Nearly half of all children in South Asia suffer from malnutrition. That alarming statistic is under discussion this week at the United Nations Special Session on Children in New York. The problem of child-malnutrition in South Asia is getting worse, and it is not simply a question of children not getting enough to eat.

No baby likes to be poked and prodded, and weighed on a cold scale, but the doctor weighing little Ashu at the Unit Three clinic in the poor New Delhi neighborhood of Sangam Vihar is concerned about something she sees. Dr. Manju Gurnant says Ashu is far too small and suffers from chronic malnutrition.

"He has second-degree malnutrition, and he is two-years-old," she said. "His weight is only around eight or nine kilograms."

Ashu only weighs about half of what he should for his age, and he is sick, very sick. Dr. Gurnant says the child is suffering from a variety of infections, including, she believes, tuberculosis.

All across South Asia, there are millions of children like Ashu. The region has the highest rate of child malnutrition in the world. There are 167 million underweight, under five-year-olds in the world. Ninety million of those children live in South Asia, according to United Nations statistics.

Abdullah Dustagheer, who directs malnutrition programs in India for UNICEF, says 40 to 45 percent of children suffer from malnutrition in South Asia, compared with about 30 percent of the children in Africa. He says the situation is not improving.

"In fact, the situation is stagnating, and we have only noticed a decrease of one percent per year in terms of child malnutrition," he said. "And if you compare it with a population growth of around two percent, that means, in absolute terms, you may be having more numbers of children malnourished."

Abdullah Dustagheer says, in India, about 30 percent of households do not have enough food to eat. However, he says, malnutrition is often caused by factors other than a shortage of food.

"There are other more important factors like inaccesibility to adequate child health services and adequate sanitation," he said. "And even more important is the level of care that is provided to the child at the household and family level."

Even though millions of children in South Asia go to sleep hungry, experts say it is factors like no clean drinking water, low birth weight and vitamin and iodine deficiencies that are the primary causes of most child malnutrition cases.

Dr. Ashmina Mitra, who oversees operations at the Unit Three clinic in Sangam Vihar, says children like Ashu are suffering from malnutrition because they live in a poor environment.

"In this community, they do not know how to prepare the food. They have food, but they do not know how to make the food nutritious," she said. "This is a medium type of malnutrition, because you can change the food, and the baby will grow normally. But, sometimes, there are also parasitic infections, the parasite takes all the food the baby does not get. More common are diarrheal diseases, because there is no potable water. Babies take their water from outside, from vendors. From that, the diarrhea starts, and slowly diarrhea leads to malnutrition."

The doctors treating Ashu say he will probably die from the infections and diseases brought on by malnutrition. Each year, 38 million children are born in South Asia. Five million die every year, and experts say up to three million of those deaths are from causes associated with malnutrition.