Child Malnutrition, Child Malnutrition, Child Health and Child Health and the Mid-Day Mealthe Mid-Day Meal

Opportunities for Action.Opportunities for Action.

By : Dr. T Sundaraman, By : Dr. T Sundaraman, Executive Director, NHSRCExecutive Director, NHSRC

Malnutrition.. not child specific

Indicator NFHS- 2 NFHS- 3

Children< 3 Stunted

45.50 38.40

Children <3 Wasted-

15.50 19.10

School Child 36.0%

Women 15 to 24 BMI < 18.5

44.1

Men 15 to 24 BMI <18.5

34.2

Women 25 to 49

35.6

M en 25 to 49 34.2

But Children Most Vulnerable…

Almost one third low birth weight at birth.

Improved by about 6th month

Then worsens and remains high in 0 to 6

Peaks again in adolescence- for the first and only time being male predominant.

Then declines moderately- over next three decades

Rises again in old age.

Malnutrition Rates International comparisons show India

performing very poorly

Adjusted for GDP per capita – it would be the worst performance.

Reasons relate to Poverty and Economic Disparity.

Social inequities- gender, caste, geographic

Changing Dietary Patterns

Burden of ill health and sickness.

Govt. Schemes that Address Malnutrition….

Public Distribution System

NREGS

ICDS & Nutrition Supplement for Pregnant women, lactating mothers and children below 5

Mid-day meals in schools.

The Creche Programme

Management of Severe Acute Malnutrition….

Drinking water and sanitation schemes..

The Mid-Day Meal Major tool – that has helped boost enrolment

and retention of school children.

Possibly helped in reducing absence and in improving learning.

Meant to cover 30% of the nutrition needs of the growing child.

However it has not been consciously leveraged as an opportunity for increased child health.

School Health Programmes

As early as the Bhore Committee Report- A school healht service must include

Health Measures, preventive and curative, which include Detection and treatment of defects and diseases Creation and maintenance of a hygenic environment in

and around schools

Measure for promoting positive health should include Provision of supplementary food to improve the

nutritional state of the child Physical culture through games, sports and gymnastic

exercises Health education thru formal instruction and practice of

the hygenic mode of life.

Health Screening and Management.( 6 monthly)

Six Monthly

Nutritional Status- BMI

Anemia.

Common Skin diseases

Ear discharge/Eye redness

Common dental conditions

Annually

Vision and Hearing Problems

Heart defects

Learning Disorders

Psycho-social assessment and assistance for the child.

Disability

For Management of Malnutrition and Anemia.

Preventive measures- the mid-day meal plus a weekly Iron and Folic Acid Tablet as supplement.

One could add micronutrients onto locally prepared food where indicated. – eg using iodised salt.

But for children with moderate or severe malnutriton or anemia- Test and Treat and monitor till cured!!!

Add more to food supplements- either as a morning snack or as a extra-portions on the meal- to help correct the gap.

Role of nutrition counseling…

Only within a setting where the school sees itself as responsible for addressing malnutrition and anemia.

Nutrition counseling and management is a complex skills- requires judgment, considerable subjective factors- individual dialogue, understanding of contexts….

But with the mid day meal in hand – one could supplement with nutrition for the needy child.

And Health Education…

Inclusion in the formal curriculum

Inclusion as special series of school health sessions- audited- not credited.

Informal methods- peer education

Promotion of Hygenic Practices

Physical education and Sports.

Adolescent Health- the whole area of sex education and sexual health.

Social Health… Support to the physically challenged child

Support to the child with learning difficulties- mental problems,

Dealing with violence in the school and in the homes

The role of cultural activities and building solidarity and the spirit of caring.

In conclusion The School is charged with not

only producing an educated child – but a healthy child as well.

And Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity….

And school is one of the best opportunities to achieve this.