Blog 11 | HEaL Institute & IJME Covid-19 Insights | June 5, 2020
Amidst the upsurge of Covid and the recent lockdowns, various distressing and critical issues have come to light – neglected state of public health, plight of migrant workers, gender issues, surge in domestic violence , communal issues related to spread, disruption of maternal health services, lack of personal protective equipment (PPE’s) for healthcare workers, difficult working conditions and even deaths of doctors. I would like to highlight another vital issue, which requires attention – the adverse effect of the Covid-19 pandemic on nutrition status of children.
There have been some reports about the effect of coronavirus infection among children. A recent study shows that the severity of the Covid infection is much lower among children than adults. However, another study finds that nutritional deficiencies of energy, protein, and specific micronutrients (iron, zinc, and vitamins A, E, B6, and B12) are associated with depressed immune function and increased susceptibility to infection. Hence, undernourished children who are in an immuno-compromised state are vulnerable. Vulnerability to Covid among those residing in informal settlements and depending on common sanitation facilities may be higher.
Moreover, according to the April 2020 United Nations policy brief; socioeconomic consequences and global economic downturn caused by this unprecedented pandemic will have a profound and long-lasting impact on children’s lives around the world. The uncertainty of food security and dwindling economic situation with disrupted social sector services could result in more children falling prey to undernourishment, due to dearth of food let alone nutritious meals. This has been evidenced in Prime minister’s own constituency, i.e. Varanasi. When the 21 days lockdown was announced in March 2020, children from the Mushahar community in Koiripur village were reportedly eating weed that grows in the field which is usually given as fodder to cattle, due to sheer hunger. The breadwinners of the family worked in brick-kiln and were stranded there due to the abrupt lockdown.
Pre-covid child health issues
“Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients” (WHO, 2020). However, this term covers both ‘overnutrition’ and ‘undernutrition’. Here we would be discussing about the latter term, which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). ‘Stunting’ is a chronic condition, occurring due to poor socioeconomic conditions, poor maternal health and recurrent bouts of infection, which results in serious and irreversible growth impediments. ‘Wasting’ indicates recent weight loss that occurs due to hindrance in assimilation of nutrition because of chronic infections and is fatal, it is treatable. ‘Undernutrition’ refers to both ‘stunting’ and ‘wasting’.
A recent study published in Lancet states that the proportion of under-5 deaths attributable to malnutrition in the country changed only modestly from around 70·4% (67·0–74·0) in 1990 to 68·2% (65·8–70·7) in 2017 .i.e. 2 out of 3 children are still dying as a consequence of malnutrition. Despite the drop in under-5 stunting (48% to 37.9%) and underweight (48% to 32.5%) achieved in last decade, there has been increase in wasting (19.8 to 21%). Additionally, the figures are higher than average for stunting (25%) and wasting (8.9%) amongst developing countries. The latest Global nutrition report (2020) reveals that India is off course to achieve global targets in reduction of malnutrition. What is worse is that the Covid pandemic may reverse the little progress we have made so far.
Acerbation of a crisis
The Covid-19 will result in dramatic reduction in quality of diet, as the mitigation measures can result in unemployment, which could in turn, influence the value chain. It will affect the poor households badly, and healthy foods are almost 10 times more expensive in poor countries than the calories from maize, wheat, rice, cassava adding to the agony. In addition, the economic shock, the hastily applied lockdown measures risk the local food market and food supply chain thus posing a challenge to food security especially among children, pregnant women. The disruption in food supply chain is affecting the prices of vegetables and milk products and hence the food security.
From the experiences of earlier pandemics, it’s been observed that food distribution system is disrupted during such crisis, affecting the access to nutritious diets to young children and women the most. The current crisis has hampered the functioning of two large scale national schemes against malnutrition- Integrated Child Development Services (ICDS) and mid-day meal schemes, putting millions of children at risk of malnourishment. The ICDS is Government of India’s largest safety net programme, which serves supplementary nutrition to pregnant & lactating mothers, infants and pre-school children, is found to be improving nutrition status of the most malnourished children (Kandapal,2011). Amidst lockdown and mandate to maintain social distancing, only a few centres are serving hot cooked meals, the working of Anganwadi centres have been disrupted. Some states have cut short the number of hours it operates; some have started delivering dry ration to the homes, some had to close the centres. There is an argument against delivering dry ration, that it may be divided to other household members and the child may not get the required dietary intake. Similarly, another unintended but serious impact of lockdown is the disruption of mid-day meal scheme due to the closure of schools. It has deprived over 90 million children (out of which 52% are girls) of the meals served in school, which could be the only nutritious meal of the day for many.
As Covid-19 management is resource intensive, it may rob resources from other important issues services such as maternal and child health (MCH) services could result in increase of malnourished children warns an IFPRI (International Food & Policy Research Institute) senior researcher. The front line workers Accredited Social Health Activists (ASHAs), who provide assistance and guidance as part of MCH services, including detection and treatment of cases malnutrition, have been deployed for surveillance and detection of Covid – 19 cases in the community. The diversion of this quintessential workforce could lead to many cases of malnourishment being undetected. And ability of malnourished child to fight with Covid may be jeopardized due to poor immunity levels.
Additional woes for children of migrant labourers
Behera, Daniel and Minz (2014) published a report ‘Young lives at working site’ on the status of migrant labourer’s children across seven cities. It revealed the unviable living conditions, and the drop in utilization of maternal and child health services. Around 33.68% of the migrant participants stated that they accessed ICDS services at their native place, after moving to the migration site only 5.9% attended anganwadi.
The woeful mass exodus of migrant labourers is an economic ramification of Covid, pushing these families to walk miles in scorching heat, in the hope of getting two square meals back in their native land. As, number of rural households depend upon the remittances, the loss of job of the parents will directly affect the food security and health outcomes of the children. This could have serious implications on their health. Kerala has set an example again, as it is set to provide ration irrespective of their income status due to ongoing Covid crisis. If other governments respond to this issue as Kerala has done, it is possible to stall the tide of malnutrition.
A piece in New York times while arguing about food grain stocks in India stated – “Yet the government is sitting on wheat surpluses — now at about 53 million metric tons — that would stretch to the moon and back at least twice if all the bags were lined up.”. In a country like ours, that ranks 102 out of 117 countries in Global Hunger Index (2019), the human costs due to deaths from starvation and deprivation caused by Covid -19 could be too huge, with the children being worst hit by it.
Blog editor: Tejal Barai – Jaitly