NOURISH TO FLOURISH :
WAYS TO TACKLE MALNUTRITION
ANURAG DUTTA CHAUDHURY
HAMZA RAZA ZAIDI
SOME FACTS -
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
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, while 78
out of the 81 developing
countries studied, including
Pakistan, Nepal, Bangladesh
and Zimbabwe succeeded in
improving hunger condition.
25% of all hungry people
worldwide live in India.
Malnutrition causes 45 per cent
of deaths of under-five children
The UN ranks India in the
bottom quartile of countries by
under-1 infant mortality (the
53rd highest), and under-5 child
mortality (78 deaths per 1000
According to the 2008 CIA fact
book, 32 babies out of every
1,000 born alive die before
their first birthday.
A MULTI CASUAL PROBLEM :
embedded in social
Lack of information
Low status of
Early marriage of
Early & frequent
Lack of information
specific objective of
care services for
women and children.
Low access to safe
drinking water and
No action based
Photo : RupsaCPhoto : Chaurahha…The Crossroad
FUNDAMENTAL CAUSES OF MALNUTRITION IN INDIA NOT YET
ADDRESSED PROGRAMMATICALLY :
Malnutrition in India is deeply rooted
in the inter-generational cycle of low
birth weight babies, underweight
children, malnourished, anemic
adolescent girl sand pregnant women.
However, current policies and
programmes do not address the issue
More than 30% population of India
suffers from a Calorie-Protein,
Micronutrient Deficit, (CMPD)*
This factor not yet acknowledged or
addressed specifically in any
programme(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.
TPDS does not provide adequate
calories, protein or micronutrients
for a healthy life. *(NNMB repeat surveys, 1988-90, 1996-97, NNMB Technical Reports No.20, 21, 22, 2000-03)
There is inadequate awareness and
information regarding proper
nutritional practices amongst the
population, even with in existing
At least 10-15% of the population
suffer from malnutrition not because of
poverty/lack of purchasing power but
because of lack of awareness and
In spite of the 11th Plan
recommendation for initiating a
nutrition awareness generation
campaign, it has not yet happened.
1 2 3
*TPDS : Targeted Public Distribution System
PROVIDE MICRO-NUTRIENT SUPPLEMENTS FOR FREE TO
MALNUTRITIOUS CHILDREN AND PREGNANT WOMEN'S
proteins & water) are
needed for energy and
cell multiplication &
Micronutrients are trace
elements & vitamins,
which are essential for
Resolves diseases caused
by Iron, Zinc, Iodine and
Vitamin A deficiency.
What are Micronutrient ?
The majority of world’s
children live in developing
Lack of food & clean
water, poor sanitation,
infection & social unrest
lead to LBW & PEM.
Malnutrition is implicated
in more that 50% of deaths
of less than 5 years of
children (5 million per
Diarrhea ARI Perintal causes Measles Malaria
55 % of total have malnutrition
Proposed Solution -
LBW : Low Body Weight
PEM : Protein Energy Malnutrition
ANC : Antenatal Care
EBF : Exclusive Breast Feeding
Conceptual Interpretation - 6
Mid Day Meal
Kishori Shakti Yojana
National Rural Drinking
Current Nutrition Related
address some causes
of Malnutrition but
not all of them and
In the absence of
and often isolated
interventions are lost
on account of
absence of other
Proposed Micro-Nutrient Nutrition
“To provide multiple vitamin and mineral supplements for
pregnant and lactating women, and for children aged 6 to 59
Introduce nutrition and micro-nutrient interventions for the
three critical links of malnutrition viz. children 6 months to 6
years, adolescent girls, and pregnant and lactating women
to be prepared by Collaborations of Scientists, based on
research of the past and present.
Several Formula’s of these Micro-Nutrients are already been
made and used in emergencies(Natural Disasters) by WHO.
Introduce nutrition and micro-nutrient interventions for the
general population to bridge the protein-calorie gap by making
available in the market, protein-energy dense foods for free.
Structure and monitor tightly integrated multi-sectoral
interventions to address all or majority of the direct and indirect
causes of malnutrition simultaneously.
Initiate a sustained general public awareness campaign
regarding proper nutritional practices within existing
family budgets, and to create demand. SHG : Self Help Group
ROADMAP OF SOLUTION PROVIDED -
by Team of
of the MN Food.
available at different
government stores such
as TPDS for free.
Form an effective
external agency) for
effective changes & mid
Initiate a Public
awareness campaign, to
reach and inform about
MN Food and proper
Since, this is a Research Based Project, estimated budget for this project
would depend upon time and material consumed during research and its
mass production and feasibility for the poor.
Micronutrients Pregnant Children
Women (6-59 months)
Vitamin A µg 800.0 400.0
Vitamin D µg 5.0 5.0
Vitamin E mg 15.0 5.0
Vitamin C mg 55.0 30.0
(vitamin B2) mg
Vitamin B6 mg 1.9 0.5
Vitamin B12 µg 2.6 0.9
Folic acid µg 600.0 150.0
Iron mg 27.0 5.8
Zinc mg 10.0 4.1
Copper mg 1.15 0.56
Selenium µg 30.0 17.0
Iodine µg 250.0 90.0
The composition of multiple micronutrient supplements
for pregnant women, lactating women, and children
from 6 to 59 months of age, designed to provide the
daily recommended intake of each nutrient (one RNI)
MicroNutrient Food used during Emergency by WHO & UNICEF
The recommended daily intake of
micronutrients is to provide foods
fortified with micronutrients.
Fortified foods, such as corn-soya
blend, biscuits, vegetable oil
enriched with vitamin A, and
iodized salt, are usually provided
as part of food rations during
The aim is to avert
micronutrient deficiencies or
prevent them from getting worse
among the affected population.
Such foods must be appropriately
fortified, taking into account the
fact that other unfortified foods
will meet a share of micronutrient
We can implement the
same concept to tackle
Malnutrition in India
However, foods fortified with
micronutrients may not meet fully the
needs of certain nutritionally vulnerable
subgroups such as pregnant and lactating
women, or young children.
For this reason UNICEF and the WHO
have developed the daily multiple
micronutrient formula(shown in Table
on the left) to meet the Recommended
Nutrient Intake (RNI) of these
vulnerable groups during emergencies
Target Groups Fortified Food
rations are NOT
1RNI each day 1 RNI each day
1 RNI each day 2 RNI each
Schedule for giving the multiple micronutrient
supplement shown in Table 1 which provides a
daily recommended nutrient intake (1 RNI)
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:
Weightment of child within 6 hours of birth and thereafter at
Timely initiation of breastfeeding within one hour of birth, and
feeding of colostrum to the infant.
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.
Fortification of common foods.
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.
(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
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 of basic health services to women.
Expanded and improved nutrition education and involvement at
Panchayat and community level to create demand.
Increased gender equity.
Linking Agriculture/Horticulture and Nutrition.
Challenges and Implementation
Since at least 4% of India’s GDP
($29 Billion) annually is lost on
account of malnutrition, the cost of
addressing malnutrition is far
below the cost of not addressing it.
Investing in human resources
development for the future – in the
shape of healthy children, adolescents
and adults with higher cognitive and
productive capacity, is an
investment that will pay for itself
several times over
The project will eradicate the curse of
malnutrition in the shortest possible
time, so that every Indian is able to
reach his or her full physical and
cognitive potential, enhance income
generation capacity and contribute
to the country's progress.
Positive Aspects of Project :
Bridge the Protein-calorie-micro
nutrient deficit which affects at least
50 % of the population.
This project formulate a tightly
integrated multi-sectoral strategy to
address all or majority of direct and
indirect causes of malnutrition
simultaneously, many of which exist in
on going programmes.
Community based nutrition
monitoring and surveillance through
ICDS infrastructure could help
growth monitoring of infants and
children and weight monitoring of
adolescent girls and women.
Government is not interested in any
research funding project
Processing cost of micro-nutrition
food can not be easily predicted.
Difficulty in convincing
malnutricious population about the
project i.e. to take MN Food.
Time taken for extensive scientific
research will make this project slow
just in initial phase, but once its done,
government can help process MN
food at a faster rate.
THANK YOU FOR PAYING ATTENTION !!
India’s Malnutrition: A Multi-Sectoral Solution : Report by Veena S Rao
The Micronutrient Report by John. B. Mason, Mahshid Lotfi, Nita Dalmiya, Kavita Sethuraman and Megan Deitchler
Child malnutrition in India: Why does it persist? : Report by Sam Mendelson with input from Dr. Samir Chaudhuri (CINI)
Children in India 2012 - A Statistical Appraisal : Report by Ministry of statistics and Programme Implementation, Government of India
India’s Undernourished Children - A Call for Reform and Action : Report by Michele Gragnolati, Meera Shekar, Monica Das Gupta,
Caryn Bredenkamp and Yi-Kyoung Lee August 2005
Preventing and controlling micronutrient deficiencies in populations affected by an emergency : Report by Joint statement by the World
Health Organization, the World Food Programme and the United Nations Children’s Fund
Why malnutrition in shining India persists by Peter Svedberg