Malnutrition is responsible for nearly 45 per cent of deaths in children under-five, according to new research report published as part of The Lancet Series on maternal and child nutrition. The research shows that malnutrition is responsible for around 3.1 million deaths in children under five annually.

Results estimate that stunting (reduced growth) affected at least 165 million children worldwide in 2011 while at least 52 million children were affected by wasting (low weight for height), and 100 million children were underweight. Over 90 per cent of these were in Asia or Africa, with Africa the only major world region where the number of children with stunting increased.

A study based on a survey of the height and weight of more than one lakh children across six States in India last year had found that as many as 42 per cent of under-fives were severely or moderately underweight and that 59 per cent of them suffered from moderate to severe stunting. The findings — contained in the Hunger and Malnutrition (HUNGaMA) report by the Naandi Foundation— were described by Prime Minister Manmohan Singh as a “national shame.” Undernutrition affects development of a child, with consequences ranging from poorer school performance to increased susceptibility to infectious disease.

While the adverse effects of premature birth on a child’s survival and development are well-established, the study reveals new findings which show that children born too small for their gestational age — over a quarter (27 per cent) of births in low-and middle-income countries — are also at substantially increased risk of dying. Restricted growth in the womb, due to maternal under-nutrition, is estimated to be responsible for more than a quarter of all newborn deaths. Children born too small are considerably more likely to be stunted a year later, and are also at greater risk of some types of illness as adults.

Maternal undernutrition

In addition to the enormous burden of illness and disease resulting from maternal and child undernutrition, changing diets and patterns of physical activity mean that obesity and overweight are now increasingly affecting many of the countries already suffering the adverse consequences of undernutrition, resulting in a ‘double burden’ of maternal and child disease and illness, the report says.

The authors, led by Professor Robert Black, of Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, performed a comprehensive new analysis of the different causes of maternal and childhood malnutrition to arrive at these conclusions.

Studies were done on breastfeeding practices and deficiencies of vitamins and minerals such as vitamin A, zinc, iron and calcium. They also analysed the consequences of malnutrition, including stunting, wasting and underweight (low weight for age), all of which result in increased risk of death and illness for both pregnant women and children.

Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential.

Maternal undernutrition contributes to foetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life.

Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.

The Lancet reports that undernutrition reduces a nation’s economic advancement by at least eight per cent because of direct productivity losses, losses via poorer cognition and losses via reduced schooling.

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