Malnutrition cases in Maharashtra under-reported, finds survey

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A survey by the public health department in four districts of Maharashtra has found significant under-reporting of malnutrition cases. The preliminary findings in three of these districts — Pune, Nandurbar and Raigad — show that percentage of wasting and of under-nutrition is higher than as recorded by the National Family Health Survey-4 and the Integrated Child Development System (ICDS), a scheme that provides free, nutritious meals to children.


  • In Pune, for instance, the survey found that 28.18 per cent children, aged less than six, were underweight as opposed to ICDS records that registered 10.38 per cent underweight children. Malnutrition was found in 14.5 per cent cases in contrast to 5.03 per cent under ICDS.
  • The government survey was conducted after a non-government organisation (NGO) presented similar findings from a study of 25 anganwandis in October last year. The previous study conducted by NGO Sathi surveyed 1,659 children and found that anganwadis had no or incomplete records of 50.9 per cent of the children. An anganwadi is a centre where free, nutritious meals are provided to children aged less than six under the ICDS scheme, which is run by the Women and Child Development Department.
  • The Sathi study further said there were 29.1 per cent malnourished children, and proportion of under-reporting was higher in Palghar and Nandurbar. As opposed to the Sathi study, under National Family Health Survey-4 (NFHS-4), the prevalence of severe acute malnutrition stands at 9.4 per cent and that of moderate acute malnutrition at 16.5 per cent in Maharashtra.
  • Following the findings, the public health department was directed to conduct a detailed survey across 15 primary health centres in Nandurbar, Raigad, Pune and Palghar through a team of medical officers, child development project officers and Sathi representatives.
  • The survey began in November last year, and is yet to cover children in Palghar. The preliminary findings say that presence of “medical officers and trained supervisors yields higher rates of detection”. It recommended that anganwadis require capacity building and standardisation in measuring equipment to diagnose SAM (severe acute malnourishment) and MAM (moderate acute malnourishment) of children.
  • In Pune’s Junnar block, the public health department found that of the 809 children surveyed, 118 or 14.59 per cent were wasted. Of these, 103 were MAM (12.7 per cent). When compared, ICDS records found only 5.03 per cent wasting and 4.02 percent MAM in Pune.
  • Similarly, there was disparity in records of underweight children. The ICDS data of 50 anganwandis in Pune showed 10.3 per cent children were underweight, while the latest health survey diagnosed 28.18 children as underweight.
  • In Nandurbar, across 174 anganwadis 9,744 children were analysed. Of these, 94 were found SAM and 305 MAM. Nandurbar is also the district with highest deaths related to malnutrition in Maharashtra. Local activists allege that anganwadi workers do not regularly visit the centres to serve meals to enrolled children in the tribal district.
  • In Raigad’s Karjat block, 1,621 children were observed and malnutrition was found in 8.9 per cent of them.
  • Figures from the NHFS-4 suggest wasting is prevalent in 25.6 per cent children, of which 9.4 per cent are severely wasted in Maharashtra. State health department officials, however, estimate the prevalence may be higher across all districts following this survey. Those who were part of the survey said they could not cover the entire population, indicating that a few undernourished children may have remained out of radar. “Those children not availing ICDS services were not included,” the survey report said.
  • “Under-reporting could be deliberate. But it also possible that records are not kept properly by anganwadis. It seems unlikely that migration could be responsible for why there is under reporting,” said activist Brian Lobo from Palghar. He added that the WCD must ensure that anganwadi supervisors monitor anganwadi workers.
  • The under-reporting is also suggestive of a large section of children falling frequently ill but missed by the WCD department. Children are given four eggs a week and two meals every day in anganwadis. Those found malnourished are provided additional meals, six per day, through the village child development centre.

ICDS Scheme

Launched by the Government of India in 1975, the ICDS scheme is today one of the world’s largest and most unique programmes for early childhood development. Its aim is to provide nutritional support, healthcare and pre-school education for children under 6 (and for pregnant or lactating mothers) in order to reduce the incidence of mortality, malnutrition and school dropout.

The Integrated Child Development Services (ICDS) scheme is a government initiative for the all-round development (health, nutrition and education) of children under 6. Its aim is to reduce infant mortality, child malnutrition and to provide pre-school education. PACS has been working to improve the non-discriminatory access of mothers and children, especially those from socially excluded groups, to these services.

Under the ICDS scheme, children under 6 and pregnant or lactating mothers can access four main services:

  • Supplementary nutrition – vitamin A tablets, food grains and rice, and fortified food packages are available for children and mothers who are showing signs of malnourishment. Weight-for-age growth cards should be maintained for all children under six years of age – children below the age of 3 should be weighed once a month and children aged 3-6 should be weighed quarterly.
  • Immunizations – children should be given full vaccinations against six preventable diseases: poliomyelitis, diphtheria, pertussis, tetanus, tuberculosis and measles. Pregnant women should receive a vaccination against tetanus that reduces maternal and neonatal mortality.
  • Health check-ups – various health services should be provided for children including treatment of diarrhoea, de-worming and distribution of simple medicines (along with weight and height monitoring, and immunisations). Ante-natal and post-natal check-ups should be provided for pregnant women and new mothers.
  • Referral services – if, after a health check-up, children or mothers are in need of medical attention they should be referred to the Primary Health Centre or sub-centre. Severely malnourished children should be referred to Nutrition Rehabilitation Centres (NRCs) and young children with disabilities should be referred to specialists.

In addition, children aged 3-6 should be able to access pre-school non-formal education under ICDS. Women and adolescent girls (aged 15-45) should also be able to access nutrition and health education, providing them with advice and support to help them look after their own health, nutrition and development needs as well as that of their children and families.

National Family Health Survey-4

  • In 2014-2015, India will implement the fourth National Family Health Survey (NFHS-4). Like its predecessors, NFHS-4 will be conducted under the stewardship of the Ministry of Health and Family Welfare, coordinated by the International Institute for Population Sciences, Mumbai, and implemented by a group of survey organizations and Population Research Centres, following a rigorous selection procedure. Technical assistance for NFHS-4 will again be provided by ICF International, USA with the major financial support from the United States Agency for International Development and Ministry of Health and Family Welfare, Government of India.
  • In addition to the 29 states, NFHS-4 will also include all six union territories for the first time and will also provide estimates of most indicators at the district level for all 640 districts in the country as per the 2011 census. NFHS-4 sample size is expected to be approximately 568,200 households, up from about 109,000 households in NFHS-3. This is expected to yield a total sample of 625,014 women and 93,065 men eligible for the interview. In these households information on 265,653 children below age 5 will be collected in the survey. Data will be collected using Computer Assisted Personal Interviewing (CAPI) on mini-notebook computers.
  • NFHS- will provide updates and evidence of trends in key population, health and nutrition indicators, including HIV prevalence. Moreover, the survey will cover a range of health-related issues, including fertility, infant and child mortality, maternal and child health, perinatal mortality, adolescent reproductive health, high-risk sexual behaviour, safe injections, tuberculosis, and malaria, non-communicable diseases, domestic violence, HIV knowledge, and attitudes toward people living with HIV. The information will enable the GOI to provide national and international agencies to monitor and evaluate policies and programmes related to population, health, nutrition, and HIV/AIDS.

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