Call For Mitigating Malnutrition

According to the World Health Organisation (WHO), malnutrition refers to deficiencies or excess in nutrient intake and imbalance of essential nutrients. There is a term called the double burden of malnutrition which consists of both undernutrition and overweight and obesity, together with diet-related non-communicable diseases. Undernutrition manifests in four broad forms, including wasting, stunting, underweight, and micronutrient deficiencies.

According to the Nepal Demographic Health Survey 2022, which collected the height and weight of 2,765 children under the age of 5, in NDH surveys, the anthropometric indices height-for-age are referred to as stunting, weight-for-height as wasting, and weight-for-age as underweight, used to measure nutritional status in young children. The percentage with valid data for height-for-age and weight-for-height, and weight-for-age were 97 per cent, 97 per cent, and 98 per cent respectively. The Nepal government’s target for Sustainable Development Goals (SDG) states that the prevalence of stunting among children under 5 years be at or below 29 per cent by 2022 and at or below 15 per cent by 2030. 

Prevalence of wasting

Similarly, the target for the prevalence of wasting among children below 5 years is 7 per cent by 2022 and 4 per cent by 2030 as mentioned in the National Planning Commission (NPC) 2020. The nutritional status of children under the age of 5, according to the three anthropometric indices NDH have taken, is 25 per cent of children are stunted, 8 per cent are wasted, and 19 per cent are underweight. One per cent of the children under 5 are overweight. The NDH survey’s finding is that the trend of prevalence of stunting has declined from 57 per cent in 1996 to 25 per cent in 2022. 

During the same period, the prevalence of wasting declined from 15 per cent to 8 per cent, and the prevalence of overweight was steady at 1 per cent. However, in reality, is it really that the Nepali population is overcoming malnutrition? According to WHO, in 2022, 2.5 billion adults were overweight, including 890 million who were living with obesity, while 390 million were underweight. WHO also states that globally in 2022, 149 million children under 5 were estimated to be stunted, 45 million to be wasted, and 37 million were overweight or living with obesity. Nearly half of the deaths among children under 5 years of age are linked to undernutrition mostly in low- and middle-income countries.

This has a long-lasting social and economic impacts not only in the countries where this is heavily prevalent but also globally. Burdens of malnutrition, particularly, have serious and long-lasting impacts on individuals and their families. The NDH survey results of 2022 show progress in stunting and wasting. However, NDH also has data that clearly shows that in certain regions of country, malnutrition is still a status to worry about. NDH states that the proportion of stunting is highest in the Karnali Province with 36 per cent followed by 29 per cent in the Madhesh Pradesh and lowest with 18 per cent in the Bagmati Province. 

The highest prevalence of wasting or acute malnutrition is in Lumbini Province at 16 per cent, followed by 10 per cent in the Madhesh Pradesh. Nepal ranks 81 out of 121 countries in the 2022 Global Hunger Index. Therefore, there is still an urgent need for immediate intervention measures to prevent further deterioration of the situation here. Remote districts, including Humla, Bajhang, Bajura, Baitadi, Surkhet, Dotri, Achham, Okhaldhunga, Terhathum, Panchthar have malnutrition above 56 per cent with Humla being the district with the highest number. 

Nepal has had negative impacts of climate change and the COVID-19 pandemic has had its adverse impact too. Families, mostly below the poverty line and marginalised communities mostly get hit harder by any crisis and this is definitely the case in a low-income country like Nepal. When calamities hit the most affected are women, children, the elderly, and people living with disabilities. The lack of food and low intake of nutrition by pregnant women leads to malnutrition among them and the foetus in their wombs. Based on the economic, social, religious, gender, and different other factors which have created discrimination among people, malnutrition can start from the womb itself, even before a child is born. 

Double burden

When there is poverty and scarcity of food, the newborn girl child is more likely to be neglected as the mother has to work and this could lead to stunting, and wasting. According to the Ministry of Health and Population, acute respiratory infections and diarrhoea are leading causes of deaths among children below 5 years of age in Nepal, and this is linked to acute malnutrition. Malnutrition is further aggravated by the fact that several parts of the country have poor access to safe drinking water and sanitation facilities together with poor hygiene practices, and living conditions. Over the years, the government has put in policies and laws to address the issue of malnutrition. 

However, it has been under the so-called double burden of malnutrition which consists of both undernutrition and overweight and obesity due to the imbalance in the intake of nutrition. 

The constitution has a provision that all citizens get access to proper nutrition and thus the government has a goal to achieve nutritional well-being of all people to maintain a healthy life to contribute to the socio-economic development of the country, through improved nutrition programme implementation in collaboration with relevant sectors. 

Although policies are put in place, data shows that the most vulnerable population of the country is still not getting the appropriate nutritional intake either due to lack of such nutrition or due to lack of proper knowledge regarding this. Therefore, proper attention is required to address this issue.

(Sharma is a senior journalist and women's rights advocate. namrata1964@yahoo.com. Twitter handle: @NamrataSharmaP)