In response to the severe outbreak of COVID-19, 107 countries on March 12, 2020, temporarily closed their educational institutions affecting around 70% of the global student population. So far, more than 190 countries have implemented national school closure affecting 1.57 billion children, i.e., approximately 90% of the global student population. School closures have deepened the nutritional crisis for school children in India who were mainly dependent on school meals for their daily dietary requirements. Mitigating the impacts of COVID-19 is a priority for the entire globe. However, while dwelling on one problem, we should avoid falling into another!

The pandemic has induced a food crisis (hunger, and undernutrition), especially in children from low-income families, which requires immediate attention.

Also Read| Is India Heading Towards A Health Crisis Post This Pandemic?

Criticality of school feeding programs:

School feeding programs provide healthier meals and fulfil up to one-thirds of the child's daily nutritional needs. For children from lower-income families, having the meals from feeding programs such as the Midday Meal Scheme (MDMS) is not an option but a means for their survival. Malnutrition, undernutrition and dietary requirements of the 9.12 crore children from the disadvantaged section of the society has been effectively addressed via Mid-Day-Meal (MDM) scheme running over 11.35 lakh schools across India.

Even for a shorter time period, nutrition shortfalls can cause weakened immune system, fatigue, and risk of communicable disease, which may severely affect the physical, emotional, and psychological development of a child in the long run. Prolonged unavailability of food via MDM will lead to increased health vulnerabilities and intellectual inequalities along the children of the country. Malnourished and undernourished children are more susceptible to infection from COVID-19 as well due to their already impaired immune system.

Case study on impact assessment of MDMS on child health and nutrition

A survey of 594 school going children of Bangalore demonstrates the criticality of the meal for children coming from low income families. The analysis indicates that consumption of MDM is associated with healthy weight of children in comparison to the children who does not consume MDM on regular basis.The survey consisted of 45% male and 55% female children in the age group of 5-16 years. The parental demographics are given in Figure 1. Fathers were working in wide range of occupations including daily wage labourer, construction labourer, farm labourer, auto driver, carpenter, factory worker, and a few as small retail shop owners. Mothers were mostly found to be engaged as housemaid, factory worker, and daily wage labourer.

Fig. 1:? Parental demographics

Analysis of the impacts of midday meal on height and weight of the children was done by categorizing the weight into five types, namely, severely underweight, underweight, average weight, overweight and obese, along with categorizing the height into five types, namely, severely stunted, stunted, average height, tall, and very tall. Multinomial logistic (MNL) regression was used to regress weight and height categories upon multiple independent variables including ‘regular consumption of MDM’. Results show (Table 1) that regular consumption of MDM reduces the probability of a child being underweight and increases the probability of being in the average weight and overweight category. Similarly, consumption of MDM increases the probability of being in average height, and taller category (Table1).

(** denotes significance at 95%)

Overall, the research clearly depicts the relevance and significance of MDM for better well-being of children manifesting as healthy weight and average height of children. Specifically, for low-income households, midday meals play a vital role in alleviating hunger, providing proper diet and improving the health and nutritional status of children.

Also Read| Improvement Needed To Meet All Child malnutrition targets by 2022

Defining ‘Normal’ and Preparedness for the post-pandemic world

In the current pandemic era, when the nutritional support of the child has already weakened due to the disruption in schooling, what will “Normal” mean when the schools re-open?

Pandemic situation is evolving in a linear manner, and there seems to be no end as of now. Still, if we look at the situation ideally and consider that the pandemic will get over within the next 6-8 months, then the question arises: are we, as a nation, prepared to handle the post pandemic nutritional damage on schools going children? If not, what should be our level of preparation for restoring the damage due to COVID-19?

Anticipating that the pandemic situation will continue for a several more months, damage in the nutritional status of the child will directly impact their learning and well-being.

Even before the pandemic, India’s burden of child health and nutrition was more than any other country with casualties of 1.8 million children (below the age of five) every year, along with stunting rate of 52 million population. Now, the situation has become far more complicated due to multiple stressors including COVID-19, impoverished economic status, loss of employment, poor and unhygienic living conditions, and lack of healthcare facilities.

Overall, the combined impacts of all the stressors will further deteriorate the health and nutritional status of children and warrants immediate operationalization and implementation of MDM scheme across all the regions in coming days. However, effective implementation may not be enough. A comprehensive solution would lie in enriching the nutritional contents of MDM by supplementing the existing menu with more fruits, milk, cereals and vegetables to compensate for the nutritional imbalance of the child. This necessitates additional funding from the government and decision makers. At a broader level, better coordination between mid-day meal providing agencies and the governmental agencies can strengthen this weak health and nutrition network for India and the globe.

Acknowledgement:

We gratefully acknowledge the support provided by the Akshaya Patra Foundation and Accenture Labs in the data and the discussions.