Most Number of ‘Zero-Food Kids’ Globally: Decoding India’s Malnutrition Crisis

What can be done to prevent malnourishment in children at such a vulnerable age for their growth and development?

What should be done to prevent malnourishment in children at such a vulnerable age for their growth and development?

(Photo: Vibhushita Singh/FIT)

India has 6.7 million ‘zero-food children’, or children between the ages of 6-23 months ‘who did not consume animal milk, formula, solid, or semisolid food in the span of 24 hours’, according to a new study, published in JAMA Network Open.

The study ranks India as the country with the third highest percentage of ‘zero-food children’ at 19.3 percent, behind only Guinea (21.8 percent) and Mali (20.5 percent).

However, in absolute numbers, India has the most number of ‘zero-food children’. 

"India has emerged as the country with the highest number of zero-food children, representing almost half of the total number from the 92 countries in the study."

The Study Authors

To help decode the study and find out what this really means for India’s healthcare systems, FIT spoke with public health and policy expert, Dr Anant Bhan, and child health and nutrition expert, Dr Rajiv Tandon.

What Do the Numbers Say?

The study took into account data from 92 countries. Out of all the children surveyed, 10.4 percent of children between the ages of 6-24 months were ‘zero-food children’. This number came up to 13.9 million children.

Out of these 13.9 million children, South Asia accounted for 8 million children.

Since 6.7 million of these children were from India, the country accounts for almost half of the world’s ‘zero-food children’.

West and Central Africa accounted for 2.9 million or 10.5 percent of these children.

According to the National Family Health Survey-5, the number of zero-food children in India increased between 2016-2021. In 2016, the number was at 17.2 percent.

However, it rose to 17.8 percent in the next five years. 

The top five countries when it comes to the number of 'zero-food children'.

(Source: Study titled Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries)

Beyond the Numbers: What Can We Infer From This Data?

Malnutrition in India, especially in children, is an issue that has been highlighted time and time again. 

Answering a question in the Rajya Sabha in May 2023, Union Minister Smriti Irani had said that according to data from the government’s Poshan Tracker, there were more than 14 lakh ‘severely malnourished children’ in India.

Speaking to FIT, Dr Anant Bhan says, "This is an age during which the child undergoes a lot of development that has significant health outcomes throughout their life. At this time, they need good quality nutrition for growth."

"If they’re devoid of that, that will have an impact on not just them, but their family and communities too, in many ways."

Dr Anant Bhan

Dr Rajiv Tandon agrees. He says that among India’s many vulnerable populations, a more attentive and focused strategy needs to be introduced to help children in the most backwards of areas where last mile reach of government programmes may not be equitable. 

Dr Bhan goes on to add that several other inferences can be made from this data, indirectly. He says:

• The data might be able to show that the parents and primary caregivers of these children might be struggling with food access and food scarcity too – since most families prioritise the nutrition of children.

• Building on the same argument, it could also show that the families could be struggling with health concerns too.

• The lack of nutrition at such a young age could lead to development and growth disorders in the children.

However, Dr Tandon is not fully convinced that the data on ‘zero-food children’ could be used to make an inference about maternal health as well.

He points out that at the six-months mark, the infant starts gaining some mobility and their health could now be independent of the mother’s.

“Another thing to look at is whether the mothers of these children were able to breastfeed and whether they were receiving adequate nutrition in the breastfeeding phase.”

Dr Anant Bhan

Interestingly, the study does mention that over 99 percent of the ‘zero-food children’ had been breastfed during the span of the 24 hours when they consumed no other form of nutrition.

However, it goes on to add, “After age six months, breast milk alone is insufficient to meet the growing nutritional requirements of infants and young children. The introduction of adequate foods, in addition to continued breastfeeding, during this critical window is of paramount importance for optimal nutrition, overall health, and human development.”

‘Immediate Intervention & More Research’: The Next Plan of Action

So, what is it that needs to be done to prevent malnourishment in children at such a vulnerable age?

According to Dr Tandon, “The need is to ensure programme delivery becomes equitable, it reaches the last mile, and actually has a greater focus on the most vulnerable.”

The study authors suggest that countries:

• Address the socioeconomic and environmental factors that contribute to food insecurity,

• Enhance access to nutritious foods,

• Improve maternal and caregiver knowledge about appropriate feeding practices, and

• Strengthen health systems to ensure the availability of necessary resources and support.

Dr Bhan agrees. He says,

“More research needs to be done to find out – who are these kids, where are they from, to which communities do they belong, what is the likely cause of malnutrition, and why is there still such a large number of ‘zero food kids’."

He goes on to add, "What should also be looked at is whether schemes that focus on children’s nutrition are reaching these families or not. This is a huge burden gap in healthcare that needs to be prioritised with immediate intervention.”