Undernourished Children( under 5 years)

Under nutrition is defined as the outcome of

insufficient food intake & repeated infectious

diseases.

It includes

-under weight for one’s age.

-too short for one’s age (stunted).

-very thin for one’s height (wasted).

-micronutrient malnutrition.

WHO ARE UNDER WEIGHT CHILDREN?

“The prevalence of underweight children under 5years of age is defined

as the percentage of children aged 0-59 months, whose weights are less

than 2 standard deviations below the median weight for age groups in

the international reference population.”

- It is an internationally recognised public health indicator for monitoring

nutritional status & health in populations.

- It’s a composite indicator influenced both by wasting & stunting. Hence

includes both acute and chronic health condition.

- Its composite nature complicates its interpretation also. Most of the

recent surveys hence include mainly Wasting & Stunting.

Age & Sex

Low birth weight

Genetic susceptibility

Prev. nutritional status

Immunization status

Bacteria

Virus

Parasites

Physical &

Chemical hazards

Socioeconomic Status

Geographic area

Cultural Factors

Degree of Urbanization

Availability of essential services

EPIDEMIOLOGICAL TRIAD

HOST

ENVIRONMENTAGENT

RISK FACTORS - UNDER NUTRITION

Socio economic

•Lower socioeconomic status

•Patriarchal society

•Educational level

•Cultural influence & social taboos

Biological

•Low birth weight baby

•Poor Infant feeding practices

•Poor Maternal Health

•Diseases

Miscellaneous

• Natural Calamities

• Adulteration of food & uneven

distribution of food

• Unhygienic practices & food habits

• Access & Quality of essential services

CHALLENGE OF INTER-GENERATIONAL CYCLE OF

SURVIVAL, GROWTH AND DEVELOPMENT

-Early & frequent pregnancy

-improper child spacing

-Inadequate care during

pregnancy

-Inadequate child care

-Improper feeding practices

-Burden of diseases &

infections

-Gender discrimination

-Inadequate growth & Education

-Early marriage, early &

frequent pregnancies with

improper child spacing

-Poor diet & inadequate care

during pregnancy

Low birth

weight

Under nourished,

less aware,

vulnerable

adolescent girls.

Under nourished

mothers

UNDERNUTRITION

Macronutrient Deficiency

Protein energy Malnutrition

KwashiorkorMarasmus

Micronutrient Deficiency

“ Hidden Hunger ”

Iodine

Vitamin A & others

Iron

Zinc

Short term effects

- Growth retardation,

Appetite loss,poor absorption.

- Immune development

More prone to infections.

Long term effects

- Stunting

- Cognitive development

Attention Deficit disorder

Impaired school performanceImpaired memory, Social skills.

WORLD 12.5%

DEVELOPED WORLD 1.4% DEVELOPING WORLD 14.9%

LATIN AMERICA

8.3%

AFRICA

22.9%ASIA

13.9%

Under nutrition causes more than half of all child death worldwide

World Scenario

L.America Carriabean S.America

Percentage 8.30% 17.80% 7.70%

8.30%

17.80%

7.70%

Latin America

Africa N. Africa Sub Saharan

Percentage 22.90% 2.70% 26.80%

22.90%

2.70%

26.80%

Africa & it's regions

Asia Western Southern Central Eastern

Percentage 21% 10.10% 46% 7.40% 11.50%

21%

10.10%

46%

7.40%

11.50%

Asia & it's Regions

The “South

Asian

enigma”

South Asian women

have lower status &

less decision making

power.

>30% Indian babies

are born with Low

birth weight

compared with 16%

Sub Saharan Africa.

Hygiene/

Sanitation

standards are

below in South

Asia than Sub

Saharan Africa.

THE INDIAN PROFILENFHS 4 (2015-2016) <5 under weight data is taken in terms of weight for age.

Total household 291431

Total children 728532.5

Under nutrition in <5 yrs child

241365 ( averaged as per 18

states calculated in India)

33.13%of Indian children <5years is under weight.

India is 17.5% of world’s population but 39% of world’s

undernourished children live in India .

1 in every 3rd undernourished child lives in India .(world bank report, UNICEF 2011 )

NFHS 4 is averaged of 18 states of India

.

In every 10 children 3 are under weight in India .

India is 17.5% of world’s population but 39% of world’s

undernourished children live here.

1 in every 3rd undernourished child lives in India .

In every 10 children 3 are under weight.

Bihar43.9%

Uttrakhand26.6%Haryana

29.4%

MadhyaPradesh

42.8%

Maharashtra36%

West Bengal

31.5%Telangana28.5%

Karnataka35.2%Goa

23.8%z

AndhraPradesh

31.9%

TamilNadu23.8%

Andaman & Nicobar Islands

21.6%

Puducherry22%

Sikkim14.2%

Assam29.8%Manipur

13.8%

Tripura24.1%

Meghalaya

29%

Rural, 50%

Urban, 38%

Girls, 48.9%Boys, 45.5%

RURAL URBAN GIRLS BOYS

% p

reva

len

ce

Axis Title

% Prevalence under weight<5 INDIA

TARGET GROUP MAJOR SCHEMES SERVICES FROM SCHEMES

Pregnant and

lactating mothers

• Integrated Child

Developmental

Scheme ICDS

• National Health

Mission

• Reproductive Child

Health RCH-II

• Janani Suraksha

Yojana JSY

• Janani Shishu

Suraksha

Karyakaram

• ICDS:-Promotion of Breastfeeding, Supplementary Nutrition, Immunization, Nutritional Education to Mothers, Preschool Education, Health Check up & Conditional maternity benefits.

• NHM:- Antenatal care & counselling , Iron supplementation, Immunization, Transportation for institutional delivery, cash benefit, post natal care, counselling for breast feeding and spacing of children.

GOVERNMENT PROGRAMMES TO ADDRESS UNDERNUTRITION

Children( 0-3 years)

• Integrated Child Development Scheme

• RCH –II , NHM

• ICDS:- Supplementary nutrition , Growth monitoring, Counselling, Health education of mother on child care, Promotion of infant & young child feeding, Home based counselling for early childhood stimulation, referral & follow up of under nourished & sick children.

• NHM:- Home based new born care, immunisation, micronutrient supplementation, Deworming, Health check up, Management of childhood illness & sever under nutrition, referral and cash less treatment for 1st month of life, care of Sick newborns , Facility based management of severe acute malnutrition & follow up.

Children (3-6 years)

• ICDS

• RCH- II, NHM

• ICDS:- Non formal pre school education, Growth monitoring, Supplementary Nutrition, Health Check up & referral, Health Education, Counselling for Care givers.

• NHM:- Immunization, Micronutrient supplementation, Deworming, Health check up, Management of illness & severe Under nutrition.

Adolescent Girls( 11-18 years)

• NHM • NHM:- weekly Iron and folic acid supplementation

INDIRECT SCHEMES IMPROVING UNDERNUTRITION

Improving Food

Production, Quality &

Quantity

NFSM: National Food Security

Mission

National Mission for

Sustainable

Agriculture

Rashtriya Krishi Vikas Yojana

Increasing the Purchasing

power of people

MGNREGA- Mahatma Gandhi

National Rural Employment

Guarantee act

Prime Minister’s Employment

Generation Scheme

Improving the Access &

Quality of essential

services

Total Sanitation campaign

Nirmal Bharat Abhiyan

National Rural Drinking Water

Programme

FOOD FORTIFICATION

To maintain nutritional quality of food

To increase the added nutrition value of food

INDIA INTEGRATED FOOD FORTIFICATION

• Fortifying Complementary food with : Iron, Iodine, Zinc, Vitamin A, Vit.

B complex, Folic Acid.

• Technical & Financial Support is received from GAIN i.e. Global Alliance

for Improved Nutrition.

• Example : Salt fortifying with Iodine.

- Milk with Vitamin A/D.

- Flour , Bread , Rice with vitamin B complex.

So, India’s primary policy response to Child Under Nutrition ??

The ICDS Program.

Are results meeting expectations ??

ICDS was designed to address the Multidimensional causes of

Under nutrition.

But still there are repeatedly raised concerns about the mismatches.

What are the concerned areas & how to improve the nutritional

status??

CONCERNED AREAS? HOW TO IMPROVE THE EFFECTIVENESS

1. Poor Target Based Approach:-Designed to address the Intergenerational cycle but focused more on older children i.e. 3-6 years.

2. Mismatch between Original intention & Actual implementation i.e. focusing more on food supplementation.

• Increase focus on Pregnant women & Young children of age 0-3 years.

• Strengthen Nutrition & health Educational activities.

• Targeting more on high risk groups.

• Improve the childcare behaviours.• Counselling Parents about proper nutritional

requirements with Demonstration Education to mothers.

3. Lack of Coordination

between AWW & ANM,

hampering the early detection

& treatment.

4. Design is standardised.

• Improve the Coordination, home visits,

outreach activities.

• Strong Monitoring & Evaluation

system.

• Introduce flexibility & Decentralise

responsibility according to local needs

& area.

• More Funding to poorer state with high

under nutrition prevalence.

• Improving the Anganwadi centre

infrastructure.

What more can be done?

1. Inter department Synergy

(ICDS+NHM+MGNREGA, Primary Education + RCH)

2. Community Participation in service delivery (Mahila mandal with AWW)

3. Improve Opportunity: Developing small & medium scale enterprises.

4. Increase Use of science & technology In Agriculture to enhance food

Production and Supply.

5. All these require Political , Social & Economic efforts and Commitment.

6. More active & Strengthening Mass Media Campaign.

“We are guilty of many errors and many faults

But our worst crime is abandoning children,

Neglecting the foundation of life.

Many of things we can wait.

The Child cannot.

Right now is the time his bones are being formed ,

his blood is being made

and his senses are being developed.

To him we cannot answer tomorrow.

His name is today.”

Gabriela Mistral.

1948

ZERO

HUNGER

CHALLENGE

“ IN THE FIGHT AGAINST MALNUTRITION, KNOWLEDGE IS POWER ” -UNICEF