The World Bank World Bank is a term used to describe an international financial institution that provides leveraged loans to developing countries for capital programs. The World Bank has a stated goal of reducing poverty estimates that India Home to the ancient Indus Valley Civilisation and a region of historic trade routes and vast empires, the Indian subcontinent was identified with its commercial and cultural wealth for much of its long history. Four major religions, Hinduism, Buddhism, Jainism and Sikhism originated here, while Zoroastrianism, Judaism, Christianity and Islam is ranked 2nd in the world of the number of children suffering from malnutrition, after Bangladesh Bangladesh (Bengali: বাংলাদেশ, pronounced /bæŋgləˈdɛʃ/; Bangladesh), officially the People's Republic of Bangladesh (Bengali: গণপ্রজাতন্ত্রী বাংলাদেশ Gônoprojatontri Banglādeśh) is a country in "South Asia." It is bordered by India on all sides except for a small (in 1998), where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.[1] The UN The United Nations Organization or simply United Nations (UN) (Arabic: الأمم المتحدة, French: Organisation des Nations Unies, Chinese: 联合国 / 聯合國, Spanish: Organización de las Naciones Unidas, Russian: Организация Объединённых Наций) is an international organization whose stated aims are estimates that 2.1 million Indian children die before reaching the age of 5 every year – four every minute - mostly from preventable illnesses such as diarrhea, typhoid Typhoid fever, also known as typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella typhi. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. The organism is a Gram-negative short, malaria Malaria is a mosquito-borne infectious disease caused by a eukaryotic protist of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas , Asia, and Africa. Each year, there are approximately 350–500 million cases of malaria, killing between one and three million people, the majority of whom, measles Measles, also known as Rubeola, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include fever, cough, runny nose, red eyes and a generalized, maculopapular, and pneumonia Pneumonia is an inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung and abnormal alveolar filling with fluid (consolidation and exudation). Every day, 1,000 Indian children die because of diarrhea alone. According to the 1991 census India has around 150 million children, constituting 17.5% of India's population, who are below the age of 6 years.
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Introduction
India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1,139.96 million (2009) and growing at 1-4% annually (from 2001-2007).[2] India's economy is growing where its GDP The gross domestic product or gross domestic income (GDI) is a measure of a country's overall official economic output. It is the market value of all final goods and services officially made within the borders of a country in a year. It is often positively correlated with the standard of living, though its use as a stand-in for measuring the growth is 9.0% from 2007 to 2008; since Independence in 1947, its economic status has been classified as a low-income country with majority of the population at or below the poverty line.[3] Though most of the population is still living below the National Poverty Line, its economic growth indicates new opportunities and a movement towards increase in the prevalence In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how common a condition is within a population over a of chronic diseases In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a which is observed in at high rates in developed countries such as United States ^ b. English is the de facto language of American government and the sole language spoken at home by 80% of Americans age five and older. Spanish is the second most commonly spoken language, Canada The land occupied by Canada was inhabited for millennia by various groups of Aboriginal peoples. Beginning in the late 15th century, British and French expeditions explored, and later settled, along the Atlantic coast. France ceded nearly all of its colonies in North America in 1763 after the Seven Years' War. In 1867, with the union of three and Australia For at least 40,000 years before European settlement in the late 18th century, Australia was inhabited by indigenous Australians, who belonged to one or more of the roughly 250 language groups. After sporadic visits by fishermen from the immediate north and discovery by Dutch explorers in 1606, Australia's eastern half was claimed by Britain in 177. The combination of people living in poverty and the recent economic growth of India has led to the co-emergence of two types of malnutrition: undernutrition and overnutrition Overnutrition is a form of malnutrition in which nutrients are oversupplied relative to the amounts required for normal growth, development, and metabolism.[4] The implications of both overnutrition and undernutrition indicates that a country can exert rates of infectious diseases An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants. Infectious pathologies are also and chronic diseases simultaneously: A situation that has not been observed before in history. This new phenomenon of the rising incidence of chronic diseases such as heart disease Heart disease or cardiopathy is an umbrella term for a variety of different diseases affecting the heart. As of 2007, it is the leading cause of death in the United States, England, Canada and Wales, killing one person every 34 seconds in the United States alone.[verification needed], cancer and type II diabetes Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus , or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. While it is often initially managed by increasing exercise and dietary modification, along with the presence of infectious diseases such as pneumonia Pneumonia is an inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung and abnormal alveolar filling with fluid (consolidation and exudation), and tuberculosis Tuberculosis or TB is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in is mainly attributed to rapid population growth and the increase in the countries economy. The increase in income has made it possible for people living in urban areas to have access to a wider range of food outlets, to afford transportation and other luxuries of western society that have led to an increase in fast food consumption and a more sedentary lifestyle.
Undernutrition
According to the World Food Program The World Food Programme is the food aid branch of the United Nations, and the world's largest humanitarian organization addressing hunger worldwide.. WFP provides food, on average, to 90 million people per year, 58 million of whom are children. From its headquarters in Rome and more than 80 country offices around the world, WFP works to help and the M.S. Swaminathan Research Foundation (MSSRF), over the past decade there has been a decrease in stunting among children in rural India, but inadequate calorie intake and chronic energy deficiency levels remain steady.[5]
Today child malnutrition is prevalent in 7 percent of children under the age of 5 in China and 28 percent in sub-Saharan African compared to a prevalence of 43 percent in India.[6] Undernutrition is found mostly in rural areas and is concentrated in a relatively small number of districts and villages with 10 percent of villages and districts accounting for 27-28 percent of all underweight children.[7]
Undernutrition includes both protein-energy malnutrition and micronutrient deficiencies. Undernourishment not only affects physical appearance and energy levels, but also directly affects many aspects of the children’s mental functions, growth and development which has adverse effects on children’s ability to learn and process information and grow into adults that are able to be productive and contributing members of society. Undernourishment also impairs immune function leaving them more susceptible to infection. Children with infections are more susceptible to malnutrition and the cycle of poverty and malnutrition continues. Child malnutrition is responsible for 22 percent of India’s burden of disease..
Micronutrient deficiencies are also a widespread problem in India. The prevalence of micronutrient deficiencies varies in different states, More than 75 percent of preschool children suffer from iron deficiency anemia Iron deficiency anemia is a common type of anemia, and is known as sideropenic anemia. It is the most common cause of microcytic anemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency Vitamin A deficiency is a lack of vitamin A in humans. It is common in developing countries but rarely seen in developed countries. Night blindness is one of the first signs of vitamin A deficiency. Complete blindness can also occur due to retinal injury - Vitamin A has a major role in phototransduction. Approximately 250,000 to 500,000 (VAD). Iodine deficiency is endemic in 85 percent of districts, mostly due to the lack of iodized salt that is common in the developed world. Progress in reducing the prevalence of micronutrient deficiencies in India has been slow. The prevalence of different micronutrient deficiencies varies widely across states.
Most growth retardation occurs by the age of two, and most damage is irreversible. The prevalence of underweight in rural areas 50 percent versus 38 percent in urban areas and higher among girls (48.9 percent) than among boys (45.5 percent).[7]
Overnutrition
At the same time as a large number of population suffers from malnutrition Malnutrition is the insufficient, excessive or imbalanced consumption of nutrients. A number of different nutrition disorders may arise, depending on which nutrients are under or overabundant in the diet, more than 100 million people (11% of Indian population) in India are over-nourished.[8] Over-nutrition can be defined as consuming either too much calories or the wrong types of calories such as saturated fat, trans fat or highly refined sugar which leads to obesity Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index , a measurement which compares weight and height, defines people as overweight (pre-obese) when their BMI is between 25 kg/m2 and 30 and many other chronic diseases.[9] For example, there are over 30 million people with diabetics in 1985 and by next year (2010) India is projected to have 50.8 million diabetics.[10] India is hence considered as the country with the largest population of diabetics.[11] This diabetes (diabetes mellitus Diabetes mellitus —often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn't produce enough insulin, or because body cells don't properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb) is one of the diseases closely associated with overweight.[12] The direct cause of overweight in India would be lack of physical activity due to sedentary life style, loss of traditional diet, faulty diet, high stress etc.[10] Over-nutrition is most prevalent in the cities among affluences[13] from demographic transition due to sudden economic growth in India. This tells that indirect, underlying cause of over-nutrition would be significantly high rate of economic growth.
Related Studies
Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India
A Study done by S V Subramanian and George Davey Smith, investigated the effect of socioeconomic status and nutrition in India. The study was based on a nationally representative sample involving 77,220 women from different socioeconomic status backgrounds, and with varying body mass indices.
The results of the study found that being underweight had an inverse relationship with socioeconomic position, meaning that as socioeconomic position increased, the chances of being underweight decreased. A positive correlation, however, was found between socioeconomic position and being pre-overweight, overweight, and obese.
The study concluded that undernutrition and overnutrition were epidemics of the impoverished and the affluent in India.[14]
MSU Study
A study done by experts in the Food and Nutrition department of M S University (MSU), found that there was a big divide in the children aged six to fourteen of the urban and rural areas of the Vadodara district. The study found that 75% of 3,000 children in the rural areas of this district were malnourished, whereas 15% of the 23,000 children studied in the urban areas were found to be overweight. That is 3,450 overweight and 2,250 underweight of the 26,00 children studied.
The study used anthropometrical surveys to calculate these numbers, focusing on the Body Mass Index The body mass index , or Quetelet index, is a statistical measure which compares a person's weight and height. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on a person's height. Due to its ease of measurement and calculation, it is the most widely used diagnostic tool to (BMI) as the main indicator of nutrition.[15]
Nutritional Trends of Various Demographic Groups
Many factors, including region, religion, and caste affect the nutritional status of Indians. Living in rural vs. urban areas also contribute to nutritional status.[16]
Gender
Women tend to be at higher risk of both under and overnutrition than men. Nearly 50% of females aged 15 – 19 face undernutrition, with a very low percentage of overnutrition, however this trend reverses with age. As women get older, they are more at risk for overnutrition and less for undernutrition. Women are also at higher risk of developing anemia than men.[16]
Socioeconomic Status
In general, those who are poor are at risk for undernutrition, while those who have high socioeconomic status are relatively more likely to be overnourished. Anemia is negatively correlated with wealth.[16]
Region
Undernutrition is more prevalent in rural areas, again mainly due to low socioeconomic status. Anemia for both men and women is only slightly higher in rural areas vs. urban areas. For example, in 2005, 40% of women in rural areas, and 36% of women in urban areas were found to have mild anemia.[16]
In urban areas, overweight status and obesity are over three times as high as rural areas.[16]
In terms of geographical regions, Madhya Pradesh, Jharkhand, and Bihar have very high rates of undernutrition. States with lowest percentage of undernutrition include Mizoram, Sikkim, Manipur, Kerala, Punjab, and Goa, although the rate is still considerably higher than that of developed nations. Further, anemia is found in over 70% of individuals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, Karnataka, Haryana, and Jharkhand. Less than 50% of individuals in Goa, Manipur, Mizoram, and Kerala have anemia.[17]
Punjab, Kerala, and Delhi also face the highest rate of overweight and obese individuals.[16]
Religion
Studies show that individuals belonging to Hindu or Muslim backgrounds in India tend to be more malnourished than those from Sikh, Christian, or Jain backgrounds.[18]
Caste
Those belonging to scheduled castes Scheduled Castes and Scheduled Tribes ("ST"s) are Indian population groupings that are explicitly recognized by the Constitution of India, previously called the "depressed classes" by the British. SCs/STs together comprise over 24% of India's population, with SC at over 16% and ST over 8% as per the 2001 Census. The proportion, schedules tribes, or other backwards castes are also at increased risk of malnutrition. In particular, children of scheduled tribes have the poorest nutritional status and the highest wasting.[18]
Identifying Malnutrition
Malnutrition can be identified into two constituents, protein-energy malnutrition and micronutrient deficiencies, where protein-energy malnutrition is clearly observed in India and other developing countries[19] There are different methods of identifying malnutrition; physical findings generally help in the diagnosis of advanced malnutrition. In identifying it early in the development malnutrition, it is of advantage to allowing early rehabilitation[20] One of the classification of protein-energy malnutrition is done by Gomez, which uses anthropometric indices.
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