Malnutrition alters bodily growth and evolution and is an underlying cause of increased morbidity and mortality in developing nations. Estimations show two billion people to be troubled worldwide due to malnutrition. Childhood mortality is resulting from different sorts of malnutrition amount to 2.6 billion suggesting an enormous global disease burden. Malnourishment is highly widespread among Asian children as Asia is estimated to accommodate 70% of the world malnourished children.
The south Asian countries are peculiar with their dietary practices and living style compared to the rest of the world. In this region, malnutrition's critical reasons were inadequate food supply, micronutrient deficiencies, low household income, illiteracy, unhygienic and substandard living, inappropriate child's care and caregiver, food insecurity and vicious cycle of poverty.
The causes of malnutrition are complex as a vicious cycle of poverty plays a significant role in the dominance of malnutrition in selected countries. Food insecurity largely troubles population groups of low socioeconomic status, and more impoverished families may not be able to have access to nutritious foods due to poverty. However, fundamental determinants for malnutrition may vary within different developing countries of South Asia. In light of Sustainable Development Goals (SDG), a multi-faceted policy should be implemented to prevent and control malnutrition problems in these countries. The policy should cover all aspects: dietary support, supporting exclusive breastfeeding and appropriate complementary feeding, providing micronutrient fortification and supplementation, improving education, providing nutritional awareness to adolescent girls and mothers, and completing immunizations coverage to prevent infectious disease, ensuring poverty alleviation and food security.
Since Article 47 of Indian constitution assigned a duty on the state to improve nutrition, standard of living and improve public health in 1950, the Indian government started several programs like Mid-day meal programme in primary schools by Tamil Nadu govt in 1962, ICDS programme in 1975, Food for work programme in 1977, Nutritious food scheme to reduce malnurishment- Tamil Nadu in 1982, Mid-day meal by Kerala govt in 1984. After having constitutional right and several national and state level nutrition programs in 40 years between 1950 to 1990, 77 percent of Indian children aged 0-59 months were anaemic. This plight situation might be the outcome of three major reasons. Firstly, India’s engagement in several wars (Kashmir War 1947-48; India-China war of 1962, India-Pakistan war of 1965); Closed economy and lastly India got independence in 1947 only. After ten years, India got eight percent reduction in anaemia from 1990 (77%) to 2000 (69%). In this duration, Indian govt made several programs like Mid-day meal extended to 12 states in 1991, Feeding Bottles and Infant Foods Act in 1992, Nutrition policy in 1993 and launched the Targeted Public Distribution System (TPDS) to resolve the problems of poor communities in 1997 etc. From 2001 (68%) to 2010 (60%), India again achieved eight percent reduction in anaemia of child that might be with the help of several policies like extended Mid Day Meal Scheme in 2002, National Health Policy in 2003, National Food for work (NFWP) in 2004, Adopted National Food Security Mission in 2007, National Rural Drinking Water Programme (NRDWP) in 2009 etc. India could not keep the reduction rate, after 2010, after making several policies like National Rural livelyhood Mission in 2011, National Policy for Children in 2013, National Food Security Act in 2013, Indira Gandhi Matritva Sahyog Yojana in 2014 etc. Therefore, from 2011 (59%) to 2016 (57%), India achieved only two percent reduction. The reason behind the low reduction might be the problem in connection with implementation of the programs.
Bangladesh became as an independent country from Pakistan in 1971 unlike India. Bangladesh also gives food right to its citizen by constitutional provision-article 18-1. Under this provision, Bangladesh had set up several institutions like institute of Public Health Nutrition to assist the government in formulating policy and strategy for nutrition related activities and programmes in 1975, Bangladesh National Nutrition Council (BNNC) in 1975. About 73 percent of Bangladesh children aged 0-59 months were anaemic in 1990 after 20 years of independence with constitutional food right and several efforts. After ten years, Bangladesh reduced 11 percent in anaemia from 1990 (73%) to 2000 (62%) by several efforts like nutrition Policy and Program for Bangladesh, which was approved by the BNNC and published, Conference on Nutrition in 1992, participated in World Food Summit in 1996, National Food and Nutrition policy in 1997 etc. From 2000 (62%) to 2010 (48%), Bangladesh again achieved 14 percent reduction in anaemia of child that might be with the help of effective policies like National Food Policy in 2006 and previous policies as well. Bangladesh kept the reduction rate even after 2010 and again reduced eight percent of anemia between 2010 (48%) and 2016 (40%).
Nepal attempted multiple measures to address nutritional problems in the country. It is a fundamental human right enshrined in the 'Convention on the Rights of the Child (CRC) 1989. After the National Nutrition Strategy in 1978. Further, Nepal National Plan of Action for Nutrition 1998, Nepal Health Sector Programme- Implementation Plan 2004-2009, National Nutrition Policy and Strategy 2004, National Plan for Action on Nutrition (NPAN) 2007, National Nutrition Policy and Strategy 2008 and current National Nutrition Program(Pahari, 2011) were implemented. The government has also implemented the School Health and Nutrition Strategy 2006 to improve school-aged children's health and nutrition status. By these efforts, Nepal has reduced its anemia by 31 percentage from 74 percent in 1990 to 43 percent in 2016.
Article 38 of the Pakistan constitution gives the right to food. After having constitutional right in 40 years between 1950 to 1990, 70 percent of Pakistan children aged 0-59 months were anaemic. This plight situation might be the outcome of two major reasons. Firstly, Pakistan’s engagement in big wars with India (Kashmir War 1947-48; India-Pakistan war of 1965); and Secondly Pakistan got independence in 1947 only. After ten years, Pakistan got 12 percent reduction in anaemia from 1990 (71%) to 2000 (59%). In this duration, Pakistan govt made several programs like National Health Policy in 1990, Launched the National Programme for Family Planning and Primary Healthcare in 1994, Streamline it further of National Health Policy in 1997, National Vitamin A strategy meeting was held in 1999 and these policies might have played an important role to get 12 percent anaemia reduction among children. From 2000 (59%) to 2010 (57%), Pakistan achieved only two percent reduction which clearly manifests the prelude of priority changes from child health. Pakistan’s priority changes from child health have been crystal clear when its anaemia prevalence increase by two percent from 2010 (57%) to 2016 (59%).
In selected countries have a constitutional base to provide nutritional support to their citizens; thus, India, Pakistan, Bangladesh, and Nepal have implemented nutritional programs. The prevalence of anemia among children in 2016 shows that selected countries' efforts need to develop a comprehensive nutritional plan to deal with anemia. India and Pakistan have a 70-year history, whereas Nepal and Bangladesh have a more than 50-year history of implementation, but anemia's prevalence is still high. These findings suggest that there is scope for strategy improvement.
Figure 1 to 4 reveals that all the countries have high anemia among children in 1990. The prevalence of anemia started declining in South Asian countries. Despite progress in the last decade for anemia reduction in children, anemia continues to be a major public health concern in South Asia. Our findings have revealed to accelerate anemia reduction, a holistic approach targeting the known underlying determinants of anemia is needed.
The study finds nutritional programs have a positive impact on the prevalence of anemia. The high prevalence was observed in 1990 and started to decline over time. A similar declining trend was observed in all the selected countries, except Pakistan. The majority of anemia increases after 2010 in Pakistan, which shows a lack of interest in implementing the nutritional policy. On the other hand, the low prevalence was observed in Bangladesh and Nepal despite fewer policies and programs than in India and Pakistan which manifests quality of policy is more important rather than quantity of policy. The study suggests, to eradicate anemia among the children, India and Pakistan need to take a lesson from the neighboring countries.