WHO recommends measuring weight of the child for a given height

In 2009, the Central government issued an order asking the Integrated Child Development Scheme to collect data using the World Health Organisation standards for nutrition. However, till date, the Anganwadis in Puducherry continue to use the old scheme of measurement which estimates the level of malnourishment based on different grades.

The WHO growth standards recommend the use of a scale that measures weight of the child for a given height, which is the norm recommended by the Government of India as well. Till date, however, Anganwadis in both Tamil Nadu and Puducherry have not been measuring the height of children that are registered in the ICDS.

In the Union Territory, the levels of malnourishment of children that are registered with the Anganwadis are measured using the old scale of grades. The measurement of grades is based only on weight for a given age. When a child weighs 90 per cent or more of the required weight for a given age, they are labelled normal. Children between 80 per cent and 90 per cent of the recommended weight for their age is labelled Grade one and so on.

Children weigh less than half of their recommended weight for their age are labelled Grade four or severely malnourished. These standards were set in the 1970s and are still followed in the Union Territory, former coordinator for the Food and Nutrition Board Thirunavukkarasu said.

Unfortunately, just measuring the weight for a given age will not indicate the level of malnourishment, because if a child is extremely tall, but very thin, they will not be considered. Because of the flaws in the system, the Government of India adopted the new growth standards. Since they were adopted, Anganwadi workers received training in the use of the new standards, but so far it has not been implemented, he said.

According to the data currently available, Puducherry has no children with severe malnourishment and in general most of the children between the ages of six months and three years are either normal or acutely malnourished, an official from the Department of Women and Child Development said.

Speaking to The Hindu on the subject, Assistant Professor of the Department of Community Medicine at the Indira Gandhi Government Medical College and Research Institute Hemant Shewade said, even though the levels of severe acute malnourishment in the Union Territory may be lower than in Tamil Nadu or the rest of the country, it is not possible to say it does not exist.

According to a study conducted by him on the prevalence of Severe Acute Malnutrition (SAM) among under-five children in the slums of Muthialpet Dr. Shewade found that even though the prevalence was much less than the national average of six per cent, there were still cases of SAM.

Around four per cent of the children that were surveyed in the area exhibited SAM, which is measured using the child’s weight for a given height, mid upper arm circumference, visible severe wasting or malnutrition with bipedal oedema. Of the 305 children surveyed, 3.6 per cent of them were found to have SAM based on the weight for height criteria.

Being below weight for a given height is termed as wasting, and around 8.5 per cent of the children exhibited moderate wasting. Of the total, 7.5 per cent of the children were moderately underweight, 4.9 per cent were severely underweight.

In terms of stunting, or height for a given age, 7.8 per cent of the children surveyed exhibited moderate stunting and 5.5 per cent had severe stunting, the study revealed.

Unless the data is collected in a methodical manner, it is impossible to estimate the actual level of malnourishment in the Union Territory. Even if the numbers are much less than the national average, it cannot be said that there is not malnourishment here, Dr. Shewade said.

(This story has been facilitated under the One World-POSHAN fellowship grant)

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