Malnutrition: Stumbling from the StartPresentation Transcript
Malnutrition: Stumbling from the Start 26 November 2010 Rajib K. Haldar Additional Director, CINI Child in Need Institute www.cini-india.org
Outline of the PresentationA. CINI: A Brief HistoryB. What We do?C. Malnutrition: An Integrated ApproachD. Where We Work?E. OutreachF. Emergency Ward & Nutrition Rehabilitation CenterG. Community based Nutrition Security ProgrammeH. Success StoriesI. Key AchievementsJ. Challenges and ConstraintsK. Future PlansL. Awards & Recognitions
CINI: A Brief History In 1970, a national study conducted by Indian Council of Medical Research(ICMR)/ AIIMS identified calorie deficit, Vitamin A and Iron deficiency to be widely prevalent in children below 6 years. The countrywide flagship ‘Integrated Child Development Services’ (ICDS) Scheme was launched to address the situation. CINI’s Founder Director, Dr. Samir Chaudhuri, a Paediatrician by training, conducted the above research study at All India Institute of Medical Sciences (AIIMS), New Delhi Upon return to Kolkata, he founded CINI in 1974 with a multi- disciplinary team of professionals CINI started as a Child Health clinic for Under 5 malnourished children on the outskirts of Kolkata city, continues to attract patients from far and wide till today CINI – award winning NGO, of 36 years of experience, works in the most disadvantaged areas of the country
Child Malnutrition- Why does it matter? The Sign ofShame An estimated 40% of the World’s severely malnourished children under 5 live in India, 49.5 % below age5 are severely or moderately underweight. 3 in every 4 children are anaemic and 1 in 3 are stunted. At least half of Indian infant deaths are related to malnutrition, often associated with infectious diseases In the districts of West Bengal, 51.8% of the children below 2 years of age are malnourished. 22.09% of these children suffer from moderate to severe anemia. The fourth worst State with malnutrition status and anaemia. The most damaging effects of under-nutrition occur during pregnancy and the first two years of a child’s life. These damages irreversible. Malnutrition impedes motor, sensory, cognitive , inclusive social and economic development. Malnourished children are less likely to benefit from schooling, vulnerable to child exploitation and will consequently have lower income as adults .
What we do? Mission : „Sustainable Development in Health, Nutrition, Education and Protection of Child, Adolescent and Woman in need‟. CINI helps marginalised mothers and children in India break free from the cycle of poverty. CINI reaches out across all levels of Indian society from door to door in the villages and slums as well as talking to locally elected representatives and influencing social sector policies Multi-layered, Rights based approach towards sustainable improvement in nutrition, healthcare and education while protecting the children CINI‟s work concentrates on the core areas of nutrition, Mothers and children supported by CINI healthcare, education and protection and on helping to establish Child and Woman friendly Communities(CWFC) and achieve MDGs.
What we do? Nutrition Healthcare Education Protection Child & Women Friendly Communties Influencing & Outreach Training Other Activities Education, Protection, Health and Nutrition facilities of CINI
Malnutrition: An Integrated Approach Malnourishment can be addressed through adoption of healthy child feeding and caring practices in households –Frequency, Quantity and Quality CINI recognizes nutrition as a key determinant of health and tackles malnutrition by addressing all the above in an integrated response CINI‟s nutrition model focuses on educating women to make the best of what is available. It also runs a Nutrition Rehabilitation Centre which has been adopted as a model by a number of state governments under NRHM. Children having nutritious food at CINI NRC Life Cycle Approach
Intergenerational Cycle of Malnutrition Child growth failureLow birth Early Low Weight weight Pregnancy & Height in baby Adolescence Small adult women
Life Cycle Approach: A Package of InterventionsAddresses risks and opportunities during critical stages of lifecycle,starting with pregnancy and moving through birth, infancy, earlychildhood and adolescence. Pregnancy Early registration Ensure adequate weight gain Ensure TT , IFA, 3 or more ANC Attended delivery Early childhood Adolescence (0-2 years) Adequate nutrition Birth weight above 2500 gm Reduce anaemia among Proper feeding as well as girls weaning Awareness regarding Early stimulation pubertal changes Timely immunization Develop life skills Prevent frequent illness Reduce incidence of death
Where We Work?Some of the poorest areas of CINI reaches out to 2 India – Jharkhand, million people in the area Chhatisgarh, West Bengal of our operation Children of the community in CINI work area CINI has trained over 25,000 Government health workers and representatives from over hundreds of NGOs
Outreach Community based Interventions (current):17,00,000 population Reaches out to 9,000 children in urban slums on issues of health, nutrition and hygiene Training on health and malnutrition issues: Total Government staff (1978-2003): 51,365 Anganwadi Workers (2003-2010): 1,658 ASHA workers (various batches): 42,687
Emergency Ward (EW) and Nutrition Rehabilitation Centre (NRC) About 21,000 severely acute malnourishedchildren treated and saved from deaths in 36years
Emergency Ward (EW) : The Institutional based Service model A 10 bed unit for treatment of children with disease and acute malnutrition related problem Children nursed till they are strong enough to join NRC Feeding is one of the crucial components of managing moderate and severe malnutrition related case management The learning is, ‘go slow’ and avoid ‘force feeding’. Emergency Ward
Nutrition Rehabilitation Center (NRC) model 12 bed unit for undernourished children plus supportive care and capacity building of mothers/care givers A mother is provided with accommodation, food and counselling support as her child is nursed back to health. Health workers demonstrate and provide training on health and hygiene, breast feeding and complementary Nutrition Rehabilitation Centre (NRC) feeding, home management of diarrhoea, plus growth monitoring and promotion. Parents , particularly fathers are also informed about the value of primary immunization and child care practices.
CINI NUTRIMIX : The Social Business Model Supplementary nutrition, is usually secured from the market and is mostly accessible to households with high purchasing power. Innovated in 1974, low cost supplementary nutrition made from locally. Now awarded by World Bank as a Social Business model. Nutrimix, an innovative product of balanced nutrition for the child at low cost. This social business venture aim at improving nutritional status of the child on the basis of cost recovery or more. Available cereals and pulses Easy to prepare Versatile - can be prepared in sweet (e.g. laddoos, halwa) and salty (e.g. upma) variants NUTRIMIX Laddoos Can be used as a fortifying agent in chappatis Low cost- one kilogram packet costs Rs. 40 only Is used in community and clinical settings Marketed through Self-help Groups of Women
Success StoriesAnita Roy - Before
Anita Roy - After
Success StoriesApu Mondal - Before
Apu Mondal - After
Key Achievements Piloted and developed India’s first model for facility based care of Severe Acute Malnourished (SAM) children(NRC). A 10 bedded NRC operational in CINI Main campus in South 24 Parganas district. Government has now plans for scaling up CINI’s NRC model in West Bengal and across country. Community based Nutrition Security Programme : Positive deviance and Community Health Care Management Initiatives (CHCMI) projects to cover 5 districts in West Bengal Reduction of severe malnutrition among children <3 years from 4% to 1% , including in the most backward villages. Working on pilots in reduction of anaemia in West Bengal and Jharkhand
Challenges and Constraints Malnutrition is invisible in its early stages. Often, neglected by care givers, family members. Although the issue is now recognized, actual facilities of EW almost non-existing for severely malnourished children. Donors funding for NRC and EmergencyWard, a big challenge. Monitoring and follow- up of cases – sustaining behaviour and family practices - the key to rehabilitation at the community level Availability of Doctors and skilled manpower –payment of salary and compensation Capacity building of service providers and government frontline workers . Finally, call for increased investment and funding support to end malnutrition For them, Tomorrow is too Late. Please join us in our work on ‘ Malnutrition Matters’.
Future Plans Purpose: Treatment, Management and Nutrition rehabilitation of severely affected malnourished children Focus: Reduce the incidence of child under-nutrition in the 0 – 2 years age group in South 24 Parganas district Activities: Facility based management of Severe, Acute Malnutrition (SAM) through Nutrition Rehabilitation Centers (NRCs) in accordance withWHO guidelines for management of SAM children. Rehabilitation of a single child with one caregiver over an average stay of 15 - 21 days, costs nearly Rs 10,000. Nutrition Rehabilitation Center: Rs. 4,47,500 OPD and Thursday clinic for 20,000 patients and mothers’ counselling/follow-up: Rs. 7,50,000 Emergency Ward for treatment of 600 severe, acute malnourished children’s cases @ Rs. 20,000 per child average: Rs. 55,02,500Total annual budget of nutrition management programme Rs. 67 lacs
Awards & Recognitions 2008 Annual Rotary India Award (for making the most significant contribution in reducing child mortality) 2008 Ellis Island Medal of Honor, USA (to CINI‟s director and founder, Dr Chaudhuri) 2007 World of Children Award (to CINI‟s director and founder,Dr Chaudhuri) 2005 Parliament prize for infants from the Italian Parliament Commission for Infants (to CINI‟s director and founder, Dr Chaudhuri) 2004 The National Award in the field of Child Welfare(CINI is the only NGO to have won this award twice) 1994 Allen Feinstein Hunger Award, Brown University, USA 1991 Jal Modi Grant, Rotary Club of Calcutta 1991 The “Liguria” prize from the International Centre forDevelopment of Culture of People, Genoa, Italy 1985 The National Award in the field of Child Welfare, Government of India Dr Chaudhuri receiving award from erstwhile Hon’ble HRDCINI acts as the partner of the government : Minister Shri Arjun SinghCINI is a consulting member of the Drafting Committee of the National Council of Nutrition of the Prime Minister of IndiaCINI Nutrimix is recognized as an innovative and sustainable Social Business model Regional Resource Centre by Ministry of Health and Family Welfare, Government of India State Nodal agency for ASHA training, National Rural Health Mission Mother NGO by Ministry of Health and Family Welfare, Government of India Collaborative Training Institute for Reproductive and Child Health Training by National Institute of Health and Family Welfare
Thank you Contact Us Rajib K. Haldar Additional Director Child In Need Institute (CINI)Daulatpur, Pailan, South 24 Parganas West Bengal -700104 web: www.cini-india.org Email: firstname.lastname@example.org email@example.com