Micronutrient Malnutrition Control for Better Productivity & Economic Growth

Dr. Saraswati Bulusu

National Program Manager, India

The Micronutrient Initiative

April 24, 2006

Overview

• Micronutrient deficiencies is a major public health problem in India affecting productivity and overall economic development. Minimal loss to GDP due to VMDs per year: Rs 27,720 crores

• ICDS is the largest program in the world for integrated child nutrition with a network of 5,68,888 AWC’s across the country.

• ICDS is targeted to reach the most vulnerable segments like <2 children, 2-6 yrs and PLW, who suffer more from these micronutrient deficiencies.

• ICDS offers a scope for innovations to reach micronutrients to the at risk groups, leveraging the ICDS infrastructure.

• The fortification programs could be piggy backed to the supplementary nutrition component of ICDS.

Proven Opportunities to Control Micronutrient Deficiencies through ICDS

• Supplementation (Since 1970’s):

– Strengthening Bi-annual Supplementation of Vit A for Children 9m-59ms

– IFA tablets to P&LW, Adolescent Girls and children.

• Fortification :

– Nutri Candies

– Fortified ‘khichdi’

– Fortified RTE Foods

– Fortified Wheat Flour ( ICDS & TPDS)

– Multiple Micronutrient Sachets (Anuka)

MI India – Summary of Interventions

Fortified Candy

Anuka

Khichdi & RTE

VAS

Salt Initiatives

Wheat Flour Fortifcation

Nutri-candies: 5 Million Beneficiaries Covered Per Day

Advantages of Nutri-candies

• Simple distribution & compliance is nearly 100%

• Targeted delivery

• Centrally processed – qty. of mns ensured,

• Packed attractively and hygienically

• Cost effective (Rs.55 to 60 per ben. per year with 4 micronutrients inclusive of indirect costs)

• Drawn the attention of policy makers

• Proven : Sensory (IHE); Stability (NPIL); Effectiveness (CINI) & Efficacy (AIIMS)

Effect of candies on attendance of pre-school children at AWCs - West Bengal (Udaynarayanpur Block,

Howrah dist)

Graph 1 Average no of children attending the AWC: Zone 2

0

5

1015

20

25

30

3540

45

50

Months (June'04 - Nov'04 without candies & Dec'04 - May'05 with candies)

Average attendance per day

Impact of the Intervention on Prevalence of VAD in Howrah

22.5

18.1

26.5

18.3

10.5

15.5

0

5

10

15

20

25

30

Preg & Lactating women Adolescent girls PSC

Pre

v of

VA

D in

%

Pre Post

Efficacy Trials on Anemia Prevalence in Pre-school Children

50

23.5

0

10

20

30

40

50

60

Pre Post

Pre

vale

nce

of A

nem

ia %

50

23.5

0

10

20

30

40

50

60

Pre Post

50

23.5

0

10

20

30

40

50

60

Pre Post

‘Vita Shakti’ to Fortify ‘Khichdi’-- An Innovative Approach

• Khichdi -- Locally cooked at AWC with rice, lentil, oil & salt. (Presently reaching 1.2 million)

• Vita Shakti -- premix with iron(7mg), vit A(500iu) & folic acid(50mcg)

• Packaging -- 1 kg pouch that can cater to 4000 beneficiaries

• Mode of addition -- A small spoon measuring 1.25 gms of the premix to be used for 5 beneficiaries, costing 3p per beneficiary per day.

• Training - Dilution, Mixing, Storage : temp & light

• Efficacy Study by Tufts University & CINI

Prevalence of Anemia for Non-Fortified Khichdi (NFK) and Fortified Khichdi (FK) groups at 0, 12, and 24

weeks.

32.6

19.1

13.3

9.8

20.7

4.1

0

4

8

12

16

20

24

28

32

36

40

NFK FK

0 Weeks

12 Weeks

24 Weeks

Treatment Group

Mean Prevalence Anemia

Serum Ferritin Conc.in Non-Fortified Khichdi (NFK)

and Fortified Khichdi (FK) groups at 0 and 24 weeks.

25.725.12

22.91

35.48

20

22

24

26

28

30

32

34

36

38

40

NFK FK

0 Weeks

24 Weeks

Treatment Group

Mean SF Concentration (µg/L)

µ

ANUKA

Wheat Flour Fortification for Control of IDA & VAD

• Pilot project in Darjeeling Sadar Subdivision in West Bengal through TPDS – reaching 0.6 million

• Scaled up in Kalimpong & Kurseong through TPDS - today reaching 1.8 million

• Launched in Haryana, Punjab & Chandigarh in 2005 through open market - today reaching 2.5 million (Jan 05)

• Govt. Of AP initiated flour fortification through PDS (Nov 05)

• Govt of Gujarat Model – Public Private Partnership for WFF (Jan 06)

• Advocacy meetings at West Bengal & Orissa last week

• Commitment of GOI at the national level – Policy Change??

Iodized Salt & Double Fortified Salt

• Use of adequately iodized salt in ICDS

• Salt fortified with iron & iodine (DFS) is presently available – NIN and MI formula.

• TNSC is presently manufacturing DFS which is being used in Mid Day Meal Program in Tamilnadu with support from MI

• Efforts to scale up in ICDS/MDM/PDS