Lok Sabha Question No. 79 (UNSTARRED), answered on 2024-02-02
Subject: Malnutrition in Bihar
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: Chandeshwar Prasad

## GOVERNMENT OF INDIA MINISTRY OF WOMEN AND CHILD DEVELOPMENT

## LOK SABHA UNSTARRED QUESTION NO. 79 TO BE ANSWERED ON 02.02.2024

## MALNUTRITION IN BIHAR

79. Shri Chandeshwar Prasad

Will the Minister of Women and Child Development be pleased to state

- (a) Whether there has been an increase in the number of malnourished women and children in Bihar during the last three years and if so, the details and the reasons therefor,
- (b) Whether the cases of malnutrition are not detected due to faulty methods  adopted for diagnosis of malnutrition and if so, the details thereof, and
- (c) The details of the efforts made by the Government to reduce malnutrition  among women and children in the State?

## ANSWER

## MINISTER OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SMRITI ZUBIN IRANI)

(a) to (c) The indicators for malnutrition like underweight, and stunting have shown a steady improvement in National Health Family Survey (NHFS) conducted by Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years in the State of Bihar have improved as compared with NFHS-4 (201516). Stunting has reduced from 48.3% to 42.9%, and Underweight prevalence has reduced from 43.9% to 41%. Additionally, percentage of women whose Body Mass Index (BMI) is below normal (BMI<18.5 kg/m 2 ) has reduced from 30.4% to 25.6%.

As per the data of Poshan Tracker for the month of December 2023 for the State of Bihar, around 96.22 lakh children under 6 years were measured, out of whom 41% were found to be stunted, 24% were found to be underweight and 10% children under 5 years were found to be wasted. The levels of underweight and wasting are much less than that projected by NFHS 5.

IT  systems  have  been  leveraged  to  strengthen  and  bring  about  transparency  in  nutrition delivery support systems at the Anganwadi centres. The 'Poshan Tracker' application was rolled out on 1 st  March, 2021 as an important governance tool. The Poshan Tracker facilitates monitoring  and  tracking  of  all  AWCs,  AWWs  and  beneficiaries  on  defined  indicators. Technology under Poshan Tracker is being leveraged for dynamic identification of stunting, wasting,  under-weight  prevalence among children. Further, under Poshan 2.0, for the first time, a digital revolution was ushered in when the Anganwadi Centres were equipped with mobile  devices.  The  mobile  application  has  also  facilitated  digitization  and  automation  of physical registers used by AWWs that helps in improving their quality of work. Poshan Tracker is available in 22 languages including Hindi and English. It has facilitated near real time data collection for Anganwadi Services such as, daily attendance, ECCE, Provision of Hot Cooked Meal (HCM)/Take Home Ration (THR-not raw ration), Growth Measurement etc.

The Government has accorded high priority to the issue of malnutrition and is implementing several  schemes/programmes  of  different  Ministries/Departments  through  States/UTs  to address various aspects related to nutrition. In the 15th FC, components of nutritional support for children below the age of 6 years, pregnant women and lactating mother, Adolescent Girls (14 - 18 years); Early Childhood Care and Education [3-6 years]; Anganwadi infrastructure including  modern,  upgraded  Saksham  Anganwadi,  POSHAN  Abhiyaan  and  Scheme  for Adolescent Girls have been reorganised under Mission Saksham Anganwadi and Poshan 2.0 (Mission Poshan 2.0). Mission Poshan 2.0 focuses on Maternal Nutrition, Infant and Young Child  Feeding  Norms,  Treatment  of  MAM/SAM  and  Wellness  through  Ayush  practices  to reduce wasting and under-weight prevalence besides stunting and anaemia.

Under Mission Poshan 2.0, Supplementary nutrition is provided to beneficiaries 300 days in a year through the network of 13.97 lakh AWC located across the country for bridging the gap in  the  intake  as  compared  to  the  recommended  dietary  intake.  Only  fortified  rice  is  being supplied to AWCs to meet the requirement of micro nutrient and control anemia among women and children. Greater emphasis is being given on the use of millets for preparation of Hot Cooked Meal and Take Home rations (THR) at Anganwadi centres for Children below 6 years of age, Pregnant Women, Lactating Mothers.

The objectives of Poshan 2.0 are as follows:

- To contribute to human capital development of the country;
- Address challenges of malnutrition;
- Promote nutrition awareness and good eating habits for sustainable health and wellbeing; and
- Address nutrition related deficiencies through key strategies.

Steps have been taken to improve nutritional quality and testing in accredited labs, strengthen delivery and leverage technology under Poshan Tracker to improve governance. States/UTs have been advised to promote use of AYUSH systems for prevention of malnutrition and related  diseases.  A  programme  to  support  development  of  Poshan  Vatikas  at  Anganwadi Centres to meet dietary diversity gap leveraging traditional knowledge in nutritional practices has also been taken up.

In addition, Ministry of Women & Child Development and Ministry of Health & Family Welfare jointly released the protocol for Community Management of Malnutrition (CMAM) to prevent and  treat  severe  acute  malnutrition  children  thereby  reducing  associated  morbidity  and mortality. The community-based approach involves timely detection and screening of children with  severe  acute  malnutrition  in  the  community,  management  for  those  without  medical complications with wholesome, local nutritious foods at home and supportive medical care. Those malnourished children which have medical complications are referred for facility-based care.

The key interventions of MoHFW to improve maternal and child health including nutritional deficiencies, inter alia , are placed at Annexure I .

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## Annexure I

ANNEXURE REFERRED IN REPLY TO PART (c) of LOK SABHA UNSTARRED QUESTION NO.  79  FOR  2.02.2024  REGARDING  'MALNUTRITION  IN  BIHAR'  ASKED  BY  SHRI CHANDESHWAR PRASAD, M.P.

Interventions of Nutrition Division of MoHFW to improve maternal and child health including nutritional deficiencies are:

1. Mothers'  Absolute  Affection  (MAA) to  improve  breastfeeding  coverage  which includes  early  initiation  of  breastfeeding  and  exclusive  breastfeeding  for  first  six months  followed  by  age-appropriate  complementary  feeding  practices  through capacity building of frontline health workers and comprehensive IEC campaigns.
2. Nutrition  Rehabilitation  Centres  (NRCs) are  set  up  at  public  health  facilities  to provide in-patient medical and nutritional care to children under 5 years suffering from Severe  Acute  Malnutrition  (SAM)  with  medical  complications.  Under  nutritional management of these children admitted in NRCs, therapeutic diet is provided in the form of starter diet during Stabilization phase, followed by Catch up diet for rebuilding wasted tissues during rehabilitation phase. In addition to curative care, special focus is  given  on  timely,  adequate  and  appropriate  feeding  for  children,  correction  of micronutrient deficiencies, improving the skills for mother and caregivers on complete age-appropriate caring and feeding practices and counselling support is provided to mothers for identifying nutrition and health problems in child.
3. Anemia Mukt Bharat (AMB) strategy is implemented to reduce anemia among six beneficiaries age group - children (6-59 months), children (5-9 years), adolescents (1019 years), pregnant and lactating women and in women of reproductive age group (1549 years) in life cycle approach through implementation of six interventions via robust institutional  mechanism.  The  steps  taken  to  address  the  problem  of  anemia  are prophylactic Iron and Folic Acid Supplementation in all six target age groups, periodic deworming, intensified year-round Behaviour Change Communication (BCC) Campaign,  testing  of  anemia  using  digital  methods  and  point  of  care  treatment, addressing non-nutritional causes of anemia in endemic pockets with special focus on malaria,  hemoglobinopathies  and  fluorosis  and  convergence  and  coordination  with other line departments and ministries for strengthening implementation.
4. Under National Deworming Day (NDD) albendazole tablets are administered in a single fixed day approach via schools and anganwadi centres in two rounds (February and  August)  to  reduce  the  soil  transmitted  helminth  (STH)  infestation  among  all children and adolescents (1-19 years).
5. Monthly  Village  Health,  Sanitation  and  Nutrition  Day  (VHSND) is  an  outreach activity at Anganwadi centers for provision of maternal and childcare including nutrition in convergence with the ICDS.
6. MCP Card and Safe Motherhood Booklet are distributed to the pregnant women for educating  them  on  diet,  rest,  danger  signs  of  pregnancy,  benefit  schemes  and institutional deliveries.
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