Half of world's under-nourished kids live in India as debate around benefits of RUTFs rumbles on

By Cheryl Tay contact

- Last updated on GMT

Only around 10% of rural children between six months and two years old receive adequate diets. ©Getty Images
Only around 10% of rural children between six months and two years old receive adequate diets. ©Getty Images
India is home to the largest number of malnourished children globally, with 50% of the world's under-nourished children residing in the country, according to new data.

That statistic was revealed in a joint study by the Associated Chambers of Commerce and Industry of India (ASSOCHAM) and Ernst and Young India, entitled Bridging the gap: Tapping the agriculture potential for optimum nutrition​.

The study also stated that approximately 39% of India’s children are stunted, 37% are underweight, 21% are wasted, and 8% are "severely acutely malnourished"​, though the country’s overall infant and under-five mortality rates have decreased in the past decade.

Malnutrition is more prevalent in rural areas, where 38% of children are underweight; the figure is 29% in urban areas.

The study found that only around 10% of rural children between six months and two years old receive adequate diets.

But while under-nutrition is common in rural India, the problem in urban India is over-nutrition.

In fact, India is the world's third most obese nation (after the US and China) and is known as the world's diabetes capital: as of 2015, the WHO reported that the country had 69.2 million diabetics.

Demand from supply

ASSOCHAM said "malnutrition derives not just from a lack of food but from a diverse set of interlinked processes"​ involving healthcare, education, sanitation and hygiene, and access to resources.

It added: "The choices that individuals make regarding foods to produce and market, and the diets they consume have a direct bearing on nutrition outcomes.

"Similarly, the availability of nutritious food in markets plays an equally significant role in motivating the community to make the right choices."

Despite the clear need for better nutrition in India, however, there has been years-long debate over what is termed ready-to-use therapeutic food (RUTF) to combat malnutrition.

RUTF is a medical intervention for children with Severe Acute Malnutrition (SAM). Also called energy-dense nutritious food (EDNF), it is a packaged paste made from peanuts, milk powder, sugar, oil, and vitamins and minerals, and sometimes also includes grains, nuts, legumes and sweeteners for better taste.

The paste contains between 520 and 550 calories per 100g, and is typically medically prescribed to children aged six months to six years; up to three servings can be consumed daily for a month.

Pilot projects to use RUTF to treat children with SAM have kicked off in Bihar, Jharkhand, Maharashtra and Uttar Pradesh.

But in August this year, the country's Union Ministry of Women and Child Development (WCD) said the "use of RUTF for (the) management of malnutrition is not an accepted policy of the government of India"​.

Cost of care

It pointed to a lack of evidence of RUTF's efficacy, and expressed concerns that it might replace "nutritional best practices and family foods"​ children normally eat, as well as affect breastfeeding in children older than six months.

Shortly after, Maharashtra cancelled the tender to obtain RUTF for 83,120 children with SAM.

The United Nations Children's Fund (UNICEF), on the other hand, had reported in 2013 that if applied correctly, "RUTF is safe (and) cost-effective"​, adding that it had "saved hundreds of thousands of children's lives"​.

The same report stated that RUTF contains the necessary nutrients for children with SAM to recover, and India is among the 16 countries whose local RUTF manufacturers have received UNICEF accreditation.

In addition to India's double burden of malnutrition, its government must also consider the financial burden RUTF could pose.

Treatment for just one child could cost up to Rs2,250 (US$34) a month, and since over a third of children under five in India are underweight or stunted, implementing a nationwide RUTF programme would incur a huge cost to the government.

The Indian Express​ reported that to avoid this, the Health Ministry is in the midst of developing guidelines for early childhood development that will involve a "family-centric approach instead of food-centric approach"​, so as to lessen the dependence on therapeutic food.

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