From: sanjeev nayyar
Date: Mon, Mar 18, 2013 at 5:59 PM
Subject: What about malnutrition in Gujarat? by Bibek Debroy in Eco Times
To: esams Nayyar
The term malnutrition is tossed around indiscriminately, without people paying much attention to measurement and data. Within malnutrition, there can be under-nutrition (either protein or energy), over-nutrition (consumption of too many calories) or abnormal nutrient loss. WHO also has reports on overweight children and childhood obesity. When we say malnutrition, we really mean under-nutrition of the protein-energy type. For a certain age, we know what the median height (or weight) should be and deviations from that are graded according to severity of under-nutrition. When we look at WHO's data on under-nutrition, they are separately given for height, weight, weight/height and BMI. What is the data source for malnutrition in Gujarat figuring so prominently in the discourse? As far as I can make out, most of it can be traced to IFPRI's "India State Hunger Index", published in February 2009. In that aggregate index, Gujarat is 13th out of 17 States ranked and is followed by Chhattisgarh, Bihar, Jharkhand and Madhya Pradesh. But this is a composite hunger index, based on calorie consumption, under-5 under-weight children and under-5 mortality rate. Since we are on malnutrition, we should concentrate on under-5 under-weight children. In that, 44.7% of Gujarat's children were under-weight, compared to an all-India figure (of the States included) of 42.5%.
This isn't that good. What's the data source? Here are two quotes from the IFPRI paper. For under-5 under-weight children, data used were "the third round of the National Family Health Survey (2005–06) for India (referred to as the NFHS-III data)". In addition, "We used the World Health Organization (WHO) 2006 international growth reference and NFHS-recommended sample survey weights to estimate the proportion of children in each state whose weight-for-age was less than two standard deviations below the WHO reference". Hence, data are for 2005-06, a fact often missed by those who continue to cite the numbers in 2013. As a minor point, the WHO database, as mentioned earlier, provides information on height, weight, weight/height and BMI and you not only have 2SDs below, but also 3SDs below. On both height and weight, Gujarat is worse than the all-India average. But on weight/height and BMI, Gujarat is slightly above the all-India average. Those BMI figures also tell us that while 15% of Gujarat's under-5 population is 2SDs below, 2.3% is also 2SDs above. In other words, there are assorted malnutrition indicators and they don't necessarily show similar trends.
The more interesting question is one IFPRI doesn't answer, because it is a snapshot at one point in time. Have there been improvements over time, especially in the high growth years? Because we are stuck with 2005-06, we don't know an answer to that. Here is a quote from Vol.1 of the 12th Five Year Plan document. "India has had the largest and the longest running child development programme in the world in the form of ICDS, but the problem of malnutrition remains large. Unfortunately, the latest data on child malnutrition are from the National Family Health Survey (NFHS-3) conducted in the period 2005–07 which pre-dates the Eleventh Plan. The full impact of the Eleventh Plan programmes on this aspect of human capability is therefore not yet known. Surveys undertaken by the State Governments seem to suggest that malnutrition has fallen in many States. The next Annual Health Survey for 2012–13 will include data on malnutrition and these data will provide a reliable basis for assessing what has happened since NFHS-3." Therefore, we don't know. Yes, there was Naandi Foundation's HUNGAMA (hunger and malnutrition) survey in 2011. But that didn't include any districts from Gujarat. Bihar, Jharkhand, MP, Orissa, Rajasthan and UP were covered.
We are only left with the recent CAG audit report on the working of the ICDS. This has a moderately malnourished category and a severely malnourished category. Let's take the former. The percentage of moderately malnourished children in Gujarat was 69.83% in 2006-07, 60.74% in 2007-08, 57.97% in 2008-09, 53.88% in 2009-10 and 34.21% in 2010-11. Data given in CAG report are not comparable to something like a proper health survey. However, the suggestion is clear enough. There has been an improvement over time and the drop in 2010-11 is quite sharp. Therefore, until we have evidence to the contrary, we should conclude that while the malnutrition record in Gujarat may have had a low base, there have been incremental improvements. In any event, the debate should focus on increments, not the base and also remember the timeline for data.
sanjeev nayyar
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