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Micronutrient Malnutrition Control for Better Productivity & Economic Growth
Dr. Saraswati Bulusu
National Program Manager, India
The Micronutrient Initiative
April 24, 2006
Overview
• Micronutrient deficiencies is a major public health problem in India affecting productivity and overall economic development. Minimal loss to GDP due to VMDs per year: Rs 27,720 crores
• ICDS is the largest program in the world for integrated child nutrition with a network of 5,68,888 AWC’s across the country.
• ICDS is targeted to reach the most vulnerable segments like <2 children, 2-6 yrs and PLW, who suffer more from these micronutrient deficiencies.
• ICDS offers a scope for innovations to reach micronutrients to the at risk groups, leveraging the ICDS infrastructure.
• The fortification programs could be piggy backed to the supplementary nutrition component of ICDS.
Proven Opportunities to Control Micronutrient Deficiencies through ICDS
• Supplementation (Since 1970’s):
– Strengthening Bi-annual Supplementation of Vit A for Children 9m-59ms
– IFA tablets to P&LW, Adolescent Girls and children.
• Fortification :
– Nutri Candies
– Fortified ‘khichdi’
– Fortified RTE Foods
– Fortified Wheat Flour ( ICDS & TPDS)
– Multiple Micronutrient Sachets (Anuka)
MI India – Summary of Interventions
Fortified Candy
Anuka
Khichdi & RTE
VAS
Salt Initiatives
Wheat Flour Fortifcation
Nutri-candies: 5 Million Beneficiaries Covered Per Day
Advantages of Nutri-candies
• Simple distribution & compliance is nearly 100%
• Targeted delivery
• Centrally processed – qty. of mns ensured,
• Packed attractively and hygienically
• Cost effective (Rs.55 to 60 per ben. per year with 4 micronutrients inclusive of indirect costs)
• Drawn the attention of policy makers
• Proven : Sensory (IHE); Stability (NPIL); Effectiveness (CINI) & Efficacy (AIIMS)
Effect of candies on attendance of pre-school children at AWCs - West Bengal (Udaynarayanpur Block,
Howrah dist)
Graph 1 Average no of children attending the AWC: Zone 2
0
5
1015
20
25
30
3540
45
50
Months (June'04 - Nov'04 without candies & Dec'04 - May'05 with candies)
Average attendance per day
Impact of the Intervention on Prevalence of VAD in Howrah
22.5
18.1
26.5
18.3
10.5
15.5
0
5
10
15
20
25
30
Preg & Lactating women Adolescent girls PSC
Pre
v of
VA
D in
%
Pre Post
Efficacy Trials on Anemia Prevalence in Pre-school Children
50
23.5
0
10
20
30
40
50
60
Pre Post
Pre
vale
nce
of A
nem
ia %
50
23.5
0
10
20
30
40
50
60
Pre Post
50
23.5
0
10
20
30
40
50
60
Pre Post
‘Vita Shakti’ to Fortify ‘Khichdi’-- An Innovative Approach
• Khichdi -- Locally cooked at AWC with rice, lentil, oil & salt. (Presently reaching 1.2 million)
• Vita Shakti -- premix with iron(7mg), vit A(500iu) & folic acid(50mcg)
• Packaging -- 1 kg pouch that can cater to 4000 beneficiaries
• Mode of addition -- A small spoon measuring 1.25 gms of the premix to be used for 5 beneficiaries, costing 3p per beneficiary per day.
• Training - Dilution, Mixing, Storage : temp & light
• Efficacy Study by Tufts University & CINI
Prevalence of Anemia for Non-Fortified Khichdi (NFK) and Fortified Khichdi (FK) groups at 0, 12, and 24
weeks.
32.6
19.1
13.3
9.8
20.7
4.1
0
4
8
12
16
20
24
28
32
36
40
NFK FK
0 Weeks
12 Weeks
24 Weeks
Treatment Group
Mean Prevalence Anemia
Serum Ferritin Conc.in Non-Fortified Khichdi (NFK)
and Fortified Khichdi (FK) groups at 0 and 24 weeks.
25.725.12
22.91
35.48
20
22
24
26
28
30
32
34
36
38
40
NFK FK
0 Weeks
24 Weeks
Treatment Group
Mean SF Concentration (µg/L)
µ
ANUKA
Wheat Flour Fortification for Control of IDA & VAD
• Pilot project in Darjeeling Sadar Subdivision in West Bengal through TPDS – reaching 0.6 million
• Scaled up in Kalimpong & Kurseong through TPDS - today reaching 1.8 million
• Launched in Haryana, Punjab & Chandigarh in 2005 through open market - today reaching 2.5 million (Jan 05)
• Govt. Of AP initiated flour fortification through PDS (Nov 05)
• Govt of Gujarat Model – Public Private Partnership for WFF (Jan 06)
• Advocacy meetings at West Bengal & Orissa last week
• Commitment of GOI at the national level – Policy Change??
Iodized Salt & Double Fortified Salt
• Use of adequately iodized salt in ICDS
• Salt fortified with iron & iodine (DFS) is presently available – NIN and MI formula.
• TNSC is presently manufacturing DFS which is being used in Mid Day Meal Program in Tamilnadu with support from MI
• Efforts to scale up in ICDS/MDM/PDS