Project to Programme

1
Project to Programme
MISSION POSHAN

• Addressing Malnutrition in Uttar Pradesh

2
Undernutrition Prevalence in UP
52 children in U.P. are undernourished
Source NFHS, 1998-99 NIN-IASDS 2003
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Pattern of Underweight in UP
Source Vir Nigam, 2001
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Undernutrition Prevalence - Monthwise
Source Vir Nigam, 2001
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Malnutrition in Women (BMI lt18.5)
Source GoUP, IASDS Unicef, 1999
6
Risk Factors and their Loading (Undernutrition in
Children)
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Conceptual Framework of Malnutrition
Malnutrition
Malnutrition Immediate Causes Underlying
Causes
Inadequate Dietary Intake
Disease
Insufficient Health Services Unhealthy
Environment
Insufficient Household Food Security
Inadequate Women Child Care
Source Unicef, 1991
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Coverage - Community Based MCHN Project

• 4 districts (8 blocks)
• 907 villages
• Popn. 1.34 mn

AGRA
JHANSI
VARANASI
JHANSI
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Objectives of the Community Based MCHN Project

• Reduce PEM by 20
• VAS Coverage - 80
• Iodised Salt Consumption 100
• IFA Tablets (min. 100 ) to pregnant mothers - 60

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Participating Institutions
State Nutrition Resource Centre District
Nutrition Resource Centre
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Interventions under Community Based MCHN Project

• For Pregnant Mothers
• Antenatal check-ups
• TT
• Consumption of 100 IFA tablets
• One additional meal
• 2 hours of day rest
• For Newborn Children upto 6 months of age
• Initiation of breastfeeding within ½ to 1 hour
  of birth
• Feeding of colostrum
• Exclusive breastfeeding (not even water) up
  to first 6 months of birth

Contd. . .
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Contd. . .

• For Children
• Appropriate introduction of complementary feeding
• Vitamin A supplementation
• Complete immunization
• Use of ORS during diarrhoea
• Continuing feeding during diarrhoea/illness
• For Family
• Consumption of iodized salt
• Use of safe water and personal hygiene practices
• For Currently Married Women Newly Weds
• Promoting right age of conception

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Community Based MCHN Project
Families at risk Children under 2s, pregnant
lactating mothers, newly weds

• Family level counselling
• Creating demand for HN services
• Ensuring provision of HN services (RI, vit. A,
  referral)

Community Mobilisers (BPMs)
Block Facilitator (BTM)

• 4 districts (8 blocks)
• 907 villages
• 550 570 BPMs/block

ANM
AWW
Bal Parivar Mitra - Child Nutrition Health
Sanitation Mobiliser
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Community Mobilisers (Bal Parivar Mitra)

• Over 4516 for 8 blocks (97 women, 50 literate
  and gt18-40 years)
• Selection process involved ICDS, Health, Pradhans
  Community
• Tasks reaching families at risk malnutrition
• Counselling, Creating demand for HN services
• Linking with AWW/ANM for HN services
• Counselling monitoring using pictorial cards

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BPM Counselling Monitoring Card
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MCHN Project (Jan 01 to Dec 04)Evaluation
undertaken Apr - May 05

• Positive trends compared to baseline
• Increase in ANC registration
• Consumption of IFA tablets
• Early initiation of breastfeeding practice
• Colostrum feeding practice
• Introduction of semi-solids gt 6 months practice
• Hygiene practice (washing hands after defecation
  and prior to cooking/feeding)
• Use of appropriate water source
• Awareness on feeding during illness/diarrhea
• Use of ORS

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Care During Pregnancy (Endline)
Baseline practice 44.5 Consumption
among those received
18
ANC Services
Source of Information ANMs 61 BPMs
21 AWWs 14
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Breastfeeding Practice
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Practice of Feeding Colostrum
Breastfeeding initiated within 24 Hrs.
Baseline is not available
Baseline data not available
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Practice of Exclusive Breastfeeding
Note Data of 348 mothers (22 of total 1601)
who did not introduce any other feed other than
breast milk immediately after birth
22
Age of initiating semisolid food to children
(N1601)
Baseline 18 semisolids foods to children gt6
mths Of these 50 lt6 months
23
Hygiene Practice (washing hands after
defecation)- District-wise
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Source of Drinking Water
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Nutritional Status of Children lt2 yrs of Age
(wt/age - IAP classification)
Note Excludes Jhansi district since baseline is
not available
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Areas Requiring Special Attention

• HN Practices
• Increased diet during pregnancy
• Exclusive breastfeeding up to 6 months
• Complementary feeding after completion of 6
  months
• Health Services Response
• ANC services
• Vitamin A supplementation
• Complete immunisation
• Coordination of Health ICDS workers
• Defined tasks and responsibilities

MCHN evaluation 3 ANCs 11.5 Vit. A - 1st
dose-26, 3rd dose- 2.8 Complete Immunisation
33
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Lessons Learnt - MCHN

• Prioritize and focus on families at risk of
  malnutrition
• Frequent family level visits/ IP counselling
  community mobilizer crucial (120 households)
• Pictorial monitoring by community mobilizers
  effective
• Behavioral change observed in practices mothers
  can do themselves breastfeeding, iodised salt
• Block facilitators (BTM) role important
• Special efforts required to improve response to
  health services (RI, VAS, ANC, NBC Referral)
• Roles of ICDS Health need to be clearly defined
  with reference to identification, mobilization
  and delivery of services

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Biannual Child Health Nutrition Months (Bal
Swasthya Poshan Mah Jun./Dec.) launched 2004
Health System
ICDS System

• Biannual surveys
• Identification of beneficiaries lt 3yrs (Apr/Oct)
• IEC Social Mobilisation
• VAS RI
• BF CF (IYCF)
• Iodised Salt Consumption

• Sharing Microplan
• Services RI Session Days
• Vitamin A (9-36mths.)
• Routine Immunisation
• Management of Severe
• Malnutrition

Children lt 3 years
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Consumption of Iodised Salt (18 dist.)
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VAS Coverage (18 districts)
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Formulation of Strategy ICHN - Reaching Under 3s
Biannual Bal Swasthya Poshan Mah (BSPM)
Weekly Nutrition Health Days (WNHD)-Saturdays
Home visits 4/ week

• Focus on high risk
• Families
• Pregnant mothers
• Newborns infants
• Severely malnourished

Focus on ltthrees
W1- GMPlt3 yrs W2- Preg. Mothers W3- M.
Mandals W4- KSY Meet

• Selected Package
• Vit. A Imm.
• Excl. BF/CF
• Manag. of Sev. Mal.
• Iodised salt

• ICDS Counselling
• Referral
• Infant Young Child Feeding
• ANC, NB care RI

linked to ANMs visit- as per RI/outreach
microplan (Wed/Sat)
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Home Visits (4/week)

• Identification of at risk families/groups by AWWs
  (about 40-50 families per 1000 population)
• Pregnant
• Children lt1 year and
• Severely malnourished children up to 5 years.
• Counselling standardized messages

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Weekly Nutrition Health Days (Saturdays)

• Weekly supplementary food distribution to 7 to
  36 months children, pregnant and lactating
  mothers
• Health Nutrition Education
• Fixed monthly themes
• Through the year IYCF, RI
• Schedule for NHE Session
• 1st week - Weighing lt 3s GMP
• 2nd week - Antenatal Mothers
• 3rd week - Mahila Mandal
• 4th week - Meeting with Adolescent Girls

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ICDS (UP) - MISSION POSHAN
Adolescent Girls (10-19 yrs)
Children (gt3-6 years)
ICHN Under 3s
Kishori Shakti Yojana (UMANG) Strategy
Centre BasedAWC
Focus on at risk families

• Suppl. feeding linked to hygiene education
• Deworming

• Weekly IFA
• Biannual deworming
• FLE/ NHEd.

• Home visits
• Weekly Nutrition Health Days
• Biannual Activities

• Reducing Moderate Severe Undernutrition
• Improving VAS Coverage
• Improving Iodised Salt Consumption
• Reducing Anaemia

Community Mobilisers/ Mother Support Groups
Linkage with NRHM (RI sessions)