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Gujarat's health risk higher than 13 states due to child and maternal malnutrition: World Bank-supported study

*Disability-adjusted life-year
By Rajiv Shah
A new study, published in one of the world’s most prestigious online health journals, “Lancet”, has revealed that, among major Indian states, “model” Gujarat’s mortality and morbidity risk factor as a result of child and maternal malnutrition is higher than as many as 13 of the 21 major Indian states.
Calculated using a World Health Organization (WHO) term, Disability-Adjusted Life Year (DALY) rate, which seeks to quantify the burden of disease, with one DALY considered as one lost year of "healthy" life, Gujarat’s DALY rate for child and maternal malnutrition is 5013 per 100,000 population.
Major states with a higher DALY rate than Gujarat for child and maternal malnutrition – which the Lancet considers the most important health risk factor out of 17 factors – are seven, Bihar, Rajasthan, Uttar Pradesh, Assam, Madhya Pradesh, Chhattisgarh and Jharkhand.
Interestingly, not just prosperous states but also Odisha, West Bengal, Uttarakhand, Jammu & Kashmir and Himachal Pradesh perform better than Gujarat on this score. Kerala performs the best, with a DALY rate of 1212, followed by Himachal Pradesh 2614.
The sum of DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.
The factors which Lancet calculates for DALY include, apart from child and maternal malnutrition, are air pollution dietary risks, high systolic blood pressure, high fasting plasma glucose, tobacco, unsafe water-sanitation-handwashing, high total cholesterol, high body-mass index, alcohol and drug use, occupational risks, impaired kidney function, unsafe sex, other environmental risks, low physical activity, low bone mineral density, and sexual abuse and violence.
The other major factor which should be of concern for policy makers for poor DALY rate is high total cholesterol – 1844 per 100,000 population. Of the 21 major states, those that perform worse than Gujarat on this score are Haryana (2281), Andhra Pradesh (2044), Karnataka (1885), Punjab (2232) and Tamil Nadu (2396).
The Lancet study, titled “Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study”, has been sponsored jointly by the Bill & Melinda Gates Foundation, Indian Council of Medical Research, and the World Bank.
It says, “Child and maternal malnutrition mainly contributed to DALYs from neonatal disorders, nutritional deficiencies, and diarrhoea, lower respiratory, and other common infectious diseases.”
While pointing out that “these DALYs decreased by 64·3% from 1990 to 2016”, the study says, “Child and maternal malnutrition was still the top risk factor, causing the highest disease burden in India in 2016 as it was in 1990, when it caused 35·5% of the DALYs.”
The study says, “The age-standardised DALY rate in India dropped by 36% from 1990 to 2016, indicating overall progress in reducing disease burden. Behind this, however, are huge variations in the magnitude and progress across the states of India for the various diseases and risk factors.”

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