Nourish To Flourish
Reducing Malnutrition In India
Akash Raval (Co-ordinator)
Malnutrition And India
1 of every 3 malnourished children live in India
About 50% of all childhood deaths are attributed to
In India, around 46% of all children below the age of
three are too small for their age
7% are underweight and at least 16% are wasted.
Many of these children are severely malnourished
Gross domestic product (GDP) loss to malnutrition runs as
high as 3 to 4%
Under-nutrition is the underlying cause for about 50% of
the 2.1 million Under-5 deaths in India each year.
Productivity losses to individuals are estimated at more than
10% of lifetime earnings
If every child was breastfed within an hour of birth, given only
breast milk for their first six months of life, and continued
breastfeeding up to the age of two years, about 220 000 child lives
would be saved every year globally. (4i)
Children who are breastfed have a 20 percent lower risk of
dying between the ages of 28 days and 1 year
Breastfeeding provides protection from diseases like Diarrhea
What UNICEF has to say of India
In addition to containing health enhancing enzymes, proteins
Ignorance in Breastfeeding
Why Timely Breast-feeding is so Important ??
Alloting a high budget on breast
feeding awareness programs
Initiating programs such as village
play, which promotes the
breastfeeding and child care
Advertising the related materials at
prime times and especially during
Inadequate functioning of PDS leading to lack of essential food to the needy
The Package provided at fair price shops should be revamped,
to include other supplement's like iodized salt, edible oil, Pulses
Providing fortified blended foods (FBFs, such as Corn Soy
Blend or Wheat Soy Blend) to groups with higher nutritional
needs, such as the moderately malnourished, and pregnant and
Network of the PDS should be more broader and should
primarily focus on slum and hilly areas where malnutrition
affects the most
Inclusion of ORS(Oral Rehydration Salts) in the PDS
structure can help children from Diaheria
Expand availability of low cost nutritious food in rural areas
through PDS, Public Private Partnership, Women self help
group and other mechanisms
Inclusion of high quality complementary foods for children of
age group 6-24 months in PDS
World Food Programe has a variety of food
developed to tackle malnutrition this can be
incorporated in the PDS Structure and can be
provided to the needy
For treatment of moderate acute malnutrition
and stunting it should include:
Super Cereal Plus which has key ingredients of
Corn/wheat/rice soya, milk powder, sugar, oil, V&M
for children of 6-59 months . The profile includes
394-787 kcal, 16-33g protein (17%), 10-20g fat (23%).
Super Cereal which has key ingredients of
Corn/wheat/rice soya, V&M for Pregnant and
Lactating Women and Malnourished Individual . It
includes 376-752 kcal, 15-31g protein (16%), 8-16g fat
Micronutrient Powders which has key ingredients
of Vitamins and minerals.
Source : WFP Specialized Nutritious Foods Sheet
Plans to Improve the PDS
Though the Government of India runs about 6 direct and 6 indirect policies for
fighting Malnutrition , but it doesn't reaches the targeted audience !!
Thailand: Halved child malnutrition between 1982 and
1986 (from 50 to 25 percent in less than a decade)
Thailand’s 2nd National Health and Nutrition Policy
(1982–86) focused on targeted nutrition interventions to
eliminate severe malnutrition as well as on behaviour
change and communication to prevent mild to moderate
Government Of India funding for Integrated Child Development Services (ICDS) in 2001-2002
increased to 1311.2 crore !! Still its ineffective.(6i)
China: Reduced child malnutrition by more than half
between 1990 and 2002 (from 25 to 8 percent in 12
China pursued a successful poverty alleviation strategy
along with rapid economic growth.
Effective nutrition, health, and family-planning inter-
ventions were implemented at a large scale.(6ii)
Failure of the Government Policies is due to :
All of these programs have potential, but they do not form a comprehensive nutrition strategy, and they have
not addressed the nutrition problem effectively so far.
For example, several evaluations of ICDS have shown it to have low coverage, poor targeting, and little impact
on reducing child Malnutrition.
Furthermore, the different programs are often poorly integrated, with some households receiving benefits
from a number of sources and others remaining excluded.
Nutrition should be integrated within the National Economic and Social Development Plan, and
linkages between agriculture and nutrition needs to be established, ensuring sustainability.
A strong local, action-oriented surveillance system allowed for monitoring and evaluating
Nutrition and health programs and policies should be redesigned to implement them
synergistically and at scale to effectively address the main nutrition problems.
Efforts should be focused on states, districts, and communities with the highest
concentration of poor and vulnerable households, and on more vulnerable individuals within
What needs to be looked upon currently
To accelerate progress in reducing child malnutrition in India, the most urgent policy changes
Expanding the scale, improving the targeting, and strengthening the implementation of existing
programs and policies.
Building analytical and monitoring capacity ensuring that programs and policies are effectively
pro-poor and pro-nutrition and that they focus on improving women’s status.
Special attention is needed in the states that carry the highest burden of child malnutrition.
Mid Day Meal for 200 days in a year as suggested by
Supreme Court For Primary School :
480 calories and 8-13 gm protein
For Upper Primary :
700 calories and 12-20 gm protein.(8ii)
MDM was introduced to improve the nutritional status of children by the food being
given to them.
As this scheme can directly affect the children and a proper implementation can have a
sufficient improvement in the nutritional status special emphasis should be given on it
94% of children in the age group of 6 to 9 are
mildly, moderately, or severely underweight.
About 67.5% of children under 5 years and 69%
of adolescent girls suffer from anaemia due to
iron and folic acid deficiency. (8i)
Of the 2000 calorie specified only provision for
700 is made.
Pilferage and adulteration of grains occurs
since grains are supplied and distributed in
loose form to schools .
What Goes Wrong ?
Introducing private enterprises in the running of the MDM
scheme may be a better idea than governmental agencies
themselves getting involved as it would save time that is
wasted by teachers in serving and could concentrate on
Efficiency of the nutrition delivery could be increased by
offering fortified packaged foods.
In fact, menu could include local ready-to-eat chikki and
sukhdi or an occasional nutrition bar.
Golden Rice an GM variety of rice is a naturally fortified in
terms of nutrients such as beta-carotene. Use of Gold Rice
rice in MDM scheme may improve nutritional delivery to the
Partial substitution of delivery of loose grains by packaged
items may also improve accountability in the supply chain.
Failure to include nutrition
concerns in major cropping
and farming Systems
The Problem Lies Here
Limited availability of nutrient rich foods Seasonal food shortages
Large spending on agriculture increases the
overall yield but the approach is not a
sustainable one hence affecting the food
crop in the long run
Agricultural institutes to be made accountable for reform in agricultural practices
Reason for choosing this
1.Better knowledge on the specific natural plantation of the area
2.Scientific approach to agricultural practices
3.New and Indigenous varieties of food crop seeds available
Methodology to be
1.Directly guiding the farmer on know hows of sustainable agriculture
2.providing small land holding farmers with quality seeds and tools.
3.Encouraging R&D in this field.
4.Submission of an annual report on the statistics of production.
Resources needed 1.Setting up of such new educational institutes
2.Funding for R&D in food technology for sustainable developement
The agricultural sector of each state or few together should be under direct control of an
agricultural university or agro-research Organizations or such Institutes
Each institute should look into
condition and need of the local
Special programs for farmers'
Devising and implementation of
reformed and scientific
More emphasis on the locally
grown crops ex-reviving the
plantation of litchi in Bihar, guar
in places with water scarcity like
Gujarat and Rajasthan
Promoting food crops rich in
protien content like soyabeans
and other low cost nutritious
food like flax seed
Promoting alternative option to
high cost dal with keshari and
other low cost but high potein
Being well informed with the
latest technology around world
in agricultural practices and
Can be helpful in getting
subsidies or aid from
and locally grown food crop
Tieing up with other
Products for Fighting
1) Measure height and weight to get a BMI (body
mass index) score. (BMI kg/m2)
BMI >20 (>30 obese), score 0
BMI 18.5 to 20 - score 1
BMI <18.5 - score 2
2) Note percentage unplanned weight loss in last 6
<5% - score 0
5% to 10% - score 1
>10% - score 2
3) Establish acute disease (any underlying illness,
such as a psychological condition) effect
If the patient is acutely ill and there has been or is
likely to be no nutritional intake for over 5 days -
4) Add scores from steps 1, 2 and 3 together to
obtain overall risk of malnutrition
Low Risk - Score 0
Medium Risk - Score 1
High Risk - Score 2 or more
Low risk, score 0 :
Keep a track of your intake and
have proper screening periodically
Medium risk score 1 :
Document dietary intake for 3
days and consult clinic, if approved
follow or change it
High Risk Score 2
Improve and increase overall
Monitor and review care plan
5) Use management guidelines and/or local policy to develop care plan.
British Association for Parenteral and Enteral Nutrition's MUST (Malnutrition Universal
Screening Tool ) Method for diagnosing malnutrition
• 2i - http://www.unicef.org/infobycountry/india_statistics.html
• 4i - http://www.who.int/mediacentre/factsheets/fs342/en/
• 4ii - http://www.babycenter.com/0_how-breastfeeding-benefits-you-and-your-baby_8910.bc
• 4iii –http://tribune.com.pk/story/596576/natural-advantages-breastfeeding-week-from-aug-26-31/
• 5i – World Food Program Specialized Nutritious Foods Sheet
• 6i – India’s Undernourished Children: A Call for Reform and Action by Michele Gragnolati, Meera Shekar,
Monica Das Gupta,Caryn Bredenkamp and Yi-Kyoung Lee
• 6ii - Accelerating Progress toward Reducing Child Malnutrition in India , Jan 2008
• 8i - National Programme 0f Mid Day Meal in School [MDMS] Annual Work Plan & Budget 2010-11 Name of
the State : Chhattisgarh , Page 7
• 8ii - Mid-Day Meal Programme (Annual Work Plan & Budget 2013-14) , Page 1