The Key Determinants of Undernutrition

Children of the preschool age are considered to be the most nutritionally vulnerable population simply because most of our growth occurs during the first five years of our lives. Infant nutritional status largely determines our health in the subsequent years as an adolescent and later as an adult. And for this very reason, the stagnant rates of undernutrition in children of preschool age are a strong cause for concern in India, especially considering the long-term effects that underweightedness, stunting, and wasting can have. Declining numbers of children who suffer from undernutrition in India has indicated some efficiency in the current interventions, but comparative rates project that India will continually house the largest number of undernourished children under the age of five in the world. When considering potential interventions for these stagnant rates and even identifying the issues with the current plans, biological, social and cultural, environmental, economic, and political determinants are integral in understanding the cause of undernutrition in India.


Most undernutrition cases in preschool aged children can be attributed to the individual and biological determinants that are manifested in the health of the human being either directly or indirectly. An individual’s nutritional status can be connected to primarily to the nutritional health of the mother. According to a study conducted in Mysore, Karnataka, the number of children of preschool age who maintained a normal nutritional status doubled if the mother could be categorized as having a normal Body Mass Index (BMI). Conversely, if a mother had Chronic Energy Deficiency, her child was three times more likely to be severely malnourished (Lakshmi A. et al. 53).


These findings can be linked to the maternal nutrition kept during the time of pregnancy, as well. An inadequate BMI of an expecting mother could compromise the amount of weight gained during pregnancy to support the child’s neonatal growth. A low BMI, mostly determined by undernutrition in a mother herself, can lead to a preterm birth (a cause of low birth weight) or a low birth weight in her child. In India, 30% of preschool children are born with a low birth weight (“6.5. Nutritional Status During Infancy and Early Childhood”). This, in addition to poor nutrition, can consequently affect the first two years of growth, as seen by the decreasing physical stature of Indian children compared to other developing regions.


Individual biological determinants like age and sex of the child can also affect his or her nutritional status in the first five years of life – however, not to the extent that low birth weight and maternal nutritional health does. As a child’s age increases, the incidence of stunting and wasting seems to decrease, but underweightedness appears to have an arbitrary trend, which is meager evidence for its effect on undernutrition in India (Lakshmi A. et al. 47).


A child’s sex, though, is a key determinant of his or her nutritional status. In many ways, this determinant is socially influenced, as well. The study conducted in Mysore, Karnataka mirrors most of India’s national data. Girls have a consistently higher rate of undernutrition (underweightedness, stunting, and wasting) than boys do during the preschool, adolescent, and the adult years. Nutritionists note that negligence of girls is the root of the problem (Lakshmi A. et al. 50). Negligence in food distribution may occur, but more so, inattentiveness to ill girls is often a social practice as a result of a cultural stigma against females. Acquired illness during infancy can lead to weight-loss, especially if treating a female child is not a priority.


Socioeconomic determinants are also cofactors in several of these biological contributors to undernutrition in India. Health in India is largely determined by the remnants of the caste system (for lack of a better term). The large differences between the wealthiest quintile and the poorest quintile in India also accounts for the high levels of undernutrition within the population. In 2005, it was estimated that 41% of the Indian population falls below the international standard poverty line (World Bank Report 2005). Out of India’s population of roughly over one billion in 2005, 442,908,399 people were impoverished. While this outstanding number of people below the international poverty line has decreased, it is still reflective of the levels of undernutrition within different economic sectors of the population.


When families are limited by money, options for food and healthcare are reduced. A family in the lowest quintile in India may not be able to provide adequate food for pregnant women and, later, their children, contributing to his or her low nutritional status. This is reflected in the statistics: 60% of preschool age children in the lowest economic quintile are undernourished versus the 33% in the richest quintile (“6.5. Nutritional Status During Infancy and Early Childhood” 170). Although the difference between the two is demonstrative of the impact of money on access to foods, even the richest quintile struggles with undernourishment. However, low castes, poorer states, rural areas, and urban slums are all most susceptible to housing undernourished children because they are the economically poorest regions of India.


India, though, still revolves around traditional practices, which preserve culture, but at the same time create social determinants for undernutrition. Sadly, many of these social determinants are a result of the persistent stigma against women. For example, maternal literacy has a positive association with the “body weight of the child right from conception to the rapid stages of the development period” (Lakshmi A. et al. 52). Mothers who have been educated even for a short time (8-10 years) had a 20% lower rate of undernourished children (52). Unfortunately, the rate of literacy for women in rural India is significantly lower than in urban sectors, which further perpetuates the economic determinants of undernutrition.


Culturally, the practice of breastfeeding can also largely contribute to an infant’s health and nutritional status. And while breastfeeding is almost exclusively practiced among educated groups in India, faulty feeding practices are a key determinant of undernutrition. A mother’s Colostrum is rich in antibodies that are vital for a developing infant. The subsequent breastfeeding for the first six months of infancy reduces a child’s risk of gastrointestinal problems that may contribute to high weight-loss and the undernourishment that follows. Exclusive breastfeeding can null some of the effects of undernourishment during the first six months of infancy, and later when supplemented with nutritional foods, can help a child attain a normal weight-to-height reading (“Faulty Feeding Practices and Malnutrition”).


But nutrition is not limited to just the actions or inactions of the individual, culture, or society. Politics and the environment in which a person lives also contribute to the determinants of undernutrition in preschool aged children. For example, India lacks adequate environmental policy, especially when it involves sanitation. Several rural villages in India still use open defecation sites, where water contamination is nearly guaranteed. A sanitary living situation can obviously increase the physical, mental, and social comfort of individuals. However, when these provisions are lacking, children who are still in the most crucial stages of development are highly prone to contracting infectious diseases, which can result in weight loss and malnutrition. Because of the lack of policy in India, these unsanitary environments often go unacknowledged, and create another risk factor for undernutrition.


Undernutrition cannot be limited to any one single key determinant category because of its complex nature. But this very combination of contributing factors is what makes it difficult to structure an effective intervention. However, it is clear that certain determinants are more impactful than others, and if an intervention can be fashioned to prevent a determinant from occurring in the first place, Public Health will be successful. The astonishing 55% of childhood deaths due to malnutrition must be reduced, and taking preventive measures to rapidly decrease the rate of undernutrition in India is integral to the process.


(Note: works are cited parenthetically for the time being)