COVID-19 pandemic may have led to 14% spike in number of underweight children in Bihar, Odisha: Study

The disruption of India’s food systems during the COVID-19 pandemic caused a steep rise in underweight children as the lockdown severely impacted their nutritional status, according to a new study by the Tata-Cornell Institute for Agriculture and Nutrition (TCI), affiliated with the New York-based Cornell University.

The proportion of underweight children increased from 31 per cent to 45 per cent between June 2017 and July 2021, noting a 14 per cent rise in the number of malnourished children, the researchers calculated 18 months after the lockdowns ended in India.

About 511 households and 622 children were surveyed in three districts, namely Munger in Bihar, and Kandhamal and Kalahandi in Odisha.

The analysis showed a decline in the children’s body weight of 0.5 to 0.6 from the standard deviations (SD) of weight after the pandemic, according to Weight-For-Age Z (WAZ) scores. A negative sign (-) reveals that the child’s body weight is less than the median child of the same age and gender in the reference group, therefore indicating malnourishment. A positive sign (+) indicates that the child has more than the median weight.

“A child is classified as being underweight (a measure of nutritional failure) if their WAZ score is 2 SD below that of the reference group. We follow the recommendations of the World Health Organization (WHO) and omit children who fall beyond -6 and above 5 SD from the mean (WHO 2006),” the paper, published in the Economic and Political Weekly, elucidated.

The mean WAZ scores fell from -1.41 to -1.93 in Bihar and from -1.30 to -1.81 in Odisha. This is reflected in a significant increase in the proportion of underweight children in both states, with nearly 48 per cent and 43 per cent of children classified as ‘underweight’ in Bihar and Odisha, respectively, the researchers found.

“We hypothesise that the pandemic adversely affected the ability of households to provide nutritious foods and adequate care practices for young children and that this is expected to be reflected in a significantly higher prevalence of undernutrition, specifically anthropometric outcomes, in children under five years of age,” the paper added.

According to the researchers at TCI, the children’s weight-for-age worsened as various government-sponsored food schemes came to a halt in 2021, including the Integrated Child Development Services (ICDS), the POSHAN scheme, and the Mid-Day Meal Scheme. The ICDS addresses the nutritional needs of children below six years of age, their overall health, and development, including their mothers. However, its reach had fallen during multiple lockdowns. As schools were closed during the pandemic, primary school children in government schools who were provided with one meal a day had lost out.

The disruption of these schemes was compounded by supply chain disruptions, price inflation, and loss of work, impacting the availability of food for the rural population.

“Researchers long suspected that pandemic-related disruptions to India’s food systems reduced access to healthy, nutritious diets, especially for marginalised populations dependent on government programs,” said Prabhu Pingali, director of TCI, in a statement.

As part of the Technical Assistance and Research for Indian Nutrition and Agriculture (TARINA) programme, researchers found that the prevalence of malnutrition could potentially disproportionately affect children under two years old post-pandemic. Their reasoning was based on the fact that India had the most number of children plagued by significant malnutrition on a global scale and their magnitude could have increased post-pandemic due to an “unprecedented nutritional shock”.

“Besides this, restoration of basic maternal and childcare health services will be critical in alleviating any loss in health due to the non-receipt of these services during the pandemic. Our results reiterate the importance of maternal health for child health outcomes. Mothers’ BMI is associated with a significant improvement in WAZ scores for the total sample and all of our subgroup analyses,” the researchers said.

The paper quotes a 2021 study published in Nature Food led by Saskia Osendarp, executive director of the Washington-based Micronutrient Forum. Based on predicted declines in gross national income in  118 countries, it predicted early on that the pandemic could lead to an increase of 7,90,000 under-five children children with low weight-for-height (wasting) in South Asia alone.

Another study estimated that even if children were to experience a mere five per cent weight loss, it would lead to an increase of about 4.4 million additional underweight children in India post-pandemic, the TCI researchers stated.

In the face of severe acute malnutrition, there is still no quantitative evidence of the impact of the pandemic on children’s anthropometric outcomes in Low and Middle-Income countries, the researchers added.

“To directly address the reduction of access to these programs during pandemics and other crises, states should explore switching to direct cash transfers when the physical delivery of services is difficult by addressing the disruptions that most impacted children’s nutrition and building household resilience through diversified farming, policymakers can minimise harm to children’s health and development during future adverse events,” TCI researcher Payal Seth recommended.