Undernutrition among children under 5 years old remains a major public health problem. It is defined as being underweight, stunted, wasted, or deficient in micronutrients. In India, 33% of children under 5 are underweight. The Integrated Child Development Services program aims to address undernutrition through supplementary nutrition, healthcare, and education for mothers and children. However, the program could be improved by increasing its focus on the most vulnerable groups like pregnant women and young children, strengthening nutrition education, and improving coordination between frontline workers. Addressing undernutrition requires coordinated efforts across sectors like health, agriculture, education, and community participation.

1. Undernourished Children
( under 5 years)

2. Under nutrition is defined as the outcome of
insufficient food intake & repeated infectious
diseases.
It includes
-under weight for one’s age.
-too short for one’s age (stunted).
-very thin for one’s height (wasted).
-micronutrient malnutrition.

3. WHO ARE UNDER WEIGHT CHILDREN?
“The prevalence of underweight children under 5years of age is defined
as the percentage of children aged 0-59 months, whose weights are less
than 2 standard deviations below the median weight for age groups in
the international reference population.”
- It is an internationally recognised public health indicator for monitoring
nutritional status & health in populations.
- It’s a composite indicator influenced both by wasting & stunting. Hence
includes both acute and chronic health condition.
- Its composite nature complicates its interpretation also. Most of the
recent surveys hence include mainly Wasting & Stunting.

4. Age & Sex
Low birth weight
Genetic susceptibility
Prev. nutritional status
Immunization status
Bacteria
Virus
Parasites
Physical &
Chemical hazards
Socioeconomic Status
Geographic area
Cultural Factors
Degree of Urbanization
Availability of essential services
EPIDEMIOLOGICAL TRIAD
HOST
ENVIRONMENTAGENT

5. RISK FACTORS - UNDER NUTRITION
Socio economic
•Lower socioeconomic status
•Patriarchal society
•Educational level
•Cultural influence & social taboos
Biological
•Low birth weight baby
•Poor Infant feeding practices
•Poor Maternal Health
•Diseases
Miscellaneous
• Natural Calamities
• Adulteration of food & uneven
distribution of food
• Unhygienic practices & food habits
• Access & Quality of essential services

6. CHALLENGE OF INTER-GENERATIONAL CYCLE OF
SURVIVAL, GROWTH AND DEVELOPMENT

7. -Early & frequent pregnancy
-improper child spacing
-Inadequate care during
pregnancy
-Inadequate child care
-Improper feeding practices
-Burden of diseases &
infections
-Gender discrimination
-Inadequate growth & Education
-Early marriage, early &
frequent pregnancies with
improper child spacing
-Poor diet & inadequate care
during pregnancy
Low birth
weight
Under nourished,
less aware,
vulnerable
adolescent girls.
Under nourished
mothers

8. UNDERNUTRITION
Macronutrient Deficiency
Protein energy Malnutrition
Kwashiorkor
Marasmus
Micronutrient Deficiency
“ Hidden Hunger ”
Iodine
Vitamin A & others
Iron
Zinc
Short term effects
- Growth retardation,
Appetite loss,poor absorption.
- Immune development
More prone to infections.
Long term effects
- Stunting
- Cognitive development
Attention Deficit disorder
Impaired school performance
Impaired memory, Social skills.

9. WORLD 12.5%
DEVELOPED WORLD 1.4% DEVELOPING WORLD 14.9%
LATIN AMERICA
8.3%
AFRICA
22.9% ASIA
13.9%
Under nutrition causes more than half of all child death worldwide
World Scenario

10. L.America Carriabean S.America
Percentage 8.30% 17.80% 7.70%
8.30%
17.80%
7.70%
Latin America

11. Africa N. Africa Sub Saharan
Percentage 22.90% 2.70% 26.80%
22.90%
2.70%
26.80%
Africa & it's regions

12. Asia Western Southern Central Eastern
Percentage 21% 10.10% 46% 7.40% 11.50%
21%
10.10%
46%
7.40%
11.50%
Asia & it's Regions

13. The “South
Asian
enigma”
South Asian women
have lower status &
less decision making
power.
>30% Indian babies
are born with Low
birth weight
compared with 16%
Sub Saharan Africa.
Hygiene/
Sanitation
standards are
below in South
Asia than Sub
Saharan Africa.

14. THE INDIAN PROFILE
NFHS 4 (2015-2016) <5 under weight data is taken in terms of weight for age.
Total household 291431
Total children 728532.5
Under nutrition in <5 yrs child
241365 ( averaged as per 18
states calculated in India)
33.13%of Indian children <5years is under weight.
India is 17.5% of world’s population but 39% of world’s
undernourished children live in India .
1 in every 3rd undernourished child lives in India .
(world bank report, UNICEF 2011 )
NFHS 4 is averaged of 18 states of India
In every 10 children 3 are under weight in India .

15. India is 17.5% of world’s population but 39% of world’s
undernourished children live here.
1 in every 3rd undernourished child lives in India .
In every 10 children 3 are under weight.

16. Bihar
43.9%
Uttrakhand
26.6%Haryana
29.4%
Madhya
Pradesh
42.8%
Maharashtra
36%
West
Bengal
31.5%Telangana
28.5%
Karnataka
35.2%Goa
23.8%z
Andhra
Pradesh
31.9%
Tamil
Nadu
23.8%
Andaman &
Nicobar
Islands
21.6%
Puducherry
22%
Sikkim
14.2%
Assam
29.8%
Manipur
13.8%
Tripura
24.1%
Meghala
ya
29%

18. Rural, 50%
Urban, 38%
Girls, 48.9%
Boys, 45.5%
RURAL URBAN GIRLS BOYS
%prevalence
Axis Title
% Prevalence under weight<5 INDIA

19. TARGET GROUP MAJOR SCHEMES SERVICES FROM SCHEMES
Pregnant and
lactating mothers
• Integrated Child
Developmental
Scheme ICDS
• National Health
Mission
• Reproductive Child
Health RCH-II
• Janani Suraksha
Yojana JSY
• Janani Shishu
Suraksha
Karyakaram
• ICDS:-Promotion of Breastfeeding,
Supplementary Nutrition, Immunization,
Nutritional Education to Mothers,
Preschool Education, Health Check up &
Conditional maternity benefits.
• NHM:- Antenatal care & counselling , Iron
supplementation, Immunization,
Transportation for institutional delivery,
cash benefit, post natal care, counselling
for breast feeding and spacing of children.
GOVERNMENT PROGRAMMES TO ADDRESS UNDERNUTRITION

20. Children
( 0-3 years)
• Integrated Child Development
Scheme
• RCH –II , NHM
• ICDS:- Supplementary nutrition ,
Growth monitoring, Counselling,
Health education of mother on
child care, Promotion of infant &
young child feeding, Home based
counselling for early childhood
stimulation, referral & follow up of
under nourished & sick children.
• NHM:- Home based new born care,
immunisation, micronutrient
supplementation, Deworming,
Health check up, Management of
childhood illness & sever under
nutrition, referral and cash less
treatment for 1st month of life, care
of Sick newborns , Facility based
management of severe acute
malnutrition & follow up.

21. Children
(3-6 years)
• ICDS
• RCH- II, NHM
• ICDS:- Non formal pre school education, Growth
monitoring, Supplementary Nutrition, Health Check up &
referral, Health Education, Counselling for Care givers.
• NHM:- Immunization, Micronutrient supplementation,
Deworming, Health check up, Management of illness &
severe Under nutrition.
Adolescent Girls
( 11-18 years)
• NHM • NHM:- weekly Iron and folic acid supplementation

22. INDIRECT SCHEMES IMPROVING UNDERNUTRITION
Improving Food
Production, Quality &
Quantity
NFSM: National Food Security
Mission
National Mission for
Sustainable
Agriculture
Rashtriya Krishi Vikas Yojana
Increasing the Purchasing
power of people
MGNREGA- Mahatma Gandhi
National Rural Employment
Guarantee act
Prime Minister’s Employment
Generation Scheme
Improving the Access &
Quality of essential
services
Total Sanitation campaign
Nirmal Bharat Abhiyan
National Rural Drinking Water
Programme

23. FOOD FORTIFICATION
To maintain nutritional
quality of food
To increase the added
nutrition value of food
INDIA INTEGRATED FOOD FORTIFICATION
• Fortifying Complementary food with : Iron, Iodine, Zinc, Vitamin A, Vit.
B complex, Folic Acid.
• Technical & Financial Support is received from GAIN i.e. Global Alliance
for Improved Nutrition.
• Example : Salt fortifying with Iodine.
- Milk with Vitamin A/D.
- Flour , Bread , Rice with vitamin B complex.

24. So, India’s primary policy response to Child Under Nutrition ??
The ICDS Program.
Are results meeting expectations ??
ICDS was designed to address the Multidimensional causes of
Under nutrition.
But still there are repeatedly raised concerns about the mismatches.
What are the concerned areas & how to improve the nutritional
status??

25. CONCERNED AREAS? HOW TO IMPROVE THE EFFECTIVENESS
1. Poor Target Based Approach:-
Designed to address the
Intergenerational cycle but
focused more on older
children i.e. 3-6 years.
2. Mismatch between Original
intention & Actual
implementation i.e. focusing
more on food
supplementation.
• Increase focus on Pregnant women & Young
children of age 0-3 years.
• Strengthen Nutrition & health Educational
activities.
• Targeting more on high risk groups.
• Improve the childcare behaviours.
• Counselling Parents about proper nutritional
requirements with Demonstration Education to
mothers.

26. 3. Lack of Coordination
between AWW & ANM,
hampering the early detection
& treatment.
4. Design is standardised.
• Improve the Coordination, home visits,
outreach activities.
• Strong Monitoring & Evaluation
system.
• Introduce flexibility & Decentralise
responsibility according to local needs
& area.
• More Funding to poorer state with high
under nutrition prevalence.
• Improving the Anganwadi centre
infrastructure.

27. What more can be done?
1. Inter department Synergy
(ICDS+NHM+MGNREGA, Primary Education + RCH)
2. Community Participation in service delivery (Mahila mandal with AWW)
3. Improve Opportunity: Developing small & medium scale enterprises.
4. Increase Use of science & technology In Agriculture to enhance food
Production and Supply.
5. All these require Political , Social & Economic efforts and Commitment.
6. More active & Strengthening Mass Media Campaign.

28. “We are guilty of many errors and many faults
But our worst crime is abandoning children,
Neglecting the foundation of life.
Many of things we can wait.
The Child cannot.
Right now is the time his bones are being formed ,
his blood is being made
and his senses are being developed.
To him we cannot answer tomorrow.
His name is today.”
Gabriela Mistral.
1948

29. ZERO
HUNGER
CHALLENGE
“ IN THE FIGHT AGAINST MALNUTRITION, KNOWLEDGE IS POWER ” -UNICEF