Creative Solutions For Child Malnutrition in South Asia
In 2009, the Indian government banned the import of Plumpy'Nut nutrient bar by UNICEF to treat moderate to severe acute malnutrition among Indian children. Defending the government action, Mr. Shreeranjan, the joint secretary of the Ministry of Women and Child Development, told the Reuters that "Nothing should come behind our back. Nothing should be done in the name of emergency when we have not declared an emergency."
Clearly, Mr. Sheeranjan does not see the food emergency that is causing almost half of India's children to be malnourished. According to UNICEF's State of the World's Children's report carried by the BBC, India has the worst indicators of child malnutrition in South Asia: 48% of under fives in India are stunted, compared to 43% in Bangladesh and 37% in Pakistan.
Meanwhile 30% of babies in India are born underweight, compared to 22% in Bangladesh and 19% in Pakistan. UNICEF calculates that 40% of all underweight babies in the world are Indian.
Malnutrition is the leading cause of death in children in developing countries, including India and Pakistan. According to World Health Organization about 60% of all deaths, occurring among children aged less than five years in developing countries, could be attributed to malnutrition.
Those who survive the trauma of early childhood malnutrition suffer various degrees of brain damage and continue to lack sufficient cognitive and motor skills later in life.
According to World Bank's HNP (Health and Nutrition) paper "India's Undernourished Children", here is some data on the scale of the problem India faces:
1. 47% of Indian children under 5 suffer from malnutrition.
2. 60 million in all, highest in the world.
3. Two million Indian children under 5 die each year.
4. At least one million of them die from low immunity attributable to malnutrition.
5. Ten million children out of the statistical range a year suffer from lack of motor and cognitive skills for the rest of their lives.
6. Most of the retardation occurs between two to three years of age.
In the face of such shocking data, what is particularly disturbing is the lack of focus in pursuing solutions to this problem that affects tens of millions of children in the developing world, especially in sub-Saharan Africa and South Asia.
If the governments, such as India, are concerned about dependence on foreign food imports, they need to have policies and plans in place to encourage development of local alternatives to what are called ready to use therapeutic food (RUTF) bars such as Plumpy'Nut made from fortified peanut paste.
Community-based therapeutic care is being pushed in Pakistan by an Agha Khan University project. It is an attempt to maximize broad impact through improved coverage, access, and cost-effectiveness of treatment for malnutrition. Such community-based nutrition packages can provide effective care to the majority of acutely malnourished children as outpatients, using techniques of community mobilization to engage the affected population and maximize coverage and compliance. Children with SAM without medical complications are treated in an outpatient therapeutic program with ready-to-use therapeutic food and routine medications. It proposes the use of Ready-to-use Therapeutic Food (RUTF) and Fortified Supplementary food for the treatment of moderate and severe malnutrition. The advantage of these commodities is that they are ready-to-use paste which does not need to be mixed with water, thereby avoiding the risk of bacterial proliferation in case of accidental contamination.
While the advantages of the RUTF solutions such as Plumpy'Nut and Cipla's generic equivalent Nutrinut are proven, the cost of such treatment needs to be made a lot more affordable than it is. A standard Plumpy'nut treatment goes for four weeks (twice a day) at a cost of 12 Euros in Africa. India's Cipla also makes a generic version of Plumpy'Nut. It's being used in Nepal for Nepali Rupees 52 (~75 US cents) for a 500 Kcal bar. At 92 grams net weight; 12.5 grams protein; 32.86 grams lipid). It has the same nutritional content of F-100 milk formula and plumpy’Nut.
On the extreme affordability front, Bangladesh is setting an example for others to follow. Bangladeshi Nobel Laureate Mohammad Younus's Grameen, in joint venture with Danone of France, is producing a special yogurt called Shakti Doi from pure full cream milk that contains protein, vitamins, iron, calcium, zinc and other micronutrients to fulfill the nutritional requirements of children of Bangladesh and contribute in improving their health. While 'Shakti Doi' (which means 'power yogurt') is primarily intended for children, it is also appropriate for adults. The price of each 80 gram cup of yogurt is only 5 takas, equivalent to Euro 0.05 (five cents). It is an affordable price even for the poor people of Bangladesh. It's locally made and significantly cheaper than Plumpy'Nut, costing about one-tenth of the cost of solutions offered outside Bangladesh.
In his email to me, Col. Nair has proposed a solution for India with the target cost of one Indian rupee or less. His solution seeks to address protein energy malnutrition (PEM), iron deficiency anemia (IDA), and vitamin A deficiency (VAD) found among Indian children. Nair's idea is to develop a nutrient bar consisting of locally produced oats mixed with honey and crushed peanuts weighing about 15-20 grams, and fortified with iron (50%), vitamin A (75%), vitamin B6 and B12 (25% each), vitamin C (50%), vitamin E (50%), Iodine (50%), zinc (50%), and other nutrients like biotin, folic acid, calcium, sodium and potassium.
I am not a nutritionist. However, I do think Col. Nair's proposal to develop a low-cost solution to address the massive problem of child malnutrition in India and Pakistan deserves a serious look and concrete follow-up. It's an opportunity for social entrepreneurs and the corporate sector to jump in with their creative energies and dollars to meet the challenge thrown by Col. Nair. Meeting this common challenge as joint India-Pakistan effort will ensure a better future for all south Asians, and bigger future profits from a brainy, healthy and highly productive next generation of Indians and Pakistanis.
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World Food Program in India
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