Living on the edge? Sensitivity of child undernutrition prevalence to bodyweight shocks in the context of the 2020 national lockdown strategy in India

Abstract

Background: The National Family Health Survey (NFHS) 2015-16, finds that every second child in India suffers from at least one form of nutrition failure. Dichotomised indicators of underweight and wasting based on z-score cutoff does not provide any information regarding those children who are clustered around the threshold and are at an elevated risk of undernutrition through any minor weight-loss. This paper aims to estimate the effect of bodyweight shocks on net increments in the prevalence of child underweight and wasting among the poorest households in India. Methods: We used cross-sectional information from NFHS 2015-16 to estimate possible increase in the prevalence of child underweight and wasting as a result of reduction in their bodyweight. The shocks are presumed to range from a minimum of 0.5% to a maximum 5% reduction in the bodyweight for every child from the poorest 20% households. Various raw weight measures scenarios were developed and transformed into age-specific z-scores using World Health Organization child growth standards. Results: Nutritional status of children is sensitive to smallest of the shocks to bodyweight. In fact, a reduction of 0.5 and 1 percent in weight can lead to substantial increase in underweight and wasting prevalence. Under a scenario of bodyweight shock of 0.5 percent, the prevalence of underweight and wasting will increase by 1.42 and 1.36 percentage points, respectively. These estimates get translated into 410,413 and 392,886 additional cases of underweight and wasting, respectively. Conclusion: With such high concentration of children around the undernutrition threshold, any minor shock to nutritional health of the children can have major implications. In the current scenario of national lockdown and restrictions due to coronavirus disease 2019 pandemic, it is critical to ensure an uninterrupted supply of nutritious meals and food supplements to the poor children while arresting the infection spread.

Changes in household food security, access to health services, and income in northern Lao PDR during the COVID-19 pandemic

“…This suggests that even small effects of COVID-19 on food security, and thus bodyweight, could undo years of progress. This echoes findings from a study conducted in India and is likely generalizable to many LMICs where there is a high prevalence of undernutrition [27]. At the same time, we did not observe a difference in the WAZ or WHZ scores between children whose household reported greater difficulty meeting food needs and those who did not, nor did we see a difference in child dietary diversity score between these groups in multivariate analyses.…”

“…A child was considered stunted, wasted, or underweight if they had a WAZ, WHZ, or WAZ score below -2SD, respectively. The degree to which even small changes to body weight will translate into changes in the proportion of children classified as underweight or wasted varies between populations, as it depends on the density of Z-scores clustered around the dichotomous classification threshold of -2SD [27]. As undernutrition prevalence is a key indicator used to monitor progress and allocate nutrition and other health services, we considered the theoretical implications of increased food insecurity on undernutrition prevalence in our population.…”

“…We examined the change in childhood undernutrition in our study population to a simulated reduction in bodyweight. Following prior study, we presumed potential COVID-19 associated shocks to range between a 0.5% and 1% reduction in bodyweight [27]. We simulated a reduction of 0.5% and 1% by multiplying child weight by 0.995 and 0.99, respectively, and recalculated the WAZ and WHZ scores under this simulated weight.…”

Revisiting the stunting metric for monitoring and evaluating nutrition policies

“…Indeed, it is likely that the underlying problem of child undernutrition has only worsened due to COVID-19 related disruptions. 8 In summary, the stunting metric, due to its sensitivity to maternal height, cannot accurately assess the extent of the current undernutrition burden. Among the target indicators identified in POSHAN Abhiyaan, stunting is least indicative of current nutrition-specific and nutrition-sensitive conditions.…”

Reproductive, maternal and child health services in the wake of COVID-19: insights from India

“…Similar observations were documented based on the preliminary reports of HMIS for the month of March 2020 in terms of newborns and infants missing their BCG, Pentavalent and Rotavirus vaccines. 69 9/16 https://doi.org/10.35500/jghs.2020.2.e28 RMNCH services in the wake of COVID-19 pandemic https://e-jghs.org In addition, the closure of Anganwadis (rural child-care centres) providing free meals to children between the ages of 6 months and 6 years, has led to questions on the impact of the lockdown on the nutritional well-being 70 and survival of children under-5. Similarly, the closure of schools has impacted the provisioning of mid-day meals to children aged 6-14 years.…”