According to the recent policy brief released by UN, though children at present are not the face of the pandemic but the economic adversity caused by the lockdown could be responsible for more child deaths in 2020 thus reversing the progress achieved in past few years.
In India, the covid-19 cases continue to rise and have doubled in a week of 8 to 14 April (5916 to 11487) and so have the deaths (178-393). The Covid-19 has more likely risk in elderly age group with pre-existing conditions. This is more to do with individuals who are immuno-compromised. There is also a plausible link between nutrition status and immune health, thus making malnourished more prone to Covid-19. It is a double edged sword affecting both the undernourished and overweight & obese and predispose to non-communicable diseases. As per a recent report, “food insecurity, malnutrition and poverty may escalate, particularly among marginalized people in the developing world due to the rapid spread of coronavirus”. It is important to understand how the virus is affecting the vulnerable children, pregnant and lactating women.
According to a review, children are less likely to be severely affected by coronavirus. The symptoms are milder in children and have lower risk of severe disease. Another study concludes children of all ages are susceptible to coronavirus, however the clinical manifestation are lesser than adults. Most of the child patient cases in China were found to be asymptomatic or with mild to moderate symptoms and the median age was 6.7 years. Children are likely to develop antibodies to wade of the virus with frequent bouts of respiratory illness. However all this does not rule out the probability of children not being affected by coronavirus.
Malnourished children with impaired immune system are more susceptible to infectious diseases and have higher mortality risk. The nutritional status and resistance to infection have a strong relation and is important to address in children. Malnutrition tends to aggravate the risk to infections and vice-versa by decreasing appetite. India grapples with malnutrition despite program commitments like Integrated Child Development Services and Mid-Day Meal Scheme. According to National Family Health Survey (NFHS) 4, stunting, wasting and underweight in children under five years is 38.4, 21, and 35.8 percent respectively. India is second highest in terms of stunted children after Africa. India is also home to half the wasted children globally.
To top the problem of malnutrition is the problem of hunger in India. According to Global Hunger Index 2019, India suffers from a serious level of hunger. There is all likelihood for people to die of hunger than the coronavirus in the wake of the lockdown. India’s poor scoring in the Global Hunger Index is reflective of the low minimum acceptable diet of 9.6 percent in children 6 to 23 months. This is linked to the high rate of stunting and the intergenerational cycle of malnutrition.
India’s health system is compromised with inadequate health professionals, high patient load and rural-urban divide. The rural-urban divide is also evident from the percent of stunted children in rural, possibly due to the low economic status and making them susceptible to infections. Overcrowding has been known to be causative for outbreak of diseases and risk to health. Places with high population f=density and lack of sanitation facilities are likely to suffer if a pandemic strikes the country. The Dharavi case is a classic example of how big the challenge is to tackle the contagion.
With vulnerable communities at large in India, there has been a social and economic impact due to the coronavirus and subsequent lockdown. The Covid-19 has put both lives and livelihood at stake. With shortage of food supply, disruption of supply chains triggered by the lockdown has led to poor access to sufficient food and likely impact on food security. The economic impact can be severe for India due to the existing problems of poverty and malnutrition and added loss of income to the informal sector workers.
There is a correlation in food demand to income, and Covid-19 has led to loss of income thus affecting the consumption. Agriculture has been the primary sector of economy in India, contributing 17 percent of the GDP and employs more than half the population. The Covid-19 is largely affecting the agriculture and food sector. The poultry sector has seen a major loss since the coronavirus outbreak and the subsequent lockdown.
India with 1.3 billion population faces the highest percentage of undernourishment and are food insecure, Covid-19 may just add on to the woes. Covid-19 led economic decline, and existing poverty can lead to food insecurity for India. Food security programs in India have been affected due to the lockdown. The ICDS provides supplementary nutrition to children upto 3 to 6 years coming to the anganwadi centers and take home rations to children less than three years and pregnant and lactating mothers, which covers a part of their daily recommended allowance. However, amidst lockdown the hot cooked meal being provided to children at the anganwadi center has been stalled.
The department of women and child development in states of Odisha, Telangana, Uttarakhand, Kerala have ordered anganwadi workers to deliver the take home rations to beneficiaries at home. The Ministry of Human Resource Development had advised the states and UT’s to provide hot cooked mid-day meals or security allowance to meet the nutritional requirements of students during the lockdown period. But, there seems a major lacunae in the implementation of the directive. Despite orders and CSO’s coming forward to help provide beneficiaries with supplement nutrition (Panjiri/Paushtik Laddoo), there are reports of shortage of supply. The government has announced a relief package of 1.70 lakhs as relief package for the poor, includes providing of pulses to the families to meet their protein requirements.
Covid-19 and the lockdown has led to children being deprived of nutrition support, adding to the burden of families not able to meet ends due to loss of wages and looming poverty. There is a need to strengthen the existing food availability and supply along with adequate counselling on hand washing and social distancing. If we don’t act now, experts point to possibility of increase in number of severe acute malnourished children who are vulnerable to the virus due to lack of immunity. This could have a long lasting health and socio-economic impact for India.
We need to take act now as also urged by the Joint Statement on nutrition in the context of the COVID-19 pandemic in Asia and the Pacific, suggesting 6 key actions on healthy diets; maternal, infant and young child nutrition; management of wasting; micronutrient supplementation; school feeding and nutrition, and nutrition surveillance.
Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...Read More +