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Tuesday, September 24, 2019

To fight malnutrition in India, engage all stakeholders | Analysis

One of the major advantages of a multisectorial approach is resource optimisation. Also, it aims to ensure a strong focus on management through institutional and programmatic convergence, by integrating it in the planning, implementation and supervision processes

Zero hunger and good nutrition have the power to transform and empower the present and future generations. India’s greatest national treasure is our people but one-fourth of our children are born with low birth weight, 35.7% of children under five are underweight, 38.4% are stunted and 21% are wasted. Severe acute malnutrition (SAM), estimated, as severe wasting is 7.5%. Although India has shown progress in improving child nutrition, malnutrition remains high.
Poor nutrition in the first 1,000 days of children’s lives can have irreversible consequences. For millions of children, it means they are stunted, which in turn makes them more susceptible to sickness. The consequences of child hunger and undernutrition can be extreme, both for families and cumulatively for the communities and nations.
Community management of acute malnutrition (CMAM) is a proven approach to manage SAM and MAM moderate acute malnutrition (MAM) in children under five. It involves timely detection of SAM children in the community and the provision of treatment for those without medical complications with nutrient-dense foods at home. The Integrated Child Development Services programme provides supplementary nutrition in the form of take-home ration to cater to the malnourished children. Currently, there is a lack of policies and common national guidelines to address both, the treatment and the prevention of SAM children. The guidelines of Poshan Abhiyaan states that the community-based traditional events must be organised once in a month at Anganwadi centres to promote and support social behaviour change to improve maternal and child nutrition through the information, education and communication approach along with interpersonal commination. In the absence of clear guidelines, however, community management faces challenges such as poor follow-up of cases, the lack of convergence among ministries and line departments, poor networking among government functionaries due to a lack of clarity, as highlighted in the position paper on India’s CMAM review.
United Nations Children’s Fund’s (Unicef, 1990) conceptual framework on the determinants of child malnutrition illustrates the multidimensional nature of the problem and requires a multisectoral approach to address it. Multisectoral approach is one of the key steps to tackle malnutrition and micronutrient deficiencies to help control infections, morbidity, disability and mortality.
Poshan Abhiyan recognises that chronic malnutrition is a major nutrition problem in the country. This approach considers the factors that limit the capacity of government institutions to implement it. The Poshan Abhiyaan already ensures convergence with various line departments aimed at initiating convergent action plans at every level of care, to achieve synergy and the desired results. Taking a sector-wide approach by engaging multiple stakeholders can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths to produce better health outcomes.
One of the major advantages of a multisectorial approach is resource optimisation. Also, it aims to ensure a strong focus on management through institutional and programmatic convergence, by integrating it in the planning, implementation and supervision processes. This approach will lead to better policies, institutions and programmes to improve nutrition outcomes.
However, there is still a massive challenge in making a functional multisector action plan. This hurdle can be overcome with national guidelines, and its implementation through leadership at every level — a strong catalyst to initiate and strengthen the convergence and collaboration.
Rajasthan and Gujarat have been successful in implementing a community-based model for treating children. It’s time to make efforts in the rest of the country as well.
There are no medical complications for the majority of children with SAM and they can be managed at their homes with standard protocols. There is an urgent need to streamline CMAM guidelines as a routine part of the government system. Together, this may prove to be the most robust investment we can make to fulfil the promise of the 2030 agenda.
Sujeet Ranjan is executive director, The Coalition for Food and Nutrition Security
Source: Hindustan Times, 23/09/2019

A Drop of Water


A shepherd was tending his flock in the hills of Judah. He became thirsty and went to his favourite brook in the hills to take a drink. As he was drawing the crystal clear water in his palm and putting into his mouth, something caught his eye. He saw drops of water falling on a huge stone — drip, drip, drip — and directly where the drops were falling, there was a deep hole in the stone. “What mighty power there is in a drop of water,” thought the shepherd. “Could my stony heart ever be softened that way?” “Hello Akiba! What are you gazing at?” It was Rachel, his master’s daughter. She was wise and kind and fair. “Look what the little drops of water did to the rock,” Akiba exclaimed. “Do you think there is hope for me? Suppose I began to study the Torah, little by little, drop by drop, do you think my stony heart would soften?” “Oh yes, Akiba. If you persevere, if you keep it up as these drops of water.” “But I am 40 years old! Is it not too late to start?” “Oh no, Akiba. It is never too late, if you promise to learn our Holy Torah. I know you will not be ignorant for long.” The shepherd gazed at the drops of water for a long time, and then his mind was made up. And this is how Akiba the shepherd became the Great Rabbi Akiba, the greatest and wisest scholar and teacher of his day, who had 24,000 pupils. He often told them that it was a drop of water that changed his life.


Source: Economic Times, 24/09/2019

Just 24% of students in top schools women


Female scholars number just 24% in 127 institutions of national importance although overall there are more females in eight out of 16 undergraduate and postgraduate programmes on Indian campuses, according to the All India Survey on Higher Education (AISHE) 2018-19. There are more females pursuing science and medicine at undergraduate level, while for BCom, there are 99 females for every 100 males on campus. Also women comfortably outnumber men among those graduating at UG, PG, PG diploma and MPhil level. Female participation is high and has increased sharply at MA, MSc and MCom levels during the last five years. In master’s level, there are more females in science and arts with 62.72% and 61.78% of the total enrolment, respectively. Women made big strides in BCom, BSc & MBBS in 5 yrs Today some of the programmes where the gender gap is significantly in favour of the females are medical (at UG level) where it is 60.6%, Arts at 53.03% and Science at 51% of total enrolment. In master’s level there are more females in Science and Arts with 62.72% and 61.78% of total enrolment respectively. Female participation has been dominant in BA, BEd, BSc nursing, MA, MCom and MSc for past five years. But the bigger stride by women in the last five years has been made in BCom, BSc and MBBS. But what can cause some concern are the figures for the last three years in institutions of national importance which show the numbers for female scholars are more or less static at institutions like AIIMS, IITs, IISERs, NITs and Schools of Planning and Architecture, among others. Females have also a lot of catching up to do in law where enrolment stands at 33.7% and just 28% and 28.86% in BTech and BE, respectively. In MTech, there has been a continuous decline as the number of females per 100 males have dipped from 64 in 2014-15 to 54 in 2018-19. Despite marked improvement from 58 females per 100 males to 75 in MBA courses, and 64 in 2014-15 to 70 in 2018-19 in BCA, the gender gap remains significant. Women fare poorly in overall enrolment in technical education (BE/ BTech) with the bulk of the institutions of importance offering professional technical courses. The biggest gap is at the undergraduate level, where there are 26,736 females as compared to 96,724 males. Similarly at postgraduate level, the number of females is just 12,819 in a population of 50,201. The AISHE data also indicates a shift in preference as increasing number of students opt for professional programmes like management, law, computer applications, pharmacology and medicine, touching a fiveyear high in enrolment. However, traditional engineering and arts programme, as well as BTech/ BE/ MTech enrolment have continued to slide in the last five years. Meanwhile, enrolment numbers continue to decline for the fifth consecutive year for engineering and technology, bachelor in arts. BSc and MA have for the first time in five years registered negative enrolment figures in 2018-19.


Source: Times of India, 24/09/2019

Monday, September 23, 2019

Two out of three child deaths due to malnutrition: report


Analysis of health data finds that Assam, Bihar, Rajasthan and U.P. are the most affected States

Two-thirds of the 1.04 million deaths in children under five years in India are still attributable to malnutrition, according to the first comprehensive estimate of disease burden due to child and maternal malnutrition and the trends of its indicators in every State from 1990.
The report states that the disability-adjusted life year (DALY) rate attributable to malnutrition in children varies 7-fold among the States and is highest in Rajasthan, Uttar Pradesh, Bihar and Assam, followed by Madhya Pradesh, Chhattisgarh, Odisha, Nagaland and Tripura.
The report was published on Wednesday in The Lancet Child & Adolescent Health by the India State-Level Disease Burden Initiative. The report says the overall under-five death rate and the death rate due to malnutrition has decreased substantially from 1990 to 2017, but malnutrition is still the leading risk factor for death in children under five years, and is also the leading risk factor for disease burden for all ages considered together in most States.
The malnutrition trends over about three decades reported in this paper utilised all available data sources from India, which enable more robust estimates than the estimates based on single sources that may have more biases.
The India State-Level Disease Burden Initiative is a joint initiative of the Indian Council of Medical Research (ICMR), Public Health Foundation of India, and Institute for Health Metrics and Evaluation in collaboration with the Ministry of Health and Family Welfare along with experts and stakeholders associated with over 100 Indian institutions, involving many leading health scientists and policy makers from India.
Vinod K. Paul, member, NITI Aayog, said that the government is now intensifying its efforts to address the issue of malnutrition across the country. “State governments are being encouraged to intensify efforts to reduce malnutrition and undertake robust monitoring to track the progress,” he said.
Balram Bhargava, Director General, ICMR said: “The National Institute of Nutrition, an ICMR institute, and other partners are setting in place mechanisms to ensure that there is more data available on malnutrition in the various States which will help monitor progress. The findings reported in the paper published today highlight that there are wide variations in the malnutrition status between the States. It is important therefore to plan the reduction in malnutrition in a manner that is suitable for the trends and context of each State.”

Low birth weight

Senior author of the paper Lalit Dandona, also director of the India State-Level Disease Burden Initiative, explained that the study reports that malnutrition has reduced in India, but continues to be the predominant risk factor for child deaths, underscoring it importance in addressing child mortality. “It reveals that while it is important to address the gaps in all malnutrition indicators, low birth weight needs particular policy attention in India as it is the biggest contributor to child death among all malnutrition indications and its rate of decline is among the lowest. Another important revelation is that overweight among a subset of children is becoming a significant public health problem as it is increasing rapidly across all States,” he said.
Soumya Swaminathan, chief scientist at the World Health Organisation and first author on this paper, noted that the study findings have highlighted where efforts need to be intensified.
“For substantial improvements across the malnutrition indicators, States will need to implement an integrated nutrition policy to effectively address the broader determinants of under-nutrition across the life cycle. Focus will be needed on major determinants like provision of clean drinking water, reducing rates of open defecation, improving women’s educational status, and food and nutrition security for the most vulnerable families,” she explained.
Source: The Hindu, 19/09/2019

Quote of the Day


“Life cannot subsist in a society but by reciprocal concessions.”
‐ Samuel Johnson
“परस्पर आदान-प्रदान के बिना समाज में जीवन का निर्वाह संभव नहीं है।”
‐ सेमुअल जॉन्सन

Economic and Political Weekly: Table of Contents



Vol. 54, Issue No. 38, 21 Sep, 2019

Politics after NRC threatens to change old framework of Assamese nationalism

When the Bill returns, seeking to accommodate Hindu migrants from Bangladesh, it will upset the section of Assamese whose opposition to illegal migrants does not recognise religion.


A distant but distinct memory from my student days, which I often recall with fondness, concerns an incident so trivial that I would never have thought of bringing it up in connection with something as serious as the National Register of Citizens (NRC). Yet there can be no better illustration of what our identity meant to us:
It was after dinner at our engineering college hostel, and we were taking a new boarder through an introductory routine. We asked him to chant the national anthem; he faltered a little. Are you not Indian, we asked. I am Naga, the freshman said with pride. You are Naga but Indian first, one senior started to preach, when another interrupted him: Let him be Naga first if he wishes, as long as he is Indian; just as we are Assamese first and also Indian.
No need for anyone to outrage. Nearly every Assamese I know is as proud of his or her nationality as an Indian from any other state. That observation by my friend was just a reflection of the times. In the wisdom of the 1980s, “Assamese first” was the identity we wore on our sleeve. A logician might find the idea questionable — each one of us was all his identities simultaneously — but what the phrase conveyed was tied with emotion. It remains in circulation today; the question is whether it carries the same import as before. As we get more and more “mainstreamed” and a new politics of religion competes with the regional pride of old, every Assamese may one day need to reflect on what we once were, and what we are turning out to be.
Take the NRC. The exercise was religion-neutral at its core, seeking to identify citizens on the basis of a cut-off date. But after its completion, the focus has been on the religious faith of one section among the 19 lakh excluded — Bengali Hindus, who may eventually be given citizenship — and even more on one section among the 3.11 crore included. The NRC has given legitimacy to lakhs of migrant-origin Muslims, who had papers to show that they or their ancestors had entered Assam before the cut-off date. For this very reason, many of them had welcomed the NRC, but it turns out that they are still being viewed with suspicion despite — and because of — their high inclusion in districts bordering Bangladesh.
What I have set out to reflect on is not, however, whether the number of exclusions is too low or just right, or the unanswered question of what will happen to those who will still be left out after the NRC is trimmed further after the appeals and legislation. This is about a puzzle called the Assamese identity, now confounded by religion.
Religion has cast its shadow in strange ways. Take the “Miya Poetry” controversy, when verses of self-assertion by Bengal-origin Muslims caused offence to many Assamese, leading to police booking them. Those who had filed the complaints included a number of Assamese Muslim organisations. In one news report, a complainant was quoted as saying that “we are Assamese first and Muslims later”. Those two words again, so nostalgic and relatable. Come to think of it, however, it begs a question: Is it necessary to mention your religious faith to show that you are more Assamese than others?
Indeed, the idea of Assamese identity, for some, has often coexisted with contempt for the other. The 1979-85 agitation against illegal immigration may have limited its focus to those who had entered Assam after a cut-off date, but the emotions it generated were built on larger Assamese anxieties around the migrant communities as a whole. When the cut-off was agreed and signed, it came with the implicit premise that the greater Assamese society would accommodate migrants on the right side of that date. Instead, a number of factors, including population growth and political consolidation around the AIUDF, have raised the anxieties around Bengal-origin Muslims, while the proposed Citizenship Amendment Bill has threatened to reopen a fault line between Assamese and Bengali Hindus.
When the Bill returns, seeking to accommodate Hindu migrants from Bangladesh, it will upset the section of Assamese whose opposition to illegal migrants does not recognise religion. It will also raise a new question, between one Assamese and another. If a Hindu migrant is a better migrant than a Muslim migrant, does it mean, by extension, that an Assamese Muslim is less Assamese than an Assamese Hindu?
As a society, we appear to be holding on. We still pat each other on the back, thump our secular chests with Assamese pride, and still celebrate our shared culture and shared history of centuries — from the Battle of Saraighat when our ancestors brought Mughal invaders to their knees, to the language riots when our elders were killed, and the agitation against illegal immigration when 855 of our generation became martyrs.
As voters, however, we are already divided. In 2016, when the BJP won Assam for the first time, a survey by Lokniti-CSDS, published in this paper, found that two-thirds of Assamese Hindus had voted for the BJP and two-thirds of Assamese Muslims for the Congress. Like Assamese Hindus, two-thirds of Bengali Hindus had voted for the BJP, while Bengali Muslims had split evenly between the Congress and AIUDF.
Maybe I worry too much, but I keep an eye on the Muslim population, already over one-third of Assam’s total by 2011. Yes, that population includes both Assamese and Bengal-origin Muslims. But if it keeps growing, will an Assamese who looks at me as a fellow Assamese today, see instead a Muslim tomorrow?
Who knows, that day too may come. It can never be sweeping, though; there will always be some who continue to believe in what we once were. Defined by the cliché we used that night more than three decades ago. Assamese first. Non-negotiable.
kabir.firaque@expressindia.com
Source: Indian Express, 23/09/2019