India faces high levels of malnutrition that impact over half its children and cause substantial economic losses. The Integrated Child Development Services (ICDS) program aims to address malnutrition's causes but has had limited impact due to focusing on increasing coverage rather than improving service quality or changing family behaviors. ICDS must be reformed to emphasize disease prevention, nutrition education, and targeting the most vulnerable groups in order to realize its potential to reduce malnutrition.
Prof. Vibhuti Patel How inclusive is the eleventh five year plan a sectoral r...VIBHUTI PATEL
Measures to Improve the Condition of Women
Vibhuti Patel
1. Current Macro Economic Scenario
The current macroeconomic scenario has intensified feminization of poverty. A mid-term evaluation of the
Eleventh Five Year Plan from a gender perspective therefore is the need of the hour. Real wages of a large number
of women have declined. Women’s work burden in unpaid care economy (cooking, cleaning, nursing, collecting
fuel, fodder, water, etc) has increased many-fold due to withdrawal of state from social sector (Chakraborty,
2008). Privatisation of education, health and insurance has increased unpaid work of women in the working
class and lower middle class households (Hirway, 2009)—not accounted in the system of national accounting.
Gender friendly implementation of National Rural Employment Guarantee Act (NREGA) in terms of skill
building, resource generation, work conditions and remuneration reaching actual women beneficiaries is still a
distant dream. While large majority of women are drowning in the ocean of market fundamentalism, they are
given small sticks in the form of Self Help Groups (SHGs) and micro finance to save themselves.
Inflation in agricultural commodities, sky rocketing prices of essential food items such as grain, vegetables
and seasonal fruits has imposed massive hardship for women. The Arjun Sengupta Committee’s Report on
Unorganized Sector Labour (2007, GoI) notes that over 394.9 million workers (more than 85 per cent of the
working population and more than 78 per cent of the workers in unorganised sector) live with an income of less
than Rs. 20 a day. 80% of the Scheduled Tribes and the Scheduled Castes, 80% of the Other Backward Classes
and 85% of Muslims belong to the categories of “poor and vulnerable,” who earn less than Rs. 20 a day. 21%
to 46% of men and 57% to 83% of women in non-agricultural sectors are employed as casual workers, who
get less than minimum wages. The unorganised work-force contributes around 60% to the national economic
output of the country.
The neoliberal economic policies of financial sector reforms; attacks on the livelihood base of the farmers,
forest people and slum dwellers; land grab in the name of creation of Special Economic Zones, massive
displacement and relocation of the masses to suit the interests of construction industry violate ‘rights’ or
‘entitlements’ of the urban and rural poor, especially women from the marginalized sections.
On December 5th, 2016, Transform Nutrition Co-Research Director John Hoddinott gave a seminar on issues surrounding chronic undernutrition in Ethiopia. In addition to reviewing current trends and the factors associated with these, Dr Hoddinott summarized TN research on chronic undernutrition in Ethiopia, conveying key messages and outlining areas requiring attention in the future. The lecture was attended by representatives from civil society organizations, academics, government officials and researchers.
Prof. Vibhuti Patel How inclusive is the eleventh five year plan a sectoral r...VIBHUTI PATEL
Measures to Improve the Condition of Women
Vibhuti Patel
1. Current Macro Economic Scenario
The current macroeconomic scenario has intensified feminization of poverty. A mid-term evaluation of the
Eleventh Five Year Plan from a gender perspective therefore is the need of the hour. Real wages of a large number
of women have declined. Women’s work burden in unpaid care economy (cooking, cleaning, nursing, collecting
fuel, fodder, water, etc) has increased many-fold due to withdrawal of state from social sector (Chakraborty,
2008). Privatisation of education, health and insurance has increased unpaid work of women in the working
class and lower middle class households (Hirway, 2009)—not accounted in the system of national accounting.
Gender friendly implementation of National Rural Employment Guarantee Act (NREGA) in terms of skill
building, resource generation, work conditions and remuneration reaching actual women beneficiaries is still a
distant dream. While large majority of women are drowning in the ocean of market fundamentalism, they are
given small sticks in the form of Self Help Groups (SHGs) and micro finance to save themselves.
Inflation in agricultural commodities, sky rocketing prices of essential food items such as grain, vegetables
and seasonal fruits has imposed massive hardship for women. The Arjun Sengupta Committee’s Report on
Unorganized Sector Labour (2007, GoI) notes that over 394.9 million workers (more than 85 per cent of the
working population and more than 78 per cent of the workers in unorganised sector) live with an income of less
than Rs. 20 a day. 80% of the Scheduled Tribes and the Scheduled Castes, 80% of the Other Backward Classes
and 85% of Muslims belong to the categories of “poor and vulnerable,” who earn less than Rs. 20 a day. 21%
to 46% of men and 57% to 83% of women in non-agricultural sectors are employed as casual workers, who
get less than minimum wages. The unorganised work-force contributes around 60% to the national economic
output of the country.
The neoliberal economic policies of financial sector reforms; attacks on the livelihood base of the farmers,
forest people and slum dwellers; land grab in the name of creation of Special Economic Zones, massive
displacement and relocation of the masses to suit the interests of construction industry violate ‘rights’ or
‘entitlements’ of the urban and rural poor, especially women from the marginalized sections.
On December 5th, 2016, Transform Nutrition Co-Research Director John Hoddinott gave a seminar on issues surrounding chronic undernutrition in Ethiopia. In addition to reviewing current trends and the factors associated with these, Dr Hoddinott summarized TN research on chronic undernutrition in Ethiopia, conveying key messages and outlining areas requiring attention in the future. The lecture was attended by representatives from civil society organizations, academics, government officials and researchers.
Drivers of change in nutrition in Senegal: the critical role of political institutions by Halie Kampman, Amanda Zongrone, Rahul Rawat, and Elodie Becquey
meaning of small family norms: Small family norm connotes control over the number of children.
The rate of reproduction and the level of acceptance of family control methods are to a large extent influenced by what people consider as the ideal family size.
Adoption of small family norms is today not only desirable but It has become difficult to survive with a large family particularly because of rising cost of living, growing needs and necessities.
It is a fact that a small family is a happy family.
Lesser number of children is a boon not only to their parents but also to the country.
They have better chances of food, clothing and education.
almost a necessity
nature of small family norms
benefits of small family norms
barriers of small family norms
THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.
Although the proportion of people experiencing chronic hunger is decreasing globally, one in nine individuals still does not get enough to eat, writes Gaelle Gourmelon, Communications and Marketing Manager at the Worldwatch Institute (www.worldwatch.org), in the latest Vital Signs Online article. The United Nations Food and Agriculture Organization estimates that 805 million people were living with undernourishment (chronic hunger) in 2012–14, down 209 million since 1990–92.
Undernourishment is defined as an inability to take in enough calories over at least one year to meet dietary energy requirements. It can lead to undernutrition, a broader term that describes a condition caused by a deficient or imbalanced diet or by poor absorption and biological use of nutrients within the body. Undernutrition can in turn lead to impaired physical functions and has high social and economic impacts. The combined cost of undernutrition and micronutrient deficiencies is equivalent to US$1.4–2.1 trillion per year, or 2–3 percent of gross world product.
Drivers of change in nutrition in Senegal: the critical role of political institutions by Halie Kampman, Amanda Zongrone, Rahul Rawat, and Elodie Becquey
meaning of small family norms: Small family norm connotes control over the number of children.
The rate of reproduction and the level of acceptance of family control methods are to a large extent influenced by what people consider as the ideal family size.
Adoption of small family norms is today not only desirable but It has become difficult to survive with a large family particularly because of rising cost of living, growing needs and necessities.
It is a fact that a small family is a happy family.
Lesser number of children is a boon not only to their parents but also to the country.
They have better chances of food, clothing and education.
almost a necessity
nature of small family norms
benefits of small family norms
barriers of small family norms
THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.
Although the proportion of people experiencing chronic hunger is decreasing globally, one in nine individuals still does not get enough to eat, writes Gaelle Gourmelon, Communications and Marketing Manager at the Worldwatch Institute (www.worldwatch.org), in the latest Vital Signs Online article. The United Nations Food and Agriculture Organization estimates that 805 million people were living with undernourishment (chronic hunger) in 2012–14, down 209 million since 1990–92.
Undernourishment is defined as an inability to take in enough calories over at least one year to meet dietary energy requirements. It can lead to undernutrition, a broader term that describes a condition caused by a deficient or imbalanced diet or by poor absorption and biological use of nutrients within the body. Undernutrition can in turn lead to impaired physical functions and has high social and economic impacts. The combined cost of undernutrition and micronutrient deficiencies is equivalent to US$1.4–2.1 trillion per year, or 2–3 percent of gross world product.
ICN2-Diet Matters: Approaches and Indicators to Assess Agriculture's Role in ...FAO
Diet Matters:Approaches and Indicators to Assess Agriculture's Role in Nutrition
By Diego Rose, Brian Luckett, and Adrienne Mundorf
School of Public Health & Tropical Medicine
Tulane University
Food supplementation programmes for improving the health of socio-economicall...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of food supplementation programmes for improving the physical and psychosocial health of socio-economically disadvantaged children.
Dr. Elizabeth Kristjansson, Professor, School of Psychology, University of Ottawa, led the session and presented findings from her latest Cochrane review:
Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. (2015). Food supplementation for improving the physical and psychosocial health of socio‐economically disadvantaged children aged three months to five years. Cochrane Database of Systematic Reviews,2015(2), Art. No.: CD009924
Undernutrition has contributed to the deaths of more than three million children in 2011. Evidence about the effectiveness of food supplementation interventions for young children is fundamentally important for governments, funding agencies, and children themselves. This review examines the effectiveness of supplementary food programmes for improving the health of disadvantaged children. 32 (21 RCTs and 11 CBAs) studies from mostly low- and middle- income countries are included in this review. In low- and middle-income countries, providing additional food to children aged three months to five years led to small gains in weight (0.24kg/year in RCTs and CBAs) and height (0.54cm/year in RCTs only), and moderate increases in haemoglobin. This webinar highlighted factors that contribute to the effectiveness of child supplementation programmes as well as implications for practice.
Ensuring agricultural biodiversity and nutrition remain central to addressing...Bioversity International
Given at Bioversity/FAO meeting on Biodiversity and sustainable diets, 3-5 November 2010. Read more about Bioversity International’s work on diet diversity for nutrition and health: http://www.bioversityinternational.org/research-portfolio/diet-diversity/
Boosting Nutrition Impact via Integrated Program Strategiesjehill3
Boosting Nutrition Impact via Integrated Program Strategies
Heather Danton and Paige Harrigan, Save the Children
CORE Group Spring Meeting, April 30, 2010
This Powerpoint shows about Child Malnutrition in Ethiopia that includes introduction, cause & effect and conclusion. For instance, some children get malnutrition which can lead to many diseases. And finally how to slove this problem.
Scaling Up Nutrition:-How to solve the problem of malnutrition?Aakash Guglani
It is about the status of malnutrition in India and how can we solve this problem.
It has also been selected for Manthan A national level event presided by Shri Narendra Modi Ji.
Investing in Stunting Prevention and Reduction in Sudan Short version.pdfAlaa Hamed
Presented on June 6, 2022 at Africa Health Excon in Egypt. It presents an approach to prioritize and select affordable high impact nutrition specific and sensitive interventions in low resources settings at national and local levels.
India is the second rank in population and developing in the world. It leads to other countries by own Scio-economic, cultural way. Any country health affects growth in their average expectancy and various socioeconomic indicators like Human Development Index, Multidimensional Poverty Index, and Gross Domestic Product per capita other way reducing the burden of disease. Children, pregnant and lactating women are the most affected with a reduction in cognitive and physical growth and prone to unhealthy which directly affect the productivity of the country. After independence in Indian constitute have a provision in part -IV (Article -45, 47) development of nutritional strategies and intervention in the five-year plans. Hence Government has devised several nutrition programmes like National Nutritional Anaemia Prophylaxis Programme, National Goitre Control Programme, National, Iodine Deficiency Disorders Control Programme, Midday Meal Programme, Applied nutrition Programme, Akshaya Patra Program. The activities in each program have been seen and its impact assessed by various evaluation programs and it was found that these programmes helped the nation. They helped to provide the proper nutrition to the children and women. The implementation of these principles, together with intensification of public health and primary care services, offers an approach to ensure more equitable health care for India’s population. Keywords: India, nutritional programs, Article-45, 47
Future Health System evidences on malnutrition and the need for adopting a multi-sectoral approach through convergence between nutrition sensitive & nutrition specific interventions.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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2. Problem
Preventing under-nutrition has emerged as one of the most critical challenges to India’s
development planners in recent times. Despite substantial improvement in health and well-being
since the country's independence in 1947, under-nutrition remains a silent emergency in India,
where almost half of all children under the age of three are underweight, 30 percent of newborns
born with low birth weight, and 52 percent of women and 74 percent of children are anaemic.
Other major nutritional deficiencies of public health importance in the country are Vitamin A
deficiency and iodine deficiency.
Productivity losses to individuals are estimated at more than 10 percent of lifetime earnings, and
gross domestic product (GDP) loss to malnutrition runs as high as 3 to 4 percent.
Under-nutrition is the underlying cause for about 50% of the 2.1 million Under-5 deaths in India
each year. The prevalence of under nutrition is the highest in Madhya Pradesh (55%), Bihar (54%),
Orissa (54%), Uttar Pradesh (52%) and Rajasthan (51%), while Kerala (37%) and Tamil Nadu (27%)
have lower rates.
3. Causes Of Malnutrition:
Approximately 60 million children are underweight in India. Given its impact on health,
education and productivity, persistent undernutrition is a major obstacle to human
development and economic growth in the country, especially among the poor and the
vulnerable, where the prevalence of malnutrition is highest. The progress in reducing the
proportion of undernourished children in India over the past decade has been modest and
slower than what has been achieved in other countries with comparable socioeconomic
indicators. While aggregate levels of undernutrition are shockingly high, the picture is
further exacerbated by the significant inequalities across states and socioeconomic groups
– girls, rural areas, the poorest and scheduled tribes and castes are the worst affected –
and these inequalities appear to be increasing.
In India, child malnutrition is mostly the result of high levels of exposure to infection and
inappropriate infant and young child feeding and caring practices, and has its origins
almost entirely during the first two to three years of life. However, the commonly-held
assumption is that food insecurity is the primary or even sole cause of malnutrition.
Consequently, the existing response to malnutrition in India has been skewed towards
food-based interventions and has placed little emphasis on schemes addressing the other
determinants of malnutrition.
5. Solution
India’s primary policy response to child malnutrition, the Integrated Child
Development Services (ICDS) program, is well-conceived and well-placed to address
the major causes of child undernutrition in India. However, more attention has been
given to increasing coverage than to improving the quality of service delivery and to
distributing food rather than changing family-based feeding and caring behavior.
This has resulted in limited impact.
Urgent changes are needed to bridge the gap between the policy intentions of ICDS
and its actual implementation. This is probably the single biggest challenge in
international nutrition, with large fiscal and institutional implications and a huge
potential long-term impact on human development and economic growth.
6. Steps Involved in implementation
• The first immediate step should be to resolve the current ambiguity about the priority of different
program objectives and interventions;
• To reduce malnutrition, ICDS activities need to be refocused on the most
important determinants of malnutrition. Programmatically, this means
emphasizing disease control and prevention activities, education to improve
domestic child-care and feeding practices, and micronutrient supplementation.
Greater convergence with the health sector, and in particular the Reproductive
and Child Health (RCH) program, would help tremendously in this regard;
• Activities need to be better targeted towards the most vulnerable age groups
(children under three and pregnant women), while funds and new projects need to
be redirected towards the states and districts with the highest prevalence of
malnutrition;
• Monitoring and evaluation activities need strengthening through the collection of
timely, relevant, accessible, high-quality information ⎯ and this information
needs to be used to improve program functioning by shifting the focus from
inputs to results, informing decisions and creating accountability for performance.
• Involving communities in the implementation and monitoring of ICDS can be
used to bring in additional resources into the anganwadi centers, improve quality
of service delivery and increase accountability in the system;
7. However, examples of successful interventions (Bellary district in Karnataka) and
innovations/variations in ICDS from several states (the INHP II in nine states, the Dular
scheme in Bihar and the TINP in Tamil Nadu) suggest that the potential for better
implementation and for impact does exist.
(ii) Service delivery is not sufficiently focused on the youngest children (under three), who could
potentially benefit most from ICDS interventions. In addition, children from wealthier
households participate much more than poorer ones and ICDS is only partially succeeding in
preferentially targeting girls and lower castes (who are at higher risk of undernutrition);
(iii) Although program growth was greater in underserved than well-served areas during the
1990s, the poorest states and those with the highest levels of undernutrition still have the
lowest levels of program funding and coverage by ICDS activities.
8. ICDS was designed to address the multidimensional causes of malnutrition. As the
program has expanded to reach more and more villages, it has tremendous potential to
impact positively on the well-being of the millions of women and children who are
eligible for participation. The key constraint on its effectiveness is that its actual
implementation deviates from the original design. There has been an increasing emphasis
on the provision of supplementary feeding and preschool education to children four to six
years old, at the expense of other components that are crucial for combating persistent
undernutrition. Because of this, most children under three—the group that suffers most
from malnutrition—are not reached, and most of their parents do not receive counseling
on better feeding and child care practices. Realizing ICDS’ potential, however, will
require substantial commitment and resources in order to realign its implementation with
its original objectives and design:
9. ELEMENTS OF SUCCESS IN PUBLIC HEALTH: HOW CAN ICDS REACH
ITS FULL POTENTIAL?
• Predictable, adequate funding – further expansion or consolidation of impact?
Availability of funds has not been a major problem for ICDS, which has received
extensive financing from both national and international sources. Over the years, absolute
spending, as well as the spending per child on various ICDS components, has increased
substantially2. For example, the GOI’s contribution increased from Rs 329.8 crores in
1992/93 to Rs 1311.2 crores in 2001/02. The expenditure on supplementary nutrition,
which is financed by the state governments, also increased by almost four times during
the same period. However, it is not clear that the increased funding has had a measurable
impact on children’s nutritional status, and it might be more beneficial to allocate funds
to improving service delivery within existing AWCs projects, rather than to expand
coverage.
10. • Political leadership and commitment – do malnutrition in India and ICDS
really matter to the key decision-makers?
High-level political commitment to the cause is key to all successful public health
programs. Although India has one of the highest proportions of underweight children in
the world and the Government has often expressed its commitment to reducing
malnutrition, this is not adequately reflected in current policy discussions. Several factors
may explain the failure to implement an effective nutrition intervention, including lack of
awareness of the most cost-effective interventions; a tendency to view malnutrition
interventions as transfers to the poor and to under-estimate their economic impact for the
country as a whole; the multiplicity of organizational stakeholders involved; and the
relatively muted voice of the poor.
• Technical consensus about the right approach – can the mismatches in ICDS
be fixed?
• Good management on the ground – can service delivery be improved?
Good and effective service delivery requires that trained and motivated workers are in
place and have the supplies, equipment, transportation and supervision to do their job
well. This requires both adequate funding and good management – and in some instances
strong management can partially compensate for budgetary restrictions.
11. Effective use of information – can information be used for action?
Information is important in three ways. First, information about the extent of a problem
raises awareness and focuses political and technical attention on finding solutions.
Second, research on health behaviors and on the effectiveness of different service
delivery approaches can help shape the design of a program and increase its prospects for
success. Third, information creates accountability and motivates.
• Community participation and decentralization – can they introduce flexibility,
attract more resources and create accountability?
Given the heterogeneity of malnutrition patterns observed in 73
India, state governments should be encouraged to tailor the basic model to local needs
and assume responsibility for the management of the overall program rather than focus
almost exclusively on the procurement and distribution of supplementary food, i.e. the
only activity in the program that they finance directly. A budget line that is specific to the
financing of ICDS should be introduced in the state budgets so that the planning and
monitoring of investments in ICDS becomes an explicit activity of State governments.
12. NEXT STEPS: RATIONALIZE DESIGN AND IMPROVE IMPLEMENTATION
Some alternatives include:
• Retain the present structure whereby a preschool function for older children (4 to 6
years), on the one hand, and maternal and child health and nutrition interventions
with special emphasis on younger children (0 to 3 years), on the other hand, are
offered within the same program. If this option is pursued, then the difficulties in
simultaneously carrying out these disparate tasks need to be resolved. At the moment,
this dual objective tends to result in AWWs devoting most of their day to preschool
education and older children, to whom educational activities are directed, squeezing
out the attendance of younger children. Since AWHs devote most of their day to food
preparation, human resources are skewed even further away from health interventions
and counseling parents about feeding and caring practices. If the present structure is
maintained, introducing a system of two workers – one charged with health and
nutrition functions and one charged with the preschool function – may be a good
option. The National Health Mission that is planned for fiscal year 2005-2006 is
considering introducing an additional village health worker (ASHA) to focus on
maternal and neonatal health issues. If this option is pursued, such a worker can be
assigned the needs of 0 to 3 year old children, including nutrition. The AWW would
focus on preschool education of older children and the AWH would continue
supporting the preparation of food. Coordination with the work of the Auxiliary
Nurse Midwife of the RCH program also needs to be carefully studied, articulated
and monitored.
13. Preventing under-nutrition has emerged as one of the most critical challenges to India’s
development planners in recent times. Despite substantial improvement in health and well-being
since the country's independence in 1947, under-nutrition remains a silent emergency in India,
where almost half of all children under the age of three are underweight, 30 percent of newborns
born with low birth weight, and 52 percent of women and 74 percent of children are anaemic.
Other major nutritional deficiencies of public health importance in the country are Vitamin A
deficiency and iodine deficiency.
Productivity losses to individuals are estimated at more than 10 percent of lifetime earnings, and
gross domestic product (GDP) loss to malnutrition runs as high as 3 to 4 percent.
Under-nutrition is the underlying cause for about 50% of the 2.1 million Under-5 deaths in India
each year. The prevalence of under nutrition is the highest in Madhya Pradesh (55%), Bihar (54%),
Orissa (54%), Uttar Pradesh (52%) and Rajasthan (51%), while Kerala (37%) and Tamil Nadu (27%)
have lower rates.
14. Malnutrition sets in very early in the life of an Indian child. Indeed, nearly a quarter of all
children are born with a major nutritional disadvantage – low birth-weight, meaning that they
weigh less than 2.5kg at birth. Important reasons for low birth-weight are the high proportion
of mothers who themselves are underweight (one-third of all pregnant women have a body
mass index (BMI) of less than 18.5) and who suffer from anemia or iron deficiency (nearly 60%
of pregnant women suffer from anemia).
Why is combating hunger and malnutrition so important? Freedom from hunger and
malnutrition is a basic human right, and until India can provide these freedoms, its claims to
successful human development are questionable. As Prime Minister Manmohan Singh said
recently, the country’s unacceptably-high level of child malnutrition is a ‘national shame’.
The economic costs of hunger and malnutrition :
In addition to the human cost, there is a huge economic cost to hunger and malnutrition – in
terms of loss of cognitive ability, schooling, and labour productivity. Estimates, albeit rough
ones, suggest that malnutrition may be costing the Indian economy the equivalent of 4%-5% of
its GDP.
15.
16. Infant and young child feeding practices in particular continue to be a serious
challenge to reduce malnutrition among children. In spite of unprecedented
economic growth, improvements in childhood nutritional status in India over
the last decade have been slow. The status of various aspects of nutrition
among children points towards urgent need to take the call for aggressive
awareness campaigns along with improved health care facilities with special
privileges for the weaker sections of the society.