The nutritional profile of Assam

The observance of September as the POSHAN month calls for bolstering mobilizing communities to community mobilization and people's participation in the flagship programme aimed at the gradual removal of malnutrition in the country. It also brings the opportunity for the states to take a look at their nutrition profiles and evaluate the nutritional outcomes for children, adolescents, pregnant women and lactating mothers. The Nutrition Profile of Assam published in March by the International Food Policy Research Institute (IFPRI) indicates that apart from improving the implementation of various components of the programme, the state needs to involve the communities in a big way to achieve the key objective of reducing the malnutrition burden. IFPRI estimates show that stunting prevalence among children below five years declined by 11 percentage points (pp) between 2006 and 2016 and by one pp between 2016 and 2021 while wasting increased by 3 pp between 2006 and 2016 and by 5 pp between 2016 and 2021. This implies that a large number of households continue to be gripped by chronic undernutrition and inadequate nutrition over a shorter period due to inadequate quantity and poor nutritional value of food. An increase in Anemia by 32 pp in children over the past 5 years is a cause of concern as anaemia leads to poor cognitive problems and weak physical constitution. Another key takeaway from the IFPRI document is that anaemia in non-pregnant and pregnant women declined by 23 pp and 27 pp between 2006 and 2016 but increased by 20 pp and 9 pp between 2016 and 2021, respectively. Financial and technical support is provided to all the States and union territories for effective implementation of interventions under the Anemia Mukt Bharat strategy based on proposals submitted in their respective Programme Implementation Plan. Key interventions under AMB include Prophylactic iron-folic acid supplementation, deworming, mandatory provision of iron folic acid fortified food in public health programmes and addressing non-nutritional anaemia in endemic pockets with a special focus on malaria, hemoglobinopathies and fluorosis. The target of 3 pp reduction per year was set for six focussed groups - adolescent boys, adolescent girls, children (6-59 months), lactating women, pregnant women, and women of reproductive age from 15-49 years. The National Family Health Survey-5 (2019-21) finding presents a grim picture of the prevalence of anaemia as high as 57% among women aged 15-49 years in the country. The prevalence is more in rural areas (58.5) compared to urban areas (53.8) for women in this age group while the prevalence of anaemia in adolescent girls (15-19 years) across the country in rural areas is 60.2 per cent and in urban areas is 56.5 per cent which poses additional challenges requiring special focus on target population in rural areas. Undertaking a comprehensive review is essential for identification of the gaps and prioritizing activities to achieve the targets. The POHSHAN lagging behind the targets raises the question if fortified food can serve as a substitute for a quality daily diet in optimal quantity and statistics revealing a high prevalence of anaemia provide the answer. The State Nutrition Profile provides snapshots of the highest-burden districts like Karimganj, Nagaon, Dhubri, Cachar and Barpeta and is a ready reckoner for programme implementing authorities in these districts to innovate new campaign strategies for public awareness to enlist the active participation of households in targeted activities during the month. The underlying essence of observation of the POSHAN month is to make efforts to end malnutrition by turning the programme into a people's movement by making community leaders, village heads, panchayat and urban body functionaries, social activists, school authorities and most importantly the head of the family and other members play the lead role and not remain a passive beneficiary of a government-sponsored scheme or programme. Disruption in the Mid Day Meal programme due to closure and suspension of offline classes during the COVID-19 pandemic, health intervention by ASHA workers, and Anganwadi workers due to their engagement in COVID-related activities adversely affected the POSHAN campaign and activities. This explains why observance of POSHAN month this year is of special significance and needs to be scaled up to make up for the losses during a pandemic. Failure on the part of the government to mobilise the communities could result in an increasing disease burden and problems malnutrition growing into a major public health problem in the state and the country. Declaration of 2023 as the International Year of Millets by the United Nations at the initiative of India brings new opportunities of involving the communities to understand the significance of growing the Nutri-cereals and adding them to daily household diets in the state from the perspective of fighting malnutrition. The inclusion of a millet-based menu for children is a step in the right direction but the state government needs to ensure the availability of millet at affordable prices to translate this into reality. The POSHAN month brings an opportunity for the communities to contribute towards building a healthy nation free from malnutrition by taking nutritional care of targeted population groups.