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Issues in Undernutrition

Issues in Undernutrition. Undernutrition in Children under Age 3. Percent. Undernutrition trend by age. Stunted. Wasted. Undernutrition trend by age tells a great deal. 30% are stunted and 25% are wasted at ~1month Not surprising, one third neonates are low birth weight

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Issues in Undernutrition

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  1. Issues in Undernutrition

  2. Undernutrition in Children under Age 3 Percent

  3. Undernutrition trend by age Stunted Wasted

  4. Undernutrition trend by age tells a great deal • 30% are stunted and 25% are wasted at ~1month • Not surprising, one third neonates are low birth weight • Maternal factors therefore must be very important • Wasting incidence peaks at 3-12 months • Stunting incidence peaks between 18 mo to 24 months • Act before birth with mother • Act from 1st hour, 1st day of life, through 1st year … • Too late after 24 months

  5. Conclusions: Breastfeeding What works • Individual counseling of mother and family • Group counseling of mother and family / community • Mass media campaigns • Peer support (mothers, women’ groups) • Need multi-pronged approach

  6. What worksPromoting Complementary Feeding In food secure population: Educational interventions In food insecure population: Educational interventions plus Food supplementation Cash transfer/incentive

  7. Low birth weight babies 30-45% among low SE families Account for ~ ¾ of all neonatal deaths 3 times risk of mortality, 22 times risk of being stunted in the first year Have much higher incidence of BF problems, especially <2000g (10% of all babies) Previous BF trainings lay inadequate emphasis of feeding of LBW babies

  8. Continuum of careBF (& beyond) Facilities Do the respective professionals / workers have the required skills? Home • ASHAs • AWWs • TBAs • ANMs • Women’s support groups • Physicians • Nurses • Counselors Lalitpur pilot has useful lessons (BPNI)

  9. Wasting • Acute undernutrition • Often precipitated by illness • Mortality risk twice of stunted • Incidence peaks at about 10-12 months • Needs nutritional therapy and tx of associated infections

  10. Wasting • Severe wasting treated in hospitals, followed by home management • Community-based approaches are also effective • Linked to IMNCI approach – treat as sickness needing referral

  11. Promoting optimal IYCF • When to act • Are we doing enough in the 1st hour, 1st day and 1st year of child’s life? • Are we doing enough during antenatal period? • Are we doing enough for adolescent girls?

  12. Nutrition: s p r e a d across ministries Department of women & child development • Integrated Child Development Services (ICDS) Scheme • Nutrition Program for Adolescent Girls • Nutrition advocacy and awareness general programs for good & nutrition board (FNB). • National Nutrition Mission • National guidelines: eg on IYCF

  13. Nutrition: spread across ministries Ministry of Health & family Welfare Micronutrients • Iron and folic acid supplementation of pregnant women. • Vitamin A supplementation of children of 9-36 months age groups. • National iodine deficiency Disorder Control Program Energy / macronutrients • Integrated management of neonatal and childhood illnesses (IMNCI) • ANC package • Management of sick children including the severely malnourished

  14. Nutrition: spread across ministries Department of Elementary Education and literacy • Mid-Day meal for primary school children. • Sarva Shiksha Abhiyan • Adult Literacy Program Department of Agriculture & Cooperation • Food Production • Horticulture interventions Food and Public Distribution • Targeted Public Distribution System • Antodaya Anna Yojana • Annapurna Scheme Ministry of Science • Food research • Fortification • GM foods

  15. Nutrition: spread across ministries Rural and Urban Development • Food for work program • Poverty Alleviation Program • Safe drinking water and sanitation program • National rural employment guarantee scheme Planning Commission Overarching role

  16. Principles of convergence • Commitment to national goal and strategy • Consensus on technical contents • Agreed roles and responsibilities • Respect for the role of others • Agreed decision-making procedures • Agreed coordination mechanism • Empowered coordination unit • Agreed procedures of communication • Clarity about who provides the stewardship: who has the final word?

  17. 2. Nutrition related budget: 2008-09 Proposed Budget for Nutrition interventions: 2008-09

  18. 3. KEY NUTRITION INTERVENTIONS: 2008-09 (details)

  19. 3. KEY NUTRITION INTERVENTIONS: 2008-09 (contd.) Monthly Village Health & Nutrition Days/ VHNDs (details)

  20. 3. KEY NUTRITION INTERVENTIONS: 2008-09 (contd.) Biannual drives for child health and nutrition activities • Proposed by Assam, Bihar, Chhattisgarh, Madhya Pradesh and Uttar Pradesh • Rs. 36.22 crores budgeted • Bi-annual month long drives for child health and nutrition activities usually cover the following: Vitamin A supplementation; Immunisation; De-worming; Breastfeeding Promotion, etc.

  21. 3. KEY NUTRITION INTERVENTIONS: 2008-09 (contd.) Nutritional support through self-help groups • Proposed by Andhra Pradesh, Tripura, and West Bengal • Rs. 32.12 crores budgeted

  22. 3. KEY NUTRITION INTERVENTIONS: 2008-09 (contd.) Nutritional Rehabilitation Centres • Bihar – 8 existing and 10 new • Chhattisgarh – at 48 CHCs • Madhya Pradesh – 61 in place, and 50 new • Orissa – 2 DHs • Rajasthan – 33 DHs and 2 CHCs • Maharashtra – 663 current, plan for all RH/ CHCs • Delhi – 9 (one in each district) Total budget proposed – Rs. 8.07 crores

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