KOCHI: The state’s claim on robust health indices has received a jolt with a recent report published by NITI Aayog as part of launching the national nutrition strategy. As per the report, the rate of nutritional deficiency among women in six states, including Kerala, is on the rise, despite the high living standards. It is the unhealthy and unbalanced eating habit which is the major reason for this, according to health experts. The other states concerned are Punjab, Himachal Pradesh, Delhi, Uttar Pradesh and Tamil Nadu. Not starvation, but malnutrition, whether under-nutrition or over-nutrition, is the issue in Kerala. Nutritional deficiency is one of the major challenges faced by the state. One out of five children belonging to the age group of below five years is suffering from malnutrition in the state, according to recent reports.
The state also lags behind in providing pregnancy care with a declining breastfeeding rate. Though the economic condition of the household is one of the most significant predictors of malnutrition, the rate of malnutrition in urban and rural areas is almost the same in Kerala. “Clinical observation and studies have shown that there is no urban-rural divide in malnutrition in the state. Balanced nutrition is crucial as the number of premature deliveries and underweight babies is on the increase. Mothers with nutritional deficiency give birth to unhealthy and underweight babies while infertility rate among women with over- nutrition – obesity and overweight- will be higher due to conditions like polycystic ovary syndrome (PCOD). They have to opt for infertility treatment facilities like IVF again in which the chances for premature delivery are high,” said Dr. Sachidananda Kamath, past national president of Indian Academy of Paediatrics.
However, the prevalence of malnutrition varies significantly according to the household’s living standards. Women in the highest socio-economic groups are more likely to be overweight or obese. About one-third of women from high household standard of living are overweight or obese, whereas one-third of poor women are underweight.
State still has no nutrition policy
Despite having an impressive position in health and other social indicators, Kerala is yet to implement a nutritional policy which should be the base of conceptualizing various projects for health and nutrition. Dr Mumtaz Khalid Ismail, secretary of Kerala chapter of Nutrition Society of India, said, “though the national nutrition policy was formulated in 1970 which was followed by other states, Kerala is yet to implement it. As per the state government’s request, I formulated a draft policy in 2012 and submitted it. Later, another draft, prepared in coordination with Indian Academy of Paediatrics, was also submitted. But it is yet to be implemented,” she said.
She served as consultant nutritionist of National Rural Health Mission and was instrumental in planning and developing nutrition policies and procedures for the hospitals as per the National Accreditation Board of Hospitals and health care providers for the state government. It is high time to implement a state-specific nutritional policy as the rate of over-nutrition, lifestyle diseases and under-nutrition is on the rise. Both over-nutrition and under-nutrition are equally dangerous.
“The number of women with malnutrition is on the rise though most of them will come to hospitals only when other associated complications appear. Majority of women have carbohydrate and fat-rich food with very less intake of protein, vitamins and minerals,” said Dr. Susan Itty, chief clinical nutritionist at Aster Medcity, Kochi. As per the national family health survey 2015 – 16, the percentage of anaemia among women in the age group of 15 to 49 is 32.7 while the percentage of underweight children in Kerala is 18.5. Anaemia is an important indicator of micronutrient deficiencies and important factor for poor child development. More than half of Indian women in their child -bearing years, aged 15 to 49 years, in 13 states have anaemia.
Nydin Poulin, senior dietician at Medical Trust Hospital, Kochi, said, “though severe nutritional deficiency cases are rarely reported in our hospital, women with other complications like hormonal imbalance, renal problems or absorption issues need nutritional supplementation. In such cases food alone can’t serve the purpose,” said Poulin. Meanwhile, nutritional experts have welcomed the move to introduce a national nutrition strategy and national nutrition mission. “Like the national health mission which could make effective intervention in rural and urban health scenario, the nutritional mission also can implement innovative and sustainable projects which will help in improving the nutritional standards of Kerala society,” added Dr. Mumtaz.
Expert calls for ‘rainbow revolution’ in children’s diet
As per the World Health Organisation growth standard, the percentage of malnourished and severely malnourished children in Kerala is 36.92 per cent and 0.08 percent respectively as on March 2011. Even as the rate of obesity and overweight among school children is on the rise, imbalance in nutrition, whether it is over- nutrition or under-nutrition has serious health consequences, according to nutritional experts. “There has been an alarming increase in the rate of overweight and obesity among children. The rate of obesity among children is 15 per cent in Kozhikode, the least in the state, while 39 per cent of children in Ernakulam are overweight. Earlier, the rate of overweight children in Kerala was just 5 per cent. Children, even from their infancy, are not getting quality food which leads to severe malnutrition,” said Dr. K.E. Elizabeth, Professor of Paediatrics at SAT Hospital, Government Medical College, Thiruvananthapuram, a nutrition expert.
It is high time a ‘rainbow revolution’ is brought back in the dietary pattern, including healthy foods such as vegetables, fruits, brown rice, pulses and dairy products, she observed. “In Thiruvananthapuram medical college, 50 to 60 cases of children with severe malnutrition are being reported,” she added. Children who are exposed to a very different junk food culture are not getting essential vitamins and minerals. It is a triple burden of malnutrition on children – over-nutrition, under-nutrition and deficiency of micronutrients.
“Due to the scare over pesticide-laden vegetables and fruits, parents are nowadays reluctant to give it to children, which often results in deficiency of vitamins and minerals. How to overcome the situation is a challenge,” said Dr. Narayanan, paediatrician and president of Kochi chapter of Indian Medical Association. A child having regular healthy homemade food, including carbohydrate, proteins, fats, vegetables and fruits will not have nutritional deficiency. But the diet pattern of children has changed with daily inclusion of carbonated drinks and fried foods. “Malnutrition is usually reported among children under five only in tribal and most rural areas while obesity due to over-nutrition is common among school children,” he added.