Maharashtra state seems to have made big strides in reducing childhood malnutrition, a problem India has been struggling to overcome for years.

The latest survey in Maharashtra shows that the state has almost halved the number of malnourished children under the age of two from 2006.

According to provisional figures from a comprehensive nutrition survey conducted in Maharashtra by the Mumbai-based International Institute for Population Sciences, an educational and research institute, 22.8% of children under two are stunted, or too short for their age, a decrease from 39% in 2006. 21.8% of children under two were found to be underweight, compared from 29.6% in 2006, the study states.

India has been struggling to reduce childhood malnutrition, which has remained high despite rapid economic growth. In the most recent national government survey in 2006, 51 percent of children under the age of three, were underweight. This represented only 6 percent decline from the previous survey in 1999.

The United Nations Millennium Development Goals include halving malnutrition by 2015 worldwide.

This latest Maharashtra study included both rural and urban households in six administrative divisions in Maharashtra - Amravati, Aurangabad, Konkan, Nagpur, Nashik and Pune. It was conducted over four months, from February to May this year, and will be completed by the end of 2012.

Commissioned by the state government, the study received technical and monetary support from The United Nation’s Children’s Fund, known as UNICEF.

The latest Maharashtra survey, sanctioned independently by the government of the state, is a way to fill the gap in information on malnutrition. The most recent national data on malnutrition from the Indian government is from the National Family Health Survey of 2006.

Understanding why Maharashtra has succeeded in reducing rates significantly could help show India the way.

Government officials said one reason Maharashtra appears to have cut malnutrition rates is better coordination between the different government departments in charge of nutrition and health. Malnutrition results from a confluence of problems, from poor feeding practices to bad sanitation and healthcare, so a coordinated approach is believed to be key.

To increase coordination between departments, Maharashtra was also assisted by a special mission set up by the state government in 2005 to focus on improving childhood and maternal nutrition. Known as the Rajmata Jijau Mother-Child Health (RJMCH) and Nutrition Mission, this body gets monetary and technical help from UNICEF. It helps monitor workers in villages and suggests changes in government policy.

Also, improving the work of grassroots workers in villages was critical, according to officials involved. These workers are funded and trained by the National Rural Health Mission, the health ministry division in charge of improving rural healthcare.

A few important developments in maternal and child care have accelerated Maharashtra’s “much faster decline” in malnutrition rates, says Victor Aguayo, chief nutritionist at UNICEF India.

More than 60% of children get breastfed within an hour from birth, up 10% from 2006, said Dr. Aguayo. Breastfeeding is very important for the child to get essential nutrients, he said.

Another reason, he said, is more visits by anganwadi workers, community nutrition counselors, and medical officers to check on the health of pregnant mothers in rural areas. The survey shows that more than 89.6% of pregnant mothers received three visits from a medical officer during the course of their pregnancies, up from only 59.3% in 2006.

The improvements in other facilities, such as sanitation and the availability of nutritious food, has also helped, according to Dr. Aguayo.

For instance, 62 % of households surveyed had toilets, up from 53%, and around 78% used iodized salt in food compared to 59% on 2006.

Another key finding of the study is the wide difference between numbers in different places. For instance, around 32% of children from Nashik were stunted, while only about 15% from Nagpur were stunted, according to the survey.

Prithviraj Chavan, the chief minister of Maharashtra, says the government plans to understand the reasons for the discrepancy and focus on the areas with higher malnutrition numbers.

Maharashtra’s success might show a way forward for the rest of the country. Mr. Chavan said, several other states are considering using the Maharashtra model.

Still, he cautioned, “there is still a long way to go in eliminating malnutrition.”

This survey will help the state government understand which programs undertaken to combat malnutrition have had an effect, and indicate what must be done to further reduce child malnutrition, he added.

The state government also plans to extend and adapt its special nutrition mission to urban areas with the help of the local municipal corporation soon, said officials from the mission.

The most important part of a child’s development is the first 1,000 days of his of her life, Dr. Aguayo said. After that, whatever is done to reverse malnutrition is, “a waste of time, energy and resources.”

So the second phase of the special nutrition mission’s work in Maharashtra will focus on providing healthcare and nutrition to expectant mothers and children under the age of two, the report says.

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