The government is reviewing parameters used to measure stunted growth in children to see how they can be “Indianised” according to anthropology of Indians, sources said.

Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection and inadequate psychosocial stimulation. It is presently calculated by taking measurements of height.

India tops the list of countries with 46.6 million children who are stunted, followed by Nigeria (13.9 million) and Pakistan (10.7 million), according to the Global Nutrition Report 2018.

According to the National Family Health Survey-4 (NFHS-4), 38.4 per cent children under five years of age are stunted or low height-for-age and 21 per cent wasted or low weight-for-height in India.

As many as 48.3 per cent of children in Bihar under five are stunted, the survey said.

But official sources said the anthropology of Indian children varies in different parts of the country and there cannot be standard parameters to measure stunting in children across all states, especially in a diverse country like India.

“The government in collaboration with the Harvard T.H. Chan School of Public Health and World Health Organisation is looking into how these international parameters can be Indianised,” an official source said.

India also accounts for 25.5 million children who are wasted, followed by Nigeria (3.4 million) and Indonesia (3.3 million).

Wasting, or low weight-for-height, is a strong predictor of mortality among children under five years of age. It is usually the result of acute significant food shortage or disease.

Wasting and stunting are associated with increased mortality, especially when both are present in the same child. Added to this, it is becoming increasingly clear that children who are wasted are more likely to become stunted and children who are stunted are more likely to become wasted.

In a bid to better understand the food needs and requirements of malnourished children from different states, the Centre is also studying locally available nutritious food that would not only be healthy but also cost-effective and conveniently obtainable for the families, officials said.

“The government is also working towards educating children and parents about the access of locally available nutrient-rich food that would help them understand what would benefit them in terms of nutrition,” the official said, adding that special focus is being given in the ‘Rashtriya Poshan Maah’ (national nutrition month) during which the government aims to reach out to 10 crore beneficiaries.

A study in diversity

India holds almost a third (31 per cent) of the world’s burden for stunting, and because India is so diverse from state to state, it is important to understand how and why stunting prevalence differs, said the Global Nutrition Report 2018.

The International Food Policy Research Institute (IFPRI) used district-level aggregate data from the 2015-16 National and Family Health Survey covering 601,509 households in 604 districts in India to understand the causes of the spatial variation.

Researchers used mapping and descriptive analyses to understand spatial differences in distribution of stunting. The mapping showed that stunting varies greatly from district to district (12.4 per cent to 65.1 per cent), with 239 of 604 districts having stunting levels above 40 per cent.

Using regression decomposition models, the study compared districts with low (less than 20 per cent) versus high (more than 40 per cent) burdens of stunting and explained over 70 per cent of the difference between high and low-stunting districts.

The study found that factors such as women’s low BMI (body mass index) accounted for 19 per cent of the difference between the low versus high-burden districts. Other influential gender-related factors included maternal education (accounted for 12 per cent), age at marriage (7 per cent) and antenatal care (6 per cent). Children’s diets (9 per cent), assets (7 per cent), open defecation (7 per cent) and household size (5 per cent) were also influential.

This study is important in that it reinforced the multisectoral nature of stunting by highlighting that differences between districts were explained by many factors associated with gender, education, economic status, health, hygiene and other demographic factors.