported in severe wasting which is a serious matter of concern for public health functionaries. Wasting is easily reversible once the impact of infectious disease recedes and health status improves. Severe wasting, however, requires concerted medical attention along with appropriate nutritional intake.

On the issue of various policies being in place in the state and yet Gujarat not seeing an improvement, Mr Ranjan added,

Yes, there are various initiatives that have been taken up by the Gujarat government. But the state needs to enhance these schemes and programmes through community-based service-delivery platforms and ensure everyone is getting access to these. In order to improve malnutrition among children in the age group 0-6 years, more focus needs to be given on the first 1000 days of life through multi-sectoral and community-based approaches. The counselling of caregivers especially by health functionaries at the centre and frontline workers during home visits could contribute significantly to better nutrition outcomes.

On the other hand, Dr. Sheila Vir, Founder Director, Public Health Nutrition and Development Centre, feels that though the state has overall good household environment in terms of electricity, water, sanitation, women status and coverage of women and child health services yet there has been an increasing trend in malnutrition parameters, which can be attributed to the state not utilising the available resources in a mindful way.

High Prevalence Of Anaemia Among Women And Children

Gujarat is the poor performing state in the country when it comes to anaemia in children under five years old as compared to NHFS 4 (2015-16). Anaemia among children aged 6-59 months increased to 79.7 per cent from 62.6, an increase of 17.1 per cent in five years. Whereas, anaemia in non-pregnant women increased to 65.1 per cent from 55.1 per cent  and in expecting women it increased to 62.6 per cent from 51.3 per cent.

As far as men are concerned, in the age of 15-49 years Anaemia increased to 26.6 per cent from 21.6 per cent and in 15-19 years category, it increased to 36 from 31.9.

This is not the first time, Gujarat has seen such a trend. Back in 2015-16, according to the Nutrition Atlas which has been prepared by the Hyderabad-based National Institute of Nutrition, Gujarat was  among the top 15 Anaemic states of India, with a higher percentage of anaemic women than the national average of 53.1 per cent.

Also Read: Anaemia Continues To Rise Among Women Of Childbearing Age And Children In The Country, Shows NFHS-5

In Gujarat, Anaemia among children, women and men have shown a rise in last five years

This is not the first time, Gujarat has seen such a trend. Back in 2015-16, according to the Nutrition Atlas which has been prepared by the Hyderabad-based National Institute of Nutrition, Gujarat was  among the top 15 Anaemic states of India, with a higher percentage of anaemic women than the national average of 53.1 per cent.

Dr. Sujeet Ranjan added,

Anemia among women and children remains a major concern across India, especially in Gujarat as we have seen in last few years that the state has  witnessed a sharp rise. I think, the state desperately needs to focus on providing Iron Folic Acid supplements to its pregnant women. We have to understand that fighting anaemia among children alone will not help us check its prevalence. Until we target young girls and to-be mothers, the population will continue to be iron deficient.

Dr Ranjan also said that a weak mother will have an effect on the whole household as if she is suffering from exhaustion and susceptible to infections, she will have an effect on children and elderly as in Indian households it is women who take care of the house. He added,

The role of Civil Society Organisations, Self Help Groups, and Panchayati Raj Institutions is even more important as they can enhance availability, accessibility, and counselling for proper utilisation of services, and build awareness on locally available foods, and promotion of appropriate dietary habits. The counselling of caregivers especially by frontline workers during home visits could contribute significantly to better anaemia control outcomes.

Women In Gujarat Are Adopting Hygienic Method During Menstruation

NFHS-5 has revealed some increase in menstrual hygiene among women between 15 to 24 years of age in 2019-20, compared to NFHS-4. The state saw a jump of 5.5 per cent in this area as 65.8 per cent of the women surveyed in the said age group were using hygienic methods of menstrual management as compared to 60.3 per cent in NFHS-4.

Infant And Child Mortality Rate Shows A Decline

The NFHS-5 data shows a declining trend in Infant Mortality Rate (IMR), which is the number of babies less than one year of age dying per 1,000 live births, and Under Five Mortality Rate (U5MR), which refers to the number of children dying before reaching the age of five years per 1,000 live births.

According to the NFHS-5, infant mortality rate (IMR), saw a decline by 8.7 per cent from 2015-16 to 2019-20 – from 34.2 deaths per 1,000 live births in 2015-16 to 31.2 deaths per 1,000 live births in 2019-20. However, in the context of rural areas, the state was still among the bottom seven states with 33 IMR.

Deaths of infants in the state have always made headlines, for example, in 2017, in the month of October, 18 new born babies succumbed to death in Ahmedabad Civil Hospital because they were underweight. In 2019, the Gujarat government told the legislative assembly in the February session that more than 1000 children died in Adani hospital in Kutch in the last five years. Even, in the last three months of 2019, according to the reports, there have been deaths of almost 200 children and infants in two government hospitals in Rajkot and Ahmedabad in the state.

According to NFHS-5, Gujarat’s  under-five mortality rate (U5MR) is at 37.6 deaths per 1000 lives in 2019-20, down from 43.5 deaths per 1,000 live births in 2015-2016.

The NFHS-5 data also shows that institutional deliveries increased in the state from 88.5 per cent in 2015-16 to 94.3 per cent in 2019-20.

Basanta Kumar Kar, recipient of the Global Nutrition Leadership Award added,

There are reported cases of child deaths due to malnutrition or malnutrition as an underlying cause across many states in India and not just Gujarat. I think, right to survive and thrive should be a top policy level commitment. It is high time, to make nutrition as a top investment priority, Poshan Abhiyaan for Jan Andolan has to be realised at the ground. Working on just and equitable governance, the right to survive and thrive, program delivery effectiveness, data driven management and Atmanirbhar Poshan(Nutritional self-reliance) are the quintessence. 

Gujarat sw a decline of 8.7 per cent from 2015-16 to 2019-20 in Infant Mortality Rate in last five years

Gujarat’s Under-Five Mortality Rate (U5MR) saw a decline of 13.5 per cent in five years

Also Read: There Has Been Drastic Rise In Obesity Among Children Under 5-Years In 20 States, Reveals NFHS 5 Report

Increased Immunisation

According to the survey, there has been an improvement of 25.9 per cent in full vaccination coverage among children aged 12-23 months, among those surveyed in Gujarat in 2019-20 as compared to 2015-16. It has increased from 50.4 per cent in NFHS-4 to 76.3 per cent in NFHS-5. According to the Ministry of Health and Family Welfare, full immunisation implies vaccinating children with BCG (Bacille Calmette-Guerin) which is a vaccine for tuberculosis (TB), vaccines to prevent measles – MMR (measles, mumps, and rubella) and three doses each of polio (excluding polio vaccine given at birth) and DPT (diphtheria, pertussis, and tetanus).

Infant And Child Feeding Practices Shows A Reverse Trend

For the state Gujarat, another reverse trend has been seen in infant and child feeding practices when compared to the data recorded under the NFHS-4. Among the children surveyed, about 37.8 per cent of the children were breastfed within one hour of the birth in 2019-20 as compared to 49.9 per cent in 2015-16. However, there has been an increase of about 9.2 per cent in the proportion of children being exclusively breastfed in 2019-20 (65 per cent) as compared to 2015-16 (55.8 per cent).

Along with this, there has been a marginal gain in the proportion of children in the age group 6-23 months receiving an adequate diet from 5.8 per cent in NFHS-4 to 5.9 per cent in NFHS-5. But, the percentage of children receiving the adequate diet is still very low as compared to other states.

Improved Access To Drinking Water And Sanitation

According to NFHS-5, about 97.2 per cent of the sample population has access to drinking water in Gujarat as compared to NFHS-4 (95.9 per cent). According to the Union Health Ministry, the sources of drinking water include piped water in the residence or piped to the neighbour, public taps, tube-wells, dug-wells, rainwater tanks, community RO plants among others.

The survey also revealed an increase in per cent of the population surveyed with access to an improved sanitation facility. There has been an increase of 10.4 per cent when compared to the population having access to toilets in NFHS-4 which was 63.6 per cent.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.