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Child Malnutrition, Child Health and the Mid-Day Meal

Child Malnutrition, Child Health and the Mid-Day Meal. Opportunities for Action. By : Dr. T Sundaraman , Executive Director, NHSRC. Malnutrition.. not child specific. But Children Most Vulnerable…. Almost one third low birth weight at birth. Improved by about 6 th month

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Child Malnutrition, Child Health and the Mid-Day Meal

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  1. Child Malnutrition, Child Health and the Mid-Day Meal Opportunities for Action. By : Dr. T Sundaraman, Executive Director, NHSRC

  2. Malnutrition.. not child specific

  3. But Children Most Vulnerable… • Almost one third low birth weight at birth. • Improved by about 6th month • Then worsens and remains high in 0 to 6 • Peaks again in adolescence- for the first and only time being male predominant. • Then declines moderately- over next three decades • Rises again in old age.

  4. Malnutrition Rates • International comparisons show India performing very poorly • Adjusted for GDP per capita – it would be the worst performance. • Reasons relate to • Poverty and Economic Disparity. • Social inequities- gender, caste, geographic • Changing Dietary Patterns • Burden of ill health and sickness.

  5. Govt. Schemes that Address Malnutrition…. • Public Distribution System • NREGS • ICDS & Nutrition Supplement for Pregnant women, lactating mothers and children below 5 • Mid-day meals in schools. • The Creche Programme • Management of Severe Acute Malnutrition…. • Drinking water and sanitation schemes..

  6. The Mid-Day Meal • Major tool – that has helped boost enrolment and retention of school children. • Possibly helped in reducing absence and in improving learning. • Meant to cover 30% of the nutrition needs of the growing child. • However it has not been consciously leveraged as an opportunity for increased child health.

  7. School Health Programmes • As early as the Bhore Committee Report- A school healht service must include • Health Measures, preventive and curative, which include • Detection and treatment of defects and diseases • Creation and maintenance of a hygenic environment in and around schools • Measure for promoting positive health should include • Provision of supplementary food to improve the nutritional state of the child • Physical culture through games, sports and gymnastic exercises • Health education thru formal instruction and practice of the hygenic mode of life.

  8. Health Screening and Management.( 6 monthly) Six Monthly Annually Vision and Hearing Problems Heart defects Learning Disorders Psycho-social assessment and assistance for the child. Disability • Nutritional Status- BMI • Anemia. • Common Skin diseases • Ear discharge/Eye redness • Common dental conditions

  9. For Management of Malnutrition and Anemia. • Preventive measures- the mid-day meal plus a weekly Iron and Folic Acid Tablet as supplement. • One could add micronutrients onto locally prepared food where indicated. – eg using iodised salt. • But for children with moderate or severe malnutriton or anemia- Test and Treat and monitor till cured!!! • Add more to food supplements- either as a morning snack or as a extra-portions on the meal- to help correct the gap.

  10. Role of nutrition counseling… • Only within a setting where the school sees itself as responsible for addressing malnutrition and anemia. • Nutrition counseling and management is a complex skills- requires judgment, considerable subjective factors- individual dialogue, understanding of contexts…. • But with the mid day meal in hand – one could supplement with nutrition for the needy child.

  11. And Health Education… • Inclusion in the formal curriculum • Inclusion as special series of school health sessions- audited- not credited. • Informal methods- peer education • Promotion of Hygenic Practices • Physical education and Sports. • Adolescent Health- the whole area of sex education and sexual health.

  12. Social Health… • Support to the physically challenged child • Support to the child with learning difficulties- mental problems, • Dealing with violence in the school and in the homes • The role of cultural activities and building solidarity and the spirit of caring.

  13. In conclusion • The School is charged with not only producing an educated child – but a healthy child as well. • And Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity…. • And school is one of the best opportunities to achieve this.

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