Team:Paris Bettencourt/Background

Background

According to the Food and Agriculture Organization (FAO), more than 17% of the world’s population is underfed, with around 25,000 people dying of malnutrition every day and a large concentration of malnourishment present in Southeast Asia. These figures seem hard to change and hide many causes and consequences. A sufficiently nutritious diet should provide, among other things, ions, vitamins or essential amino acids. A deficiency in one of these elements can trigger pathologies: an iron deficiency disturbs oxygen transport, or a vitamin A deficiency can lead to blindness. [to re-write]

[give some numbers about malnutrition in India]

The FAO reports that more than half the adults have a BMI under 18.5 kg/m2 in the states of Karnataka, Gujarat, Madhya Pradesh and Orissa, due to malnutrition. The states of Arunachal Pradesh, Maharashtra Andhra Pradesh are also shown to have extremely poor nutritional status.
However, several studies reveal an improvement in the nutritional status of the Indian population in the last two decades. They are attributed by the FAO to socio-economic factors, increased availability of drinking water and improvement of health facility. The Global nutrition report 2014 also mentions nutrition-specific interventions, improved access to food and education, and diminution of poverty and fertility as key factors that have allowed child stunting to be reduced by 1/3 since 2006. But the situation is still dire.
In order to evaluate whether and how synthetic biology could help fighting malnutrition in this country, we researched the other solutions that have been proposed so far to reduce vitamin and iron deficiency, and examined their respective benefits and what obstacles and drawbacks they faced.

1. The Integrated Child Development Services (ICDS) programme

The ICDS is a indian governmental programme established in 1975 which monitors growth and provides supplementary foods, as well as education and primary healthcare for children under six and pregnant and lactating mothers. The programme is implemented through a network of community-level anganwadi centres (AWC), which gives supplementary food daily in the center, as well as take-home rations. Those supplements include doses of vitamin A and tablets of iron and folic acid, in order to prevent xerophtalmia - which can lead to blindness - and anaemia.

However, the National Family Health Survey (NFHS-3) held in 2005-2006 in India reports that only 28% of children received those supplements and healthcare even though 4/5 of children under six lived in a region covered by an anganwadi center. In the 6 months preceding the survey, only 1/4 of the children between 12-35 months were given vitamin A supplements - and in 9 states of India, this number falls to less than 20%. The access to ICDS was improved in the recent years though (2). A national survey held in 2013-14 says that 46% of children aged 6-59 months had received vitamin A doses.

Doses of other vitamins do not seem to be included in the programme.

It is also to be noted that India is one of the country with the less coverage rate of nutrition-specific interventions for iron and folic acid supplementation according to the 2014 Global nutrition report - which could suggest that there is a lack of such interventions. The 2013-14 survey reports only 14% of children aged 6-59 months having received iron and folic acid supplements.

In conclusion, the ICDS programme holds great promises, especially for vitamin A supplements, and seems to be helping more and more children and women in the recent years. But it is limited by the important cost of the numerous centers for the state, the access people have to such centers, and its lack of intervention for other vitamins and iron and folic acid.

2. Vitamin pills