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  1. 1. A Manthan of reducing “Malnutrition in India”
  2. 2. Problem Statement Malnutrition refers to the situation where there is an unbalanced diet in which some nutrients are in excess, lacking or wrong proportion.
  3. 3. Scope of Broad Problems What is the Problem? The World Bank estimates that India is one of the highest ranking countries in the world for the number of children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub- Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth. The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading countries with hunger situation. It also places India amongst the three countries where the GHI between 1996 and 2011 went up from 22.9 to 23.7 Why it is a Problem? Despite India's 50% increase in GDP since 1991, more than one third of the world's malnourished children live in India. Among these, half of them under 3 are underweight and a third of wealthiest children are over-nutriented. One of the major causes for malnutrition in India is gender inequality. Due to the low social status of Indian women, their diet often lacks in both quality and quantity. Women who suffer malnutrition are less likely to have healthy babies. In India, mothers generally lack proper knowledge in feeding children. Consequently, new born infants are unable to get adequate amount of nutrition from their mothers.
  4. 4. Causes of Problems Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. •Diseases and infections: Malnutrition can be a consequence of health issues such as gastroenteritis or chronic illness, especially the HIV/AIDS pandemic Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. Parasite infections can also lead to malnutrition. •Dietary practices A lack of adequate breastfeeding leads to malnutrition in infants and children, associated with the deaths of an estimated one million children annually. Illegal advertising of breast milk substitutes continues three decades after its 1981 prohibition under the WHO International Code of Marketing Breast Milk Substitutes.
  5. 5. Causes of Problems From 2010 to 2011 •No major Policy Change or Strategy Shift •ICDS Restructuring still in process •New Scheme for Adolescent Girls -Sabla, introduced in 200 Districts •New Responsibilities, but no additional worker •Karnataka Nutrition Mission implementation begins
  6. 6. Reasons for Selecting a Specific Cause Future threats: There are a number of potential disruptions to global food supply that could cause widespread malnutrition. Climate change is of great importance to food security, with 95 percent of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics. According to the latest IPCC reports, temperature increases in these regions are "very likely“. Even small changes in temperatures can lead to increased frequency of extreme weather conditions. Many of these have great impact on agricultural production and hence nutrition. An increase in extreme weather such as drought in regions such as Sub-Saharan Africa would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productivity of many crop species, also decreasing food security in these regions. Colony collapse disorder is a phenomenon where bees are dying in large numbers. Since many agricultural crops worldwide are pollinated by bees, this represents a serious threat to the supply of food. An epidemic of wheat stem rust caused by race Ug99 is currently spreading across Africa and into Asia and, it is feared, could wipe out more than 80 percent of the world’s wheat crops.
  7. 7. Reasons for Selecting a Specific Cause
  8. 8. Reasons for Selecting a Specific Cause
  9. 9. Fighting malnutrition, mostly through fortifying foods with micronutrients (vitamins and minerals), improves lives at a lower cost and shorter time than other forms of aid, according to the World Bank. Tablets of the therapeutic Spirulina dietary supplement. Micronutrients can be obtained through fortifying foods. Fortifying foods such as peanut butter sachets (see Plumpy'Nut and Spirulina) have revolutionized emergency feeding in humanitarian emergencies because they can be eaten directly from the packet, do not require refrigeration or mixing with scarce clean water, can be stored for years and, vitally, can be absorbed by extremely ill children. The United Nations World Food Conference of 1974 declared Spirulina as 'the best food for the future' and its ready harvest every 24 hours makes it a potent tool to eradicate malnutrition. Proposed Solution
  10. 10. Proposed Solution Multi-SectoralSolutions  •Nosingleinterventioncaneradicatemalnutrition  •Thepackageofinterventionsmustbewidelyinter- sectoralsoastoaddressatleastamajorityofthecauses  •Theymustbesimultaneoussothatthebenefitofoneinter ventionisnotlostonaccountoftheabsenceofanother  •Theymustcovertheentirelifecycleofwomenandchildre ntocreateandimmediateimpactwithinonegenerationo nthenutritionalstatusofthethreeciticallinksofmalnutr ition,namely,children,adolescentgirls,andwomen  •Only then can the benefits be sustainable enough to break the inter-generational cycle, and be passed on the next generation.
  11. 11. Proposed Solution Fundamental causes of Malnutrition in India not yet addressed programmatically  Malnutrition in India is deeply rooted in the intergenerational cycle of low birth weight babies, underweight children, malnourished, anemic adolescent girls and pregnant women. However, current policies and programs do not address the issue inter-generationally.  More than 30% population of India suffers from a Calorie-Protein, Micro nutrient Deficit, (CMPD). This factor not yet acknowledged or addressed specifically in any program, (except in general through the TPDS, whose out reach to the lowest percentile of poverty is poor.) Besides, TPDS even if working efficiently only provides for cereals,(and in some cases pulses and sugar,) a subsistence diet for the poor. Until the above two root causes are substantively addressed, existing scattered interventions will have negligible impact on reducing malnutrition.
  12. 12. Essential Interventions to Combat Malnutrition (A)Direct interventions– Related to the consumption and absorption of adequate protein calorie/micro-nutrient rich foods essential to combat malnutrition, namely:  Weighment of child within 6 hours of birth and thereafter at monthly intervals.  Timely initiation of breastfeeding within one hour of birth, and feeding of colostrums to the infant.  Exclusive breastfeeding during the first six months of life.  Timely introduction of complementary foods at six months and adequate intake of the same, in terms of quantity, quality and frequency for children between 6-24 months.  Dietary supplements of all children between 6 months –72 months through energy dense foods made by SHGs from locally available food material to bridge the protein calorie gap.  Safe handling of complementary foods and hygienic complementary feeding practices.  Complete immunization and Vit. A supplementation.  De-worming of all family members bi-annually. Implementation of Solutions
  13. 13. Essential Interventions to Combat Malnutrition  Frequent, appropriate, and active feeding for children during and after illness, including oral rehydration with Zinc supplementation during diarrhea.  Timely and quality therapeutic feeding and care for all children with severe and acute malnutrition.  Dietary supplements of iron –rich, energy dense foods made from locally available food material prepared by women SHGs for adolescent girls and women, especially during growth periods and pregnancy to fill the protein calorie gap and ensure optimal weight gain during pregnancy.  Anaemia screening for children, adolescent girls and women.  Weight monitoring of all adolescent girls and pregnant women.  Prevention and management of Micro-Nutrient deficiencies, especially through IFA supplementation to prevent anaemiain adolescent girls and women.  Making available low cost energy foods for the general population.  Fortification of common foods. Implementation of Solutions
  14. 14. Essential Interventions to Combat Malnutrition (B)Indirect Interventions– Related to issues of health, safe drinking water, hygienic sanitation and socio- cultural factors such as early marriage and pregnancy of girls, female literacy and poverty reduction, to eradicate malnutrition on a long term, sustainable basis.  Access to safe drinking water (treatment, storage, handling and transport), sanitation and hygiene.  Increased female education and completion of secondary schooling for the girl child, delayed age of marriage and pregnancy.  Increased access to basic health services by women.  Expanded and improved nutrition education and involvement at Panchayat and community level to create demand.  Increased gender equity.  Linking Agriculture/Horticulture and Nutrition. Implementation of Solutions
  15. 15. The Mission strategy is based on the following over-arching principles:  Bridge the protein-calorie-micronutrient deficit which affects at least 50% of the population.  Cover the entire life-cycle of women and children so as to break the inter-generational cycle of malnutrition within the shortest possible time.  Formulate a tightly integrated multi-sectoral strategy to address all or majority of direct and indirect causes of malnutrition simultaneously, many of which existing on going programs.  Interventions include Direct interventions, based on adequate food and micro-nutrients, and Indirect interventions, addressing issues of health, education, water, sanitation and socio-cultural, factors that are critical to eradicate malnutrition on a long term, sustainable basis.  Initiate a sustained general public awareness campaign, through the multi-media and interpersonal communication mode to reach the general public, especially at the grass-roots, regarding proper nutritional practices.  Establish vigorous monitoring mechanisms at the administrative and community levels, using participatory mechanisms and cast responsibility upon the respective functionaries for achieving results. Build accountability through intensive monitoring of nutritional indicators in the Mission Blocks by the Mission Secretariat, Community Monitoring, and by third-party evaluations. Impact of Solutions
  16. 16. MEGACOORDINATION Challenges & Mitigation Factors No single Ministry can effect such Mega Coordination. Effective coordination between the Ministries that have substantive primary mandates of their own, requires a Mission Mode, under the leadership of the Prime Minister or Deputy Chairman Planning Commission.
  17. 17. Thank you A Presentation by Aditya Chaturvedi, Ayushi Jain, Ishu Mishra, Asmita Madan, Portia Pachauri