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Comprehensive National Nutrition Survey

  Jun 25, 2020

Comprehensive National Nutrition Survey (CNNS)

What is the importance of nutrition?

Nutrition is central to human development. Childhood and adolescent undernutrition undermines survival, growth and development, and diminishes the strength and resilience of communities and countries around the world. Micronutrient deficiencies are an important cause of morbidity and mortality especially in infants and preschool children.

What is Comprehensive National Nutrition Survey (CNNS)?

The Comprehensive National Nutrition Survey (CNNS) is the first nationally representative and comprehensive nutritional survey profiling children and adolescents (ages 0–19) in India to better understand the magnitude of micronutrient deficiencies; and nutritional status, which is measured by data including height and weight; anemia and other micronutrient deficiencies. The survey under Ministry of Health and Family Welfare (MoHFW) is supported by the United Nations Children’s Fund (UNICEF), US Centre for Disease Control (CDC) and Indian institutes like AIIMS.The CNNS 2016-18 provides an unprecedented amount of data allow for a greater understanding of the problems of nutrition among children.

Comprehensive National Nutrition Survey (CNNS) is the largest micronutrient survey in the world, with a focus on nutritional indicators among children of age groups 0-4, 5-14, and 15-19 years of age.

What is the objective of CNNS?

The main objective of the CNNS was to collect nationally representative data on the nutritional status of pre-schoolers (0–4 years), school-age children (5–9 years) and adolescents (10–19 years) through interviews, comprehensive set of anthropometric measures and biochemical indicators. CNNS sought to collect such data on the causes of anaemia in children, as well as on micronutrient deficiencies among pre-school, school-age and adolescent youths. 

Any associated data that CNNS collected?

It also identified background characteristics such as the percentage of children’s mothers who had attended school, the percent of children and adolescents who were exposed to mass media and their socioeconomic background.

What is the survey based on?

The CNNS 2016-18 survey was based on interviews with 112,316 children and adolescents, 360 anthropometric measurers, and 51,029 blood, stool and urine samples. It was conducted by 2,500 survey personnel across 30 states.

Its findings were varied and multi-faceted.

How rampant is anaemia in India? What has CNNS found?

Anaemia is a condition marked by low-haemoglobin levels and is mostly triggered by iron deficiency triggered by poor nutrition. It can lead to increased morbidity and negative effects on physical well-being including weakness, fatigue, and delayed mental and psychomotor development, as well as a higher risk of maternal morbidity. Anaemia has several consequences for an individual’s productivity. The Global Burden of Diseases (GBD) study found that dietary iron deficiency caused the most disability in India. AnIndiaSpend report found that anaemia cost India Rs 1.5 lakh crore in GDP losses in 2016.

According to the CNNS, 41 per cent of pre-schoolers, 24 per cent of school-age children and 28 per cent of adolescents were anaemic, with the greater prevalence among children below two years of age. Female adolescents had more than twice the prevalence (40 per cent) than that of male adolescents (18 per cent).In the data on anaemia, the prevalence was highest among Scheduled Tribes, followed by that of Scheduled Castes. It was found that anaemia-prevalence reduced as household wealth increased. Madhya Pradesh had the highest prevalence of anaemia (54 per cent) while Nagaland had the lowest (at eight per cent), followed by Kerala at nine per cent.

What about deficiencies of vitamins and micronutrients? 

On deficiencies, as per the survey, the prevalence of vitamin A deficiency was 18 per cent among pre­school children, 22 per cent among school­ age children and 16 per cent among adolescents. Vitamin D deficiency was found among 14 per cent of pre­school children, 18 per cent of school­ age children and 24 per cent of adolescents. Nearly one ­fifth of pre­school children (19 per cent), 17 per cent of school ­age children and 32 per cent of adolescents had zinc deficiency. On anaemia, the survey found that forty­ one per cent of pre­schoolers, 24 per cent of school ­age children and 28 per cent of adolescents suffered from it

What does CNNS data on diet and malnutrition in India show?

Diet plays an important part in fending off the onset of anaemia. Only six per cent of children between the age of 6-23 months were fed a minimum acceptable diet. The levels of this correlated with the education of the mother, with ten per cent of children having a minimum acceptable diet whose mothers had 12 or more years of schooling. The CNNS found that 31 per cent, 42 per cent and 53 per cent of mothers of children in the brackets 0-4, 5-9 and 10-19 years, had not attended school. Likewise, less than nine per cent of children aged 6-23 received iron-rich foods. 

Vegetarians had low consumption of iron-rich foods, at just four per cent. According to the report, consumption of iron-rich foods was substantially higher among Christian children (30 per cent), followed by Muslim children (16 per cent),” with high state variability, with the lowest consumption of the same (one per cent) in Haryana and the highest consumption in Meghalaya (54 per cent).55 per cent of children of all age groups in the (nationally-representative) study were found to consume a vegetarian diet without egg. 

Over 35 per cent of children had non-vegetarian diets, and the remainder, a minority, had vegetarian diets including the consumption of egg. Stunting, which in almost all cases takes place within the first 1,000 days after birth, was found in 34.7 per cent of children under the age of five—with 38.7 million cases. 

The most populous states, Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, had the highest rates of stunting (between 37 to 42 per cent), while the lowest prevalence was found in Goa and Jammu and Kashmir.

33.4 per cent of children under the age of five were found to be underweight, with 37.2 million cases. Wasting was found in17.3 per cent of children under the age of five.

What other findings are relevant?

Citing other studies, the CNNS stated that 46 million children under the age of five suffered from stunting, 72 million adults had diabetes and that 166 million adults were overweight or obese.

The survey attributes the rise in non-communicable diseases, obesity and diabetes to a shift in diet and lifestyle patterns, as food and drinks high in far, sugar and sugar grow cheaper and more widely-consumed. Diabetes, according to the latest studies, is no longer associated with affluence and has grown prevalent across socio-economic categories.

What programmes does the government have? 

Under POSHAN Abhiyaan, the government targets reducing stunting, underweight and low birth weight by two per cent a year and anaemia prevalence by three per cent a year. Overall, India plans to reduce anaemia levels to one-third of what was recorded in the fourth National Family Health Survey, by 2022.

Similarly, under the Sustainable Development Goals, India needs to reduce the prevalence of anaemia in women of reproductive age by 50 per cent by 2030.

Does India’s economic growth have commensurate health status?

Despite India’s economic and agricultural progress, still today, nearly 40 percent children under age five are stunted, and 66 percent (or three in five children) have anemia.  India accounts for more than a third of the of the stunted children in the developing world.