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Economics of Malnutrition
Symposium on Nutrition
DDOs, ICDS Prog Officers & CDHOs
Gandhinagar 13.5.06
Is there need to invest in reduction
of malnutrition ?
Single biggest contributor (60%) to child mortality
Anaemia causes 60,000 deaths yearly in women
It’s a silent emergency
Low weight infants have 2 to 10 times risk of death
Leads to growth faltering & stunting
Reduced physical work capacity & productivity
Poor resistance & predisposition to infections
Is there need to invest (Contd) ?
Impaired drug response (anti-retrovirals)
Defective vision & low immunity
Folate def causes severe birth defects in 250,000
Iodine def causes mental impairment in 18m yearly
The damage is irreversible and life long
It passes from generation to generation
Poverty reduction strategies can be de-railed
MDG on nutrition would not be achieved by 2015
When does the damage take place ?
• Major damage caused by malnutrition takes
place in
– the womb
– first two years of life
Window of
How are poverty &
malnutrition interrelated
Income Poverty
Low Food
Hard Physical
Direct losses
In productivity
from poor
Physical status
Indirect losses
in productivity
from poor cognitive
& schooling
Loss in resources
from increased
health care costs
of ill health
What is the economic fall out ?
Productivity losses to individuals are estimated at
more than 10% lifetime earnings, and gross
domestic product (GDP) lost to malnutrition runs
as high as 2 to 3%
Median total losses (physical and cognitive) due
to iron def are $16.8 per capita,4.05% of GDP
Improving nutrition is therefore as much–or moreof an issue of economics as one of welfare, social
protection and human rights
Improving nutrition is a pro poor strategy,
disproportionately increasing the income-earning
potential of the poor
Does malnutrition also occurs
in families that are not poor ?
But Why?
Preg & nursing mothers eat less than body needs
Exclusive breastfeeding is not universal
People do not always know what food and
feeding practices are best for their small children
Food intake is restricted during illness in children
People can not easily tell when their child is
becoming malnourished
Growth faltering is not visible in the early stages
Micronutrient deficiencies are not visible to
untrained eyes
How much can economic
growth achieve ?
With substantial increase in income, malnutrition
in developing countries has not declined
When GNP doubles, malnutrition improves by 32
to 23%
Its estimated that sustained per capita economic
growth of 2.5% between 1990s and 2015 would
reduce malnutrition by 27%
This is just half of the MDG goal of 50% reduction
What investments give best returns ?
Health & nutrition related
Non Health
Controlling HIV/AIDS
Providing micronutrients
Controlling malaria
Improving infant/child
• Scaling up basic health
• Reducing prevalence of
Liberalizing trade
Lowering barriers to migration
New agricultural technology
Small scale water technology
Community managed water
• Research on water in agricult
• Lowering cost of business
Copenhagen Consensus May 2004
What are the quick routes to
improving nutrition status ?
Micronutrient supplementation – Vitamin A, Iodine
and Iron-Folate
Exclusive breastfeeding for first 6 months
Periodic growth monitoring
Timely & adequate complementary feeding
Complete immunization cover
Prompt treatment of childhood diseases
Birth spacing (> 2 years)
What are the long term measures to
sustain gains of improving nutrition
Economic growth
Macroeconomic policies
Female education and enhanced women’s status
Women’s workload
Food production
Water supply & sanitation
Family planning – birth timing & limiting
What are the ongoing interventions ?
Growth monitoring
Supplementary feeding & counseling
Supplementation of Vitamin A, IFA & Iodine
Breastfeeding, NBC, Disease control, IMNCI and
child care at home
Maternal care
TSC & Swajaldhara
PDS, SHG, Food for Work, etc.
What is missing ?
Community level awareness
Early & exclusive breastfeeding
Quantity & frequency of feeding
Prompt treatment of illnesses
Sanitation & hand washing with soap
Action following growth monitoring
What can the District Managers do?
• Ensure 300 days of feeding by ICDS for <3s
• Monthly growth monitoring & counseling of mothers
• Visits homes of children of Grade III/IV, with growth
faltering and absentees for any risks
• AWW to visit homes of pregnant and nursing for
counseling on feeding/care practices
• Medical check-up of Gr III/IV children
• Hand washing with soap, safe drinking water, toilet
use & sanitation at AW
In the village ………. ?
Iodized salt and food grains at the PDS shop
Iron-Folate tabs for adolescent girls
Any marriage < 18 yrs
All births registered in Ist wk & certificates issued
Any infant, child or maternal death
Immunization sessions held in last three months
Any child 6-14 out of school
Availability of ORS, Condoms, drinking water, home
• Visit home where birth taken place recently
• Link couples, VEC, Women SHG, Volunteers, etc
Can the children be well-nourished
and contribute to the economic
growth of the State?
Science is known
Systems are in place
With little systemic and effective support by all,
children in Gujarat could be well nourished.
Thank You!!!