Department for Women, Children, Disabled & Senior CitizensGovernment of Andhra Pradesh

Andhra Pradesh – Making a difference ! in

ICDS and IYCF

Warm Greetings !!

Importance of Infant and Young Child Feeding (IYCF) practices

Interventions for improving IYCF practices in Andhra Pradesh

Share of under-five deaths (%), 2011, by country

5 countries contribute towards 50% of child deaths globally

http://www.childinfo.org/mortality_underfive.php

Neonatal Mortality Rate (NMR) - India

Current: 29/1000 live births

Neonatal mortality

75%

Rest25%

Infant deaths

40/1000live

births Neonatal mortality

56%

Rest44%

Under-five mortality

52/1000live births

Accounts for almost ¾ th of IMR & >½ of U5-MR

Source : SRS

According to WHO estimates malnutrition is responsible for around 60% of child mortality

Malnutrition among children occurs almost entirely during the first two years of life and is virtually irreversible after that

As more than 90% of brain develops during first two years child undernutrition implies cognitive development, intelligence, energy & productivity loss is tremendous even amongst the survivors

The global strategy on IYCF recognizes that malnutrition is related to inappropriate infant feeding practices

Brain development

Underweight (-2sd) NFHS-3

Over 60 million

10 lakh children

die during

first month,

14 lakhs by

1 year, and 20 lakhs

by 5 yrs. 2/3rd are related to poor feeding.

Why reduce Malnutrition ?

Optimal Infant and Young Child Feeding

Initiation of breastfeeding immediately after birth, preferably within one hour

Exclusive breastfeeding for 1st six months i.e., the infants receives

only breast milk & nothing else, no other milk, food, drink or water

Appropriate and adequate complementary feeding after six months of

age while continuing breastfeeding

Full Immunization for infants

Adequate nutrition for pregnant and lactating women

Trends of IYCF indicators in AP

0

20

40

60

80

22.4

62.7 63.754.9

74.562.3

NFHS(2005-06) DLHS (2012-13)

Anaemia: The percentage of anaemic pregnant women has increased from 41.8% to 56.4% from 1998- 99 to 2005-06

Malnutrition among Women in A.P

BMI : Between 1998-99 and 2005-06, there is a marginal decline from 37.4 % to 30.8 % of women who are having BMI below 18.5

Andhra Pradesh Karnataka Tamilnadu Kerala India

41.848.6

57.1

20.3

49.7

56.4 59.553.3

35.2

57.9

NFHS-2 NFHS-3

- % of children below 3 years in A.P who are underweight is very high at 29.8%

- trends shows a slow decline in reduction of prevalence of under- weight

- every 3rd child below 3 years is underweight

Low Birth Weight Children

Malnutrition among Children in A.P

Underweight Children

- % of children born with low birth weight in A.P. is 19.4% which is highest among the southern states

- every 5th child born has birth weight less than 2.5 kg

19.4 18.7 17.2 16.121.5

Meaningful Food Models in ICDS1

Intensified Health & Nutrition Education

2

– Special weaning food for children 7 months to 3 years and hot meal for children 3 to 6 years

– Supervised feeding for malnourished children

– One full meal for pregnant and lactating women

– Capacity building on skilled IYCF counselling through counselling courses

– Two Nutrition and Health Days (NHD), one for growth monitoring and other for health services

– A convergence initiative of allied depts. with community

Interventions to improve IYCF Practices in AP

“Balamrutham” for 7 months to 3 years

– The new weaning food consists of wheat, channa dal, sugar, oil & milk powder– “Balamrutham” is fortified & is a caloric dense food– is distributed in packets of 2.5 kg per child per month – is widely accepted by the mothers

Revised Food Models for Children

“Hot meal” for Pre-School children

– Hot meal consisting of rice, dal and vegetable served in the afternoon – 4 eggs in a week served in the morning and snacks served in the evening

Balamrutham: Weaning Food for Children < 3 YearsComposition per 100 g Ingredients Parts(g) Energy(kcal) Protein(g)Roasted Wheat 55 190.3 6.4Bengal Gram 5 18.0 1.0Skimmed Milk Powder 10 35.7 3.6Sugar 20 80 0Oil 10 90 0TOTAL 100 414.0 11.0

Nutritive value per 100 gmS.No. GOI Norms Available Nutrients Fortification Total1 Energy (kcal) 414 0 4142 Protein (g) 11 0 113 Calcium (mg) 167 200 3674 Iron (mg) 3.1 6 9.15 Vitamin A (µg) 2.5 200 202.56 Vitamin B1 (µg) 0.3 0.3 0.67 Vitamin B2 (mg) 0.2 0.35 0.558 Vitamin C (mg) 0.5 15 15.59 Folic Acid (µg) 7.1 15 22.110 Niacin (mg) 2.3 4 6.3

Identification of malnourished children upto 5 yrs

– children upto 5 years are categorized as Severely Underweight (SUW) based on “Weight for age” criteria

– children are also categorized as Severe Acute Malnutrition (SAM)/ Moderately Acute Malnutrition (MAM) based on

“Weight for height” criteria

– children are weighed once in a month & height

measured once in 3 months

Supervised feeding for Malnourished Children upto 5 Years

Medical check-up of malnourished children

Supervised feeding-Model Menu for SUW/ SAM/ MAM Children of 7mths – 3 yrs

Sl.No.

Feeding Time Item

Venuefor feeding

Quantityper day

Tentative cost (Rs.per day)

Nutritive Value

Energy (Kcal)

Protein (g)

Calcium (mg)

1 7:30 am Balamrutham Home 50g 2.29 207.00 5.50 183.502 9:30 am Egg AWC 50g 3.50 86.50 6.65 30.003 11:30 am Milk AWC 100 ml 3.20 117.00 4.30 210.004 12:15-1:00

pmMini Meal + Extra Oil (5g)*

AWC 65g 1.66 236.12 4.81 13.40

5 3:30 pm Mashed Veg./Fruit

Home 50gby family 52.50 1.80 16.06

6 5:30 pm Balamrutham Home 50g 2.29 207.00 5.50 183.507 7:30 pm Meal at home +

Extra Oil /Ghee (5g)

Home 65g by family 236.12 4.81 13.40

8 Demand feeding

Breast Milk 600ml

402.00 6.60 168.00

Transport 0.10 Fuel 0.20 Total 13.24 1544.24 39.97 817.86

Supervised feeding - Model Menu for SUW/ SAM/ MAM Children of 3 – 6 yrs

Sl No

Feeding Time Item Venue for

feedingQuantity per day

Tentative cost (Rs. per

day)

Nutritive Value

Energy (Kcal)

Protein (g)

Calcium (mg)

1 7:30 am Tiffin + Extra Oil/Ghee (5g)

Home 100 g by family 325.00 7.00 20.00

2 9:30 am Egg AWC 50g 3.50 86.50 6.65 30.00

3 11:30 am Milk AWC 100 ml 3.20 117.00 4.30 210.004 12:15-

1:00 pmMeal + Extra oil (5g)*

AWC 125g 2.96 427.23 9.63 26.78

5 3:00 pm Snack AWC 15-20g 0.83 80.00 2.40 3.406 4:00 pm Balamrutham

(made into Laddoo /Java)

AWC 50g 2.29 207.00 5.50 183.50

7 5:30 pm Fruit + Snack Home 50g by family 200.00 3.00 20.00

8 7:30 pm Meal + Extra Oil/Ghee (5g)

Home 125g by family 427.23 9.63 26.78

Transport 0.10 Fuel 0.20 Total 13.08 1869.96 48.11 520.46

“Spot feeding of One Full Meal” for Pregnant & Lactating women Take Home Ration(THR) for Pregnant and Lactating women is

inadequate & consumed by family members

“Spot feeding of one full meal” been introduced in 101 ICDS projects out of 254 for 3.35 lakh Pregnant and Lactating women

“One Full Meal” is likely to– improve maternal nutrition– reduce incidence of anaemia– reduce incidence of Low Birth Weight– quickly reduce IMR& MMR

Funding “One Full Meal”– Rs 7 per day per women under ICDS – Additionally Rs 13 per day per women under State budget

Noon Meal: Rice(125g), Dal(30g),Veg(50g), Milk(200ml), Egg(1No.), Oil(16g)

1052 Calories30.8 g Protein400 mg Calcium

40% of the RDA

What does “One Full Meal” mean ….

What does “One Full Meal” mean ….

Along with One full meal

Administration of IFA

Weight monitoring

Counselling

• Improvement in the Postnatal care

0102030405060708090

100

19

6748

10

79 90

Concurrent Monitoring in Partnership with NGO Alliance, CESS & UNICEF

Capacity Building on IYCF practices

• Capacity building on skilled IYCF counselling through counselling courses been taken up by WCD

• Nearly 400 plus people (AWTC Instructors, CDPOs, Supervisors) have been trained as middle level trainers in IYCF using BPNI material at Hindupur

• Using these Middle Level Trainers the frontline workers have been trained

Nutrition and Health Days (NHDs) – Growth Monitoring & Counselling

Instead of one NHD in a month, two NHDs are being conducted

The focus of NHD-1 is on Growth Monitoring & THR

‒ NHD-1 is conducted on 1st of every month

‒ It allows focus on growth monitoring and categorization of children as SUW/SAM/MAM

‒ It ensures availability of food stock before 1st of every month

The focus of NHD-2 is on providing immunization and ANC services by ANM

Counselling of mothers is conducted on both NHDs

Convergence – Reducing IMR, MMR, Malnutrition & improving IYCF practices

Convergence A Key

Maarpu - A Convergence Initiative

Community

PRIs

SanitationSHGs

Health

Nutrit

ion

Safe Water

Gram Panchayat1

PHC Level2

District Level3

– Sarpanch as President– Other members of JB Committee (i.e. MPTC,SHG (2),

Social Activists (2)– ASHAs, ANMs, VO chairpersons– GP Secretary as convener & AWW as co-convener – MPP as President– Other members of JB Committee (i.e. ZPTC, MPTC(2),

Sarpanches (2), Social Activists (2) , SHG member (1), MPDO)

– Dy. DM & HO, ICDS Supervisors, MPHS (M&F), MPHEOs, AWW (RWS),AEE (PR), APM,MMS chairperson

– MO(PHC) as convener & CDPO as co-convener

– District Minister as chairperson, District Collector– ZP Chairperson, MLAs, CEO (ZP), PD(DRDA),

PD(DWMA), PD(MEPMA),SE(RWS), SE(PR),PO(ITDA), Addl. DM&HO (MCH& Tribal) DPHN,ZMS chairperson

– DM&HO as member convener & PD (ICDS) as co-convener

Convergence Structure Institutionalized

Early registration of pregnancy Growth Monitoring

Antenatal check ups Complementary feeding

Maternal nutrition Management of illness

High risk pregnancies Referral system

Birth planning Family planning

Institutional delivery Maternal & child death reviews

Early initiation of breast feeding Sanitation & hygiene

Exclusive breastfeeding for 6 mths Age at marriage

Newborn care Adolescent girls

Immunization Gender sensitization

Focus on 20 identified key interventions

• To improve service delivery, to create awareness & to enable behaviour change• Intensified Health & Nutrition Education by CRPs and health & nutrition functionaries

Way forward…..

To prepare annual plans for imparting Nutrition and Health Education

Need to position additional staff of ICDS mission to strengthen counselling

To actively involve community, SHGs and PRIs as partners in these efforts

To have close coordination with Health Department for effective convergence

To re-design food models in particular for malnourished children & pregnant women

To continue the skilled IYCF Counselling training courses

Thank You