Context: According to an RTI query, more than 9.2 lakh children in India are severely acute malnourished with the most in Uttar Pradesh followed by Bihar.
Severe Acute Malnutrition (SAM)
The World Health Organisation (WHO) defines SAM by

• Very low weight-for-height or
• Mid-upper arm circumference less than 115 mm, or
• Presence of nutritional oedema.

Children suffering from SAM have very low weight for their height, and are nine times more likely to die in case of diseases due to their weakened immune system.
Key Highlights

• An estimated 9,27lakh ‘severely acute malnourished’ children from six months to six years were identified across the country till November 2020.
• Of these, Uttar Pradesh counted for 3.9 lakhs and Bihar 2.8 lakhs.
• Ladakh, Lakshadweep, Nagaland, Manipur and Madhya Pradesh reported no severely malnourished children.
• Except for Ladakh, none of the Anganwadi centres in the other four, including Madhya Pradesh reported any data on the matter.
• Maharashtra reported 70,665 SAM children followed by Gujarat, Chhattisgarh, Odisha, Tamil Nadu, Jharkhand, Andhra Pradesh, Telangana, Assam, Karnataka, Kerala and Rajasthan.

National Family Health Survey figures

• The last available figure of SAM children is from National Family Health Survey-4 (NFHS-4) in 2015-16.
• According to which prevalence of SAM among children was reported at 7.4%.
• NFHS-5 survey released in December 2020, gave figures for 22 states and UTs also presented a grim scenario.
• The NFHS-5 was conducted on 6.1 lakh sample households.
• NFHS-5 said malnutrition increased among children in 2019-20 from 2015-16 in 22 states and UTs.
• Around 13 states and UTs out of the 22 surveyed recorded a rise in percentage of children under five years who are stunted in comparison to 2015-16.
• 12 states and UTs recorded a rise in percentage of children under five years who are wasted.
• 16 states and UTs recorded a rise in the percentage of children under five years who are severely wasted and underweight in 2019-20.

Steps Taken by Government

• POSHAN Abhiyaan: The government of India has launched the National Nutrition Mission (NNM) or POSHAN Abhiyaan to ensure a “Malnutrition Free India” by 2022.
• Anemia Mukt Bharat Abhiyan: Launched in 2018, the mission aims at accelerating the annual rate of decline of anaemia from one to three percentage points.
• Mid-day Meal (MDM) scheme: It aims to improve nutritional levels among school children which also has a direct and positive impact on enrolment, retention and attendance in schools.
• The National Food Security Act (NFSA), 2013: It aims to ensure food and nutrition security for the most vulnerables through its associated schemes and programmes, making access to food a legal right.
• Pradhan Mantri Matru Vandana Yojana (PMMVY): Rs.6,000 is transferred directly to the bank accounts of pregnant women for availing better facilities for their delivery.
• Integrated Child Development Services (ICDS) Scheme: It was launched in 1975 and the scheme aims at providing food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.

Key Concerns

• The numbers would rise due to the ongoing COVID-19 pandemic.
• The rise in unemployment and the economic crisis is bound to have repercussions on hunger and malnutrition.
• The possibility of children reaching Anganwadis has become hard because of lockdowns.
• Anganwadi centres play a significant role to improve the nutrition status of the children.
• Studies suggest that Nutrition Rehabilitation Centres (NRCs) have not been very effective.
• There is the need to strengthen NRCs which are meant to treat SAM cases. 

Suggestion

• Anganwadi centres must reach the severely acute malnourished children.
• Customised menus should be designed in consultation with experts for SAM cases and formulating guidelines.
• SAM cases could be segregated into smaller units for administrative and operational convenience and better accountability.
• The responsibility to manage/coordinate and monitor smaller units could be handed over to independent entities such as medical colleges, local NGOs, women’s collectives – under the overall guidance of the District/Block health staff.