Malnutrition in South Asia—A Critical Reappraisal

Abstract

Malnutrition continues to be a major public health challenge especially in South Asian developing countries. The aim of the present review is to spotlight the magnitude of the prevalence of malnutrition and its dynamics in South Asian region and to suggest potential approaches for the prevention and control of this issue of public health significance. An extensive review of literature, covering malnutrition and its determinants, health and economic consequences and pragmatic preventive strategies was performed on computer based bibliographic databases (PubMed, Google Scholar, Scopus, Medline and Sciencedirect.com ) to retrieve abstracts and full texts for India, Pakistan, Bangladesh, Sri Lanka and Nepal. All relevant titles and abstracts were examined and evaluated for malnutrition and its prevalence in South Asia. The results revealed malnutrition to be a major public health problem and a potential cause of high disease burden and mortality in South Asia. Compelling evidence suggests malnutrition to be the leading cause of stunting, wasting and underweight with drastic economic consequences among vulnerable populations. Reduced cognitive performance and low productivity have also been associated with micronutrients malnutrition. Suboptimal breastfeeding, inadequate food supply, micronutrient deficiencies, low household income, poor health care system, increased healthcare costs, illiteracy, unhygienic and substandard living, inappropriate child's care and the caregiver, food insecurity and on top of that vicious cycle of poverty, have been recognized as principal indicators for growing malnutrition prevalence in South Asia. Global organizations, local governments, program managers, NGOs, academia, industry in particular and the society at large need to take up the challenge to completely confiscate malnutrition from the region for economic prosperity and a healthier future.

Trends in inequalities in child stunting in South Asia

“…Despite tremendous reductions in stunting from 61% to 37% from 1990 to 2016, four countries analysed in this study are among 21 countries with stunting rates above 40% (UNICEF, ). The significant burden of stunting in South Asia has been noted in the literature (Akhtar, ; R. E. Black et al, ; R. E. Black, Victora, et al, ; UNICEF, ) giving rise to the term “Asian enigma” (Ramalingaswami, Jonsson, & Rohde, ), which attributes markedly high and persistent stunting rates to gender inequalities. Substantial work has attempted to explore the causes of stunting, much of it linking stunting with single factors such as breastfeeding, micronutrient deficiencies, handwashing, and poor hygiene (studies are summarized in two recent reviews of the global evidence; Bhutta et al, , ).…”

“…are among 21 countries with stunting rates above 40% (UNICEF, 2013). The significant burden of stunting in South Asia has been noted in the literature (Akhtar, 2015;R. E. Black, Victora, et al, 2013;UNICEF, 2013) giving rise to the term "Asian enigma" (Ramalingaswami, Jonsson, & Rohde, 1996), which attributes markedly high and persistent stunting rates to gender inequalities.…”

“…Together, these three types of socio‐economic disadvantage represent three, nested levels of the determinants of child nutrition—child‐level, mother‐level, and household‐level—in UNICEF's conceptual model of nutrition (UNICEF, ). Although much work considers socio‐economic gradients in child stunting (Akhtar, ; Di Cesare et al, ; Gaiha & Kulkarni, ; Headey, ; Headey & Hoddinott, ; Headey, Hoddinott, & Park, ; Kanjilal, Mazumdar, Mukherjee, & Rahman, ; Kumar & Kumari, ; Kumar, Kumari, & Singh, ; Menon, ), to our knowledge, only a few studies consider all three types of disadvantage in South Asia (Di Cesare et al, ; Fenske, Burns, Hothorn, & Rehfuess, ; Gaiha & Kulkarni, ). We concentrate on these three factors at the individual, caregiver, and household levels, a focus which reflects our interest in the impact of socio‐economic disadvantage on stunting.…”

Inequality of childhood undernutrition in Bangladesh: A decomposition approach

“…According to the recent national health survey, the prevalence of stunting (low height for age) had reduced from 51% in 2004 to 36% in 2014, while the prevalence of underweight (low weight for age) had reduced from 43% in 2004 to 33% in 2014 . Although Bangladesh has made rapid progress over the last decade in meeting most of the Millennium Development Goals, malnutrition remains a crucial public health challenge . A substantial literature has identified various factors such as child's age, birth order, birth size, parents' education, media exposure, mother's BMI, height, nutritional knowledge and frequency of feeding, place of delivery, number of under‐five children, age of household head, household economic status, and regional differentials, which are associated with child malnutrition .…”

Climbing Legumes: An Underutilized Resource With Significant Potential to Intensify Farming on Terrace Walls (FTW) for Smallholder Farmers

“…Zinc deficiency can cause stunted growth, low immune system functioning and diarrheic disease (Darton-Hill, 2013). Other significant micronutrient deficiencies identified by the World Health Organization include vitamin A, folate, and iodine; these often occur because of inadequate diversity in the diet due to limited resources (Akhtar, 2016; Johns and Eyzaguirre, 2007). With respect to livestock, during the dry season it becomes difficult for farmers in many regions to find enough high quality fodder (Small and Raizada, 2017).…”