Final Report on Malnutrition.pdf

8/10/2019 Final Report on Malnutrition.pdf

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Malnutrition: An Invisible and SilentEmergency

A Report on Malnourished ChildrenIN Urban Slums of Bangalore

DATE: June 07, 2013

Dr. Megha RanjanPost Graduate Diploma in Health Management

Institute of Health Management Research, Jaipur


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Contents

Acknowledgement 4 Abstract 5

SECTION 1: - ANALYSIS OF DATA ON MALNOURISHEDCHIILDREN IN DIFFERENT PAG AREAS

1.1) Introduction to CRY PAG Areas ..6

1.2) Summary of Results 7 1.3) Reasons for Malnutrition in PAG areas.9 1.4) Complications of Malnutrition11

1.5) Menace of Malnutrition..12 1.6) Case Stories of Malnutrition.13 Rakshita13 Sudha..14 Charan.15 Estharani16

1.7) Details and Key findings of malnourished childrenIn PAG areas17

a) Koromangala PAG ..18 b) Jeevan Beema Nagar PAG 27 c) Yeshwantpur PAG ..31 d) Madivala PAG 37

SECTION 2: Insight into MALNUTRITION AND HEALTH SCEMES 2.1 Introduction ..39 2.2 Background.40

What is Nutrition and Malnutrition??? 40 Types of Malnutrition 40 What we come across in field..??? 41 Classification of Malnutrition 42 Causes of Malnutrition ..43 Irony of Girl Child Malnutrition45


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Section 4: AnnexureAnnexure I: Excel Spreadsheets of data on malnourishedchildren ..78

Annexure II: Composition of food items distributedunder ICDS in Rajasthan and as recommended byGovernment of India

Annexure III: WHO Growth Standard Charts 90 1) Girls Weight for age 0-10 years2) Boys Weight for age 0-10 years


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ACKNOWLEDGEMENTI, Dr. Megha Ranjan, would like to extend my thanks to CRY for giving me thisopportunity of doing my internship with them.

I would like to express my heartiest gratitude to all the CRY volunteers in the differentPAG areas who helped me collating the data. Without their time and effort, this reportwould not have been possible.

I also extend my gratitude to all the anganwadi workers who cooperated to provide thedata. A special thanks to intern, Dr. Megha Raghvan for her immense help.

Finally, I would like to thank my mentors at CRY, Ms. Thangamma Monappa and Mr.Navneet Prakash and my mentor at IIHMR, Dr. (Major) Vinod Kumar; who helped and

guided me throughout my internship. I learned a lot under their able guidance.


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AbstractThis report describes the project on Malnutrition that I did during my

internship at CRY in Bangalore. It is a follow up to the one written by

Siddharth Jha 1, in which he undertook a detailed survey of malnourished

children in various anganwadis in each PAG area. This report provides

additional details on the mechanisms (what, how, why and consequences)

of malnutrition as well as details on each malnourished child in each

anganwadi, analysis on the data collected from the anganwadis, and finally,

discuss about how to proceed towards the management of malnutrition

both at the health facility level and home level (Nutritional Rehabilitation

at home). Further, it gives an insight into the various health schemes at the

national and state (Karnataka) level particularly a comparison of Integrated

Child Development Scheme (ICDS) among Karnataka and 5 other states.


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Section 1: ANALYSIS OF DATA ONMALNOURISHED CHIILDREN INDIFFERENT PAG AREAS

(1.1) CRY Public Action Groups(PAG) AreasThere are four Public Action Group (PAG) areas in Bangalore

1) Koromangala,

2) Madivala,

3) Yeshwantpur, and

4) Jeevan Beema Nagar.

Essentially, each PAG is a group of enthusiasts, members of the public who have come

together to stand for what is right. They wanted a change, so opted to be the change to

make a difference. And they have made a difference- from installing water filters to

setting up a new anganwadi.

Through their regular visits and interactions with the members of the

Community; they monitor and intervene in cases of Child Rights violations. The sole

purpose for them has become to ensure equal opportunities to all children, conferring

the 4 basic rights:

Right to Survival,

Right to Participation,

Right to Development and Right to Protection.

And as a result of their continuous and effective interventions which included

constant dialogues with the community as well as with the concerned authorities, they

have been successful in making a huge impact in the society.


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Summary of Results from Data collected onmalnourished children from theAnganwadis in different Public ActionGroup (PAG) Areas

Data has been collected from the anganwadis in all the four PAG areas(Koramangala, Jeevan Beema Nagar, Yeshwantpur, and Madivala) from theofficial records of children maintained by the anganwadis and againweighing the malnourished children in the anganwadis. Following figureshave emerged from the month long exercise.

Table 1: Complied Data on Malnourished Children from All the PAG AreasAs on June 1, 2013

a/Anganwadi Total No.of Mal-nourishedChildren

No ofUnderweightGirls

No. ofUnderweightBoys

No.SeverelyunderweightChildren

No. ofSeverelyUnderweightGirls

No. ofSeverelyunderweightBoys

No ofchildrenunderage of 2years

No ofunderweightgirlsunderthe ageof 2years

No. ofUnderweightboysunderthe ageof 2years

omangalaG

38 29 9 32 24 8 7 7 0

. Nagar, Nearvernmentool

10 10 0 7 7 0 3 3 0

nnada Tamilool

2 2 0 2 2 0 1 1 0

C-1, Rajendra

gar

1 1 0 1 1 0 0 0 0

C-2, Rajendragar

4 3 1 4 3 1 0 0 0

bedkar Nagar.r Publicet

6 4 2 5 3 2 0 0 0

S Quarters 1 0 1 0 0 0 0 0 0


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Cross, L. R.gar

7 6 1 6 5 1 3 3 0

u Anganwadi 4 1 3 4 1 3 0 0 0de Urduool

1 0 1 1 0 1 0 0 0

stri Nagar 2 2 0 2 2 0 0 0 0hwantpur

G21 11 10 7 5 2 4 1 3

riff Nagar 4 4 0 3 3 0 1 1 0

yathri Slum 1 1 0 1 1 0 0 0 0appa Garden 4 2 2 2 1 1 0 0 0C-2, Sheriff

gar12 4 8 1 0 1 3 0 3

van Beemagar

69 40 29 19 14 5 3 2 1

M Palaya 17 10 7 3 2 1 2 2 0C- 2lurupura

13 10 3 4 3 1 0 0 0

C- 3,

lurupura

28 13 15 8 6 2 1 0 1

C- 4,lurupura

11 7 4 4 3 1 0 0 0

DIVALA PAG 4 1 3 2 1 1 0 0 0Palya 4 1 3 2 1 1 0 0 0

For management of malnourished children Refer toSection 2: Page No. 47 and 53 for NutritionalRehabilitation.

For Government Initiatives towards ending malnutritioni.e. various government health schemes Refer to Section3: Page No. 56

2

1 Data collected from the official records of anganwadis in April, 2013


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Reasons for the high number of

malnourished children in the PAG areasa) Low level of education among mothersb) Lack of Knowledge towards healthy dietsc) Cultural beliefs about discarding the colostrum and

breastfeedingd) Care: Poor maternal care and child care practices due to a

lack of knowledge about infant care on the part of mothersand other caregivers in the family

e) Lack of knowledge about the importance of complementaryfeeding.

f) Lack of commitment towards health issuesg) Lack of political commitment towards providing funds and

other provisions to anganwadis which are the importantpillars to combat Malnutrition.

h) Lack of adequate health services, clean water and sanitation.

Fundamentally, poverty is at the root of under nutrition. Verypoor people are generally unable to afford the foods, educationor health care they need to nourish themselves or their children .


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Picture 1: Reasons for malnutritionSource: UNICEF, Save the Children


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Complications of Malnutrition

InadequateBreastfeeding

FrequentBouts ofDiarrhea,Pneumonia,Malaria

Picture 2: Complications of MalnutritionSource: http://challengedkidsinternational.wordpress.com/2013/03/


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Menace of Malnutrition

Picture 3: Consequences of MalnutritionSource: http://challengedkidsinternational.wordpress.com/2013/03/


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CASE STORIES OF MALNUTRITION1) From Rajendra Nagar, Koramangalaa) RakshitaAnitha, frail and underweight got married at the age of 20 and soon gave birth to herfirst child, Rakshita. Rakshita was small and malnourished ever since. She is 4 years oldnow and weighs just 9 Kgs. Her father is the reason she is facing this menace ofmalnutrition. If he would have taken care of her mother and would not have run away,she could feed Rakshita well. Now she has to work and cannot take care of her in Rs2500 per month. She cannot even provide her milk mentions Anithas sister, Sunitha.Sunitha takes care of Rakshita when her mother is at work and provides her withwhatever little food she can.

With the little knowledge about malnutrition, its consequences,Anitha has ignored about this issue ever since was born. The girl frequently catches cold,cough, robbed by diarrhea quite often and trap her more deeply in the paws of

malnutrition.

A playful, curious Rakshita Courtesy: Dr. Megha Raghavan

When we (Me, Dr. Megha Raghvan and Nischal) met her for the first time she wasplaying in the streets of Rajendra Nagar. She was curious as we were looking at her with

wide eyes, trying to figure out what is so wrong with her to make some strangers stareat her. Discussing with her aunt Sunitha about her health issue (brought to our notice byUrdu Anganwadi where Rakshita is though enrolled but rarely attend) ; she gotconvinced that Rakshita needs to see a doctor and requires proper nutrition.

Ever since we have been trying that some positive change can be brought into her life.She has been ch ecked by the doctor from St. Johns Medical College as well who visitthe Koromangala once a year for health check ups. Her mother has been counseled for


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proper feeding practices and preparation of some low cost nutritious recipes. She hasbeen put on the priority list of health care workers of Adugudi PHC who has promised tofollow her up regularly.

We hope with our efforts we can bring her out of the red zone soon andgive her a new healthy start with her enrollment in PARIKRAMA School next year, adream seen by her mother for her.

SudhaAnother small girl who USED TO LIVE in the urban slum of Koromangala opposite toNational Games village; YES used to live, because she passed away 15 days back.

5years old and weight just 6.5 Kgs crippled by malnutrition to a point that she hasdeveloped irreversible brain damage and hooked with many other developmentaldisorders. What a steep contrast is seen on the two side of the road. On one side thereis flourishing new age buildings and on the other side people are struggling to get onemeal of the day.

Parents were worried that their little girl is not growing well, sheis fragile, weak and mostly lies silently on the floor but when they recognized the

situation it was already too late. She was rushed to nearby hospitals where she washospitalized twice due to frequent episodes of diarrhea which further deteriorated herhealth. Finally she was seen by the Pediatrician at the Indra Gandhi Institute of ChildHealth Hospital, where after check up doctor mentioned that due to chronicmalnutrition, her brain has been irreversibly damaged and she is also suffering from anarray of developmental disabilities due to improper nutrition during her growth years.

Sudha is not alone, as most of the children who fall under the category of severelymalnourished have parents who are ignorant about malnutrition, what causes it and itsdire consequences and lack resources for providing not only the medical attentionrequired when there is an emergency, but also the basic resources to provide for abalanced diet for the child.

Had the parents been acted on time, Sudha could be saved from clutches ofmalnutrition.

From preventing any other child suffering from such situation we must act swiftlytowards making the community aware that if they wont act in a responsible mannerNext can be their child.

3

2 Case stories compiled after discussion with the parents and anganwadi teachers


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2) N S Palya, Madivala PAG CharanOn April 13, 2013; CRY kick started dropout survey in N S Palya area of South Bangalore.We (Me and other volunteers- Prateek, Shreoshi, Akanksha, Allen) were excited to havean opportunity to bring some changes in the life of the lesser privileged. We beganhouse to house surveys to collect the information about the school drop-outs. Andwhen we came across the anganwadis of the area. Charan was on the radar ofvolunteers but they could not locate his house or meet him until today.

Anganwadi helper guided us to Charans house where we had first glimpse ofCharan. He is a 4 year old boy residing in one of the narrow lanes of G D Mara slumwhich houses population of about 10,000 people; sandwiched between residential sky-scrappers on one side and upcoming five star hotel on the other which also threatens todemolish the disputed G D Mara slum.

Charan represents the textbook picture of severe malnutrition-extremely thin legs and hands, an extended pot belly, crackled skin and wide eyes. Hepeeked from behind his father and instantly we felt like we need to do something aboutthis kid. We asked anganwadi worker, talked to his father and the same old story cameto our notice. The household can afford to maintain refrigerator, a cable connection,television but not able to feed his child properly.

A year back, when Charan had a severe bout of diarhhoea he was admittedin Indira Gandhi Institute of Child Health Hospital where he was diagnosed with ProteinEnergy Malnutrition PEM). He was prescribed with a proper line of treatment which ifwould have been followed up, then today Charan would have been fine by now. But hisparents chose not to care and his condition has worsened over the period of time. Wealways encounter him in the streets of G D Mara slum sitting next to a vegetable vendorand every time when we visit his house, we are welcomed by a locked door.

Anganwadi worker is least bothered about his condition, his parents are aloof over hishealth..

Charans deteriorating health in spite of being seen by the IGICH Doctors is an issue ofurgent concern, in fact it is an emergency and we will have to find a way to help him outand soon.


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Esther Rani(Compiled by Rajeev, Volunteer EAST PAG)

Age: About 2 years

Status: MalnourishedLocation: Anganwadi GM Palya (CRY East PAG, Bangalore)Challenges: Diagnosed at birth with Congenital Heart Disease

Esther Rani is the youngest amongst 3 siblings, the others being brother Anil (now about13) and sister Sharada (now about 10). Born on 13 th June 2011 to Malamma (now about43) and Sabanna (now about 53), she was diagnosed with a Heart condition by Sri

Jayadeva Institute of Cadiovascular Sciences and Research Bangalore . Her Fatherbeing a Casual Worker and Mother a Homemaker, did not have the resources to treather condition. CRY Volunteers discovered her as a SAM child at the GM Palya

Anganwadi in mid-2012.

A Plan was set into motion to rescue her from her condition under the Bala SanjeevaniScheme of the ICDS. The Anganwadi Teacher prepared the Enrolment Form for visitingthe Public Health Worker visiting the Anganwadi, for reference to the Primary HealthCentre Vibhutipura. Consequently, the PHC referred her to the requisite DistrictHospital in KR Puram. The DHO recommended that she be treated for her Cardiaccondition by a Government owned or aided facility. Contact was made by CRY with theDirectors of Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore,to examine and treat the Child under the relevant ICDS scheme. Consequently, and aftermuch persuasion, the Parents agreed to accompany CRY Volunteers on the appointeddate to the concerned hospital. However on the morning of the appointment, theParents appeared to have changed their mind and did not show-up at the Anganwadi inorder to be ferried to the Hospital. CRY Volunteers then had to involve the Teacher topressure the Father to allow for the Child to be examined. Taking the help of theAnganwadi Helper, the Volunteers tracked down the house of the Child and finallysucceeded in driving the Child with her Parents to the Hospital. At the MRI conducted inthe OPD that morning, it was found that the Childs heart condition had been correctedand just needed treatment for Malnutrition. Fearing the non-seriousness of the Parentsto allow the Child to undergo any kind of corrective treatment at IGICH, a request wasmade immediately to the concerned Doctor at the Hospital to recommend Tonics and

Supplements that will help the Child come out of the SAM state. As prescribed, suppliesfor 3 months were purchased and handed over to the Parents while dropping them offhome that afternoon.

Esther Rani appears to be on the path of recovery from her SAM state and is gainingweight, to be a normal Child soon .


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Details of Malnourished Children

in Each Anganwadi

Brief Introduction to Anganwadi

The Anganwadi - literally a courtyard play centre - is a childcare centre. It isthe focal point for the delivery of services at community levels to childrenbelow six years of age, pregnant women, nursing mothers and adolescentgirls of the age group 12-18.

Every AWC is supposed to cater to two adolescent girls every 6 months.They are supposed to receive a take home ration of supplementarynutrition. This is done both for the benefit of the girls as well as any futurechildren of theirs, since a child born to a malnourished mother is likely tobe malnourished himself.

The WCD has ordered that severely malnourished children be given eggs

and milk four times in a week4 to combat the problem of malnutrition. A

plan was recently announced to expand this to providing milk and eggs to

all children, everyday from January 1 st , 2013. 5

4 The Hindu, 20 April 20125 http://www.thehindu.com/news/states/karnataka/milk-eggs-to-be-on-menu-for-anganwadi-children/article4112879.ece last accessed on 20th April 2013


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S.No.

Name of thechild

Age inyears ason 30thMarch,2013

Sex Weight in Kgsas on 21stDecember,2012

Weight inKgs as on31stMarch,2013

IdealWeightfor age(-1 SD)

Grade ofMalnutrition

1 Nirasha 1.2 Female 5.2 6.48.3

Severe

2 Sneha 2.4 Female 8.1 8.5 10.9 Severe

3 Anupriya* 3.3 Female 9.3 9.312.7

Severe

4 Shalini 2.3 Female 7.8 8.010.7

Severe

5 Vedavathi 3.9 Female 10.3 10.813.6

Severe

6 Manasaa 4.6 Female 11.2 11.514.9

Severe

7 Benitha 5.7 Female 9.3 9.616.8

Very Severe

8 Samara 3.9 Female 11.9 11.913.6

Moderate

9 Shruthi 1.7 Female 8.2 8.59.2

Mild

10 Priyadarshini 1.6 Female 9.0 9.110.2

Mild

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6 * Mentally challenged, Neurological abnormalities - needs complete evaluation; been to IGICH, Dr.Megha Raghavan was following her. For details refer to her database and manual .


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2) Kannada Tamil School, Rajendra NagarTeacher: Usha (8884761834)

Key findings

a) There are 2 malnourished children, who were identified by Intern Siddharth Jha inDecember, 2012. However no follow up has been done since then on these children. I

tried to follow these children but found anganwadi closed every time I have visited thearea.

b) All are females and are severely malnourished.

S.No. Name of theChild

Age inyears ason 30 th March,2013

Sex Weight in Kgs ason 21 st December, 2012

Ideal Weightfor age (-1 SD)


1 Laxmi 1.5 Female 6 8.9 Severe

2 Ammu 3.0 Female 9 12.2 Severe

3) AWC-1, Rajendra NagarTeacher: Selvi 9945075660

Key Findingsa) Anganwadi has not been followed up since December, 2012

S.NO. Name Age inyearsas on30 th March,2013

Sex Weight in Kgs ason 21 st December, 2012

Ideal Weightfor age (-1SD)


1 Aisha Kannu 4.2 Female 9.3 14. 3 Severe


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5) Ambedkar Nagar, Near Public ToiletTeacher: Manjula (8710075205)

Key Findingsa) There are 6 malnourished children in the anganwadi out of which 4 arefemales and 3 females are severely underweight for her age. All the children areabove 2 years of age.

b) All children are doing fairly well and are being regularly followed up.

c) Bharth has been diagnosed with PEM and has been taken to Shantinagar PHCwhere he has been prescribed protein supplements by the Doctor. His family hasalso been counseled about proper feeding practices and he has shown someimprovement since then but need regular follow up.

d) Sudha had progressed to advanced brain damage due to chronic malnutrition.She has been seen by doctors at Indra Gandhi Hospital but they suggested that

nothing can be done now as she developed irreversible damage. She passedaway in May, 2013

e) Sholo has been doing well with proper counseling of his parents. Needsregular follow up.

S.NO.

Name Age inyears ason 31 st March,2013

Sex Weight inKgs as on21 st December,2012

Weight inKgs as on

31 st March,2013

IdealWeightfor age(-1 SD)


1 Sudha* 4.6 Female 6.8 6.8 14.9 Very Severe

2 Sholo Breakmance 4.0 Male 11 11.5 14.4 Severe

3 Sanjana 3.4 Female 9.4 9.9 12.8 Severe

4 Arogya Stella 4.8 Female 12.2 13.2 15.2 Moderate

5 Shobha 4.0 Female 11.0 11.3 14.0 Severe

6 Bharth # Male

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8 * Sudha- passed away in May, 2013. Case story- refer page no 15 of the report# Bharath- seen by Doctor at Shantinagar Maternity center in April, 2013


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6) EWS QuartersTeacher: Sumathi (8904437493 )

Key Findingsa) Due to demolition of Ejipura Slum, 6 out of 7 children have moved from the area.

Only Kaushik is enrolled with EWS anganwadi.

b) Malin Bahno has moved to Ambedkar Nagar, Jalali cross, contact no is 88840027

c) Ferdoz Begum, Ruhi Begum and Madhumati, Sara has moved to Husor Road andSarjapur Road respectively and are also not enrolled in any anganwadi.

d) Ruhi has moved to L.R. nagar, 11 th cross. No other contact details.

e) Kauhsik has been regularly followed up. Also his guardians have been counseledabout proper feeding practices and he has been doing well

S.NO. Name Age inyears ason 30 th March,

2013

Sex Weight in Kgsas on 21 st

December,2012

IdealWeight forage (-1 SD)


1 Malin Bahno 3.5 Male 8.9 13.4 Severe

2 Ferdoz Begum 4.5 Female 10.5 14.8 Severe

3 Ruhi Begum 2.2 Female 7.7 10.5 Severe

4 Madhumatti 2.0 Female 6.5 10.2 Severe

5 Ruhi 1.8 Female 6 9.4 Severe

6 Sara 4.8 Female 11.1 15.2 Severe

7

Kaushik* 3 Male

11.4 (taken on

April 15, 2013)

12.6

Moderate

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9 * Kaushik: Hearing and Speech difficulty. Been to Chandrashekhar Speech and Hearing Institute (CSHI)


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7) 1st Cross L. R. Nagar Teacher: Regina (9900809567)

Key Findingsa) There are 7 malnourished children in the anganwadi out of which 6 are females.

b) 6 children are severely malnourished out of which 50% are under the age of2years.

c) The children are not doing well despite the best efforts on the part of Anganwaditeacher Regina.

d) There is either drop in weight or weight is not improving in all the cases.

e) Mother of Shankar and Priya (seen by doctors at IGICH) has been counseledabout the diet for the children and needs a regular follow up. Also while talkingto their mother, it has come to our notice that despite having BPL card, thefamily was charged for laboratory investigations at Indira Gandhi Hospital andthe medicine prescribed by the Doctor is not available at the Hospital Pharmacy.

S.NO.

Name Age inyearsas on30 th

March,2013

Sex Weight inKgs as on 21 st December,2012

Weight inKgs as on

30 th March,2013

IdealWeight

for age (-1SD)


1 Shankar 5.6 Male 10 11 17.0 Very Severe

2 Priya 3.5 Female 10.1 10 13.0 Severe

3 Tejaswini 1.7 Female 7 7 9.2 Severe

4 Jayashree 1.5 Female 6.6 6.8 8.9 Severe

5 Sania Misra 5.5 Female 11.2 11.5 16.5 Severe

6 Monisha 1.7 Female 6.2 7 9.2 Severe

7 Keerti 2.7 Female 9.9 9 11.4 Moderate


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7) Urdu AnganwadiTeacher: Name Unknown

Key Findingsa) There are 4 malnourished children in the anganwadi out of which 2 are

females and all the children are severely malnourished.

b) Since the anganwadi is newly opened, it does not have adequate funds fromthe concerned authorities for the provision of EGGS, MILK andsupplementary food. Therefore children are not given EGGS and MILK andoccasionally supplementary food is provided.

c) # Rakshita has been regularly followed up. She has been taken to AdigudiPHC where her mother was counseled by the Link Worker with respect toregular visits to PHC. Her mother was also counseled by us for proper feedingpractices. She needs to be regularly followed up.

d) Izaz and Aman has not been followed up.Aman has gone to his village and hence has not been seen since a month.

e) Sufian is the son of same Anganwadi teacher and is doing well.

S.NO. Name Age inyears ason 30 th March,2013

Sex Weight in Kgsas on 30 th

March,2013



1 Izaz 3.1 Male 8 12.9 Very Severe

2 Rakshita # 4 Female 8.7 14 Very Severe

3 Aman 4 Male 10.7 14.4 Severe

4 Sufian 4 Male 11.1 14.4 Severe


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8) Inside Urdu SchoolTeacher: Pushpa

Key Findingsa) The anganwadi has one malnourished child, Sultan who is severelyunderweight for his age and suffers from frequent infections due to lowimmunity. He has been seen by the doctor at Sidhamaya Hospital and his mother

has been counseled for proper feeding practice. He needs to be regularlyfollowed up.

b) Also the anganwadi has not been followed up since December, 2012.


Sex Weight in Kgsas on 30 th

March,2013



1 Sultan 2.5 Male 5.6 11.7 Severe

10) Shastri Nagar Teacher: Padma (8453578256)

Key Findings

a) Anganwadi has not been followed up since December, 2012.b) There are 2 malnourished children in the anganwadi who were identified by

intern Siddharth Jha.c) However, we have been trying to meet the anganwadi teacher and the parents

of these two children but could not.



December,2012



1 Kavya 3.3 Female 9.6 12.7 Severe

2 Franka 2.9 Female 8.9 11.7 Severe


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Yeshwantpur PAGWe have been covering only 4 anganwadis in the area. Each anganwadi caters to two

adolescent girls per six months. They get a take-home ration of food. In each

anganwadi, malnourished children are provided with a supplementary diet of milk and

eggs. Eggs are provided four times a week while milk is provided twice a week.

Additionally, they are given Chitrana/ Payasam alternatively.

Details of Malnourished children in the area

1) Sheriff NagarTeacher: Tahseen Taj ( 9591841468 )

Key Findings

a) There are 4 malnourished children in the anganwadi and all are females.

b) Out of 4, 3 are still severely underweight for their age but one child Tasleem hasmade progress from being severely malnourished to moderately malnourishednow.

b) Though at a slow pace but all children are doing fairly well but still needs regularfollow up.

S.

NO.

Name Age in

yearsas on30 th

March,2013

Sex Weight in

Kgs as on21 st December,2012

Weight in

Kgs as on30 th

March,2013

Ideal

Weightfor age(-1 SD)

Grade of

Malnutrition

1 Mehek 3.1 Female 8 8.5 12.4 Very Severe

2 Rihalia 2.3 Female 8.5 9.1 10.7 Severe

3 Jeelan 1.8 Female 7 7.5 9.4 Severe

4 Tasleem 2.8 Female 9.5 10 11.6 Moderate


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3 Sachin

Manikuntta 3.7 Male 11

13.7

Severe

4 Geetha 3.3 Female 10 12.7 Severe

4) AWC-2, Sheriff Nagar Teacher: Not Known

Key findings

a) There are 12 malnourished children in the anganwadi out of which only 1 child isseverely underweight for his age, 2 moderately underweight and 4 mildly underweight.

b) Out of 12 children, only 4 are females.

c) 5 children have been graded malnourished by the anganwadi teacher but since theirage/Date of birth is unknown, it is difficult to say under which grade of malnutrition theycan be categorized

S.NO.

Name Age inyears ason 30 th March,2013

Sex Weight inKgs as on

21 st December

, 2012



1 Mehek 4.3 Female 12.5 14.5 Moderate

2 Sultan 4.8 Male 14 15.5 Moderate

3 Umar 1.7 Male 9 10.0 Mild

4 Hemad Ul

Rehman

1.4 Male 9 9.4 Mild


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5 Ameenabi 2.1 Female 10 10.3 Mild

6 Abdul 0.5 Male 4.5 6.7 Severe

7 Hanif 2.9 Male 12 12.3 Mild

8 Shahid Unknown Male 10.5 Unknown

9 Shahid-2 Unknown Male 10 Unknown

10 Asif Unknown Male 10 Unknown

11 Sab Falaak Unknown Female 7.5 Unknown

12 Rekha Unknown Female 8 Unknown


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Jeevan Beema Nagar PAGIn this area, only GM Palya caters to adolescent girls two of them per six months. They

get a take-home ration of food. In each anganwadi, malnourished children are provided

with a supplementary diet of milk and eggs. Eggs are provided four times a week while

milk is provided twice a week. Additionally, they are given Chitrana/ Payasam

alternatively.

Details of Malnourished Children in the area

1) G M Palaya Teacher: Laxmiamma (9740583215)

Key Findings

a) There are 17 malnourished children in the area out of which10 are females.14 are under the age of 5 years

b) Out of 17,3 are severely underweight for their age,10 are moderately underweight and4 are mildly underweight.

c) Among the severely underweight children Estharani and Dinesh are being regularlyfollowed up. Chaarulata has not been followed up since December, 2012

S.NO.

Name Age in yearsas on 30 th

March,

2013


31 st March,

2013



1 Estharani# 1.9 Female 7.2 9.6 Severe

2 Dinesh 2.8 Male 10 12.1 Severe


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3 Chaarulata 4 Female 11 14.0 Severe

4 Giridhar 4.4 Male 13.9 15.0 Moderate

5 Pavithra 5.4 Female 14.3 16.3 Moderate

6 Vaishnavi 4.1 Female 11.9 14.2 Moderate

7 Basavaraj 2.5 Male 10.8 11.7 Moderate

8 Hema 3.5 Female 11.2 13.0 Moderate

9 Niket 5.2 Male 14.8 16.4 Moderate

10 Sandhya 4.8 Female 13.5 15.2 Moderate

11 Vishal 3.7 Male 11.7 13.7 Moderate

12 Priyadarshini 4.6 Female 12.4 14.9 Moderate

13 Pavan 5.2 Male 14.9 16.4 Moderate

14 Mahesh 3.9 Male 14 15.8 Mild

15 Kavitha 3.1 Female 11.4 12.4 Mild

16 Sapna 4 Female 13.4 14.0 Mild

17 Sushmita 1.9 Female 9.4 10.5 Mild

10

10 # Estharani: has heart condition. Seen by the doctors in March, 2013


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2) AWC-2, NellurupuraTeacher: Rajeshwari 9916511827(Teachers husband)

Key Findingsa) There are 13 malnourished children in the anganwadi out of which

10 are females11 are under the age of 5 years

b) Out of 13,4 are severely underweight for their age of which only 1 is male3 are moderately underweight of which 0 males

6 are mildly underweight of which 2 are males

c) Among the severely malnourished children, all have shown little progress exceptPranavi who has lost weight over the period of time. Earlier she was 8.4Kgs andreduced to 8.2 Kgs. Though the decline is not so steep but it suggests that she

suffers from infections frequently and looses weight with each episode ofinfection. Therefore she needs to be followed up regularly.

S.NO.



31 st March,2013



1 Surendra 3.5 Male 8.1 13.4 Severe

2 Bhargavi 3.5 Female 10.2 13.0 Severe

3 Akhila 3 Female 10.2 12.2 Severe

4 Pranavi 4 Female 8.2 14.0 Severe

5 Spoorthy 4.5 Female 13.5 14.8 Moderate

6 Nandini-2 4 Female 13 14.0 Moderate

7 Sauolya 4 Female 12 14.0 Moderate

8 Nandini 4 Female 13.9 14.0 Mild


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9 Siddhu 4 Male 12.2 14.4 Mild

10 Triveni 5 Female 15.9 18.2 Mild

11 Laavanya 4.5 female 13.4 14.8 Mild

12 Dharani 5 female 14.4 18.2 Mild

13 Vinay 3.5 Male 12.1 13.4 Mild

3) AWC-3, NellurupuraTeacher: Narayanamma (7795348456)

Key Findings

a) There are 28 malnourished children in the anganwadi out of which13 are females17 are under the age of 5 years

b) Out of 288 are severely under weight for their age of which only 2 are males9 are moderately underweight of which 5 are males11 are mildly underweight of which 8 are males

S.NO.

Name Age inyears as on

30 th March,2013


31 st March,2013



1 Jaswant 5.0 Female 12.4 15.8 Severe

2 Monica 4.2 Female 12.1 14.3 Severe

3Manish Kumar 3.5 Male 9.5

13.4Severe

4 Divya 5.3 Female 12.2 16.2 Severe

5 Nandhini 5.8 Female 13.2 16.9 Severe

6 Shalini 6.0 Female 12.4 17.5 Severe


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7 Navya 7.4 Female 16.2 19.9 Severe

8 Nikhil 1.5 Male 6.79.6

Severe9 Deekshith 4.2 Male 12.8 14.7 Moderate

10 Ashok 4 Male 13.4 14.4 Moderate

11 Venkatesh 4.1 Male 12.5 14.5 Moderate

12 Chandru 3 Male 10.9 12.7 Moderate

13 Aishwarya 5.4 Female 14.2 16.3 Moderate

14 Aparna 3.2 Female 11 12.5 Moderate

15 Srividhya 5.0 Female 13.2 15.8 Moderate

16 Ravi 6.5 Male 17.4 18.8 Moderate

17 Kusuma 3.0 Female 10.2 12.2 Moderate

18 Shahin 2.9 Female 11.7 13.5 Mild

19 Prasannakumar

5.1 Male 1618.5

Mild

20 Chakradhar 3.8 Male 13.5 15.7 Mild

21 Akash 5.2 Male 16.3 18.7 Mild

22 Kushi 6.1 Female 17.2 20.3 Mild

23 Charantej 2.3 Male 11 12.7 Mild

24 Sindhuja 2.6 Female 11 12.7 Mild

25 Sathish 4 Male 13.8 16.3 Mild

26 PrithviNarayana 3.1 Male 12.4

14.5Mild

27 Venkatesh 4 Male 14.1 16.3 Mild

28 Uday 3.0 Male 11.7 Mild


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4) AWC-4, NellurupuraTeacher: Sunanda (8861138455 )

Key Findingsa) There are 11 malnourished children in the anganwadi out of which

7 are females7 are below the age of 5 years andAge of 3 children is not known

b) Out of 8 children4 are severely underweight for their age of which only 1 is male4 are moderately underweight of which 2 are males

S.NO.

Name Age inyears ason 30 th

March,2013


March, 2013

IdealWeight

for age (-1

SD)


1 Ramya4.8

Female 11.515.2

Severe

2 Varalakshmi3.8

Female 10.613.4

Severe

3 Aradhana3

Female 8.912.2

Severe

4 Gagan3.8

Male 10.613.8

Severe

5 Adi 3 Male 1112.7

Moderate

6 Pavani5.4

Female 1516.3

Moderate

7 Priya3.5

Female 10.913.0

Moderate

8 Charan3.7

Male 11.513.7

Moderate

9 ArunaUnknown

Female 12.7 UnknownUnknown

10 Ponispuri (namenot sure) Unknown Female 14.2 Unknown Unknown

11 Appu Unknown Male 14.7 Unknown Unknown


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MADIVALA PAGIn each anganwadi, malnourished children are provided with a supplementary diet of

milk and eggs. Eggs are provided four times a week while milk is provided twice a week.

Additionally, they are given Chitrana/ Payasam alternatively.

There are two areas which the PAG covers.

a) Siddharth Nagar in Madivala Proper Following information is

available from C RY interns George and Ramyas Report (November, 2012). No

follow up has been done since then.

Anganwadi

Name

No of

Children

No of

Pregnan

t

Women

No of

Lactatin

g

Mother

s

No of

children

below

3yrs

No of

Malnouri

shed

children

TotalAnganwadusers

Siddhartha Nagara,Madivala Hosur road

20 6 7 25 3 58

1st floor Siddhartha

Nagara

Madivala Hosur road.

20 5 5 23 2 53

Siddhartha Nagara opp.

Church

Madivala Hosur road

20 6 5 22 3 53


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b) N S Palaya Area Volunteers have been working hard to get the information

about malnourished children. The details of some of the kids we have come across are

given below.

N. S. Palaya AreaThere are 4 anganwadis in the area. Though only the following children have come to

our notice

S.NO.



31 st March,2013

IdealWeight

for age (-1 SD)


1 Charan 4 Male 6 14.4 Severe2 Charmi 3 Female 9 12.2 Severe

3 Joseph 14 Male Unknown Unknown Unknown4 Appu Unknown Male Unknown Unknown Unknown

So, the volunteers now really need to look into the followingnecessary questions:

1) What is Malnutrition???? 2) How it presents itself in the children???? 3) What causes malnutrition..???

4) Why the nutrition in girl child so important..???5) What are perceptions about nutrition in the

community..???6) How should we manage the cases of malnutrition????

(Refer to Page No. 47)7) What are the initiatives by the Government ??? (Refer to

Page no. 56)

And answers to these questions are necessary to know toaddress the issue of malnutrition in a comprehensive manner.Until we know the answers to above questions, we keep onacting haphazardly instead of going in a systematic manner. Sofor the answers Refer to Section 2.


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Section 2: Insight intoMalnutrition

(2.1) Introduction to MalnutritionKarnataka, India s eighth largest State in terms of geographical size (191,791 sq km), ishome 5.1 % of India s population. With SGDP of 8.2% in 2010-11 (more than thenational average), Karnataka is one of the fastest growing state having per capitaincome of Rs. 60,000 according to Economic Survey 2010-11. Despite the rapid progressmade by the state on the economic front, the status of nutrition in Karnataka is a matterof shame. According to National Family health Survey-3 conducted in 2005-06 byGovernment of India, 33.3% of children in Karnataka are underweight, 42.4% stuntedand 18.9% wasted. Though there has been some reduction in malnutrition as shown inthe NFHS1 and 2 but it is far cry from the Millennium Development Goals (MDG) goalsthat have to be achieved by 2015.

(2.2) What is Malnutrition.?? Nutrition is the process of nourishing or being nourished, especially by which a livingorganism assimilates food and uses it for growth and development and Malnutrition isthe condition that develops when the body does not get the right amount of thevitamins , minerals, and other nutrients it needs to maintain healthy functions of thebody.

The term malnutrition encompasses both under-nutrition and over-

nutrition (ex.: obesity). However more commonly it is used to denoteunder-nutrition.

Child malnutrition can manifest itself in several ways. It is broadly classified as:

Malnutrition

Protein- Energy Malnutrition (PEM) Micronutrient deficiency diseases

The common condition we come across in thefield.It results from deficiencies in any or allnutrients.

In this report we are discussing about PEM.

It co-exists with PEM but most commonlyover looked in the absence of knowledge.It results from a deficiency of specificmicronutrients such as Iron deficiency,Vitamin A and Vitamin C deficiency
http://medical-dictionary.thefreedictionary.com/Vitaminshttp://medical-dictionary.thefreedictionary.com/Vitaminshttp://medical-dictionary.thefreedictionary.com/Vitamins


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(2.3) What we come across in thefield.?? WHO has recommended certain indicators to assess malnutrition and givenstandard values to compare. The common indicators which are used are asfollows:

Normal Child withweight and height inrange for the age

Wasting or thinness . Ita sign of acutemalnutrition i.e. developsdue to rapid weight loss

Stunting orshortness ofheight. A sign ofchronic malnutritioni.e. it develops over a

long period of time.

Underweight: combination of bothstunting and wasting.Most commonly usedto assess malnutritionin India.

easured as: Weight forheight

Height forage

Weight forage


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Classification of malnutrition forweight for age based on z-scores

Classification z-score valuesAdequate -2SD< Z-score< +2SD

Moderately malnourished -3SD< z-score


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Causes and Cycle of Malnutrition

Picture 4: Causes of Maternal and Child MalnutritionSource: www.ThousandDays.org


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Picture 5: Immediate and Underlying causes ofChild Malnutrition


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The Irony of Girl ChildMalnutrition

Picture 6: Vicious Cycle of Malnutrition in Girl Child in IndiaSource: UNICEF, SAVE THE CHILDREN, FAO, UNESCO, IFPRI


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Myths and Facts

Myths Facts1) If the mother is not being able toproduce enough milk to breast feed thebaby during first six months, give the babywith milk powder.

Milk powder makes the baby more prone toinfections as the immunity of the baby is not welldeveloped. Besides that during to poor feeding heis 10 times more likely to get the frequent boutsof infections.

Instead counsel the mother to take propernutrition and take cumin seeds which helps information of milk and ask them to try tobreastfeed the baby as much as possible. Sucklingreflex itself stimulated the milk glands to producemore milk. OR give the baby cow milk.

2) If the baby/ child is active mentally,playful and respond normally despitebeing underweight; the child is fine anddoes not need attention.

This is not true. Even at the moment, the child ismentally active, playful and responding, he/sheneeds nutritional attention. Reason

Underweight children have low immunity andare more prone to infections like diarrhea,pneumonia and malaria.

A single bout of such infections robs thechildren of vital nutrients and make themmalnutrition in turn, decreases the ability

of the immune system to fight further infections,making diarrheal episodes more frequent.Repeated bouts of diarrhea stunt childrensgrowth and the cycle continues.


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Management of the MalnourishedChildren

In the management of malnutrition, the very first step involves CommunityOutreach and Identification of the cases. It includes the following:

a) Mobilization of the community through information, education andcommunication (IEC) on malnutrition.IEC includes posters, flash cards, videos on nutrition to be shown to thecommunity on health days or days of mothers meeting with anganwadi teachers

Talking to Anganwadi Teachers: encouragethem to fix the days to weigh the childrenso that community is aware of it and nochild is missed.

Talking to School Principal

House to House Survey (whilst Drop outdata)

Talking to Healthcare Worker and Linkworkers at PHC

After identifying the case: Separate visit to theparents/family and ask them about the following:

1) Further details on the condition of the kid i.e.since when is the child like this or any otherassociated problems like frequent infections ordiarrhea or fever.

2) If the child has been seen by the PHC doctor ortaken to any hospital

3) If yes then what did the doctor say and anyproblems faced during treatment. For BPL cardapplication see Dr. Raghvans Manual


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WINDOW of OPPORTUNITY The 1,000 days from the start of a womanspregnancy until h er childs 2nd birthday offer a unique window of opportunity.

The right nutrition during this 1,000 day window can have an enormous impact on achilds ability to grow, learn, and rise out of poverty. It also ha s a profound effect onthe long-term health, stability, and development.

TREATMENT Referral of the severe and moderate casesto the PHCs

Severely Underweight forAge

Moderatelyunderweight for

Age

Mildlyunderweight for

Agetep1 Hospital Based Management

a) Inpatient Careb) Outpatient Care

tep 2 Home based Management

Step 1 Outpatient CareStep 2 Home basedManagement

Home Based Management

Hospital BasedManagement

Identification + Discussion withparents

Register child with PHC

No Complications

omplication

Outpatient Care1) After identifying the cases,refer the cases to nearby PHC inthe respective PAG areas .

a) The child is registered

with the PHC

b) The PHC doctor prescribesthe protein powder andother vitamintablets/syrup (should beavailable at the PHCpharmacy) and

c) Link workers counsel theaccompanyingparents/guardians aboutthe diet and monthlycheck ups. And refer forfurther follow up withAnganwadi Teacher

Children who are mildlyunderweight for their ageseems to be fine and do notrequire any intervention.

However they are at the risk ofbecoming moderately orseverely malnourished if nottaken care of.

Thus, home based managementof such children is necessary toprevent them moving into thedanger zone.


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NoComplication

PHC doctor prescribesthe protein powder andOther vitamin tablets/syrup

hould be available at the PHC pharmacy)

ink workers counsel the accompanyingarents/guardians about the diet andonthly check ups. And refer for furtherllow up with Anganwadi Teacher

AWW).

Children with complicationke

a) Fluid accumulation in the feet(checked by putting thumbpressure near the ankle, if thedepression due to pressure doesntgo away immediately, there ispossibility of fluid accumulation a sign of PEM)

b) Crackled and Rough textured Skin

c) Frequent infections, episodes ofdiarrhea, or fever reported by theparents/guardians of the children

Refer to the Under listedHospitals

an be taken directly or referred by theHC doctor to the following hospitals :

(AWW).

HOME BASEDMANAGEMENT

The children with moderatemalnutrition need to be takencare of at home also.

Since the immunity of thechildren is weak they are proneto infections very frequently.Hence hygiene and Sanitationcomes into play.

Parents/ Guardians should becounseled about proper feedingpractices and should be advised

to include the following to theregular diet:

a) Eggs at least 1 Egg dailyor 4 times in a week inaddition to what isprovided at anganwadi.

b) Milk Milk is essential toprovide energy andcalcium which areresponsible for the growthof the child

c) Green leafy vegetables -Add Palaka, Gonguraleaves to routine diet.They are good source ofiron and other necessarynutrients

d) Pulses like moong dal,Bengal gram, black gram

e) Fruits like Pomegranate,Bananas

HOME BASEDMANAGEMENT

The children with moderatemalnutrition need to be takencare of at home also.

Since the immunity of thechildren is weak they are proneto infections very frequently.Hence hygiene and Sanitationcomes into play .

Parents/ Guardians shouldbe counseled about properfeeding practices and should beadvised to include the followingto the regular diet:

1) Eggs at least 1 Eggdaily or 4 times in aweek in addition towhat is provided atanganwadi.

2) Milk Milk is essentialto provide energy andcalcium which are

responsible for thegrowth of the child

3) Green leafy vegetables -Add Palaka, Gonguraleaves to routine diet.They are good source ofiron and other necessarynutrients

4) Pulses like moong dal,Bengal gram, black gram

5) Fruits like Pomegranate,Bananas

For Details of the Recipes


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1) Indira Gandhi Institute ofChild Health (under BALSANJEEVANI SCHEME)

Near NIMHANS Hospital, Bairasandra,angalore.ontact No.: 26342421 / 2634314

2) Vanivilas Women and Child

Hospital , NutritionalRehabilitation Center (NRC)

Fort Rd, Near Victory Hospital, KrishnaRajendra Market, Kalasipalyam,BengaluruContact No.: 080 2670 2487

Dr. Some GowdaMedical Superintendent

Phone : 94482 73928

Dr.MadhusudanResident Medical Officer

Ph : 99800 0667

Emergency No.:080-2670 5206080-2670 5204

3) Bowring And Lady Curzon HospitalDr. H. Satish Chandra

Medical SuperintendentPhone - PRO : 98452 02266

hone: 080 2559 1325/1326ax: 080 2559 1325

-Mail :[email protected]

ublic Relations Officer : Dr. KhajaMohideen (9845202266 )

or HOME Based management refer torange section.

For Details of the RecipesSee Annexure I and II

See Annexure I and II

11 11 www.igch.org / - Indira Gandhi Institute; www.vanivilashospital.in/ - Vani Vilas Hospital ;www.bmcri.org/bowring_hosp.html- Bowring hospital
http://www.bmcri.org/bowring_hosp.html-http://www.bmcri.org/bowring_hosp.html-


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Contact Details of Urban Health Centers indifferent PAG Areas

AREA UHC/ANGANWADI

NAME OF THEPERSON

CONTACT DETAIL

MADIVALA N S PALYA DR. ASGARI (MO) 26780191A B SIDDQUI (STAFF

NURSE)

NEELA (AWW-AWC 3) 9945539964

MAHALAKSMIAMMA(AWW- AWC 4)

9632092676

KORAMANGALA ADUGUDI DR. SHIVLINGAM (MO) 22975870MAHADEVIAMMA (STAFFNURSE)

9986462707

Kannada TamilSchool, RajendraNagar

Usha (AWW) 8884761834

AWC-1, RajendraNagar

Selvi (AWW) 9945075660

AWC-2, RajendraNagar

Manjula (AWW) 7204785225

Ambedkar Nagar,Near Public Toilet

Manjula (AWW) 8710075205

EWS Quarters Sumathi (AWW) 8904437493

1st Cross, L. R. Nagar Regina (AWW) 9900809567


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Shastri Nagar Padma (AWW) 8453578256

EEVAN BEEMANAGAR

C V RAMAN NAGAR DR. LAKSHMI (MO) 9341326023

KODIHALI DR. MEERA NAIK 9448860796SUMITRA (STAFF NURSE) 9972241866NISHA (LINK WORKER) 8861063663

G M Palaya Laxmiamma (AWW) 9740583215

AWC-2, Nellurupura Rajeshwari (AWW) 9916511827(Teachershusband)

AWC-3, Nellurupura Narayanamma (AWW) 7795348456

WC-4, Nellurupura Sunanda (AWW) 8861138455 YESHWANTPUR Akiappa Garden Manjula (AWW) 9739210980

SHERIFF NAGAR-1 Tahseen Taj 9591841468


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Nutritional Rehabilitation at HOME

To combat malnutrition, the first step starts at home only. Simple and easy nutritionalintervention at HOME can help to reduce the malnutrition.

Age Suggested Diet

Birth - 6 months 1) Start breastfeeding after one hour of delivery.Give baby Colostrum (the first secreted yellow colored milk)

2) Exclusively Breastfeed the baby for SIX months- means onlybreast milk nothing else not even water.

6 months - 9 months Continue Breastfeeding but start complementary feeding. Allfood is not good for complementary feeding. Include thefollowing:1) Cereal based Porridge like suji, ground rice wheat flour, ragi,millet mixed with cow milk, sugar/salt to taste and enrichedwith ghee/oil

2) Mashed fruits like Banana (balehannu) or other seasonalfruits like papaya or mango mixed with cow milk or mashedpotatoes (alugade) mixed with a pinch of salt are acceptable.

Note :1) In case of Diarrhea, Do not stop breastfeeding and add ricewater mixed with a pinch of salt and a teaspoon of sugar.

2) Feed thick mixtures rather than thin gruels. Initially startwith 3-4 spoons and gradually increase to half a cup at a time.

9 months - 12 months baby should be given the following:

1) Mashed vegetables (green vegetables like palaka), daals like


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moong dal (heasarubele), bengal gram(Kadale Bele) and blackgram(Udhina bele)2) Mashed chappatti made of ragi and wheat softened in daalor milk

3) Eggs- make them an important part of babys routine meal.At least one egg daily is given to baby from 12 months of age.

After 12 months Continue with the above diet and add the following ready toeat food :

Nutrimix: Wheat/rice 4 handful and Bengal gram (Kadale Bele)/ Moong - 1 handful.Can be made more energy dense by adding seasonal fruits andVegetables.

LAPSI: Green millet- 1 handfulMashed peanuts- 1/2 cup,Jaggery - according to taste

SAT Mix: Roasted and groundrice, wheat, black gram and sugar in ratio

1 bowl rice1 bowl wheat

1 bowl black gram2 bowls sugar

HalwaWheat flour (atta) 200 gLentils (mashur dal) 100 gOil (soya) 100 ml

Jaggery 100 gWater (to make a thick paste) 600 ml

Rice SujiRice powder (g) 60

White of eggs (g) 100 (4 eggs)Sugar (g) 35

Soya oil (g) 30

Sattu Maavu :Wheat flour -1 handful

Maize flour -1 handfulRagi flour -1 handful

Bengal gram flour- 1 handfulJaggery- to taste

Roast all the contents together and mix well.


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After 2 years Feed the baby with1) Eggs2) Green leafy vegetables like palaka3) Pumpkin Seeds (Poosani Vidhai) Make a paste of poosanividhai and add to boiled milk and add sugar and rice to it.4) Pomegranate seeds ( Dalimba bijagalu )5) Also add the above mentioned recipes to the routine diet.

Adolescent Girls, PregnantWomen, And Nursing Mothers

Above mentioned recipes can be fed except papaya.In addition to that add the following to the diet:

1) Coconut water and Nimbu Pani to compensate for fluidloss2) Gongura bhaaji

3) Ragi chapaties stuffed with potatoes and tomatoes at least3 chapaties daily. Add cumin Seeds to it. OR Prepare Upma,dosas and idlis with Ragi.

4) Wheat- Green Gram Laddus (suggested by NIN)

IngredientsIngredient Quantity

Whole wheat 2 handful

Moong Dal 2 Handful

Ragi ( Nachani ) 1 handful

Groundnuts half bowl

Pure Ghee/ Mustard Oil 5 teaspoons

Jaggery 250gms

Khichuri

Rice 2 handfulLentils(mashur dal/ moong daal) 1 handfulOil Mustard 5 teaspoonPotato 1 potatoPumpkin 100 gmLeafy vegetable (Soppu) 250gmOnion (2 medium size) 1 onionSpices (ginger, garlic, turmericand coriander powder) 1 teaspoon eachWater 5 cups


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Note:

All the recipes are easy to make and can be stored in dry form and water can be addedlater on.

1) The above mentioned quantities of Ingredients serves the enough amount ofnutrients for an adult for a day at an average cost of Rs. 5 per person.

2) For infants start with 2-3 spoons initially at a time and then gradually increase theamount to half a cup at a time.

3) Avoid un-mashed food items for infants as their swallowing reflex is not welldeveloped and hence can cause obstruction in their airway.

3) For children, feed them with the above mentioned recipes initially half a cup at a time

and gradually increase

4) Cook in Iron Utensils: It also increases the iron content of the food. But prolonged usecan be harmful.

NOTE: More nutritional recipes are attached in ANNEXURES which are distributed underICDS in other states. So those recipes can also be advised. Refer to Annexure II on PageNo. 79


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Section 3: Government Initiativesto fight Malnutrition

What the Government is doing toimprove the nutritional status of thecountry??

Government of India has introduced its flagship program Integrated ChildDevelopment Scheme (ICDS) in 1975 to comprehensively address themalnutrition issue. Other Schemes of the central and state (Karnataka)include:

a) Integrated Child Development Scheme (ICDS)b) Kishori Shakti Yojana (KSY)c) Rajiv Gandhi Scheme for Empowerment of Adolescent Girls

(RGSEAG) SABLAd) Indira Gandhi Matritva Sahyog Yozana (IGMSY)e) Janani Shishu Suraksha Yozana (JSSY)

Integrated Child DevelopmentScheme (ICDS): According to Government of IndiaICDS website http://wcd.nic.in/icds.htm Launched on 2 nd October 1975, today, ICDS Scheme represents Indias biggest response

to the challenge of providing pre-school education on one hand and breaking the viciouscycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.

Services Target Group Service Provided bySupplementaryNutrition

Children below 6 years:

Pregnant & Lactating

Anganwadi Workerand Anganwadi Helper
http://wcd.nic.in/icds.htmhttp://wcd.nic.in/icds.htmhttp://wcd.nic.in/icds.htm


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Mother (P&LM)Immunization* Children below 6 years:

Pregnant & LactatingMother (P&LM)

ANM/MO

Health Check-up* Children below 6 years:


ANM/MO/AWW

Referral Services Children below 6 years:


AWW/ANM/MO

Pre-School Education Children 3-6 years AWWNutrition & HealthEducation

Women (15-45 years) AWW/ANM/MO

Revised Population Norms for setting up AWC/Mini AWCs

For Rural/Urban Projects ( Anganwadi Centers- AWC)

400-800 1 AWC

800-1600 2 AWCs

1600-2400 3 AWCs

Thereafter in multiples of 800 1 AWCFor Mini AWC

150-400 1 Mini AWC

For Tribal/Riverine/Desert, Hilly and other difficult areas/Projects

300-800 1 AWC

For Mini AWC in above areas

150-300 1 Mini AWC


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Financial Norms for Supplementary Nutrition (Ministrys letter No. F.No. 4-2/2008-CD.II dated 07.11.2008)

Sl.No. Category Pre-revised rates Revised rates (perbeneficiary per day)

1. Children (6-72 months) Rs.2.00 Rs.4.002. Severely malnourished children

(6-72 months)

Rs.2.70 Rs.6.00

3. Pregnant women and Nursingmothers

Rs.2.30 Rs.5.00

Nutritional Norms for SupplementaryNutrition (Revised vide letter No. 5-9/2005-ND-Tech Vol. II dated 24.2.2009)

SI.No.

Category Pre-Revised Revised (per

beneficiary per day)Calories

(K Cal)

Protein (g) Calories

(K Cal)

Protein (g)

1. Children (6 months-6years)

300 8-10 500 12-15

2. Severely malnourishedchildren (6 months- 6years)

600 20 800 20-25

3. Pregnant women andNursing mothers

500 15-20 600 18-20

During 2007-08 a new scheme has been introduced by the Government ofKarnataka in which Rs. 750/- per year is given to each severelymalnourished child for meeting medical expenses for therapeutic food andmedicines etc. to improve the childs health.

Bal Sanjeevani Scheme Under ICDS

During 2010-11, a sub scheme under the main scheme namely BalaSanjeevani was conceived and implemented. This scheme covers BPLfamilies wherein 0- 6 yr children who are registered in AWC and sufferingfrom acute diseases requiring tertiary treatment are treated free in 8selected hospitals in the State


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Comparison of SupplementaryNutrition Provided under ICDS indifferent States through Anganwadis

KarnatakaBangalore Urban) RajasthanDept. Of Women and Child,Govt. of Rajasthanhttp://wcd.rajasthan.gov.in

/

Andhra PradeshDept. Of Women and ChildGovt. of Andhra Pradesh

https://mail.google.com/mail/u/0/?shva=1#inbox

Eggs- 4 times in a week all yearxcept in the months of February,arch, April, and May.eason: High cost of Eggs during thiseriod. Government provides Rs.3.50 forggs instead price of eggs is Rs.4 or Rs50 in Bangalore. So anganwadis arenable to buy the eggs. What happensith the funds for eggs has not beenvealed by the AWW. For children

nder 3 years of age given as THR

Eggs and Milk are given in thebreakfast along with the following:1) Rice (Puffed) & Roasted Chana

With Jaggery2) Ready (Dry) Alternatives For

Snanks (Roasted Chana With Gur)3) Halwa

All the three options are givenalternatively on three days of theweek.Average cost per person : Rs.2.50

3 types Food Models are given to theChildren 6 Months to 6 years andPregnant & Lactating Women.

1) Ready to Eat Food (RTE) a) RTE / Modern Therapeutic Food

supplied by A.P. Foods.

b) Three types of Hot Cooked FoodPremixes, supplied by A.P. Foods,

1. Halwa Mix.2. Kichidi Mix.3. Upma Mix.

Milk: is given 2 times in a week. Milkgiven in form of the milk powder. For

hildren less than 3 years of age, givenTHR,

In the afternoons:1) Hot cooked meal:

a) Khichadib) Dalia

Dalia and Khichadi are givenalternatively.

2) Panjiri Mix containing Sattu3) Halwa PremIx4) Upma Premix5) Indiamix

2) Local Food Model: Ration issupplied by the Project Directorsthrough District Purchase Committee.i) Hot Pongalii) Broken Wheat Kichidi.

Hot Cooked Food is supplied throughAnganwadi Centers for the Childrenage group of 3-6 years.

3) CM SNP: Supplied Jowar Mix byMothers Groups.Take Home Ration is being given for 6M 3Ys, Pregnant & Lactating Womenonce in 15 days...
http://wcd.rajasthan.gov.in/http://wcd.rajasthan.gov.in/http://wcd.rajasthan.gov.in/https://mail.google.com/mail/u/0/?shva=1#inboxhttps://mail.google.com/mail/u/0/?shva=1#inboxhttps://mail.google.com/mail/u/0/?shva=1#inboxhttps://mail.google.com/mail/u/0/?shva=1#inboxhttps://mail.google.com/mail/u/0/?shva=1#inboxhttp://wcd.rajasthan.gov.in/http://wcd.rajasthan.gov.in/


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3) Chitrana/ Payasam: In theafternoon Chitrana and Payasamis given alternatively which arerice based meals.

Kesaribath and bisibelebath twiceweek is a provision: For Pregnantdies, Lactating mothers anddolescent Girls. Though nothing haseen provided at AWC instead they

e given rice as THR

Provisions for Children per day1) 6 months 3years: 125gm

Panjiri mix/120gm halwa

2) 6 months-3years (SeverelyMalnourished kids) : 240gmHalwa/ 125gm Panjiri Mix

3) 3-6 years : 51gm halwa/ 42gmupma in breakfast and Hot

cooked meal in lunch

4) 3-6years (SeverelyMalnourished) : In breakfast51 gm Halwa/ 42 gm Upmaand in Lunch Hot cooked mealplus 78gm halwa / 70 gm ofUpma

Ration Size: Increased Ration Size asper revised cost norms.

For Children 6 Months to 6 Years90 gms.

For Pregnant & Lactating Mothers140 gms.

For malnourished Children140 gms.

Proposed changes in SNP in 2011

y then WCD minister C.C. Patil are: avalakki (beaten) mixture, rava laddu, puliyogare rice, coconut rice and sambar rice on different days

of the week

or children below three years ofge, rava ladu, ragi kheer and rice

heer would be supplied six days in aeek.

Puliyogere rice, coconut rice,ambar rice, multigrain chapathi androtein rich ragi mudde would berovided twice a week for pregnantomen and lactating mothers

Provisions for Pregnant Ladies,

Lactating mothers and Adolescentgirls (per day):

140gm Halwa/ 130gm Upmaunder ICDS

155gm Halwa underDecentralized NutritionalSupplement and Womenempowerment Scheme

140gm Halwa Premix/130gm

Upma Premix under SABLAScheme

Indiramma Amrutahastam:The program is aimed at poor

women as they were not able toconsume the required quantity ofnutritious food.

The scheme is the result of jointefforts by the ICDS, DRDA and theMedical and Health Department.

Pregnant and lactating women

will be provided one full mealunder the program.

Rs 100 will be given to the womenwho lose their daily wages when inhospital after delivery and anotherRs 50 towards nutritious food.

or detailed Recipe of Chitrana See

nnexure I

For detailed Recipes of the food

premixes and hot cooked mealsSee Annexure I


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BiharDept. Of Women and Child

Govt. of Bihar www.icdsbih.gov.in/

OrissaDept. Of Women and Child

www.wcdorissa.gov.in/

nder ICDS

Service Target Service Entitlement / Service StandardsHotcookedmeal

Children 3-6years

I. Provided at AWC for 25 days a month

II. Snacks

Biscuits, fruits, roasted grams to beserved at 9 AM when preschool starts

III. Hot cooked meal served at 12 noonMonday, Wednesday & Saturday -KhichriTuesday -RasiyavThursday HalwaFriday -Pulao

IV. EntitlementNutritive value and cost per day

Energy(Kcals) Protein(gms) Cost(Rs)Children3-6 years 500 600 4.00

AdolescentGirls 12-15 20-25 5.00

b) TakeHomeRationTHR)

WomenPregnant&Lactatingmothers

Children6 months -3yearsa) Malnourishedb) Severelymalnourished

I. Provided for 25 days in a monthII. Distributed at AWCs on 15 th of everymonthIII. Entitlement - Food

Age group Rice(kg) Dal (kg)Children 6m to 3 yearsa. Malnourished 2.5 1.25b. Severely malnourished 4.0 2.0

Pregnant- Lactating women 3.00 1.5

Under ICDSa) Emergency Feeding

Under this each beneficiary is providedwith

250 gms of rice, 30 gms of dal, vegetables,

oil, salt and condiments andThe nutritional value of which is 812 K. Cal.of energy and 21.6 grams of protein

Under this program BPL Rice is allocated bythe Government of India.

The ration cost under the scheme is fixedat Rs. 5.50 per day per beneficiary.

b) Supplementary Nutrition:Supplementary Nutrition isprovided according to the ICDSnorms. In addition to that, with thehelp of World Food Program (anarm of United Nations) INDIAMis distributed to the beneficiaries

INDIAMIX contains roasted, milled maize (40per cent), wheat (40 per cent) and full-fat soya(20 per cent) fortified with vitamins andminerals. This mix is comparable to a nutritioussupplementary food that has been usedthroughout the world

oorak Poshaahar Yojana: provides supplementary nutrition to thehildren between 6 months-6 years of age, pregnant and lactating women

nd adolescent girls.he Scheme is funded by the Centre and State Governments on a 50:50tio basis. Each AWC provides supplementary nutrition at the rate ofs. 2 /- per child per day,s. 5 /- per woman and girl per day ands. 6 /- per day per child, where the child is severely malnourished.

he centre provides these services for 25 days in a month.

New initiative :Aame Bi Paribu Positive Devianceapproach to reduce malnutrition rapidly

The main features of the program are asfollows:

a) Survey and identification ofmalnourished children

b) Form a group of 10-15 children


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c) Take steps to de-worm the children

d) Give them a lesson of 12 days inNutritional Care &

e) Counseling Cession (NCCS) cooktogether, make the children eattogether, share with and learn fromeach other.

f) Children should be weighed before &after attending the NCCS

g) Next 18 days mothers practice the newideas from NCCS at home.

h) In another 12 days the child with themother will attend the NCCS.

This process continues till the child gainsweight.This has yielded good results in Mayurbhanjand Kalahandi. Districts of Bihar.

MaharashtraDept. Of Women and Child

http://www.nutritionmissionmah.gov.in/Site/Home/Index.aspx he state of Maharashtra has implemented the concept of Village Childevelopment Centers (VCDCs).

Ma lnutrition is measured by method of Weight according to length oreight instead of Weight according to age standard which is used fordmitting children in Village Child Development Centre (VCDC) and Childevelopment Centers (CDC) and accordingly these children are classifiedto Severe Acute Malnourished SAM and Medium Acute Malnourished

MAM categories.

Government of Maharashtra hasopened Child Development Centers(CDC) and Village Child DevelopmentCenters (VCDC) to manage themalnourished children.

Medical officer and Child

Development project officer shouldclassify MAM and SAM childrencovered under the area of PrimaryHealth Centre. Following criteriashould be applied for the saidclassification:
http://www.nutritionmissionmah.gov.in/Site/Home/Index.aspxhttp://www.nutritionmissionmah.gov.in/Site/Home/Index.aspxhttp://www.nutritionmissionmah.gov.in/Site/Home/Index.aspx


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utritional Protocol for VCDC:-

1 to 30 Days NutritionIdeally

Nutritive

Sr. No. Time Calories ProteinNutrition for each

ChildRequirement

gm

8:00AM 420 8

Amylase rich flour

Shira / Upma /Lapshi 100mg

10:00AM

Anganwadi food + 5ml oil

12:00Noon

Anganwadi food + 5ml oil

2:00 Home diet

4:00 100 41 Boil Potato, 1Banana / 1 Egg, 1Banana

100

6:00PM

420 8

Shira / Upma /Lapshi whichcontaining amylaserich

100

8:00PM

Home diet

Total 940 20Calories in kgcalories & Proteinin gm / dose in gm

lease note - If sweet dish is given in morning then sameish should not be repeat in evening

VCDC HOME conceptSpecial diet charts for mothers ofSAM and MAM children

A diet chart has been prepared tofeed the baby every 2 hours

Mothers trained to prepareprescribed recipes which are easyo prepare

WHO growth charts distributed andmothers trained to track the weightof children

Anganwadi workers visit these mothers daily to ensure propersupervision and support

1) Those SAM/MAM children whodo not suffer from anycomplication therefore do notrequire any medical treatment

Village child development centre(VCDC).

2) Those SAM/MAM children whohave minor complications

CDC at primary health centre(PHC)/ village hospital / district

hospital according to nature oftheir illness

3) Those SAM/MAM children, whohave serious complications andneed special medical services

Medical college / super specialtyhospital.

VCDC are set up at everyAnganwadi at the village level andheaded by the Anganwadi worker.

This centre will provide diet andhealthcare services and facilities forempowerment of mothers. Theyfunction for 30 days, excludingholidays


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Kishori Shakti YozanaKishori Shakti Yojana (KSY) a special intervention has been planned for adolescent girlsusing the ICDS. It is meant to break the cycle of nutritional and gender disadvantage, toprovide a supportive atmosphere for self development.

Services: Approaches

i. Educational activities throughnon formal & functioned literacypattern.

1) Girl to Girl Approach (ForGirls in the Age Group of 11 15 Years)

ii. Immunization In each selected Anganwadi area 2 girlsin the age group of 11 15 years areidentified. These adolescent girls areprovided with a meal on the same scaleof the pregnant women or nursingmother namely one that would provide500 calories of energy and 20gms.

iii. A general health check up everysix months 2) Balika Mandal (For Girls in

the Age Group 15 18 Years)iv. Treatment for minor ailments It has more focus on social and mental

development of girls mainly in the agegroup 15-18 years

v. De worming

vi. Prophylaxis measures againstanemia, goiter, and vitamindeficiencies etc.

vii. Referral to PHC/District Hospitalin the case of acute need

viii. Convergence with ReproductiveChild Health Scheme.

12

12 http://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=en wcd.nic.in/KSY/ksyintro.htm - Ministry of Women and Child Development
http://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=enhttp://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=enhttp://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=enhttp://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=en


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INDIRA GANDHI MATRITVASAHAYOG YOJANA (IGMSY)

From 2010-11 a new scheme called Indira Gandhi Matritva Sahayog Yojana (IGMSY) isbeing implemented on a pilot basis in 2 districts of the state, viz Dharwad and Kolar.

Pregnant and nursing mothers are given nutrition and health education, health tips and IYCFguidance.

AWCs are used as the main platform for implementation of the scheme in the piloted ICDSprojects.

IGMSY is a centrally sponsored scheme with 100% assistance from GOI.

An amount of Rs. 4,000/- is paid in 3 installments .

Pregnant women would receive

a) Rs. 1,500/- within 6 months of pregnancy,b) Rs. 1,500/- within 3 months of delivery, andc) thereafter Rs. 1,000/- after six months of child birth after following the norms laid

down under the scheme.d) The above beneficiaries are also eligible for financial assistance under Janani Suraksha

Yojana (NRHM).

14

14 http://pib.nic.in/newsite/erelease.aspx?relid=92392 ; http://wcd.nic.in/ - Ministry ofWomen and Child Development, Government of India
http://pib.nic.in/newsite/erelease.aspx?relid=92392http://pib.nic.in/newsite/erelease.aspx?relid=92392http://pib.nic.in/newsite/erelease.aspx?relid=92392http://pib.nic.in/newsite/erelease.aspx?relid=92392


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Schemes Under NRHM- Karnataka

Prasooti Araike - Care for thepregnant

MADILU - Caring For the mother andthe child

The benefits and conditions of thescheme are as follows:

The pregnant women have toregister their names with the JuniorFemale Health Assistant of the area.

The beneficiaries will get

Rs. 1000 during the 2 nd trimesterANC (i.e. between 4th and 6thmonth) and

Rs. 1000 during the 3 rd trimesterANC (i.e., between 7th and 9thmonth), totaling Rs. 2000 paidthrough bearer cheque.

This facility is extended to allpregnant women belonging to belowpoverty line families

The benefit is limited to the firsttwo deliveries.

Under this scheme a kit containing

i. Mosquito curtainii. Medium sized carpet

iii. Medium sized bed sheetiv. A thick blanket for motherv. Bathing Soap

vi. Washing soap

vii. Cloth to tie abdomen of motherviii. Sanitary pads

ix. Comb and coconut oilx. Towel

xi. Tooth paste and brushxii. bed spread over rubber sheet for the

babyxiii. Bed sheet for babyxiv. Bathing soap for babyxv. Rubber sheet for baby

xvi. Diaperxvii. Baby vest

xviii. Sweater, cap and socks for babyxix. One plastic kit bag.

The beneficiaries must belong to belowpoverty line families, and delivered ingovernment hospitals.

The benefit is limited to two live deliveries.

15

15 NRHM Karnataka: http://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspx
http://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspxhttp://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspxhttp://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspxhttp://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspx


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Janani Shishu Suraksha Yozana(JSSY)

Features of Cash Assistance(a) States/UTs have been classified into two categories based on the institutional deliveryrate. The 10 states namely the eight EAG states and the states of Assam and Jammu & Kashmirwould constitute Low Performing States (LPS) and the rest High Performing States (HPS).

(b) Cash assistance linked to Institutional Delivery: The benefits under the scheme would belinked to availing of antenatal check ups by the pregnant women and getting the deliveryconducted in health centers/hospitals.


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(c) Cash Assistance in the graded scaleThe assistance will be available as per the following rates:

Categoryof states

Assistancepackage tomother

Packagefor ASHA

Total Assistancepackage tomother

Packagefor ASHA

Total

LPS 1400 600 2000 1000 400 1400

HPS 700 600 1300 600 400 1000

Eligibility CriteriaLPS HPS LPS & HPS

All pregnant womendelivering in govt.

health centers.

No age constraint .

BPL pregnant women;aged 19 and above

All SC/ST womendelivering govt. health

facilities.

LIMITATIONSLPS HPS

All births delivered in the govt.health centers

Up to 2 live births

Note 1: The package for ASHA or an equivalent worker provided in the schemeincludes:

The referral transport assistance for ASHA and the expectant woman togo to the nearest health centre,

The compensation for ASHA or an equivalent worker if she stays with the pregnant woman inthe health centre for delivery,

16

16 Ministry of Women and Child Development, Government of India:http://pib.nic.in/newsite/erelease.aspx?relid=72433 ; http://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ece dated May 22, 2013;

Directorate of Health and Family Welfare, Karnatakahttp://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspx ; http://www.iapsmgc.org/userfiles/8GuidelinesforJSSK.pdf

Rural Areas Urban Areas
http://pib.nic.in/newsite/erelease.aspx?relid=72433http://pib.nic.in/newsite/erelease.aspx?relid=72433http://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspxhttp://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspxhttp://www.iapsmgc.org/userfiles/8GuidelinesforJSSK.pdfhttp://www.iapsmgc.org/userfiles/8GuidelinesforJSSK.pdfhttp://www.iapsmgc.org/userfiles/8GuidelinesforJSSK.pdfhttp://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspxhttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://pib.nic.in/newsite/erelease.aspx?relid=72433


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May 22, 2013; The HINDU(http://www.thehindu.com/news/national/age-limit-relaxed-for- jsy-benefits/article4736820.ece dated May 22, 2013)

All women from BPL category, Scheduled Castes and Scheduled Tribes in all States andUnion Territories will be eligible for JSY benefits if they have given birth in a governmentor private accredited health facility. BPL women who prefer to deliver at home can alsoget JSY benefits. The decision was taken after it was rea lized that a majority of women, who needed JSYbenefits, remained out of the purview of the scheme because they had to prove theywere 19 years of age and had no more than two children, Anuradha Gupta, AdditionalSecretary and Mission Director, National Rural Health Mission (NRHM), told The Hindu on Tuesday.
http://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ecehttp://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ece


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Road Ahead. What needs to be donefurther..???????

The following key issues needs to be

addressed:From the details above, it is clear that there are a large number of severely

malnourished children across the urban slums of Bangalore. To address this issue, the

ICDS scheme calls for each child to be given a supplementary nutrition of milk and eggs.

According to the orders of Women and Child Development Department, since

January 1, 2013; the children in the anganwadi are to be provided with eggs and milk

daily. However at none of the anganwadis, this provision is followed. Moreover, during

the period of February to May, eggs are not provided as they are costlier than the

amount of funds provided for eggs .

Therefore, a concerted effort has to be made to ensure

that all children in the anganwadi not just those who are malnourished are supplied


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with milk and eggs every day. This will be of great benefit to the health of all the

children in the anganwadi, and moves us further towards the goals of the ICDS.

Volunteers can follow up and ensure that the children are getting their quota of milk

powder.

Volunteers please have a look at

this too

1) Follow up regularly at least the severe cases (twice a month)about their health condition and if need to be checked by thedoctor, take the child to nearest Urban health centers (UHCs)in the respective PAG areas.

2) Follow the moderate cases at least once in two months andmild cases once in three months.

3) As from the analysis of the data available on malnourishedchildren, there are high numbers of malnourished femalechildren. We need to further identify the root cause of such asituation.


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4) Also the malnutrition is linked to educational level ofmothers. We need to identify the educational level ofmalnourished children.(http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127 ; http://www.ncbi.nlm.nih.gov/pubmed/1879910 )

5)

The cycle of malnutrition can be broken by making thepregnant females healthy.

Under ICDS, pregnant females are entitled to get Take HomeRation (THR). To get the THR from the anganwadi, pregnantfemale need to have THAYI card which is issued from the UrbanHealth center (UHC) by the Link Worker/Doctor. The doctor atUHC checks the pregnant lady and accordingly recommends forentitlements from the anganwadis

Thus, if volunteers come across such cases in the field as pregnant ladiesare not getting THR, please inform the Link workers in the nearby UHCs andask them to make THAYI card for such females

6) Since some of the anganwadis are new, they are not gettingenough funds for eggs and milk and other provisions ofsupplementary nutrition. One such anganwadi is Urduanganwadi in Rajendra Nagar,

7) Koromangala. Volunteers can raise the issue with thecorporator of the area.

8) Volunteers can also take up the issue of difference betweenthe actual price of the eggs in the market and the fundsprovided by the government for the eggs.; with thecorporators as children are not getting eggs regularly at the

anganwadis because of this issue.

9) In Madivala PAG, no follow up has been done in SiddharthNagar since November, 2012 ( CRY interns Ramya and GeorgesReport on ICDS), so follow up the anganwadis in SiddharthNagar. Also the anganwadis in N S Palaya have not beencooperating well, please follow on this issue as well.
http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127http://www.ncbi.nlm.nih.gov/pubmed/1879910http://www.ncbi.nlm.nih.gov/pubmed/1879910http://www.ncbi.nlm.nih.gov/pubmed/1879910http://www.ncbi.nlm.nih.gov/pubmed/1879910http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127http://www.medwelljournals.com/fulltext/?doi=sscience.2009.118.127


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Conclusion

In India, 8.1 million children are estimated to suffer from severe acute malnutrition (SAM)and 50% of children in urban slums of Bangalore are malnourished. In a state, marchingahead on the economic front, the magnitude and serious consequences of SAM amongchildren makes it unethical not to urgently initiate measures to prevent and

Documents

Final Report on Malnutrition.pdf