HUMANITIES & SOCIAL SCIENCES
A Literature Review of Government Nutritional Program and Their Effect on Childhood Nutrition A m i t h U m e s h & Va r u n M a h a d e v a n INTRODUCTION
Malnutrition is a silent crisis in South Asia. Without adequate resources to ensure proper health education nor to purchase life-saving treatments, many South Asian countries, such as India and Bangladesh often fail to even recognize that malnutrition afflicts its children. India, specifically, is burdened by a large proportion of malnutrition in South Asia. In fact, more than one-third of the world’s malnourished children are located in India. Every year, almost half of children in India suffer from malnutrition and nearly a million children die before surpassing one month of age.1 About 60 million Indian children are underweight, about 45 million are stunted, 20% are wasted, and 57% are Vitamin-A deficient.1 Stunting is defined as a low height for weight whereas wasting is defined as having a low weight for age.2 Despite growing to the sixth largest economy by GDP in the latter half of the 20th century, India has experienced growth in rates of malnutrition, especially in its most impoverished states.1 However, governmental work on malnutrition throughout South Asian countries has bolstered in the last 30 years. For example, Bangladesh has implemented a national nutrition policy, pledging to control and prevent malnutrition.3 The government of Pakistan also has programs such as the Micronutrient Initiative and the School Health Programme, which are focused efforts of larger development schemes to improve the health and economy 32
of its country.4 Specifically, these programs are aimed at delivering healthy food options to children and mothers in order to prevent and treat malnutrition. The most cohesive of these schemes, the Integrated Child Development Services Program (ICDS), was developed by the government of India. It provides health check- ups, vaccinations, food and preschool education to children up to six years of age.5 Furthermore, nutritional rehabilitation centers provide primary care inpatient services to children who are severely malnourished.5, 6 Admitted children receive energy-dense supplementary feedings, micronutrient supplementation, and consultation with dietitians to develop long-term health goals.5 Although literature has examined the broad efficacy of these governmental initiatives, often in terms of education delivery or referral services, a rigorous and focused inspection of nutritional delivery, such as supplementary feeding, through governmental institutions is lacking. Furthermore, many systematic reviews on nutritional feeding strategies for malnourished children have studied delivery through non-governmental organizations such as United Nations Children’s Fund (UNICEF) or the World Health Organization (WHO). We seek to understand whether the long-term prevention and solution to malnutrition in South Asia involves the cohesive integration of supplemental nutrition delivery with governmental institutions
Hopkins Undergraduate Research Journal
to reach the greater population burdened with malnutrition. To this end, a focused examination of past successes and failures of such an integration is paramount to guiding future efforts in alleviating this crisis. Therefore, in this review, we aim to examine the relationship between government programs that deliver nutrition in South Asia and malnutrition in their beneficiary children.
METHODS
Eligibility Criteria All reviewed articles examined the effect government deliveries of nutrition on how children responded to these treatments. Responsiveness was measured using anthropometric changes in measures such as weight and height. Eligibility criteria included the type of program, specifically government nutritional intervention programs, including those delivered in conjunction with non-profit organizations that played a non-primary role in delivery of program. Childhood malnutrition as an outcome was another eligibility criterion screened for. The age range was restricted to studies examining participants under 18, and the type of malnutrition examined by studies included the following: moderately (<2SD) or severely (<3SD) undernourished, and stunted (low height-for-age), wasted (low weightfor-height), and underweight (low weight-for-age) in the WHO Anthro Survey Analyzer, which includes globally agreed upon normal weight distribution among children under five.2
