New Delhi, May 12: Too much emphasis on food is contributing to malnutrition among Indian children which, in some states, is at levels higher than even in sub-Saharan Africa, a World Bank study has said.

It has attributed the malnutrition to “mismatches” between the design and implementation of the Integrated Child Development Services (ICDS) programme, the government’s 30-year-old scheme to provide health, education and nutrition to children.

“The ICDS has been well-designed, but actual implementation deviates from the original design,” said Michele Gragnolati, a senior economist with the World Bank and co-author of the study, at a workshop to discuss its findings.

The ICDS operates through an army of anganwadi workers who work with children in their own localities. The study found that the anganwadi workers typically spend up to 40 per cent of their time in preparing and distributing supplemental food and another 30 per cent of their time in pre-school education.

This “dominant focus” on food detracts from other aspects that are crucial to prevent malnutrition. “It’s not lack of food alone that causes malnutrition. High levels of exposure to infection and inappropriate infant and young child feeding and caring practices also contribute to malnutrition,” Gragnolati said.

The prevalence of malnutrition among children in India has reduced from 53 per cent in 1992 to 47 per cent by 1999, a figure that is nearly double than that of sub-Saharan Africa.

“The decline has not been fast enough,” Gragnolati said.

“Malnutrition is not a single-cause problem and there is no single solution,” another World Bank official said.

The study found, for instance, that only 40 per cent of mothers in India practise exclusive breastfeeding to infants.

The delivery of services through the ICDS is also not focused enough on under 3, the study said. “The window of opportunity to improve nutrition is only between 18 and 24 months of age,” Gragnolati said.

About 30 per cent of children in India are born with low birth weight and if it is not taken care of by two years, the growth retardation is largely irreversible.

The study also found that the five states with the highest prevalence of malnourished children ? Rajasthan, Uttar Pradesh, Bihar, Orissa and Madhya Pradesh ? spend less on ICDS than other states.