Tuesday, March 3, 2015

Malnourished and under nourished children in India-A reality check

Food, health and life are intricately interlinked and unless there is a balance and moderation in food intake, health is bound to be seriously affected adversely. An oft repeated question is whether the world to day is a better place to live compared to that which existed 5-6 decades ago? If the yardstick for measuring the quality of life is the health, definitely it is much worse than before. There is terrible inequality in accessing available food across the population with opulent countries enjoying a surplus of foods which are very often wasted ignoring the pitiable living conditions of millions of people spanning the three continents Asia, South America and Africa. The two aspects of food which are important to be kept in mind are quality and quantity. In many developed countries quantity of food available, if taken on an average, is more than sufficient to meet the calorie needs of their population. What is sorely missing is the quality of food consumed by them which leaves very much to be desired. Look at the health status of people in the US where more than half the population is over weight while almost one third is afflicted by obesity epidemic. This raises the inevitable question as to what constitutes a good diet and what happens if the diet is not based on factors that influence maintaining of good health.

As a thumb rule,human beings generally need about 2000 kCal, 50 g of proteins, 50 g of fat, 25 g of dietary fiber, 8 essential amino acids and two essential fatty acids which human body cannot make and vitamins and minerals. Water, though not considered a nutrient is also essential corresponding to an intake of 1 ml per calorie ingested. This is supposed to be a golden guideline for preventing development of many health disorders in life and can be easily met by judicial combination of natural food ingredients like cereals, pulses, milk, nuts, fruits, vegetables with or without animal based foods like meat, egg and fish. If the above assumption is correct why is that Americans eating rich foods including an abundance of highly nutritious animal based products still suffer from many diseases to day? Answer to this lies in the fact that the cereals they consume are highly refined devoid of practically all natural nutrients, most calories coming from highly refined white sugar or HFCS, heavy consumption of fat rich foods such as fried ones, baked goods etc and eating too much animal products. It is only recently that a scientific study in the US brought out the startling truth that eating even a small amount of whole grains about 33 g a day can reduce the chance of premature death very significantly! 

What about situation that is obtaining in India? Here again there are sufficient foods available in the country to meet the needs of every citizen but the access to these foods is constrained by economic factors. For many poor people constituting almost 40% of the country's population high quality foods like milk, pulses, egg and meat in sufficient quantities are beyond their reach. This problem is all the more intractable in the rural hinterlands of the country where most poor people live eking out a dreary existence. The highly unpredictable agricultural situation and lack of opportunities for engaging in income generation avocations make matter worse! The much touted Food Security Act does promise almost 1000 kCal of food in the form of very low priced cereals like rice and wheat, while other needs like proteins, fat and some of the essential nutrients are ignored in the scheme of things. All government programs designed so far and being implemented are just to keep hunger away among the poor people but do not bother about the quality of the food distributed under the social responsibility umbrella. 

The most recent circus government is doing under the FSA is giving away rice at Re 1 per kg and wheat at Rs 2 per kg for almost two thirds of the country's population whether all of them really deserve them or not based on economic criteria. The existing school feeding programs are also heavily loaded in favor of cereals. There are supposed to be about 7 lakh kitchens staffed by 26 lack cooks cum helpers serving about 11 crore children in thousands of schools across the country, probably the largest socially oriented scheme any where in the world. This is no doubt a tremendous feat worth appreciating and admiring. Unfortunately these numbers hide more than what they reveal. The program claims to provides about 300 kCal of energy and 16 g of protein for every kid though no one knows how far this target is fulfilled by cooking foods in these school kitchens out of cereals supplied by the government. Providing calories and proteins once a day may be theoretically adequate partially as far as nutrition is concerned but does it fill the tummy of the child who comes to the school hungry? Hardly! Many kids are reported to be coming to the school with empty stomach and wait eagerly till lunch time to get their share of meals cooked at the school. If this is so can the children be expected to concentrate on the lessons taught in the class rooms?

Some pundits have suggested that government should consider providing break fast also to the school kids besides the midday meals   May be a good suggestion but where is the end for such freebies , especially in a country like India not considered to be very rich to squander its resources? A honest citizen often wonders what is the role of the government in welfare of a citizen? A family which spawns a child has no responsibility to look after it and see through its adulthood and further till it can stand on its own legs? Look at India to day where there are government freebies for practically every thing from conception till the end whether they deserve them or not! If government has to give free medical service, child care service, educational service, housing service, subsidized transportation, special allowances for female children, heavily subsidized food grains, pension for old age population and widows, write off loans taken from government banks, provide subsidized fertilizers to farmers whether rich or poor and many other hidden economic help, what is the role of the parents? In this case if breakfast and lunch are provided at school, what else parents have to do? How can a child consider his parent as his own if they are not providing him with food at home? After all government is even giving jobs under NREGA for at least 100 days that puts about Rs 15000 in the hands of many laborers who declare that they do not have any other income.With Rice and Wheat being made available at Rs 1-2 per kg where is the problem in feeding the children at home? If low response to the NREGA scheme as reported in Karnataka is really true, poor people might be hard to find who are enamored by the Rs 15000 that can be earned by working for 100 days! May be there are a few genuine cases with extremely low income who must be identified  as targets for such freebie schemes.             

Many NGOs and international bodies are lamenting that 1 out of 3 children in India is malnourished and world's largest malnourished children live in India. It may sound shocking that 50% of childhood mortality is attributed to malnutrition and under nourishment. Similarly another stock claim is that 46% of children below 3 years of age in India have low Body Mass Index (BMI) which is supposed to be a manifestation of undernourishment and malnutrition. They further aver that inadequate food in quantity and nutritional quality during pregnancy, lactation and after birth are responsible for this sordid situation. One of the critical deficiencies being focused is essential fatty acids (EFA) like Omega-6 and Omega-3 fatty acids which are necessary for proper development of brain, eyes and preempting onset of diseases like CVD, high blood pressure, diabetes, obesity, Alzheimer's, dementia and others during growth later. Plant foods are not considered excellent sources of these essential fatty acids and well to do population derive them from fish and marine food sources. But two plant sources Soybean and Sunflower seeds can be significant sources of EFA , both Omega-6 and Omega-3 and all the programs presently running under the food service schemes must consider including one or more of these oil seeds in the meal recipes being followed.  

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