1) The document discusses the Spoken Tutorial Project of IIT Bombay which creates audio-video tutorials on breastfeeding and child nutrition topics. 2) Over 75 topics have been covered in various Indian languages and made available for free online and offline self-learning. 3) The methodology involves training frontline workers, mothers, and healthcare providers who can then conduct local trainings and monitor growth of young children. Several success stories from implementation areas in India are highlighted.

1. The Spoken Tutorial Project- IIT Bombay
Dr. Rupal Dalal, MD (USA) IBCLC
Adjunct Associate Professor, Dept. of CTARA, IIT B
Director of Health & Nutrition, Shrimati Malati Dahanukar Trust, Mumbai
Pediatric Urgent Care Provider, Santa Clara Valley Medical Hospital, San Jose, USA

2. Introduction & Objectives

3. Nutritional Status of Children under age of 5 (All India)-NFHS 4
19.75
22.11
19.50 19.11
24.80
43.8 42.80
41.50
24.7
30.1
26.9 26.2
29.5
35.7
37.7 38.6
34.3
31.1
29.9
28.7
27.3
21.6
18.7 17.8
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
0-2 m 3 m 4-5 m 6 m 7-12 m 13-24 m 25-36 m >36m
Nutritional Status according to child age (Months)
Stunted % Underweight % Wasted %

4. WHO Growth Charts

7. Why Every Mother Needs Help
Whether Mother is in Western World or in Tribal or Slum Area….

8. Sample of 532 First Time Mothers at UC Davis Hospitals, CA1
92% of the new moms reported at least one breastfeeding concern
Mothers' complaints on day 3
52 % Not feeding well at breast
44% Breast feeding Pain
40% Perceived lack of sufficient
milk
Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with
peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0–infinity]). The concerns yielding the largest
adjusted PAR for stopping breastfeeding were day 7 “infant feeding difficulty” (adjusted PAR = 32%) and day 14 “milk quantity” (adjusted
PAR = 23%)

9. Some of the Growth Charts of our Babies

10. 2 Different Children from Orissa.. Both gaining at 40grams/Day
BF Latching
BF Latching

11. Weight(kg)
0 1 2 3 4 5 6
2
4
6
8
10
3/97 % 5/95 % 10/90 % 25/75 % 50 %
Age (months)
Weight(kg)
0 1 2 3 4 5 6
2
4
6
8
10
3/97 % 5/95 % 10/90 % 25/75 % 50 %
Age (months)

13. Growth Failure (WFA, WFL)-Change in 17 Days for WFL
Bf Latching

23. 973 children
< 6 months
163
single visit
806 children
> 1 visit
(2 – 106 visits)
49% Female
8% <= 2.5 kg
Median Age (IQR),months 1.9 (0.8,
4.1)
X
4
Incomplete
Data
969 Children
< 6 months
Weight – Digital scale
Length – Recumbent length
board
Plotted on WHO chart
X
DATA
8806 visits which included all available electronic record visits on term and
preterm children that had joined the program at under 6 months of age and
left the program within the last 2 years (January 2011 – March 2017) that
were exclusively breastfed on starting the program

26. UNDERWEIGHT p= < 0.001
N = 806 Healthy Moderate Severe
Baseline n 592 137 77
Final n 644 121 41
50% reduction in Severe Underweight status

30. Acute Malnutrition

31. WASTING p=0.001
N = 765 Healthy Moderate Severe Overweight
Baseline n 652 70 30 13
Final n 691 55 10 9
30% reduction in overweight 75% reduction in severe wasting

34. Acute Malnutrition

35. Moderate Acute Malnutrition

36. Stunting in our Data set

37. STUNTING
Healthy Moderate Severe
Baseline n 764 105 73
Final n 764 127 54

41. Case Study of a Tribal Family

43. 2 year old Sanskruti with her 3 year old Cousin
Brother – 3 Kg BW

44. Tribal areas of Melghat, Maharasthra

46. Effective Breastfeeding Technique

48. Spoken Tutorial Project

49. What is a Spoken Tutorial (ST)?
● It is a 10 minute long audio-video tutorial, created
through screen capture, with a running commentary.
● A script, approved by a beginner as
understandable, is used to create the material.
● It is designed for self learning.
● A set of tutorials is prepared in English.
● The audio of each tutorial is translated and
dubbed into all 22 Indian languages to make it
accessible to people in their native language.
● The entire set can be downloaded and used
offline, so that one can conduct training
programs without internet. One can access
them through mobiles as well.
● Both ST and the open source software trained
by them are available free of cost to everyone.
“The target audience for Spoken Tutorials is a girl in a remote village, who gets
time to learn new skills only at night. As she cannot contact anyone for help at
that time, the learning material should be suitable for self learning.”

50. Spoken Tutorial for MIYCF
● The well proven Spoken Tutorial Technology is now extended to nutrition training, with the initial
focus being on the first 1,000 days of a baby.
● A team of five creators and five animators, led by a Ph.D graduate, and guided by Dr. Rupal Dalal, is
creating these tutorials.
● The first lot of 26 tutorials, with a focus on techniques and skills of breastfeeding, has been launched
on ST website and YouTube in 15 languages.
The entire series is created using graphics and
animation with simultaneous narration in simple
words to help illustrate the respective topics with
maximum clarity.

51. Large Scale Training on Nutrition through Spoken Tutorial
Methodology
Target audience:
● Urban and
rural parents
● HCWs
● Anganwadi
workers
● ANMs
● ASHAs
No dilution of
knowledge:
Script is checked
multiple times by
domain expert
before recording.
Aims to cover the
entire Indian
landscape:
Will be translated
and dubbed in 22
official Indian
languages.
Designed for self-
learning:
All volunteers who
have undergone this
training can
themselves conduct
such trainings.
Easy to share a link
with the mother
when needed:
Accessible on
smartphones
through ST website
or YouTube for free.
Those who don’t
have a smartphone
can undergo this
training through
Aakash tablets
provided by IIT
Bombay.
These tutorials can
also be played in
hospitals and
government health
care centres.
The large IT training
Spoken Tutorial
network can be
used to scale up
nutrition training in a
big way.

52. www.spoken-tutorial.org/series
(For mobile phones: Works only on Firefox web browser)

55. Written Exam For Each Tutorial

59. Topics – 75 Topics
● Cross Cradle Hold for breastfeeding
● Football Hold for breastfeeding
● Cradle Hold for breastfeeding
● Side-lying Hold for breastfeeding
● Laidback Hold for breastfeeding
● Breast Crawl
● Breastfeeding latching
● Physical Methods to Increase Milk Supply
● Breastfeeding Difficulties
● Nipple Conditions
● Breast Conditions
● Kangaroo Mother Care (KMC)
● Newborn Care
● Newborn Bath
● Growth Charts
● Hand expression and safe storage of
breastmilk
● Basics of Nutrition
● Types of Micronutrients
● Importance of 1st 1000 Days
● Essential Nutrition Action
● Pregnancy Nutrition Requirements
● Lactating Mother Nutrition Requirements
● Complementary Foods Basics
● Homemade nutritious powder recipes
● CF recipes for 6-8 months
● CF recipes for 9-11 months
● CF recipes for 12-23 months
● Safety and hygiene in preparation, feeding and storage
of complementary foods
● Recipes for Pregnant Mothers
● Recipes for Lactating Mothers
● Responsive Feeding
● Behaviour Issues of children
● Recipes rich in individual micronutrients

60. Pedagogical Approach

61. Master
TrainerSpoken Tutorial &
Workshops
Medical
Officers
Ayush
Asha
Mothers
ANMs
Mothers
Staff
Nurse
Mothers
AWWs
Other AWWs and Mothers
Asha
Other Ashas and Mothers

62. Watch ST
Video
Take
Written
Exam
Attend
workshop
Practical
Training
under
supervisor
Follow 10
Babies, if
any poor
weight gain

63. Follow Up & Monitoring Tool

64. Under 6 months Babies

65. 6 Months to 5 years

66. Sabarkantha
District MOs, ANMs
and Ashas
areTrained Using
ST Methodology

68. Exams Taken By ANMs

70. Ashas Training by MO & Practical Demonstration to District
Hospital Nurses

71. ANC Mothers Learning from ST & MO
Asha learning on Breast Model and Baby Doll

72. Latest from Sabarkantha District (Stunting 51%)
BW: 2.2 kg, 3 month: 6.45 Kg
BW: 2.6 Kg, 2 months: 4.890 Kg

73. TRAINING WITH SPOKEN TUTORIALS

74. TRAINING WITH SPOKEN TUTORIALS

75. TRAINING WITH SPOKEN TUTORIALS

76. Maa aur Shishu Poshan Helpline
1 800 200 2098*
* Reliance is shutting the service so number will change as
of 1st January 2020

77. Maa aur Shishu Poshan Helpline - 1800 200 2098
It is a toll free helpline for mother and child nutrition developed by Prof. Kameswari and team from the
Computer Science department of IIT Bombay.
1. Four categories
● Premature and
undernourished
babies
● Breastfeeding
● Child nutrition and
complementary
food
● Mother’s nutrition
2. Five languages for
callers & volunteers in
the App interface
● English
● Hindi
● Marathi
● Gujarati
● Tamil
3. Volunteers
● Doctors
● Lactation
consultants
(IBCLC)
● Dietitians and
Nutritionists
● Nurses
● Trained HCWs
4. Written records
● Category of each
call
● Question asked in
each call
● Answer provided
by the volunteer in
each call
● Feedback given
by the caller

80. Some Before and After Pictures of
Children of Tribal Area of
Dharampur, Gujarat
Consent of parents is taken..c

81. Success Stories

95. Tribal areas of Palghar, Maharashtra

96. Twins Children of Palghar Area

100. Rural areas of Shrirampur, Maharashtra

107. Urban Slum, Mumbai

108. Happy Mothers & Happy Babies

111. Thank You…….