NOURISH TO FLOURISH: REDUCING MALNUTRITION

TEAM DETAILS :

Coordinator : Kriti Bhayana

Team Members : Aarchie Gupta

Debanjana Dutta

Deepti Mittal

Manmeet Kaur

College : LADY HARDINGE MEDICAL COLLEGE

(LHMC)

ABBREVIATIONS

U5 Under 5 Years

AWC Anganwadi Centre

AWW Anganwadi Worker

SN Supplementary Nutrition

P&L Pregnant and Lactating Women

PHC Primary Health Centre

MCTS Mother and Child Tracking System

THR Take Home Ration

MALNUTRITION is defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more

nutrients. It comprises four forms:

1. Under nutrition 2. Specific Deficiency 3. Over nutrition 4.Imbalance

However the problem that plagues our country the most is under nutrition. What makes the situation even more serious is that the

main victims of malnutrition are children under the age of 15. But children under the age of 5 years are hit the hardest.

GRADING OF MALNUTRITION:

CAUSES:

• Scarcity of suitable food.

• Lack of purchasing power of the family.

• Traditional beliefs and taboos about what one should eat.

• Poor maternal health.

• Infectious diseases.

To counter the lack of purchasing power of the family, the government has introduced food subsidies for such families. However, the

problems encountered in these plans were of uneven and inefficient distribution.

Degree of Malnutrition % of desired body weight for age and sex

Normal 90%-110%

Mild: Grade I (1st degree) 75%-89%

Moderate: Grade II (2nd degree)

60%-74%

Severe: Grade III (3rd degree) <60%

RURAL SETUP: PRESENT SCENARIO

I. Problems with provision of supplementary nutrition under the ICDS SCHEME at AWC:

Registration of beneficiaries: 49% of eligible under 5s (U5s) are

actually registered.

Of those registered, only 64% of U5s, 78% of pregnant &

lactating mothers and 42% of adolescent girls received SN (NOT necessarily 300 days or

as per entitlement).

Effective coverage of ICDS beneficiaries for SN = Proportion

of beneficiaries actually getting SN x Proportion of days SN received

out of 300 days in a year.

At the national level it was 41% among U5, 38%

among P&L women and 10% among adolescent

girls (for 2008‐09). 0

10

20

30

40

50

60

70

80

90

<12 23-Dec 24-35 36-47 48-59 60-71

Not receiving anysupplementarynutrition

any services

Almost daily receivingsupplementarynutrition

Figure 1: Percentage of children age 0-71 months receiving services from an AWC

Inadequacy of infrastructure at AWC.

Wide variations in the number of children enrolled per

AWW (Himachal Pradesh = 9; Uttar Pradesh = 65).

Wide divergence between official statistics and ground reality:

i) registered beneficiaries, ii) number of days SN served, iii)

nutritional status. etc.

Prevailing coverage norms: U5 40-42; 20-25 P& LM.

II. Most people are dependent on ration shops to buy grains at subsidized rates. But this system holds little accountability and

transparency. Till now, the amount of food consumed has not been linked to reduction in malnutrition. So, it becomes difficult to

realize the causes of conditions such as severe malnutrition in specific family set ups.

FACTS TO KNOW:

1 PDS shop per village. Roughly 30 villages under 1 PHC.

Govt. has introduced the scheme of women and child targeting. Under this scheme, all women of the rural household are being given mobile phones. Also the data about health of pregnant mothers and children is fed into the MCTS. This is Name Based web enabled tracking of pregnant women and children to ensure and monitor preventive, promotive and curative health services to them.

Wide variations in the number of children enrolled per AWW

(Himachal Pradesh = 9; Uttar Pradesh = 65).

Figure2: Percentage of children 0-59 months in areas covered by AWC by frequency of weighing

26% shortage of AWCs/ mini AWCs; 22% shortage of

Anganwadi workers (AWWs); 43% deficiency of ICDS

supervisors.

PROPOSED SOLUTIONS:

1. In order to improve the accountability and transparency of the existing PDS, our proposal intends to bring it under the direct supervision of the PHCs.

2. PDS shopkeepers to maintain record of food grain collected by families of that village.

4. This data will be fed into MCTS.

3. A health worker from the concerned PHC will collect height & weight of each individual of every household quarterly.

5. THR for the special groups which was earlier supplied by AWC will now be given by PDS. This ration will be provided in the

same quantity and for the same duration of time as currently provided by AWC.

6. Thus health status can be linked to dietary intake.

HOW THIS PLAN WILL WORK:

Every 3 months a health worker from a PHC will record and collect height & weight of every

individual of all households

The workers will ,add this data into the online MCTS

Depending upon the analysis of this report if:

FINANCES FOR RURAL SETUP

Presently, 5665 crores are invested by government to provide SN through ICDS by AWCs out of which approximately Rs 2,943 crore (i.e. 60% of the resource) gets wasted every year.

Cost of the additional food meant for the special groups as currently being done under the ICDS will be bore by the state government.

However, this proposal ensures that the resources spent by the government can now be used effectively.

• Weight for age detected below normal range.

• SMS sent to the health worker & ASHA to inform about the

deteriorating health of the concerned individual.

• SMS also sent to the individual to visit the respective PHC.

• On not turning up the health worker/ASHA visits the individual.

• On examining, if the cause is found to be any nutrient deficiency ,

then appropriate supplements will be prescribed & provided by the

PHC .

URBAN SETUP:

PRESENT SCENARIO

I. In urban areas most people have the capacity to buy adequate amount of food but lack the awareness to buy the right kind of

food.

II. A very large portion of the demand for food is based on the non-nutritive attributes of food, such as taste, aroma, variety, and

status which forms the major cause of malnutrition among the affluent classes.

WHAT WE PROPOSE ?

We propose to introduce diet plans for the school going children in schools that are not covered under the mid-day meal scheme.

In addition to this, we also intend to introduce a subject who will cover the important aspects of healthy living and nutrition.

Our major objective behind such proposals is to contain the prevalence of malnutrition.

PROPOSAL 1: • Every district will consult a nutritionist to design diet charts for one month.

These charts will be revised every fortnight.

• The diet charts will be directed to all the Public, Government aided and

Kendriya Vidyalaya schools present in the district.

•

• The diet chart will be different for different age groups, keeping in mind

their physical, mental and developmental needs.

• The charts will be different for vegetarian and non-vegetarian.

• The charts will be different for vegetarian and non-vegetarian.

•

• The intake of appropriate amount of micronutrients will also be ensured.

• The diet plan will include seasonal vegetables and fruits of that region.

BENEFICIARIES

Direct beneficiaries of the

proposed plan will be children

enrolled in

Public schools

Govt. aided schools

Kendriya Vidyalaya

Indirect beneficiaries will be

families of the school going

children.

FINANCES:

PROPOSAL 2:

Introducing nutrition education in school curriculum:

In order to make sure that good eating habits in children are inculcated from the beginning, it is essential to introduce nutrition

education as part of the curriculum.

• Each Nutritionist will be paid an amount of around Rs.4000 per month.

• The respective State govt. will bear the salary of the Nutritionist.

• There are 640 districts in India. Therefore the total estimated cost on a national basis per month will be Rs.4000*640=Rs.25, 60,000.

• Annual cost on a national basis Rs. 25,60,000*12= Rs.3,07,20,000.

• On an average, a State will have to bear an amount of Rs.10,24,000 per annum approximately.

s

Under this plan, we propose that students of standard 6th to 8th should have nutrition education as a subject irrespective of the board the school is affiliated to.

It will be taught in all public, government aided, central and Municipal Corporation/ Municipality schools.

This subject should essentially be taught keeping in mind its practical aspect.

The syllabus for this will be designed by a team of experts that will consist of atleast 2 doctors belonging to the Department of Preventive and Social Medicine (PSM) among others.

No examination needs to be conducted separately for this subject; however, regular assessment during practicals is highly recommended.

OBJECTIVES BEHIND THIS PROPOSAL:

The subject will be based on the

concept of 'Learning by doing’.

If the children learn about good health

and balanced diet through a series of

lectures and elaborated

practicals(innovative learning), it will

motivate them to maintain

themselves in a good state of health.

BENEFICIARIES DIRECT: Children going to:

Public schools Government aided schools Kendriya Vidyalaya Municipal Corporation/

Municipality schools

INDIRECT: Families of the school going children.

Rural Urban

Total Cost of the Project

Food subsidy

through PDS

SN by AWC

through ICDS

Rs 72000 crores

as used earlier

Rs 5665 crores of

which 60% is wasted Currently

As proposed Rs 5665 crores

used effectively

Nutrition education

in schools

Diet charts in

school

Rs 3 crores Initial finance

required to

introduce the

subject

REFERENCES

Park's Textbook of Preventive & Social Medicine, K. Park, Twenty second Edition.

Annual Report, 2012-2013, Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of India, www.mohfw.nic.in

Annual Report, 2011-2012, Department of Food & Public Distribution, Ministry of Consumer Affairs, Food and Public Distribution, Government of India, http://fcamin.nic.in

ICDS, 11th Plan- June 2007

Nutrition in South- East Asia,2000, WHO