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Wednesday, 19 June 2013

The Asian enigma

The three countries of south Asia (SA), Bangladesh, India and Pakistan are house to half of the world’s malnourished children. The child nutritional status continues to be worse in south Asia (SA) compared to sub-saharan Africa (SSA). This has been described as Asian enigma ( a term coined by Vulimiri Ramalingaswami first). Several factors have been implicated for this difference: women’s status (much better in SSA than SA), sanitation (better use of toilet facilities in SSA than SA), water (more use of well water in SA than SSA which is linked to poor nutritional status of children), and urbanization (living in an urban area has positive effect on child nutrition in SSA than SA). Besides, socioeconomic factors and men’s education have also some contribution to this difference but not as large as the others.

If we consider proximate determinants such as women’s nutritional status, SA is worse than SSA (40+% vs 10+%). This is reflected in the rates of LBW babies born in these two regions: 1/3rd in India, ½ in Bangladesh but only 1/6th in SSA! The same goes for antenatal, delivery by skilled attendants, post natal care, child feeding practices etc. where the performance of SSA is much better than SA. Lastly, there are the regional factors such as climate, population density, political and cultural factors which are specific to SA for influencing child nutritional status.

Recently, a causal relationship has been established between stunting (low height for age) and lack of sanitation, e.g., open defaecation. The latter is particularly harmful in densely populated regions and countries. Researchers argue that only ensuring availability and access of food won’t ensure good nutrition. Of more importance is whether the ingested food is properly absorbed from the gut! Various faecally-transmitted infections (soil-transmitted helminthes e.g., giardia, ascaris, hookworms, trichuris etc.) and the resulting antibodies from immune responses may interfere with absorption of nutrients from gut. Sometimes these infections are sub-clinical, with the child apparently not sick. The resulting undernutrition makes the child vulnerable to other infections that hampers growth. Thus, the importance of sanitation and hygiene practices in reducing stunting cannot be overemphasized. As sanitary condition is better in SSA than SA, this is a significant factor for the differences between the two areas.

This once again reiterates the importance of water, sanitation and hygiene for improving the nutritional status of the children, much more than any nutritional supplements!

  Chambers R, Medeazza GV. (2013). Sanitation and stunting in India: undernutrition’s blind spot. Economic and Political Weekly; XLVIII(25): 15-18.

2 Ramalingaswami V, Jonson U, Rohde J. Commentary: the Asian enigma. http://www.unicef.org/pon96/nuenigma.htm

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