A New Report Reveals What is behind Maharashtra State’s Reduction in Stunting


Photo by Esther Havens

Photo by Esther Havens

In 2005, an alarming 39 percent of children were stunted in Maharashtra state, the second largest state in India with a population of over 100 million people. By 2012, a survey revealed that this number dropped to 24 percent among children under the age of two. A recent report published by the Institute of Development Studies (IDS) examines why this unprecedented reduction in stunting occurred.

Stunting is a condition that causes irreversible damage and occurs when a child does not receive the right kind of food and nutrients. Stunted children often have weaker immune systems leaving them more susceptible to infections and making them five times more likely to die from diarrhea. Infections caused by neglected tropical diseases (NTDs) are closely linked to malnutrition. Intestinal worms, for example, are among the underlying causes of stunting, anemia, loss of key nutrients like Vitamin A and iron, and overall poor nutritional status. Not only does India have more children suffering from NTDs than any other country in the world, they are home to the highest number of stunted children under the age of five.

Historically, Maharashtra state’s high levels of income inequality have contributed to malnutrition and stunting in children. Even though Maharashtra is one of the wealthiest states in India, children who are stunted are not benefiting from this growth.  Stunting impairs a child’s growth and perpetuates poor health and nutrition, preventing them from growing into their full physical and economic potential. Children who are unhealthy and lack access to proper diets, safe water, healthcare and sanitation facilities are trapped in a perpetual cycle of disease and poverty.

According to the authors, a number of key factors, working in tandem, contributed to Maharashtra state’s reduction in stunting. The launch of the state’s Nutrition Mission and the National Rural Health Mission created strong political will to improve nutritional status of young children. Because NTDs can contribute to malnutrition, Maharashtra state’s Nutrition Mission Action Plan ensured that deworming tablets were distributed to children at risk for intestinal worm infections.  And promisingly, the number of children receiving deworming treatments more than doubled, increasing from 8 percent to 19 percent. Maharashtra’s efforts towards addressing NTDs is a positive step in the right direction to lower the occurrence of stunted children and subsequent malnutrition among young children.

IDS also noted that other important factors in the reduction of stunting include: a favorable political, social and economic environment; strong economic growth; robust poverty reduction performance; and improvements in women’s empowerment and health. In the same manner, addressing NTDs requires a multi-pronged approach. In addition to deworming, creating an enabling environment for children will amplify the possibilities for the future, particularly by simultaneously improving access to clean water, sanitation and hygiene and delivering key nutrition interventions like Vitamin A alongside deworming treatments.

While the rapid decline in stunting in Maharashtra state was unique, we congratulate them on embracing a comprehensive approach to tackling this issue and remain hopeful that other states endemic for NTDs and malnutrition will feel encouraged to follow their lead.

Acute Malnutrition: An Everyday Emergency


Photo by Olivier Asselin

Photo by Olivier Asselin

As part of World Humanitarian Day, Sabrina de Souza, Nutrition Advocacy Coordinator at RESULTS UK, part of the ACTION Partnership, highlights severe acute malnutrition (SAM) — a type of malnutrition that often occurs alongside humanitarian crises, but increasingly in non-emergency settings as well. While acute malnutrition can be treated with energy-dense, micronutrient-enriched foods, efforts to control and eliminate neglected tropical diseases (NTDs) can also improve nutrition outcomes.

When you see an image of an emaciated child, what’s your instant reaction? You wouldn’t be wrong in thinking that this child may be caught in the middle of some humanitarian emergency, such as a drought or a famine. It is a common outcome of such crises. Millions of children — 52 million to be exact — suffer from acute malnutrition, which causes rapid and severe weight loss, leaving children emaciated. In the most severe form — severe acute malnutrition — this condition can quickly result in death without treatment.

Thankfully, treatment is available. Cost-effective and high-impact approaches to treatment have revolutionized the fight against acute malnutrition. Through community-based approaches we are able to identify and treat more children than ever before. Energy-dense, micronutrient-enriched foods — known as RUFTs — can effectively treat children in a matter of weeks, without needing to be admitted to hospital.

Despite revolutions in treatment, 90 percent of children suffering from severe acute malnutrition (SAM) are unable to access the treatment they need. In 20 years, between 1990 and 2011, the global burden of acute malnutrition fell by just 11percent, from 58 million to 52 million. In sub-Saharan Africa, the numbers of acutely malnourished children actually grew during this period from 10 million to 13 million. This is due, in part, to the way that the treatment of acute malnutrition is delivered.

An everyday emergency

While acute malnutrition can occur during humanitarian emergencies, it commonly occurs in stable settings as well — making it an everyday emergency. The treatment of severe acute malnutrition is primarily delivered via emergency responses, which are typically short in duration. Therefore, children who are at risk of acute malnutrition in stable, non-emergency settings often struggle to access this life-saving treatment.

The supply of life-saving RUTFs is often restricted to periods of crisis. As a result, clinics can suffer from regular stock-outs — a major barrier to accessing treatment. Repeated stock-outs can contribute to community-based SAM treatment services as being perceived as unreliable, leading to significant increases in length of stay, absenteeism and children defaulting from treatment.

A staggering 1 million children die each year from this condition, despite the fact that it is preventable and treatable. If we hope to make a dent in this number, and safeguard the futures of millions of children, then more needs to be done to bridge the gap between short-term humanitarian funding and long-term sustainable development funding.

The UK: leading by example

Sustainable funding is needed so governments in high-burden countries can plan and implement long-term strategies to tackle acute malnutrition. The UK, which is among the top providers of humanitarian assistance, is making encouraging steps to fund multi-year nutrition-related programmes in a number of high-burden countries, including Sudan, Kenya, Somalia, Uganda, Ethiopia and Yemen, which aim to bridge the gap between humanitarian aid and longer-term funding. However, more needs to be done and there is scope to replicate these much needed programmes in other high-burden countries that DFID works in.

The Generation Nutrition campaign encourages other donors, including Sweden, Turkey, the United States and EU institutions, which sit alongside the UK as the top providers of humanitarian assistance, to follow suit in recognising acute malnutrition as a development issue, not just a results of a humanitarian crisis, that requires sustainable funding for both the treatment and prevention of life-threatening condition.

What can you do?

Sign the Generation Nutrition petition calling on leaders all over the world to take urgent action to reduce the number of children suffering from acute malnutrition and safeguard the lives of millions of children.

The Role of Worms in Malnutrition


Photo by Olivier Asselin

Photo by Olivier Asselin

In impoverished communities worldwide, children and pregnant women are especially vulnerable to malnutrition, anemia, impaired cognitive and physical development, and pregnancy complications. As a result, they remain trapped in poverty, facing the socioeconomic consequences of decreased productivity and an inability to work or go to school because of their poor health.

But the reason behind their suffering may surprise you.

A new article in PLOS NTDs reveals how soil-transmitted helminths — a group of three parasitic worm infections — can be the culprit in many areas with heavy neglected tropical disease (NTD) burdens and bleak living conditions.

The authors, Sabin Vaccine Institute President Dr. Peter Hotez, former World Bank Lead Health Specialist for Africa Dr. Donald Bundy and Baylor College of Medicine (BCM) Medical Resident Dr. Selvi Rajagopal, focus on vitamin A and iron deficiencies and their relationship to the three soil-transmitted helminths: ascariasis, hookworm and trichuriasis.

On vitamin A, the authors write, “As well as having direct effects, severe vitamin A deficiency can have significant indirect consequences, for example, increasing susceptibility to potentially fatal illnesses such as measles and lower respiratory infections. As a result, the link between vitamin A deficiency and ascariasis has potentially important consequences for global health, especially since ascariasis may be the most common chronic childhood infection worldwide.”

Hookworm and trichuriasis, meanwhile, can lead to iron deficiency anemia. “Among adults, even light [hookworm] infections can produce anemia, especially in pregnant women. … Moderate-to-heavy hookworm infections and trichuriasis specifically have in some circumstances been shown to lead to failure to achieve intellectual potential and cognitive impairment. … Anemia and a moderate-to-heavy parasite burden of either helminth species were identified as independent risk factors for stunting,” the authors explain.

Given the clear linkages between soil-transmitted helminths and malnutrition, the authors suggest that more research be conducted to help identify how programs delivering interventions for each can be integrated in a cost-effective, sustainable way.

To read the full article, “Micronutrient Supplementation and Deworming in Children with Geohelminth Infections,” click here.

Friday Reading List



Check back here every Friday for the latest news on NTDs.

2.7 million Ugandans safe from river blindness— New Vision, 8/7/14
Private medical practitioners must set the pace — Ghana Web 8/11/14
Ajaja: The monthly environmental sanitation The Guardian, 8/13/14
Mayor Gives Away Deworming Pills to Students — The New Indian Express, 8/13/14
6 Scary Waterborne Illnesses to Watch For — The Weather Channel, 8/13/14

Image by Flicker user Sebastien Wiertz.