Malnutrition continues to be a major problem in India, with over 50% of under-5 deaths contributed by malnutrition. The prevalence of undernutrition, as measured by wasted, stunted and underweight children under age 3, has declined slightly from NFHS-2 (1998-1999) to NFHS-3 (2005-2006) but remains very high. Multiple factors contribute to malnutrition, including improper feeding practices like non-exclusive breastfeeding, poor hygiene and sanitation, as well as inadequate care and support from families and communities. Addressing malnutrition requires interventions across pregnancy, birth to age 2, and adolescence focused on nutrition, health care, immunization, and behavioral change. Community participation is key to early detection,

1. PRESENTED BY
DR N C DE
DR S K MISHRA

2. PICTURE OF MALNUTRITION
0
10
20
30
40
50
60
70
80
NFHS-2
(98-99)
NFHS-3
(05-06)
WastedStunted Under weight Anemia
51 45
20 23
43 40
74 79
Comparison of under-nourished
Children Under 3 years of age
10 Million under 5 die in the world,
2.2 million in India
More than 50% of them contributed by Mal
nutrition

3. PREVALENCE OF MALNUTRITION
State IMR Under nutrition
India 57 43
W. B 48 39
Orissa 65 41
Kerala 15 23

4. Not by Food alone
FOOD/ENERGY HEALH CARE
LOVE & CARE

5. The pot remains
empty.
Recurrent infections drain
Nutrition.
Nutrition

7. Malnourished Child
Low Birth Weight
<2.5 Kg Adolescent
Malnourished
adult woman
Early MarriageEarly Marriage

8. Improper Feeding
& Infection
Nutrition
intervention
What goes wrong…What goes wrong…
•Non Exclusive Breastfeeding
•Improper complementary food
•Poor hygiene, sanitation and
immunization
•Too-many too soon
•Inadequate care & Support by
family/community

9. I. Pregnancy
II. Birth – 2 Yrs.
III. Adolescents
Growth Spurt / Empowerment
Birth

10. Care in PregnancyCare in Pregnancy
Health and Nutrition – (Antenatal Care)
Safe Delivery
Post Natal Care
Good Referral System ( Emergency Obstetric service
& care of sick new born)

11. Care of the Infant.Care of the Infant.
Care of the New Born at Birth.
Exclusive Breast-feeding
Appropriate complementary feeding with Continued
breast-feeding.( IYCF)
Immunization
Growth Monitoring
Referral

12. Adolescent CareAdolescent Care
Health, Nutrition & Education
Family life education.
Capacity Building (Self Esteem)
Prepare for useful member of the family and the society

13. Who will do & How ?Who will do & How ?
Existing Government Departments/Systems – ICDS
(AWW), NRHM (ANM, ASHA )
NGOs
CBO/PRI (VHC)
Community Participation and ownership-
accountability/sharing responsibility.

14. Who & How (contd.)
Early detection & referral.
Prompt and effective quality service.
Follow-up and prevention of relapse.
Treatment of Severe Acute Malnutrition (SAM) with
complications at Hospital /NRC.
Community/Home based management for those
without complications.

15. Training NeedTraining Need
Up-gradation of Knowledge , Skill & Motivation
Behavior Change Communication (BCC)
Practical Hands on Training
Stress on IMNCI.

16. SIMPLE INEXPENSIVE NUTRITION
INPUTS
Exclusive Breastfeeding-Six months
Home-made complementary Food along with
continued Breastfeeding.
Hygiene&Sanitation, Immunization and removing
superstitions of all kinds.
Growth Monitoring and Promotion.
Early Childhood Stimulations, love and Care.

17. Positive Deviance Approach.Positive Deviance Approach.
Some children grow better in spite of same
adverse socio-economical environment as that of
their counterpart due to improved feeding and
caring practices. The process is called Positive
Deviance Approach.
It encourages community participation, learning
by doing, self reliance and sustainability.

18. Challenges to be met.Challenges to be met.
• Community empowerment, sharing responsibility
and accountability for development of a true Child
and Woman Friendly Community (CWFC).
• Provision of quality health services and delivery
of integrated nutrition package (true convergence).
• Development of communication skill at every
level for bringing in behavior change.

19. Concluding paragraph.Concluding paragraph.
“Ultimately, there is nothing as important as
informed public discussion and the participation
of the people in pressing for changes that can
protect our lives and liberties. The public has to
see itself not merely as a patient, but also as an
agent of change. The penalty of inaction and
apathy can be illness & death.”
--Concluding remark by
Amartya Sen in “Health in Development”
Keynote address to fifty Second World Health Assembly, Geneva,
May 1999 {Bulletin of the WHO, 1999(77)}

20. AccountabilityAccountability
and sharing responsibility.and sharing responsibility.
Thank youThank you