Living on the edge? Sensitivity of child undernutrition prevalence to bodyweight shocks in the context of the 2020 national lockdown strategy in India

The National Family Health Survey (NFHS) 2015–16, finds that every second
child in India suffers from at least one form of nutrition failure. Dichotomised
indicators of underweight and wasting based on z-score cut-off does not
provide any information regarding those children who are clustered around
the threshold and are at an elevated risk of undernutrition through any minor
weight-loss. This paper aims to estimate the effect of bodyweight shocks on
net increments in the prevalence of child underweight and wasting among
the poorest households in India. We used cross-sectional information from
NFHS 2015–16 to estimate possible increase in the prevalence of child
underweight and wasting as a result of reduction in their bodyweight. The
shocks are presumed to range from a minimum of 0.5% to a maximum
5% reduction in the bodyweight for every child from the poorest 20%
households. Various raw weight measures scenarios were developed and
transformed into age- specific z-scores using World Health Organization child
growth standards. Nutritional status of children is sensitive to smallest of the
shocks to bodyweight. In fact, a reduction of 0.5 and 1 percent in weight can
lead to substantial increase in underweight and wasting prevalence. Under a
scenario of bodyweight shock of 0.5 percent, the prevalence of underweight
and wasting will increase by 1.42 and 1.36 percentage points, respectively.
These estimates get translated into 410,413 and 392,886 additional cases
of underweight and wasting, respectively. With such high concentration of
children around the undernutrition threshold, any minor shock to nutritional
health of the children can have major implications. In the current scenario of
national lockdown and restrictions due to coronavirus disease 2019 pandemic,
it is critical to ensure an uninterrupted supply of nutritious meals and food
supplements to the poor children while arresting the infection spread.