Comprehensive National Nutrition Survey (CNNS) to present real child nutrition status in India
With several cases of malnutrition and under nutrition reported in children across media platforms in India, there has been a marked shift in policy interventions related to the improvement of nutrition level in the past few years. The government with its schemes and strategies tried to better the scenario with programs like Integrated Child Development Services, National Family Health Surveys, National Food Security Act 2013, and Mid-Day Meal schemes. But all of that met with limited success. Further, it is common knowledge that cases of malnutrition and under nutrition not reported and not known far outnumber the ones reported. The root of the problem lies in the lack of availability of proper data.Hence, the above plans showed little results with selective execution.
Why Nutrition Survey
To highlight the poor condition â€œGlobal Nutrition Report 2016â€ outlined the ranking of countries from lowest to highest on stunting (low weight for age) India ranked 114 out of 132 countries i.e. poorer than Nepal and Bangladesh. On wasting (low weight for height) India ranked 120 out of 130 countries. As per India Health Report: Nutrition 2015, over 38 per cent of children in India have stunted growth.
The need of the hour is to have more inclusive and targeted surveysat a regular basis with better implementation practices for the policies in India. It is to be noted that Comprehensive Nutrition Surveys in most developed countries are conducted in every three years. For instance, government of Democratic Peopleâ€™s Republic of Korea in association with UNICEF conducted Comprehensive National Nutrition Surveys in 2009 and 2012. Taking a step in this direction the government of India with its Ministry of Health and Family Welfare and Ministry of Statistics and Program Implementation joined hands with UNICEF India to conduct a â€˜Comprehensive National Nutrition Surveyâ€™ (CNNS).
Comprehensive National Nutrition Survey â€“ a break from past
The CNNS coming after the three National Family Health Surveys (NFHS) holds importance especially when the last NFHS conducted was in 2005-06. And ever since, India hasnâ€™t had any comprehensive national survey on nutrition. In fact, Ex-PM Dr. Man Mohan Singh called it a â€˜national shameâ€™ while launching the `Hungamaâ€™ report. Prime Minister Narendra Modi said child malnutrition would be tackled on a â€˜mission modeâ€™. However, there is still clear lack of data to suggest the action being taken.
The 3rd NFHS which stated â€œYoung children in India suffer from some of the highest levels of stunting, underweight, and wasting observed in any country in the world, and 7 out of every 10 young children are anemic.Although poverty is an important factor in the poor nutrition situation, nutritional deficiencies are widespread even in households that are economically well off. Inadequate feeding practices for children make it difficult to achieve the needed improvements in childrenâ€™s nutritional status, and nutrition programs have been unable to make much headway in dealing with these serious nutritional problems.â€
What is CNNS?
The CNNS started out in March 2016 with an aim to cover 1.20lakh children in the age-group of 0 to 19 years. â€œCNNS is a multidisciplinary survey that includes biochemical and nutritional samples. It even takes into account cognitive domain, anthropometric, household food security, water sanitation and socioeconomic features,â€ mentioned Jee Hyun-rah, UNICEF Nutrition Specialist.
As of now, the survey has been completed in around 10 States of India and it is expected that all States of India will be covered by the end of 2017. According to several health related organizations, there is an evident lack of data at present. There is no clear mechanism to monitor the levels of nutrition even when there are nutrition missions in place. For instance, in 2005 Maharashtra became the first State to launch a Nutrition Mission. It was followed by five other States namely Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, and Karnataka.This survey is expected to plug the loopholes and fill the gap that exists in government policies. It will take into account mineral and vitamin requirements, nutritional deficiencies like Vitamin A, Folic Acid, Zinc, and protein deficiencies.
CNNS includes measuring deficiencies in body mass, micronutrients, vitamins, minerals as well as worm infestations among children.â€œThe survey will help create the right policy interventions to address the root cause of malnourishment,â€ said Hyun
Referring to the 2005-06 data of NFHS it was found that â€œalmost half of children under the age of five years (48 percent) are chronically malnourished.â€ Also underweight children under five years of age are in the range of 20 to 60 per cent in different states. Sikkim and Mizoram faring well with around 20 per cent children underweight while Madhya Pradesh being worse off with 60 per cent. And that more than half (54 percent) of all deaths before age five years in India are related to malnutrition.
The way forward
With the current survey exercise in full swing in many districts, soon there shall be proper data for the state to plan and target its programs in a better way. That is if more data should lead to better implementation practices, more targeted policies and greater awareness. Now that the first step is taken, it should be followed with a restructured ICDS scheme, multi-sectoral approach and better coordination among various state agencies. Some recent steps in this direction like the setting up of Nutrition Rehabilitation centers at district and sub district level, vitamin A supplementation strategy in children for reduction in pneumonia and diarrhea related mortality, National Iron Plus initiative for control of anemia and others are laudable. But there is still a long way to go before we fully realize our directive principle of raising the level of nutrition as per article 47 and that the road to attaining the Sustainable Development Goals of zero hunger and good health and well-being still lies so far ahead.
S M UMAIR is an independent journalist.