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Health & Medicine
Mahesh

28/12/23 06:22 AM IST

Child Malnutrition- WHO standards versus India crafted

In News
  • There is an emergent debate on a number of issues related to the use of WHO growth standards in India.
Multicentre Growth Reference Study
  • The WHO standards are based on a Multicentre Growth Reference Study (MGRS) that was conducted in six countries between 1997 and 2003 (Brazil, Ghana, India, Norway, Oman and the United States).
  • The purpose was to determine the pattern of growth (from birth to five years) of children who did not face any known deficiencies in their environments.
  • The references that were previously used (WHO-National Center for Health Statistics references) were based on children only from the U.S., many of whom were not breastfed but formula-fed.
  • The MGRS took a prescriptive approach, with the specific aim of setting growth ‘standards’ (how children ought to grow, provided they have a healthy environment) and not growth ‘references’ (how children of the reference group grow).
  • Among children (six-23 months) in households of the highest quintile in National Family Health Survey (NFHS)-5 (2019-21), only 12.7% meet the requirements of a ‘minimum acceptable diet’ as defined by WHO.
  • While almost all mothers in the MGRS sample had completed more than 15 years of education (in 2000-01), 54.7% of women in NFHS-5 had completed 12 or more years of schooling.
  • The MGRS included a component of counselling to ensure appropriate feeding practices, which is obviously missing in the NFHS or Comprehensive National Nutrition Survey.
Other Concerns
  • Another important set of issues with regard to using the MGRS standards is the difference in genetic growth potential of Indians with respect to others and the influence of maternal heights on child growth.
  • At an individual level, maternal height is undeniably a non-modifiable factor for the growth of her child.
  • Low average maternal heights are themselves a reflection of the intergenerational transmission of poverty and poor status of women, and, therefore, a measure of an environment of deprivation.
  • An appropriate indicator of a deficient environment, such as stunting, needs to capture this deprivation as well.
  • Regional differences within India, both in the prevalence of stunting as well as increases in adult heights, also indicate that some States such as Odisha, Chhattisgarh, Tamil Nadu and Kerala are achieving much faster reductions than others.
  • Another serious concern is related to inappropriately high standards leading to a misdiagnosis of the situation, and a resultant potential overfeeding of misclassified children under programmes of the government introduced to address undernutrition, thereby resulting in an increase in overweight and obesity.
  • There is also no doubt that there are also many gaps to fill in the more distal determinants of stunting, mainly; livelihoods and poverty, access to education and women’s empowerment.
  • Using the appropriate standards is also important for international comparisons and intra-country trends — an advantage that would be lost with any new country-specific standard.
ICMR Recommendation
  • Indian Council of Medical Research has constituted a committee to revise the growth references for India.
  • It has been reported that this committee has recommended a detailed rigorous study to be conducted across the country to examine child growth with the purpose of devising national growth charts, if necessary.
Source- The Hindu

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