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COVID-19 Crisis and Malnutrition Among Children

Today COVID 19 has become a Pandemic and is a Global problem, because of its rapid contagious behavior and long incubation of the virus. In a trending Global crisis, the unsolved Global problem of Malnutrition seem to get hidden. Malnutrition which is defined as overnutrition or undernutrition is a biggest Global health Problem since ages. According to world health organization, 1.9 billion adults are overweight or obese while 462 million are underweight. In south Asia, one of every fourth child born is low birth weight baby and approximately 45% of the death among children under five are linked to undernutrition.

Undernutrition could be in any form, either underweight, wasting or stunting. There are many factors responsible for underweight including biological which includes infections. Infection and Malnutrition set a vicious cycle in a child. Malnutrition make these children more susceptible to infection and infection leads to malnutrition.

Present data from different countries suggest low mortality among children with low amount of severe case. A study from China suggest only 5.6% children had severe disease. Data from US suggest 1.7% cases belonged to 0-18 years. Only 5.7% required hospitalization. Three deaths were reported out of 2572 cases of COVID 19 till 2 April in US. Out of total cases in less than 18 years of age, 15% reported in children less than 1 year of age and 11% children belonged to 1-4 years of age.

In data released by Government of India, 8.6% of reported cases of COVID 19 till 1st April belonged to 0-20 years of age while only 3% were from 0-10 years of age.

The rate of Malnutrition in terms of severe wasting in the countries those are reporting highest cases of COVID 19 in Europe and in United State of America is not recordable or less than 1% as per The State of The World’s Children 2019, a report by UNICEF. Even in China, severe wasting is 1% as per the report for the year 2013-18. While the same report says India is having 8% of severe wasting.  

As undernutrition makes these children more vulnerable to infection and mortality due to that. No study till now published focusing COVID and undernutrition in children. Most of the countries those reporting high number of cases of COVID do not have burden of undernutrition like India. So In our opinion as a country we need to take extra precautions in dealing with COVID 19 as India has the highest amount of undernutrition in the world.

India need to prepare in advance to deal with any situation where infection reaches to these children. By that time we need to focus more on preventive measures like hand washing, and Social distancing. Educating these families to take care of their children and education regarding prevention of COVID 19 by frontline health workers will be a crucial step.

The situation of lockdown is preventing the infection spread to these children However, due to lockdown Anganwadi Centres are closed posing a challenge in such situation. Across the country Anganwadi workers are providing Take Home Ration at homes of these children. But coverage of the same intervention remain to be checked. Government is also providing rations to the families in this situation, however whether it is reaching in sufficient quantity to the families of undernourished children is a question worth to be ponder.

At present all the Nutrition Rehabilitation Centres (NRCs) are also closed. As all the NRCs are situated in hospital settings it is also desired that it remain closed, due to risk of getting the infection. As a country, we also need to think about how to take NRCs further even after opening of lockdown. Alternative strategy needs to be worked out for NRCs.  This will require more emphasis and strengthening of Community based Management of Acute Malnutrition (CMAM)

In this scenario focused approach to ensure adequate services to the families with undernourished children including enough amount of ration is a need of the hour. Government should also utilize digital platform to connect with these families through frontline health workers.

References:

  1. The State of The World’s Children 2019, UNICEF. Accessed online 16th April 2020 from https://www.unicef.org/media/63016/file/SOWC-2019.pdf
  2. Times of India, April 5 2020. Accessed online on 16th April 2020 from https://timesofindia.indiatimes.com/india/83-of-covid-19-patients-in-india-are-aged-below-60-yrs/articleshow/74988310.cms
  3. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. Accessed online on 16thApril 2020 from https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm
  4. COVID-19 in children: the link in the transmission chain. Lancet Infectious diseases March 25 2020. Accessed online on 16th April 2020 from https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930236-X

 

Authors

  1. Dr Tapasvi Puwar, Associate Professor, Indian Institute of Public Health Gandhinagar
  2. Khushi Kansara, PhD Scholar and Tutotr, CCCH Course, Indian Institute of Public Health Gandhinagar
  3. Dr Unmesh Upadhyay, Paediatrician, Ahmedabad