Good nutrition
is the ground zero of child survival, growth, health and development. Well-nourished children are better able to grow
and learn, to participate in and contribute to their communities, and to be
resilient in the face of disease, disasters, and other global crises. Malnutrition causes the unnecessary loss of
about 3 million young lives a year. Undernutrition puts children at greater
risk of dying from common infections, increases the frequency and severity of
such infections, and contributes to delayed recovery. In addition, the
interaction between undernutrition and infection can create a potentially
lethal cycle of worsening illness and deteriorating nutritional status. Poor
nutrition in the first 1,000 days of a child’s life can also lead to stunted
growth, which is irreversible and associated with impaired cognitive ability
and reduced school and work performance. (UNICEF)

India has made some impressive
achievements with accelerated economic development in the global scene in last
3 decades. In the same breadth, it is widely accepted fact that India is one of
the major contributors amongst the worst child malnutrition affected countries.
The picture is even worse than some of the sub-Saharan countries with less per
capita income. The progress made to change this is none to negligible.  One of the prominent illustrations on this
matter is in The Economist magazine, which stated in an article in its 23
September 2010 edition, “Nearly half of India’s small children are
malnourished: one of the highest rates of underweight children in the world,
higher than most countries in sub-Saharan Africa. More than one-third of the
world’s 150 malnourished under-fives live in India.” (Panagariya,

50 per cent children under five years of age are anaemic in West Bengal, as per
the latest National Family Health Survey (NFHS-4 for 2015-16) data. “In West
Bengal, though the number of children under five years of age suffering from
anaemia decreased by seven per cent points over the last decade (from 61 per
cent in 2005-06 to 54.2 per cent in 2015-16), one in every two children is
still anaemic,”.(PTI, 2016)

these grim premises we set our tone to discuss about child malnutrition, low
birthweight- major child health issues and immunization. Nutrition is the
mechanism for physical and mental growth along with build-up of internal
defence system for the child’s body to fight diseases. Even moderately
malnourished children are also at high risk to get affected by the highly
infectious diseases. In the Millennium Development Goals (MDGs), underweight
has been adopted as a key indicator of poverty and hunger. In addition,
improved nutrition can help in reaching the MDGs by contributing to the
achievement of universal primary education, reducing child mortality.

per WHO guidelines the following indicators are to be evaluated to monitor

Age ii) Weight iii) Height (length supine for children aged less than 2 years, Height
standing for children aged more than 2 years)

prevalence of stunting has fallen largely. In India and Bangladesh, more than
40 per cent of children are underweight.


                          Child stunting:
Numbers and prevalence by country






























              Source: Unicef 2013


establishes its root at a very early stage of life. The mean weight and height
is already very low at birth for Indian children compared to the healthy
population. And the situation deteriorates very progressively through the first
two years of life. The critical part to prevent malnutrition is before
pregnancy till first two years of the child’s life.  Most of these problems
occur due to inadequate care during the antenatal period and during labour.
Inadequate care immediately after birth and inadequate care of LBW infants
within the first 48 hours contribute to the rest.


Beyond the phase of infancy,
immunization becomes critical in warding off potentially fatal conditions.
Immunization is one of the most cost-effective interventions to prevent the
suffering that comes from avoidable sickness, disability and death. The
benefits of immunization are not restricted to improvements in health and life
expectancy but also have social and economic impact at both community and
national levels.


An effective, evenly targeted
immunization programme and its ability to reduce the burden of
vaccine-preventable diseases (VPDs) will greatly contributed in achieving the
Millennium Development Goal 4 (MDG4) that aims for a two-third reduction in
child mortality by 2015.

India has the largest number of births
in the world – more than 26 million a year – and also accounts for more than 20
per cent of child mortality worldwide. Though some improvement has taken place
in the past few years, the country still accounts for the large number of
children who are not immunized. Some of the challenges to immunization include
limited capacities of staff, particularly in poor-performing states


India also still lacks a powerful system
to track vaccine-preventable diseases. Vaccination coverage varies considerably
from state to state. Differences in uptake are geographical, regional, caste
and religion, rural-urban, poor-rich and gender-related. On average, girls
receive fewer immunizations than boys and higher birth order infants have lower
vaccination coverage. (Unicef)

Among the demand-side factors, birthplace of the
child and religion of the household heads came out as significant predictors
while, from the supply-side, availability of male health workers and equipment
at the sub centres, were the important determinants for month-specific vaccine
coverage. Hence, there should be a vigorous attempt to make more focused
planning, keeping in mind the nature of the barriers, for improvement of the
month-specific coverage in West Bengal.(Dutta,2013).


5.2 Data Sources
and Methodology:

5.2.1Data Sources: This chapter
is based exclusively on the secondary data. District Level Household and
Facility Survey 4 factsheet and unit level data are used. For calculating
determinant of full immunisation in West Bengal a sample of 1662 children of
age group 12 years to 23 years are taken. For determining the factors
responsible for child low birthweight 6,224 children of 0 years to 5years aged
are the sample.

5.2.2 Methodology:

A standard of living index is constructed with the household
assets, which represents the economic status of the household.

Unit level data of child immunisation and Clinical
Anthropometric Biochemical Test (CAB) data are merged with the common primary
key of reproductive women to calculate the Body Mass Index (BMI) of the mother.


 BMI is a person’s weight in kilograms (kg)
divided by his or her height in meters squared. The National Institutes of
Health (NIH) now defines normal weight, overweight, and obesity according
to BMI.

BMI = masskg /

The determinants of child’s full immunisation have been
explored using the Binary Logit model and the responsible factors for low
birthweight of child are determined by a binary Probit model (details in
chapter 3).







Nutritional Status

the health status and reducing inequalities in the health sector have become a priority
of some premier international organizations, including World Health
Organisation and World Bank. Since 1997, the World Bank’s top priority on
health sector is “to work with countries to improve the health, nutrition, and
population outcomes of the world’s poor and to protect the population from the impoverishing
effects of illness, malnutrition and high fertility”. Though outcomes in the
mentioned domains, have improved over time but inequality still persists in
gender, caste, income, education and geography. The socio-political-economic
system influences the institutional structure determining the health of the
population. In order to ensure equity in access to health care, it requires
overcoming those several factors in delivery of services, financial factors and
the main target should be the vulnerable groups.

malnutrition has a positive impact on child mortality. Deprivation in childhood
makes physical and mental damages. According to united nation’s 2006 report,
India has the largest number of undernourished people in the world and one of
the highest levels of child malnutrition. The prevalence of underweight is
highest among the children in India. With the staggering statistics it is
amongst the highs in the world. The existing literature shows the importance of
community level education, mother’s exposure to mass media, use of pit toilet,
basic sanitation, access to clean water, health expenditure and health care
services. These were determined as significant causes of infant and child
mortality and malnutrition in India

prevalence of under nutrition is a major obstacle to human development and
economic growth of any developing country, especially among the poor and the
vulnerable, where the prevalence of malnutrition is highest. Keeping this in
mind the attempt is to describe the situation of child under nutritional


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