Covid-19 to hit children, pregnant women the hardest: Experts

As the country marks 'Poshan maah' this month, healthcare experts have called for urgent action to address the impact of Covid-19 on the national nutrition mission, saying the pandemic might affect the health of children and pregnant women the hardest as they are the most vulnerable to undernutrition.

The government is celebrating the National Nutrition Month or 'Poshan Maah' in September during which several programmes to spread awareness on the issues related to malnutrition in children, pregnant women and lactating mothers will be organised.

The experts PTI spoke to said this is a time when there is an urgency among all stakeholders to join forces.

On one hand food security needs to be ensured, on the other hand correct nutrition feeding practices need to be promoted in the community, they said.

Adopting system strengthening and social behaviour change strategies together in a sustained effort and investment beyond the Poshan Maah would yield results, they added.

Sujeet Ranjan, executive director at the Coalition for Food and Nutrition Security (CFNS), said the spread of Covid-19 has impacted the health, nutrition, livelihoods and wellbeing of India's most vulnerable populations and it will have lasting effect on people.

"One of the fallouts of the Covid-19 containment measures, including the closure of primary schools and Anganwadi centres, is that children in rural India now have to do without that one guaranteed meal, potentially worsening the child malnutrition problem in India," he said.

Even though the government has ordered state authorities to ensure provision of take-home rations at the doorstep as well as a cash allowance during the lockdown, efforts to tackle acute malnutrition can still take a hit, he said.

However, due to the barriers posed by the Covid crisis there may be multifaceted repercussions on children, Ranjan said.

"We can understand that the possible impact would be on the number of meals per day and hence the quantity of food per meal as well. Ensuring diet diversity at the time of Covid also remains a challenge as the main goal during this health crisis and lockdown is the availability of basic food first. Therefore, the quality of the diet is also compromised," he said.

He suggested that information technology can be leveraged for ensuring many services related to maternal and child health such as the use of mobile phones for counselling by frontline workers; use of remote health advisory and intervention services for getting all the necessary health information and guidance, strengthening mother and child tracking system, Poshan Helpline number for ensuring healthcare, immunisation services, and regular counselling through nutrition specialists.

Khan Amir Maroof, honorary secretary at Maternal Infant and Young Child Nutrition (MIYCN), Indian Association of Preventive & Social Medicine (IAPSM), said the health of children and pregnant women might be hit the hardest as they are the most vulnerable to undernutrition.

"The lack of availability of quantity and quality of food is a matter of concern. Both macro and micronutrient deficiencies will have their own effects. In short term, it will lead to malnutrition in terms of undernutrition (low weight for age), followed by higher chances of suffering from infectious diseases such as diarrhea, acute respiratory infections," he said.

Maroof said pregnant women are at a higher risk of undernutrition due to the increased nutrition requirement which is not being optimally met during this pandemic.

"This effect is intergenerational as the child to-be-born is at high risk of low birth weight or stillbirth. These effects put the family in a vicious loop of disease and undernutrition which is difficult to overcome without external support. For the whole country, this will mean a higher prevalence of malnutrition," he added.

He said strategies to mitigate Covid's impact on the health of children and pregnant women need to be tailored to a local context and to the severity of outbreak.

Food security allowances whose provision exists under the midday meal scheme can be implemented, either by way of direct cash benefit transfer or food vouchers. Vouchers have an added benefit as compared to cash that we can ensured to some degree that it will be used for food only.

Sebanti Ghosh, program director at Alive & Thrive India, said the pandemic has the potential to reverse the hard earned gains in improving health and nutrition of pregnant women and young children as the pandemic and lockdown have adversely affected the delivery of essential health and nutrition services, resulting in reduced coverage of crucial services like institutional delivery, immunization, antenatal care, provision of micronutrient supplies to pregnant women, young children and adolescent girls.

"Early detection and treatment of severely acute malnourished children (SAM) must be prioritized and ensured," she said.

Chandrakant Pandav, former head at Centre for Community Medicine at AIIMS, suggested that India can mitigate some of the affects of Covid-19.

"India's nutrition journey is too important to be derailed by a crisis like Covid-19. There must be a clarion call for the nutrition community in India to rally strongly and to give continued attention to malnutrition in all its forms, generate relevant evidence, and to support and engage all of society to urgently and adequately address malnutrition in the context of the Covid-19 pandemic. We have come too far to turn back now," he added.