Public Health Policy Briefing: Malnutrition in Telangana's Rural Areas

This policy briefing examines the critical issue of malnutrition in children within Telangana, India, particularly focusing on rural areas. It begins with an executive summary highlighting the high prevalence of undernourishment and stunting, which are significantly higher than in urban areas. The report defines malnutrition and presents data on its prevalence, including the percentage of stunted and underweight children. It explores the effects of malnutrition, such as low energy, poor immunity, and impaired learning, and identifies risk factors like poverty, socio-economic status, and environmental drivers. The report also critiques current policies and offers recommendations to address malnutrition, emphasizing the need for government schemes and NGO involvement to provide a healthy start to children's lives. The briefing highlights the complex interplay of socio-economic and socio-cultural factors contributing to malnutrition, emphasizing the need for comprehensive interventions.

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Table of Contents
Introduction......................................................................................................................................3
Definition of Malnutrition...............................................................................................................4
Prevalence of Malnutrition in children below 6 years in Telangana State’s rural areas (India)......4
Effects of malnutrition in children below 6 years in Telangana State’s rural areas (India)............6
Risk factors of malnutrition in children below 6 years in Telangana State’s rural areas (India)....7
Socio-economic and socio-cultural context.....................................................................................8
Global Scenario...............................................................................................................................9
Critiquing the Policies on Malnutrition in children below 6 years in Telangana State’s rural areas
(India)..............................................................................................................................................9
Recommendation...........................................................................................................................10
Conclusion.....................................................................................................................................12
Reference.......................................................................................................................................13

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Executive Summary
World Bank data suggests that India is one of the countries which has the largest demographics
of children that are suffering from the undernourishment. The proportion of the undernourished
children is said to be double that of Sub-Saharan Africa. The Global Hunger Index ranking of
India is 67 out of the 80 nations and it is worse than some of the underdeveloped nations like
North Korea or even Sudan. 44 percent of the child is under the age of 6 is found to be
underweight, and 72 percent of the infants are suffering from anaemia. Especially in Telangana
(India), the rate of malnutrition is high in rural areas and the percentage is 39 percent in
comparison to the urban areas which is 31.1 percent. Data shows that the 44.7 percent of the
undernourished children belong from a poor family, 37.9 percent are Dalit children and 34.5
percent are the Adivasi children are stunted. The rates of stunting are high in girls and it is 34
percent. India needs a lot more to be done in order to reduce and manage the menace of the
undernourished child. The NGOs can be pulled in along with the government schemes so that the
policies can be implemented effectively. The NGOs can also be supported so that they can start
the crucial contribution towards giving a healthy start to a child’s life.

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Introduction
The children belonging to the rural areas of the Telangana, India are exhibiting and
suffering from the high burden of recent and acute nutritional deficit. Thus this can also be
inferred that the children of this state are more underweight as well which reflects both the
condition of acute and chronic malnutrition. The remarkable increase in the number of children
with the malnutrition in the state of Telangana demands an urgent attention. It is an established
fact that one in every third child is affected by the hunger and is lamentable. Stunting in this
children is a major phenomenon and it occurs due to the malnutrition during the periods of
growth and also during the early life. It is also important to mention that the children that reside
in the rural areas of Andhra Pradesh and in the urban areas of Telangana are suffering from the
higher burden of stunting (Challa & Challa, 2015). The vital reasons for such an issue need to be
explored, however, it can also have mentioned that the rapid changes due to the urbanization can
be denoted as the social determinant of the health of the child's health. The data collected from
the National Family Health Survey 3 reveals that the 48 percent of the children below the age of
6 and 43 percent of children below the age of six in the state of Andhra Pradesh were found to be
stunted (National Family Health Survey, 2018). The reduction in the trend reflects that the
chronic undernutrition is falling. The latest data collected from the DLHS 2012-13 reveals an
occurrence of stunting of 27.7 percent and 23.7 percent in the states of an Andhra Pradesh and
Telangana respectively (Health Management Information System, 2018). The reasons for
stunting in the state of Telangana can be designated as malnutrition and thus it needs further
exploration. Underweight is also a form of undernutrition which includes the wasting and
stunting. The present levels of underweight in the state of Telangana show the similar trends of
data in the state of Andhra Pradesh (Challa & Challa, 2015).

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Definition of Malnutrition
Malnutrition is a general or abroad which is sometimes used as an alternative term for
undernutrition and it is technically sometimes also referred to as over-nutrition. Children are said
to malnourished if the diet is incapable of providing the sufficient amount of protein and calories
for maintenance and growth. The children are unable to utilize the food they eat if the children
are suffering from an illness (undernutrition). The children are can also be said to be
malnourished if they consume more calories (over-nutrition) (Unicef, 2018).
Prevalence of Malnutrition in children below 6 years in Telangana State’s rural areas
(India)
High severity of malnutrition has been prevalent in the sister states of Telangana and
Andhra Pradesh. A Rapid Survey on Children (RSOC) within the year 2013 to 2014 by UNICEF
before the bifurcation of the state took place. According to the survey, 35.4 percent of the
children below the age of 6 years were found to be having stunted growth. The height was less in
comparisons to the 2 standard deviations of the expected height. Also, 12 percent of the children
that belong from the same age group are stunted severely (Chaurasia, 2016). This data revealed
the high levels of malnutrition in states like Telangana. Also, according to the World Health
Organization, the database on the child malnutrition and growth says that 30 percent to 39
percent of the occurrence of stunting is a perfect indicator of the severity in the malnutrition in
children. The survey data also mention that the rural areas have more percentage of the stunted
children (37.5) in comparison to the urban areas which has 31.1 percentage of stunted children. It
has also been found that the Dalit children (37.9) and the Adivasi children (34.5). The severity of
stunting has been found to be 12.1 percent in the rural areas in comparison to the 11.7 percent in
the urban areas (The Hindu 2018).

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The state of Telangana is also found to have fared badly in terms of the indicators like
underweight, wasting and malnutrition. The survey did reveal that the 6 percent of the children
under the 6 years of age also have less weight in comparison to the weight. Also, it has been
found that the 6.8 percent of the children that belong from the rural region is found to be wasted,
while it is 5.6 percent in the urban areas. The Dalit children below the age of 6 years are
malnourished and 7.3 percent of the children are suffering from wasting. Also, according to the
WHO child database, 5 to 9 percentage of the wasting also indicates that the there exists a
malnutrition of medium severity (The Hindu, 2018).
A cross-sectional study conducted for a period of 2 years and the age group involved age group
of under 60 months. The study focused on the population of the Ranga Reddy district of
Telangana which had a total population of 52,96,396 and had 5,95,352 children within the age
group of 0 to 6 years. The village to be studied had a population of 25,869 and it was
approximated that there were 2600 children under the age of 5 years. The total number of
children that participated in the study is 400 and it is found that out of the 400 children, 170
children were underweight (42.5 percent). 92 (23 percent) of the underweight children belonged
to the severe underweight category and the remaining 78 (19.5 percent) belonged to the
underweight category (Varma, 2017). The data from the NNMB report says that the prevalence
of underweight among the children that belonged to this age group is 41.8 percent (National
Nutrition Monitoring Bureau, 2018). The data furnished by the National family health survey
(2006) also mentions that the prevalence of underweight in children is 43 percent. Thus the data
found from the conducted study is in accordance with the national surveys and findings
(Worldbank, 2018).

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In several settings, the prevalence of malnutrition begins at the age of 3 months, the process then
slows down at the age of 3 years. The children within the age group of 2 to 3 years that have low
height for age reflects a continuous process of stunting and low growth. For the older children,
the failure to grow is a reflection of stunted growth. From the study, it has been found that out of
the 179 children, 81 children were found to be having severe stunting and the remaining 98
children have moderate stunting. The overall percentage of stunting is found to be 44.75 percent.
Thinness or wasting in the majority of the cases indicates the severe process of weight loss and it
is associated with the severe disease and acute starvation (Varma, 2017).
Effects of malnutrition in children below 6 years in Telangana State’s rural areas (India)
Severe malnutrition in children is seen in the state of Telangana and the report published
by the National Nutrition Monitoring Board Survey revealed that the 36.6 percent of the children
are underweight, 44.7 percent of the children are either retarded or stunted. According to the
report of World Health Organization, stunting has a direct relationship with the antenatal and
post-delivery malnutrition (The Hans India, 2018).
It is important to note that the negative impacts of malnutrition have a harmful impact on the
health and mind of the children. In other words, it can be said that the more a child is
malnourished, the more nutrient a particular child is missing. This increases the tendency of the
occurrence of problems (Debnath & Bhattacharjee, 2016). The symptoms and signs of
malnutrition vary greatly depending on the type of nutritional deficiency. There are several other
aspects of the ill effects of malnutrition are as follows:
 Low energy or fatigue
 Dizziness
 Poor immunity functions
 Scaly and dry skin

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 Bleeding and swollen gums
 Decaying gums
 Reduced reaction time and trouble paying attention
 Underweight
 Poor growth
 Muscle weakness
 Bloated stomach
 Fragile bones or osteoporosis that breaks easily
 Issues with the organ functioning
 Problem is learning (Sahu et al., 2015)
Risk factors of malnutrition in children below 6 years in Telangana State’s rural areas
(India)
1. Macro-environmental and micro-environmental drivers- the macro environmental
drivers that contributes to the malnutrition among the children are the age, sex, birth order,
mother’s education, education of the head of the household, mother’s occupation, occupation of
the household, below poverty line status, socio-economic status, religion and type of family
(Matariya, Lodhiya & Mahajan, 2016).
The microenvironmental drivers that contribute to the malnutrition to the children are
source of drinking water (ring well or tube well), storage of water for use, storage is clean or
unclean, storage stays covered or open, defaecation is in open or in latrine, hand washing by the
mother before serving the food or before cooking food, appearance of the mother's clothes (clean
or unclean), overcrowding in house of residence (Matariya, Lodhiya & Mahajan, 2016).
2. Extrinsic and Intrinsic drivers- the extrinsic drivers of malnutrition in the children is
the improper policy of the Indian government, improper implementation of the food security
policies, improper administrative system, insufficient and improper funding required for the food
security, public distribution system no operating and targeting the people that are living below
the poverty line.

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The intrinsic drivers of malnutrition in children are the poverty, geographical location of
residence from the main government infrastructure, inability to access food which is of high
nutritional value.
Socio-economic and socio-cultural context
Malnutrition is closely related to disease and poverty and each of the factors contribute
positively to the permanence of the others. The low socio-economic status is bound to adversely
affect the parent's ability to afford the nutrient-rich food, and this, in turn, results into
undernutrition. Evidence also suggests that there exists a positive relationship between the
poverty and food insecurity. Poverty is also one of the major factors which contribute to the
malnutrition, undernourishment in children. The parent's inability to purchase food of high
nutritional content renders the children undernourished (WHO, 2018).
Health inequity is mainly due to the socioeconomic determinants which play a vital role
in the health of children. it has been found that the major inequities in health are due to the lack
of proper sanitation facilities and it has a major contributory role in the child mortality. Another
vital part is the lack of breastfeeding to the children immediately their birth. It is vital to note that
the children are fed with glucose water, honey or other milk instead of feeding breastmilk after
the 3 days of delivery. This severely reduces the build-up of the child immunity and hampers the
growth in the initial phases of infancy (Pappachan & Choonara, 2017).
Global Scenario

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Half of the all the death among children under the age of 6 can be attributed to the
undernutrition. Undernutrition or malnutrition annually takes 3 million lives a year. improving
the nutrition at the global level requires the management of the political economy challenges and
this exists in the sub-national, national and global levels. A greater mind shift is required to be
build which will assist in shaping the global nutritional landscape. This will require the
systematic incorporation of the political and economic reforms so that the nutritional policies can
be reformed (Balarajan & Reich, 2016).
India ranks 114 out of the 132 countries in the Global nutrition report and has 38.7 percent of
children affected (Globalnutritionreport.org, 2018).
Critiquing the Policies on Malnutrition in children below 6 years in Telangana State’s
rural areas (India)
Positives- the national nutritional policy emphasizes the protein and calorie intake.
According to the minimum levels of intake of the protein intake, the income groups have shown
to be taking in much more than the recommended level. Thus marking a minimal limit can help
in demarcating the least amount of protein and calorie that a child must intake to sustain the good
health (Niti.gov.in, 2018).
There is also an explicit mention of the micro-nutrient intake which has resulted into the
mentioning the minimum levels of iron that a person or a child must consume (Niti.gov.in,
2018).
Negatives- one of the major drawbacks of the policy is that the policy failed to deal to deal with
the poverty and the people are unable to have the minimum levels of calorie, protein and

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micronutrients. The policy thus failed to take into the poor people that lack jobs and are unable to
sustain their life on a regular basis.
Recommendation
1. Nutrition specific intervention- Nutrition specific intervention is the best way to
intervene and provide the minimal calorie, protein and the micro-nutrient that can act as a guide.
This will help the parents to frame the minimum amount of nutrient and the calorie that needs to
be consumed so as to sustain and maintain a healthy life. The basic or the optimal level of
micronutrients, proteins and calories that are necessary for the child's development can be made
along with a dietary plan so that the undernourishment or malnourishment can be reduced or
prevented (Ruel, Alderman & Maternal and Child Nutrition Study Group, 2013).
2. Maternal nutrition- maternal nutrition is the basis and is the most vital for the good
nourishment of the child. Right from conceiving a child to the delivery of the same, the mother
needs to maintain a well-balanced diet so that it can be ensured that the child born will be safe
and healthy. Proper nourishment is required for the initial development of the baby and is vital
for the child's health as well. Children after their birth are breastfed so as to increase the
immunity of the child which helps in the building a strong body in the later part of the life
(Bhutta et al., 2013).
3. infant and young child feeding- infants are the most vulnerable and thus must only be
fed breast because mother’s milk at the initial stage of infancy has all the dietary requirement
that a baby will require. Thus, it is important to outside food away from the infants. Whereas, the
young child must be fed with a proper diet which will have the sufficient amount of calorie,

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micronutrient and protein so that the child can properly and so that the brain can develop in a
proper way (Onis et al., 2013).
4. water, sanitation and hygiene and access to health services- hygiene is the most
important along with the sanitation facilities, maintaining hygiene plays a major role in warding
off the major and minor diseases that occur due to the lack of hygiene. Sanitation is also one of
the major aspects of the maintaining proper health. Proper facilitation of the sanitation will lead
to a proper environment for the growth of a child. Water is the basic necessity and thus water
services must be inadequate quantities so that the normal day to day life is not hampered. Access
to the health services is also necessary and children must have the access to the proper health
facilities so that the diseases and other disruptions can be treated effectively (Onis et al., 2013).
5. Nutrition-sensitive approaches- A child will be rendered malnourished and undernourished
whenever the basic and the minimal requirement of the nutrient is not provided to a child. Thus,
food must be provided to a child which suffice the dietary requirements of a child. Healthy and
unadulterated food can substances can be provided to the children so that they can develop a
healthy mind and body (Sahu et al., 2015).
6. Education and Literacy- Poverty is the main reason due to which people are unable to
access job and the other social benefits. Poverty is also the sole reason due to which the children
are unable to have the sufficient amount of food. Thus, to ward off poverty and malnutrition, it is
essential to promote education and literacy in a country which can act as an active catalyst to
remove poverty (Makoka & Masibo, 2015).
7. Improvement of the status of women- empowered women is the soul of any
enlightened society. Thus, it is necessary countries must improve the status of women and give