NOURISH TO FLOURISH:REDUCING MALNUTRITION

FOR

BY:

TEAM SWADHAAR-”SWA” MEANS SELF AND “ADHAAR” MEANS DEPENDENCE

-HEARSH VARMA

-HIMANSHU JOSHI

-S RAVI TEJA

-NAGARJUNA TADISETTI

-SAMHITHA TUMMANAPALLI

Introduction

India, today is one of the most malnourished countries in the World.

More than 40% of the World’s under weight children below five years live in India (Global Hunger Index 2012).

The NFHS (National Family Health Survey)-3 asserts that not much progress has been achieved in improving human resources.

Poverty is a major, but not the only cause of malnutrition.

Percentage of population suffering from various forms of malnutrition, far exceeds the percentage below poverty line.

After National Nutrition Policy 1993 and National Plan of Action, 1995 no national programs or policies for eradicating malnutrition have appeared.

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Indicators for Assessing the Nutritional Status

Indirect IndicatorsAccess to Hygienic Sanitation and Toilet Facilities

Access to Safe Drinking Water

Female literacy

Direct IndicatorsLow Birth Weight

Infant Mortality Rate (IMR)

Under 5 Mortality Rate (U5MR)

Stunting/ Wasting/ Underweight

Anaemia

Immunization

Maternal Mortality Rate (MMR)

Chronic Energy Deficiency and Anaemia among adults

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MALNUTRITION IN INDIA: SOME STATISTICS

Analysis of the current situation:

(i) India has no comprehensive National Program for the eradication of Malnutrition. The ICDS programme in governmental and general perception is seen as a programme to address malnutrition. However, ICDS is not a programme for the eradication of malnutrition, but for Integrated Child Development.

(ii) Other Nutrition and related programmes such as the Mid Day Meal Programme, Kishori Shakti Yojana, Vitamin A supplementation programme, National Nutritional Anaemia Control Programme, and the National Iodine Deficiency Disorder Control Programme address some of the causes of Malnutrition but not all of them.

(iii) Even the recently introduced Food Security Bill, 2013 provides for providing rice, wheat and coarse grains at subsidized price, however there are many more nutrients required to prevent malnutrition.

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(iv) The population of India suffers from a high Protein Calorie deficit. Studies reveal that 30% of the households in India consume less than 70% of the energy requirement and calorie intake (NNMB repeat surveys 1988-1990 and 1996-97).

(v) There is inadequate awareness and information regarding proper nutritional practices amongst the population.

(vi) Crucial prescriptions of the National Nutrition Policy, 1993, were not translated into National Programmes, viz., popularization of low cost nutritious foods, reaching the adolescent girl, fortification ofessential foods and control of micronutrient deficiencies.

(vii) Most importantly, eradication of malnutrition should be articulated as high priority in the National Development Agenda.

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A National Strategy is required to Combat Malnutrition

Underlying Principles: Bridging the Calorie-Protein Gap

Introduce nutrition and micro-nutrient interventions for the three critical links of malnutrition viz. children 6 months – 6 years, adolescent girls, and pregnant and lactating women to be prepared by SHGs from low cost, locally available agricultural produce.

Introduce nutrition and micro-nutrient interventions for the general population to bridge the protein-calorie gap by making available in the market, protein-energy dense foods. Make low cost energy foods available for the general population (Corporate Sector/PPP)

Structure and monitor tightly integrated multi-sectoral interventions to address all or majority of the direct and indirect causes of malnutrition simultaneously.

Initiate a sustained general public awareness campaign regarding proper nutritional practices within existing family budgets, and to create demand.

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Essential Interventions to Combat Malnutrition(A) Direct interventions –

Related to the consumption and absorption of adequate protein calorie/micro-nutrient rich foods essential to combat malnutrition, namely:

1. Weighment of child within 6 hours of birth and thereafter at monthly intervals.

2. Timely initiation of breastfeeding within one hour of birth, and feeding of colostrum to the infant.

3. Exclusive breastfeeding during the first six months of life.

4. Timely introduction of complementary foods at six months and adequate intake of the same, in terms of quantity, quality and frequency for children between 6-24 months.

5. Dietary supplements of all children between 6 months – 72 months through energy dense foods made by SHGs from locally available food material to bridge the protein calorie gap.

6. Safe handling of complementary foods and hygienic complementary feeding practices.

7. Complete immunization and Vitamin A supplementation.

8. De-worming of all family members bi-annually.

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(B) Indirect Interventions –Related to issues of health, safe drinking water, hygienic sanitation and socio-cultural factors such as early marriage and pregnancy of girls, female literacy and poverty reduction, to eradicate malnutrition on a long term, sustainable basis.

1. Access to safe drinking water (treatment, storage, handling and transport), sanitation and hygiene.

2. Increased female education and completion of secondary schooling for the girl child.

3. Increased access to basic health services by women.

4. Expanded and improved nutrition education and involvement at Panchayat and community level to create demand.

5. Increased gender equity.

6. Promotion of nutrition best practices especially for girls and women.

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Nutrition Monitoring and Surveillance

A computerized Central and Block level monitoring systemsshould be devised with deliverable targets and time frames

An effective concurrent monitoring system through an external agency can also be established for measuring outcomes, and for effecting changes and mid course corrections

At the AW level, community based nutrition monitoring and surveillance through ICDS infrastructure could include growth monitoring of infants and children and weight monitoring of adolescent girls and women

Creating a data base on the nutritional status of children, adolescents and women in each Anganwadi

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Concluding Observations:Since at least 4% of India’s GDP ($29 Billion) annually is lost on account of malnutrition, the cost of addressing malnutrition is far below the cost of not addressing it.

It may be noted that the cost of construction of 3 kilometres of rural road is in excess of the amount required to address the nutrition deficit of the key target groups in the Block.

Investing in human resources development for the future – in the shape of healthy children, adolescents and adults with higher cognitive and productive capacity, is an investment that will pay for itself several times over, will eradicate the curse of malnutrition in the shortest possible time, so that every Indianis able to reach his or her full physical and cognitive potential, enhance income generation capacity and contribute to the country's progress.

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References

http://www.thehindu.com/multimedia/archive/01404/National_Food_Secu_1404268a.pdf

http://www.angoc.org/portal/wp-content/uploads/2012/09/12/vietnam-food-and-nutrition-security-situationer/India.pdf

http://en.wikipedia.org/wiki/Malnutrition

http://www.hindu.com/br/2005/01/11/stories/2005011100491500.htm

TOWARDS HUNGER FREE INDIA — From Vision to Action: M. S. Swaminathan, Pedro Medrano