NOURISH TO FLOURISH :WAYS TO TACKLE MALNUTRITION

MADE BY-

AAKANKSHA PATHAK

AISHWARYA PRASANNAN

ANURAG DUTTA CHAUDHURY

TRIPTI KHUTE

HAMZA RAZA ZAIDI

1

zaidi.hamza@gmail.com

(Team Coordinator)

SOME FACTS -

The World Bank estimates

that India is one of the highest

ranking countries in the world

for the number of children

suffering from malnutrition.

The prevalence of underweight

children in India is among the

highest in the world, and is

nearly double that of Sub-

Saharan Africa with dire

consequences for mobility,

mortality, productivity and

economic growth

The 2011 Global Hunger

Index (GHI) Report ranked

India 15th, amongst leading

countries with hunger situation.

It also places India amongst the

three countries where the GHI

between 1996 and 2011 went

up from 22.9 to 23.7, while 78

out of the 81 developing

countries studied, including

Pakistan, Nepal, Bangladesh

and Zimbabwe succeeded in

improving hunger condition.

25% of all hungry people

worldwide live in India.

Malnutrition causes 45 per cent

of deaths of under-five children

The UN ranks India in the

bottom quartile of countries by

under-1 infant mortality (the

53rd highest), and under-5 child

mortality (78 deaths per 1000

live births).

According to the 2008 CIA fact

book, 32 babies out of every

1,000 born alive die before

their first birthday.

2

A MULTI CASUAL PROBLEM :

Ph

ysi

cal

Cau

ses

Hunger.

Calorie/Protein Micronutrient Deficit.

Infection And Diseases.

So

cio

-eco

no

mic

an

d

His

tori

c C

ause

s

Poverty/Low Income.

Illiteracy/lack of skills.

Gender Discrimination embedded in social custom.

Lack of information and Awareness.

Att

itu

din

al/B

ehav

iora

l C

ause

s

Gender Discrimination.

Low status of Women.

Negative child/Mother care practices.

Early marriage of girls.

Early & frequent pregnancies.

Lack of information & awareness.

Gov

ernan

ce R

elat

ed

Cau

ses

No national Programme with specific objective of reducing malnutrition.

Inadequate, health care services for women and children.

Low access to safe drinking water and sanitation.

Poor coverage.

Programmatic gaps.

No action based Nutrition Monitoring.

Lack of accountability.

3

Photo : RupsaCPhoto : Chaurahha…The Crossroad

FUNDAMENTAL CAUSES OF MALNUTRITION IN INDIA NOT YET

ADDRESSED PROGRAMMATICALLY :

Malnutrition in India is deeply rooted

in the inter-generational cycle of low

birth weight babies, underweight

children, malnourished, anemic

adolescent girl sand pregnant women.

However, current policies and

programmes do not address the issue

inter-generationally.

More than 30% population of India

suffers from a Calorie-Protein,

Micronutrient Deficit, (CMPD)*

This factor not yet acknowledged or

addressed specifically in any

programme(except in general through

the TPDS*, whose out reach to the

lowest percentile of poverty is poor).

Besides, TPDS even if working

efficiently only provides for cereals,

(and in some cases pulses and sugar,) a

subsistence diet for the poor.

TPDS does not provide adequate

calories, protein or micronutrients

for a healthy life.*(NNMB repeat surveys, 1988-90, 1996-97, NNMB Technical Reports No.20, 21, 22, 2000-03)

There is inadequate awareness and

information regarding proper

nutritional practices amongst the

population, even with in existing

purchasing power.

At least 10-15% of the population

suffer from malnutrition not because of

poverty/lack of purchasing power but

because of lack of awareness and

information

In spite of the 11th Plan

recommendation for initiating a

nutrition awareness generation

campaign, it has not yet happened.

1 2 3

*TPDS : Targeted Public Distribution System

4P

ho

to :

Rupsa

C

PROVIDE MICRO-NUTRIENT SUPPLEMENTS FOR FREE TO

MALNUTRITIOUS CHILDREN AND PREGNANT WOMEN'S

Macronutrients (carbohydrates, lipids, proteins & water) are needed for energy and cell multiplication & repair.

Micronutrients are trace elements & vitamins, which are essential for metabolic processes.

Resolves diseases caused by Iron, Zinc, Iodine and Vitamin A deficiency.

What are Micronutrient ?

The majority of world’s children live in developing countries.

Lack of food & clean water, poor sanitation, infection & social unrest lead to LBW & PEM.

Malnutrition is implicated in more that 50% of deaths of less than 5 years of children (5 million per year).

28%

29%

26%

10%7%

CHILD MORTALITY

Diarrhea ARI Perintal causes Measles Malaria

55 % of total have malnutrition

Proposed Solution -

LBW : Low Body Weight

PEM : Protein Energy Malnutrition

5

Malnutrition

ANC : Antenatal Care

EBF : Exclusive Breast Feeding

Conceptual Interpretation - 6

ICDS

Mid Day Meal Programme

Kishori Shakti Yojana

Immunization Programmes

Vitamin A Supplementation Programme

National Nutritional Anaemia Control Programme

National Iodine Deficiency Disorder Control Programme.

National Rural Drinking Water Programme

Total Sanitation Campaign

Current Nutrition Related

Programmes :

These programmes

address some causes

of Malnutrition but

not all of them and

have several

programmatic and

coverage gaps.

In the absence of

seamless and

simultaneous

interventions, gains

accruing from

existing, dispersed

and often isolated

interventions are lost

on account of

absence of other

critical interventions.

Proposed Micro-Nutrient Nutrition

Programme :

AIM-

“To provide multiple vitamin and mineral supplements for

pregnant and lactating women, and for children aged 6 to 59

months.”

Introduce nutrition and micro-nutrient interventions for thethree critical links of malnutrition viz. children 6 months to 6years, adolescent girls, and pregnant and lactating womento be prepared by Collaborations of Scientists, based onresearch of the past and present.

Several Formula’s of these Micro-Nutrients are already beenmade and used in emergencies(Natural Disasters) by WHO.

Introduce nutrition and micro-nutrient interventions for thegeneral population to bridge the protein-calorie gap by makingavailable in the market, protein-energy dense foods for free.

Structure and monitor tightly integrated multi-sectoralinterventions to address all or majority of the direct and indirectcauses of malnutrition simultaneously.

Initiate a sustained general public awareness campaignregarding proper nutritional practices within existingfamily budgets, and to create demand. SHG : Self Help Group

7

ROADMAP OF SOLUTION PROVIDED -

Micro-Nutrient food prepared

by Team of Scientists.

Team of Specialists and Political leaders

look for required budget and feasibility

of the MN Food.

MN Food Distributed to

different Government

Agencies.

Government Agencies

Distribute these Micro-Nutrient to

Population Currently suffering from Malnutrition.

Micro-Nutrient food available at different government stores such as TPDS for free.

Form an effective monitoring system(through external agency) for measuring outcomes, effective changes & mid course corrections.

Initiate a Public awareness campaign, to reach and inform about MN Food and proper nutritious practices.

Since, this is a Research Based Project, estimated budget for this project

would depend upon time and material consumed during research and its

mass production and feasibility for the poor.

8

Micronutrients Pregnant Children

Women (6-59 months)

Vitamin A µg 800.0 400.0

Vitamin D µg 5.0 5.0

Vitamin E mg 15.0 5.0

Vitamin C mg 55.0 30.0

Thiamine (vitamin

B1) mg

1.4 0.5

Riboflavin

(vitamin B2) mg

1.4 0.5

Niacin (vitamin

B3) mg

18.0 6.0

Vitamin B6 mg 1.9 0.5

Vitamin B12 µg 2.6 0.9

Folic acid µg 600.0 150.0

Iron mg 27.0 5.8

Zinc mg 10.0 4.1

Copper mg 1.15 0.56

Selenium µg 30.0 17.0

Iodine µg 250.0 90.0

The composition of multiple micronutrient supplements

for pregnant women, lactating women, and children

from 6 to 59 months of age, designed to provide the

daily recommended intake of each nutrient (one RNI)

MicroNutrient Food used during Emergency by WHO & UNICEF The recommended daily intake of

micronutrients is to provide foods fortified with micronutrients.

Fortified foods, such as corn-soya blend, biscuits, vegetable oil enriched with vitamin A, and iodized salt, are usually provided as part of food rations during emergencies.

The aim is to avert micronutrient deficiencies or prevent them from getting worse among the affected population.

Such foods must be appropriately fortified, taking into account the fact that other unfortified foods will meet a share of micronutrient needs.

We can implement the

same concept to tackle

Malnutrition in India

However, foods fortified with

micronutrients may not meet fully the

needs of certain nutritionally vulnerable

subgroups such as pregnant and lactating

women, or young children.

For this reason UNICEF and the WHO

have developed the daily multiple

micronutrient formula(shown in Table

on the left) to meet the Recommended

Nutrient Intake (RNI) of these

vulnerable groups during emergencies

Target Groups Fortified Food

rations are NOT

being used

Fortified food

rations are

being used

Pregnant and

Lactating women

1RNI each day 1 RNI each day

Children (6-59

months)

1 RNI each day 2 RNI each

week

Schedule for giving the multiple micronutrient

supplement shown in Table 1 which provides a

daily recommended nutrient intake (1 RNI)

9

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:

Weightment of child within 6 hours of birth and thereafter at

monthly intervals.

Timely initiation of breastfeeding within one hour of birth, and

feeding of colostrum to the infant.

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.

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.

Fortification of common foods.

Dietary supplements of iron–rich, energy dense foods made

from locally available food material prepared by women SHGs for

adolescent girls and women, especially during growth periods and

pregnancy to fill the protein calorie gap and ensure optimal

weight gain during pregnancy.

(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.”

Access to safe drinking water (treatment, storage, handling and

transport), sanitation and hygiene.

Increased female education and completion of secondary schooling

for the girl child, delayed age of marriage and pregnancy.

Increased access of basic health services to women.

Expanded and improved nutrition education and involvement at

Panchayat and community level to create demand.

Increased gender equity.

Linking Agriculture/Horticulture and Nutrition.

10

Challenges and Implementation

risks :

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.

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

The project will eradicate the curse of

malnutrition in the shortest possible

time, so that every Indian is able to

reach his or her full physical and

cognitive potential, enhance income

generation capacity and contribute

to the country's progress.

Government

Scientific Community/Academia

Private Sector

Stakeholders :

Positive Aspects of Project :

Bridge the Protein-calorie-micro

nutrient deficit which affects at least

50 % of the population.

This project formulate a tightly

integrated multi-sectoral strategy to

address all or majority of direct and

indirect causes of malnutrition

simultaneously, many of which exist in

on going programmes.

Community based nutrition

monitoring and surveillance through

ICDS infrastructure could help

growth monitoring of infants and

children and weight monitoring of

adolescent girls and women.

Civil Society/NGOs/People’s

Organizations

Development Organization

Conclusion :

Government is not interested in any

research funding project

Processing cost of micro-nutrition

food can not be easily predicted.

Difficulty in convincing

malnutricious population about the

project i.e. to take MN Food.

Time taken for extensive scientific

research will make this project slow

just in initial phase, but once its done,

government can help process MN

food at a faster rate.

11

THANK YOU FOR PAYING ATTENTION !!

References : India’s Malnutrition: A Multi-Sectoral Solution : Report by Veena S Rao

The Micronutrient Report by John. B. Mason, Mahshid Lotfi, Nita Dalmiya, Kavita Sethuraman and Megan Deitchler

Child malnutrition in India: Why does it persist? : Report by Sam Mendelson with input from Dr. Samir Chaudhuri (CINI)

Children in India 2012 - A Statistical Appraisal : Report by Ministry of statistics and Programme Implementation, Government of India

India’s Undernourished Children - A Call for Reform and Action : Report by Michele Gragnolati, Meera Shekar, Monica Das Gupta,

Caryn Bredenkamp and Yi-Kyoung Lee August 2005

Preventing and controlling micronutrient deficiencies in populations affected by an emergency : Report by Joint statement by the World

Health Organization, the World Food Programme and the United Nations Children’s Fund

Why malnutrition in shining India persists by Peter Svedberg

WHO Database

Wikipedia

12Appendix -