Why Focus on Nutrition

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Why Focus on Nutrition ?
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The Problem

• Long term detrimental effects on growth, health,
  cognitive and educational outcomes
• Malnutrition leads to decrease in productivity

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Child Mortality and Malnutrition
Malaria 5
Diarrhea 19
ARI 19
Malnutrition 60
Measles 7
Perinatal 18
Other 32
Source Black and Caulfield, 2000
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The Problem

• Moderately and severely malnourished children are
  5 to 8 times more likely to die than adequately
  nourished children
• Even children with mild malnutrition who form the
  majority of children in the community, have a
  greater risk of death than children who are
  normally nourished

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Causes of Child Mortality
mild moderate
severe

• 5 in 6 malnutrition-related deaths due to mild
  and moderate malnutrition

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What is Malnutrition ?

• Malnutrition refers an excess or a deficiency
  of one or more types of nutrients in the body
• Excess is referred to "over-nutrition" and
  deficiency to "under-nutrition
• In context of children in developing countries,
  it refers mainly to undernutrition

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What is Malnutrition ?

• The immediate reason for inadequate growth is a
  deficiency of basics elements of diet, made worse
  by infections
• Symptoms and signs of deficiencies in specific
  nutrients, such as anemia, from iron deficiency,
  and night blindness, from vitamin A deficiency

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What is the extent of malnutrition ?

• About 47 of children under the age of three are
  underweight and 46 are stunted
• 74 of children between the ages of 6-35 months
  suffer from anemia
• About 36 of women 15-49 years are undernourished
  
• Prevalence of anemia among women is about 52

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What are the causes of malnutrition ?

• What can be done it prevent it ?

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Causes of Malnutrition
Manifestations
lt5 MALNUTRITION
Maternal MALNUTRITION
Immediate causes
Inadequate dietary intake
Disease
InsufficientHouseholdFood Security
Inadequate Maternal and Child Care
Insufficient Health Services Unhealthy Environme
nt
Underlying causes
Inadequate Education
RESOURCES CONTROL Human, Economic,
Organizational
Basic causes
Political and Ideological Superstructure
Economic Structure
Source Adapted from UNICEF
Potential Resources
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The Maternal and Child Nutrition Link
Mother Mothers nutrition is important for
practicing child-rearing,care and household
economic tasks,and for recovery for future
pregnancies
At birth Birth weight is closely associated with
child survival and growth ,which influences
nutrition in adolescence and determines how well
nourished mother is when she enters pregnancy
Lactation Adequate nutrition for the mother
should be maintained during breast feeding.
At 2 years Prevention of stunting in girl
children during the first 2 years can help to
break the cycle of malnutrition
Pregnancy Mothers nutrition before and during
pregnancy influences growth and development of
the fetus and its birth weight, it affects her
chances of surviving the delivery.
Adolescence Nutrient stores built up in
adolescence help the nutrition of women during
and between pregnancies.
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Malnutrition began before mother become pregnant
Child growth failure
Early pregnancy
Low birth weight babies
Low weight and height in teens
Small adult women
Source ACC/SCN, 1992
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What can be done? Improving the nutrition of the
girl child and adolescent

• Preventing malnutrition in the girl child under
  two years of age
• Ensuring that adolescents are well-nourished
• IFA supplementation

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Nutrition needs are high
Foetal weight gain by week of pregnancy
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Maternal undernutrition can lead to an
undernourished baby

• Most of the weight gain of the baby in the womb
  occurs in the last few months of pregnancy
• Poor diet and heavy physical work with inadequate
  rest
• Mother is not well-nourished during pregnancy,
  she is unable to provide sufficient nutrients for
  the body stores of the child

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Maternal undernutrition can lead to an
undernourished baby

• Iron deficiency causes anemia and severe anemia
  can lead to maternal and perinatal deaths
• Folic acid deficiency in early pregnancy leads to
  birth defects (neural tube defects)
• Vitamin C deficiency leads to anemia
• Dietary iodine deficiency during pregnancy
  hinders development of the fetus

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What can be done ? More food and rest during
pregnancy

• Increase the amount of food by eating 4 to 5
  small meals spread across the day
• Eat a variety of foods including animal products
  if feasible
• Consume IFA supplements
• Use iodized salt in food
• Rest for about 1 to 2 hours 

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Answer available for healthy mother and healthy
baby in IKP

• Nutrition center

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What do they do here?

• All the pregnant and lactating mothers from POP
  and Poor families are listed.
• Calculated the requirement of foods as per ICMR
  standards per day.
• Divided the proportion of nutrients for one meal
• Calculated the cost of one meal with all the food
  groups included.
• Prepared the proposals to get sanction under
  Social CIFs in IKP.

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Contd..

• Ensure each beneficiary share their contribution
  _at_ Rs 2 per meal.
• Members of VO came forwarded to cook the food on
  rotation.
• Opportunity was given to a needy woman to cook
  the food who will have food at the nutrition
  center itself towards sparing her time for
  preparation.
• Preparation of food is kept ready between
  9.00-11.00 am to ensure that women have food
  before they go for work or at their preferred
  time.

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Contd..

• Creates an environment that gives more relaxing
  environment as all the women come and have food
  together at one place
• Get time to know more about child care and
  maternal care issues through health education
  sessions conducted by health activists when they
  come to center.

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Contd..

• Ensures complete ANC , Institutional delivery and
  postpartum care.
• Change in the practice of use of more of green
  leafy vegetable in their regular diets at home
  also with the knowledge they acquired.
• Birth weight of the baby is more than 2.5 Kgs
• Detection of risk pregnancies if any identified
  and referred for tertiary care.
• Strengthen the institutions at all
  levels(SHG/VO/MS/ZS)

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Measures for sustainability

• Encourage to enhance beneficiary contribution to
  Rs 4 per meal.
• Negotiations with WDCW to divert the funds for
  supplementary foods allocated to pregnant and
  lactating mothers.(1.40 per day per beneficiary)
• Release of Rs 1000/ available under Janani
  Suraksha Yojana to VOs.
• Sanction of land under land development component
  of IKP and its development under CLDP of govt of
  AP and use them for cultivation of vegetable
  gardens.The profits from them will be used
  continuously for running nutrition centers.

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Contd..

• Approach donors for one time grant of Rs 500000
  per center which will be used as corpus and the
  interest accumulated will be used to meet the
  monthly expenditure.
• Encourage the all the members of SHGs to save in
  kind or cash to provide food to the needy
  pregnant and lactating mothers.

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Pre-requisites to establish a Nutrition center

• Strong Institution building
• Food security in place.
• Health and Nutrition mandal where health
  activists are positioned to educate mothers about
  preventive and promotive health care measures.
• Contribution from beneficiary
• Capacity of the SHG/VO to contribute as a social
  obligation to ensure improved nutritional status
  of their own community.

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Thank you