An estimated 47 million children under the age of 5 years were severely or moderately wasted even before the COVID19 pandemic1. Most of these children resided in predominantly sub-Saharan Africa and South Asia.

While eliminating all forms of malnutrition by 2025 is one of the goals of the United Nations Decade of Action on Nutrition 2016–2025, none of the countries is on course to meet all the ten global nutrition targets for 20252. Only 8 out of 194 countries are on track to meet four targets. The pandemic that has hit the population in early 2020 has likely exacerbated the situation, especially in low and middle-income countries. Considering the impact of COVID19, these estimates need to be revised upwards3. 

COVID19 and malnutrition are biologically related.3 Malnutrition makes an individual more susceptible to infection and vice versa. The policies employed to control the spread of the virus caused and continue to cause disruptions to health systems, food systems, economic systems, and social safety nets4. We live in a complex and interconnected world, disruption in one sector ripples to others. For instance, movement restrictions disrupt transport systems, and transport disruptions impact access to food. The constant lock and unlock to address the spikes result in loss of businesses, leading to rising unemployment and underemployment, impacting people’s purchasing power, affecting nutrition outcomes. According to the International Food Policy Research Institute, an additional 140 million people are estimated to fall into extreme poverty, out of which 42 million are from South Asia, with a 20% rise in poverty levels. Poverty is directly linked to food insecurity jeopardizing nutrition4. Thus, all forms of malnutrition are likely to have been exacerbated by the pandemic. 

The corona-control measures led to the disruption of the government schemes and service delivery mechanisms. On this site, the resources page includes a chronological map of nutrition-related policy response by state and nationally, while the policy matrix gives a birds-eye view of state-level developments. The vulnerable population, especially pregnant women and young children, was severely impacted by service disruptions. According to NFHS-4 (2015-2016), pre-COVID19 coverage of key nutrition interventions was about 65%, with significant inter-state variability, which likely to has been worsened. UNICEF has termed children as “hidden victims” of the pandemic, citing reduced coverage of life-saving free meals, vaccinations, and other services5.

Healthy child development is path-dependent, especially the first 1000 days, on timely and essential inputs. Early action is vital to prevent irreversible damage and to break the intergenerational cycle of malnutrition. The opportunity costs of nutrition interventions are lower, benefit to cost ratio of nutrition-related programs is 16:1. The earliest time to act is now. It was the case before the pandemic and still is.3

To mitigate the effects of the pandemic on malnutrition, India needs to ensure the implementation of essential nutrition interventions considering the safety of frontline workers3,4. The focus should be on increased coverage, continuity, equity, intensity, and quality. Various states stepped up to the challenge with household-level distributions of take-home ration and IFA tablets by Anganwadi and frontline workers during the pandemic. The monitoring page of this site showcases the trend and current status of continuity of nutrition-related services for each Indian state and can be found here. Many states have resumed maternal health and childcare services while others are following suit.

Additionally, measures must be taken to address the social determinants. Additional cash transfer programs can ensure basic food and income security. Information technology and social media tools can be effectively employed for social behaviour change campaigns to address gender issues- girl education, marriage age, and domestic violence. The situation demands increased financial support towards nutrition efforts continued post-pandemic. Similarly, other related systems need to be revitalized. 3,4

In order to understand the state of child malnutrition, more and accurate information is required. Social distancing measures have impacted data collection and monitoring efforts. National and international agencies have flagged data gaps and reduced monitoring coverage during the pandemic. Data availability supports the evidence base and enables informed decision-making aiding prediction and planning. 3,4 In 2020, globally, 149.2 million children under the age of 5 were stunted, 45.4 million wasted, and 38.9 million overweight. In reality, the figures for child wasting could be about 15 per cent or 1.15 times higher than reported in the Joint Malnutrition report 2021. 6,7 Post-COVID data is likely to underreport wasting as muscle and fat loss is reversible in a short time. Repeated episodes of wasting affect the linear growth of the child and cause stunting. The data gap prevents the prediction of the increased stunting prevalence as a long-term effect of the pandemic. 7 Remote monitoring, touchless monitoring technologies, and other alternatives can be explored to improve the monitoring of malnutrition. It is equally important to record and respond to the grassroots-level experiences and challenges of the frontline workers and the needs of the beneficiaries.4
India will require strong leadership and continued commitment, adaptation of the national nutrition mission, strengthening of the social safety net, and innovative evidence-based data to make informed decisions, implement them and ensure feedback to take necessary corrective action to address the chronic malnutrition crisis aggravated by the COVID19 pandemic.4

References
  1. Joint Child Malnutrition Report, 2020.
  2. Global Nutrition Report, 2020.
  3. Lawrence Haddad. Biblical, on steroids, and across generations: The coming food and nutrition crash can be averted if we act now to counter the COVID-19 crisis.IFPRI Blog Guest Post April 2020.
  4. Menon P, de Wagt A, Reddy V, Reddy K, Pandav CS, Avula R, Mathews P, Kaur S, Pawar S, Ranjan S, Sharma S, Sankar R. Supporting efforts to address malnutrition in the context of the COVID-19 pandemic in India: An emergency need. Med J DY Patil Vidyapeeth 2021;14:369-73.
  5. UNICEF Tracking the situation of children during COVID-19 Dashboard, May 2021.
  6. Headey D, Heidkamp R, Osendarp S, et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. Lancet. 2020;396(10250):519-521. doi:10.1016/S0140-6736(20)31647-0
  7. Joint Child Malnutrition Report, 2021