In this presentation, I highlight major areas of nutrition and allied interventions for school child-young adolescents, which was made for field workers' capacity building training at CHETNA, Ahmedabad in early 2018

1. Prof. Shubhada Kanani
Sr Nutrition Specialist
Adjunct Professor, Parul University
(Former Prof, Dept of Foods and Nutrition,
M.S. University of Baroda )
Presented at CHETNA, Ahmedabad
2018
School Child and Adolescent
Nutrition –
Investing for a Healthier
Tomorrow

2. The harm done by undernutrition
continues for generations
Adolescent is a good entry point to break the
inter-generational cycle of malnutrition
Child Growth Failure
Low Birth
Weight Baby
Early Pregnancy Low Weight
and Height in
Adolescence
Small Adult Women
Shubhada Kanani, 2018

3. Adolescent girls
•School dropout
•Poor self esteem
•Foods likes and dislikes
•Inadequate diet
•Compromised pubertal and adolescent growth
•Anemia
Linkages between Nutrition and Reproductive Child Health
•Stunted
•Underweight
• anemic
Early Marriage
High Obstetric risk Shubhada Kanani, 2018

4. As maternal BMI improves, prevalence of low
birth weight newborns decreases.. Begin with
improving the adolescent girls’ nutritional status
Shubhada Kanani, 2018

5. ACTION AREAS - ADOLESCENT GIRLS
• REDUCE ANEMIA AND UNDER NUTRITION
• DELAY AGE OF MARRIAGE AND FIRST
PREGNANCY
• Strengthen Govt Adol. Programs to
improve growth and reduce anemia
•Strengthen weekly IFA program;
improve IFA intake through
monitoring and counseling
•Mamta day /NHM to focus on
adolescent nutrition.
• Nutrition education needs attention
towards adolescents
•Social interventions – delay age of
marriage and first child
Shubhada Kanani, 2018

6. Nutritional needs of Adolescence
 Growth velocity fastest in infancy and
adolescence : demands for nutrients rises
 Weight and height gain more in early
adolescence 80% during 10-15 y
 Recommended dietary allowance (RDA)
for some nutrients are among the highest
in this age group
 Yet, above 80% of low-income group
adolescents meet less than 50% of their
RDA; esp micronutrients Shubhada Kanani, 2018

7.  Adolescents often get less from the family pot;
that is, intra-household food distribution in
poor families does not favour adolescents
 Food likes-dislikes, typical of the adolescent
phase, further aggravates deficiencies
 Working adolescents – may not have easy
access or time to avail of required food
resources
 School going adolescents (younger ones) meet
dual demands of school and domestic
responsibilities
Why are Nutrient Intakes from
Home Diets Dismal?
Shubhada Kanani, 2018

8. Growth Profile-How many are
undernourished?
 Gujarat profile better than many states*:
– Thin (underweight) : 52%
– Married before age 18 y: 17%
– Anemic: 57%
 Our studies (and national data) show stunting
affects about half of adolescents- which worsens as
child grows from 10 to 18 y
 Both boys and girls equally affected
A long way to go…..
*India health report-nutrition (2015) Shubhada Kanani, 2018

9. Improving adolescent growth..
The best time to intervene?
 Begin in early adolescence as 80% Of adolescent
growth takes place during pubertal growth spurt:
10-15 years.
 Height spurt occurs one year before menarche sets
in : about 11-12 years
 Catch up growth occurs in early adolescence – low
income girls gain more in linear height than high
income girls: take advantage of this window
 Program implication: Most of the girls are accessible
in primary schools (std 5th to 7th ) in early
adolescence –MDM, WIFS, Iron plus, life skills
Shubhada Kanani, 2018

10. MDM(Mid-day-meal) an important
intervention in schools..
 To promote pubertal growth spurt in
adolescence (especially among adolescent
girls)
 To provide one-third RDA (cal-protein)
provided it does not substitute home diet-
our research shows it is partial supplement
 To increase awareness regarding
enhancement of home diets to improve
nutrient intakes
 To retain girls in school
Shubhada Kanani, 2018

11. Iron Deficiency Anemia (IDA)
The Vulnerable Groups
Shubhada Kanani, 2018

12. Anemia in Adolescents
 Iron requirements reach a maximum at peak
growth
 Low iron status among adolescents may limit
their growth spurt
 In India, 55-75% of adolescent girls are
reported anemic. Gujarat (2015) : 57%*
 Anemia: a known risk factor for adverse
pregnancy outcomes, in addition to the risk of
small body size in girls.
 Boys are equally anemic, with adverse
consequences on physical-mental capacity
*India health report-nutrition (PHFI-IFPRI)
Shubhada Kanani, 2018

13. 1. Increased requirements
2. Low availability from cereal based diet
3. Poor dietary intake of iron
4. Blood loss through menstruation
5. Infectious Malaria
6. Parasitic infestation, hookworm
Causes of anemia
Causes
Shubhada Kanani, 2018

14. Delayed age at
Menarche
Delayed Growth and
Development
Decreased Appetite
Poor Mental
Performance
Decreased Work
Capacity
Poor Immune
Response
Effects on health
Consequence
s
Shubhada Kanani, 2018

15. • Food based approaches
 Diet diversification and
 Food fortification
• Non-food based approaches
 Supplementation with medicinal iron,
 Nutrition health education and
 Parasitic disease control
Prevention
Prevention and Control of
anemia
Shubhada Kanani, 2018

16. Benefits of Supervised Iron-folic acid
(IFA) Supplementation for schoolers
and teens
 Benefits like decreasing hunger
and thereby improving
concentration of children
 Increased retention of older
primary school children –
especially girls – in schools
 Enhanced physical work
capacity and mental dev.
 Reduced reproductive health
risks later on Shubhada Kanani, 2018

17. Weekly Iron-folate Suppl (WIFS ):
some experiences
 Schools losing interest in effective
implementation – teachers not committed.
 IEC materials no longer available in most
schools; or not used if available.
 Children not aware of benefits, scared of side
effects; throw tablets away
 Parents’ resistance is often exaggerated
 Refresher training urgently needed
 Health dept –to streamline supply of IFA,
integration with edu dept
 Monitoring is weak Shubhada Kanani, 2018

18. BCC:moving towards Practice change
Factors that enable change in behaviors
among adolescence:
1. Peer influence – they are
effective change agents
2. Knowledge/experience
of benefits motivates process of change
3. Enhancing self esteem – “ I am worth it”
4. Family support – esp mother
5. Role models
Shubhada Kanani, 2018

19. Integrated Action for Adolescent Nutrition
Action Area Purpose Sector
1. Strengthen
MDM
Enhance normal weight- height gain Education
2. Reduce Anemia
– WIFS/Iron Plus
Improve Hb, to varying degrees –
improve PWC, cognition, growth
Education,
Health,
WCD -ICDS
3. Adequate
nurition focus in
health and WCD
adol programs
Reproductive health and general
health (esp delaying 1sr pregnancy),
anemia reduction through-
RMNCH+A; Mamta Taruni, SABLA
Health -
NHM
WCD-ICDS
4. BCC focus in
nutrition
education in all
adolescent
programs stated
above
Increase awareness and improve
practices related to quantity-quality
of food intake, use of available
services, healthcare, improved IFA
compliance,
NHM, WCD-
ICDS,
EDUCATION
,
WASH
Shubhada Kanani, 2018

20. Behavior change Communication
(BCC):moving towards Practice change
Factors that enable change in behaviors
among adolescence:
1. Peer influence – they are
effective change agents
2. Knowledge/experience
of benefits motivates process of change
3. Enhancing self esteem – “ I am worth it”
4. Family support – esp mother
5. Role models
Shubhada Kanani, 2018