Lok Sabha Question No. 3383 (UNSTARRED), answered on 2019-07-12
Subject: Infant Deaths due to Diseases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Anto  Antony

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3383 TO BE ANSWERED ON 12 TH JULY, 2019

## INFANT DEATHS DUE TO DISEASES

## 3383. SHRI ANTO ANTONY:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has any statistics regarding number of children who died below the age of six due to various epidemics/diseases;
- (b) if so, the number of children who died during the last five yea rs, year and State/UT - wise;
- (c) whether malnutrition is one of the reasons for the diseases causing death among children;
- (d) if so, the details thereof and the major reasons for malnutrition along with the steps taken by the Government to eradicate malnutrition and the amount earmarked in this regard for the aforesaid period; and
- (e) whether poverty is one of the reasons for malnutrition, if so, the details thereof and the steps taken by the Government to eradicate poverty?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (SHRI ASHWINI KUMAR CHOUBEY)

- (a)  &  (b) Under  five  mortality  estimates  are  available  through  Sample  Registration  Syst (SRS) report of Registrar General of India. The State/UT wise detail of under - five mortality rate for last five year is enclosed at annexure 1.
- (c) to  (e) Malnutrition is no t a direct cause of death among under five children, however, it can increase morbidity and mortality by reducing resistance to infections. Malnutriti on is a vicious cycle. Malnutrition begins from womb as baby born with an intra -uterine growth retardation is more likely to become a stunted child and unable to attain full growth potential
- Key reasons for malnutrition - low birth weight, faulty and sub - optimal infant and young child feeding practices
- Repeated  episodes  of  childhood  illnesses  such  as  diarrhoea  and  pneumonia,  hi prevalence of soil transmitted helminths infection (STH)
- Socio - economic  determinants - poor  maternal  nutritional  status  during  pregnancy,  food inadequacy in family, large family size, inappropriate hygiene and sanitation practic

The steps being undertaken by Government of India for improvement in the status of Child under - nutrition are as under

- Integrated Child Development Scheme (ICDS) to improve the nutritional and health sta of  children  in  the  age -group  0 - 6  years  is  being  implemented  in  all  State/UTs  by  the Ministry of Women and Child Development, Governm ent of India. The details of Budget Allocation and Expenditure for the year 201 5- 16 to 2019 - 20 in respect of Supplementary Nutrition Program  (SNP)  under  Anganwadi  services  is  enclosed  at  annexure  2 (A). POSHAN  Abhiyaan  has  been  set  up through  convergent  act ion  and  robust  monitoring system to address malnutrition across the States/UT. The detail of State/UT budget f 2017- 18 & 2018 - 19 is enclosed at annexure 2(B).
- 2) Under  National  Health  Mission  (NHM),  the  Ministry  of  Health  and  Family  Welfare  i strengthening the health systems which includes various programs to reduce under - nutrition in vulnerable population across the life cycle, such as micronutrients supplementat ion program, management of sick children with severe acute malnutrition in health facilities, impro of  appropriate  Infant  and  Young  Child  Feeding  Practices,  Vitamin  A  supplementatio National Deworming Day etc. Prevention of Childhood illnesses such as Diarrhoeal diseases in turn  prevents  childhood  malnutrition  indirectly.  Intensified  Diarrhoea  Control  For (IDCF)  is  being  implemented  for  this  purpose.  Janani  Shishu  Suraksha  Karyakram  (JSSK which includes provision of free diet for the pregnant mothers and infants during their stay at health  facility  is  another  strategy  to  provide  nutritional  support.  Other  programm Immunization, Home Base Young Childcare programme (HBYC) and Integrated Management of  Neonatal  and  Childhood  Illnesses  (IMNC I)inter - alia  address  malnutrition  and  improve nutritional status.

In  order  to  promote  and  support  breastfeeding,  Government  has  implemented  ' MAA -Mothers' Absolute Affection' programme to improve breastfeeding coverage and appropriate breastfeeding pract ices in the country.

Anaemia  Mukt  Bharat  (AMB)  strategy  is one  of  the  important  components  of  POSHAN Abhiyaan.  The  strategy  covers six population  groups  [Under  five  children,  children  (5 - 9 years), adoloscents (10 - 19 years), pregnant and lactating women and women of reproductive age (WRA)], six interventions and six institutional mechanisms.

Promotion for intake of iodized salt and monitoring salt quality through testing under National Iodine Deficiency Disor ders Control Programme.

Prevention  of  childhood  illness es such  as  diarrheal  diseases  in  turn  prevents  childhood malnutrition.  Control  of  childhood  diarrhoea  is  being  carried  out  by  conducting  a Intensified Diarrhoea Control Fortnights (IDCFs).

Rashtriya Bal Swasthya Karyakram (RBSK) provides child health screening for 30 common health conditions including nutritional status screening and provides free referral and facilities for screened children.

Village  Health  and  Nutrition  Days  and  Mot her  and  Child  Protection  Card are  the  joint initiative of the Ministry of Health & Family welfare and the Ministry of Woman and C Development for addressing the nutrition concerns in children, pregnant women and lact mothers. Village Health Sanita tion and Nutrition Days (VHNSDs) are monthly days held at village level in Anganwadi centre to increase the awareness and bring about desired chan the  dietary  practices  including  the  promotion  of  breastfeeding  through  group  couns sessions.

Treatment of sick children with Severe Acute Malnutrition (SAM) at special units calle Nutrition  Rehabilitation  Centres  (NRCs),  set  up  at  public  health  facilities. The  specific programs  which  have  bearing  on  nutritional  status  of  women  and  children  an d  their expendit ure is enclosed at annexure 2 (C ).

- 3) To address malnutrition related to poverty ,National Food Security Act, 2013 (NFSA), seeks to provide for food and nutritional security in human life cycle approach, by ensuring ac adequate quantity of quality food at affordable prices to people to live a life with di Act provides for  coverage of upto 75% of the rural population and upto 50% of the urb population  for  receiving  highly  subsidized  food  grains  under  Targeted  Public  Distri System  (TPDS),  thus  covering  about  two - thirds  of  the  population  or  at  least  81.35  crore per sons, at Census 2011 population.

The Act also has a special focus on the nutritional support to women and entitled to nu meals, free of cost, as per the prescribed nutritional standards. In case of non - supply of entitled foodgrains or meals, the b eneficiaries are entitled to receive food security allowance.

In  addition  to  NFSA,  Gol  is  also  allocating  food grains  under  following  five  welfare schemes: Wheat Based Nutrition Programme (WBNP), Mid Day Meal Scheme (MDM), Scheme for  Adolescent  Girls  (SAG),  Allocation  of  food grains  under  Welfare  Institutions&  Hostel Scheme and Annapurna Scheme.

## Annexure 1

## State - wise trend of Under - 5 Mortality Rate (U5MR) in India, SRS

| States           | 2012   | 2013   |   2014 |   2015 |   2016 |
|------------------|--------|--------|--------|--------|--------|
| India            | 52     | 49     |     45 |     43 |     39 |
| Andhra Pradesh   | 43     | 41     |     40 |     39 |     37 |
| Assam            | 75     | 73     |     66 |     62 |     52 |
| Bihar            | 57     | 54     |     53 |     48 |     43 |
| Chhattisgarh     | 55     | 53     |     49 |     48 |     49 |
| Delhi            | 28     | 26     |     21 |     20 |     22 |
| Gujarat          | 48     | 45     |     41 |     39 |     33 |
| Haryana          | 48     | 45     |     40 |     43 |     37 |
| Himachal Pradesh | 43     | 41     |     36 |     33 |     27 |
| Jammu & Kashmir  | 43     | 40     |     35 |     28 |     26 |
| Jharkhand        | 50     | 48     |     44 |     39 |     33 |
| Karnataka        | 37     | 35     |     31 |     31 |     29 |
| Kerala           | 13     | 12     |     13 |     13 |     11 |
| Madhya Pradesh   | 73     | 69     |     65 |     62 |     55 |
| Maharashtra      | 28     | 26     |     23 |     24 |     21 |
| Orissa           | 68     | 66     |     60 |     56 |     50 |
| Punjab           | 34     | 31     |     27 |     27 |     24 |
| Rajasthan        | 59     | 57     |     51 |     50 |     45 |
| Tamil Nadu       | 24     | 23     |     21 |     20 |     19 |
| Telangana        |        |        |     37 |     34 |     34 |
| Uttar Pradesh    | 68     | 64     |     57 |     51 |     47 |
| Uttarakhand      |        |        |     36 |     38 |     41 |
| West Bengal      | 38     | 35     |     30 |     30 |     27 |

## Annexure 2 (A)

## Details of funds allocated for Supplementary Nutrition Programme (SNP) under Anganwadi Services (Integrated Child Development Services)

| Sl. No.   | State/UTs         | Supplementary Nutrition Programme SNP   | Supplementary Nutrition Programme SNP   | Supplementary Nutrition Programme SNP   | Supplementary Nutrition Programme SNP   | Supplementary Nutrition Programme SNP   |
|-----------|-------------------|-----------------------------------------|-----------------------------------------|-----------------------------------------|-----------------------------------------|-----------------------------------------|
| Sl. No.   | State/UTs         | 2015-16                                 | 2016-17                                 | 2017-18                                 | 2018-19                                 | 2019-20                                 |
| 1         | ANDHRA PRADESH    | 34210.58                                | 33996.12                                | 32916.43                                | 39530.13                                | 35844.15                                |
| 2         | BIHAR             | 55524.38                                | 58085.28                                | 54423.27                                | 70750.25                                | 77825.28                                |
| 3         | CHHATTISGARH      | 15102.69                                | 19992.11                                | 22699.81                                | 27099.81                                | 29809.79                                |
| 4         | GOA               | 445.75                                  | 498.28                                  | 664.6                                   | 863.98                                  | 845.46                                  |
| 5         | GUJARAT           | 21720.72                                | 21973.18                                | 28235.82                                | 32535.82                                | 35789.4                                 |
| 6         | HARYANA           | 7891.50                                 | 6575.13                                 | 6342.75                                 | 7645.58                                 | 8410.14                                 |
| 7         | JHARKHAND         | 21017.46                                | 18153.74                                | 25140.96                                | 29083.25                                | 31991.58                                |
| 8         | KARNATAKA         | 32923.88                                | 41444.92                                | 45222.48                                | 49589.22                                | 54548.14                                |
| 9         | KERALA            | 5108.70                                 | 6280.32                                 | 8296                                    | 10784.8                                 | 11863.28                                |
| 10        | MADHYA PRADESH    | 54421.61                                | 49406.18                                | 55724.11                                | 63241.34                                | 69565.47                                |
| 11        | MAHARASHTRA       | 49668.12                                | 39526.98                                | 49665.28                                | 55055.2                                 | 60560.72                                |
| 12        | ODISHA            | 34900.31                                | 35046.9                                 | 35698.64                                | 46408.23                                | 51049.06                                |
| 13        | PUNJAB            | 5950.22                                 | 4978.88                                 | 6144.75                                 | 7488.18                                 | 8237                                    |
| 14        | RAJASTHAN         | 25875.29                                | 23535.76                                | 28939.88                                | 33221.84                                | 36544.02                                |
| 15        | TAMIL NADU        | 24779.52                                | 25535.68                                | 28651.21                                | 37246.57                                | 39331.66                                |
| 16        | TELANGANA         | 20123.05                                | 18292.97                                | 18076.35                                | 21170.5                                 | 23287.55                                |
| 17        | UTTAR PRADESH     | 145338.73                               | 160784.24                               | 165244.43                               | 156155.99                               | 171771.59                               |
| 18        | WEST BENGAL       | 38878.68                                | 38485.72                                | 47617.5                                 | 54420                                   | 59862                                   |
| 19        | DELHI             | 6814.14                                 | 6740.28                                 | 6762.17                                 | 6762.17                                 | 7438.39                                 |
| 20        | PUDUCHERRY*       | 132.03                                  | 3404.04                                 | 348.12                                  | 0                                       | 0                                       |
| 21        | HIMACHAL PRADESH  | 5323.79                                 | 5523.79                                 | 5366.32                                 | 6976.22                                 | 7673.84                                 |
| 22        | JAMMU & KASHMIR   | 8070.34                                 | 8070.34                                 | 4257.02                                 | 4257.02                                 | 4682.72                                 |
| 23        | UTTARAKHAND       | 9512.41                                 | 9691.34                                 | 11392.44                                | 12090.44                                | 13299.48                                |
| 24        | ANDAMAN & NICOBAR | 252.62                                  | 262.67                                  | 284.57                                  | 369.94                                  | 406.94                                  |
| 25        | CHANDIGARH        | 574.06                                  | 380.98                                  | 592.09                                  | 769.72                                  | 846.69                                  |
| 26        | D. & NAGAR HAVELI | 203.80                                  | 203.8                                   | 129.89                                  | 168.86                                  | 185.74                                  |
| 27        | DAMAN & DIU       | 174.12                                  | 174.12                                  | 130.83                                  | 170.08                                  | 187.09                                  |
| 28        | LAKSHADWEEP       | 8.34                                    | 68.31                                   | 77.12                                   | 100.26                                  | 110.28                                  |
| 29        | ARUNACHAL PRADESH | 3757.20                                 | 4239.79                                 | 4085.14                                 | 5010.68                                 | 3830.67                                 |
| 30        | ASSAM             | 35842.49                                | 37818.61                                | 35875.31                                | 45037.9                                 | 49541.69                                |
| 31        | MANIPUR           | 3676.04                                 | 3077.49                                 | 3914.63                                 | 5089.02                                 | 9960.45                                 |
| 32        | MEGHALAYA         | 7756.43                                 | 8352.22                                 | 9422.19                                 | 10468.21                                | 11515.03                                |
| 33        | MIZORAM           | 2467.59                                 | 2156.92                                 | 2000.25                                 | 2242.64                                 | 2466.9                                  |
| 34        | NAGALAND          | 4216.06                                 | 3490.47                                 | 6902.3                                  | 7588.35                                 | 7967.69                                 |
| 35        | SIKKIM            | 657.60                                  | 585.52                                  | 632.47                                  | 751.11                                  | 582.82                                  |
| 36        | TRIPURA           | 4032.24                                 | 5946.55                                 | 6650.22                                 | 7488.55                                 | 8979.7                                  |
| Total     | Total             | 687424.49                               | 702779.63                               | 758527.35                               | 857631.86                               | 936812.41                               |

(Rupees in Lakhs)

## Fund Released to States/UTs under POSHAN Abhiyaan

## Annexure 2 (B)

| State/UT             | Central Share Release   | Central Share Release   |           |
|----------------------|-------------------------|-------------------------|-----------|
| State/UT             | 2017 - 18               | 2018-19                 | TOTAL     |
| Andhra Pradesh       | 1284.63                 | 8604.68                 | 9889.31   |
| Arunachal Pradesh    | 52.93                   | 2663.35                 | 2716.28   |
| Assam                | 2298.27                 | 15492.36                | 17790.63  |
| Bihar                | 6724.06                 | 15001.67                | 21725.73  |
| Chhattisgarh         | 965.45                  | 9629.51                 | 10594.96  |
| Delhi                | 945.95                  | 2206.88                 | 3152.83   |
| Goa                  | 238.07                  | 197.78                  | 435.85    |
| Gujarat              | 3036.66                 | 11228.03                | 14264.69  |
| Haryana              | 400.97                  | 5992.46                 | 6393.43   |
| Himachal Pradesh     | 1557.26                 | 4153.15                 | 5710.41   |
| Jammu & Kashmir      | 388.59                  | 8343.52                 | 8732.11   |
| Jharkhand            | 1555.35                 | 5110.45                 | 6665.80   |
| Karnataka            | 3351.05                 | 9870.89                 | 13221.94  |
| Kerala               | 1273.37                 | 6491.91                 | 7765.28   |
| Madhya Pradesh       | 3441.49                 | 15894.17                | 19335.66  |
| Maharashtra          | 2572.31                 | 20989.28                | 23561.59  |
| Manipur              | 340.46                  | 3865.37                 | 4205.83   |
| Meghalaya            | 462.98                  | 1713.27                 | 2176.25   |
| Mizoram              | 119.38                  | 957.65                  | 1077.03   |
| Nagaland             | 163.74                  | 1251.97                 | 1415.71   |
| Odisha               | 4600.46                 | 10571.65                | 15172.11  |
| Puducherry           | 39.24                   | 393.70                  | 432.94    |
| Punjab               | 819.51                  | 6090.33                 | 6909.84   |
| Rajasthan            | 2045.73                 | 9680.99                 | 11726.72  |
| Sikkim               | 98.59                   | 328.47                  | 427.06    |
| Tamil Nadu           | 1340.51                 | 12210.93                | 13551.44  |
| Telangana            | 1736.94                 | 8595.70                 | 10332.64  |
| Tripura              | 277.91                  | 3695.72                 | 3973.63   |
| Uttar Pradesh        | 8440.60                 | 29582.87                | 38023.47  |
| Uttarakhand          | 1866.25                 | 4301.57                 | 6167.82   |
| West Bengal          | 5545.27                 | 19294.11                | 24839.38  |
| Andaman & Nicobar    | 100.22                  | 416.89                  | 517.11    |
| Dadra & Nagar Haveli | 108.83                  | 129.32                  | 238.15    |
| Daman & Diu          | 42.06                   | 197.66                  | 239.72    |
| Lakshadweep          | 60.00                   | 138.90                  | 198.90    |
| Chandigarh           | 158.88                  | 306.82                  | 465.70    |
| TOTAL                | 58453.97                | 255593.98               | 314047.95 |

(Rs in Lakhs)

## Annexure 2 (C)

## State/UT- wise Funds spent (In lakhs) in Micronutrient Supplementation Programmes, Infant and Young Child Feeding (IYCF) practices, Nutrition Rehabilitation Centres (NRCs) and Diarrhoea Control activities in the  Financial years 2014 - 15 to 2 018- 19

| S. No.                    | Name of the State/UTs     | 2014- 15                  | 2015- 16                  | 2016- 17                  | 2017- 18                  | 2018- 19                  |
|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|---------------------------|
| A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      | A. High Focus States      |
| 1                         | Bihar                     | 675.15                    | 437.29                    | 540.98                    | 1007.20                   | 515.55                    |
| 2                         | Chhattisgarh              | 298.99                    | 393.30                    | 451.02                    | 534.06                    | 544.97                    |
| 3                         | Himachal Pradesh          | 0.07                      | 20.64                     | 34.83                     | 14.10                     | 7.81                      |
| 4                         | Jammu & Kashmir           | 12.54                     | 27.32                     | 24.57                     | 71.98                     | 30.45                     |
| 5                         | Jharkhand                 | 484.83                    | 565.24                    | 436.14                    | 419.70                    | 685.61                    |
| 6                         | Madhya Pradesh            | 1815.16                   | 1907.71                   | 2854.19                   | 2657.04                   | 2668.95                   |
| 7                         | Orissa                    | 281.24                    | 194.58                    | 247.63                    | 306.46                    | 1040.53                   |
| 8                         | Rajasthan                 | 205.92                    | 390.16                    | 437.15                    | 302.23                    | 460.25                    |
| 9                         | Uttar Pradesh             | 189.39                    | 570.83                    | 1004.69                   | 980.34                    | 714.33                    |
| 10                        | Uttarakhand               | 9.63                      | 19.39                     | 59.36                     | 30.55                     | 157.03                    |
| B. NE States              | B. NE States              | B. NE States              | B. NE States              | B. NE States              | B. NE States              | B. NE States              |
|                           | Sub Total                 | 3972.92                   | 4526.46                   | 6090.55                   | 6323.66                   | 6825.50                   |
| 11                        | Arunachal Pradesh         | 20.08                     | 29.42                     | 118.62                    | 49.08                     | 15.45                     |
| 12                        | Assam                     | 75.49                     | 270.20                    | 246.69                    | 183.83                    | 209.25                    |
| 13                        | Manipur                   | 110.72                    | 24.05                     | 163.63                    | 10.29                     | 99.77                     |
| 14                        | Meghalaya                 | 20.44                     | 13.75                     | 68.76                     | 11.38                     | 85.13                     |
| 15                        | Mizoram                   | 14.06                     | 112.42                    | 71.60                     | 4.20                      | 6.75                      |
| 16                        | Nagaland                  | 4.32                      | 77.41                     | 110.79                    | 4.10                      | 87.86                     |
| 17                        | Sikkim                    | 2.56                      | 8.34                      | 10.66                     | 1.83                      | 1.70                      |
| 18                        | Tripura                   | 8.75                      | 52.59                     | 14.18                     | 21.31                     | 7.14                      |
| C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States | C. Non- High Focus States |
|                           | Sub Total                 | 256.43                    | 588.19                    | 804.92                    | 286.02                    | 513.05                    |
| 19                        | Andhra Pradesh            | 29.20                     | 316.43                    | 279.09                    | 122.57                    | 380.00                    |
| 20                        | Goa                       | 8.47                      | 0.97                      | 15.12                     | 8.24                      | 1.11                      |
| 21                        | Gujarat                   | 988.83                    | 1231.48                   | 1043.31                   | 913.46                    | 926.01                    |
| 22                        | Haryana                   | 130.51                    | 9.51                      | 18.31                     | 37.41                     | 512.61                    |
| 23                        | Karnataka                 | 48.93                     | 73.54                     | 72.50                     | 79.56                     | 106.47                    |
| 24                        | Kerala                    | 10.72                     | 3.69                      | 38.65                     | 50.29                     | 118.09                    |
| 25                        | Maharashtra               | 768.28                    | 162.55                    | 201.21                    | 225.05                    | 188.34                    |
| 26                        | Punjab                    | 58.76                     | 18.76                     | 49.35                     | 72.03                     | 0.69                      |
| 27                        | Tamil Nadu                | 353.57                    | 53.18                     | 199.53                    | 242.32                    | 194.97                    |
| 28                        | Telangana                 | 4.38                      | 45.61                     | 39.85                     | 123.97                    | 55.67                     |

| 29                  | West Bengal               | 248.55              | 1478.36             | 893.42              | 933.68              | 1125.91             |
|---------------------|---------------------------|---------------------|---------------------|---------------------|---------------------|---------------------|
| D. Small States/UTs | D. Small States/UTs       | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs | D. Small States/UTs |
|                     | Sub Total                 | 2650.21             | 3394.07             | 2850.33             | 2808.58             | 3609.87             |
| 30                  | Andaman & Nicobar Islands | 0.72                | 0.00                | 2.18                | 0.06                | 0.00                |
| 31                  | Chandigarh                | 0.21                | 0.00                | 0.00                | 0.88                | 0.21                |
| 32                  | Dadra & Nagar Haveli      | 1.33                | 59.20               | 0.93                | 0.26                | 0.11                |
| 33                  | Daman & Diu               | 0.00                | 0.00                | 0.08                | 0.00                | 1.13                |
| 34                  | Delhi                     | 3.51                | 4.91                | 3.78                | 4.78                | 16.42               |
| 35                  | Lakshadweep               | 0.00                | 0.66                | 0.97                | 1.24                | 0.00                |
| 36                  | Puducherry                | 0.00                | 15.00               | 24.98               | 1.40                | 13.63               |
|                     | Sub Total                 | 5.77                | 79.77               | 32.92               | 8.62                | 31.50               |
|                     | Grand Total               | 6885.33             | 8588.49             | 9778.73             | 9426.88             | 10979.91            |

## Note:

- Expenditure includes expenditure against Central Release, State share & unspent balan the beginning of the year. It is updated upto 31 - 03- 2019, hence provisional.
- The Above Figures are as per FMR reported by State/UTs.

(Rs in Lakhs)