Malnutrition is an unspoken diagnosis in India’s pediatric hospitals

July 30, 2016

By Harman Boparai

Editor's Note: This is the fifth in a series of posts about child health in India, where, in 2011, 1.7 million children under the age of 5 died. Health reporting fellow Harman Boparai travels to India, where he once practiced as a physician, to take a deeper look at child health in his home country. "A Doctor's Notes" is part of a GlobalPost Special Report titled "The Seven Million," about the many challenges faced worldwide in an effort to reduce child mortality.

PANNA and NEW DELHI, India — The pediatric ward at Panna District Hospital was cramped with the bustling crowd of patients and their families. Not a single bed was empty. Three-year old Deeksha, in the hospital for the seventh day, was two beds away from the door.

With sunken eyes and shriveled skin, she lay listless next to her mother amid all the commotion. She weighed barely 15 pounds, and had been diagnosed with chronic diarrhea as well as primary tuberculosis.

Directly opposite Deeksha lay another 3-year-old, Chandini. At 16 pounds, she was also severely underweight, and suffered from a skin infection. I walked with Dr. LK Tiwari, the only pediatrician in the district, as he took his rounds. The families of the children stood expectantly as he went from one bed to the next, just a foot or two apart from each other.

The children suffered from different ailments and came from different villages. But most all of them had one thing in common: they were severely undernourished. Malnutrition is so common at Panna District Hospital that the staff takes it for granted.

“Most children who come are malnourished, and the chances of them not surviving serious illnesses double because of their low weight,” said Dr. Tiwari as he examined the weight chart of another child.

Globally 165 million children under 5 years of age were stunted in 2011. That means that one in four of the world's children didn’t get the right food or nutrients just to grow normally. And one in every three malnourished children in the world lives in India.

Malnutrition for young children has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development. Their immune system is weaker, leaving them more vulnerable to disease. For instance, they're five times more likely to die from diarrhea. Poor nutrition is associated with nearly half of deaths for children under five — 3.1 million children each year.

As I left Panna, I was humbled by the hardship that people went through on a daily basis and the grave risk that the children were facing because their families were entangled in a web of socioeconomic stagnation and extreme poverty. With these thoughts, I traveled to the capital of the country, New Delhi, to ask people who had been working on these issues what they thought.

At Save the Children India, which works in 13 Indian states to improve maternal and child health, I met Shireen Miller. Miller, the nonprofit’s director for advocacy, said the implementation of government food security programs was vital to survival of children in the country.

“Malnutrition is a critical factor in child survival,” she said. “When we say that a child dies of illnesses like diarrhea and pneumonia, it is because of the fact that they’re malnourished, which has reduced their ability to withstand that illness.”

In India, around 46 per cent of all children under 3 are too small for their age, or stunted, and 47 per cent are underweight, according to UNICEF — many of them being severely malnourished. The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 percent) and Kerala among the lowest (27 percent).

To counter the trend, the Government of India started a program under the banner of Integrated Child Development Services, which aims to improve the nutrition of poor Indian children. In addition to providing immunization and supplementary nutrition, the program provides pregnant women and mothers of young children with health and nutrition education.

Around one third of all adult women are underweight. Inadequate care of women and girls, especially during pregnancy, results in low birth weight babies. And with nearly 30 percent of all newborns having low weight at birth, it leaves them susceptible to complications and remains a major contributor to child death in India.

When I came back to my home state of Punjab for the last leg of my journey, I attended a conference commemorating World Breastfeeding Week. Dr. Surat Kaur, a gynecologist who has been practicing in Amritsar for the last three decades, spoke of the importance of extensive nutrition counseling of women.

“With demonstration of nutritious recipes using readily available, low-cost ingredients we can ensure that the poorest people can access healthy food,” Dr. Kaur said.

As she talked, I thought about what it would take to meet the dietary needs of pregnant women, newborns and children. Even with schemes like India’s midday meal program, which provides hot, cooked meals to children in over a million schools, malnutrition remains a persistent problem. And it’s not just in this country.

Across the developing world, 66 million children attend primary school hungry. Malnourished children are less likely to perform well in school. They’re more likely to grow into malnourished adults and are at greater risk of for disease and early death.

The World Food Program calculates that $3.2 billion is needed per year to reach all 66 million hungry school-age children. That is less than 0.2 percent of the world’s military expenditure.

I cannot imagine not getting enough to eat and having to go to school hungry when I was that young. The world produces enough food to feed everyone, but, without help, where is a child to find some?

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