Research Abstracts On Nutrition

Research Abstracts on Nutrition
1998 2008
2009
Documentation Centre for Women and Children
National Institute of Public Cooperation and Child Development

5, Siri Institutional Area, Hauz Khas, New Delhi 110016
Number of Copies: 100
Copyright: National Institute of Public Cooperation and Child Development, 2009
Project Team
Guidance and Support
Dr. Dinesh Paul Dr. Sulochana Vasudevan
Project In-Charge
Meenakshi Sood
Abstracting
Punita Mathur
Computer Assistance
Pawan Kumar
Foreword Research on women and children reveals that there are several areas which require the attention of planners and programme implementers. Policy decisions based on research findings are rooted in ground reality, and therefore have the capacity to bring about tangible improvement in the situation, whether it is with regard to nutritional status, health practices, income generation, domestic violence or rights of women and children. Research on social issues in India is being conducted by a plethora of organisations, namely research institutes, ministries and departments of union and state governments, autonomous organisations, home science colleges, social work departments of universities, medical colleges, international and national voluntary organisations. As research is a vital input for development, planners, administrators and researchers are on the look out for social factors which have the potential to impact the outcomes of various programmes. With this aim in view, the Documentation Centre for Women and Children (DCWC) of NIPCCD has been engaged in the process of collecting and documenting valuable and relevant research material in the areas of women and children. DCWC collects research findings from many widely scattered sources for the use of users. Hence this project was undertaken to bring out compilations of research abstracts on various areas for the benefit of users. Research Abstracts on Nutrition, 1998-2008 has been compiled to present widely scattered research in a compact form, and assist in making encapsulated information and recommendations of research available to planners, programme implementers and researchers. Research studies conducted by various organisations during the period 1998 to 2008 have been summarised on various subjects such as anaemia/ iron deficiency, breastfeeding, child nutrition, food security, iodine deficiency, malnutrition, Mid Day Meals/ICDS, Vitamin A deficiency, etc. It is hoped that this document would be of immense value to all stakeholders working for the survival, development and empowerment of women and children. It would not have been possible to bring out this document without the cooperation of various organisations who have very kindly shared their research studies with NIPCCD. I wish to place on record my appreciation of the efforts put in by the staff of DCWC specially Smt. Meenakshi Sood, Deputy Director, and Dr. Dinesh Paul, Additional Director (TC) and Dr. Sulochana Vasudevan, Joint Director (WD) for overall guidance and support in completion of the project. (A.K. Gopal)
Contents
S. No.
Subject and Titles
Page No.
Adolescents Girls
1. Physical dietary, environment and nutritional status of adolescent mothers. (1997). - Govt. Home Science College Chandigarh. Department of Foods and Nutrition. Nutritional status of adolescent girls in urban slums and the impact of IEC on their nutritional knowledge and practices. (2002). - Saibaba, A. et al. - Indian Journal of Community Medicine. 1
2.
Anaemia/ Iron Deficiency/ Iron Supplementation

3. Process documentation of Gumla Anaemia Project. (2007). - AMS Consulting, Ranchi. Prevention and control of anaemia in rural adolescent girls through school system, Andhra Pradesh (Hathnura and Kondapur). (2002). - Indian Institute of Health and Family Welfare, Hyderabad. Prevention and control of anaemia among rural adolescent girls through school system in Andhra Pradesh (Hathnura, Kondapur, Jinnaram and Pulkal). Hyderabad. (2003). - Indian Institute of Health and Family Welfare, Hyderabad. Reducing iron deficiency anaemia and changing dietary behaviours among adolescent girls in Maharashtra. (~2005). - Institute of Health Management Pachod, Pune. Adolescent girls anaemia control program. (~2005). - Kotecha, Prakash V., Karkar, Purvi and Nirupam, Siddharth. - Ahmedabad : Medical College Vadodara, Dept. of Preventive and Social Medicine. Anaemia in pregnancy : interstate differences. (2005). - Nutrition Foundation of India, New Delhi. 3
4.
5.
6.
7.
8.
S. No. 9.
Subject and Titles Prevalence of iron deficiency anaemia and malnutrition in India. (2004). - Reddy, Ramakrishna. - Institute for Social and Economic Change, Bangalore. Identification of an appropriate strategy to control anaemia in adolescent girls of poor communities. (2000). - Sharma, Anshu, Prasad, Kanti and Visweswara Rao, K. - Nutrition Foundation of India, New Delhi. Iron food supplement. (2002). - Sood, Mousmee and Sharada D. - The Indian Journal of Pediatrics.
Page No. 9
10.
11
11.
12
Breastfeeding
12. Nutritional and health impact on children breastfed beyond infancy : evidence from India. (2004). - Acharya, Rajib et al. - Demography India. Breastfeeding practices in two blocks of east Singhbhum district, Jharkhand. (2002). - Barge, Sandhya. - Centre for Operations Research and Training, Vadodara. Effect of community based promotion of exclusive breastfeeding on diarrhoeal illnesses and growth : a cluster randomised controlled trial. (2003). - Bhandari, Nita et al. - AIIMS, New Delhi Socio-economic dimensions of breast feeding: a study in Hyderabad (2000). - Bharati, Sunita Reddy. - Health and Population. The State of the World's Breastfeeding South Asia report : tracking implementation of the global strategy for infant and young child feeding. (2007). - IBFAN, Asia International Baby Food Action Network, New Delhi. Breast feeding practices in the rural community of District Darjeeling, West Bengal. (2000). - Ram, Rama et al. - Indian Journal of Community Medicine. 13
13.
14
14.
15
15.
16
16.
17
17.
18
S. No. 18.
Subject and Titles Breastfeeding behaviour of Indian women. (2004). - Rameshwararao, A. A. - Indian Journal of Community Medicine. Breastfeeding practices of mothers in urban slum. Is it really exclusive? (2002) - Sangole, S.S. and Durge, P.M. - Indira Gandhi Medical College, Deptt. of Preventive and Social Medicine, Nagpur. Knowledge, attitude and practices of mothers about breastfeeding in Bihar. (2004). - Yadav, R. J. and Singh, P. - Indian Journal of Community Medicine.
Page No. 19
19.
20
20.
21
Child Nutrition
21. Investing in child nutrition in Asia. (1999). - Hunt, Joseph and Quibria, M.G., ed. - Asian Development Bank, Manila, Philippines. Improving child nutrition in Asia. (2001). - Mason, John, et al. - Asian Development Bank, Manila, Philippines. 22
22.
23
Diabetes
23. IDDM and early exposure of infant to cow's milk and solid food. (2001). - Esfarjani, E, Razzahy Azar, M. and Gafarpour, M. - Indian Journal of Pediatrics. 26
Food/ Dietary Behaviour/ Food Intake

24. Nutritional intake in India 2004-05 : NSS 61st Round July 2004 - June 2005. (2007). - India, Ministry of Statistics and Programme Implementation, National Sample Survey Organization, New Delhi. Perceived adequacy of food consumption in Indian households 2004-05 : NSS 61st Round July 2004 - June 2005. (2007). - India, Ministry of Statistics and Programme Implementation, National Sample Survey Organization, New Delhi. 27
25.
28
S. No. 26.
Subject and Titles Changing food consumption patterns in India. (2008). - Ramachandran, Prema. - Nutrition Foundation of India, New Delhi. Dietary intake, physical activity and nutritional status of Indian adults. (2008). - Ramachandran, Prema. - Nutrition Foundation of India, New Delhi. Do food related experiences in the first 2 years of life variety in school aged children. (2002). - Skinner, Jean D. et al. - Journal of Nutrition Education and Behavior predict dietary
Page No. 29
27.
30
28.
32
29.
Women and health : survey on food and nutrition : a study. (2003). - Sophia Centre for Women's Studies and Development, Department of Chemistry, Sophia College, Mumbai.
32
Food Fortification
30. Distribution of fortified candy in ICDS : a pilot project Bengal. (2005). - Child In Need Institute, Daulatpur, West Bengal. Howrah, West 34
31.
32.
Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian school children : a double-blind randomized controlled trial. (2006). - Moretti, Diego, et al. - St. John's National Academy of Health Sciences. Bangalore. Community level micronutrient fortification of a food supplement in India : a controlled trial in preschool children aged 36-66 months. (2007). - Verma, Jessica L. et al. - Child in Need Institute.
35
36
Food Security/ Food Insecurity

33. The State of food insecurity in the world 2005. (2005). - Food and Agriculture Organization, Rome. Food security among preschool children. (2000). - George, E. and Daga, A. S. - Indian Journal of Pediatrics 38
34.
39
S. No. 35.
Subject and Titles Report on the state of food insecurity in rural India. (2008). - MS Swaminathan Research Foundation, Chennai.
Page No. 40
Hunger/ Hunger Deaths/ Right to Food

36. India State Hunger Index : comparison of hunger across states. (2009). Menon, Purnima, Deolalikar, Anil and Bhaskar, Anjor. International Food Policy Research Institute. Washington, D.C Report of people's tribunal on starvation in eastern Uttar Pradesh. Varanasi. (2005). - People's Vigilance Committee on Human Rights, Varanasi. Malnutrition disaster in Madhya Pradesh : a sad picture of chronic hunger and un-accountable system. (2006). - Right to Food Campaign Madhya Pradesh Support Group, Bhopal. The Right to food : report of the Special Rapporteur on the Right to Food, Ziegler : Addendum : Mission to India : 20 August to 2 September 2005. (2006). - Ziegler, Jean. - United Nations, Economic and Social Council, Geneva. 42
37.
43
38.
44
39.
45
Infant and Young Child Feeding/ Weaning Foods

40. Feeding practices and pattern of growth and development of infants in Varanasi. (2002). - Banerjee, Anindita. - Banaras Hindu Univ. Deptt. of Home Science, Foods and Nutrition Unit. Varanasi. An Educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. (2004). - Bhandari, Nita et al. - AIIMS, New Delhi. Use of multiple opportunities for improving feeding practices in under twos within child health programmes. (2005). - Bhandari, Nita et al. - AIIMS, New Delhi. 47
41.
48
42.
49
S. No. 43.
Subject and Titles Infant feeding practice in Tamil Nadu. (2000). - Gunasekaran, S. et al. - Health and Population. Status of infant and young child feeding in 49 districts (98 blocks) of India 2003 : a national report of the quantitative study. (2003). - Gupta, Arun and Gupta, Y.P. - Breastfeeding Promotion Network of India (BPNI), New Delhi. Are recommended infant and young child feeding practices being followed in our region? Assessment methods and research evidence. (2005). - Kanani, Shubhada et al. - MS Univ. Faculty of Home Science, Department of Foods and Nutrition, Vadodara. Multi country study on infant and young child feeding: a report of field test protocol. (2003). - National Institute of Public Cooperation and Child Development, New Delhi. Nutritional status and feeding practices of children attending MCH centre. (2001). - Rasania, S.K and Sachdev, T.R. - Indian Journal of Community Medicine. Hazard analysis and critical control points of weaning foods. (2000). - Sheth, Mini et al. - Indian Journal of Pediatrics. A Study of infant feeding practices and the underlying factors in a rural area of Delhi. (2003). - Taneja, D.K. et al. - Indian Journal of Community Medicine Growth in the first year in children following IAP policy on infant feeding. (2000). - Tripathy, Radha et al. - Indian Pediatrics. Status of infant and young child feeding Uttarakhand : a report of the study from 13 districts. (2006). - Uttarakhand. Department of Women and Child Development, Dehradun.
Page No. 51
44.
51
45.
53
46.
54
47.
56
48.
56
49.
57
50.
58
51.
58
S. No.
Subject and Titles
Page No.
Iodine Deficiency Disorders/ Goitre/ Iodized Salt

52. Towards sustaining elimination of IDD Kerala India. (2004). - All India Institute of Medical Sciences, Department of Community Medicine, New Delhi. - ICCIDD. Towards sustaining elimination of IDD Orissa India. (2004). - All India Institute of Medical Sciences, Department of Community Medicine, New Delhi. - ICCIDD. Tracking progress towards sustainable elimination of IDD in Bihar India. (2001). - All India Institute of Medical Sciences, Dept. of Community Medicine, New Delhi. Biochemical assessment of iodine deficiency disorders in Baroda and Dang districts of Gujarat state. (2001). - Brahmbhatt, S.R. et al. - Indian Pediatrics. Evaluation of Universal Salt Iodisation in India. (1999). - India, Ministry of Industry, New Delhi. Assessment of current status of salt iodization at the beneficiary level in selected districts of Uttar Pradesh. (2001). - Kapil, Umesh, et al. - Indian Pediatrics. Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu. (2004). - Kapil, Umesh et al. - The Indian Journal of Pediatrics. Status of Iodine Deficiency Disorders (IDDs) in Amreli District of Gujarat. (2005). - Khan, Q. H. and Singh, M.P. - Health and Population Perspectives. 60
53.
61
54.
63
55.
64
56.
65
57.
66
58.
67
59.
68
S. No. 60.
Subject and Titles Current status of IDD in select districts of different regions of the country. Hyderabad (2003). - National Institute of Nutrition, Hyderabad. Prevalence of goitre in 6-12 years children of Kandhamal District in Orissa. (2005). - Sahu, T. et al. - Indian Journal of Community Medicine.
Page No. 69
61.
70
Malnutrition/ Undernutrition/ Protein Energy Malnutrition (PEM)

62. National strategy to reduce childhood malnutrition : investment plan final report. (1997). - Administrative Staff College of India, Hyderabad. Etiological factors of malnutrition among infants in two urban slums of Delhi. (2001). - Aneja, B. et al. - Indian Pediatrics. Attacking the double burden of malnutrition in Asia and the Pacific. (2001). - Asian Development Bank, Manila, Philippines. India's undernourished children : a call for reform and action. (2006) - Gragnolati, Michele, Das Gupta, Monica and Shekar, Meera. - World Bank, New Delhi. Nutritional status of preschool children in the drought affected Kalahandi district of Orissa. (2000). - Mahapatra, A. et al. - Indian Journal of Medical Research. Nutritional neglect and physical abuse in children of alcoholics. (2001). - Nagaraja Rao, K. et al. - Indian Journal of Pediatrics. Determining grades of malnutrition in children : classification and the alternative. (2003 ). - Nigam, A.K. - Demography India. standard deviation 72
63.
73
64.
74
65.
75
66.
76
67.
77
68.
77
S. No. 69.
Subject and Titles Double burden of malnutrition : case study from India. (2006). - Nutrition Foundation of India, New Delhi. Malnutrition, an emergency : what it costs the nation. (2008). - Rao, Veena S. - CAPART, New Delhi. Gender differentials in malnutrition : a case study of (2000). - Visweswara Rao, K. et al. - Man in India. preschool children.
Page No. 79
70.
80
71.
82
Micronutrients/ Micronutrient Deficiency

72. Prevalence of iron deficiency anaemia and Vitamin A deficiency in the state of Jharkhand. (2002). - Brahmam, G.N.V., Rao, M. Vishnuvardhana and Dwivedi, Shubhra. - Department of Health and Family Welfare, Ranchi, Jharkhand. Status of micronutrients before and after rehabilitation. (2000). - Elizabeth, K. E. - SAT Hospital and Medical College, Deptt. of Pediatrics, Thiruvananthapuram. Report of the Task Force on Micronutrients (Vitamin A and Iron). (1996). - India. Ministry of Human Resource Development, Department of Women and Child Development, New Delhi. Prevalence of micronutrient deficiencies. Hyderabad (2003). - National Institute of Nutrition, Hyderabad. Role of Micronutrients Supplementation in Improving Child Health. (2008). - Sachdeva, H. P. S. - Nutrition Foundation of India, New Delhi. Nutritional status along with micronutrient deficiency disorders and morbidity in pregnant and lactating women in desert areas of Rajasthan. (2004). - Singh, Madhu, B., Fotedar, Ranjana and Lakshminarayana, J. - Desert Medicine Research Centre, Jodhpur. 83
73.
84
74.
84
75.
86
76.
87
77.
88
S. No. 78.
Subject and Titles Micronutrient profile of Indian population. (2004). - Toteja, G.S. and Padam Singh. - Indian Council of Medical Research, New Delhi.
Page No. 90
Mid Day Meals/ ICDS

79. An Empirical study of the mid day meal programme in Khurda, Orissa. (2008). - Anima Rani and Sharma, Naresh Kumar. - Hyderabad Univ., Hyderabad. 91
80.
Nutritional status and gender differences in the children of less than 5 years of age attending ICDS anganwadis in Vadodara city. (2002). - Bhalani, K. D. et al. - Indian Journal of Community Medicine. The Government primary school mid day meals scheme : an assessment of programme implementation and impact in Udaipur district. (2005). - Blue, Julia. - Seva Mandir, Udaipur. Measuring effectiveness of Mid Day Meal Scheme in Rajasthan : participatory expenditure tracking survey : final report. (2007). - CUTS, Centre for Consumer Action, Research and Training, Jaipur. Towards more benefits from Delhi's mid day meal scheme. (2005). - De, Anuradha, Noronha, Claire and Samson, Meera. - Collaborative Research and Dissemination, New Delhi. Mid day meal scheme : understanding critical issues with reference to Ahmedabad city. (2007). - Deodhar, Satish et al. - Indian Institute of Management, Ahmedabad. National Programme of Nutritional Support to Primary Education : Mid-Day Meals : comparative lessons of experience in Uttar Pradesh and Himachal Pradesh. (2000). - Giri Institute of Development Studies, Lucknow. Mid day meal scheme in Madhya Pradesh : a study. (2007). - NIPCCD, Regional Centre Indore, Indore.
92
81.
93
82.
94
83.
95
84.
96
85.
98
86.
99
S. No. 87.
Subject and Titles Evaluation of mid day meal programme in MCD schools. (2006). - Sharma, Sushma et al. - Nutrition Foundation of India, New Delhi. Mid day meal scheme in primary schools of Uttar Pradesh : summary. (2006). - Voluntary Action Network India Uttar Pradesh, Lucknow.
Page No. 101
88.
102
National Nutrition Monitoring Bureau

89. Special report: nutritional status of adolescents, nutritional status of elderly, food and nutrient intakes of individuals. (2000). - National Ins of Nutrition, Hyderabad. 104
Nutrition Education/ Training Nutrition

90. Community-based nutrition education for improving infant growth in rural Karnataka. (2005). - Kilaru, A. et al. - Indian Pediatrics. Dietary characteristics of trained and untrained farm women under WYTEP. (2004). - Shantha Kumari K. and Puttaraj, Shashikala. - Indian Journal of Nutrition and Dietetics. Profile and training status of manpower of NGOs working nutrition and health. (2004). - Tikku, Nirmal. - NIPCCD, New Delhi. in the area of 105
91.
106
92.
107
93.
Training activities in the area of nutrition and health : an analysis. (2004). - Tikku, Nirmal. - NIPCCD, New Delhi. Training of manpower of NGOs engaged in the delivery of services to improve nutritional and health status of women and children. (2002). - Tikku, Nirmal. - Vardhaman Mahaveer Open University, Department of Management, Kota.
108
94.
109
S. No.
Subject and Titles
Page No.
Nutrition Intervention
95. What works: a review of the efficacy and effectiveness of nutrition interventions. (2001). - Allen, Lindsay H. and Gillespie, Stuart R. - United Nations, Sub-Committee on Nutrition, Administrative Committee on Co-ordination, Geneva. 111
Nutrition Rehabilitation
96. Outcome of nutritional rehabilitation with and without zinc supplementation. (2002). - Elizabeth, K. E., Sreeden, P. and Narayanan, S. Noel. - SAT Hospital and Medical College, Deptt. of Pediatrics, Thiruvananthapuram. 112
97.
The role of developmental stimulation in nutritional rehabilitation. (1997). - Elizabeth, K. E. and Sathy, N. - SAT Hospital and Medical College, Deptt. of Pediatrics, Thiruvananthapuram.
112
Nutrition Situation
98. The Nutrition scene in India : time trends. (2004). - Ramachandran, Prema. - NFI Bulletin. 114
Nutritional Status/ Dietary Pattern

99. Diet and nutritional status of population and prevalence of hypertension among adults in rural areas. (2006). - Brahmam, G.N.V. et al. - National Institute of Nutrition, Hyderabad. 116
100. Assessment of nutritional status of children below five years of age. (2000). - Chiddarwar, Sonali S. - Indira Gandhi Medical College, Department of Preventive and Social Medicine, Nagpur.
117
S. No.
Subject and Titles
Page No. 119
101. Anthropometric parameters for the assessment of nutritional status in (0-6) years children in Varanasi. (2000). - Das, Lipi, Bishnoi, Indira and Das, B. K. - Man in India. 102. Linear growth as an index of nutritional status Gopalan, C. (2005). - Nutrition Foundation of India, New Delhi. 103. Nutritional status of rural pre-school children of Haryana State. (2000). - Jood, Sudesh et al. - Indian Journal of Pediatrics. 104. Nutrition and malnutrition among children between 1 to 10 years. (2001). - Kango, Mangala. - Govt. Girls Post Graduate College, Department of Home Science, Ujjain. 105. Health and nutritional status of school going children in Patna. (2005). - Kumari, K . - Health and Population Perspectives and Issues. 106. Impact of NSS programme on the nutritional status of preschool children. (2004). - Lakshmi, U.K. and Padma Priya, T. - The Indian Journal of Nutrition and Dietetics. 107. Nutritional deprivation among Indian pre-school children : does rural-urban disparity matter?. (2007). - Mishra, Rudra Narayan. - Gujarat Institute of Development Research. Ahmedabad. 108. A pilot study of the nutritional status of disabled and non-disabled children living in Dharavi, Mumbai. (2001). - Pai, M. et al. - Indian Pediatrics. 109. Determinants of nutritional status of young children in India: an analysis of 1992-93 NFHS data. (2000). - Rajaretnam, T. and Hallad, Jyoti S. - Demography India.
119
121
121
122
123
124
126
126
S. No.
Subject and Titles
Page No. 127
110. Rapid assessment of nutritional status and dietary pattern in a municipal area. (2000). - Ray, Sandip Kumar et al. - Indian Journal of Community Medicine. 111. Studies on the nutritional status of rural population in desert area of Rajasthan. (2007). - Singh, Madhu, B., Fotedar, Ranjana and Lakshminarayana, J. - Desert Medicine Research Centre, Jodhpur.
128
112. Studies on the nutritional status of children aged 0-5 years, in a droughtaffected desert area of western Rajasthan, India. (2006). - Singh, Madhu, B. et al. - Desert Medicine Research Centre, Jodhpur. 113. Perceptual development in relation to nutritional status. - Upadhyay, S.K., et al. - Indian Journal of Pediatrics. 114. Nutritional status of children in Uttar Pradesh. (2001). - Vir, Sheila C. and Nigam, A. K. - UNICEF, Lucknow.
129
130
131
Nutritional Surveillance
115. Development of nutrition surveillance system in Andhra Pradesh. (1998). - National Institute of Nutrition, Hyderabad. 132
Obesity
116. Are we making school children sedentary and obese ? Intervention study of 6000 Indian school children. (2004). - Choudhary, Bakhtia and Kishore, Ajay. - The Indian Journal of Nutrition and Dietetics. 134
Research Nutrition
117. Diet and nutritional status of adolescent tribal population in nine states of India. (2007). - Mallikharjuna Rao, K. et al. - National Institute of Nutrition, National Nutrition Monitoring Bureau (NNMB), Hyderabad. 135
S. No.
Subject and Titles
Page No. 137
118. Food colours in ready to eat foods in unorganized sector : a case study. (2004). - National Institute of Nutrition, Hyderabad. 119. Integrated Child Development Services : Body composition and BMI criterion for Indians: NFI Bulletin, 2005 Oct. (2005). - Nutrition Foundation of India, New Delhi. 120. Integrated child development services : World Bank review. (2006). - Nutrition Foundation of India, New Delhi. 121. Small at birth and chronic diseases in later life. (2003). - Prasad, M P Rajendra. National Institute of Nutrition, Hyderabad. 122. Fifty years of primary health care : the Kerala experience. (2007). - Soman, C.R. - Nutrition Foundation of India, New Delhi.
138
139
140
141
Vitamin A Deficiency
123. Vitamin A deficiency - overkill. (2008). Gopalan, C. Nutrition Foundation of India, New Delhi. 124. Effect of Vitamin A deficiency during pregnancy on maternal and child health. (2006). - Radhika, M.S. et al. - National Institute of Nutrition, Hyderabad. 125. Prevalence of Vitamin A deficiency among preschool children in rural areas. (2006). - National Institute of Nutrition, Hyderabad. 143
144
145
Voluntary Organisations Nutrition

126. NGOs in three north Indian states. (2004). - Tikku, Nirmal. - NIPCCD, New Delhi. 147
Index
149
Research Abstracts on Nutrition
ADOLESCENT GIRLS
Govt. Home Science College Chandigarh. Deptt. of Foods and Nutrition. (1997). Physical Dietary, environment and nutritional status of adolescent mothers. Chandigarh: GHSCC-DFN. 1p.
Key Words : 1.NUTRITION 2.ADOLESCENT MOTHER 3.NUTRITIONAL STATUS 4.NUTRITIONAL STATUS-TEENAGE MOTHER 5.TEENAGE MOTHER 6.LOW INCOME.
Abstract : A survey was carried out on 50 adolescent mothers (16-18 years) from low income families (earning less than Rs. 2000 a month) to assess physical, dietary, environment and nutritional status of adolescent mothers. It was found that 68% of them got married and 46% became pregnant at the age of 16 years. The incidence of pre-term births, still births and abortions was higher among 16 and 17 year olds as compared to 18+ year olds. Their cereal based diet (with very little pulses, vegetables and milk) was very poor, quantitatively and qualitatively. They were consuming 63%, 42%, 80% and 31% of Recommended Dietary Allowance (RDA) of energy, proteins, carbohydrates and fat respectively. Similarly the intake of minerals and vitamins were also less than half of their RDA. As a consequence, these young mothers were manifesting moderate to severe symptoms of protein energy malnutrition, vitamin and mineral deficiency. Grossly low intake of macro nutrients affected their anthropometric indices. 14% were normal, 20% were low weight, and the rest were suffering from mild to severe chronic energy deficiency according to B.M.I. classification. Unsatisfactory environmental and personal hygiene made them prone to frequent attacks of viral fever, Gastro Intestinal Tract (GIT) and bacterial infections, and all these factors also affected their children's nutritional status. The anthropometric indices of their children revealed that 100% of them were classified as 3rd degree wasted and stunted. A highly significant positive correlation was found between BMI of mothers and their macro nutrient intake, number of normal children born, age of marriage and oedema of pregnancy.
Research Abstracts on Nutrition, 1998 - 2008
Adolescent Girls
Saibaba, A. et al. (2002). Nutritional status of adolescent girls in urban slums and the impact of IEC on their nutritional knowledge and practices. Indian Journal of Community Medicine, 27(4) : 151-56.
Key Words : 1.NUTRITION 2.ADOLESCENT GIRLS 3.IEC 4.NUTRITIONAL STATUS 5.NUTRIENT INTAKE.
Abstract : The present study was conducted in the registered slums under India Population Project-VIII, MCH, located in twin cities of Hyderabad and Secunderabad, Andhra Pradesh, India. Girls between 10 and 19 years of age were covered in the study to assess the nutritional status and nutritional knowledge of adolescent girls. One hundred slums were selected based on criteria like availability of (a) an active NGO, (b) urban health post (c) link volunteer scheme, etc. From each of the 100 slums, a quota of 25 adolescent girls, a total of 2500 respondents were covered, which accounted for 63% of all adolescent girls available in the study areas. A combination of methods, anthropometry, biochemical analysis, dietary assessment and interview schedule was used for assessing the nutritional status and nutritional knowledge of adolescent girls. The study was conducted in three stages. In first stage, baseline data was collected using a specially designed pre-tested interview schedule. In the second stage an IEC intervention was carried out for a period of 6 months mainly through Inter Personal Communication (IPC) techniques. IEC tools included cooked demonstrations, posters, information booklet, innovative games and nutritious meals. In the third stage, repeat survey was conducted to find out the impact of IEC intervention in terms of improvement in knowledge scores. It was revealed iron deficiency anemia was found to be the most common nutritional problem observed in them. After IEC intervention significant proportion of girls could correctly identify the foods rich in various important nutrients. A marked increase in the intake of finger millet or 'Ragi' was observed which is a very rich source of calcium as well as iron. It was concluded that IEC intervention resulted in improvement of nutritional knowledge of adolescent girls as well as behavioural pattern envisaged by better cooking methods and increase in the consumption of nutrient rich food.
ANAEMIA/ IRON DEFICIENCY/ IRON SUPPLEMENTATION
AMS Consulting, Ranchi. (2007). Process documentation of Gumla Anaemia Project. Ranchi : AMSC. ~90p.
Key Words : 1.NUTRITION 2.ANAEMIA PREVENTION 3.GUMLA ANAEMIA PROJECT 4.NUTRITION IN ICDS 5.ICDS AND NUTRITION 6.MINORITY DISTRICTS 7.ADOLESCENT GIRLS 8.PREGNANT WOMEN 9.BEHAVIOUR CHANGE.
Abstract : Anaemia is widely prevalent in many regions of India. Gumla district was identified as a priority area for anaemia eradication. Multiple interventions were taken up by the Government of Jharkhand to reduce anaemia in partnership with MOST (India), the USAID micronutrient programme along with Vikas Bharti, a local NGO, as the implementing partner. This study was conducted in 5 blocks of Gumla district and covered 424 villages. The Gumla Anaemia Project was undertaken to improve the health status of pregnant and lactating women and adolescent girls (AGs) by reducing the prevalence of anaemia through awareness generation, training of functionaries, and community involvement. It was found that the training modules prepared covered in detail the project process and issues on awareness and knowledge on anaemia and its causes and consequences. Village Health Workers (VHWs) were not given any regular honoraria under the project. They were discouraged by their family members to perform their duty, and no refresher training/ orientation of VHWs was organized after the initial training by Vikas Bharti, and VHWs became complacent and less motivated. Pregnant women mentioned that the visit/ meetings with the ANM and the AWW were the greatest motivation for them, and women had tremendous faith on them. The regular meetings of the VHW and the social support group members to share the outcome of their visits with pregnant women were very useful. At several places all AGs were given Iron and Folic acid (IFA) tablets to consume in the presence of everybody to make IFA popular and to ensure that tablets were consumed. Not able to meet the growing demand for IFA in their area was the most common woe of ANMs. When the supplies at the sub-centres were exhausted, the ANMs would collect it from the PHC. The AGs of Ghaghra mentioned that they never got any IFA tablets. Women confessed that earlier when they used to receive IFA tablets they would throw them away and not consume them. The best friend and mentor of pregnant women was the ANM and then the AWW. When they suffered from the side effects of consuming IFA tablets, they consulted the ANM/ AWW of their area. After women were made aware of the consequences of anaemia, many more women started 3
consuming IFA. Husband and other family members also encouraged them to regularly consume IFA and supported them when they suffered from side effects. Earlier their husband/ family members would suggest that they discontinue IFA consumption. AGs were also encouraged by their family members to consume IFA. Vikas Bharti had been working for the people of the area on various fronts and the community people had faith on Vikas Bharti. Women should keep track of the number of IFA tablets consumed by them, and some tests should be done in hospitals to check the haemoglobin level changes after the consumption of IFA tablets. Male members need to be educated about anaemia as the women were ready to consume IFA tablets but the men resisted. Regular supply of IFA should be ensured in AWCs, so that there is no discontinuation in the consumption of IFA tablets.
Indian Institute of Health and Family Welfare, Hyderabad. (2002). Prevention and control of anaemia in rural adolescent girls through school system, Andhra Pradesh (Hathnura and Kondapur). Hyderabad : IIHFW. 7p.
Key Words: 1.NUTRITION 2.ANAEMIA 3.ADOLESCENTS 4.ADOLESCENT GIRL 5.RURAL ADOLESCENTS 6.ANAEMIA PREVENTION AND CONTROL.
Abstract : The present study was undertaken to assess the project on Prevention and Control of Anemia in adolescent girls utilizing school system in rural areas of Andhra Pradesh. The project was initiated during 2001 in Medak, a border district of Andhra Pradesh, registering a mean school enrolment of girls at 83% and retention at 41.9% in Government high schools located in two randomly selected mandals. All adolescent girls between 10 and 15 years of age, studying in 6th to 10th Standard in 16 high schools located in both the mandals were listed. A combination of anthropometry, biochemical and interview schedule methods were used for assessing the nutritional anaemia status and awareness of anaemia among study subjects. Out of 1811 girls enrolled from 16 selected schools, 1516 subjects studying in Classes VI to X were covered under the study in baseline survey. It was revealed that the mean age of subjects was 12.4 1.44 years. Majority of girls belonged to backward castes and were from poor socio-economic background. Signs and symptoms of anaemia like pallor, fatigue, breathlessness, poor appetite, lack of concentration in studies were reported by 12.5%, 14.1% 9.2% 26.5% and 86% of girls respectively. A meager percentage of respondents were aware of anaemia (7.4%) and the national programme to control it. Iron deficiency anaemia was found to be
the most common nutritional problem encountered by 81% of respondents. Mild, moderate and severe grades of anaemia was observed in 63.2%, 12.5% and 5.3% of respondents respectively. Only 19% of respondents had normal haemoglobin (Hb) levels of 12g / dl or above. About 34.4% of respondents reported that they came to know about the current project through their school teacher. After the objectives of the programme were explained in detail, 96.5% of subjects showed their willingness to ensure as beneficiaries of the programme. Electronic media 42%, followed by games (33%), and print media (22.6%) were the preferred channels through which subjects desired to know more about anemia and the project. Side effects like abdominal pain, nausea, vomiting, diarrhoea were reported in 5-15% of girls at the beginning of projects and remained at 3% at mid-term survey evaluation. Assessment of blood Hb status was undertaken after 6 month of IFA consumption. During the mid-term survey, blood samples for Hb estimation were collected from 682 girls i.e., 45% of baseline subjects. About 62% of subjects did not skip even a single IFA tablet indicating good compliance. Mean blood Hb level at baseline survey was 10.6 1.1 g/dl which increased to 11.6 1.0 g/dl during mid term survey. Haemoglobin levels improved in 45.6% while they were static in 49.4% and declined in only 5% of subjects. It was evident from the results of mid-term survey that IFA supplementation to school going girls, under teacher supervision, for the preceding six months, together with IEC intervention, resulted in a significant increase in Hb levels indicating the feasibility of this approach.
Indian Institute of Health and Family Welfare, Hyderabad. (2003). Prevention and control of anaemia among rural adolescent girls through school system in Andhra Pradesh (Hathnura, Kondapur, Jinnaram and Pulkal). Hyderabad : IIHFW. 8p.
Key Words : 1.NUTRITION 2.ADOLESCENT HEALTH 3.ADOLESCENT GIRLS 4.ANAEMIA.
Abstract:This study was taken in line with the study initiated earlier (2001-2002) with UNICEF support in two randomly chosen mandals of Medak district, Andhra Pradesh, to examine the feasibility and acceptability of weekly IFA supplementation to adolescent girls, using school system as a vehicle for anaemia reduction. The present study was undertaken to scale up this approach in the remaining mandals of the district in a phased manner. Therefore besides continuing weekly IFA supplementation in the present mandals viz., Hathnura and Kandapur, 5
two more new mandals namely Jinnaram and Pulkal were also included under the project during the current year (2002-03). It was revealed that the mean haemoglobin level of paired samples at the baseline was 11.11.1g/dl, which increased to 12.11.0 g/dl after 52 weeks of IFA supplementation. Percentage of subjects with normal Hb. values increased from 17.1 (baseline) to 59.8 (end line) and concomitant decrease could be noticed in percentage of subjects with mild and moderate degrees of anaemia indicating the efficacy of weekly IFA supplementation. Haemoglobin levels improved in 50.1% cases, while they were static in 42.9% cases, and declined in 7.0% of subjects. The study has clearly shown that IFA supplementation for 52 weeks to the school going girls under the teacher's supervision, together with IEC intervention has resulted in a significant increase in Hb. levels confirming the feasibility and efficacy of this approach.
Institute of Health Management Pachod, Pune. (~2005). Reducing iron deficiency anaemia and changing dietary behaviours among adolescent girls in Maharashtra. Pune : IHMP. 2 p.
Key Words : 1.NUTRITION 2.ANAEMIA ADOLESCENT GIRLS 3.BEST PRACTICES 4.ADOLESCENT GIRLS ANAEMIA 5.GOOD PRACTICES 6.INTERVENTION PROGRAMME 7.INSTITUTE OF HEALTH MANAGEMENT PACHOD 8.VISTAAR PROJECT.
Abstract : India has the highest prevalence of iron deficiency anaemia among women in the world. The present study was carried out on 1142 adolescent girls residing in 16 slums of Pune from 2000-2003. The main objective was to increase the number of daily meals adolescent girls eat from 2 meals to 3-4 meals, and to encourage girls to consume iron rich foods on a daily basis. Weekly iron and folic acid tablets were given in the first 3 months; ongoing nutrition education through home visits and meetings was done by community health workers, participatory activities were undertaken such as food fairs, community projects were undertaken through IHMPs life skills programme; audiovisual materials such as flash cards and posters were developed by the adolescent participants. Blood samples were collected at baseline and end of the study, and haemoglobin was estimated. Findings showed that anaemia is significantly more likely among girls who eat two or fewer meals in a day, have been sick in the past year, and consume few iron rich foods. It was also found that intervention has influenced dietary behaviour with a significant increase in the intervention site compared to the control site in the percentage of girls who eat more than 3 meals a day, eat lemon with their meals, as well as in the frequency of eating fruits. Blood testing showed that mean Hb levels increased from 5.8 to 9.5
gm/ dl for severely anaemic girls, and from 8.9 to 11.2 gm/ dl for moderately anaemic girls. It was suggested that Governments Anaemia Prevention and Control Programme should focus on adolescents. Participatory nutrition education can influence adolescent girls anaemia status and dietary behaviour. Iron supplementation programmes need to include nutrition education programmes to be effective. Key dietary behaviour messages for girls include: eating more than 3 meals a day, eating with family so as to eat enough, eating green vegetables daily, and eating lemon or amla with meals. More effective methods need to be devised for community based Hb testing.
Kotecha, Prakash V., Karkar, Purvi and Nirupam, Siddharth. (~2005). Adolescent girls anaemia control program. Ahmedabad : Medical College Vadodara, Dept. of Preventive and Social Medicine. 31 p.
Key Words : 1.NUTRITION 2.ANAEMIA ADOLESCENT GIRLS 3.ADOLESCENT GIRLS ANAEMIA 4.INTERVENTION PROGRAMME ANAEMIA 5.GUJARAT 6.VISTAAR PROJECT.
Abstract : Anaemia is widely prevalent among adolescent girls (AGs). The present study was initiated by Government of Gujarat with the main aim to ensure that 90% of the adolescent girls (13-19 years) in schools and 70% of out of school girls participate in weekly consumption of IFA tablets under supervision. The Anaemia Control Programme is operational in 410 schools covering 65,000 adolescent schoolgirls as beneficiaries. 30 schools were taken at baseline from urban (10), rural (10), and tribal (10) areas. To measure anaemia prevalence, haemoglobin (Hb) level and serum ferritin levels were measured at baseline and end line, and the difference was seen. A total of 2766 AGs were available for final analysis. Anaemia prevalence (Hb<120 gm/ l) was recorded as 53.2% at end line compared to baseline anaemia prevalence of 74.7%. There was a reduction of 21.5% in anaemia prevalence after initiation of the programme. The reduction achieved was maximum in rural areas followed by urban areas, both showing a net reduction of over 23%, while tribal areas showed a reduction of about 16%. Mean rise of haemoglobin was seen to the extent of 6.4 gm/ dl with regional differences, and maximum rise was seen in rural areas, followed by urban areas. Severe anaemia prevalence reduced from 1.6% at baseline to 0.5% at end line. Reduction values for moderate and mild anemia were 51% and 22% points. A total of 804 samples were studied for serum ferritin in the present study. The proportion of girls having serum ferritin less than 12 g/ ml, indicative of poor iron storage, declined from 49.7% to 39.4%, and the decline was consistent in all the areas. The median ferritin of the group increased from 12 mg/ ml to 16.5 mg/ ml, and
the improvement was recorded across all ages. Results revealed that 34.9% of the anaemic girls became non-anaemic. About 19.8% non-anaemic girls, that is 5.1% of the total girls (52/1016), became anaemic. Net reduction of anaemia prevalence was 20.8% (74.2% to 53.4%). Maximum reduction of anaemia prevalence (25.2%) was observed in urban areas, followed by rural areas (22.8%), and tribal areas (12.7%). Out of 2766 girls, 72.4% mentioned that they received the brochure; more rural and tribal girls reported this as compared to urban girls. 87.2% of the girls had read the brochure, either by themselves (57.2%), or with their friends (55.1%), or with their teachers and friends (23.1%). 99% respondents recalled at least one correct message. 37.8% of the girls had actually seen posters related to the Anemia Programme in their schools. Majority of those who responded (90%) were able to give correctly the name of the condition of pale blood, anaemia or pandurog (anaemia). 66.6% of the girls could not correctly reply when asked to name the nutrient which leads to pale blood. Only 12.1% answered iron or Loahtatva. 7.5% mentioned 3 or more correct signs or symptoms of anaemia. IEC material had been received and read by most of the girls. However, the understanding of messages and retention of information was not fully satisfactory. It is still to be explored, how best IEC can be used adequately. This may mean more motivation, systematic monitoring of IEC uses, and enhanced emphasis on IEC during training.
Nutrition Foundation of India, New Delhi. (2005). Anaemia in pregnancy : interstate differences. New Delhi : NFI. 31 p.
Key Words : 1.NUTRITION 2.ANAEMIA PREGNANT WOMEN 3.ANAEMIA PREGNANCY 4.MICRONUTRIENT DEFICIENCY.
Abstract : India perhaps has the highest prevalence of anaemia due to iron and folate deficiency, ranging between 50-90% among pregnant women according to Indian Council of Medical Research (ICMR) and other research agencies. The National Family Health Survey (NFHS-2) was the first national survey to measure haemoglobin levels of ever married women aged 15-49 years. According to NFHS-2, anaemia among pregnant women was 49.7%. The Department of Family Welfare funded NFI to carry out a research study in seven states namely Tamil Nadu, Kerala, Himachal Pradesh, Haryana, Assam, Orissa and Madhya Pradesh. The prevalence of anaemia was lowest in Kerala and highest in Madhya Pradesh. Women in Kerala had higher literacy, better housing, better access to mass media and health care. In Tamil Nadu, more than 90% women were anaemic in both the groups; whereas among pregnant women, 58% in Kerala, and 68% in Himachal Pradesh were anaemic, while
among lactating women 60% women in Kerala and 91% in Himachal Pradesh were anaemic. According to NFHS-2, in Assam 60%, Orissa 60%, Tamil Nadu 58%, Haryana 56%, Madhya Pradesh 56%, Himachal Pradesh 30%, and Kerala 20% pregnant women were anaemic; while according to NFI study, in Orissa 100%, Madhya Pradesh 99%, Assam 94%, Haryana 92%, Tamil Nadu 84%, Himachal Pradesh 64%, and Kerala 54% pregnant women had anaemia. Anaemia in lactating women was 70% in Assam, 65% in Orissa, 60% in Tamil Nadu, 59% in Madhya Pradesh, 56% in Haryana, 50% in Himachal Pradesh, and 20% in Kerala (NFHS-2). The NFI study revealed that anaemia among lactating women was 93% in Assam, 92% in Madhya Pradesh, 90% in Haryana, 83% in Tamil Nadu, 68% in Himachal Pradesh, and 32% in Kerala. National Nutrition Micro-nutrient Survey (NNMB), DLHS and NFI Survey reported higher prevalence of anaemia than NFHS-2. The present survey confirmed that there are interstate differences in the mean haemoglobin levels as well as the prevalence of different grades of anaemia, which is a major problem even in children and adolescent girls. Anaemia is a major cause of maternal and perinatal morbidity and mortality. As a large proportion of Indias one billion plus population is anaemic, it is imperative that every effort is made to increase the iron and folate intake of the population, and to ensure universal screening for anaemia as a part of antenatal care.
Reddy, Ramakrishna. (2004). Prevalence of iron deficiency anaemia and malnutrition in India. Bangalore : Institute for Social and Economic Change. 116 p.
Key Words : 1.NUTRITION 2.ANAEMIA 3.MALNUTRITION 4.WOMEN AND CHILDREN 5.NFHS 2 DATA.
Abstract : Prosperity of a nation is reflected in the strength of its human resources, and welfare states all over the world aim to ensure the well-being of their populations in order to remain in the forefront of development at all times. This study is basically an in-depth analysis of the secondary data available on the prevalence of iron deficiency anaemia and malnutrition. Iron deficiency anaemia is the leading cause of morbidity among vast sections of people, especially in developing countries. In 1998-99, data on iron deficiency anaemia and malnutrition among 90,000 ever married women in the reproductive age group of 15-49 years and their children aged below 3 years were collected by directly measuring haemoglobin levels. A total of 92,466 households were surveyed of which two-thirds were in rural areas (NFHS-2 data). Prevalence of moderate anaemia was higher among teenage women being 18%, followed by 17% among women in the age group 20-24
years. Assam had the highest prevalence of iron deficiency anaemia in the country (70%), followed by Bihar (63%) and Tripura (59%); and the lowest prevalence rate was in Kerala (23%), followed by Manipur (29%). About 72% infants aged 6-11 months had anaemia, with 27% having mild anaemia, 42% moderate anaemia and the rest had severe anaemia. Anaemia increased in the second year of life, and 78% children aged 12-23 months had anaemia. The pattern of prevalence of anaemia among children was highest in the eastern region of the country, namely the states of Bihar, Orissa and West Bengal among children aged 6-35 months at 77%; followed by North Indian States like Delhi, Haryana, Himachal Pradesh with 76% prevalence; and north eastern states namely Arunachal Pradesh, Assam, Manipur which had lowest prevalence of iron deficiency anaemia at 59%. About 13% currently married women had height below 145 cm. As fertility became lower in the age group 30-34 and 35-49 years the prevalence of malnutrition reduced by about 8-9%. Malnutrition was widely prevalent in the north eastern region of the country. The percentage of women with BMI below 18.5 was significantly lower among women with high standards of living (17%) compared to women with low standards of living (48%). The percentage of women with height less than 145 cm was highest in Meghalaya (21%); followed by Bihar (20%). The nutritional status of 24,600 children was assessed using anthropometric measurements, and 57% children were underweight or undernourished, 59% were stunted and 17% were wasted. Maharashtra had the highest prevalence of iron deficiency anaemia (46%) and malnutrition (38%) in the Western region. The prevalence of malnutrition was higher, among children of illiterate mothers; with 79% children being underweight and 78% suffering from iron deficiency anaemia. The NFHS-2 data has brought out the fact that a large section of women in their reproductive phase in India face the greatest disadvantage of the risks involved in reproduction. There is a need for repeating haemoglobin tests and anthropometric measurements at specified intervals to monitor the situation. The period specified as early childhood should be increased from 0-35 months to 0-59 months so that more children come within the ambit of Government programmes. Unmarried adolescents should be treated as a prime segment of the female population. Targeted nutritional supplementation programmes must be introduced from infancy and early childhood, for preschool children, pregnant women and lactating mothers. Food security is another aspect that needs to be given priority by planners considering the widespread prevalence of malnutrition in the country.
10
Sharma, Anshu, Prasad, Kanti and Visweswara Rao, K. (2000). Identification of an appropriate strategy to control anaemia in adolescent girls of poor communities. New Delhi : Nutrition Foundation of India. 7 p.
Key Words : 1.NUTRITION 2.ANAEMIA ADOLESCENT GIRLS 3.ADOLESCENT GIRLS 4.COMBATING ANAEMIA 5.INTERVENTION PROGRAMME ANAEMIA 6.VISTAAR PROJECT.
Abstract : Even today nearly 1.5 billion people all over the world are affected by iron deficiency anaemia (IDA). In India alone, depending on age and sex, IDA has been reported to range from 38-72%, majority of them being women and children. The IDA prevalence rate beyond the age of 6 years increases in girls. This could be due to certain factors like menstruation, gender discrimination in intra household food allocation and early marriage leading to early pregnancy. Adolescent girls form 22% of the total population and estimates suggest that about 25-50% girls become anaemic by the time they reach menarche. Absorption from a single dose of iron supplementation reduces from 30-40% on the first day to as low as 3-6% after a few days of continuous daily administration of iron supplements. The present study was therefore conducted to obtain baseline data on haemoglobin (Hb) levels of adolescent girls belonging to low socio-economic groups; investigate the comparative efficacy of once weekly and daily administration of iron-folate tablets with respect to impact on the Hb levels; and find out the effect of added ascorbic acid supplementation. The subjects were divided into the following three treatment groups: Group 1: 1 tablet of iron folate (100 mg elemental iron + 500 mg folate) once weekly; Group 2: 1 tablet of iron folate Vitamin C (100 mg elemental iron + 500 mg folate + 25 mg Vitamin C) once weekly; Group 3: 1 tablet of iron folate (100 mg elemental iron + 500 mg folte) daily. Children were administered tablets after lunch. The Hb level of a total of 520 urban girls and 185 rural girls was tested and the Hb status of urban girls was found to be better than that of rural girls. The percentage of girls with Hb less than 12g/dl in the urban sample was 61.9% as against 85.4% in the rural sample. Only 38.1% urban girls and 14.6% rural girls had Hb levels more than 12.0 g/dl. Prevalence of anaemia was lower in taller and heavier subjects. Weekly iron/ folate supplementation improved Hb by 0.62 g/ dl at 3 months and 0.79 g/ dl at 6 months. Iron/ folate/ Vitamin C supplementation increased Hb by 1.05 g/ dl at 3 months and 1.17 g/ dl at 6 months. However, daily iron/ folate supplementation was more effective than once weekly with an increase by 0.99 g/ dl at 3 months and 1.57 g/ dl at 6 months. Important findings that emerged from the study were children who were severely malnourished showed better absorption; to combat anaemia locally available GLVs (green leafy vegetables) could be used; and
11
consumption of low cost sources of iron and Vitamin C rich fruits and vegetables needs to be advocated. Inclusion of Vitamin C in iron/ folate as part of a Public Health Operation may be recommended as it enhances the absorption of iron significantly, even weekly iron/ folate supplementation may be used in ICDS programme for less fatigue, better productivity, improved immune function, and reduced risk of reproductive failure and maternal mortality.
Sood, Mousmee and Sharada D. (2002). Iron food supplement. The Indian Journal of Pediatrics, 69(11) : 943-46.
Key Words : 1.NUTRITION SUPPLEMENT DEVELOPMENT 2.ANAEMIA 3.IRON FOOD SUPPLEMENT 4.FOOD
Abstract : The present study was conducted to develop an iron rich supplement with locally available foods and to test its feasibility in school going children (7-9 years) belonging to low income families. Children from the upper primary school in Rajendra Nagar were screened for hemoglobin (HB) levels and 36 children having HB levels below 11 g/dl were selected. Based on their HB levels, age and gender, 24 children were grouped as experimental and the rest as control. A supplement food was developed using locally available foods like jaggery, processed rice flakes, garden cress, cress seeds and amaranth seeds (45 : 40 : 10 : 5). In the experimental group, children were given one ladoo per day for a period of 60 days. Effect of Supplement on Hb levels, height and weight were assessed. It was found that 97% of these children were under-nourished and 50% were in grade II malnutrition. Significant increase in Hb levels was observed in both the boys and girls after 30 days of supplementation only. The increase was comparatively more in the first 30 days than the second 30 days. The overall increase in Hb levels was more in 7-8 years than 8-9 years age group. In majority of the subjects progression from one Hb levels to the next higher level was observed. There was no significant improvement in their height & weight. It was concluded that the product developed contributed around 39 mg of iron. Thus its efficacy as an iron rich supplement in combating iron deficiency anemia was reflected in the results obtained.
12
BREASTFEEDING
Acharya, Rajib et al. (2004). Nutritional and health impact on children breastfed beyond infancy : evidence from India. Demography India, 33(2) : 205-229.
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.CHILD FEEDING 4.INFANT FEEDING 5.BREASTFEEDING PRACTICES 6.CHILD HEALTH 7.WEANING FOODS.
Abstract : Breastfeeding is the physiological norm for both mothers and children. The study was carried out to examine the beneficial effect of breastfeeding on common childhood morbidities and its positive impact on child growth related to height and weight of children in the age group 0-35 months. Data about children was collected from mothers covered by National Family Health Survey-2, 1998-99, and a questionnaire was used to collect information related to weaning status and duration of breastfeeding. Results showed that 15% children suffered from diarrhoea who were completely weaned (no breastfeeding), 25% who were not weaned (only breastfed) and 20% who were partially weaned. The prevalence of Acute Respiratory Infection (ARI) increased drastically from 15% for completely weaned children to 26% for children not weaned at all, and 21% among children who continued to be breastfed along with supplementary food. Household conditions, hygiene, economic conditions, general health of baby and mother, and age of mother were some of the reasons associated with the prevalence of ARI and diarrhoea. 46% to 63% children who were not weaned at all and breastfed even after 18 months suffered from childhood diseases. It was found that 63% children who were partially weaned were underweight and 27% were severely underweight. 50% children in the age group 12-35 months who were completely weaned were stunted and 25% of them were severely stunted. Those children who were given weaning foods as per schedule and breastfed for 18-23 months tended to be less underweight than those who were breastfed for less than a year. It was found that prolonged breastfeeding had a positive effect on weight and growth of babies but it was also important that proper supplementary diet was given to the child along with breast milk.
13
Breastfeeding
Barge, Sandhya. (2002). Breastfeeding practices in two blocks of east Singhbhum district, Jharkhand. Vadodara : Centre for Operations Research and Training. 23 p.
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.SEX DISCRIMINATION.
Abstract : The study was carried out in Patamda and Potka block of East Singhbhum district of Jharkhand with an objective to explore the breastfeeding practices among mothers and also to identify the areas of intensified interventions to improve breastfeeding practices, so as to make a sustainable impact on nutritional status and child survival. Under the guidance of CARE, a questionnaire for data collection was finalized and was translated into the local language. A total of 474 women : 244 from Patamda and 239 from Potka, were interviewed who had given birth to a child 12 months prior to the survey. The study revealed that 60% of the sample lived in joint families. Average household size was 6 members per household. 91% of the houses were made of kuchha material and did not have basic facilities 99% did not have any toilet facility; 51% depended on wells and 40% on hand pumps for drinking water. 71% illiteracy was recorded among women of Patamda and 64% in Potka block; as a result a higher percentage of women in Potka earned (60%) cash for their work, compared to those in Patamda (48%). Exposure to information channels like radio and TV was very limited. It was noted that 81% of the women made all efforts to avail antenatal services, and these services were mainly availed from government sources. Only 21% and 14% of the women in Patamda and Potka respectively, were either examined or advised by health workers during their home visit in the post-natal period. The need for check-up during post-natal period was found to be less. The study also revealed that 60% mothers had the knowledge that first milk of the mother should be given to the new born; and 82% knew that breastfeeding should be initiated within 8 hours of child birth. But 58% were unaware about exclusive breastfeeding up to first six months; and that child needs to be supplemented with additional diet within the stipulated time period. 80% initiated breastfeeding within 8 hours of child birth, 66.7% did not give pre-lactal feed to the child, and 41% did so as they were asked by their mother-in-law to do so. Colostrum feeding was practiced by most of the women. Breastfeeding practices remained the same for both boys and girls, without any discrimination. It was found that there is a need to educate women on the importance of health services at an early stage of pregnancy, exclusive breastfeeding, benefits of colostrum, etc. Health workers must understand the importance of follow-up care during antenatal and post-natal period, and should use personal interactions to advise women on family planning. 14
Breastfeeding
Bhandari, Nita et al. (2003). Effect of community based promotion of exclusive breastfeeding on diarrhoeal illnesses and growth : a cluster randomised controlled trial. New Delhi : AIIMS, Dept. of Pediatrics. 6 p.
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.IMPACT 4.DIARRHOEA 5.INFANT GROWTH 6.VISTAAR PROJECT. OF BREASTFEEDING
Abstract : In developing countries, breastfeeding is common but exclusive breastfeeding is not. The present study was carried out to assess the feasibility and effectiveness of an educational intervention to promote exclusive breastfeeding in India. The study was conducted in Haryana during 1998-2002. In the Intervention Project, health and nutrition workers were trained to counsel mothers for exclusive breastfeeding at multiple opportunities. Traditional birth attendants (TBAs), local village based workers namely Anganwadi workers (AWWs) of the ICDS Scheme, auxiliary nurse midwives (ANMs), and other health care providers were trained to counsel mothers/ caregivers. 1115 infants, born in the 9 months after the functionaries were trained, were taken for the study, 552 in the intervention and 473 in the control communities. Feeding at the age of 3 months, anthropometry and diarrhoea prevalence at age 3 months and 6 months were assessed. It was found that exclusive breastfeeding rate at the age of 3 months was 381 (79%) in intervention and 197 (48%) in control groups. About 22% children in the intervention group and 30% children in the control group had suffered from diarhhoea in the 7 days preceding the study. 50% women and 15% men have never been to school. Maternal under nutrition was high, and 26% married women have body mass index (BMI) less than 18.5 kg/ m2. Health care is provided through primary health centres, each of which serves a population of about 30,000 through two or three medical officers, auxiliary nurse midwives and other ancillary staff. There were six sub-centres attached to each primary health centre. Exclusive breastfeeding rates in infants aged 4-6 months were 5% (78) and 8% (74) in the intervention and control communities, respectively. Similarly, 13% (195) infants younger than six months in the intervention group had diarrhoea in the previous 7 days compared with 15% (196) in the control areas. By age 3 months more infants and mothers in the intervention than in the control communities had been visited at home by Anganwadi Workers (254 (53%) vs. 110 (27%)), had attended weighing sessions (202 (42%) vs. 22 (5%)) and immunization sessions (414 (86%) vs. 330 (80%)), had visited a primary health centre (80 (17%) vs. 28 (7%)), and had met with an auxiliary nurse midwife at the monthly meeting (71 (15%) vs. none). The intervention had a small effect on the
15
Breastfeeding
proportion of infants delivered by traditional birth attendants (384 (70%) vs. 305 (66%)). The proportion of health worker to mother interactions in which mothers spontaneously recalled being counselled on exclusive breastfeeding was 49% (218) vs. 1% (3) in immunization sessions, 61% (155) vs. 2% (2) during home visits and 61% (123) vs. none at weighing sessions. Information obtained during home visits when infants were aged 3 months showed that pre-lacteal foods of honey, tea and diluted milk were fed to 31% neonates in the intervention group compared to 75% in the control communities, and many more children were exclusively breastfed in the intervention group. At the 3 month and 6 month visits, fewer mothers in the intervention areas than in control areas reported infants with diarrhoea in the previous 7 days. It was recommended that infants should be breastfed exclusively till 6 months of age.
Bharati, Sunita Reddy. (2000). Socio-economic dimensions of breastfeeding: a study in Hyderabad, Health and Population, 23(3) : 144-59.
Key Words : 1.NUTRITION. 2.BREASTFEEDING.
Abstract :To examine the patterns and duration of breastfeeding, the study was conducted in a sample of 100 urban mothers of Hyderabad. Data was collected regarding literacy, employment pattern and income of mothers. Most of the mothers (41%) belonged to the lower income group, followed by the middle (31%) and upper income groups (28%). The incidence of breastfeeding was highest among the lower income group mothers (98%), followed by upper income group mothers (96%) and middle income group mothers (84%). Only 15% of the mothers in the middle income group weaned their children after one year and 37% weaned infants in the age group of 1-3 months, as against only 7 per cent of the mothers in the lower income group and 3 per cent of the mothers in the upper income group who weaned their children in the age group 1-3 months. 100% of mothers working in the unorganized sectors have ever breast-fed and 77 per cent of mothers working in the organised sectors could ever breastfeed. The pattern indicates a steady decline in the duration of breastfeeding when the level of formal education of mothers goes up. The study recommended dissemination of proper information through printed materials, posters and electronic media related to breast feeding, its benefits and problems.
16
Breastfeeding
IBFAN, Asia International Baby Food Action Network, New Delhi. (2007). The State of the World's Breastfeeding South Asia report : tracking implementation of the global strategy for infant and young child feeding. New Delhi : IBFAN. 103 p.
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.INFANT AND YOUNG CHILD FEEDING 4.GLOBAL STRATEGY ON INFANT FEEDING 5.SOUTH ASIA.
Abstract : Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children. This report provides information on the findings and action taken by countries over the past two years. It deals with infant and young child feeding practices, policies, and programmes, the status of child malnutrition and survival in South Asia. South Asia has about 1.4 billion people and the highest number of under-five deaths and under-five children who are underweight. More than 70 million out of 146 million under-five under weight children are in South Asia. These countries are struggling to attain the required pace of reduction of child mortality. According to IBFAN Asia Pacific 2006, the region has 37,145,000 annual estimated births with underfive mortality rate (U5MR) of 97 contributing significantly to the global burden of under-five mortality. More than 77 million children under the age of five years are underdeveloped and undernourished. According to the Global Strategy for Infant and Young Child Feeding, malnutrition has been responsible, directly or indirectly, for 60% of the 10.9 million deaths annually among children under five. Over 66% of these deaths, which are often associated with inappropriate feeding practices, occur during the first year of life. Less than 35% infants worldwide are exclusively breastfed during the first 4 months of life. Malnourished children who survive are more frequently sick and suffer life-long consequences of impaired development. The challenge is significant in many countries of South Asia where neonatal mortality represents at least 50% of infant deaths. In South Asia, more than 1,400,000 babies are estimated to die during the first month of life, and another 2,200,000 during 2 to 12 months. In India alone, about 1,100,000 babies die during the first month of life, and another 500,000 during 2 to 12 months of age. The primary causes of neonatal deaths are neonatal infections (52%), asphyxia (20%), and low birth weight (17%). Most of the infectious deaths are from diarrhoea and pneumonia. As about 66% of all child deaths occur during infancy, action is needed during that period. The World Breastfeeding Trends Initiative (WBTI) is an innovative flagship project of IBFAN Asia that aims at initiating action worldwide to
17
Breastfeeding
ensure optimal infant and young child feeding practices. The WBTI toolkit helps to colour, rate and rank a country by practice. The colour rating ranges from Green, Blue, Yellow and Red reflecting excellent to poor state of infant feeding. Given the role breastfeeding plays in contributing to all eight Millennium Development Goals (MDGs), the WBTI provides all nations an opportunity to track their implementation of the Global Strategy. The WBTI initiative builds effective partnerships around mother and child health. WBTI process provides increased flow of pertinent information to decision makers and leads to capacity building and policy formulation support. The coverage of key/ critical breastfeeding interventions is low in the whole of South Asia. The rate of adequate complementary feeding in South Asian Countries varies from 22% to 98%. India falls in Grade D in Red colour (35%). The data on initiation of breastfeeding within one hour reveals that it varies from 16% to 75%, for India it was 16% and India fell in Grade D (Red colour). Exclusive breastfeeding varied from 10% to 68% in South Asia, and India was categorized as Yellow in Grade C with 46%. There is an urgent need to create a positive environment for optimal breastfeeding in all these countries. It was recommended that effective resource allocation is needed to change the status for indicators that are now in the Red. All political parties and forums should take stock of the situation and provide the necessary impetus to move forward to the next level of achievement. National governments should adopt comprehensive policies on infant and young child feeding.
Ram, Rama et al. (2000). Breastfeeding practices in the rural community of District Darjeeling, West Bengal. Indian Journal of Community Medicine, 25(2) : 79-82.
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.DIARRHOEA 4.RURAL HEALTH.
Abstract : The study was conducted to find out the pattern and influence of socioeconomic and cultural factors on breastfeeding practices of mothers with special reference to association with occurrence of diarrhoea in the rural areas of Darjeeling district. Interviews of 1200 mothers having babies 6-24 weeks attending the immunization clinic were conducted. Results revealed that 85.5% mothers initiated breastfeeding within 7-18 hours after delivery and 100% mothers started within 24 hours. 55% of the mothers got information regarding breastfeeding from their family members, 17.5% from paramedical staff and 16.3% from doctors. Socio-economic and educational status of mothers had significant association with duration of breastfeeding. Shorter duration was noted among educated mothers 18
Breastfeeding
with high education and socio-economic status as compared to illiterate mothers with poor status. Diarrhoea among exclusively breastfed children was nil and 32 children who were bottle fed were having diarrhoea. The study recommended that women should avoid non-human milk with or without bottle up to the age of 4 months and should focus on timely weaning practices.
Rameshwararao, A. A. (2004). Breastfeeding behaviour of Indian women. Medicine, 29(2) : 62-64.
Indian Journal of Community
Key Words : 1.NUTRITION 2.BREASTFEEDING 3.AGE OF MARRIAGE 4.EXCLUSIVE BREASTFEEDING.
Abstract : The study was conducted in Latur and Osmanabad district of Maharashtra during February 1997. The objectives were to know different types of breastfeeding behaviour among mothers; the extent of exclusive breastfeeding (EBF) practices; to compare urban and rural breastfeeding practices; and its relationship with social variables like income, literacy, age at marriage and parity of mothers. WHO 30 cluster sampling technique was used to select 30 villages (clusters) from each district. Breastfeeding practice was divided into 4 categories exclusive breastfeeding (EBF), almost exclusive breastfeeding (AEBE), partial breastfeeding, and token feeding (TF). The study covered 314 mothers, 65 in urban and 249 in rural areas. The study found that EBF practice was inadequate (39.5%). EBF improved with increasing parity and with age of marriage between 19-25 years. EBF was practiced more by urban mothers (49%) compared to rural mothers (37%). It was also found to decrease among urban mothers with increasing parity, which could be due to negligence or cosmetic purposes. It had no relationship with income and literacy status of mothers. Almost exclusive type breastfeeding was found among 19% mothers, whereas partial breastfeeding was 38%, and token feeding was 3.6% among mothers. The usual duration of breastfeeding was 5-10 minutes and interval between feeds was 1-3 hours. Though EBF was not adequate, practice of prolonged breastfeeding up to 1-2 years was significant enough to combat malnutrition and infections. The study found that there is a need for intensifying IEC activities in Child Survival Safe Motherhood (CSSM) programme, and community involvement to increase EBF practice.
19
Breastfeeding
Sangole, S.S. and Durge, P.M. (2002) Breastfeeding practices of mothers in urban slum. Is it really exclusive ?. Nagpur : Indira Gandhi Medical College, Deptt. of Preventive and Social Medicine. 8 p.
Key Words : 1.NUTRITION 2.BREASTFEEDING PRACTICE 3.SOCIOECONOMIC FACTORS 4.KAP OF MOTHER.
Abstract : Exclusive breastfeeding means no drinks such as honey, water, glucose water, gripe water, juices, vitamins, animal and powdered milk or foods other than breast milk. The study was conducted with the objective to find the pattern of breastfeeding practices in the urban slum, and socio-economic and cultural factors which influenced exclusive breastfeeding. The Preventive and Social Medicine Department of Indira Gandhi Medical College, Nagpur carried out a cross-sectional study of 600 mothers having infants aged 0-1 years. Information about sociocultural factors and practices of breastfeeding were collected from 600 mothers. The study was completed between 1st April to 30th September 2001. Only 7 out of 600 mothers (1.16%) practiced exclusive breastfeeding. Among non-exclusive breastfeeding majority, 171 mothers (28.83%) had given vitamin drops as per advice given by private practitioners and health workers, and 127 (21.41%) had given gripe water to their babies on one or many occasions. Private practitioners should promote exclusive breastfeeding. Socio-economic status of mothers had significant association with duration of breastfeeding. Shorter duration of breastfeeding was noted among mothers with high education, and prolonged duration among poor and illiterate mothers. Insufficient milk was the main reason for discontinuation of breastfeeding within 6 months. 227 out of 322 mothers (70.49%) discontinued breastfeeding because they started weaning when the infant was 6-12 months old. Prolonged breastfeeding and delayed weaning resulted in malnutrition. There was an association between initiation of breastfeeding and information received by mothers regarding breastfeeding during ante-natal care (ANC). Breastfeeding was started earlier by mothers who had received knowledge about it during ANC period. To ensure a healthy future for young ones and to fulfill their rights to survival, development, protection and participation, emphasis should be given on effective, accurate and unbiased communication on exclusive breastfeeding.
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Breastfeeding
Yadav, R. J. and Singh, P. (2004). Knowledge, attitude and practices of mothers about breastfeeding in Bihar. Indian Journal of Community Medicine, 29(3) : 130-31.
Key Words : 1. NUTRITION 2.BREASTFEEDING 3.SUPPLEMENTARY FOOD.
Abstract : The Institute for Research in Medical Statistics (IRMS) undertook a study in Bihar to assess the knowledge, attitude and practices of mothers related to breastfeeding and introduction of supplements. Two villages were selected from each block using Probability Proportion to Size (PPS) sampling. In each village, 20 households were selected. The survey covered about 28,000 households from all 591 blocks of the districts. About 8000 mothers were interviewed. Information was collected on household characteristics, demographic profile, anthropometry, breastfeeding practices, special food intake during pregnancy, lactation, awareness and cause of night blindness. The study revealed that about 29% of the mothers started breastfeeding within 24 hours. About two third mothers discarded colostrum. About one third mothers discarded the colostrum on the advice of their elders. Majority of mothers were of the opinion that a child should be breastfed for more than one year. Cereal preparations and milk formed the major food item as a supplement for breast milk. The main reasons for starting supplements were mothers insufficient milk, childs demand, and mothers opinion that supplements were required for proper growth. The special foods preferred by mothers during pregnancy and lactation were mainly ghee and milk products irrespective of their socio economic conditions. Majority of the mothers were aware of night blindness and anaemia. Only few knew about protein energy malnutrition. Thus, efforts should be made to have IEC activities targeted to educate the mothers specially in rural areas.
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CHILD NUTRITION
Hunt, Joseph and Quibria, M.G, ed. (1999). Investing in child nutrition in Asia. Manila, Philippines : Asian Development Bank. 273 p.
Key Words : 1.NUTRITION 2.CHILD NUTRITION 3.COMMUNITY BASED NUTRITION 4.MICRONUTRIENT DEFICIENCY 5.FOOD SECURITY 6.CHILD CARE.
Abstract : This study investigated the impact of malnutrition in countries in Asia and the Pacific, namely, Bangladesh, Cambodia, China, India, Pakistan, Sri Lanka and Vietnam, on poverty and depressed human and economic development. This study was divided into three parts, i) Part One dealt with nutrition interventions for poor women and children, with benefits accruing to families, communities and nations throughout the life cycle, ii) Part Two reviewed and assessed the scientific evidence available about nutrition policies, programs and developmental assistance that would have an impact on and raise the quality of human resources; and iii) Part Three dealt with the creation of opportunities for public, private and civil sector partnerships, that could raise the dietary quality of the poor, and enhance the learning and earning capability of poor children. This study covers about two thirds of the worlds 150 million preschool children under five years. Each country including India, prepared a ten-year investment program, nutrition situation analysis, reviewed the linkages between health and nutrition service delivery programs and community-based interventions for children, etc. It was estimated that the relative risk of mortality for a child with sub-clinical deficiency was 1.75 times that for a non-deficient child. The study revealed that in low-income Asia, 2.6 million child deaths per year were associated with protein-energy malnutrition (PEM), 0.36 million child deaths per year with Vitamin A deficiency, and 65,000 maternal death per year with iron deficiency anaemia. To improve the nutrition situation rapidly in the Asian region, the study suggested that (i) educated and socio-economically empowered Asian women were the key to improving the nutrition situation and developing mental acuity among young children; (ii) communities can play a major role in supporting families to improve the nutrition of their children; and (iii) conventional food subsidies should be properly targeted for women.
22
Child Nutrition
Mason, John, et al. (2001). Improving child nutrition in Asia. Manila, Philippines : Asian Development Bank. 85 p.
Key Words : 1.NUTRITION 2.CHILD NUTRITION 3.COMMUNITY BASED NUTRITION 4.MICRONUTRIENT DEFICIENCY 5.NUTRITION STRATEGY 6.INTERVENTION PROGRAMME.
Abstract : A series of country studies were conducted from 1997 till 1999 on investment needs for reducing malnutrition in seven Asian countries, namely, Bangladesh, Cambodia, India, Pakistan, Peoples Republic of China, Sri Lanka and Vietnam. These studies were conducted by Asian Development Bank (ADB) and UNICEF collaboration with national governments. In each country, government departments undertook a review of the problems in relation to present policies and programs, and based on the analyses, made recommendations for a strengthened strategy for accelerated nutritional improvement. The reports covered situational analysis, review of current community based and service delivery programs, support policies, forward-looking strategies, finances available and implementation. It was estimated that around US $ 1 to 2 billion per year for the period of 10 years in each of these countries would bring a significant reduction in child malnutrition, and might reach the goal of halving child malnutrition. Around 160 million children (under 5 years of age) are underweight in the world now, of which 75% (120 million) are in these eight countries - 62 million in India, 17 million in China and about 10 million each in Bangladesh and Pakistan. Malnutrition, manifested as growth failure, carries increased risk of mortality and sickness, and can inhibit educability, adult fitness and productivity. The high level of growth failure represents an enormous loss of human capital for Asia. The slow rate of improvement shows that in India, it would take 100 years to reach zero level of malnutrition. Poverty or low income shows a strong correlation with malnutrition. In India, 45.2% preschool children were underweight in urban areas, and 55.9% in rural areas. In Tamil Nadu, 65% of preschool children in slums were found to be underweight, and 35% were underweight in rural areas. Many other socio-economic and environmental factors can be related to malnutrition, namely, housing, water, sanitation, assets, access to health services, and so on. Educational status of women had an impact on malnutrition, for example, in Bangladesh child stunting prevalence was 18% for the
23
Child Nutrition
group with highly educated mothers, and 50% for the least educated mothers. Elimination of Vitamin A deficiency (VAD), means prevalence of low serum retinal (below 0.7 m/1) of less than 5%, with clinical indicators of less than 1%. Standardized estimates of preschool children in 1995 indicated that Bangladesh and Cambodia have clinical prevalence rates of over 1%, with India and Pakistan having 0.8% prevalence rate, the other countries and had even lower rates. VAD was assessed generally as symptoms of eye damage that can cause major damage to other organs. Around 25% of child deaths in South Asian countries and Cambodia are expected to be prevented by eliminating Vitamin A deficiency. Better socioeconomic development leads to favourable Vitamin A status and improvement in health situation. Vitamin A deficiency increases mortality and morbidity among children, and UNICEF has been working closely with governments in the distribution of vitamin A capsules (VAC). Anaemia (low haemoglobin in blood) was a major consequence of iron deficiency, especially in pregnant women. Over 200 million women, and nearly 500 million children (aged 0 to 14 years) were anaemic, iron deficient or both in Asia. Iodine-deficiency disorders (IDD) and iron deficiency are the most common nutrient deficiencies in the world. Goitre is prevalent among 25% of the population in endemic areas in India, and it ranges from 1.5% prevalence in Assam to 68.7% in Mizoram. In 1998, about 70% of the salt in India was iodized. Iodized oil supplements to the infants in Indonesia and iodized water supply in China had succeeded in reducing human mortality. The underlying and basic causes of malnutrition are viewed as inadequate food, health and care mainly. A number of interventions like antenatal care, safe delivery, breastfeeding including colostrum, immunization and disease management were considered essential for improving the nutrition situation. Community based nutrition oriented programs like Integrated Child Development Services (ICDS) in village anganwadi centers provides supplementary food, health and educational services; Public Distribution System (PDS) supplies subsidized food and other basic necessities through fair price shops (FPS) for the poor; Tamil Nadu Integrated Nutrition Project (TINP) provides nutritious food to children (up to 6 years) and expectant and nursing mothers through paid community nutrition workers (CNW), who are involved in addressing general malnutrition. Prophylaxis programmes against Vitamin A deficiency, Iron deficiency anaemia and Iodine deficiency disorders are adopted in India to address micronutrient malnutrition. It was proposed that nutrition-oriented programmes should not be undertaken unless the contextual factors are appropriate either inherently, or by fixing them. It is necessary to have a concept of general malnutrition that encompasses protein-energy and micronutrient deficiencies. The contextual factors recommended for community-based nutrition-oriented programmes were political commitment at all levels of society; presence of 24
Child Nutrition
community organizations like NGOS, etc.; a high level literacy, especially among women; infrastructure for the delivery of basic services; a local culture with a first call for children including favourable child care practices; charismatic leaders in the community, and parallel implementation of poverty-reducing programmes. The programme factors recommended were the creation of awareness of the high prevalence, serious consequences, and available low-cost solutions of the nutrition problem; the support of a process where communities participate in assessing and deciding how to use their own and additional resources for actions; setting clear and time-bound goals (targets) at all levels of the program; community-based monitoring; providing income-generating activities, particularly for poor women, supported by low-interest credit arrangements, and the involvement of NGOs. It was also proposed that ICDS programme, which covered 74% blocks, should cover 100% blocks.
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DIABETES
Esfarjani, E, Razzahy Azar, M. and Gafarpour, M. (2001). IDDM and early exposure of infant to cow's milk and solid food. Journal of Pediatrics, 68(2) : 107-10.
Key Words : 1. NUTRITION 3.BREASTFEEDING.
Indian
2.INSULIN-DEPENDENT DIABETES MELLITUS (IDDM)
Abstract : The study investigated the role of early infant feeding in the development of insulin-dependent diabetes mellitus (IDDM). The study subjects comprised 52 IDDM patients and 52 control subjects matched for sex, age, social status, country, geographical location and selected from pediatric departments of different hospitals in Tehran. Diabetic children (21 boys, 31 girls) were of the ages of 1.5 to 14 years. Information regarding feeding patterns during the two years of life was collected through a questionnaire administered to mothers. The questionnaire evaluated the duration of exclusive or partial breastfeeding and the age at which dietary products containing formula, fresh cow's milk, and solid foods were introduced into the diet. Most of the diabetic children rather than the control children had been breast-fed, and the risk of IDDM among children who had not been breast-fed was below unity. No significant difference in the duration of breastfeeding was observed between diabetic and control group. Results do not support the existence of a protective effect of breastfeeding on the risk of IDDM nor do they indicate that early exposure to cow's milk and dairy product has any influence on the development of IDDM.
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FOOD/ DIETARY BEHAVIOUR/ FOOD INTAKE
India, Ministry of Statistics and Programme Implementation, National Sample Survey Organization, New Delhi. (2007). Nutritional intake in India 2004-05 : NSS 61st Round July 2004 - June 2005. New Delhi : NSSO. ~500 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL INTAKE 5.STATISTICS 6.NSSO REPORT 7.NSS 61ST ROUND. 3.FOOD INTAKE 4.DIET
Abstract : The National Sample Survey Organization (NSSO) conducts socioeconomic surveys covering various subjects on regular basis. The present report focused mainly on nutritional intakes of Indian households in the Seventh Quinquennial Consumer Expenditure Survey (CES) of the NSSO during the 61st Round covering the period from June 2004 to July 2005. Among the different nutrients, only 3 nutrients, namely calorie, protein and fat were discussed in this report. The survey covered all the states and UTs (Union Territories) in the country. Data was collected from a sample of 79,298 rural and 45,346 urban households spread over 7,999 villages and 4,602 urban blocks respectively. The consumer expenditure survey showed that the percentage share of food expenditure to total expenditure of the Indian population was 55% in rural areas and 42.5% in urban areas. At the all India level, the number of meals eaten at home by household members had decreased by 0.57% in rural areas between 1993-94 and 2004-2005. In urban India, popularity of home kitchen had declined by 1.66% over the last ten years. On an average, the members of rural households had taken 2.5 meals and those of urban households had taken 2.3 meals per day during the reference period. The study found that average daily intake of calories by rural population had dropped by 106 Kcal (4.9%) from 2153 Kcal to 2047 Kcal from 1993 94 to 2004 2005, and by 51 Kcal (2.5%) from 2071 to 2020 Kcal in urban areas. A higher intake of calorie and protein was observed in rural India (2540 Kcal and 70.8 gms.) as compared to urban India (2475 Kcal and 69.9 gms.), whereas the consumption of fat was relatively much lower in rural areas (44 gms.) compared to that in urban areas (58.2 gms.). All the intake levels were found to be low for persons belonging to lower Monthly Per Capita Consumer Expenditure classes (MPCE) and quite high for persons belonging to the higher MPCE classes. At the national level, out of the total calorie intake, more than 67% of the calorie intake in rural areas and 56% in urban areas was derived from cereals alone. It was found that the average daily intake of protein by the Indian population had decreased from 27
60.2 to 57 grams in rural areas between 1993-94 and 2004-05, and remained stable around 57 grams in urban areas during the same period. A significant rise in per capita daily average intake of fat was observed during the decade (1993-94 to 2004-05) in both rural and urban areas. It increased from 31.4 grams to 35.5 grams (13.1%) in rural areas, and from 42 grams to 47.5 grams (13%) in urban areas.
India, Ministry of Statistics and Programme Implementation, National Sample Survey Organization, New Delhi. (2007). Perceived adequacy of food consumption in Indian households 2004-05 : NSS 61st Round July 2004 - June 2005. New Delhi : NSSO. ~150 p.
Key Words : 1.NUTRITION 2.FOOD CONSUMPTION 3.FOOD ADEQUACY 4.FOOD AVAILABILITY 5.HUNGER 6.FOOD INTAKE 7.STATISTICS 8.NSSO REPORT 9.NSS 61ST ROUND.
Abstract : Data on household consumer expenditure is being collected every year by the National Sample Survey Organization (NSSO) as part of its regular Rounds. Each Round is normally of an years duration and includes two or three subjects of survey. This report presents data on perception of Indian households by daily availability of enough food during the last 365 days on a sample of 74298 households and 403207 persons in rural areas, and 45346 households and 206529 persons in urban areas. The period of survey was of one years duration from 1st July 2004 to 30th June 2005. The survey covered the whole of the Indian Union except (i) Leh (Ladakh) and Kargil districts of Jammu and Kashmir, (ii) interior villages of Nagaland, and (iii) villages in Andaman and Nicobar Islands which remain inaccessible throughout the year. At the all India level the percentage of rural households where all the members got enough food everyday throughout the year was around 97.4%. In urban India, the overall percentage of households where all members got enough food everyday throughout the year was around 99.4%. The percentage of households not getting enough food every day in any month of the year was 0.4% in rural areas and 0.1% in urban areas. The percentage of rural households not getting enough food every day in some months of the year was the highest in West Bengal (10.6%). The proportion of those households who did not get enough food every day in any month of the year was highest in the state of Assam (3.6%), followed by Orissa and West Bengal (1.3%). In the urban sector, the state of Kerala had maximum percentage of dissatisfied households (1.7%). About 2.1% households reported that they did not get enough food in any month of the year in the state of Assam, followed by Bihar (1.1%). In rural areas, the percentage of households where
28
all the members got enough every day throughout the year rose from 94.5% to 97.4% from 1993 1994 to 2004 2005, and in urban areas it increased from 98.1% to 99.9%. The percentage of households not getting enough food every day in some months of the year decreased from 1.1% to 0.4% over the eleven year period 1993 1994 to 2004 - 2005. The percentage of households not getting enough food every day in any month of the year also declined from 0.5% to 0.1%. As a whole, scheduled tribe households reported highest seasonal inadequacy of food (3.5%), and scheduled caste households recorded highest perennial inadequacy of food (0.6%). Antyodaya cardholders (5.8%) reported the highest percentage of households who believed they were not getting enough food for some months of the year, followed by BPL cardholders (3.6%) in rural areas. In rural areas, proportion of households reporting inadequacy of food during the months from December to March was higher than in other months. In urban areas, such inadequacy was reported from December to February, but by a much lower percentage of households.
Ramachandran, Prema. (2008). NFI Bulletin, 2008 Jul, 29(2) : changing food consumption patterns in India. New Delhi : Nutrition Foundation of India. 8 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.DIETARY INTAKE 4.FOOD CONSUMPTION 5.EXPENDITURE ON FOOD 6.GROWTH 7.GROWTH RETARDATION 8.ANTHROPOMETRIC INDEX.
Abstract : The NSSO has been carrying out Consumer Expenditure Survey at roughly at 5 year intervals for assessing the impact of economic, agricultural and food distribution related interventions on food consumption over time in different states in urban and rural areas and in different income groups. Data from the 27,32,38,43,50,55 and 61st Rounds of NSSO on consumption expenditure on food and non-food items show that there has been a decline in the proportion of expenditure on food items in the last three decades in both urban and rural areas. The decline is mainly due to low cost of cereals which are the major source of energy in Indian dietaries, and it was seen in all income groups. The share of cereals in household expenditure has fallen from 41% to 18% in rural India and from 23% to 10% in urban India over the same period. Over this period, the expenditure on pulses has remained more or less the same in all the income groups. However, because of the soaring cost of pulses, there has been a decline in pulses consumption in all the income groups. Among the upper income groups, there has been a greater dietary diversification with increase in consumption of milk and animal products; as a
29
result, in these income groups there has not been any decline in protein intake in spite of reduction in pulse intake. However, among the poorer segments of the population, pulses remain the major source of protein and lower pulse consumption can result in further reduction in already low protein consumption. NSSO Survey data showed that there has been an increase in the per capita consumption of edible oil. There has been a rise in oil consumption both in rural and urban areas. Vegetable oils such as groundnut, mustard oil, soya oil, sunflower oil are the major oils used. The growing consumption of empty calories from oils, fats, sugars and beverages is a matter of concern, because they contribute to the increasing prevalence of overnutrition in all age groups, especially among the urban affluent segments of the population. NSSO Consumer Expenditure Data shows that there has been a slow but steady decline in energy intake in rural areas. In urban areas there has been a very small reduction in energy intake between mid seventies and mid nineties. There was a small rise in 1999-2000 but in 2004-05 the energy intake was lower than in all the previous years. There has been a small but steady decline in protein consumption in rural areas between 1973 and 2004-05; this is mainly attributable to the decline in cereal and pulse consumption. The protein consumption in urban areas has remained unaltered perhaps because of the increasing consumption of milk and animal products. However, in 2004-05 average fat intake contributed to less than 15% of the total energy intake. There were relatively large inter state differences in protein consumption. Intake is relatively low in states like Tamil Nadu, Karnataka, Orissa and West Bengal where rice is the major cereal consumed and pulse consumption is low. India is currently undergoing rapid socio-economic demographic, health and nutritional transition; and NSSO Surveys can help nutrition scientists to monitor the on-going transition in household food consumption, identify beneficial and adverse trends, and initiate appropriate interventions.
Ramachandran, Prema. (2008). NFI Bulletin, 2008 Jul, 29(3) : dietary intake, physical activity and nutritional status of Indian adults. New Delhi: Nutrition Foundation of India. 5 p.
Key Words: 1.NUTRITION 2.RESEARCH NUTRITION 4.BODY MASS INDEX 5.VITAMIN A DEFICIENCY. 3.NUTRITIONAL STATUS
Abstract : In this paper, the changing pattern of dietary intake and physical activity In adults, and the impact of these on nutritional status of adults is explored. Analysis is based on secondary data from NNMB (National Nutrition Monitoring
30
Bureau 1990), NFHS2 (National Family Health Survey1998-99) and INP (India Nutrition Profile 1975-2005). Data from the NNMB and INP surveys show that in mid 1990s, the average intake of cereals was near the recommended dietary allowance (RDA). The reported intake of foodstuffs was higher in INP states as compared to NNMB states; this is attributable to higher intake of cereals and pulses in the non-NNMB states, which were covered in the INP. Intake of pulses, vegetables and fruits were low among both men and women in all the states. NNMB data showed that over time there has been a reduction in the average intake of cereals, among both men and women, especially since the mid 1990s. Data from the NNMB surveys show that energy intake was high in the mid 1990s and subsequently there has been a small decline in energy intake. Data on time trends in total energy intake and percentage of energy intake from fat, carbohydrate and protein from all the major states from INP for adult men and women show that carbohydrates remain the major source of energy in the Indian diet. Data from NNMB surveys showed that dietary intake has not undergone any major shift towards increase in the consumption of fat/ oils, sugar and processed food. Since 1990s there has been an increase in percentage of energy from fat till 2001, but subsequently there was a reduction in percentage energy from fat. However, even in 2001, the percentage energy from fat was below 15% (WHO/ FAO/ UNO). NFHS-2 data showed that the prevalence of under nutrition in adults was higher in rural areas as compared to urban areas. Prevalence of over nutrition was higher in urban areas. Prevalence of both under nutrition and over nutrition was higher in women as compared to men. NFHS-3 data showed that the prevalence of over nutrition was four-fold higher in urban areas as compared to rural areas. All the states in India have entered the dual nutrition burden era. According to the Prospective Urban and Rural Epidemiological (PURE) India study, majority of the urban population is working in white or blue collar jobs, where occupation related physical activity levels are low. As a result even though urban men and women spend time in domestic and occupation related activities, their energy expenditure for these activities is low. Average intake of nutrients by men according to NNMB survey in 2004-05 were 54.8 g protein, 26.9 g fat, 2000 kcal energy, 511 mg calcium, 16.9 mg iron, 267 ug Vitamin A, 1.3 mg Thiamin, 0.7 mg Ribo, 16.1 mg Niacin, and 50 mg Vitamin C. The nutrient intake for women was 46.5 g protein, 21.8 g fat, 1738 kcal energy, 443 mg calcium, 13.8 mg iron, 254 ug Vitamin A, 1.1 mg Thiamin, 0.6 mg Ribo, 14.2 mg Niacin, and 47 mg Vitamin C. It was suggested that adults should eat a balanced diet with adequate energy intake, and lots of vegetables should be consumed. NHE messages should be communicated to all. If they follow this advice there will be improvement in under nutrition and micronutrient deficiencies.
31
Skinner, Jean D. et al. (2002). Do food related experiences in the first 2 years of life predict dietary variety in school aged children. Journal of Nutrition Education and Behavior, 34(6) : 310-15.
Key Words : 1.HEALTH 2.INFANTS 3.CHILDREN 4.VEGETABLE VARIETY 5.FRUIT VARIETY 6.BREASTFEEDING 7.LONGITUDINAL STUDY
Abstract : The objective of the study was to determine if food related experiences in the first 2 years of life predict dietary variety in school aged children. Child/mothers pairs were interviewed 7 or 8 times when children were 2 to 24 months using a randomized incomplete block design. Each child/ mother pairs was interviewed when the age of the child was 6,7 and 8 years. Child/mothers pair (n=70) were continuous participants in the longitudinal study. Dependent variables were children's vegetable and fruit dietary variety, assessed from 3 days of dietary data at ages 6, 7 and 8 years. Independent variables from the first 2 years of life were selected from the longitudinal data set. It was revealed that vegetable variety in the school-aged child was predicted by mother's vegetable preferences, R2=.084. Fruit variety in the school aged child was predicted by breastfeeding duration, early fruit variety (R2= .254) and fruit exposure (R2= .246). It was concluded that nutrition education messages for mothers should emphasize the importance of early food related experiences to school aged children's acceptance of a variety of vegetables and fruits. Sophia Centre for Women's Studies and Development, Department of Chemistry, Sophia College, Mumbai. (2003). Women and health : survey on food and nutrition : a study. Mumbai : SCWSD. 16 p.
Key Words : 1.NUTRITION 2.WOMEN AND NUTRITION 3.DIETARY HABITS 4.EATING HABITS 5.MEALS 6.BEVERAGES 7.HEALTH FOODS 8.NUTRITION AND WOMEN 9.COLLEGE STUDENTS 10.ADOLESCENT GIRLS.
Abstract : This project was initiated under the theme Women and Health undertaken by Sophia College for Women. Information was elicited from students through questionnaires. The questions pertained to their eating habits and daily diet. The survey also tried to find out whether they were happy with their present way of life as well as the items purchased by the family towards their food for the
32
month. After statistical observation, information was obtained that 59% students rarely skipped their meals, but 9% of the girls missed their meal on a daily basis. Some students (28.71%) skipped meals as they did not feel hungry; and 40.26% skipped meals due to lack of time. 11% students skipped meals in an attempt to lose weight. About 44% students skipped meals due to their busy schedule. Ideally, the time gap between meals should not be more than 4 hours, but a majority of the respondents had their meals at an interval of 4 hours or more. About 58% students (48 out of 75) had a time gap of 6 hours or more between meals, which was not healthy. Around 60% of the student population consumed 5.8 glasses of water. The most preferred drink by the students during meals was buttermilk, which was consumed by 164 students out of 590. About 44% respondents rarely ate out, but 15% respondents ate out at least twice a week. Biscuits and chocolates seemed to be a daily habit with the students, and sandwiches and potato wafers were also popular. Nearly 55% students rarely or did not take soft drinks, while 45% students did have an ice cream either regularly or once in a while. About 75% consumed non-vegetarian foods on alternate days, or at times less frequently in the month. About 35% students believed that they were overweight. 34% were already avoiding sweets and oily foods in an attempt to reduce weight, and outdoor games came second in this effort to reduce weight, with 32% students choosing this form of exercise. Jogging, swimming and yoga were other modes of exercise preferred by the students. Approximately 18% students came up with the correct answer for the proper order of the mode of cooking which would least affect the nutritional value of food. Almost 80% of the students had not heard about organic farming, and 60% had not heard about genetically modified food products. Majority of the population believed that they were consuming adequate amounts of all nutrients, 23% students believed that their intake of calcium and iron was insufficient, while 23% believed they were consuming excess amount of carbohydrates, and 28% believed that their consumption of fatty foods was above the average permissible limit. This survey indicated that a majority of the students believed that they were overweight. Though students have access to information about their nutritional needs; this information is not applied in their daily life. There is a great need for creating awareness regarding the nutritional needs of college-going adolescent girls. Through competitions and public education programmes on radio and television channels, girl students and boys can be made aware of tasty, aesthetically appealing and nutritious diets.
33
FOOD FORTIFICATION
Child In Need Institute, Daulatpur, West Bengal. (2005). Distribution of fortified candy in ICDS : a pilot project Bengal. Daulatpur, West Bengal : CINI. 44 p.
Howrah, West
Key Words : 1.NUTRITION 2.FORTIFIED CANDY 3.FOOD FORTIFICATION 4.ICDS 5.NUTRITION 6.MICRONUTRIENT DEFICIENCY 7.HOWRAH 8.WEST BENGAL.
Abstract : Iron deficiency is a global nutritional problem affecting mainly infants, children, adolescent girls and women of child bearing age. The World Health Organization (WHO) estimated that about 40% of the worlds population, more than 2 billion individuals suffer from anaemia. Vitamin A deficiency is also compromising the immune systems of approximately 40% to 60% of the developing worlds underfives, and leading to the deaths of approximately 1 million young children each year. In West Bengal, a pilot project baseline survey was conducted in Howrah and in 24 North Parganas to combat anaemia and Vitamin A deficiency (VAD) in three different target groups namely, pregnant and lactating women, preschool children and adolescent girls. Fortified candies were distributed in plain areas namely Howrah district and 24 North Parganas district in 1500 households. Fortified candies contained Vitamin A (1500 1U), Vitamin C (10mg), folic acid (50 mcg) and iron (7 mg). After 18 months, a resurvey was done in both intervention (Howrah district) and control areas (24 North Parganas). In the intervention district, an increase of 0.8 grams in mean haemoglobin resulted in 15.5% reduction in anaemia among preschool children. 79 adolescent girls, who comprised the sample, also showed an increase of 0.7 grams in mean haemoglobin and the prevalence of anaemia decreased by 10%. The mean haemoglobin in Howrah at baseline was 11.66 (SD 1.55) and at endline it was 11.53 (SD 1.72). There was no significant change in mean haemoglobin of pregnant and lactating women. About 64.7% respondents could read and write, 1.8% were graduates, 1.3% were post graduates, and 0.1% were PhD in Howrah, while in 24 North Parganas, 70% could read and write, and only 3% were graduates. About 60% respondents had not even heard about Vitamin A. The reduction in prevalence of VAD noticed in all target groups was statistically significant. Less than 25% respondents knew that fruits and vegetables are good sources of Vitamin A. During pregnancy, 63% in Howrah and 68% in 24 North Parganas had taken iron supplements. More than 60% of the population, in both districts was using iodised salt. Another baseline survey was conducted in the hilly areas namely Sadar subdivision of Darjeeling covering 1510 households in August 2000, and in Kalimpong 34
Food Fortification
district in September 2000 covering 1509 households. Micronutrient fortified candy was given in the intervention district. The follow up study was done in intervention and control districts, 24 months following implementation of project intervention. The prevalence of anaemia decreased by 16.7% and 4.3% in Darjeeling and Kalimpong, and the respondents moved to non anaemic levels. The study has demonstrated significant reduction in anaemia prevalence among preschool children and adolescent girls. The attendance and regularity of attendance improved in all anganwadi centres. The cost of the candies was low and intervention was costeffective. The cost was Rs. 50 per child per year for providing 30% to 50% of the daily requirement of iron and Vitamin A. The Government can consider providing fortified candies to beneficiaries of ICDS programme and children covered under mid-day meal scheme as add on to the food distributed. Moretti, Diego, et al. (2006). Extruded rice fortified with micronized ground ferric pyrophosphate reduces iron deficiency in Indian school children : a double-blind randomized controlled trial. Bangalore : St. John's National Academy of Health Sciences. 8 p.
Key Words : 1.NUTRITION 2.ANAEMIA 3.FOOD FORTIFICATION 4.SCHOOL LUNCH 5.SCHOOL FEEDING PROGRAMME 6.MICRONUTRIENT DEFICIENCY 7.VISTAAR PROJECT.
Abstract : Iron fortification of rice could be an effective strategy for reducing iron deficiency anaemia in South Asia. The study aimed to determine whether extruded rice grains fortified with micronized ground ferric pyrophosphate (MGFP) would increase body iron stores in children. The study was carried out in Franciscan School of Bangalore on 970 students, of 4-14 years. It was found that mean (+SD) daily iron intakes in 6-13 years old children were 5.0+2.2 mg (boys) and 4.7+2.2 mg (girls). Only 6% was heme iron. Estimated dietary iron bioavailability ranged between 4.5+2.3% and 6.5+ 2.9% (boys) and between 4.6+2.0% and 7.1+8.2% (girls) depending on the model used to assess iron bioavailability. The sensory study showed that at both 3 and 5 mgFe/ 100 g rice, fortified and unfortified uncooked rice were indistinguishable. Similarly, in all the cooked recipes plain white rice, vegetable rice, lemon rice, tomato rice and tamarind rice the meals containing rice fortified at 3 mgFe/ 100 g were indistinguishable from the meals containing unfortified rice. The mean (+SD) iron content of the lunch meals served to the iron fortified and control groups were 19.2+2.5 and 1.2+0.6 mg Fe/ meal, respectively. For specific meals, the mean (+SD) iron content per daily serving of the unfortified tomato rice, 35
Food Fortification
lemon rice and vegetable pulao meals was 1.0+0.2, 1.6+0.2 and 1.4+0.6 mg respectively. The mean (+SD) phytate content of the tomato rice, lemon rice and vegetable pulao was 95+20, 120+30 and 175+15 mg, respectively. No detectable ascorbic acid was present in any of the cooked samples received. It was observed that the prevalence of Iron deficiency (ID) decreased from 78% to 25% in the iron fortified group and from 79% to 49% in the control group. By logistic regression, there was significant time X treatment interaction for ID, whereas IDA was not significantly affected by treatment (p=0.161) or time (p=0.453). However, the prevalence of IDA decreased from 30% to 15% in the iron fortified group and remained virtually unchanged in the control group (28% and 27%). There was no significant difference in mean C-reactive proteins (CRP) or the prevalence of elevated CRP values between the 2 groups from baseline to the midpoint of the study, with the prevalence increasing from 7.6% to 20% in the iron fortified group and from 9% to 17% in the control group. There was no significant evidence of an effect of treatment on the frequency or severity of infectious disease, as measured by the questionnaire. At baseline, mean Z scores in the entire sample were as follows height for age, Z=1.36 (SD=1.17); weight for age, Z= -2.09 (SD=1.11); and weight for height, Z= -1.77 (SD=1.12). Findings indicated that providing ironfortified extruded rice grains in a school feeding programme is an effective iron fortification strategy. Whether applied more generally or targeted to school feeding programmes, extruded iron fortified rice could help reduce the large burden of ID and IDA in the rapidly growing urban populations of South and Southeast Asia.
Verma, Jessica L. et al. (2007). Community level micronutrient fortification of a food supplement in India : a controlled trial in preschool children aged 36-66 months. Child in Need Institute. Kolkata : CINI. 7 p.
Key Words : 1.NUTRITION 2.ANAEMIA PRESCHOOL CHILDREN 3.FOOD FORTIFICATION 4.IRON SUPPLEMENT 5.VITAMIN A 6.NUTRITION AND ICDS 7.ICDS AND NUTRITION 8.MICRONUTRIENT DEFICIENCY 9.VISTAAR PROJECT.
Abstract : Children participating in the ICDS in India have high rates of iron and Vitamin A deficiency. This study was conducted in 30 AWCs of Mahestala block in South 24 Parganas, West Bengal to assess the efficacy of a premix fortified with iron and Vitamin A added at the community level to prepared khichdi, a rice and dal mixture. All attending children received a single 200 gm portion of the khichdi 36
Food Fortification
treatment assigned to their AWC 6 times a week for 24 weeks. For each 200 gm serving of khichdi, the premix provided 14 mg encapsulated ferrous fumarate, 500 International Unit (IU) Vitamin A (retinyle acetate: particle size of 250; cold water soluble) and 0.05 mg folic acid. The placebo premix contained only dextrose anhydrous. Both premixes were packed in re-sealable polyethylene bags in 500 gm increments. Each selected AWC received 500 gm premix at baseline and after 3 months of the intervention. After 2 weeks of the intervention, 85% AWWs had minor problems with the packaging of the premix, including breakage of the polyethylene bag and failure of the bag to properly seal. Total 684 children were screened and enrolled, 168 (24.5%) were lost to follow-up (dropped out) before the 24 week assessment; thus 516 completed the 24 week trial. Reasons for loss to follow-up were refusal of further veni-puncture (n=161), change of location (n=5), and low attendance at the AWC (n=2). Most of the characteristics of the children who dropped out of the study did not differ significantly from those of the children who completed the trial, including the age, sex, iron status, and mean haemoglobin concentration. However, the prevalence of anaemia was significantly greater in the children lost to follow-up (35.1%) than in those who completed the trial (26.2%) (p<0.05). Prevalence of anaemia in fortified group was 19.1% at 0 week; 9.8% at 12 weeks; and came down to 4.1% at 24 weeks. Similarly in non-fortified group it was 32.6% at 0 week; 13.3% at 12 weeks and 20.7% at 24 weeks. Iron deficiency in fortified group was 22.5% at 0 week; 10.2% at 24 weeks; and in non-fortified group it was 20.7% at 0 week and 30.4% at 24 weeks. Prevalence of Vitamin A deficiency of fortified group was 17.5% at 0 week; and 8.1% at 24 weeks; and in non-fortified group it was 13% at 0 week; and 6.3% at 24 weeks. Low Vitamin A status in fortified group was 47.9% at 0 week and came down to 21.5% at 24 weeks. Similarly, in nonfortified group, low Vitamin A prevalence was 40.8% at 0 week, and it came down to 20.4% at 24 weeks. The failure of the fortified khichdi to increase serum retinol concentrations or to reduce the prevalence of Vitamin A deficiency and low vitamin status might have resulted because of the deterioration of Vitamin A in the fortified premix. The addition of a fortified premix to khichdi in ICDS AWCs provides an excellent opportunity to provide the needed micronutrients to children with or at risk of micronutrient deficiencies through out India. It also would be an effective means of meeting the micronutrient malnutrition needs of pregnant and lactating women and of younger children who are consuming solid foods.
37
FOOD SECURITY/ FOOD INSECURITY
Food and Agriculture Organization, Rome. (2005). The State of food insecurity in the world 2005. Rome : FAO. 36 p.
Key Words : 1.NUTRITION 2.FOOD SECURITY 5.ERADICATING HUNGER 6.MALNUTRITION. 3.FOOD INSECURITY 4.HUNGER
Abstract : The world population is expected to grow by approximately 2 billion between the baseline period (1990-92) and 2015. Nearly 600 million people in the developing world will still suffer from chronic hunger. To reach the World Food Summit target of 400 million, the proportion of the population who are undernourished would need to be reduced not by half, but by two thirds. Hunger is a cause of poverty, illiteracy, disease and mortality. 11 million children die before reaching the age of 5 years, and 530,000 women die during pregnancy and child birth. The Tsunami that hit the coastal areas of Asia caused an estimated 240,000 deaths and displaced more than 1.6 million people from their homes. In India, the Tsunami killed 10,672 people and displaced 600,000 persons. Fisheries and coastal agriculture were destroyed in many areas depriving communities of their main sources of food. In rural areas where the vast majority of the worlds hungry people live, research shows that a farmer with four years of primary education is on an average, almost 9% more productive than a farmer with no education. Nearly 600 million children die from hunger and malnutrition each year, and lack of essential vitamins and minerals also increases the risk of dying from childhood diseases Millennium Development Goals (MDG) set a target of reducing the rate of death among children under five by two-thirds between 1990 and 2015. Between 1960 and 1990, the number of child deaths fell at a rate of 2.5% each year. Since 1990, the baseline year for the MDG, the pace has slowed to just 1.1%. WHO, UNICEF and Integrated Management of Childhood Illnesses (IMCI) Initiative emphasizes the importance of improved diets and feeding practices at home, and attention paid to the risk of hunger and malnutrition when children are brought to clinics for treatment of common childhood ailments. More than 30% children are born with low birth weight because of malnourished mothers. Hunger and poverty drive men to become migrant labourers, women to turn to prostitution or other sexual relationships, children to drop out of schools, and all face the risk of HIV/AIDS. The International Fund for Agricultural Development (IFAD) and the World Food 38
Programme mapped out a twin-track approach for strengthen the productivity and incomes of the hungry and poor, targeting rural areas where the vast majority of them live and the agricultural sector on which their livelihoods depend. Education is an input that reduces hunger and malnutrition. Better education for women is strongly associated with improvement in their childrens nutrition and family health. If developing countries gear up their efforts to revitalize agriculture and rural development, and ensure that the hungry have access to food, if donor countries fulfill their pledges to increase development assistance substantially, we can still reach the WFS and MDG hunger reduction targets. We would also progress towards all of the other MDGs as well.
George, E. and Daga, A. S. (2000). Food security among preschool children. Indian Journal of Pediatrics, 67(7): 483-85.
Key Words: 1.NUTRITION 2.PRESCHOOL CHILDREN 3.FOOD SECURITY 4. MALNUTRITION.
Abstract : The study was conducted to estimate food security among preschool children, and to evaluate socio-economic, demographic and anthropometric factors associated with food security in a 'D' class hospital employees residential colony in Mumbai. The community had 405 households and 122 children under five years. The average household size was 6 and average family size was 2.38. Average per capita income was Rs.600/- per month. Nutritional assessment revealed that 51.6% under fives were underweight, 46% were stunted and 11.1% were wasted. Only 42.6% households and 54% preschoolers from these households were calorically secure. Food security was 52% in the 12-23 months age group, 53% in 24-35 months age group, 62% in 36-47 months age group, and only 7% in 48-59 months age group. Per capita income, increasing birth order, family size, household size, literacy level of mothers, less than 4 meals per day and pulse insufficiency at home were associated with food insecurity. Per capita income ensures food availability at home, and family size ensures better distribution. Women with high school education were twice as likely to have well-nourished children compared to illiterate and primary educated mothers.
39
MS Swaminathan Research Foundation, Chennai. (2008). Report on the state of food insecurity in rural India. 174p.
Chennai : MSSRF.
Key Words: 1.NUTRITION 2.FOOD SECURITY 3.HUNGER 4.MALNUTRITION 5.ICDS 6.MID DAY MEALS 7.PUBLIC DISTRIBUTION SYSTEM.
Abstract: The malnutrition scenario in India is a cause for deep concern. 40% children below 3 years are underweight and 45% are stunted; 22% to 30% children are low birth weight babies; 36% adult women and 34% adult men suffer from chronic energy deficiency (CED); anaemia has increased from 74% in 1998-99 to 79% in 2005-06 in children under 5 years, and from 52% in 1998-99 to 56% in 2005-06 in young women. FAO (1983) stated that food security meant that all people at all times have physical and economic access to the basic sufficient food they need. To ensure food security the main food security safety nets that the Government has put in place include (i) Targeted Public Distribution System (TPDS); (ii) Supplementary feeding programmes such as ICDS, Mid Day Meal Scheme (MDM) and food support to the poorest of the poor known as Antyodaya Anna Yojana (AAY); (iii) Food for Work Schemes and programmes of food distribution to old and destitute persons and supplementary nutrition for adolescent girls. In 2006-07, production of food grains was 211.78 million tonnes. Access to food is linked to the purchasing power of households, and food insecurity in this study has been assessed on the basic of percentage of persons consuming less then 1890 Kcal/cu/day (kilo calories/ consumer unit/ day). As per NSSO Survey 2004-05 covering 19 major states of India, the percentage of persons consuming less than 1890 Kcal/ cu/ day declined marginally from 15.1% in 1999-2000 to 13.2% in 2004-05. People in many states were consuming less than 1890 Kcals/ cu/ day indicating that hunger is wide spread. These states are Andhra Pradesh (12.5%), Assam (8.9%), Bihar (10.0%), Chhattisgarh (16.2%), Gujarat (17.1%), Haryana (7.8%), Himachal Pradesh (2.8%), Jammu and Kashmir (2.4%), Jharkhand (13.8%), Karnataka (20.5%), Kerala (17.5%), Madhya Pradesh (16.0%), Maharashtra (19.7%), Orissa (15.4%), Punjab (6.4%), Rajasthan (5.2%), Tamil Nadu (23.4%), Uttar Pradesh (8.0%), and West Bengal (11.9%). The Targeted Public Distribution System (TPDS) has not achieved its stated objectives. It has not reduced food subsidy nor leakages or diversion, but it has excluded large numbers of poor and nutritionally insecure persons from access to PDS, and seriously worsened food security for a substantial segment of the population. On 31 March 2006 the ICDS system provided supplementary nutrition
40
to 22.7 million children aged 6 months to 3 years, 24 million children aged 3-6 years, and 9.5 million pregnant and lactating mothers. In the NIPCCD study on ICDS it was reported that ICDS has played a role in improving maternal and child nutrition and in lowering infant and child mortality. Supreme Court issued orders on ICDS dated 28 November 2001, 29 April 2004, 7 October 2004, and 13 December 2006 stating that Government of India should operationalize a minimum of 14 lakh AWCs in a phased manner to cover all hamlets and habitations, and provide all services including supplementary nutrition to every person who is entitled to them as prescribed under ICDS norms. The necessary funds should be made available to meet the Governments legal obligation in the light of the Supreme Courts directives. The National Programme of Nutritional Support to Primary Education reaches out to about 12 crore children in 9.5 lakh schools/ EGS centres across India. It has improved the nutritional status of children in Classes I-V, as well as enhanced school enrolment and attendance. It was recommended that there needs to be much greater integration between MDM scheme and government interventions in health and nutrition. The PDS can be improved and made more effective through certain policy interventions and reform. The case for universal PDS with a uniform affordable price is compelling. The state of Tamil Nadu has continued with universal PDS. There is need for more focused direct investment in nutrition and health even in states that are categorized as food secure or have high rates of economic growth, but do not emerge as food secure.
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HUNGER/ HUNGER DEATHS/ RIGHT TO FOOD

Menon, Purnima, Deolalikar, Anil and Bhaskar, Anjor. (2009). India State Hunger Index : comparison of hunger across states. Washington, D.C : International Food Policy Research Institute. 32p.
Key Words: 1.NUTRITION 2.HUNGER INDEX 3.HUNGER 4.STATE-WISE HUNGER 5.GLOBAL HUNGER INDEX 6.UNDER FIVE MORTALITY RATE 7.CHILD NUTRITION 8.UNDER WEIGHT CHILDREN 9.CALORIE CONSUMTPION.
Abstract: India has the largest number of hungry people in the world. There are three inter-linked dimensions of hunger inadequate food consumption, child under weight (under five), child mortality (under five) - measured to assess and compute Global Hunger Index (GHI). The India State Hunger Index (ISHI) represents the index calculated using a calorie undernourishment cut off of 1,632 kcals per person per day to allow for comparison of the India State Hunger Index with the Global Hunger Index. The Hunger Index of India was calculated for 17 major states in the country, and it covered more than 95% of the Indian population. It revealed Indias continued lackluster performance at eradicating hunger, and India ranks 66 out of the 88 developing countries studied. The objective of the ISHI was to focus attention on the problem of hunger and malnutrition in India. It was found that not a single state in India fell in the low hunger or moderate hunger category defined by the GHI 2008. Instead most states fell in the alarming category and Madhya Pradesh fell in the extremely alarming category. Four states namely Punjab, Kerala, Andhra Pradesh and Assam fell in the serious category. India State Hunger Index was found to be 23.30. The Hunger Index was found to be high in Punjab (13.63), Kerala (17.63), Andhra Pradesh (19.53), Assam (19.83), Haryana (20.00), Tamil Nadu (20.87), Rajasthan (20.97), West Bengal (20.97), Uttar Pradesh (20.13), Maharashtra (20.80), Karnataka (23.73), Orissa (23.80), Gujarat (24.70), Chhattisgarh (26.63), Bihar (27.30), Jharkhand (28.67), and Madhya Pradesh (30.87). It was also found that nutrition programmes in India were not effectively delivering and achieving the set objectives, although strides had been made on the public health front to ensure sustained reduction in child mortality. But it was observed that improvement in child nutrition and nutrition situation in the country were not satisfactory. Therefore it is suggested that States need to invest in direct nutrition programmes and poverty alleviation interventions even during periods of sustained economic growth. It was also suggested that investments need to be made to strengthen agriculture, improve overall food availability and access to the entire population, and to improve child nutrition and mortality outcomes. 42
People's Vigilance Committee on Human Rights, Varanasi. (2005). Report of people's tribunal on starvation in eastern Uttar Pradesh. Varanasi : PVCHR. 62 p.
Key Words : 1.NUTRITION 2.HUNGER DEATHS 3.MALNUTRITION 4.STARVATION DEATHS 5.LACUNAE IN ICDS 6.ICDS 7.PUBLIC DISTRIBUTION SYSTEM 8.LACUNAE IN GOVERNMENT PROGRAMMES 9.RIGHT TO FOOD 10.UTTAR PRADESH.
Abstract : Right to food is an inalienable and fundamental right, with equal footing to that of right to life. The present study was carried out to investigate the situation of food insecurity among marginalized communities in eastern Uttar Pradesh (UP), and to investigate the hunger and starvation deaths in Varanasi, Mirzapur, Kushinagar, and Sonebhadra districts. In the study, the cases that came before the Tribunal spoke of how the Government has neglected the starving vulnerable groups of eastern UP. Villagers have not received wages after participating in work schemes, and records are made up by Government bureaucrats to give a false impression of the functioning of schemes. All the victims who deposed before the Tribunal were from the poorest sections of society, and many were from the lower castes of Hindu society. In all cases the victims had complained to the authorities responsible for administration regarding the issues they faced. In all cases the responses from the responsible authorities were none or to the minimum extent, which according to this Tribunal is a criminal neglect of their duty for which the responsible officers must be punished in accordance with the law of the country. The state representatives refused to answer any questions asked by the Tribunal, though prior notice was served to the representative state agencies before the hearing. Further, international pressure by FIAN International, along with a continuous and massive campaign by the PVCHR (Peoples Vigilance Committee for Human Rights) and the Bunkar Dastkar Adhikar Manch led to success in the struggle against state apathy. Necessary steps ensured the right to food in the case of two weaver families who experienced starvation deaths. Deaths due to starvation had been widely reported from the village of Shankapur in Varanasi district (UP), where around 400 weaver families suffered from severe hunger and malnutrition. Due to decline in the weaving industry, many families lost their jobs and did not have any source of income. Neither did they get access to the Antyodaya Anna Yojana Scheme (AAY) Red Card, dedicated to the poorest of the poor, to avail subsidized food grains although they possessed the Red Card. The weavers were struggling to survive under these precarious circumstances. A look at the food schemes
43
implemented in these districts presented a very grim picture. In Varanasi, Sonebhadra, Jaunpur, Khushinagar and Mirzapur, from where the starvation deaths were reported, only 31% of the children in 0-6 years age group were covered by ICDS. In 64 projects, nearly 9% of the anganwadi centres were not reporting to the Department of Women and Child Development. The staffing of these projects was also very poor where 19% of the sanctioned anganwadi workers and 30% of the sanctioned anganwadi helpers in Mirzapur, and 11% of the sanctioned AWWs and 12% of the sanctioned AWHs in Jaunpur were not appointed. In the case of employment related schemes, the five districts have utilized only 78% of the allocated funds and 56% of the sanctioned food grains under the Sampoorna Gramin Rozgar Yojana (SGRY). Mirzapur performed worst, with only 39% utilization of food grains. This is despite the fact that Mirzapur is a poor district, and here the percentage of agricultural labourers to main workers is 33.78% and percentage of marginal workers to main workers is 3.39%. The proportion of agriculture workers and marginal workers to main workers is much higher here than in Uttar Pradesh on an average. A Hong Kong based Regional Group accused local officials of deliberately ignoring starving people in Betwa because of caste hatred. On the basis of the findings, the study recommended that district-wise enquires on reported hunger deaths should be made to provide necessary assistance to these families. To ensure that all AWCs are operational and reporting, and all vacancies are filled in ICDS projects, the Government must ensure that welfare programmes initiated by the Union Government do not fail in implementation at the state level.
Right to Food Campaign Madhya Pradesh Support Group, Bhopal. (2006). Malnutrition disaster in Madhya Pradesh : a sad picture of chronic hunger and un-accountable system. Bhopal : RFCMPSG. ~30 p.
Key Words : 1.NUTRITION 2.MALNUTRITION MADHYA PRADESH 3.HUNGER 4.RIGHT TO FOOD 5.CHRONIC HUNGER 6.COMBATING MALNUTRITION 7.MADHYA PRADESH.
Abstract : Malnutrition is one of the most sensitive and burning issues in Madhya Pradesh. Data provided by the Government of Madhya Pradesh shows that about 5.7 million children were malnourished. The study showed that in the state of Madhya Pradesh alone there were 10.6 million children in the age group 0-6 years and out of these only 2.33 million have been brought into the realm of the Integrated Child Development Services Scheme, which aims to providing a reasonable level of nutrition to poor children. Data collected by Kuposhan Niwaran Abhiyan (Malnutrition Elimination Campaign), which was carried out in 5 phases, showed that
44
the percentage of malnourished children in the first round was 57.57% and it was 55.24% in the fifth phase. In the year 2001, in a study conducted by CEHAT, it was found that 80% children of Bhil tribal community were severely malnourished. The inadequate allocation of funds was also a major issue which proved the negligence of the State towards the problem of malnutrition. According to the Planning Commissions assessment of fund requirements, funds needed for SNP (Supplementary Nutrition Programme) for children (0-4 years old) and mothers in Madhya Pradesh were Rs.211 crores (Rs.2110 million), but instead of that only Rs.59 crores (Rs.590 million) were made available by the State Government. Some regions of Madhya Pradesh were the worst affected. These were Chhattarpur where 8 children died due to malnourishment and measles within a period of 12 days, Damoh where 7 children died due to malnutrition within 2 months, Khandwa, Shivpuri, Morena and Sheopur where 13 children died within 3 weeks. There is urgent need to improve the health and nutritional status of children aged 0-6 years by expanding the supplementary nutrition programme (SNP) and bringing more children under its ambit, and by improving coordination within State Health Department to ensure delivery of required health inputs in remote areas.
Ziegler, Jean. (2006). The Right to food : report of the Special Rapporteur on the Right to Food, Ziegler : Addendum : Mission to India : 20 August to 2 September 2005. Geneva : United Nations, Economic and Social Council. 23 p.
Key Words : 1.NUTRITION 2.RIGHT TO FOOD 3.FOOD SECURITY 4.NUTRITION SITUATION INDIA 5.ICDS 6.NUTRITION IN ICDS 7.HUNGER 8.MALNUTRITION. 9.SPECIAL RAPPORTEUR REPORT.
Abstract : India has the largest number of undernourished people in the world, and one of the highest levels of child malnutrition. The present report showed the situation of hunger, malnutrition and food insecurity in India, and examined the main findings and concerns regarding the realization of the right to food. According to Government statistics, levels of malnourishment fell from 62.2% to 53% between 1990 and 2000, and the proportion of stunted children fell from 54.8% to 47%, but this was not fast enough to reach the goals. Reports of more than 250 starvation or malnutrition deaths in the last 2 years (2004-05) in the states of Rajasthan, Jharkhand, Bihar, Madhya Pradesh and West Bengal were presented to the Special Rapporteur at the Judicial Colloquium on the Right to Food. Most of the victims of starvation were women and children, members of Scheduled Tribes and Scheduled
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Castes, with their deaths due to discrimination in access to food or productive resources, evictions or the lack of implementation of food based schemes. The Special Rapporteur received numerous complaints about forced displacement of communities as a consequence of state development projects without adequate resettlement and rehabilitation. Around 11,000 families in Madhya Pradesh, 1500 families in Maharashtra and 200 families in Gujarat were still to be rehabilitated, and all these factors affected the right to food of the people. Due to mining, many tribal communities had been forcibly evicted from their land to allow private mining activities and the Government had also not provided any rehabilitation for these tribal communities. There was also lack of implementation of the food based schemes in most states of India, namely Bihar, Jharkhand and Uttar Pradesh, who had not even begun to implement its directions to supply cooked Mid Day Meals. Still in Arunachal Pradesh, Assam and Manipur, severely malnourished children were not covered by the programme, and many of the most vulnerable persons have not been granted ration cards. Implementation of all food based schemes must be improved by incorporating the human rights principles of non-discrimination, participation, transparency and accountability, and monitoring done of all food based programmes to reduce severity of chronic under nutrition. A system must be put in place or instituted to prevent malnutrition deaths.
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INFANT AND YOUNG CHILD FEEDING/ WEANING FOODS
Banerjee, Anindita. (2002). Feeding practices and pattern of growth and development of infants in Varanasi. Varanasi : Banaras Hindu Univ., Deptt. of Home Science, Foods and Nutrition Unit. ~190 p.
Key Words : 1.NUTRITION 2.INFANT FEEDING 3.BREASTFEEDING 4.INFANT AND YOUNG CHILD FEEDING 5.NUTRITIONAL STATUS INFANTS 6.VARANASI 7.UTTAR PRADESH.
Abstract : Faulty feeding practices of infants in India generally arise from ignorance, superstitions and wrong food beliefs. These are mainly responsible for aggravating malnutrition in poor Indian communities. The study tried to investigate the underlying causes of poor growth and development of infants in Varanasi; assess how far away existing infant feeding patterns were from the recommended feeding practices; and study developmental milestones of the sample. The study was carried out on 300 infants of Varanasi district. Pre-designed and pre-tested schedule and door to door visits were used for data collection. 24 hour food recall method was adopted for calculating the nutrient intake of the sample. It was found that the practice of giving pre-lacteals was widespread in rural and urban areas. The acceptance of colostrum was found to be more or less equal in rural (63.9%) and urban (64.1%) areas. All infants (100%) received breast milk. 68.8% mothers initiated breastfeeding within 24 hours of birth. 75.41% rural and 61.5% urban mothers started solids at 3-6 months of age. The mean calorie intake was found to be much lower than ICMR standards, but the protein intake gm./kg. body weight was more than the recommended norms given by ICMR. Calcium intake was also very high due to the fact that a majority of the infants were bottle fed and weaned before the age of 6 months. Body weight of girls was lower than that of boys. The supine length was also higher in boys than girls. The head, chest and mid arm circumference was also lower in females than males. 24% infants were in Grade I, 26% in Grade II, and 11% in Grade III malnutrition on Gomez classification. The milestones were also appearing late in comparison to other studies. Findings of the study indicated that faulty weaning practices were one of the root causes of malnutrition in the blocks studied. It was recommended that National authorities should integrate their policies related to women and children into the overall health and development policies. Mothers should be educated regarding importance of breastfeeding, complementary feeding and timely introduction of solid foods. Pregnant women and 47
other family members attending antenatal clinics must be informed of the benefits and management of breastfeeding and its duration so that no child is deprived of the advantages of exclusive breastfeeding due to lack of information, even if the mother chooses to deliver at home. Mothers should be informed about the ill effects of bottle feeding. If the bottle is used it should be sterilized. Nutrition education programmes for dissemination of information regarding nutrient intake of mothers and infants should be carried out. There should be separate growth standards for breastfed, and bottle fed infants. It would be unjust to compare bottle fed and breastfed babies.
Bhandari, Nita et al. (2004). An Educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. New Delhi : AIIMS, Dept. of Pediatrics. 7 p.
Key Words : 1.NUTRITION 2.INFANT AND YOUNG CHILD FEEDING 3.COMPLEMENTARY FEEDING 4.NUTRITION EDUCATION 5.CHILD GROWTH 6.INFANT GROWTH 7.INFANT FEEDING PRACTICES 8.VISTAAR PROJECT.
Abstract : More than 60% of the children living in South Asia are malnourished. Complementary feeding practices are often inadequate in developing countries, resulting in a significant nutritional decline between 6 and 18 months of age. Primary Health Centres (PHCs) provide health care; each serves a population of ~30,000 through 2 or 3 Medical Officers, auxiliary nurse midwives, and other ancillary staff. There were 6 Sub-Centres (SCs), serving a population of ~5000, attached to each PHC. The study was conducted in the state of Haryana in India. Training was given to health and nutrition workers including ICDS Anganwadi workers regarding detection of feeding problems, negotiation with mother on possible solutions, starting complementary feeding at 6 months of age, the specific foods, meal frequencies, food density, inclusion of locally accepted foods, etc. The effect of the intervention was measured on child feeding practices and growth between 6 and 18 months of age. A total of 1115 infants were identified from 8 communities. Of these 1025 were available at the baseline visit, 552 in the intervention and 473 in the control communities. The children available in the intervention and control groups for the measurement of outcomes at the age of 6, 9 and 18 months of age were 468 (84.8%) and 412 (87.1%), 451 (81.7%) and 403 (85.2%), and 435 (78.8%) and 394 (83.3%) respectively. Intervention exposures were reported for the previous 3 months interval as elicited through interviews at infant ages 9 and 18 months. At the 9
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months visit, a higher proportion of infants in the intervention group compared with those in the control communities had one or more of the following contacts in the last 3 months: home visits by Anganwadi workers (67% vs. 31%), attendance at weighing sessions (47% vs. 1%), immunization sessions (77% vs. 85%) and visits to primary health centres or private practitioners (77.8% vs. 80.4%). Over a fourth of caretakers in the intervention communities had attended one or more meetings conducted by auxiliary nurse midwives (27% vs. 0.2%). Caretakers in the intervention communities reported being counselled more frequently at these contacts; the proportion who spontaneously recalled being counselled on optimal complementary feeding practices was 34% vs. 0.2% at the immunization sessions, 43% vs. 0.5% at home visits, and 36% vs. 0% at weighing sessions, in the intervention and control communities respectively. The intervention group children attained higher length at 12 months and had higher increment in length between 6 and 12 months of age. The proportion of children with height for age Z scores less than 2SD did not differ between the 2 groups. Among males, the intervention resulted in a 0.37 cm higher attained length at 18 months (95% cl, 0.08, 0.66). The 24 hour breastfeeding frequency in the control group children at 9 months was 6.6+3.0 and it was 7.8+3.0 in the intervention group. The breastfeeding frequency was similar in the 2 groups at 18 months of age. The proportion of children breastfed at 9 months was 90.8% in the control communities and 94.7% in the intervention communities. The proportion of children breastfed was similar at 18 months of age (72.2% vs. 70.8%). At 9 months, 34.8% mothers in the intervention group reported that they actively encouraged their child to eat more compared with 7.7% in the control group. It was suggested that educational interventions can improve feeding practices, but the effect of such interventions on physical growth varies in different settings. Bhandari, Nita et al. (2005). Use of multiple opportunities for improving feeding practices in under twos within child health programmes. New Delhi : AIIMS, Dept. of Pediatrics. 9 p.
Key Words : 1.NUTRITION 2.INFANT AND YOUNG CHILD FEEDING 3.COMPLEMENTARY FEEDING 4.INFANT FEEDING 5.YOUNG CHILD FEEDING 6.UNDER TWOS 7.NUTRITION COUNSELLING 8.NUTRITION EDUCATION 9.HARYANA 10.VISTAAR PROJECT.
Abstract : Under-nutrition is associated with over half of the 11 million childhood deaths that occur annually all over the world. The present study was carried out to promote exclusive breastfeeding and appropriate complementary feeding practices
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in under twos to ascertain the feasibility of using available channels for nutrition counseling, their relative performance, and the relationship between intensity of counseling and behaviour change. A community based controlled, effectiveness trial was carried out in rural Haryana. Following channels were used for the intervention: 1. traditional birth attendants to counsel on immediate and exclusive breastfeeding at birth; 2. local village based workers (anganwadi workers) belonging to ICDS scheme to counsel mothers of children under two; 3. auxiliary nurse midwives to counsel mothers at immunization clinics; and 4. primary health centre physicians and private practioners to counsel caregivers. A total of 1025 newborns were enrolled in the cohort, 552 in the intervention and 473 in the control group. In the cross sectional survey, a total of 2350 interviews were conducted (1173 in the intervention and 1177 in the control communities). The majority of births were assisted by traditional birth attendants (TBA); 72.5% in the intervention communities and 67.7% in the control areas. Immunization contacts were the most common opportunities for counselling during the first 9 months of life. Beyond 9 months, health care provider visits were the most common opportunity. Mothers of over 95% of the children aged 3-18 months were exposed to at least one of the channels of counselling, 26% to 34% were exposed to at least 2 channels, and 29% to 34% were exposed to three or more channels. Monthly meetings conducted by auxiliary nurse midwives (ANMs) with community representatives, and neighbourhood meetings held by community representatives were additional opportunities that generated awareness about the intervention. The highest attendance of caregivers of infants in the cohort at monthly meetings was 28.4% at the 12 months assessment; for neighbourhood meetings it was 20.2% at 18 months. Rates of counselling by dais for the intervention group were 32% for immediate breastfeeding, 14.3% for advice on not giving any water, and 18% for advice against administering ghuttis, a herbal product. There was a significant increase in the proportion of caregivers counselled during home visits at 6 months. Between 6-9 months of age, home visits were the most reported source of counselling (42.6%), followed by immunization and weighing sessions; these rates were similar for the 9 to 12 months period. Counselling during home visits and weighing sessions continued to be important, but counselling and immunization sessions declined as expected, because fewer children were brought for immunization at this age. Between 30% and 47% mothers were not counselled by any channel, 25% by 2 to 3 channels; and counselling by all 4 channels was rarely reported between birth and 18 months. Among the 155 mothers who reported being counselled through only one channel at the 3 month assessment, immunization clinics (56.7%) were the common source of counselling, followed by home visits (28.4%), weighing sessions (11.6%), and sick child contacts (3.2%). At the 9th month assessment, in those who reported being 50
counselled only once, home visits (48.6%) were the most common source of counselling, followed by weighing sessions (31.3%), and immunization sessions (27.1%). Mobilizing anganwadi workers and mothers was more rewarding in terms of counselling than training health workers. Moreover, it was feasible to use multiple opportunities available within existing programmes, without affecting routine services, and some of these are substantially enhanced by the approach. Gunasekaran, S. et al. (2000). Infant feeding practice in Tamil Nadu. Health and Population, 23(1) : 17-27
Key Words: 1.NUTRITION 2.INFANT FEEDING PRACTICE.
Abstract: The study was conducted on a sample of 912 children born during 199094 in Tamil Nadu to study the existing infant feeding practices among mothers and suggest educational strategies to improve feeding practices. Data was collected on timing and duration of breastfeeding, colostrum feeding and age of introduction of solid food and age of mothers at the time of marriage. Results revealed that only 29 per cent infants had the advantage of getting timely breastfeeding, colostrum feeding, and breast milk for a minimum recommended period and solid food supplement at the right age. More urban women (32%) practiced ideal infant feeding compared to their rural counterparts (22%). Place of residence, age at marriage, sex of the child, number of antenatal visits by ANM during pregnancy and place of delivery had a significant relationship with infant feeding practices. To bring about improvement in the delivery of maternal and child care services, the study suggests strengthening of health education programme, with special emphasis on interpersonal communication with women to improve the number of women practicing ideal infant feeding practices. Gupta, Arun and Gupta, Y.P. (2003). Status of infant and young child feeding in 49 districts (98 blocks) of India 2003 : a national report of the quantitative study. Breastfeeding Promotion Network of India (BPNI). New Delhi : BPNI. 42 p.
Key Words : 1. NUTRITION 2.BREASTFEEDING 3.INFANT FEEDING 4.CHILD FEEDING 5.YOUNG CHILD 6.BREASTFEEDING PRACTICES.
Abstract : This report was conducted in 49 districts of 25 states and 3 Union Territories (UTs) where district coordinators of BPNI were present. The aim of the study was to assess the status of infant and young child feeding practices in
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India, and the barriers to optimal breastfeeding practices. For quantitative research, a total of 8953 mothers with children aged 0-3 months, 4-6 months and 6-9 months, were selected. To collect the qualitative data, 142 pregnant women, 134 mothersin-laws/fathers-in-laws, 135 ANM/AWWs, and 212 mothers of infants 0-6 months were chosen. Information was gathered through interviews and questionnaires. About 45% mothers were in the age group of 21-25 years, 58% belonged to SC/ST/OBC, 37% were illiterate and 82% were not working outside the home. Nearly 28% mothers initiated breastfeeding within one hour, 30% within 1-4 hours, and 42% started breastfeeding after 4 hours or more. About 49% mothers gave pre-lacteal feed to their babies and these were honey (given by 30%), followed by sugar water (20%), and plain water (13%). Knowledge regarding initiation of breastfeeding within 1 hour was highest in Kerala (81.7%) and lowest in Punjab (1.7%). Data showed that 54% children aged 0-3 months and 26% children aged 4-6 months were exclusively breastfed by their mothers, 43% mothers gave other food and water along with breastfeeding, and 19% mothers gave solid foods to children aged 4-6 months along with breast milk. The percentage of exclusive breastfeeding (0-6 months) was highest in Manipur i.e. 89.9% and lowest in Himachal Pradesh (3.8%). Only 23% mothers gave bottle feeding. About 32% mothers continued breastfeeding for less than 18 months, 46% mothers continued it for 18-24 months, and 22% continued beyond 2 years. 96.7% women breastfed more than 5 times during the day and all respondents breastfed the child during night also. 70% mothers gave solid/semi-solid food to the children aged 6-9 months and 98.6% mothers continued breastfeeding. In Kerala, complementary feeding (6-9 months) was as high as 95%, and lowest in Tripura 28.6%. Initiation of early breastfeeding was higher among literate mothers (61%) and ST mothers, compared to illiterate mothers (51%) and those who belonged to scheduled castes (SC). 58.2% illiterate mothers gave pre-lacteal feed to their infants compared to literate mothers (45%). No difference was found in the frequency of breastfeeding between day and night among literate (96%) and illiterate mothers (96%). Mothers aged up to 20 years preferred exclusive breastfeeding compared to mothers aged 21-25 years. Exclusive breastfeeding was higher among illiterate (42.5%) compared to literate mothers (38.4%); and among STs and OBCs compared to SCs. Some of the barriers to optimal feeding practices are the practice of giving pre-lacteal feeds, long working hours in office, lack of knowledge regarding exclusive breastfeeding, and misconception in the mind of some mothers that breastfeeding would reduce their beauty. It was suggested that there is need for skilled counselling by TBAs, AWWs, and CHWs on the correct method of breastfeeding; self help groups in villages should be motivated to spread messages on exclusive breastfeeding; and there should be provision for creches for working women at their workplace. It was 52
recommended that the Government should increase maternity leave from 135 days to 180 days. There should be proper guidelines for implementing the IMS Act; and efforts should be made at the centre and state level to strengthen basic education curriculum on infant and young child feeding in secondary schools, colleges, nursing schools, ICDS system and medical colleges.
Kanani, Shubhada et al. (2005). Are recommended infant and young child feeding practices being followed in our region? Assessment methods and research evidence. Vadodara : M S University, Faculty of Home Science, Department of Foods and Nutrition. 108 p.
Key Words : 1.NUTRITION 2.INFANT AND YOUNG CHILD FEEDING 3.INFANT FEEDING 4.COMPLEMENTARY FEEDING 5.CHILD NUTRITION 6.WEANING FOODS 7.RESEARCH TOOL.
Abstract : Childhood under nutrition is a major public health problem throughout the developing world and is one of the main causes of death of many children. In this study, data was collected at household level in rural areas and urban slums of Vadodara. The tools used were Semi-Structured Interviews (SSI), Direct Observations Method and 24-hour diet recall of children under 2 years of age. Malnutrition was present due to inadequate dietary intake that resulted from poor household food security, poor health services, and poor care of women and children, especially the girl child. Poor nutrition during formative years (0-2 years) led to significant morbidity, mortality, delayed mental and motor development, impairments in intellectual performance, unfavourable reproductive outcomes, and overall poor health during adolescence and adulthood. There was high prevalence of malnutrition among under threes, especially during the period 6-24 months when transition from breastfeeding to complementary feeding (BF-CF) took place. The contributory factors were lack of awareness of desirable BF-CF practices and inadequate caregiving. 40% - 67% of the newborns were given pre-lacteals, mainly water and honey. The main reasons for this were that it inculcates sanskar (values) in the newborn, it clears the dirt from the babys stomach, and initially no breast milk is produced and the child is hungry. Some families fed colostrum (first milk) to the child, which has anti-infective properties. Nearly two-thirds (63%) of the women squeezed out the first milk before they began breastfeeding. Complementary foods were stored, prepared and fed in an unhygienic manner, which resulted in an increased risk of illness to the child. Mothers did not pay attention to whether their child had enough
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to eat, and to other psychosocial aspects of care during feeding, which were important for adequate food and nutrient intake. Nursing mothers should be educated by nutritionist about healthy BF-CF practices. Mothers should be encouraged to practice responsive feeding that involves sitting with the child while feeding, encouraging the child to eat, etc. Good hygiene practices should be used for storage, preparation and feeding of complementary foods. National Institute of Public Cooperation and Child Development, New Delhi. (2003). Multi country study on infant and young child feeding : a report of field test protocol. New Delhi : NIPCCD. 229 p.
Key Words : 1.NUTRITION 2.INFANT AND YOUNG CHILD FEEDING 3.INFANT FEEDING 4.ICDS 5.NUTRITION COMPONENT 6.AIDS INFECTED MOTHER 7.AIDS 8.BREASTFEEDING 9.GOVERNMENT PROGRAMMES.
Abstract : This report is an assessment of the Field Test Protocol on National Infant and Young Child Feeding developed by WHO; the strengths and weaknesses of policies and programmes to promote, protect and support optimal feeding practices; and in determining supplements thereof. The study was based on the information provided by Institute of Nutrition, Mahidol University, and the data of NFHS-2, MICS-II, INP Survey, and studies conducted by BPNI. It was found that 55% of children in India were exclusively breastfed for the earlier recommended period of 4 months. This varied widely from <20% in Delhi, Meghalaya, Sikkim and Himachal Pradesh to 75% in Andhra Pradesh. Children in Kerala and several states in the North Eastern Region are most likely to receive timely complementary feeding, whereas less than 20% children of Bihar, Uttar Pradesh and Rajasthan received timely complementary feeding. Prolonged breastfeeding is common in India with 89% children breastfed at 12-15 months of age and 69% at 20-23 months. In the states of Assam, West Bengal, Sikkim, Bihar and Orissa more than 80% children were breastfed even at 20-23 months of age. Bottle feeding of infants was common in Goa (63%), Delhi (41%), and Tamil Nadu (34%). There is no separate policy for infant and young child feeding; therefore efforts were made to incorporate the issues of breastfeeding in existing policy/programmes of the Government. Protection and promotion of appropriate breastfeeding was incorporated as a part of NNP, Diarrhoea and ARI management policies, CSSM and ICDS, and BFHI was also launched in 1993-94. Efforts have been made by the Government which constituted National Task Force on Breastfeeding, opening of crche/day care centres near work place to help mothers breastfeed their babies even during working hours; breastfeeding was also promoted through ICDS programme. UNICEF
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and WHO launched BFHI as a part of global efforts to protect, promote and support breastfeeding. A hospital that followed ten steps for successful breastfeeding, developed by WHO, was designated as baby friendly. Government launched Mother Friendly Workplace Initiative (MFWI) which focused on creating working conditions that enabled women to successfully combine exclusive breastfeeding with paid work. To protect breastfeeding women in commerce and industry, measures were first outlined in 1919 by ILO; these underwent several amendments with time, and the benefits were extended to women in agricultural sector. Constitution of India supports Maternity and Child Care under Article 47, 46, 39 and 15(3). Certain legislations were also formulated by Government to give benefits and support services to working women like Employee State Insurance Act 1948, Factories Act 1948, Maternity Benefit Act 1961, Contract Labour Act 1970, Inter-State Migrant Workers Act 1980, Infant Milk Substitutes Act 1992, etc. Several significant and innovative schemes are functioning at national and state level to reach lactating women and children below 2 years of age, namely NCF, Scheme of Assistance to Creches for Children of Working/Ailing Mothers (1974), Maternal Protection Scheme (Gujarat 1986), Tamil Nadu Integrated Nutrition Project (1980), etc. Government has launched various programmes to combat the existing level of malnutrition which results from a combination of three factors inadequate food intake, illness and deleterious caring practices. Nutrition intervention programmes of DWCD are Special Nutrition Programme (SNP), Balwadi Nutrition Programme (BNP), Wheat Based Supplementary Nutrition Programme, Tamil Nadu Integrated Nutrition Programme (TINP), and Mid-day Meal Programme for school children. Intervention programme of Department of Family Welfare for combating specific nutrition deficiency diseases are Iodine Deficiency Disorders Control Programme, Anaemia Prevention and Control among Pregnant Women, and Prevention and Control of Vitamin A Deficiency among children. Programmes of Food and Nutrition Board (FNB) of DWCD also make efforts towards improving nutritional status of people through nutritious education and extension, development and promotion of nutritious foods, and fortification of foods. It was recommended that National Breastfeeding Committee should be renamed as National Infant and Young Child Feeding (IYCF) Committee. A State Committee should be set up on IYCF, and guidelines on IYCF should be formulated/ revised. Existing policies and programmes including BFHI should be strengthened. Efforts should be made for capacity building of health and ICDS functionaries in human lactation management and breastfeeding counselling. Medical nursing curriculum should be strengthened. An effective national media campaign should be launched, and global guidelines should be implemented. Social marketing techniques should be extensively used to propagate social messages of national importance. 55
Rasania, S.K and Sachdev, T.R. (2001). Nutritional status and feeding practices of children attending MCH centre. Indian Journal of Community Medicine, 26(3) : 145-50.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS 3.FEEDING PRACTICE 4.WEANING PRACTICE 5.ANTHROPOMETRIC MEASUREMENT 6.BREAST FEEDING.
Abstract : The study was carried out to know the feeding practices and their effect on nutritional status of children. A total of 354 children (187 male and 167 female) attending a Maternal and Child Health (MCH) Centre of Delhi were included in the study. Information on mother's literacy status, occupation, feeding practices, breast feeding status, initiation and duration of breast feeding, and anthropometric measurements of the child was gathered. Results revealed that 114 children had illiterate mothers, while only 31 children had mothers educated beyond school level. 71.5% children were under weight as per weight for age, while 70.1% and 62.7% of the children has deficit in height for age (stunting) and weight for height (wasting) respectively. Children who were not breastfed were found to be significantly more under weight and stunted. Weaning was started only in 147 children at the time of observation. It was started at the optimum age of 4-6 months in 42.9% of children, started early (less than 4 months) in 24.5% children, while in the rest it was delayed beyond six months. Prevalence of malnutrition was higher in bottle fed children (83%) than children on Katori/ cup feeding (55.1%). The study highlights the need for nutrition education to mothers for promotion of breastfeeding, appropriate education regarding weaning, and education regarding hygiene while feeding the child to reduce malnutrition. Sheth, Mini et al. (2000). Hazard analysis and critical control points of weaning foods. Indian Journal of Pediatrics, 67(6) : 405-10.
Key Words : 1.NUTRITION 2.WEANING FOOD 3.LOW INCOME FAMILY ANALYSIS 5.CONTAMINATION OF FOOD 4.HAZARD
Abstract : Hazard analysis was conducted to identify hazards and critical control points during the preparation, feeding and storage of weaning foods fed to children (6-24 months) belonging to low income families. Ten households from the urban slum 'Kalyan Nagar' in Baroda were surveyed to observe environmental sanitation, personal hygiene of mother and child, feeding practices and storage of cooked food. 56
Temperature of foods was taken during cooking, keeping foods after preparation and after reheating by inserting a durasil thermometer to evaluate potential hazards. High initial contamination of raw foods, poor environmental sanitation and personal hygiene, feeding of over night stored wet foods such as chapati, rice, dal and vegetables stored at ambient temperature (25-35C) and insufficient re-heating of stored wet foods were some important hazards identified. Only two families had good environmental sanitation. Six out of 10 children were suffering from upper respiratory tract infections, while 5 had diarrhoea. Relevant food safety education and change in existing sanitation practices can reduce diarrhoeal morbidity among children from under privileged communities. Taneja, D.K. et al. (2003). A Study of infant feeding practices and the underlying factors in a rural area of Delhi. Indian Journal of Community Medicine, 28(3) : 107-11.
Key Words : 1.NUTRITION 2.INFANT FEEDING 3.BREASTFEEDING 4.BREASTFEEDING PRACTICES 5.SUPPLEMENTARY FEEDING PRACTICES 6.FEEDING PRACTICES.
Abstract : The study was carried out in the rural field practice center of Maulana Azad Medical College in Delhi with an objective to study feeding practices among infants; the factors underlying various harmful practices; the sources of information/advice for the prevailing practices, and also to determine whether the practice of giving diluted animal milk to infants is associated with type of family, caste or educational status of mother. A sample of 106 mothers of infants aged 6-9 months, attending immunization clinic were enrolled for the study. They were interviewed using a semi-structured questionnaire, followed by focus group discussions. It was found that water was commonly given to breastfed babies and top feeds were introduced early; consequently, exclusive breastfeeding was uncommon. Semi-solids were started late and diluted animal milk was commonly given to infants; as mothers often thought that children cannot digest semi-solids or undiluted milk. Milk was also diluted for economic reasons. Insufficient breast milk, illness of mother or child were cited as the main reasons for early introduction of top milk. It was recommended that mothers should be taught about right infant feeding practices, and it should be brought to their notice that wrong feeding practices can lead to malnutrition. Efforts should be made to educate mothers so that exclusive breast-feeding up to six months is universally practiced. Extensive IEC efforts through mass media, and education during antenatal visits and immunization sessions can help in educating mothers about better infant feeding practices.
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Tripathy, Radha et al. (2000). Growth in the first year in children following IAP policy on infant feeding. Indian Pediatrics, 37(10) : 1051-59.
Key Words: 1.NUTRITION PATTERN. 2.BREASTFEEDING 3.INFANT FEEDING 4.GROWTH
Abstract : The present work was undertaken from 1996 to 1998 to study the growth pattern in the first year of life in children fed according to IAP Policy on Infant Feeding, to compare it with the Breast Fed Pooled Data Set (BFDS) babies who were fed according to the WHO recommendations and the current NCHS WHO reference. 114 infants with birth weight equal to and more than 2500 gm from upper and middle socio-economic status were regularly followed up from birth to 12 months of age and fed according to IAP recommendations on infant feeding. Results favoured IAP Policy on Infant Feeding, which showed adequate growth of non low birth weight infants in the first year of life. The WHO Expert Committee concluded that the current NCHS WHO reference, which was obtained from a cross-sectional study of infants mostly artificially fed, were inadequate, and new references should be developed which reflect the current health recommendations.
Uttarakhand, Department of Women and Child Development, Dehradun. (2006). Status of infant and young child feeding Uttarakhand : a report of the study from 13 districts. Dehradun : DWCD. 54 p.
Key Words : 1.NUTRITION 2.INFANT AND YOUNG CHILD FEEDING 3.INFANT FEEDING 4.COMPLEMENTARY FEEDING 5.BREASTFEEDING 6.UTTARAKHAND.
Abstract : In India infant mortality rate is very high. Every third infant born has low birth weight and every second young child is under nourished by the time they are 3 years. It is estimated that worldwide 10.9 million children under five years of age die every year, of which 2.42 million deaths occur in India. This study was done in Uttarakhand to assess infant and young child feeding practices, and understand the barriers to optional breastfeeding practices. Data was collected from 2340 mothers in 13 districts. 84% of the women having children 0-3 years old had received antenatal check-up, 47% from ANM/nurse and 34% from doctors. 61% of them had home deliveries, 19% of them delivered at a Government hospital and 9.8% in private hospitals. Breastfeeding should be initiated within one hour of birth and nothing else should be given; this was done in only 38% of newborns, 41% received 58
the first feed between 1-4 hours, and in the case of 21% children it was delayed for more than 4 hours. In exclusive breastfeeding, no other food or drink should be given to the baby for the first six months; this was done only for 37% infants aged 0-3 months, which got drastically reduced to only 5% in the 4-6 months age group. The percentage of exclusively breastfed children for 0-6 months was as low as 21%. Plain water was the major other supplementary feed given to infants aged 0-3 months. In the 4-6 months age group, other feeds were started in the case of 98% infants. 37% infants were bottle fed in Uttarakhand state, thus 63% children never received any bottle feed. 61% infants got top milk of cow, buffalo or goat, and 47% of them also received gripe water or gutti (digestive liquid). After six months of age, babies should receive complementary feeding with semi-solid home made indigenous foods along with continued breastfeeding. Almost 98% of the children aged 6-9 months were on mothers milk and water, and supplementation of solid and mushy food was given in 93% cases. To be successful in breastfeeding, women need breastfeeding education and counselling as a mandatory service. Many women have to go out to work and they chose artificial feeding as an option, particularly women belonging to poor strata, who engage in economic activity very early after birth. They must stay close to the baby and this requires maternity benefits to be provided, as is done under Tamil Nadu Child Birth Assistance Scheme, under which Rs.1,000 per month is given to mothers for six months.
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IODINE DEFICIENCY DISORDERS/ GOITRE/ IODIZED SALT
All India Institute of Medical Sciences, Department of Community Medicine, New Delhi. (2001). Towards sustaining elimination of IDD Kerala India. New Delhi : ICCIDD. 138 p.
Key Words : 1.NUTRITION 2.IODINE 4.ELIMINATION GOITRE 5.KERALA. DEFICIENCY DISORDERS 3.GOITRE
Abstract : Iodine deficiency is the single most important preventable cause of brain damage. In India, Kerala is the only state that has not banned the sale of non iodized salt. The specific objectives of this study were to determine the current status of IDD in Kerala, find the availability and cost of adequately iodized salt at retail shops, and to study the perceptions of the community towards IDD, salt and iodized salt. The study was carried out in 30 selected clusters of Kerala using the methodology recommended by WHO, UNICEF and ICCIDD. A total of 1067 school going children (529 boys and 538 girls) aged between 6 to 12 years were studied. The three main indicators used for assessment of iodine status in population were total goitre prevalence rate, urinary iodine excretion and coverage of adequately iodized salt. Findings showed that the total goitre rate was 16.6%, prevalence of Grade I goitre being 14% and Grade II goitre being 2.6%. The total goitre rate in boys and girls was found to be 14.3% and 18.8% respectively. A total of 990 urine samples were analyzed for iodine content. The range of urinary iodine excretion values was 10.2 to 378 g/L, compared to the minimum required value of 100 g/L. The median urinary iodine excretion was 123.3 g/L. The proportion of the population with urinary iodine excretion below 100 g/L was 32.5%, and that below 50 g/L was 8.2%. A total of 59 salt samples were analyzed. The proportion of retail shops selling adequately iodized salt [i.e. iodine content 15 parts per million (PPM)] was 61%. All the samples analyzed had some iodine. The range of iodine levels in salt was 1 to 180 PPM. The proportion of households consuming adequately iodized salt was 48.9%. The qualitative survey carried out in two districts of Kerala, namely Thiruvananthapuram and Calicut, showed that most women knew about the different types of salt, one or two brands of iodized salt, and the difference in price and quality of different types of salt. Almost all in urban and rural areas bought powdered salt, but in urban areas most people preferred to buy branded iodized salt, and quality and price of the product primarily influenced the buying practice. Advertisements and incentives were the motivational factors influencing the 60
decision; health benefits were not a criterion for buying a specific variety, and nearly half the respondents were ignorant about the advantages and disadvantages of iodized salt. Nearly half the respondents could mention goitre as an IDD and a few were aware of IDDs other than goitre. Majority of participants did not favour a complete ban on non-iodized salt due to cost difference which made salt less affordable to the poor, and almost all of them wanted the present system of both iodized and non-iodized salt available in the market to continue. 33% respondents opined that if a ban was imposed, they would go by the rule and purchase the available variety. Findings suggest the presence of endemic goitre as a public health problem in Kerala. The recommendations for effective implementation of the IDD elimination program included: acceleration of efforts to increase the coverage of adequately iodized salt from 49% to 100% and sustaining it thereafter; combining legislation and education to achieve Universal Salt Iodization so that its consumption becomes an integral part of good nutritional practice and a healthy habit; implementation of stringent regulatory mechanism and quality assurance procedures to ensure good manufacturing, transport and storage facilities; availability of iodized salt through public distribution system (PDS); dissemination of the results of the study at different levels and tracking progress of IDD elimination activities, and introduction of annual cyclic monitoring to ensure availability of adequately iodized salt to the people. Serious efforts should be made to eliminate IDD through information, education and communication. All India Institute of Medical Sciences, Department of Community Medicine, New Delhi. (~2004). Towards sustaining elimination of IDD Orissa India. New Delhi : ICCIDD. 59 p.
Key Words : 1.NUTRITION 2.IODINE 4.ELIMINATION GOITRE 5.ORISSA. DEFICIENCY DISORDERS 3.GOITRE
Abstract : Iodine deficiency is a worldwide public health problem. In India a high prevalence of iodine deficiency and endemic goitre has been reported from many states. In Orissa, sale of non-iodized salt is banned in all the districts and the state has a State IDD (Iodine Deficiency Disorder) Cell. The main objectives of this study were to determine the status of iodine deficiency in Orissa, find out the availability and cost of adequately iodized salt at retail shops, and to study the perceptions of the community about iodine deficiency, salt and iodized salt. The study was carried out in 30 selected clusters of Orissa using the methodology recommended by WHO, UNICEF and ICCIDD. The three main indicators used for
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assessment of iodine status in the population were total goitre, urinary iodine excretion prevalence and coverage of adequately iodized salt. A total of 1200 school going children (657 boys and 543 girls) between 6 to 12 years of age were studied. Findings showed that the total goitre rate was 8%, of which 7.6% were Grade I and 0.4% were Grade II goitre. The total goitre rate in boys and girls was 6.4% and 10.2% respectively. The range of urinary iodine excretion values was from 15.4 204.4 g/L. It was found to be less than 50 g/L in 32.2% subjects and less than 100 g/L in 60.3% subjects, the median urinary iodine excretion value being 85.4 g/L. The range of iodine levels from household salt samples was 0 164 parts per million (PPM) and only 45.0% households had 15 PPM (recommended value) or more of iodine, which is far short of the goal of at least 90% households consuming adequately iodized salt. A total of 84 salt samples across different salt types (crystal, powdered, refined) were collected and analysed. Results revealed that 16 (19%) samples had either no iodine or less than 5 PPM iodine, 28 (33.3%) samples had iodine content between 7 and 14.9 PPM and in the remaining 40 (47.7%) samples, iodine content was 15 PPM or more. Cost of salt available at retail level ranged from Rs.2 to Rs.8 for a kilogram of salt. Results of the qualitative survey among different categories, i.e. school teachers, panchayati raj institution members, anganwadi workers, health workers, and Government doctors from different locations showed that misconceptions about iodized salt existed. Most people were under the impression that only refined, packed and costly salt was iodized and very few knew that coarse crystal salt sold loose could also be iodized. Also, people who had some knowledge about the benefits of iodized salt knew only about goitre and very few knew about the link between iodine and brain development. Overall findings revealed the existence of moderate to severe iodine deficiency in the state. The recommendations for effective implementation of IDD elimination programme included dissemination of the results of the study to enlist the support of political and opinion leaders and ensure adequate financial provisions for elimination of IDD; establishment of an IDD Review Committee at the Department of Health; monitoring at production and retail level to ensure the quality of iodized salt; introduction of cyclic monitoring including both the process monitoring and progress monitoring to meet the populations need for iodine optimally and to take corrective measures whenever required; involving local self Governments, civic societies and consumer organizations to fight against IDD; and grass root level dissemination of information related to IDD through AWWs, ANMs and trained dais, which could be done by use of graphics and easy to understand IEC materials. Hence, efforts should be made on a war footing to improve the coverage of adequately iodized salt by involving all the stakeholders in successful implementation of USI (Universal Salt Iodization). 62
All India Institute of Medical Sciences, Department of Community Medicine, New Delhi. (~2004). Tracking progress towards sustainable elimination of IDD in Bihar. New Delhi : ICCIDD. 72 p.
Key Words : 1.NUTRITION 2.IODINE 4.ELIMINATION GOITRE 5.BIHAR. DEFICIENCY DISORDERS 3.GOITRE
Abstract : Iodine deficiency constitutes one of the most important nutritional groups of diseases all over the world. India has been a pioneer in both recognizing iodine deficiency as a national public health concern and providing iodized salt to its population. The entire state of Bihar is covered under Ban Notification that bans the sale of non-iodized salt for direct human consumption. The main objectives of this study were to determine the status of iodine deficiency in the state, find out the availability and cost of adequately iodized salt at the retail shops in selected clusters, and to study the perceptions of the community about iodine deficiency, salt and iodized salt. The study was carried out in 30 selected clusters of Bihar using the methodology recommended by WHO, UNICEF and ICCIDD. A total of 1169 school going children (728 boys and 441 girls) aged between 6 to 12 years were studied. The three main indicators used for assessment of iodine status were total goitre prevalence, urinary iodine excretion and coverage of adequately iodized salt. Findings revealed that the total goitre rate was 5.2% and all the thyroid swellings seen were Grade I goitre. The total goitre prevalence in boys and girls was found to be 4.8% and 5.9% respectively. A total of 1132 urine samples were analyzed for iodine content. The range of urinary iodine excretion values was 1.1-360.6 g/L; the median urinary iodine excretion being 85.6 g/L. It was found to be less than 50 g/L in 31.5% samples and less than 100 g/L in 55.3% samples, which was the minimum recommended value. A total of 1199 salt samples were analyzed, of which 1051 samples had some iodine. The proportion of households consuming adequately iodized salt [salt with iodine levels of at least 15 parts per million (PPM)] was 40.1%. The range of iodine levels in salt was 0 to 68.8 PPM. Also, 82 salt samples out of the 128 collected across different salt types, crystal, powdered and refined, were analyzed for their iodine content. Of the samples, 104 (81.2%) were branded varieties and 24 samples (18.8%) were unpacked or loose variety. However, all the samples had iodine. The range of iodine levels in salt from retail shops was 2.1 to 68.8 PPM and the cost of salt was Rs.2 to Rs.8 for a kilogram of salt. Results of the qualitative survey from 1200 households showed that almost half the respondents were aware that they bought iodized salt, over 60% respondents bought branded packet salt, about 65% could not differentiate between iodized salt and non iodized salt, most preferred
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powdered salt due to ease of use and were aware of precautions for salt storage, many did not know the health benefits of consuming iodized salt and were influenced by the advertisements seen/ heard on mass media, and 52% had never heard messages about iodine deficiency. The qualitative survey results from 69 retail shops revealed that 54% shopkeepers claimed to have sold only iodized salt, while 33% claimed to have sold both common salt and iodized salt. Also, in spite of the community not being aware of the benefits of iodized salt, the sale of refined salt was maximum at retail level due to customer demand. Findings of the study revealed that iodine deficiency continues to be a public health problem in Bihar. The recommendations for effective implementation of the IDD elimination programme included: dissemination of results of the study to enlist the support of political and opinion leaders, decision making at all levels and to enable budgeting and financial projections; encouragement by Government for greater production and increase in the households coverage of adequately iodized salt; involvement of local self governments, civic societies and consumer organizations to fight against IDD; introduction of cyclic monitoring including both the process and product monitoring to ensure that the population needs for iodine are met optimally; enforcement and monitoring of the quality of iodized salt at the retail level; improving the communitys awareness of IDD and use of adequately iodized salt through behaviour change communication; and to make quality iodized salt available in public distribution system at an affordable price for the population below poverty line. It can be conceded that success of USI (Universal Salt Iodization) depends on the following elements: awareness, availability, accessibility, acceptability and affordability for all time to come.
Brahmbhatt, S.R. et al. (2001). Biochemical assessment of iodine deficiency disorders in Baroda and Dang districts of Gujarat state. Indian Pediatrics, 38(3) : 247-55.
Key Words : 1.NUTRITION 2.GOITER 3.IODINE DEFICIENCY DISORDER.
Abstract : The objectives of the study were to assess the severity of Iodine Deficiency Disorders (IDD) in Baroda and Dang Districts of Gujarat and to establish a bio-chemical baseline in a sub-sample of the larger population of Gujarat, and to monitor the effectiveness of iodine replacement programme. 1,363 children (<1-15 years) were studied and data was collected on dietary habits, anthropometric and biochemical parameters i.e. height, weight, etc. Results showed that Iodine Deficiency Disorder is a public health problem in Gujarat. Dang District was more 64
affected due to lack of iodine in drinking water, apart from malnutrition and dietary goitrogens. Females were more severely affected in Baroda whereas in Dang District males and females were equally affected by iodine deficiency. Ban on the sale of non-iodized salt in Dang district has not eliminated IDD in the district.
India. Ministry of Industry, Department of Salt, New Delhi. (1999). Evaluation of Universal Salt Iodization in India. New Delhi : Department of Salt. 56 p.
Key Words : 1.NUTRITION 2.IODIZED SALT 3.IODINE DEFICIENCY 4.GOITRE 5.GOITRE PREVENTION 6.SALT IODISATION 7.FOOD FORTIFICATION 8.UNIVERSAL SALT IODISATION PROGRAMME.
Abstract : National Iodine Deficiency Disorders Control Programme (NIDDCP) was launched in 1992 in India with the support of UNICEF and Salt Department, Ministry of Industry to ensure universal iodization of edible salt and consumption of iodized salt by 100% of the population by the year 2000. The mid-term evaluation, conducted in 4 States, namely Gujarat, Himachal Pradesh, Madhya Pradesh and Sikkim, by Canadian International Development Agency (CIDA) in 1996, recommended taking immediate steps towards sustainability of Universal Salt Iodization (USI) programme in India. The study was carried out in 1997-98 by Institute of Health Management Research, Jaipur. The objective of the study was to review the production and distribution of iodized salt; requirement of iodized salt in various states; monitoring system at the production, distribution, supply, sale and consumption levels with respect to quantity and quality; consumption pattern of households in rural and urban areas; and the role of different departments, agencies, and institutions in the implementation of USI. Study covered 3 salt producing states, namely Gujarat, Rajasthan and Tamil Nadu; and 6 salt consuming states, namely Manipur, Karnataka, Bihar, Gujarat, Himachal Pradesh and Madhya Pradesh. A sample of 73 salt producing units was covered from Gujarat, Tamil Nadu and Rajasthan. Interviews were conducted with households; wholesalers; retailers; manufacturers; state and district level officials of various departments, namely Health, Salt, Food and Civil Supplies; PHCs; Anganwadis; and ICDS staff. Salt samples obtained from 450 households and 375 schools were tested using salt testing kits. Study revealed that continuous efforts of UNICEF helped in achieving remarkable success in USI programme by making good quality iodized salt available, and also consumed by everyone in the country. An overall increase of 47% in production of iodized salt was recorded during 1993-95. Capacity of iodized salt
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production reached 8.7 million tonnes against the requirement of 5.0 million tonnes. It was found that, on an average, each household purchased 2.1 kg of iodized salt per month. Nearly 62% household preferred powdered iodized salt, packed in polythene bags. 78% urban and 63% rural people were consuming iodized salt with iodine content of 15 ppm and above. Intensification of USI activities and ban notification of non-iodized salt by the Governments of various States and Union Territories of India resulted in increased consumption of iodized salt. Salt laboratories, particularly, mobile laboratories of the Salt Department strengthened the monitoring of quantity and quality of iodized salt at the production level. The district level monitoring information system (MIS) using salt testing kits was found to be functioning well in the states of Himachal Pradesh, Manipur and Madhya Pradesh. Salt Department was successful in effectively coordinating with Railways in the distribution and supply of iodized salt, particularly in the distant areas of Bihar and Manipur. It was also found that there was high level of awareness among salt producers and traders regarding USI programme, local ban on sale of noniodized salt, and awareness about the need and necessity for consuming iodized salt in the community. It was recommended that efforts should be made to improve distribution of salt through rail and road networks so that good quality salt reaches consumers in time, time gap between production and consumption is reduced, and producers need not incur additional expenses on storing salt for long durations. There is a need for effective and enhanced collaboration between the Salt Department and various agencies/departments at state level for the success and sustainability of USI programme. Computerized MIS should be developed and proper monitoring linkages should be established between Salt Department, Heath Department, producers, distributors, etc. Information, Education and Communication (IEC) activities need to be intensified at all levels in the country, especially at the community level, and among retailers and distributors, for successful implementation of the programme. Serious and continued efforts are required to make the programme sustainable as IDD elimination depends on continuous and regular consumption of iodized salt. Kapil, Umesh, et al. (2001). Assessment of current status of salt iodization at the beneficiary level in selected districts of Uttar Pradesh. Indian Pediatrics, 38(6) : 654-57.
Key Words : 1.NUTRITION. 2.SALT IODIZATION.
Abstract : Iodine Deficiency Disorders (IDD) are a major public health problem in India. The present study was conducted in 17 districts of UP to assess the current 66
status of salt iodization at beneficiary level. 2.7% and 5.7% of the families surveyed were consuming salt with nil and less than 15 ppm of iodine respectively. Out of 4576 samples collected, 2.7% had nil iodine content and about 43.0% salt samples had adequate iodine content. Out of 3112 powdered salt samples collected, only 3.4 had nil iodine content and 56.5% had iodine content of 15 ppm or more. Of the 1464 crystalline salt samples collected, 1.4% had nil iodine content and 84% had iodine content of less than 15 ppm. A higher percentage of crystalline salt sample (85%) as compared to the powered salt samples (43%) had iodine content of 15 ppm. There is a need for strengthening and monitoring the quality of iodized salt. The state Government should ensure the availability and consumption of salt with 15 ppm of iodine by the population as envisaged under the National Iodine Deficiency Disorders Control programme. Kapil, Umesh et. al. (2004). Profile of iodine content of salt and urinary iodine excretion levels in selected districts of Tamil Nadu. The Indian Journal of Pediatrics, 71(9) : 785-87.
Key Words : 1.NUTRITION 2.IODINE DEFICIENCY DISORDER (IDD) IODINE EXCRETION (UIE) 4.IODIZED SALT. 3.URINARY
Abstract : The study was carried out in 24 districts of Tamil Nadu in 2001 to assess the iodine content of slat and urinary iodine excretion (UIE) levels to help the Government strengthen the existing Universal Salt Iodization (USI) programme. From each district, one senior secondary school was selected which catered to low income group population. Data was collected by Uniform research methodology recommended by WHO/UNICEF/ICCIDD. Urine samples were collected using wet digestion method. A total of 3889 salt samples and 220 children aged 11-18 years were included in the study. It was revealed that 62.3% families were consuming iodized salt with more than 5 ppm of iodine. Only 10 salt samples had more than 60 ppm of iodine. In the 9 coastal districts of Nagapattinam, Thiruvarur, Villupuram, Virudhunagar, Tiruvanamalai, Madurai, Cuddalore, Thanjavur and Ramanathapuram, less than 10% beneficiaries were consuming salt with iodine content of 15 ppm and more, and district Perambadur had median UIE level less than 100 g/l, along with more than 20% of the urine samples with less than 50 g/l of iodine. Range of UIE in sample districts was between 85 >200 g/l. Only 16.2% respondents were consuming salt with the stipulated level of iodine (15 ppm and more). The findings highlighted the need for continued monitoring of the quality of salt provided to the population, to achieve the goal of Iodine Deficiency Disorders (IDD) elimination.
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Khan, Q. H and Singh, M.P (2005). Status of Iodine Deficiency Disorders (IDDs) in Amreli District of Gujarat. Health and Population Perspectives, Apr-Jun, 28(2) : 71-78.
Key Words : 1. NUTRITION 2.IODINE DEFICIENCY DISORDERS (IDD) 3.GOITRE 4.ENDEMIC GOITRE 5.MENTAL RETARDATION 6.DEAF 7.MUTISM 8.CRETINISM.
Abstract : Iodine deficiency is the most common cause of preventable mental retardation and brain damage. It causes goitre and decreases the production of hormones vital to growth and development. In India it is estimated that about 200 million people are at risk for iodine deficiency disorders. A re-survey was conducted in Amreli district of Gujarat in March 2000, by the Department of Community Medicine, Medical College Bhavnagar, to find out the existing status of iodine deficiency disorders (IDDs) and to compare the data with the survey conducted earlier (1988). For data collection, 10 villages were selected from the total of 10 talukas of the district by simple random sampling so as to cover at least 1% of the village population and 5% of the primary school children. A total of 9,652 primary school children and 12,052 village population was surveyed. Information from all individuals was collected on a standard performa and cases of goitre were identified and classified (Grade O, I and II) as per the classification by WHO. A population was considered to be endemic for goitre when the prevalence of goitre in the community exceeded 5%. Findings revealed that the overall prevalence rate of goitre among primary school children in the entire district was 10.67% with almost equal prevalence among boys and girls. Goitre in 4 school children was accompanied by other manifestations of IDDs such as mental retardation, deafness and mutism (overall 0.04%). Goitre prevalence in the entire district community was (2.65%), which included cases of both Grade I (2.55%) and Grade II goitre (0.1%). The prevalence was slightly higher in females (3.26%) than males (2.05%). The entire district had 10 cases of mental retardation, 1 case of deafness and mutism and 2 cases of cretinism. Also, comparative figures showed that the percentage of goitre cases among primary school children declined from 17.1% in 1988 to 10.67% in 2000. The decline in goitre cases may be due to increased awareness among the community. When the criteria of endemicity was applied, Amreli district of Gujarat was reported as a non-endemic district for IDDs.
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National Institute of Nutrition, Hyderabad. (2003). Current status of IDD in select districts of different regions of the country. Hyderabad : NIN. 110 p.
Key Words : 1. NUTRITION 2.IODINE DEFICIENCY DISORDER 3.IODIZED SALT 4.SALT IODIZATION 5.CHILDREN 6.DISTRICT WISE DATA.
Abstract : A study was conducted by National Institute of Nutrition (NIN) in 40 selected districts of 5 different regions of the country Northern, North Eastern, Eastern, Central, and Southern. The objective was to assess the prevalence of IDD among children 6 12 year; to estimate random urinary iodine excretion levels; and to assess the extent of use of iodized salt by the community by spot testing and analytical estimation. Study was conducted using 30 cluster sampling design recommended by WHO/UNICEF/ICCIDD, and a total sample of 10500 children, 350 children per cluster was selected. A total of 210 urine samples, 7 per cluster was collected for estimation of urinary iodine. Estimation of iodine was carried out by titrimetry on 210, 7 per cluster, salt samples from 7 households (HHs) for spot testing in each district. Information regarding knowledge and practices of salt consumption was collected from mothers of 2100 children of 70 clusters covered for clinical examination. Information on sale of salt was collected from shopkeepers of all the available clusters. It was revealed that prevalence of total goitre (TGR) in Northern Region ranged from a low of 7% in Nainital to a high of 21% in Gurdaspur district. Prevalence rate 10% is considered a cut off level in India for categorizing IDD as public health problem. This was observed in Shimla, Shahjahanpur, Saharanpur, Gurdaspur, and Sonepat. In N. E. Region, TGR ranged from 5% in Dibrugarh, Dubri, Aizawal, Chhintuipui, and Bishnupur district to 8% in Changlong and Mon. TGR was much higher than the cut off level of 5%, suggested by WHO/UNICEF/ICCIDD to indicate endemicity of IDD in all 8 districts surveyed in the Eastern Region. It ranged from 22% in Palamu and Cuttack to a high of 40% in W. Champaran. In the Central Region, prevalence of TGR ranged from 3% in Surat to a high of 16% in 7 of the 8 districts surveyed. It was 10% in Valsad, Sindhudurg, Shahdol, and Sarguja. Prevalence of TGR in Southern Region ranged from 7% in Chikmangalur to a high of 13% in Wayanad. Prevalence was 10% in Ernakulam, Wayanad, East Godavari, and Adilabad. Other signs of IDD such as deaf-mutism, mental retardation and squint were less than 1%, and cretinism was negligible in Northern, Central and Southern Region, whereas mental retardation and
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cretinism was negligible in Eastern Region. In case of N. E. Region, prevalence of other forms of IDD was found to be negligible. Median urinary iodine excretion was found to be 100g/L in all the districts surveyed except Wayanad of Kerala; North Mangam of Sikkim (<57g/L); <100g/L in Shahdol, Kolhapur, Valsad; and 5090g/L in Surat. Proportion of children with Random urinary iodine excretion levels <50g/L was more than 20% in Saharanpur, Nainital and Gurdaspur of Northern Region; Mon district of North Eastern Region; Palamu, North Mangam, Cuttak and Sundargarh of Eastern Region; and Wayanad of Southern Region. It ranged from 18% in Sindhudurg and Bikaner to a high of 49% in Shahdol in Central Region; indicating endemicity of iodine deficiency. Consumption of iodized salt in the community was not found to be satisfactory; 49-80% HHs were found to be using uniodized or inadequately iodized salt (15ppm) in E. Region, and 40-70% in S. Region. In Central region, consumption of iodized salt in HHs ranged from a low of 10% in Bikaner to a maximum of 54% in Kolhapur; and was between 44-88% in Northern Region. Iodized salt consumption was found to be better in N. E. Region. Awareness about iodized salt was poor in almost all regions of the country. All shops in the N. E. Region were found to be selling iodized salt on regular basis. TGR 5% in Dibrugarh, Changlong, Chhintuipui, Mon, Bishnupur and Chandel revealed that there is an urgent need to improve IEC in the N. E. Region. A considerable proportion of shops were found to be selling iodized salt regularly in North, eastern, Central, and Southern Regions. Reason for not selling iodized salt was lack of demand from the community and high cost. It was recommended that IEC activities should be strengthened in all the regions of India; community should be educated; and traders should be motivated to sell iodized salt and promote its consumption.
Sahu, T. et al. (2005). Prevalence of goitre in 6-12 years children of Kandhamal District in Orissa. Indian Journal of Community Medicine, 30(2) : 51-52.
Key Words : 1.NUTRITION 2.IODINE DEFICIENCY DISORDERS (IDD) SURVEY 4.GOITRE 5.GOITRE CHILDREN. 3.GOITRE
Abstract : The objective of the study was to assess goitre problem and its severity as public health problem at the district and sub district level. Thirty cluster villages and schools in 3 blocks of Khandhamal district of Orissa were randomly selected.
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The study was conducted from October 2003 to March 2004. 1448 children were clinically examined for presence or absence of goitre, of which 843 children were examined during community survey and 605 during school survey. Out of 1448 children examined, 437 (30.18%) had goitre. All three blocks were found endemic for goitre; severity of goitre was moderate in one block and severe in the other two blocks. Prevalence of goitre among boys was 27.38% and girls was 33.14% in the same age group. The higher prevalence of goitre among girls may be due to puberty related iodine metabolism in this age. School survey was able to detect more cases of goitre as compared to community survey. Goitre in 6-12 years children of Kandhamal district of Orissa with overall prevalence among 30.18% amounted to a severe public health problem. Iodine deficiency needs further epidemiological evaluation in tribal settings. School surveys should be adopted to assess the goitre problem in the community.
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MALNUTRITION/ UNDER NUTRITION/ PROTEIN ENERGY MALNUTRITION (PEM)
Administrative Staff College of India, Hyderabad. (1997). National strategy to reduce childhood malnutrition : investment plan final report. Hyderabad : ASCI. 164 p.
Key Words : 1.NUTRITION 2.CHILD NUTRITION 3.MALNUTRITION 4.MALNUTRITION CHILDREN 5.CHILD MALNUTRITION 6.COMBATING MALNUTRITION 7.FOOD FORTIFICATION 8.STRATEGY MALNUTRITION 9.STRATEGY CHILD MALNUTRITION 10.MID DAY MEAL 11.NNMB SURVEYS 12.TINP 13.SUPPORT SERVICES WORKING WOMEN 14.WORKING WOMEN 15.INFANT NUTRITION.
Abstract : The study was conducted to assess the impact of the national strategy to reduce childhood malnutrition. India, with a population growth rate of 1.97%, is annually adding about 18 million people. Birth and death rates have considerably declined in both rural and urban areas. The study was carried out in 24 states and in the Capital Territory of Delhi during 1992-93. Nearly 33% of the female children covered did not receive any primary vaccine but the figure was around 28% among males. Lowest coverage was reported for measles (males 44%; females 41%). The NFHS survey results indicated that more children residing in rural areas were underweight compared to their counterparts in urban areas (55.9% vs. 45.2%). Around 88.9% respondents felt that maternal health and nutritional status was an important determinant for childs nutritional status while 79.4% felt that hygienic practices were important. The major direct food interventions were supplementary feeding programmes such as ICDS, Mid Day Meal Programme, Tamil Nadu Integration Nutrition Project (TINP), Nutritional Anaemia and Nutritional Blindness Prophylaxis Programmes, and Universal Salt Iodization Programme. Foods safety nets such as Public Distribution System (PDS) is the major food subsidy programme in the country. Poverty alleviation programmes were Integrated Rural Development Programme (IRDP) and National Rural Employment Programme (NREP). The states with significant share of cereal subsidy were Andhra Pradesh (12.91%), Tamil Nadu (10.99%), Kerala (10.1%) and Maharashtra (5.81%). Poverty has been declining from the mid seventies from 56.4% to 35% during 1990-91. National literacy rate has gone up from 52.2% in 1991 to 63.38% in 2001. Children aged 3-6 years who under went non-formal preschool education were found to have better developmental scores and their school performance was also better than their counterparts who
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Malnutrition/ Under Nutrition/ Protein Energy Malnutrition (PEM)
did not participate in ICDS. Literacy rates ranged from 74.3% in Kerala to 31.8% in Rajasthan. Approximately 30% of all babies in India were born with low birth weight, which is less than 2.5 kg. About 70% Indians used iodized salt, and 30 out of 33 States / Union Territories in the country have banned the use of non-iodized salt for edible purposes. A larger percentage of children 1-3 years suffered from severe growth deficits. The case studies on Panchayati Raj and NGOs are limited to a few states/ areas where these institutions/ organizations have successfully demonstrated their capabilities. Attention needs to be given to some of the national priorities at the local level. PRIs should therefore, prepare a time bound action programme to tackle social issues like girls education, health and nutrition, abolition of child labour, enforcement of minimum wages, limiting the size of families, etc. Improved access to basic health care and educational opportunities should be provided at village level for younger adolescents (11-14 years) and school dropouts through bridge courses. Much more needs to be done to combat child malnutrition.
Aneja, B. et al. (2001). Etiological factors of malnutrition among infants in two urban slums of Delhi. Indian Pediatrics, 38(2) : 160-65.
Key Words : 1.NUTRITION 2.MALNUTRITION 3.NUTRITIONAL STATUS 4.PROTEIN ENERGY MALNUTRITION.
Abstract : The study assessed the etiological factors responsible for protein energy malnutrition (PEM) in infants in two urban slum communities in Delhi. One hundred and fifty children with their respective mothers belonging to low socioeconomic group were included in the study. Data on age, sex, per capita income and occupational status of the parents was collected. Anthropometric measurements of children were taken to assess nutritional status. Nutritional intake including milk consumed was enquired. Information regarding colostrum feeding, exclusive breastfeeding, introduction of top milk and semi-solid and solid foods and other weaning practices was collected. Results showed that 11, 9, 2 and 4% children were in Grades I, II, III and IV category of under nutrition respectively. 74% of the children were in normal nutritional grade. The non-feeding of colostrum, lack of exclusive breastfeeding, late introduction of solid and semi-solid foods, dilution of top milk and use of bottle milk were common practices in urban slum communities. Correct knowledge about breast feeding and complementary feeding practices among mothers are recommended as an active intervention strategy for the prevention of PEM among infants.
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Asian Development Bank, Manila, Philippines. (2001). Attacking the double burden of malnutrition in Asia and the Pacific. Manila, Philippines : ASB. 179 p.
Key Words : 1.NUTRITION 2.MALNUTRITION 3.MICRO NUTRIENT DEFICIENCY 4.BEST PRACTICE 5.GOOD PRACTICE 6.COMMUNITY BASED NUTRITION 7.ANAEMIA 8.VITAMIN A DEFICIENCY 9.IODINE DEFICIENCY 10.NUTRITION INTERVENTION.
Abstract : This study is a collaborative effort between Asian Development Bank (ADB), International Food Policy Research Institute (IFPRI), and other partners. It highlighted the emerging double burden of underweight and overweight malnutrition, and the linkage between the two. It also provided clear evidence based options for practical and affordable remedial action in different contexts. 70% of the worlds malnourished children, and 75% of all micronutrient deficient persons are found in Asia. Vitamin A, Iodine, and Iron deficiencies, which cause preventable deaths and brain damage in children and adults, and impede learning throughout life, are discussed in detail. Economic growth would not be enough to make a significant dent in malnutrition rates. Direct nutrition interventions are found to prevent and reduce malnutrition. They impact on the main or immediate causes of malnutrition, such as inadequate dietary intake, and result in improved nutritional and health status of children and women. The most common types of nutrition interventions that are community based are breastfeeding promotion, growth monitoring and promotion, communications for behavioural changes including improved complementary feeding, supplementary feeding, and micronutrient supplementation. Fortification was another approach to control micronutrient deficiency which is direct and not community based. Analysis of data from 19701995 for 63 developing countries indicated that all three underlying factors food, care and health environment had played an important role in the reduction of child underweight rates. A similar analysis showed that in South Asia, food availability, the influence of womens education, and improvement in the health environment; and in East Asia, girls education was the main contributing factor to the reduction of underweight rates in the late 1980s. In the 1970s, it was increase in food production that had contributed most significantly to reduction of child underweight rates. Majority of the undernourished persons found in South Asia are from India, Bangladesh and Pakistan. Micronutrient deficiencies, which result in failure of cognitive development, high morbidity, and increased mortality, are found to be high in Asia and Pacific region. More than 60% of preschoolers, and 70% of pregnant women are anemic in South-East Asia, including Bangladesh, India, Nepal, Sri Lanka and Thailand. Similarly, more than 40% persons in this region were at risk
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of Iodine Deficiency Disorders (IDD). The study also considered how to bring necessary changes in terms of resources, capacity, policy and institutional arrangements for effective implementation of appropriate policies and programs. The rationale for public investment in nutrition was justified because of market failures that make public sector intervention necessary. It was concluded that a topology to guide direct and indirect interventions should be framed on the basis of the nature of the problem and capacity of each country to apply it. Direct interventions like different nutrition programmes, dietary guidelines, health programmes through mass media, safe motherhood practices, immunization, deworming school children, etc., and indirect interventions like food processing guidelines, encouraging establishment of child care centers for poor mothers, improving access to sanitation for the poor, agricultural and food price policy on improving availability of micronutrient rich foods, AIDS prevention campaigns, greater access to education for girls, improved safe drinking water, etc. should be undertaken and encouraged by the public sector, depending upon the different levels of its ability to do so. It was recommended that development agencies like Asian Development Bank (ADB) should come together for public-private sector initiatives, with the involvement of civil society. Development agencies could play a lead role in forging international partnerships, based on the need to prioritize malnutrition reduction throughout the life cycle, and based on past experiences, they can point the way towards more effective and sustainable policies and programmes.
Gragnolati, Michele, Das Gupta, Monica and Shekar, Meera. (2006). India's undernourished children : a call for reform and action. New Delhi : World Bank. 120 p.
Key Words : 1.NUTRITION 2.MALNUTRITION CHILDREN 3.UNDERNOURISHED CHILD 4.ICDS 5.NUTRITION IN ICDS.
Abstract : The prevalence of child under nutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa. The present study explored the dimensions of child under nutrition in India and examined the effectiveness of the Integrated Child Development Services (ICDS) program in addressing them. It was found that 47% children under 3 were underweight or severely underweight, and a further 26% were mildly underweight, so almost 73% children were under nutritioned in India (1998/99). Findings showed that underweight prevalence was higher in rural areas (50%) than in urban areas (38%) and also higher among girls
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(48.9%) than among boys (45.5%). Statistics showed that at least one in two children were underweight in six states namely Maharashtra, Orissa, Bihar, Madhya Pradesh, Uttar Pradesh and Rajasthan. Micronutrient deficiency was widespread in India. More than 75% preschool children suffered from iron deficiency anaemia (IDA) and 57% preschoolers had sub-clinical Vitamin A deficiency (VAD). Iodine deficiency was endemic in 85% districts. With regard to ICDS, it was found that its dominant focus was on food supplementation for improving child nutritional status, but not enough attention was given to improve child care behaviours and on educating parents how to improve nutrition using the family food budget. Service delivery was not sufficiently focused on the youngest children (under three) who could potentially benefit most from ICDS interventions. In addition, children from wealthier households participated much more than poorer ones, and ICDS only partially succeeded in preferentially targeting girls and lower castes, which were at higher risk of under nutrition. The program faced substantial challenges namely inadequate worker skills, shortage of equipment, poor supervision, etc. Community workers were overburdened because they were expected to provide pre-school education to children 4-6 years old, as well as nutrition service to all children under six. ICDS program also had lowest levels of funding and low coverage in the states where under nutrition levels were very high. Urgent changes are needed to bridge the gap between the policy intention of ICDS and its actual implementation. 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, making informed decisions, and creating accountability for performance.
Mahapatra, A. et al. (2000). Nutritional status of preschool children in the drought affected Kalahandi district of Orissa. Indian Journal of Medical Research, 111 : 90-94.
Key Words : 1.NUTRITION 4.ORISSA 5. DROUGHT. 2.NUTRITIONAL STATUS 3.PRE-SCHOOL CHILDREN
Abstract : The study was undertaken to determine the level of under nutrition and protein energy malnutrition among children during 1996-97 in drought affected Kalahandi District of Orissa. 751 children aged 0-5 years from 15 Gram Panchayats were studied for anthropometric and clinical signs of nutritional deficiencies. This community based study showed no significant difference between the nutritional status of boys and girls. The study revealed the widespread prevalence of
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malnutrition in the form of wasting (27.9%), stunting (41.8%) and underweight (57.1%) among children. Positive inputs to improve growth and to overcome body weight deficits are recommended. Preventive measures are needed to improve food security, strengthen supplementary feeding programmes, and provision of adequate subsidized food through public distribution system is recommended to achieve better growth and development of children.
Nagaraja Rao, K. et al. (2001). Nutritional neglect and physical abuse in children of alcoholics. Journal of Pediatrics, 68(9) : 843-45.
Indian
Key Words : 1.NUTRITION. 2.MALNUTRITION. 3.CHILDREN OF ALCOHOLICS. 4.PHYSICAL ABUSE. 5.CHILD ABUSE.
Abstract :The study compared nutritional neglect and physical abuse in children of alcoholics with children of non-alcoholics. The sample consisted of 72 children from 30 consecutive families with one or both parents being alcoholic against 81 children from non-alcoholic families. These children were from the Pediatric Department of the Medical College, Davangere, Karnataka. Results revealed that 45 per cent of the children of alcoholics had physical injuries in contrast to 23.4 per cent of children of non-alcoholics. Malnutrition co-existed in almost all the injured children of alcoholics. About 86.1 per cent children of alcoholics and 49.4 per cent children of non-alcoholics had malnutrition of various grades. Children of alcoholics were at significantly higher risk for malnutrition and physical injuries. There is need for pediatricians to be sensitive to the indicators of child abuse while recording family history of child patients. If the children at risk are identified early, some of the morbidity can be avoided.
Nigam, A.K. (2003). Determining grades of malnutrition in children : standard deviation classification and the alternative. Demography India, 32(1) : 137-55.
Key Words : 1.NUTRITION 2.MALNUTRITION 4.GRADES OF MALNUTRITION. 3.NUTRITION CLASSIFICATION
Abstract : To assess malnutrition, classifications like Gomez and Indian Association of Pediatricians (IAP) are now widely used to analyze and present data from NNMB surveys. These classifications are on the basis of cut-off points as percentage of 77
median weight for age. The third classification is based on the cut-off points recommended by World Health Organization. According to these cut-off points, prevalence of moderate and severe levels of malnutrition is defined as the proportion of children below 2 SD of the median value of the National Centre for Health Statistics (NCHS) reference population. The use of SD/Z scores is not widespread mainly because Z scores can be derived after relatively cumbersome calculations. The present study is an effort in removing this anomaly. The study deals with NCHS standards for weight for age comparisons. The NCHS standards are given in the form of tables by single month of age and gender. The study revealed that cut-off points not only differ by age, but also by gender. Experts and researchers felt that in addition to monitoring weight, height should also be monitored. This has perhaps become more relevant with recent emphasis on stunting as an indicator of chronic malnutrition. Malnutrition could be monitored using both height for age and weight for height indicators. The average cutoff points for , 2 and 3 limits, both for boys and girls, are 96%, 92% and 88% of median respectively for height - for - age, and 91%, 81% and 72% for weight for height. The NNMB reporting of nutritional status of children is based on Gomez, IAP and standard deviation classifications using Harvards and NCHS standards. In India, at the national level, ICDS also uses IAP classification for growth monitoring and identifying severely malnourished children below 6 years for supplementary food. However, international organizations and even National Family Health Surveys uniformly use NCHS standards and standard deviation classifications. A drawback of IAP classification is that it is not only arbitrary, but also underestimates severely malnourished children. The study showed that it should be 67% of median weight based upon standard deviation classification. This gap is matter of concern as it deprives a large number of severely malnourished children of the benefits of supplementary food. The study analyzed anthropometric data of 11271 children in Uttar Pradesh. These classifications are intricate for field functionaries are research workers, as they need development and usage of appropriate software for different indicators of nutritional status. Thus it is hoped that the procedure described in the study would encourage research workers to report nutritional status in terms of standard deviation classification.
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Nutrition Foundation of India, New Delhi. (2006). Double burden of malnutrition : case study from India. New Delhi : NFI. 59 p.
Key Words : 1.NUTRITION 2.MALNUTRITION 3.MICRONUTRIENT DEFICIENCIES 4.ANAEMIA 5.DISEASES INDIA 6.OBESITY 7.OVER NUTRITION.
Abstract : In India, there has not been much change in the predominantly cereal based dietary intakes over the last three decades, except among affluent segments of society. In spite of increasing per capita income and reduction in poverty, dietary diversity is seen mainly among the affluent. Under nutrition rates remain high, and nearly one-third of all Indian infants weigh less than 2.5 kg at birth. Incidence of low birth rate is highest among low income groups. Effective management of anaemia, pregnancy induced hypertension and low maternal weight gain during pregnancy can be detected and treated. According to NNMB (1979-2002) there has been a steady decline in under nutrition in children even though the dietary intake has not shown a major change over the years. National Family Health Survey (NFHS) 1998-99 indicates that prevalence of under nutrition in urban areas is half of that in rural areas. Affluence has led to the emergence of the problem of over nutrition, and this is higher in women as compared to men. Goitre due to iodine deficiency, blindness due to Vitamin A deficiency, and anaemia due to iron and folate deficiency are major public health problems in India. NNBM survey 2002 has shown that anaemia is very high (ranging between 80-90%) in preschool children, pregnant and lactating women, and adolescent girls. All the large national surveys (NNMB-MND, ICMR-MND and NNMB 2001) have shown that clinical Vitamin A deficiency in under five children in the country is currently below 1%. The decline in Vitamin A deficiency signs in children appears to be due to implementation of Prophylaxis Programme against Vitamin A Deficiency, better access to health care and consequent reduction in severity and duration of common childhood morbidity due to infectious diseases. Iodine deficiency disorders have been recognized as a public health problem in India since the 1920s, and the Government of India launched National Goitre Control Programme (NGCP) in 1962 to provide iodized salt to the well recognized sub-Himalayan goitre belt. Data from NNMB surveys, NFHS and DLHS suggest that dietary diversification, better coverage under the National Anaemia Control Programme, administration of massive dose of Vitamin A solution, universal access to iodized salt, and later iron and iodine double fortified salt as some of the interventions that could help India to achieve rapid reduction in micronutrient deficiencies. Prevention of intrauterine growth retardation through antenatal care, and early detection and correction of under nutrition can be achieved through effective implementation of ongoing intervention programmes utilizing the available infrastructure.
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Rao, Veena S. (2008). Malnutrition, an emergency : what it costs the nation. New Delhi : CAPART. 109 p.
Key Words : 1.NUTRITION 2.MALNUTRITION 3.MICRONUTRIENT DEFICIENCY 4.MATERNAL NUTRITION 5.CHILD NUTRITION 6.COMBATING MALNUTRITION 7.COST OF MALNUTRITION 8.STRATEGIES TO COMBAT MALNUTRITION.
Abstract : Malnutrition is a complex phenomenon with multiple causes, multiple manifestations, and it is inter-generational. This paper highlights the epidemic proportions of malnutrition in India. As per NFHS III, 21.5% of the infants born are of low birth weight. According to NFHS III (2005-06), infant mortality rate (IMR) was 57 infant deaths per 1000 live births. 61.3% of infant mortality is related directly or indirectly to maternal/ child malnutrition and infant deaths are due to prematurity (30%), pneumonia (14.5%), respiratory infection (11%), anaemia (2.9%) and diarrhoea (2.9%). Stunting (deficit in height for age), wasting (deficit in weight for height) and under weight (deficit in weight for age) are critical indicators of nutritional status of children. The NFHS III data revealed that 46% children below 3 years of age were under weight, 38% were stunted and 19% were wasted. During the last decade, there has been only marginal decline in malnutrition. The prevalence of under weight is higher in rural areas (50%) compared to urban areas (38%), higher among girls (48.9%) than among boys (45.5%), and higher among scheduled castes (53.2%) and scheduled tribes (56.2%) than among other castes (44.1%). Among vulnerable groups the prevalence of under weight reaches as high as 60%. Child malnutrition is mostly the result of high levels of exposure to infection and inappropriate infant and young child feeding practices, specially during the first 2 to 3 years of life. The maternal mortality (MMR) in 2001-03 was 301 per one lakh child births. The major causes of MMR are haemorrhage, sepsis, hypertension, obstructed labour, abortion, adding up to 67%, which are directly related to anaemia, malnutrition, and poor access to institutional deliveries. As per NFHS III, in 2005-06, 51% mothers across the country had received at least three antenatal care visits during pregnancy and only 48% births were attended by a trained attendant. Almost 30% of the women in India have a Body Mass Index (BMI) below normal, thereby indicating chronic energy deficiency. The improvement between NFHS 2 and 3 has been a marginal 3%. The incidence of anaemia among ever married women aged 15-49 years has risen from 51.8% in 1998-99 to 56.2% in 2005-06. The
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prevalence of anaemia among pregnant women aged 15-49 years has also increased from 49.7% to 57.9%. In India, only 44.6% and 87.9% of households have access to toilet facilities and safe drinking water respectively. According to the National Nutrition Monitoring Bureau (NNMB) report (1996-97) about 30% of households consume less than 70% of the daily energy requirements. Micronutrient deficiencies, particularly of Vitamin A and iron are widely prevalent. About 80% of the individuals consume diets which provide less than half of the RDA for these micronutrients. About half the adults and elderly suffer from chronic energy deficiency as measured by body mass index (<18.5). The Productive Life Expectancy denotes the life time productive period of an average individual. For each nutrition deficiency disorder the productivity loss is expressed as percentage loss of the expected level. High Productivity Loss (50%) was assumed for cretinism and total blindness due to Vitamin A deficiency. This account for 3.9% of Gross Domestic Product, highlighting that nutritional disorders contribute to a significant Productivity Loss, which India can ill afford. CAPART, and autonomous body under the Ministry of Rural Development, Government of India, with a mandate of funding NGOs, prioritized the issue of malnutrition as an unaddressed gap in human resource development, and formulated a model scheme for promotion of community initiatives to combat malnutrition and provide income generation in backward regions of India. It adopted the Inter-Generational cycle approach, focused on health awareness, and promoted dietary supplementation by low cost, indigenous energy rich foods, locally prepared by womens self help groups. The scheme serves a dual purpose of combating malnutrition and providing income generation for womens self help groups, who produce, distribute and market the energy rich foods in the community. Two pilot projects have been undertaken in the Tribal blocks of Jawar and Mokhade in Thane district, Maharashtra that suffer from chronic malnutrition. CAPART is implementing these projects jointly with an NGO, MITTRA-BAIF. The report suggested a blueprint for a National Programme to Combat Malnutrition. Beginning with enhanced political commitment, it seeks to revitalize the dormant National Nutrition Council headed by the Prime Minister, and urges it to set up a High Powered Committee to formulate a National Programme to Combat Malnutrition. The programme components suggested were Awareness Generation, supply and popularization of Low Cost Nutritious Energy Foods, Food Fortification and strong Monitoring and Evaluation system.
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Visweswara Rao, K. et al. (2000). Gender differentials in malnutrition : a case study of preschool children. Man in India, 80(3-4) : 289-94.
Key Words: 1.NUTRITION DIFFERENTIAL. 2.MALNUTRITION 3.PRE-SCHOOL CHILDREN 4.GENDER
Abstract : The study attempted to trace the indicators responsible for gender differentials in malnutrition. 1649 children from rural and 2550 children from urban Hyderabad were surveyed. The prevalence rates of malnutrition by socio-economic status were computed and compared between male and female children. Per capita income, education and occupation of parents, family size and land owned were various socio-economic variables studied. Five set of variables were used to test gender differentials of malnutrition i.e. (1) boys normal vs. girls stunted, (ii) girls normal vs. boys stunted, (iii) boys normal vs. girls stunted with severe wasting, (iv) girls normal vs. boys stunted with severe wasting and (v) normal girls vs. normal boys. Results shows that the gender differentials decreased significantly with better grades of maternal literacy and occupation, followed by paternal literacy and per capita income.
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MICRONUTRIENTS/ MICRONUTRIENT DEFICIENCY
Brahmam, G.N.V., Rao, M. Vishnuvardhana and Dwivedi, Shubhra. (2002). Prevalence of iron deficiency anaemia and Vitamin A deficiency in the state of Jharkhand. Ranchi : Jharkhand, Department of Health and Family Welfare. 49 p.
Key Words : 1.NUTRITION 2.MICRONUTRIENT DEFICIENCY 3.ANAEMIA 4.VITAMIN A DEFICIENCY 5.GOITRE 6.PRESCHOOL CHILD 7.JHARKHAND.
Abstract : Under-nutrition continues to be one of the major public health problems in developing countries including India. The present study was done to assess the prevalence of Iron Deficiency Anaemia (IDA) and Vitamin A Deficiency (VAD) among vulnerable groups in rural areas Jharkhand. A total of 19,040 preschool children were examined for prevalence of clinical signs of VAD. Haemoglobin estimation was carried out by cyanmethhaemoglobin on 597 preschool children, 548 pregnant women and 587 lactating mothers. Particulars of coverage for immunization were collected from 426 children and their mothers. Iodine content was assessed on 623 salt samples using spot testing kits. Results indicated that overall prevalence of anaemia was 84% among preschool children, 91% among pregnant women and 96% among lactating women. 5.5% preschool children, 12.7% pregnant women and 8% lactating women had severe anaemia. About 12% preschool children, 28% pregnant women and 23% lactating women received IFA (Iron Folic Acid) tablets. Less than 10% respondents were aware of anaemia. Prevalence of severe Vitamin A deficiency such as corneal xerosis (0.07%), keratomalacia (0.02%) and corneal scar (0.11%) was noticed during the survey. Only 17% respondents were aware of night blindness. It was observed that about 56% of the households surveyed were using iodized salt. Only about 18% of the 1-2 year old children were completely immunized under Universal Immunization Programme (UIP). Around 52% of the women interviewed had received at least one dose of Tetanus Toxoid (TT) during the previous pregnancy. Of the 20 AWWs (Anganwadi Workers) interviewed, 90% had undergone formal training for 3 months. About 70% of them were aware of the signs and symptoms of IDA and VAD and 45% were aware of massive dose of Vitamin A distribution. While 60% were aware of IFA distribution and 45% were aware of distribution of massive dose of Vitamin A as components of National Programmes for Prevention and Control of IDA and VAD respectively, only 30% identified Health and Nutrition Education as a component of the programmes. The study suggested that Government should start campaigns, awareness programmes and educational programmes related to health, nutrition, malnutrition, nutrition education on VAD and IDA, mother and child care, etc. for the benefit of community people. 83
Elizabeth, K. E. (2000). Status of micronutrients before and after rehabilitation. Thiruvananthapuram : SAT Hospital and Medical College, Deptt. of Pediatrics. 2 p.
Key Words : 1.NUTRITION 2.MICRONUTRIENT DEFICIENCY 4.NUTRITIONAL REHABILITATION. 3.MALNUTRITION
Abstract : The study focused on micronutrient deficiency among children aged 1-5 years and was undertaken by the Division of Cellular and Molecular Cardiology. Sree Chitra Tribunal Institute for Medical Sciences and Technology, Trivandrum. It was found that acute stages of micronutrient deficiency were maximum among children aged 3-4 years. 60 children were assessed for 4 micronutrient deficiencies namely calcium, magnesium, zinc and copper, and protein and albumin for 3 months duration. Paired `T test was used to analyze the data. Male to female ratio was 45:55. Results showed that majority of the children were consuming cows milk and rice in their daily diet. After rehabilitation, there was significant improvement in weight, height, serum protein and albumin levels of children. Serum zinc, serum magnesium and serum copper level were very low even after rehabilitation. It can be suggested that children require micro-nutrient supplementation, especially trace elements. India. Ministry of Human Resource Development, Department of Women and Child Development, New Delhi. (1996). Report of the Task Force on Micronutrients (Vitamin A and Iron). New Delhi: DWCD. 43 p.
Key Words : 1.NUTRITION 2.MICRONUTRIENT 3.MICRONUTRIENT DEFICIENCY 4.VITAMIN A DEFICIENCY (VAD) 5.IRON DEFICIENCY 6.ANAEMIA 7.TASK FORCE 8.TASK FORCE ON MICRONUTRIENT DEFICIENCY 9.WORKING GROUP REPORT 10.FOOD FORTIFICATION.
Abstract : A Task Force was constituted on 5th September 1995 by Department of Women and Child Development (DWCD) to adopt a multi-dimensional and multisectoral approach to eliminate the problems of micronutrient malnutrition in all age groups. It gave suggestions for improving the delivery mechanism and increasing the coverage of risk groups, mass communication plans for media, and mechanisms for inter-sectoral coordination and monitoring. National programmes like ICDS and 84
Child Survival and Safe Motherhood (CSSM) should be used to educate people about Vitamin A deficiency and other micronutrient deficiencies. Through appropriate nutrition training, supervision and monitoring, intake of Vitamin A and Beta Carotene rich foods by all should be encouraged. Adequate supply of fruits and vegetables rich in Beta Carotene, iron and Vitamin C should be ensured. Nutrition oriented horticultural activities, home gardening and social forestry programmes should be promoted at national and local level. There should be universal coverage of 9 months to 3-year-old children under the Vitamin A Prophylaxis Programme and proper treatment should be given to Vitamin A deficient (VAD) cases. Programmes for supply of safe drinking water, improved sanitation and immunization should be intensified. Selective fortification of foods for supplementary feeding of infants, pre-school children and school children should be done. High-risk areas and special groups should be identified and protected. To tackle the problem of Iron Deficiency Anaemia (IDA), supplementation of food with iron and folic acid (IFA) was suggested for vulnerable groups like pregnant and lactating women, infants, preschool children, and adolescent girls. Double fortification of salt with both iron and iodine was also suggested. Nutrition education, consumption of iron rich food in the diet, and intake of iron tablets were recommended. The delivery mechanism of existing interventions should be improved, their coverage increased, and at risk groups accorded high priority. Contact points for immunization and supplementary feeding were suggested as best places for interpersonal nutrition counselling. Campaigns should be launched for changing the dietary behaviour using primary school network, literacy campaigns and panchayats. Linkages between ICDS and CSSM functionaries should be strengthened through joint training and supervision for improving the coverage. Infrastructure of schools and ICDS may be utilized for supply of Iron and Folic Acid (IFA) tablets to women and children. Haemoglobin testing of all pregnant women was viewed as an essential pre-requisite for prevention and control of anaemia. The existing Management Information System (MIS) in ICDS should be further strengthened for identifying low coverage areas, and causes of non-coverage, and used to initiate action to rectify the situation. Nutrition should be included in all graduate courses to create nutritional awareness among the population. Mass communication plan was suggested for Media as it has vast outreach. It was also recommended that Information, Education and Communication (IEC) on nutrition should be made an integral part of all developmental programmes. Target specific communication software needs to be developed. Communication should adopt media-mix approach, using electronic and print media, and should be reinforced through traditional and folk media. Nutrition issues should be incorporated in the formal and non-formal education system, especially for women. 85
National Institute of Nutrition, Hyderabad. (2003). Prevalence of micronutrient deficiencies. Hyderabad : NIN. 66 p.
Key Words : 1. NUTRITION 2.MICRONUTRIENT DEFICIENCY 3.NNMB SURVEY REPORT 4.NNMB REPORT 5.VITAMIN A DEFICIENCY 6.IODINE DEFICIENCY 7.IRON DEFICIENCY 8.ANAEMIA 9.ADOLESCENT GIRL 10.ANAEMIA ADOLESCENT GIRLS.
Abstract : The study was carried out by National Nutrition Monitoring Bureau (NNMB) in Andhra Pradesh, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, and West Bengal. Objectives of the study were to assess prevalence of Vitamin A Deficiency (VAD) among pre-school children, and Iodine Deficiency Disorder (IDD) among 6-12 year olds; to estimate haemoglobin level among preschool children, adolescent girls, and pregnant and lactating women; to estimate iodine level in the salt used by house holds (HHs), and serum Vitamin A level in pre-school children; and to assess awareness about IDA and VAD among women. A total of 75600 HHs from 633 villages were covered. Clinical examination of 71591preschool children was conducted for VAD, and 28437 children aged 6-12 years for IDD. 3291 preschool children, 6616 adolescent girls, 2983 pregnant women, and 3206 lactating mothers were covered for haemoglobin estimation. 5209 salt samples from HHs were tested for iodine content using spot testing kits. Knowledge and practices on VAD and IDA were assessed of 2681 and 2178 mothers of children aged 1-5 years, 2053 pregnant women, and 2213 lactating women. Overall female literacy rate was found to be 51%. It was found that prevalence of Bitot spots among 1-5 year olds ranged from nil in Kerala to a maximum of 1.4% in Madhya Pradesh, followed by 1.3% in Maharashtra, and 1.2% in Andhra Pradesh. Overall prevalence of night blindness was about 0.3% (Cl:0.26-0.34) and that of conjunctival xerosis was 1.8%. Overall prevalence of goitre among 6-12 year olds was about 4%. The proportion was higher than WHO categorization of 5% in the states of Maharashtra (11.9%) and West Bengal (9%). Prevalence of deaf mutism and mental retardation was negligible (0.1% in each district). Spot test revealed that 42% HHs were consuming uniodized salt, 31% consumed iodized salt as per recommended level of 15 ppm, and 27% consumed salt having unsatisfactory level of iodine content (about 7ppm). The lowest mean haemoglobin level was found among pregnant women (9.9g/dl), followed by preschool children (10.3 g/dl), lactating women (10.6 g/dl), and adolescent girls (11.1-11.2 g/dl). Overall prevalence of anemia was found to be 67% among preschool children; 69% among 12-14 year old adolescent girls; 75% among pregnant women; and 78% among lactating women. 41% mothers were aware of night blindness. About 24% respondents listed foods like green leafy vegetables, yellow coloured fruits, animal foods, and nutritious food to
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be consumed for preventing VAD. It was found that only 13% mothers had received nutrition education on VAD. 33.9% women were aware of anemia. 25.8% women stated dietary inadequacy as one of the causes of anemia, while 3.7% could identify it as iron deficiency. Extent of coverage for Iron and Folic Acid (IFA) tablets was very low among pre-school children (3.8%) and lactating mothers 12.3%, but higher among pregnant women (62.2%). Those who received 90 IFA tablets was very low and ranged from 2% among preschool children to 30% among pregnant women. About 9% pregnant women, 4% lactating women, and 0.3% preschool children reported side effects on consumption of IFA tablets, mostly in the form of vomiting (0.2-4.1%), nausea (0.1-5%) or black stools (0.1-1.2%). Study revealed that risk of developing Bitot spots was twice as high among children of SC/ST communities. Similarly children from HHs without sanitary toilets had higher risk (OR=1.76) than those with sanitary toilets. Risk of developing anemia was twice as high among preschool children belonging to Hindu and Muslim families compared to Christians and those from HHs not having sanitary toilets. Poor outreach of the NNMB programmes resulted in unsatisfactory nutrition education, and covered only 14% of the targeted beneficiaries. There is an urgent need for improving the implementation of national nutrition programmes and strengthening nutrition education. Sachdeva, H. P. S. (2008). NFI Bulletin, 2008 Jul, 29(4): Role of Micronutrients Supplementation in Improving Child Health. New Delhi : Nutrition Foundation of India. 5 p.
Key Words: 1.NUTRITION 2.RESEARCH NUTRITION 3.NUTRITION SITUATION 4.NUTRITION INDIA 5.MALNUTRITION 6.MICRONUTRIENT DEFICIENCY.
Abstract : Micronutrients are essential for the maintenance of health, and children are particularly vulnerable to the effects of deficiency. On the basis of observational evidence it was found that prophylactic Vitamin A supplementation helps in preventing childhood mortality between 6 months and 6 years of age. Another important micronutrient is Iron and iron deficiency is believed to be the most important causal factor for anaemia. But all anaemia is not due to iron deficiency and also not all iron deficient individuals are anaemic. On the basis of a systematic review of the findings of 55 trials, it was concluded that iron supplementation increased haemoglobin levels in children significantly but modestly. The rise was greater with baseline anaemia, and lower in malarial hyperendemic areas. The study found that iron-fortified foods result in a significant improvement in haemoglobin, serum ferritin and serum transferring receptor, and a reduced risk of
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remaining anaemic and iron deficient at the end of the intervention. Observational data indicated a strong association of iron deficiency with poor mental and motor development in children. Evidence showed that iron supplementation improves mental development scores modestly. Some evidences from earlier reviews showed that iron administration slightly increases the risk of developing diarrhoea; in non-malarious regions iron supplementation has no apparent beneficial or harmful effects on the overall incidence of infectious illnesses. It was also found that in malaria endemic regions, particularly those with high transmission rates, iron supplementation may result in increased risk of malarial infections. Another study showed that in areas where iron deficiency was common and malaria absent, daily supplementation of young children with iron and folic acid has no effect on their risk of death, but might protect them against diarrhoea, dysentery, and acute respiratory illness. Another important micronutrient is Iodine. Several reviews suggested that with iodine fortification or supplementation, goitre prevalence decreased by 19-64% in children, and almost all programmes reported normal median urinary iodine excretion levels. It was estimated that iodized salt reduced the risk of iodine deficiency and the DALYs (disability adjusted life years) associated with iodine deficiency by 41% in children. Zinc is found to be another important micronutrient, and researchers found that zinc had a beneficial role in acute and persistent diarrhoea in children. It was found that zinc supplemented children had 16% faster recovery and had a 34% reduction in the odds of acute episodes lasting more than 7 days. Studies showed that deficiency of other micronutrients Vitamin B-complex and Vitamin D was quite prevalent in India and led to adverse child health consequences. There is an urgent need to control these micronutrient deficiencies by providing fortified food, supplementation to the children having micronutrient deficiencies, and also food programmes should be organized to cope with these resultant health problems. Singh, Madhu, B., Fotedar, Ranjana and Lakshminarayana, J. (2004). Nutritional status along with micronutrient deficiency disorders and morbidity in pregnant and lactating women in desert areas of Rajasthan. Jodhpur : Desert Medicine Research Centre. 5 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS PREGNANT WOMEN 3.PREGNANT WOMEN 4.LACTATING WOMEN 5.MICRONUTRIENT DEFICIENCY 6.ANAEMIA 7.IODINE DEFICIENCY 8.VITAMIN A DEFICIENCY 9.DESERT AREAS 10.RAJASTHAN.
Abstract : The nutritional status of people residing in desert areas is generally poor due to harsh environmental conditions. This study was conducted in Jodhpur to assess the nutritional status of pregnant and lactating women; study the morbidity 88
profile of diseases among rural pregnant and lactating women of desert areas of Rajasthan; and develop a nutrition package for pregnant (384) and lactating women (400) based on the findings of the study. A total of 1193 households were covered. Pregnant and non-pregnant women were examined for nutritional deficiency signs, dietary pattern was observed and morbidity survey was undertaken. Haemoglobin level and IDD was assessed by clinical examination. Anaemia was observed to be maximum among pregnant and lactating women and least in control group. Severe anaemia was 3 times higher in pregnant and lactating women (10.5 to 14%). Consumption of iron folic acid tablets by pregnant and lactating women was observed to be low (39.0 to 48.0%). Abortions, child deaths, still births and premature births were observed to be higher in anaemic pregnant and lactating women. The analysis of 1049 urine samples revealed that the median urinary iodine values were less in lactating women (85 mcg/l) according to WHO cut off points (100 mcg/l), whereas pregnant women and control group were observed to be just on the marginal values. Nearly 34% to 42% pregnant and lactating women suffered from mild to moderate iodine deficiency disorders, whereas among control group it was 34.6%. Severe iodine deficiency disorders were higher in lactating women (14.2%) compared to control group (7.3%). Iodine deficiency disorder (UIE Level) showed increasing trend with decline of income and educational status. Iodine content of 719 salt samples was estimated using standard iodometric titration method. A high proportion of women (80.8%) consumed salt having inadequate iodine content, i.e. less than 15 PPM. Consumption of salt deficient in iodine content was higher in low income group (38.9 to 44.9%) and among illiterate women (nearly 80%). Sickness at the time of survey was highest in lactating women (9.2%) followed by pregnant women (6.5%). Main morbidities observed were aches (3.8%) and gastroenterological complaints (2.8%). Vitamin A deficiency based on Night Blindness was higher in pregnant women (8.8%). Analysis of dietary intake revealed that consumption of cereals and fats was low of pregnant and lactating women i.e. 76-84% and 80% of RDA, (ICMR norms). Consumption of pulses and legumes was very low (47 to 65% of RDA), and consumption of leafy vegetables was also low, i.e. 12 and 7% of RDA of pregnant and lactating women; but the consumption of milk and milk foods was found to be adequate. The average intake of nutrients showed high deficiency of protein and calories in pregnant and lactating women, along with high deficiency of Iron and Folic acid and Vitamin A. These results helped in developing the database for micronutrient deficiency disorders, nutritional deficiencies, and morbidity in pregnant and lactating women in desert areas. Nutritional intervention packages for this region can be developed by introducing the adequacy, i.e. bioavailability of iron and vitamin A, etc. in usual diets, which can be improved by altering meal patterns to favour promotive practices. Iron and Vitamin A supplementation are the most 89
common strategies to control these deficiencies in developing countries for the time being, until either significant improvements are made in the diets of entire populations or food fortification is achieved.
Toteja, G.S. and Padam Singh. (2004). Micronutrient profile of Indian population. Medical Research. 641 p.
New Delhi : Indian Council of
Key Words : 1.NUTRITION 2.MICRONUTRIENT DEFICIENCY 3.NUTRITIONAL STATUS 4.ADOLESCENT GIRL 5.NUTRITIONAL STATUS ADOLESCENT GIRL 6.ANAEMIA 7.VITAMIN A DEFICIENCY. 8.GOITRE
Abstract : The study prepared a micronutrient profile of the Indian population based on published and unpublished data on the dietary intake of micronutrients. The study investigated implications for public health programmes. Target groups were children, adolescent girls and pregnant and lactating women. The study revealed that maximum research studies 256 were found on iron, followed by Vitamin A (219), and the least number of studies (15) were on folic acid. The prevalence of anaemia was highest in the eastern region (70.83%), and lowest in the southern region (65.06%). Overall prevalence of anaemia in infants (6-11 months) was 71.7%. Based on published data (1950-2002), the prevalence of anaemia among children less than 6 years was 75% in both northern and eastern regions, 62.0% in western and 60.0% in southern region. According to NFHS-II data, anaemia among adolescent girls was about 52%. It was observed that iron intake as compared to RDA was much lower for children, adolescent girls and pregnant women. Kerala and Tamil Nadu showed low prevalence of Vitamin A deficiency, while Bihar and Uttar Pradesh showed high prevalence of Vitamin A deficiency. No case of Bitots spots was observed in Gujarat and Orissa, and the highest (3.0%) and lowest (0.1%) prevalence was found in Maharashtra and Kerala. Overall prevalence of goitre was found to be 21%. Based on NNMB and INP studies, mapping of Indian states by average intake of Vitamin C vis--vis RDA has been prepared. The intake of Vitamin C is adequate in most parts of country. More than 50% children and pregnant women were found to be deficient with respect to folic acid. Children under 2 years, who have relatively higher prevalence of anaemia, need to be targeted through appropriate interventions. There is need for a uniform common standardized methodology to eradicate Vitamin A deficiency. Consumers awareness about the use of iodized salt is also required to further reduce iodine deficiency disorders (IDD).
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Anima Rani and Sharma, Naresh Kumar. (2008). An Empirical study of the mid day meal programme in Khurda, Orissa. Hyderabad : Hyderabad Univ. Dept. of Economics. 10 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL 3.COOKED MEALS 4.READY TO EAT MEALS 5.SCHOOL LUNCH 6.ORISSA.
Abstract : This study aimed to investigate some aspects of the mid day meal (MDM) scheme in Khurda district of Orissa. Secondary data was obtained from district and state level authorities including reports of the Department of Women and Child Development, Government of Orissa. 150 students and their households from 10 schools were selected for the study. Apart from these, information was collected from non-governmental organizations (NGOs) and Government officials. It was reported that MDM was completely implemented as a cooked meal scheme in all the tribal districts and underdeveloped areas like Koraput, Bolangir, Nawarangpur, Sonepur, Malkangiri, Nuapada, Rayagada and Kalahandi. The other districts covered by MDM scheme were Mayurbanj, Sundargarh and Keonjhar. All the 10 block of Khurda district were distributing dry rations from 2001. The distribution rate was 3 kg of rice per child per month. The eligibility criteria for a student to obtain ration in a month was that the student should have 80% attendance in the previous month. The Government of India provides rice free of cost, while the State Government provides the funds to meet the other expenditure like cost of dal (15 gms : 35 paisa), vegetable, salt and condiments (10 paisa), oil (30 paisa) and transportation (10 paisa). Total expenditure was 85 paisa per child per day. For fuel and stationary, Rs.1.30 per child per month was spent. It was found that poor infrastructural facilities created disturbance in the smooth functioning of the cooked meal scheme. This was the main reason for shifting over to the dry rations scheme in 2001. The main reasons were no separate space for cooking; no separate place for serving meals; no storage facilities for grains; no proper storage facilities for drinking water; uncertainty about quality of rice; irregular inspection by Government officials; and disruption in the teaching process. It was found that the rate of growth of school enrolment during the cooked meal scheme (1995-96 to 2001) was 3.8% per annum, which was much higher compared to the rate of growth of enrolment of 1.5% per annum, when dry ration scheme was in operation (2000-01 to 2003-04). There was a large increase in the enrolment among boy students (17%) in contrast to the girl students (11%) in the second period over the first period. It was 91
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observed that when the cooked meal scheme was in operation, there was a marginal decline in the gender gap (from 14% to 13% in terms of the girl enrolment as a proportion of boy enrolment); this gap however widened to 16% after the switch was made to dry rations. During the household survey, it was reported by 150 households that enrolment had certainly increased when cooked meals were served. Parents were happy that their children got nutritious meals. 5 schools reported an increase in attendance, four schools reported that there was constant attendance, and in 1 school attendance was reduced. 5 schools reported decrease in the number of dropouts after the introduction of the cooked meal scheme, and four schools talked about consistency in the dropout rate. After dry rations were introduced, four schools reported an decrease in dropouts, and six schools said that dropout rates have remained constant. All schools reported an increase in nutritional status of the children after the introduction of cooked meal in their diet. 8 schools reported that the change in nutritional status of children was positive in the case of dry ration, and two schools reported consistency in the nutritional status. 102 housewives and 11 working mothers welcomed the cooked meal scheme. Only 10 working mothers and 11 housewives supported dry ration scheme. Further, 145 households feel that children had been motivated to go to school due to the cooked meal scheme. In contrast, only 19 households found that dry scheme had a motivating effect on students. 132 households (88%) felt that the cooked meal scheme should be restarted, and only 18 households (12%) were against this view. On the other hand only 30 (20%) households hold the view that dry ration should continue to be distributed. It was suggested that inadequacy of staff should be rectified. The menu of the food should be changed from time to time to break the monotony. Bhalani, K. D. et al. (2002). Nutritional status and gender differences in the children of less than 5 years of age attending ICDS anganwadis in Vadodara city. Indian Journal of Community Medicine, XXVII(3).
Key Words : 1.NUTRITION 2.PRESCHOOL CHILDREN 3.NUTRITIONAL STATUS 4.GENDER DIFFERENES 5.ICDS
Abstract : This cross sectional study was undertaken in Vadodara city between July 1, 1998 and August 31, 1998 with the following objectives: to measure the prevalence of malnutrition with the gender difference and age trend in the children of less than 5 years age, to compare the level of malnutrition in the children in the years of 1996 to 1998 and to study the pattern of change in the nutrition status of the children from the year 1996 to 1998. 3157 children aged less than 5 years
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attending ICDS anganwadis of Vadodara city participated in the study. It was revealed that from the total of 3157 children, 62.9% were found malnourished. The prevalence of moderate to severe malnutrition among girls was 28.4% as against 16.9% in boys. Nutritional status of the children started worsening in the 2nd year of their life. More than 60% infants were found to be normal as against 37.6% children in the age group 1 to 2 years. It was concluded that ICDS programme failed to bring the expected results in the slum children of Vadodra city. Blue, Julia. (2005). The Government primary school mid day meals scheme : an assessment of programme implementation and impact in Udaipur district. Udaipur : Seva Mandir. 101 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL 3.MID DAY MEAL SCHEME 4.SCHOOL LUNCH PROGRAMME 5.NOON MEAL PROGRAMME 6.IMPACT ON ENROLMENT 7.IMPACT OF MID DAY MEAL ON ENROLMENT 8.RAJASTHAN.
Abstract : In 2002, Government schools in Rajasthan began providing daily cooked meals to primary class students under the national Mid-Day Meal Scheme, which aims to increase enrolment, attendance, and retention while simultaneously impacting on the nutritional status of students of primary classes. This study explores the implementation and results of the Mid-Day Meals Scheme (MDMS) in primary schools of rural Udaipur district, especially those serving tribal communities in subsistence farming villages. The study focused on the experiences of eight primary schools in Kotra, Kherwara, and Badgaon blocks. Field visits were made in Mandwal village, Pareda, Magra and Sagware, Barwaliya (main village, Barwaliya, Bhil Basti) and Chali and Undithal. One of the schools was Seva Mandirs NFE centre in Bhil Basti, a predominantly tribal hamlet located about 3 km. from Barwaliya Government Primary School. Primary class enrolment ranged from 35 in Barwaliya (main village) to 150 in Mandwal, and approximate average daily attendance ranged from 28 to 100. Further, 11 teachers in meal programme schools, 7 cooks, 3 NFE instructors, 63 parents or relatives of primary school children, and 67 primary school children were interviewed. It was observed that the meals were always shared among all the primary class children present; each child who wanted food was given a portion. The portions were approximately 100 grams per child, which was the amount specified under the scheme. Out of 67 children interviewed, 52 said that school meals filled them, while 10 said they still remained hungry. 62 of the 63 parents interviewed claimed that school meals had no effect at all on how many of their children they
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enrolled in school, how many years the children would study, how often they sent their children to school, etc. Findings indicate that the Mid-Day Meals Scheme has had some impact on enrolment and attendance, but this effect has been uneven across age groups and communities. School meals have boosted enrolment and attendance of the youngest primary school children, but their ability to affect attendance and retention of older students is questionable. Since school meals were usually less nutritious than roti sabzi (bread, vegetable) most respondents ate at home, which was a cause for concern. Future improvements to the quality of school meals will ameliorate many of the Mid-Day Meal Schemes problems and enhance its beneficial effects on both nutritional status and school attendance. CUTS, Centre for Consumer Action, Research and Training, Jaipur. (2007). Measuring effectiveness of Mid Day Meal Scheme in Rajasthan : participatory expenditure tracking survey : final report. Jaipur : CUTSCART. ~40 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL SCHEME 3.EVALUATION MID DAY MEAL SCHEME 4.MID DAY MEALS 5.SCHOOL LUNCH PROGRAMME 6.SCHOOL EDUCATION 7.RAJASTHAN.
Abstract : Food insecurity, and the threat it poses to the health and development of children, is of critical concern to governments in developing countries. The study was done to develop and test a participatory process to track the expenditure and quality of implementation of the Mid Day Meal (MDM) scheme, thereby enhancing the accountability of service providers towards citizens. A total of 211 schools in all blocks of Chittorgarh district were covered. Schools were chosen on parameters like size, access, backwardness of the location, etc. In all 422 teachers, 2,210 students, 2,210 parents and 211 cooks were interviewed to know about their perception on the different aspects of the Mid Day Meal (MDM) Scheme. It was found that all government and government-aided primary schools had the provision of MDM on each working day. Under MDM scheme, each student of Class I to V was to be served a cooked meal that comprised 300 calorie and 8-12 grams of protein, on each working day of school. It was revealed that 89 to 95% different stakeholders (parents, teachers, students and cooks) accepted that children consumed MDM at school. Around 27% parents and 11% students reported that MDM was insufficient and not as per the requirements of a growing child. About 88% students responded that they had proper arrangements of drinking water in schools. It was found that enrollment and retention had increased in about 64% of the schools over the last 3 years due to MDM. Girls enrollment reportedly increased in only 58% schools. Only
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23% parents felt that the quality of education was good, 58% termed it satisfactory. But in the survey it was found that only 53% of the students could read and 48% could write well. On analysis it was revealed that 68% of the teachers spent more than 1 hour in managing MDM and this could reflect on overall teaching quality. Around 61% schools had toilets, but these were being used in only 21% schools because of lack of water facility. 92% children did not washed hands with ash/ soap before eating (not provided in schools) and 95% did not clip their nails. Most schools lacked appropriate cooking and storage space/ facilities. About 95% schools did not have a kitchen shed, and 62% of the cooks interviewed mentioned that MDM was cooked in an open space. Only 36% of the schools had separate storeroom for MDM supplies. Only 21% of the schools received funds every month, while the rest got it in 3 months, 6 months and once in 2 months. It was found that 69% of the selected schools received food grains on the stipulated time. On analysis it emerged that only 23% of the schools received food grains after getting it weighed. The study showed that wheat and rice of above fair average quality was received in 97% cases. The quality of MDM prepared was good and it was found that 75% of the cooks were being monitored and checked for the quality of food prepared by them. Though Mid Day Meal scheme would prove to be a milestone towards achieving the goal of universal education for all as targeted, but looking at the slow process in this direction, more concentrated efforts are needed with private-public participation in the process. Local Governments are constitutionally responsible for education and related activities. Ways should be found to make local governments enthusiastic and to take on these responsibilities and be accountable to its citizens. De, Anuradha, Noronha, Claire and Samson, Meera. (2005). Towards more benefits from Delhi's mid day meal scheme. New Delhi : Collaborative Research and Dissemination. 23 p.
Key Words : 1.NUTRITION 2.MID DAY MEALS DELHI 3.MID DAY MEALS 4.SCHOOL LUNCH PROGRAMME.
Abstract : The Mid Day Meal scheme is a welfare scheme to improve the nutritional status of school children and improve enrolment. The present research assessed the current functioning of cooked mid day meal scheme in Delhi. Kitchens were visited, 12 schools were surveyed, and teachers and suppliers employees were interviewed. The investigators spent 2.5 to 3 hours in each school. It was found that the meal arrived between 8.30 and 9.30 a.m. in morning schools, and between 1.30 and 2.30 p.m. in evening schools. The food was cooked in Centralised kitchen by separate
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organizations each serving a large number of schools. Usually it came in enormous aluminium containers in a Maruti van or truck, and was kept outside the Principals office until it was time for distribution. There were no complaints of food getting spoilt because of time lags at any point between the cooking and the eating of the meal, although this could happen due to the heat in Delhi. Preparation of food began 4-5 hours before it reached the schools, where it often remained for 30 minutes to 1 hour before it was served. Serving the meal was a smooth procedure. The distributor sent his own people (1-3 persons) to serve the meal. Children in Class 5 sometimes helped the distributor with moving the container to just outside the classes and in some cases with handing out the pooris or parathas. The entire process of serving and eating was generally done within half an hour. However, the actual teaching time disrupted in each school varied with the general level of school functioning. The process of serving began 15-30 minutes before recess; the more functional schools began classes when the time for recess was over; the less functional ones allowed recess to continue well beyond the allotted time. The quality and quantity of the meal served was good, and the menu had the approval of the children. They enjoyed their meal, and the favourite items were, dal chawal (lentils rice), chole chawal (chick peas rice), and pooris (fried bread). In a few schools the teachers mentioned that there had been worms and other pests in the food in the past. Lack of hygiene was a major problem found. Although some of the distributors wore disposable gloves while serving the food, little emphasis seemed to be placed on their general cleanliness or training. No one insisted that children wash their hands before meals, and only the rare child did so. Inadequate infrastructure and poor usage of existing facilities aggravated the problem of poor hygiene. Parents were not impressed with the mid day meal as an incentive for regular attendance. It was recommended that the government should prepare a simple list of dos and donts for suppliers, teachers, and children, which if shared with parents, could ensure better implementation of the mid day meal scheme. Deodhar, Satish et al. (2007). Mid day meal scheme : understanding critical issues with reference to Ahmedabad city. Ahmedabad : Indian Institute of Management Ahmedabad. 38 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL SCHEME 3.SCHOOL LUNCH PROGRAMME 4.GUJARAT.
Abstract : The concept of nutritional support to education is not new in India and it dates back to 1925 when Madras Corporation developed a school lunch programme.
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The broad objective of this study was to identify some of the critical issues associated with MDM scheme and to evaluate the efficiency in delivery system and service quality. The study was carried out using a three fold approach: (a) field visits were organized to 3 schools located in Gomtipur, Sabarmati and Ellisbridge, Ahmedabad, and the kitchen of an NGO food service provider, Stri Shakti, was visited; (b) working of the MDM at the macro and micro level was documented; and (c) laboratory testing of food items prepared and raw materials was done in terms of nutrition and safety, and compared with the prescribed minimum requirements. The study found that in 2005-06, a total of 31,152 schools (86% of the total primary schools in Gujarat) with 3.8 million beneficiaries (47% of the students enrolled) were covered under this scheme. Ahmedabad Municipal Corporation (AMC) covers 563 schools under 61 Mid Day Meal centres. It caters to 1.3 million beneficiaries which is about one-third of the total number of beneficiaries in Gujarat. The expenditure for MDM scheme per child per day (PCPD) is around Rs. 2.40 for Standards 1-5, and Rs. 3.40 for Standards 6-7. For Standards 1-5 food grains are provided by states/ local bodies by utilizing their own funds along with those available under various centrally sponsored schemes. The budget outlay has increased from Rs. 9,000 lakhs in 1999-2000 to Rs. 18,400 lakhs in 2004-2005. Each kitchen centre had a supervisor, two cooks and helpers and staff as per the strength of children. In the kitchen of Stri Shakti, rice, dal, puri, channa, khichdi and dal baingan was served. Kitchen staff wore clean uniforms and caps. The overall process of cleaning the grains, sorting and roasting was being done quite hygienically. Materials supplied by State Government were of reasonable quality. All the cooking utensils looked clean and were made of stainless steel. It was observed that 10% children left school after the meal. It was observed that despite paid employees hired under the scheme, teachers had to spend time to serve food to the students. Often recess time was not enough for the teachers to serve food and have their own lunch as well. The food quality evaluation tests were carried out at St. Xaviers Laboratory on the prepared meal samples collected from the schools and the NGO Stri Shakti. Samples of khichdi, sabzi and cooked rice were low in quantities of protein and iodine. However, the provision of calcium seems to be quite generous. The provision of fat and iron was close to the proportional requirements of the expected 300 calorie diet. Except for wheat in Sabarmati school and tuar dal in Stri Shakti kitchen, all other samples had levels of uric acid much higher than the stipulated rules of PFA. This only points to the possibility of the presence of rodents in storage areas, either in schools or at the warehouses of Food Corporation of India (FCI). Presence of aflatoxins is a serious concern. On the basis of the above findings it was suggested that the implementation of MDM scheme may be wanting on the grounds of nutrition and food safety. The weekly menu shows a 97
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variety of meals offered, however, the condiments and seasonings being very similar each day, the sensory variety may be lacking. In terms of calorific and nutritive intake, proportionate amounts of protein and iodine are not being provided through the meals. The HACCP system (Hazard Analysis and Critical Control Points) should be incorporated for ensuring safety in food delivery. Giri Institute of Development Studies, Lucknow. (2000). National Programme of Nutritional Support to Primary Education : Mid-Day Meals : comparative lessons of experience in Uttar Pradesh and Himachal Pradesh. Lucknow : GIDS. 184 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL 3.PRIMARY EDUCATION 4.NUTRITION SUPPORT TO PRIMARY EDUCATION 5.SCHOOL LUNCH 6.GIRLS EDUCATION 7.GIRLS ENROLMENT 8.UTTAR PRADESH 9.HIMACHAL PRADESH.
Abstract : The National Programme of Nutritional Support to Primary Education (Mid-Day Meals Scheme) is intend to give a boost to universalisation of primary education by increasing enrollment, retention and attendance, and simultaneously aims at improving the nutritional level of students. The study focused on the impact of Mid-Day Meals Scheme (MMS) on enrolment growth, retention at primary level, school attendance, profile and perception of beneficiaries in primary schools of Uttar Pradesh in comparison with Himachal Pradesh, by comparing the pre Mid-Day Meal Scheme period (pre-MMS 1989-90 to 1993-94) and post Mid-Day Meal Scheme period (post-MMS 1994-95 to1998-99). Data was collected by interviewing parents and children of the selected primary schools as well as through secondary sources. The average annual growth rate of enrollment of boys, girls and total students in Uttar Pradesh was found to be 2.73%, 3.61% and 3.03% which was high compared to pre- and post MMS level. In Himachal Pradesh, the annual growth rates of enrollment of boys, girls and total students were calculated to be 3.65%, 3.65% and 3.53% during the scheme year, which was not significant. The enrolment growth in Uttar Pradesh was relatively slower than Himachal Pradesh. The retention rates in Uttar Pradesh during MMS increased by 77% for boys, 66% for girls and 75% of total students, which was quite significant compared to pre- and post MMS levels. Retention rates in Himachal Pradesh increased by 1.40% for boys, 4.90% for girls and 3.08% for total students during the scheme period over the base of non-scheme period. Retention rates were found to be high in Himachal Pradesh compared to Uttar Pradesh. The attendance rates in Uttar Pradesh of boys, girls and total students in Classes I-V was 77.43%, 75.64% and 76.86% in 1994-95, which increased to 79.78%, 78.06% and 79.19% in 1998-99, when MMS was implemented.
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In Himachal Pradesh, the attendance rate increased to 92.9% in 1998-99. The attendance rates in Uttar Pradesh were lower than of Himachal Pradesh. Most beneficiaries who availed the benefits of MMS were from poor socio-economic background in Uttar Pradesh, and 50% of the total beneficiaries belonged to upper castes in Himachal Pradesh. Proportion of total school-aged children not going to school was much higher (nearly 17%) in Uttar Pradesh as compared to only 5% in Himachal Pradesh. The educational level of beneficiary parents was low in Uttar Pradesh compared to Himachal Pradesh. As far as quality of education was concerned, 41% parents in Uttar Pradesh and 32% parents in Himachal Pradesh were satisfied with the increasing enrolment, retention level and attendance of students at primary level. It was suggested that the delivery system of the scheme and its management should be restructured, and awareness generated about the need and importance of basic education among the community.
NIPCCD, Regional Centre Indore, Indore. (2007). Mid day meal scheme in Madhya Pradesh : a study. Indore : NIPCCD-RCI. 215 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL SCHEME 3.EVALUATION MID DAY MEAL SCHEME 4.SCHOOL LUNCH PROGRAMME 5.NOON MEAL SCHEME 6.SCHOOL ENROLMENT 7.MADHYA PRADESH.
Abstract : The MidDay Meal scheme (MDM) was started to improve the nutritional status and school enrolment of children. This study assessed the performance of the scheme and its impact in Madhya Pradesh. A total of 120 schools were selected from 30 blocks in 15 districts spread over seven divisions of Madhya Pradesh. The sample constituted 2300 children, 240 members of Parent-Teacher Association (PTA), 233 school teachers, 60 PRI members, 600 parents and 107 office bearers of Mid- Day Meal implementing agencies like self help groups, Parent Teacher Association, and Non Governmental Organizations (NGOs). The state has developed guidelines for conversion of grains to hot cooked meals, delineated the activities, and also suggested the unit cost. The provision of hot cooked meal for primary school children started in the year 2004. Presently the scheme covers 94,905 primary schools including government/ government aided primary schools, EGS, AIE, Madrasas and Ashram Shalas. The three viable models suggested for implementation of the scheme are school run kitchens managed by Parent Teacher Association, Government and NGO Partnered Central Kitchen; and Government and Women self help groups partnered initiatives. Voluntary organizations in the state have emerged
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as viable institutions to serve as a catalyst for social activities. Naandi Foundation is identified as a key NGO for implementing MDM scheme through centralized kitchen in the city of Indore, Bhopal and Jabalpur, which presently covers 791 schools in the state. The scheme has opened up a channel and created employment opportunities for needy women through Self Help Groups (SHG). SHG members deliver services in the form of cooking, serving, cleaning wheat and pounding masalas (condiments) and receive wages for their services. The state has created assets by constructing 20,869 kitchen sheds in the school premises, and nearly 46% of the sampled schools have created such assets. Only 16% kitchens were well lit and ventilated. The approved monthly requirement of food grain is supplied periodically to schools through transportation arranged by the District Collector in coordination with State Civil Supplies Department. During the rainy season, especially in tribal areas, transportation of food grains was quoted as one of the major hindrances. The stakeholders participation in the programme was minimal, as by and large, the programme was perceived to be a government programme. There were hardly any community innovations for quality optimization worth documenting. Traditional chulha was widely used as a cooking device in majority of the schools (72.5%) especially in tribal and rural areas. The drinking water facility was available in 67% of the schools surveyed. Dry type of toilet was found in 60% of the sampled schools, which is a cause for concern. Mostly the assistance for mid day meal infrastructure was drawn either from central assistance or through other schemes like SGRY, PMGSY, SSA. The scheme was operational all through the year (200 days) in 89% of the schools surveyed. This information was derived from the operational school days in a year. The quantity of meal, as perceived by all respondents, was found to be adequate. It was found that all children enrolled were utilizing the services of mid day meal. The enrollment of children had increased (18%) consequent to the provision of cooked meals in school. School attendance (11%) also increased in almost all districts after initiation of the scheme. The nutritional profile of children receiving mid day meal serves as a useful back drop for planning any intervention. The median height of boys was in the range of 115-137 cms and girls were 109-137 cms. The median weight of boys was in the range of 18-28 kg and the weight of girls was in the range of 15-27 kg. The overall prevalence of under weight (<median-2SD) was about 58%, of whom 17% were severely underweight (<median-3SD), and 41% were moderately under weight (median-3SD to median-2SD). About 42% of the children were stunted. The present study recommended extension of mid day meal to higher age groups, as prevalence of under nutrition was found to be high among older children, which is a hindrance to their over all development, specifically affecting their learning abilities. Further, this would also minimize dropout cases among children attending upper primary classes. The quantity of cereals and pulses 100
Mid Day Meals/ ICDS
should be enhanced to match one-third requirement of the child per day to bridge the calorie and protein gap. Sharma, Sushma et al. (2006). Evaluation of mid day meal programme in MCD schools. New Delhi : Nutrition Foundation of India. ~60 p.
Key Words : 1.NUTRITION 2.MID DAY MEAL SCHEME 3.READY TO EAT FOOD 4.QUALITY OF FOOD 5.HOT COOKED FOOD 6.SCHOOL LUNCH PROGRAMME 7.DELHI.
Abstract : Mid Day Meal programme (MDMP) is the popular name for the school meal programme in India. A nutritious meal is provided to the children of primary and nursery schools. In Delhi, the MDMP is run by three agencies namely Municipal Corporation of Delhi (MCD), New Delhi Municipal Corporation (NDMC) and Delhi Government. There are more than 1800 schools and 0.9 million students are enrolled. The study was carried out by trained field investigators in 410 schools and covered 72 Food Service Providers (FSPs). Storage area was assessed for pest control measures and washing area for the availability/ use of hot water and soap. The service units spread over 12 zones of Delhi, were mostly located in interior areas and were not easily accessible. Some of the FSPs had the cooking units in highly unhygienic environments with open drains in front of the service units or garbage dumps in close proximity. In most cases, the cooking area was partially covered and had natural light/ ventilation. In case of service units operating in courtyards, there were greater chances of the food getting exposed to dust and insects; and considering the fact that cooking for the morning shift started before daybreak, artificial lighting was inadequate. All the service units visited used LPG gas as the cooking fuel, and big burners were used to cook food in large vessels. Keeping two gas cylinders in close proximity to each other/ hot oven could be risky. Water supply was mainly from the Delhi Jal Board. Continuous water supply throughout the day was not available in most areas. Personal hygiene of the cooks/ food handlers was not up to the mark. In service units visited in the initial rounds, food handlers did not wear aprons/ headgear or cooking gloves. However, due to repeated instructions in the service units visited later on, most of the food handlers did wear aprons, headgear and in some cases even gloves. Towards the end of the academic session, out of the 18 menus initially planned by MCD, only 8 were finalized for use under the MDMP on the basis of preferences of children and keeping the quality of food in view, in order to minimize the chances of contamination. A total of 72 units in Round I and 51 service units in Round II were visited and evaluated. It was observed that there was not much change in the two rounds of evaluation. More than 30% of the
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service units were graded as poor in both the rounds. In 70% cases there was no change in overall grading of service units, 59% maintained their grading as fair and 11% as poor. However, in 28% cases there was deterioration, while only 2% service units registered improvement. For receiving the MDM most of the children brought their own tiffin boxes/ steel plates. Majority of the children took their utensils home for washing. Over 80-85% of the children did not wash their hands before eating their meals, even though they ate with their hands during the first year of evaluation, but during the second year it was observed that only 35% of the children did not wash their hands before eating. Quantity of meal served per child per day was found to be mostly between 150-200 grams. It was found that children relished Rice Sambar, Puri Aloo /soyabean and they did not relished Vegetable Dalia, Sweet Dalia and Moong Dalia. In most schools the time taken for distribution of the meals was about 15-30 minutes. However, in 15.6% cases the distribution took more than 45 minutes. Children were served either in the school corridor (48.5%) or in the courtyard (40.5%). When MDM was not supplied in some schools they distributed RTE food/ fruits in 1.7% cases and in 5.1% cases children were asked to bring lunch. Food handling and distribution at schools was done by personnel employed by the FSPs (70.5% cases). With regard to preference for cooked meals or ready to eat food items, 73.0% of the children preferred cooked meals, 24.9% preferred ready to eat food, and 2.1% liked both cooked and RTE food. It was recommended that MCD must continue to put MDM programme on the top of their agenda. Stakeholders collaboration is essential. A simple monitoring and evaluation system is required. Educability must go hard in hand with education. Field experience and capacity building from top to bottom is important.
Voluntary Action Network India Uttar Pradesh, Lucknow. (2006). Mid day meal scheme in primary schools of Uttar Pradesh : Lucknow : UPVAN. 12 p.
summary.
Key Words : 1.NUTRITION 2.MID DAY MEAL SCHEME 3.SUPPLEMENTARY NUTRITION 4.NUTRITION SUPPORT TO PRIMARY EDUCATION. 5.UTTAR PRADESH.
Abstract : News of the unsystematic operation of the Mid-Day Meal (MDM) scheme appearing in media resulting in the illness of school children led UPVAN (Uttar Pradesh Voluntary Action Network) to undertake a review of this scheme. A study was conducted to assess the actual implementation of the scheme; its impact on enrollment and retention, health improvement of the children; and ushering in the feelings of social values and equality. The study covered 8 districts, 16 blocks, 80
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Mid Day Meals/ ICDS
village panchayats and 80 primary schools. Gram Pradhans, members of gram panchayats, school teachers, guardians and villagers were interviewed and focus group discussions were held. Schools were visited and actual operation of the scheme was observed. Field work for the study was conducted with the assistance of grass root voluntary organizations. Findings revealed that MDM scheme appears to be moving in the opposite direction. The scheme was not heading towards achieving the desired goals due to the following reasons: i) Kitchens had not been constructed on the norms laid down under the scheme. Consequently, the cooks had to prepare food in unhygienic surroundings. In a majority of schools there were no boundary walls, which resulted in exposure of the food prepared to sun, air, dirt, etc. ii) Fuel arrangements were quite inadequate. iii) Requisite utensils were not provided in the kitchens. iv) Arrangements for drinking water and cleanliness of children were inadequate. v) The food prepared was not of good quality, and was not served properly. vi) Officers of the Education Department hardly visited schools to monitor operation of the MDM scheme. The MDM scheme was not operated properly and hence a few suggestions were submitted. There is a need to coordinate the functioning of various departments with regard to MDM scheme. The main responsibility for implementation of the scheme should be entrusted to village panchayats and the Village Pradhan should be entrusted with the entire responsibility. The Village Committee for MDM should be constituted after making some modifications in the existing provisions. The Headmaster of the concerned primary school should be made Secretary of this Committee. The indenting of foodgrains should be made only on the actual number of students. Kitchen stores should be constructed well so that healthy surroundings prevail. The cook should be appointed as per the number of students. The media and CSOs working at the grass roots level should come together to show lacuna and bring success stories to the notice of the public for mobilizing it. Proper advocacy for MDM scheme may ensure proper implementation of this scheme.
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NATIONAL NUTRITION MONITORING BUREAU
National Ins of Nutrition, Hyderabad. (2000). Special report : nutritional status of adolescents, nutritional status of elderly, food and nutrient intakes of individuals. Hyderabad : NIN. 95 p.
Key Words : 1.NUTRITION 2.NNMB REPORT ADOLESCENT 3.FOOD INTAKE 4.FOOD AND NUTRIENT INTAKE 5.NUTRITIONAL STATUS ADOLESCENT 6.NUTRITION AGED.
Abstract : The survey was undertaken to assess the diet and nutritional status of 12,124 adolescents from 2579 households (HHs) in 120 villages in 9 states. The number of boys and girls were 1259 and 1320 respectively. The mean per capita income (PCI) per month was Rs. 250/- at 1996-97 prices, while the mean PCI in the lowest quartile was Rs. 77/- per month. About 23% of the adolescent girls (AGs) were married before 18 years of age. About 24.1% AGs were of short stature (<145cm) while 18.6 per cent were underweight (<38kg.), and about 19-24 per cent could be considered `at risk'. Adolescents of all ages were shorter and lighter than their American counterparts (NCHS). Adolescents were consuming inadequate amounts of micronutrients. More than 66 per cent were consuming < 70 per cent RDA for vitamin A and riboflavin. Because of higher RDA for boys, iron deficiency was higher among boys than girls. Adolescents studied during 1996-97 were taller (2.5-3.5 cm) and heavier (1-1.5kg.) than their counterparts in 1975-79, and severe energy deficiency declined from 21% to 9% in boys and from 14% to 5% in girls. Though there was improvement in nutrient intakes, the deficiency decline in the case of Iron and vitamin `A' was less than that of other nutrients. About twothirds of adolescents were consuming inadequate amounts of micronutrients. The proportion of adolescents below the 5th percentile of NHANES-BMI ranged from 44% in 17 years of age to 78% in 11 years among boys and from 16% in 17 years to 63% in 10 years among girls. The extent of thinness was much more among boys than girls.
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NUTRITION EDUCATION/ TRAINING NUTRITION
Kilaru, A. et al. (2005). Community-based nutrition education for improving infant growth in rural Karnataka. Indian Pediatrics, 42(5) : 425-32.
Key Words : 1.NUTRITION 2.NUTRITION EDUCATION 3.NUTRITION INTERVENTION 4.INFANT NUTRITION 5.MALNUTRITION 6.INFANT FEEDING 7.INFANT GROWTH 8.GROWTH INFANT 9.COMMUNITY EDUCATION.
Abstract : The objective of the study was to evaluate a nutrition education intervention designed to improve infant growth and feeding practices in rural Karnataka. Infants below six months were enrolled between 1997-1999 from 13 villages, 11 selected randomly and two selected purposively. Infants and recent births were identified by field workers through a combination of house visits, the snowball technique and by the Auxiliary Nurse Midwife (ANM). Respondent were mostly illiterate, and monthly questionnaires were used to document feeding practices, including a 24-hour recall of foods and fluids consumed, weight of the infants, morbidity experiences in the previous month, and height was measured every three months. Visits were made till the infant completed 2 years of age. Infants enrolled in the study in early 1997 that were already a year old and without nutrition education were considered the non-intervention (NI) group. Other infants who were not older than 5 months of age when the counselling began were considered to be the intervention group. Girl infants enrolled in the intervention had a weight velocity that was 77 gm per month greater than non-intervention girls between 6-10 months of age. Significant differences were observed in the feeding of bananas, with intervention infants being more likely to eat these (33%) compared to non-intervention infants (4%). Intervention infants were also significantly more likely to be fed at least four times in 24 hours in addition to breast milk. One of the most significant findings was the increase in weight velocity among the intervention girls compared to NI girls. Girls in the intervention group were more likely to have at least 4 positive feeding behaviours compared to NI girls. The study limitations include the non-randomized allocation of the intervention and non-intervention groups. Data was collected but was not so reliable due to difficulties involved in collecting such data in the field. It was recommended that women and their families should be counseled during antenatal visits. Addressing groups of families through the anganwadi could be a better way of reducing the cost of nutrition education interventions. Teaching families to increase feeding frequency, increase dietary 105
diversity, modify household food as well as raising awareness on existing food taboos for young children (e.g. bananas and eggs), could reduce the incidence of growth faltering and subsequent malnutrition.
Shantha Kumari K. and Puttaraj, Shashikala. (2004). Dietary characterstics of trained and untrained farm women under WYTEP. Indian Journal of Nutrition and Dietetics, 41(7) : 312-18.
Key Words : 1.NUTRITION 2.NUTRITION 4.MICRONUTRIENTS 5.DIETARY PATTERN 6.DIET. EDUCATION 3.FARM WOMEN
Abstract : This article examined the dietary characteristics of trained and untrained women under Women Youth Training Extension Project (WYTEP) in Karnataka. A sample of 250 farm women from 43 villages of 3 taluks of Bangalore were selected, among whom 100 had undergone training (FWT), 100 received nutrition education with training (FWNT), and 50 untrained women (FWUT) served as a control group. Interviews were conducted to gather data. Results revealed that more than 90% women were non-vegetarian by habit. It was observed that 41% and 59% farm families consumed two or three meals respectively, and 18.7% women prepared food thrice a day. None of the farm women ate between meals. 82% FWNT and 96% women of the control group were not in the habit of eating meals outside, while 42% FWT group had their meals outside. Majority of the households preferred to cook cereal food, which included roti, fried rice, idli and dosa. 83% FWNT used wheat weekly, whereas 73% of FWT and 84% FWUT used wheat once in a month. 90% FWNT consumed red gram daal as compared to 77% of FWT and 76% FWUT. More than 90% of FWT, 85% FWNT and 82% FWUT used field beans in their daily menu. Green leafy vegetables were used everyday by 50% FWNT, as compared to the other two groups, who used them weekly or monthly. Egg, meat and chicken were consumed by 45% of the families weekly, and meat by 78% weekly. 56% FWNT consumed tomatoes daily while none of the FWT consumed tomato on a daily basis. Onion, milk and milk products were used everyday. Therefore, results proved that inclusion of 'training in nutrition' in the project resulted in better food choices, as the food consumed was rich in micronutrients, especially among FWNT group.
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Tikku, Nirmal. (2004). Profile and training status of manpower of NGOs working in the area of nutrition and health. New Delhi: NIPCCD. 10 p.
Key Words : 1.NUTRITION 2.TRAINING NUTRITION AND HEALTH FUNCTIONARIES 3.FUNCTIONARIES NUTRITION AND HEALTH 4.TRAINING OF FUNCTIONARIES NUTRITION AND HEALTH 5.TRAINING OF NUTRITION AND HEALTH FUNCTIONARIES.
Abstract : NGOs working directly with the people can make tremendous contribution towards achieving the nutritional and health targets set by the Government. A number of training institutions run by central and state Governments, international agencies and other autonomous organizations are providing training to NGO personnel. A list of NGOs working in Delhi, Haryana and Rajasthan was drawn up. There were 429 NGOs of which 222 were in Delhi, while 52 and 155 were operating in Haryana and Rajasthan respectively. Information regarding the activities, staff, their qualifications, job responsibilities, programmes attended by them, and other related information was collected. The study revealed that 48% NGOs faced problems and constraints at various levels of implementation of the welfare-cumdevelopment programmes. Lack of funds (20%), non availability of trained man power (6%), lack of volunteers (5%), distance from the city, and non availability/ lack of literature/ reading material, publicity and advocacy material were some of the constraints faced. Two NGOs from Rajasthan mentioned purdah (veil) system as one of the problems. It was found that 21 (19%) staff members, 10 from Delhi, 4 from Haryana and 7 from Rajasthan, were either matriculates and/ or undergraduates. There were 33 graduates (30%), 27 (25%) post graduates, besides 13 (12%) persons holding a Ph.D. degree. Post graduates were mainly from sociology, psychology, hindi, history and chemistry backgrounds. Professionally qualified staff was also recruited by some selected NGOs like doctors, law graduates, I.T.I. trained personnel, MBAs and Diploma-holders, etc. As there is no systematic data regarding the training status of their staff, there is an urgent need to formulate a policy on training of manpower of NGOs. Central ministries/ state governments, medical colleges, home science colleges, schools of social work, state departments dealing with agriculture, training institutions, institutions involved in distance education, community based organizations (CBOs) and funding agencies should be involved in formulating the policy for training manpower of CBOs.
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Tikku, Nirmal. (2004). Training activities in the area of nutrition and health : an analysis. New Delhi: NIPCCD. 4 p.
Key Words : 1.NUTRITION 2.TRAINING INSTITUTIONS NUTRITION AND HEALTH 3.NUTRITION AND HEALTH 4.EVALUATION TRAINING INSTITUTIONS 5.TRAINING INSTITUTIONS EVALUATION 6.EVALUATION OF TRAINING NUTRITION AND HEALTH.
Abstract : There are a number of institutions, agencies and departments involved in the training of personnel of NGOs working in the area of nutrition and health. These include Ministry of Health and Family Welfare, Department of Food and Nutrition, national level institutes, and international and autonomous organizations. An analytical study was conducted on twelve institutions/departments, 8 in Delhi, 2 in Haryana and 2 in Rajasthan. The training/ education imparted to personnel of NGOs was analyzed. The institutes/ departments selected were NIPCCD (New Delhi), NIHFW (New Delhi), Food and Nutrition Board (DCWC), MHRD (New Delhi), IGNOU (New Delhi), ACORD (New Delhi), Family Planning Association of India (New Delhi), Parivar Seva Sanstha (New Delhi), PFI (Delhi), SNS Foundation (Haryana), Indian Institute of Health Management (IIHM) (Jaipur), Centre for Health Education Training and Nutritional Awareness, (Ahmedabad, Head quarters being in Gujarat, it has activities in Rajasthan as well). Majority of the institutions are conducting programmes related to health and nutrition which include maternal and child care, planned parenthood, sexuality and reproductive health, immunization, health check ups, besides addressing nutritional needs of vulnerable groups, women, children and adolescents, infant feeding and HIV/AIDS/STDs. A few organizations cover topics related to de-addiction (alcohol and drugs). The type of programmes conducted were training/ capacity building/ orientation seminars, workshops and refresher courses. Most of the agencies were active in research/ action research/ surveys, awareness generation and advocacy like organizing camps, exhibitions, meetings, bal melas (childrens fairs), rallies, and a few were engaged in consultation services/ developing training, educational and reference material, networking, documentation and social marketing. One of the lacunae in the process of training was that institutions do not carry out any follow up exercise on their programmes to assess and observe the impact of the training and there is no proper mechanism for obtaining feedback information regarding the training provided. There is an urgent need to formulate a policy on training of manpower of NGOs. Central Ministries/ State Governments, medical colleges, home science colleges, schools of social work, State departments dealing with agriculture, training institutions, institutions involved in distance education, community based organizations (CBOs) and funding 108
agencies should be involved in formulating the policy regarding training of personnel dealing with health and nutrition issues.
Tikku, Nirmal. (2002). Training of manpower of NGOs engaged in the delivery of services to improve nutritional and health status of women and children. Kota: Vardhaman Mahaveer Open University, Department of Management. 24 p.
Key Words : 1.NUTRITION 2.TRAINING INSTITUTIONS NUTRITION AND HEALTH 3,TRAINING OF FUNCTIONARIES 4.MANPOWER TRAINING 5.NUTRITION AND HEALTH.
Abstract : The present study was done to identify the programmes conducted by NGOs for women and children to improve their nutritional and health status, and to collect information on the profile of staff associated with programmes. Data was collected from 65 NGOs out of which 27 were in Delhi, 14 were in Haryana and 24 were in Rajasthan. Data collected regarding the year of starting/ establishment of the NGOs showed that 67% of the NGOs were established during 1976 1995, which showed that from the Fifth Five Year Plan onwards more NGOs were established. The selected NGOs covered other States as well like Bihar, Himachal Pradesh, Jammu and Kashmir, Karnataka, Maharashtra, Madhya Pradesh, Orissa, Punjab, Tamil Nadu, Uttar Pradesh and West Bengal. The target group covered by the NGOs of Delhi and Rajasthan were all the three types, i.e., urban, rural and tribal, whereas NGOs of Haryana were catering to rural and urban population only. The focal beneficiary group was women and children (74% and 75%) of all the NGOs, however information regarding other categories revealed that 12 NGOs were providing services to adolescents as well. Other activities undertaken by NGOs were awareness generation, advocacy, community mobilization, providing training, conducting research and surveys, etc. It was found that a number of programmes undertaken related to health check-ups (55%), followed by family planning, immunisation (46%) and supplementary nutrition (46%). Activities related to prevention of T.B. and HIV/AIDS were also carried out by 47% and 45% NGOs respectively. The sphere of activities of NGOs was mainly dependent on the annual budget they operated upon, and around 39% NGOs had annual budgets ranging between Rs.1 to 5 lakhs, whereas 10% NGOs operated on an annual budget of Rs.6 to 10 lakhs. Further it was found that 10% had an annual budget of less than Rs.1 lakh, while 25% had a budget of above Rs. 1 crore, and majority of them, that is 12 out of 16 were from Delhi. The study revealed that 48% NGOs faced problems and
109
constraints at various levels of implementation of the welfare-cum-development programmes due to lack of funds, non-availability of trained manpower, lack of volunteers, lack of co-ordination/ support from Government Departments, etc. Around 43% had a staff strength of 3-10 persons, whereas 23% had a strength of above 50 persons. Information regarding the educational qualifications showed that all the staff members employed in NGOs were graduates and above. Services of outside subject matter specialists and experts were also being requisitioned to implement programmes related to nutrition, health and allied fields. It was suggested that there is a need to enhance the knowledge and skills of personnel of NGOs; focused and need-based training is required; and there is an urgent need to formulate a policy for the training of manpower of NGOs.
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NUTRITION INTERVENTION
Allen, Lindsay H. and Gillespie, Stuart R. (2001). What works : a review of the efficacy and effectiveness of nutrition interventions. Geneva : United Nations, Administrative Committee on Coordination, Sub-Committee on Nutrition. 124 p.
Key Words : 1.NUTRITION 2.NUTRITION INTERVENTION 3.LOW BIRTH WEIGHT 4.ADOLESCENT NUTRITION 5.CHILD GROWTH 6.ADOLESCENT PREGNANCY 7.HIV/AIDS 8.CHILD NUTRITION 9.MICRONUTRIENT SUPPLEMENTATION 10.DEFICIENCY DISEASE.
Abstract : The study reviewed the impact of malnutrition in countries in Asia and the Pacific, namely Bangladesh, Cambodia, China, India, Pakistan, Sri Lanka and Vietnam. It focused on the five major nutrition problems: low birth weight, early childhood growth failure, anaemia, iodine deficiency disorders, and vitamin A deficiency. For each of these, the nature of the problem, its prevalence, distribution, consequences and causes were discussed. The study revealed that about 60% women in South Asia and 40% in South East Asia were underweight (< 45 kg). It estimated that 70% of the worlds stunted children lived in Asia. South Central Asia has the second highest prevalence of growth stunting in the world (44%), and the prevalence of growth stunting in South East Asia (33%) is also high. On the Indian sub-continent, the percentage of anaemic women was 88% and the prevalence of clinical vitamin A deficiency (VAD) is quite low. For the last years during which information was available on children in Asia, Vitamin A deficiency ranged from 0.5% in Sri Lanka to 4.5% in Bangladesh and other age groups were affected as well, especially pregnant and lactating women. Iodization rates were 70% in South East Asia and 7.6% in Western Pacific region. The estimated Total Goitre Rate (TGR) 172 million people, or 12% in South-East Asia, are affected by goitre and 41% are at risk of goitre. The study estimated that about 40% of worlds population (more than 2 billion individuals) suffer from anaemia. The groups with the highest prevalence of anemia are pregnant women and the elderly about 50%, infants and children of 1-2 years 48%, school children 40%, non-pregnant women 35%, adolescents 30-35%, and 25% preschool children. The study gave the following recommendations related to specific nutrition policy interventions namely, a balance between food availability and practical practices that can be adopted, target changes in feeding practices by adopting a systems approach to manage behavioural change; do not ignore the first days of life; expect the worst characteristics of the daily feeding pattern during, and immediately following illness; recognize the extent to which families can do more for themselves; and recognize that effective programmes must achieve a balance between centrally managed activities and local initiatives.
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NUTRITION REHABILITATION
Elizabeth, K. E. Sreeden, P. and Narayanan, S. Noel. (2002). Outcome of nutritional rehabilitation with and without zinc supplementation. Thiruvananthapuram : SAT Hospital and Medical College, Deptt. of Pediatrics. 16 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL SUPPLEMENTATION 4.MICRONUTRIENT DEFICIENCY. REHABILITATION 3.ZINC
Abstract : The study was undertaken for 6 months in 2000 by the Division of Cellular and Molecular Cardiology, Sree Chitra Tribunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum. The aim was to examine the extent of zinc deficiency among children with Protein Energy Malnutrition (PEM) and evaluate the outcome of zinc supplementation in weight and height gain in children aged 0-5 years. 60 children who attended the malnutrition follow up clinic of a tertiary referral center were taken for the sample and divided into groups, with and without zinc supplementation. T test was used to analyze the date. It was revealed that 68% children with PEM were above 1 year of age, and of these, 27 were boys. 93% children were consuming rice and 86% were consuming milk daily in their diet. It was also found that 18% had severe wasting. Data showed that there was a significant improvement in both the groups about serum zinc levels. In the zinc supplemented group, serum zinc level improved 2 times and reached on par, and in the unsupplemented group, it improved only 1 times. It was concluded that zinc supplementation might be beneficial in the rehabilitation package for children with PEM. Elizabeth, K. E. and Sathy, N. (1997). The role of developmental stimulation in nutritional rehabilitation. Thiruvananthapuram : SAT Hospital and Medical College, Deptt. of Pediatrics. 15 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL REHABILITATION 3.COMMUNITY REHABILITATION, 4.DEVELOPMENTAL STIMULATION 5.NUTRITIONAL SUPPLEMENTATION 6.PROTEIN ENERGY MALNUTRITION 7.COMMUNITY NUTRITION 8.MALNUTRITION 9.INTELLIGENCE QUOTIENT.
Abstract : The study was conducted to examine the role of developmental stimulation and nutritional supplementation in rehabilitation of malnourished children 112
Nutrition Rehabilitation
in 2 locations, namely, Nutrition Clinic of the Department of Pediatrics, SAT Hospital and Medical College, Thiruvanathapuram, and in a backward coastal area, Poonthura, Kerala. In the hospital area, 100 children aged 6-24 months, 50 with moderate and 50 with severe PEM from low socio-economic status, were taken for the sample. The control group consisted of well nourished children, 50 from high and 50 from low socio-economic status. The study was randomized into 2 groups to administer the two types of interventions, namely, Composite Stimulation Package (STIM) and Nutritional Management (NUT). In the community area, 332 children aged 6-24 months with varying grades of PEM were studied. In both locations, environmental parameters, and growth and development of children were assessed. After 2 years, the study groups were re-assessed in comparison with the control groups. In the hospital study, 78% children with PEM were above 1 year of age. Out of them, 6% had Kwashiorkar, 12% had Marasmic Kwashiorkar and 82% had Marasmus, and 52% had head circumference below the 5th centile. 96% children in STIM group came up to normal nutritional status with regard to weight and height as against 85% and 70% respectively in NUT group. IQ assessment showed that 96% in STIM group had normal IQ compared to 72% in NUT group. There were a total of 5 dropouts and 4 deaths in STIM and NUT groups, and 4 dropouts in the control group. In the community study, 73% children with PEM were above 1 year of age, and of them none had Kwashiorkor, 1% had Marasmic Kwashiorkar, and 99% had Marasmus. Regarding wasting, 62%, 26% and 12% respectively had mild, moderate and severe wasting, while 39% had head circumference below the 5th centile. IQ test showed that 94% in STIM group had normal IQ compared to 81% in NUT group. There were 19 (15%) dropouts in SIM group, 15 (13%) in NUT group and 11 (13%) in the control group. It was suggested that Resident Community Volunteers (RCVs) can be involved in growth monitoring of children below 3 years. Child Welfare Programmes like ICDS should involve mothers in discussions on developmental milestones to ensure the quality of survival and better psychosocial development of children. It was concluded that there is a need for stimulation along with nutritional supplementation to ensure overall optimal development in early years of life, for children belonging to deprived communities.
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NUTRITION SITUATION
Ramachandran, Prema. (2004). The Nutrition scene in India : time trends. NFI Bulletin, 25(2) : 1-5.
Key Words : 1.NUTRITION 2.NUTRITION SITUATION 3.NUTRITIONAL STATUS 4.UNDERNUTRITION 5.CHILD NUTRITION 6.NUTRITIONAL STATUS CHILDREN 7.NUTRITIONAL STATUS ADOLESCENTS.
Abstract : The study showed that there has been considerable progress in India in all sectors related to nutrition in the last five decades, even though there are still some areas of concern. The Green Revolution ensured increase in food production, and as a result India moved from chronic shortages to an era of self-sufficiency, surplus and export in most of the food items. 8% of Indians do not get two square meals a day, and under nutrition takes its toll even today. Along with the steps to achieve adequate production, initiatives were taken to reach foodstuffs of the right quality and quantity to the right places and persons at the right time, and at an affordable cost through Public Distribution System (PDS). The Food for Work Programme has addressed the needs of vulnerable out-of-work persons. The ICDS programme provides food supplementation to preschool children, pregnant and lactating women. The Mid-Day Meal Programme for improving the dietary intake of primary school children and reduction in the school drop out rates has been operationalised. National Programmes for tackling anaemia, iodine deficiency disorders and Vitamin A deficiency are being implemented. In spite of lacunae in quality and coverage, these programmes have resulted in substantial reduction in severe grades of under nutrition, especially among children. The 10th Five Year Plan (2002-2007) aimed at achieving substantial improvement in nutritional status within a short time. It was concluded that India could achieve the set goals of 10th Plan for reduction in under nutrition, fertility and mortality. It is possible if there is optimal use of available infrastructure and abundant human resources; there is convergence of services at the community level; at-risk population groups, households and individuals are screened and those with nutritional problems are identified; well targeted comprehensive interventions are implemented efficiently; and community based organizations and PRIs monitoring implementation ensure midcourse corrections. Vigorous efforts to protect and promote breastfeeding during the last three decades have resulted in universal breastfeeding in the
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Nutrition Situation
country. However, efforts to communicate the importance of exclusive breastfeeding in the first six months of life and timely introduction of adequate quantity of energy dense complementary food after six months have not been as successful. Data from NFHS-II (National Family Health Survey) shows that even though breastfeeding is nearly universal, a substantial proportion of infants get breast milk substitutes from three months of age. On the other hand, nearly twothird of infants do not receive semi-solid supplements even as late as nine months. This is a major non-economic factor responsible for under nutrition in early childhood, and should be corrected through intensive nutrition education aimed at bringing about changes in infant feeding and caring practices. National Nutrition Monitoring Bureaus (NNMB) data indicated that over this period there has been a substantial decline in severe grades of under nutrition in children. This might be due to better access to health care, thus reducing the adverse impact of infection on nutritional status, and better access to contraception and consequent decline in under nutrition associated with high parity. However, the decline in mild and moderate under nutrition has been relatively slow. Screening for detection of under nutrition and management through appropriate health and nutrition interventions has not yet been operationalised as a part of the ICDS programme. The proportion of families where preschool children receive inadequate intake while adults have adequate intake has nearly doubled. Data collected indicate that one of the major reasons for under nutrition in young children is faulty child feeding practices. Nutrition education to the family that young children have a very low stomach capacity and in order to ensure adequate dietary intake, it is important to feed them once every four hours or even more often, may go a long way in reducing the prevalence of under nutrition in young children. Data from NFHS-II showed the poorest in Kerala have under nutrition rates comparable to the richest in UP. Data from the NNMB repeat surveys showed that there has not been any substantial increase in the dietary intake of adolescents; though there has been some improvement in height, weight and Body Mass Index (BMI) between 1975-79 and 1995-97. Data from NNMB also showed that there has been some increase in obesity among adolescents, especially in the affluent groups both in urban and rural areas. However, the prevalence of micronutrient deficiencies continues to be high. Nutrition education programmes need to be undertaken on a large scale.
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NUTRITIONAL STATUS/ DIETARY PATTERN
Brahmam, G.N.V. et al. (2006). Diet and nutritional status of population and prevalence of hypertension among adults in rural areas. Hyderabad : National Institute of Nutrition. 143 p.
Key Words : 1.NUTRITION 2.NNMB REPORT 3.NUTRITIONAL STATUS 4.RURAL AREAS 5.DIET 6.FOOD INTAKE 7.MICRONUTRIENTS 8.DEFICIENCY DISEASES 9.MALNUTRITION.
Abstract : NNMB carried out surveys in the rural communities of nine states viz. Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, Maharashtra, Madhya Pradesh, Gujarat, Orissa and West Bengal. The villages covered by NSSO for its 54th Round of Consumers Expenditure surveys, formed the sample frame. The objectives were to assess the diet and nutritional status of individuals, prevalence of obesity, hypertension, diabetes among adults more than 20 years of age, and anaemia among adult men and non pregnant non lactating (NPNL) women more than 18 years of age in rural communities; assess the food and nutrient intake among different age/sex/physiological groups in the rural area; assess the nutritional status of individuals in terms of anthropometry and prevalence of clinical signs of nutritional deficiencies; and to assess the prevalence of morbidity during the previous fortnight. Data was collected through nutritional anthropometry, clinical examination for nutritional deficiencies, 24-hour recall method of diet survey to assess food and nutrient intakes, history of morbidity during the preceding 15 days, blood pressure measurement, and estimation of Haemoglobin level. About 51,705 individuals of different ages from 14,256 HHs in 713 villages were surveyed for anthropometry, clinical examination and prevalence of morbidity. Information on food and nutrient intake was collected from 30,244 individuals from 7,078 households. Results indicated that children under 5 years did not exhibit signs of kwashiorkar, while the prevalence of marasmus was about 0.1%. Among school age children, the common deficiency signs noted were conjunctival xerosis (2.3%), Bitots spots (1.9%), and angular stomatitis (2%). The proportion of preschool children underweight was about 55%, while that of severe underweight was 18%. 33% males and 36% females had chronic energy deficiency. 25% adult males and 24% females had hypertension. The proportion of under-weight among children under three years was comparable with that reported in NFHS-2 surveys for the country. The extent of stunting (< median 2SD) was about 52% while about 15% 116
preschool children were wasted (< median 2SD). The study revealed that the food and nutrient intake levels were relatively lower in Kerala compared to other states, but prevalence of under nutrition among young children was low and prevalence of obesity and hypertension was markedly high among adults. Therefore there is need to carry out in depth studies to assess the lifestyle practices and other associated factors contributing to these disorders. There is also an urgent need to sensitize the community regarding the causes and consequences of obesity, hypertension (HTN) and diabetes mellitus (DM), and to educate people about the need for adopting appropriate life styles and dietary habits.
Chiddarwar, Sonali S. (2000). Assessment of nutritional status of children below five years of age. Nagpur : Indira Gandhi Medical College, Department of Preventive and Social Medicine. ~150 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS PRESCHOOL CHILDREN 3.ANAEMIA PRESCHOOL CHILDREN 4.PRESCHOOL CHILDREN 5.UNDER FIVES 6.MALNUTRITION CHILDREN.
Abstract : The objectives of the present study were to study the various factors influencing the nutritional status of children below 5 years of age and to make suitable recommendations based on findings. Data was collected through household survey in Nagpur. 384 children in the age group of 0-5 years were included in the study. After obtaining information through a pre-tested performa, all the subjects underwent clinical examination and anthropometric measurements. It was found that subjects in upper social classes had better health and nutritional status than those in lower socio-economic classes. Immunization status was found to be good. 99.18% of the children were vaccinated with BCG, 96.7% with DPT-I/OPV-I, and 90.11% were given measles vaccine. 34.62% children were given pre-lacteals in the form of honey or jaggery water. 32 mothers in the survey did not feed colostrum to their children. 39.84% children were normal, whereas 60.16% children were suffering from various grades of under nutrition. 27.47% children suffered from Grade I under nutrition, 22.53% suffered from Grade II under nutrition, and 9.34% and 0.82% were in the category of Grade III and Grade IV under nutrition respectively. The prevalence of under nutrition was highest in 36-48 months group (67.16%), followed by 48-60 months (65.38%). Increased prevalence of under nutrition in these 2 age groups reflected the cumulative effect of food deprivation, repeated bouts of acute infection, extensive parasitism, emotional deprivation, etc. The
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prevalence of under nutrition was higher among females (59.36%) than males (40.64%). The reason for this was that males were given priority over female children as they would be future breadwinners. Also, females were considered a liability. Even immunization coverage was significantly less among females as compared to males. There was an association between birth order and under nutrition. Under nutrition was found to be lowest in children of first birth order (49.65%) and highest (100%) in children of fifth or more birth order. A significant association between birth order and under nutrition could be due to the fact that with higher birth order the family size increases, leading to shortage of food. Under nutrition was higher in children of illiterate mothers (88.46%) as compared to children of mothers who were educated up to higher secondary level or above (29.87%). Reasons cited for this were that an educated mother was more aware of the importance of hygiene, sanitation, immunization, and need for health check-ups, etc. Even children of educated fathers had lower prevalence of under nutrition. The prevalence of under nutrition was lower among children of housewives (58.05%), as compared to mothers engaged in services (62.5%) or labour (88%). This could be because working mothers spent less time with their children. Children having birth weight less than 2 kgs were more undernourished (80%) as compared to children having birth weight more than 3 kgs (33.33%). Lower birth weight made the child more vulnerable to repeated infections, such as respiratory infections. Under nutrition was lowest when weaning started between 4-6 months of age (49.42%) and highest when weaning started at 12 months of age (85.71%). After the age of 6 months, breast milk was not sufficient to fulfill the caloric requirement of the child. Due to economic and cultural reasons, children were often deprived of additional foods, thus they became apathetic, reacted less to social and psychological stimuli, and were susceptible to infections. Infants with past history of illness were more likely to be undernourished than those without any history of illness. General literacy level of the community should be improved with special emphasis on mothers education. Families should be given information about the importance of regular check-ups, antenatal and post-natal care, immunization, etc. Knowledge should be given to caregivers about breast feeding and weaning practices.
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Das, Lipi, Bishnoi, Indira and Das, B. K. (2000). Anthropometric parameters for the assessment of nutritional status in (0-6) years children in Varanasi. Man in India, 80(3-4) : 345-50.
Key Words: 1.NUTRITION MEASUREMENT. 2.NUTRITIONAL STATUS 3.ANTHROPOMETRIC
Abstract : Anthropometric parameters like weight, length, height, circumferences of head, chest and mid-arm were taken to assess nutritional status of 232 children aged 0-6 years in Varanasi. All the parameters were compared with 50th percentile of Harvard Standard. Results showed that with advancing age the mean height and weight increased steadily. When compared, the 50th percentile of Harvard Standard were found to be significantly superior to the anthropometric measurements observed in the study. Due to prime importance given to males in Indian society, the anthropometric measurements of male children were higher than those of female children. The lower consumption of nutrient intake coupled with genetic and environmental factors were also responsible for lower physical measurements.
Gopalan, C. (2005). Linear growth as an index of nutritional status : NFI Bulletin, 26(2). New Delhi : Nutrition Foundation of India. 8 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.NUTRITIONAL STATUS 4.HEIGHT 5.STUNTING 6.FOOD SECURITY 7.CHILD NUTRITION. 8. STANDARDS 9.GROWTH STANDARDS.
Abstract : Environmental factors are major determinants of heights of populations. Differences in growth pattern among different ethnic groups should caution us against universal application of International Standards in growth and heights. The National Centre for Health Statistics (NCHS) data apparently represent the peak levels of heights attained by populations of the USA. International Standards based on NCHS are applicable to Indian population segments of children and adolescents belonging to the affluent sections. International Standards derived from populations of developed countries may not be appropriate yardsticks against which to measure undernutrition in population segments just emerging from poverty. According to the National Family Health 119
Survey (NFHS) Report 1992 -93, 52% of Indias under three year old children are stunted, meaning that their lengths are below 2 SD of International Standards (NCHS). These surveys largely pertain to poor rural populations and do not generally capture the upper middle class and the affluent sections. NCHS standard for under threes, which is based largely on infants and children receiving artificial feeds (and not breast milk), may require revision. The WHO is coming out with such a revised standard based on the growth performance of breastfed infants of some selected countries including India. However even this revised standard will be based on data from the most affluent sections of the populations of these countries. The WHO standard may not be the appropriate yardstick for the assessment of stunting. It is important that developing countries identify local standards for the assessment of stunting of under-five year old children in their populations. The appropriate standard against which to estimate stunting could be derived from measurements on local populations belonging to the countrys middle-class groups, who do not suffer from scarcity of basic necessities of food, clothing, shelter, and health care, and who enjoy good health and nutrition. The use of such a local standard could facilitate better targeting of nutritional intervention to really needy children. There are apparently two components involved in stunting a post-natal component attributable to repeated infections and poor child care, and a pre-natal component caused by intra-uterine growth retardation (IUGR) arising from poor ante-natal care and poor maternal nutrition, which resulted in low birth weights. Reports indicated that 25% of children born in Government hospitals in India that cater to the poor segments of the population are of low birth weight (< 2.5 kg). The NNMB surveys show that stunting (height for age below -2 SD of International Standard) had declined from 78.6% in 1975-79 to 49.3% in 2000-01. Indian diets are low in n-3 fatty acids. Many inexpensive food sources of n-3 fatty acids are within the reach of the poor, and intake of food rich in n-3 fatty acids would help in prevention of low birth weight problem. Public health policy should ensure that children should have appropriate weights for their heights (normal BMI) and that they do not suffer from wasting. The present wide disparities in linear growths between the affluent and the poor is a reflection of prevailing socio-economic inequalities and inadequate primary health care for the poor. The challenge before policy makers and public health professionals of developing countries is to narrow down these disparities through eradication of poverty, better ante-natal care, promotion of better child rearing practices, and better education and health care.
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Jood, Sudesh, et al. (2000). Nutritional status of rural pre-school children of Journal of Pediatrics, 67(3) : 189-96.
Haryana State.
Indian
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS 3.PRE-SCHOOL CHILDREN 4.HARYANA 5.ANTHROPOMETRIC MEASUREMENT.
Abstract : The present study was undertaken to assess the nutritional status of pre-school children through food intake, nutrient intake, anthropometric measurements and clinical examinations in different zones of Haryana State in different seasons. The mean daily intake of cereals, pulses, vegetables, roots and tubers, milk products, fats, sugar and fruits was found to be lower in summer season than their respective dietary intake in winter season. Mean daily food intake of milk and milk products was maximum in Kurukshetra (32% more than RDI), followed by Bhiwani (7% more than RDI), and Hisar (6% more than RDI). Mean weight and height of few children were found lower in Hisar and Bhiwani and higher in Kurukshetra compared to their reference values. Majority of the children were found normal in Kurukshetra on the basis of weight and height for age criteria.
Kango, Mangala. (2001). Nutrition and malnutrition among children between 1 to 10 years. Govt. Girls Post Graduate College, Deptt. of Home Science. 3 p.
Ujjain :
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS CHILDREN 3.MALNUTRITION CHILDREN 4.MALNUTRITION MADHYA PRADESH.
Abstract : The study was undertaken to study the nutritional status of 130 children (88 boys and 42 girls) in Ujjain, Madhya Pradesh, and assess the incidence of border line malnutrition with no apparent deficiency disease. Of these 30 were born through caesarian section, 78 were first born, and 32 were the second born. 52 children were low birth weight. There was negative association (-0.27) between the first born child and birth weight of first born child indicating that adequate care of the mother was not taken during pregnancy. There was perfect association (+0.98) between breastfeeding and normal health of infants. About 50 per cent mothers could not supplement breastfeeding at the appropriate age of 3-15 months. Supplementary foods other than milk were given to 42 children by 4 months, 32 children by 5 months and 36 children by 6 months. Supplementary foods given were 121
fruit juice (16 children), fruit pulp (22 children), cereal gruel (88 children), vegetable soup (30 children), and 18 children were fed routine household preparations and snacks from the market. Positive association (+0.88) was reported between weaning at the right time and good health. About 100 children were healthy and 28 were ill. Vitamin A inadequacy was assessed among 21.5 per cent of the children. Though there was no clinical sign of malnutrition, orientation was needed regarding infant weaning practices and quality of food stuffs consumed. Children above 3 years of age exercised their own choice regarding food. It was suggested that media, specially TV, may be used to propagate the correct choice and selection of food preparation as children readily agreed with what was said by TV.
Kumari, K . (2005). Health and nutritional status of school going children in Patna. Health and Population Perspectives and Issues, Jan-Mar, 28(1) : 17-25.
Key Words : 1. NUTRITION 2.NUTRITIONAL STATUS CHILDREN 3.HEALTH STATUS 4.RECOMMENDED DIETARY ALLOWANCE (RDA) 5.DEFICIENCY DISEASES 6.SCHOOL CHILDREN 7.BIHAR
Abstract : Health and nutrition in early stages of human life determine, to a great extent, the physical and mental well being of a person. The present study was undertaken to determine the nutritional status of 700 school going children (444 boys and 256 girls) in the age group of 6-11 years. The subjects belonged to families with varying socio-economic status and were drawn from different schools of Patna by random sampling method. The growth status of children was evaluated by applying anthropometric parameters and was compared with standards adopted by National Centre for Health Statistics (NCHS). A 24-hour recall method of diet survey was adopted to assess food intake of the children and from the data, the total intake of protein, iron, Vitamin A and overall calories was calculated. The dietary intake of nutrients was compared with the recommended dietary allowance (RDA) given by the Indian Council of Medical Research (ICMR). Results showed that regardless of the income group to which the children belonged, there was a marked deficiency in the intake of different nutrient categories. However, out of 700 children, the distribution for various nutrient groups where the children fulfilled or exceeded the RDA (100%) was in the category of calories with respect to 26 children (5 males and 21 females), protein with respect to 34 children (28 males, 6 females), Vitamin A with respect to 174 children (109 males, 65 females), and iron with respect to 244 children (83 males, 161 females). The survey revealed that children belonging to the
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low income group were the most affected in all the categories of nutrients. It was observed that as the income level of parents increased, so did the calorie intake in children. The income level was very well correlated with the intake of RDA of Vitamin A as well, and 41.67 % females and 38.0 % males in higher income group (HIG) qualified for > 100 % RDA category. Both, higher awareness about vitamin supplements and affordability seemed to be responsible for this situation. In all income groups, 50 % of the females consumed more than the RDA for iron, which was very essential for their health. The average height for boys and girls was 118.67 cm and 113.67 cm respectively, at the age of 6 years and 135.57 cm and 137.55 cm respectively at the age of 11years. The findings were slightly less than the standards recommended by NCHS. The average weight for boys and girls was 20 kg and 18.33 kg respectively, at the age of 6 years, and 28.88 kg and 29 kg respectively, at the age of 11 years. The girls weighed slightly more than the boys in the 11th year. The findings were slightly higher in comparison to NCHS standards, probably due to the altered food habits among children. The mean value of arm circumference of the children of both sexes increased with age. The findings for male children were in accordance with the standards recommended by NCHS, whereas, it differed for females in the age group of 6-10 years. However, no significant variation from standards was noted in the arm circumference in case of female children of 11 years. Nutritional deficiencies in children of HIG families indicated that there was lack of awareness about balanced and nutritious diet, independent of the economic factor among families.
Lakshmi, U.K. and Padma Priya, T. (2004). Impact of NSS programme on the nutritional status of preschool children. The Indian Journal of Nutrition and Dietetics, 41(6) : 229-40.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS 3.PRESCHOOL CHILD 4.CHILD NUTRITION 5.IMPACT OF NSS ON CHILD NUTRITION 6.NSS PROGRAMME 7. NUTRITIONAL STATUS PRESCHOOL CHILD.
Abstract : The study evaluated the impact of NSS programme on the nutritional well-being of preschool children and nutritional awareness among mothers. The study included six anganwadis located in and around Coimbatore, where NSS programmes are carried out. A total of 600 children aged 2-5 years, 300 from NSS areas and 300 from Non-NSS areas attending the anganwadis were selected. Details of monthly food expenditure pattern of the selected families revealed that in both areas, expenditure on cereals was within 25% to 50%. Expenditure on pulses
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was 11% to 20%. Expenditure was within 50% of their income on roots and tubers, greens, sugar and jaggery, and prepared food items by most of the families. Frequency of consumption of fruits, greens, and non-vegetarian foods was found to be better among families in NSS areas than in Non-NSS areas. The study found that overall height measurements were significantly different at 1% level among the group of boys and girls of NSS to Non-NSS areas. A higher percentage of boys and girls in all age groups from NSS areas had a mean mid-arm circumference more than 14 cm, whereas a higher percentage of preschool children from Non-NSS areas had values in the range of 12.5 14.0 cm. Through clinical examination, it was observed that 36.7% children from Non-NSS areas had symptoms of anaemia. Nearly 20% of the children in both the areas had discoloured/dry/sparse/ brittle hair. The mean haemoglobin levels were found to be 10.29 g/dl and 8.9 g/dl from NSS and Non-NSS areas respectively, which were lower than the standard values suggested by WHO. A sample of 20 children was selected for a detailed food and nutrient intake survey. It was found that the consumption of all food items was inadequate. But intake of milk, calcium, protein and vitamin C were found to be adequate. The study found 56% mothers from NSS areas had a good concept about balanced diet. About 71% mothers revealed that they obtained nutrition related information through NSS programmes. The study suggested that NSS and other such programmes should be launched with a wide outreach to improve the nutrition and health status of the community.
Mishra, Rudra Narayan. (2007). Nutritional deprivation among Indian pre-school children : does rural-urban disparity matter?. Ahmedabad : Gujarat Institute of Development Research. 34 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS PRESCHOOL CHILDREN 3.PRESCHOOL CHILDREN 4.UNDERNUTRITION 5.MALNUTRITION 6.PERFORMANCE OF STATES.
Abstract : India is one of the few countries in the world where there is poor nutritional status among many young children, which is detrimental to their health outcome. The present study was done to evaluate the achievement of Indian states on 3 anthropometric indicators (Height-for-age, Weight-for-age and Weight-forheight), to measure the prevalence of child nutrition. Data collected from all 28 states of India through NFHS-2 (1998-99) and NFHS-3 (2005-2006) was analysed. The rural-urban difference for states in NFHS-3 showed that Rajasthan had the
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highest difference of 13.5% points in child stunting, followed by Punjab (12.5%) among states of northern India. In the western region in Maharashtra, the ruralurban difference was 10.9% in 1998-99 which came down to 5.5% in 2005-06. The prevalence of stunting in Gujarat was nearly stagnant in all the 3 rounds, 42.4% in 2005-06, 43.6% in 1998-99 and 43.6% in 1992-93. The rural-urban difference was also stagnant at around 8%. In Kerala, southern India, the prevalence of child stunting was minimum and the rural-urban difference was also very nominal (-0.2%). And Tamil Nadu was the next best state where aggregate prevalence of stunting was about 25%. At all India level, the prevalence of stunting showed gradual decline from NFHS-1 (52% in 1992-93) to NFHS-3 (38.4% in 2005-06). Using weight-forage of children as an indicator, Punjab had the lowest prevalence of underweight (27%) children among all other counterparts of northern India. The situation in Madhya Pradesh had worsened as prevalence of underweight among pre-school children had increased from 57.4% in 1992-93 to 60.3% in 2005-06. In eastern India the concentration of under-weight among young children was very high in West Bengal, Bihar, and Chhattisgarh. For Bihar and Jharkhand the prevalence of underweight had increased from 54.3% each in 1998-99 to 58.4% and 59.2% in 2005-06. Among North-Eastern states, Meghalaya (46.3%) had the highest prevalence of underweight. Maharashtra had highest decline in prevalence of underweight in all the 3 rounds at State level, (12.9%), as well as in rural areas (14%). In south India, Kerala continues to be the best performer in the region, in all the 3 rounds (28.8% in 2005-06, 26.9% in 1998-99 and 28.5% in 1992-93). At all India level, the prevalence of underweight had came down marginally between NFHS-2 and NFHS-3 (from 47% to 45.9%). For northern India, it was found that wasting increased over the period of time at aggregate level, especially in the last phase, for all states in the region. The situation worsened in Madhya Pradesh, where the aggregate prevalence of wasting increased from 20.2% in NFHS-2 (1998-99) to 33.3% in NFHS-3 (2005-06). In eastern India the prevalence of wasting had came down in Chhattisgarh and Orissa in the NFHS-2, whereas for Bihar, Jharkhand and West Bengal, prevalence of wasting among young children has shown an increase in all the 3 rounds. Among the North-Eastern states, Meghalaya had the highest prevalence of wasting. The prevalence of wasting among young children had come down in the second phase among Western states, specially in Goa and Maharashtra. The prevalence of wasting among all the Southern states except Karnataka (where it has come down from 20% to 17.9%) has gone up between the last two rounds of NFHS. Future intervention programmes aiming at reducing undernourishment among Indian children should be more focussed.
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Pai, M. et al. (2001). A pilot study of the nutritional status of disabled and non-disabled children living in Dharavi, Mumbai. Indian Pediatrics, 38(1) : 60-65.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS 3.DISABLED CHILDREN.
Abstract : The study investigated whether disabled children were more vulnerable to malnutrition than non-disabled children and determined the impact of disability upon the nutritional status of their siblings. A total of 50 families each of disabled and non disabled in a deprived area from Dharavi, Mumbai participated in the study. Information on anthropometric measurements and dietary intake was collected from 129 children. Results showed that all children were malnourished compared to the NCHS reference population. About 71% children were moderate to severely malnourished. The prevalence of stunting was more than that of wasting. Stunting was significantly higher among disabled children compared to non-disabled children, but wasting, under nutrition and anaemia were similar in both groups. About 57% children were found to be anaemic. As it was difficult to accurately determine height among physically impaired children, the study may have over- estimated the prevalence of stunting among disabled children. Disability in the family was not associated with poor nutritional status of siblings. The study recommended that urgent attention should be given to the nutritional and health needs of children living in deprived areas like Dharavi.
Rajaretnam, T. and Hallad, Jyoti S. (2000). Determinants of nutritional status of young children in India: an analysis of 1992-93 NFHS data. Demography India, 29(2) : 179-200.
Key Words: SURVEY 1.NUTRITION 2.NUTRITIONAL STATUS 3.NATIONAL FAMILY HEALTH
Abstract: The study examined the determinants of severe under-nutrition i.e. under-weight, stunting and wasting among children aged 12-47 months using NFHS data. Based on Mosley and Chen model that considers growth faltering as a function of maternal factors, environmental contamination, nutrient deficiency, injury and personal illness control, three indices of nutritional status based on weight and height, namely weight-for-age, height for-age and weight-for-height were considered. Results revealed that majority of the children in India are underweight
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and stunted. The percentage of children severely underweight and stunted was 27.4% and 36.5% respectively. The percentage of children undernourished was exceptionally high in the states of Bihar (72.4%), Uttar Pradesh (68.7%), Madhya Pradesh (67.8%), West Bengal (66.6%), Karnataka (63.6%), Andhra and Orissa (61.1%) each, and Assam (60%), and reasonably low in Goa (40.3%), Kerala (34.3%) and Mizoram (32.8%). Analysis of the data showed that children above two years become less underweight but more and more stunted. Children born to young mothers (below 18 years), of higher birth orders (4+), and those with a birth interval of less than 2 years are at higher risk of being severely undernourished. Low birth weight babies are also at a greater risk of being severely under nourished. Improvement in the nutritional status of children in India requires improvement in the educational and nutritional status of women, better housing environment, improvement in the delivery of MCH services and strengthening of family planning services. Ray, Sandip Kumar et al. (2000). Rapid assessment of nutritional status and dietary pattern in a municipal area. Indian Journal of Community Medicine, 25(1) : 14-18.
Key Words : 1.NUTRITION FIVE CHILD. 2.NUTRITIONAL STATUS 3.DIETARY PATTERN. 4.UNDER
Abstract : The aim of the study was to assess the nutritional status of children under five years and dietary pattern of families from Siliguri. The sample comprised 316 children and 92 families. Overall prevalence of malnutrition was 62.97% and degree of severe malnutrition was 6.65% among children aged 12-23 months of age and among females. Overall prevalence of malnutrition in children under 5 years was found to be 62.97% and prevalence of severe degrees of malnutrition was 6.65%. Significant sex difference was observed in prevalence of severe degree of malnutrition, which was almost double in female children (8.47%) in comparison to male children (4.3%). Prevalence of malnutrition among children of literate mothers and fathers was comparatively lower than illiterate fathers and mothers. Average calorie intake was 2271.7 kcals and nearly half (47.8%) of the families covered in the study were getting less than 2400 k calls. The problem of malnutrition is linked with various socio-economic and demographic factors. The study suggested area specific integrated decentralised planning, and sensitisation workshops for the peripheral level functionaries on nutrition related issues.
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Singh, Madhu, B., Fotedar, Ranjana and Lakshminarayana, J. (2007). Studies on the nutritional status of rural population in desert area of Rajasthan. Jodhpur : Desert Medicine Research Centre. 7 p.
Key Words : 1. NUTRITION 2.NUTRITIONAL STATUS 3.MALNUTRITION AREA 5.DESERT AREA 6.RAJASTHAN. 4.RURAL
Abstract : The nutritional status of people in desert area requires special attention. This study was undertaken (in 2005-06), to assess the nutritional status and dietary habits of the rural population in a desert area of Rajasthan. The study covered 560 households in 28 villages belonging to 6 tehsils of Jodhpur district. A total of 3301 individuals (1731 males and 1570 females) were examined for anthropometry, dietary intake and nutritional deficiency signs. Anthropometric measurements were expressed as a percentage of the standards available from NCHS for a given age and sex. 59.5% respondents belonged to nuclear families, and 24.4% belonged to joint families. The weights of preschool children were expressed as percent of NCHS standards and categorized into different nutritional grades, based on Gomez classification. The overall prevalence of under nutrition was very high, 81.0%, and it was higher among scheduled caste and scheduled tribe communities (85.7% to 88.0%) in comparison to other communities (74.7%). Severe under nutrition was very high, 34.4%, which needed attention. Under nutrition was higher in nuclear families (82.0%) compared to joint families (79.2%), and was observed to be maximum in semi-pucca (permanent) houses (36.7%) followed by pucca houses. The distribution of adults according to BMI grades showed that 44.5% had normal BMI (18.5-25.0) while 55.5% had chronic energy deficiency. Severe chronic energy deficiency was highest in scheduled caste (23.7%) and scheduled tribe (18.4%) communities followed by backward classes and other communities. Severe chronic energy deficiency was higher in extended nuclear families (18.2%) compared to nuclear and joint families (14.5%), and maximum in families residing in semi-pucca houses. Regarding nutritional deficiency signs, it was observed that discoloration and sparseness of hair, a sign of protein calorie malnutrition was observed to be high (7.1%) and was higher in females than males. Marasmus was observed only in females (0.2%). Angular stomatitis, cheliosis and glossitis ranged between 0.2 to 1.8%. Vitamin A deficiency (Bitot Spot) was 0.3% and it was higher in males than females. Dental caries (30.4%) and dental flurosis (25.1%) were high in this area. Females suffered more from dental caries and dental flurosis than males. Thyroids, palpable and visible, were 0.6%, Koilinichia, a sign of Anaemia, was observed to be higher in females (0.2%). Dietary analysis revealed that consumption of food stuffs per day was marginally low in Cereals (97% of RDA), very low in Fats and Oils (50% of RDA),
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Pulses and Legumes (47.5% of RDA), Leafy Vegetables (4.1% of RDA ) and other vegetables (65% of RDA). It was recommended that there is a need to develop continuous monitoring service to study the nutritional status, dietary habits, food availability and the effect of the changing social and environmental factors on the health status of the population. The results of such a study in desert areas would provide information and useful guidelines not only for food policies, but also assess impact of the nutritional programme currently in progress and for future planning in Rajasthan.
Singh, Madhu, B. et al. (2006). Studies on the nutritional status of children aged 0-5 years, in a droughtaffected desert area of western Rajasthan, India. Jodhpur : Desert Medicine Research Centre. 7 p.
Key Words : 1.NUTRITION 2.MALNUTRITION PRESCHOOL CHILDREN 3.MALNUTRITION 4.NUTRITIONAL STATUS PRESCHOOL CHILD 5.STUNTING 6.UNDER WEIGHT 7.DROUGHT PRONE AREA 8.DESERT AREA 9.RAJASTHAN.
Abstract : Drought condition occurs quite frequently in the Thar Desert, which lies mostly in the Indian state of Rajasthan. The present study was undertaken to assess the impact of drought on the nutritional status of preschool children aged 05 years in a desert area in Rajasthan which faces drought conditions very frequently. The study was carried out in 24 villages in 6 tehsils of Jodhpur district, Rajasthan. A total of 914 children were examined at household level, and their nutritional status was assessed using anthropometry, dietary intake, and clinical signs of nutritional deficiency. The mean weight and height of children were compared with NCHS (National Centre for Health Statistics) standards. It was found that about 60% of the children were underweight (weight for age) while the prevalence of severe underweight was found to be about 31%. The overall prevalence of stunting (height for age) was about 53%, with the extent of severe stunting being about 34%. Analysis by age revealed that children in the age group 1-2 years suffered more from stunting. Severe stunting was higher among girls (36.7%) than boys (31.0%). It was found that prevalence of wasting was about 28% with the extent of severe wasting being 10%. Again, children in the age group 1-2 years suffered more from wasting. About 36.4% of the preschool children in this study suffered from mild to moderate deficit in fat deposits, and 36.9% suffered from severe deficit of fat deposits. Around 30.5% children suffered from anaemia on the basis of conjunctival pallor, platyonychia and koilonychia. Prevalence of marasmus
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was 1.7% among boys and girls. Vitamin A deficiency was indicated by the overall prevalence of Bitots spots among 0.2% children. The incidence of Vitamin B complex deficiency or angular stomatitis was observed to be 0.5%, cheliosis 0.9%, and glossitis 1.6%. Vitamin C deficiency was observed in 0.1% cases (bleeding gums), caries and mottling of tooth enamel were observed in 2.7% and 3.9% of the children respectively. The energy deficit observed among preschool children was very high, 76%. Efforts should be made to incorporate measures, such as ensuring the supply of adequate energy and protein to all age groups, especially preschool children, into ongoing nutrition programmes in order to improve food security. Furthermore, there is a strong need to develop nutritional packages based on the locally available diet and feeding habits of preschool children, which would provide them adequate energy, protein and nutrients.
Upadhyay, S.K. et al. Perceptual development in relation to nutritional status. Indian Journal of Pediatrics, 68(4) : 327-32.
Key Words: 1.NUTRITION 2.PERCEPTION 3.NUTRITIONAL STATUS.
Abstract: The study was conducted in Varanasi to find out the effect of nutrition on development of perception and perceptual exploration in children. 180 children in the age group 5-10 years were divided into 3 sub-groups according to their age. In each group 30 normal and 30 undernourished children were studied. Information through home visits was collected on parental literacy, occupational status, caste, and per capita income. For the assessment of perceptual skills each child was tested with the help of picture Ambiguity Test which consisted of 7 ambiguous pictures. Observations showed that with increase in age, centration effect reduces and majority of the children start decentring their perception by middle childhood. There was a significant difference in the performance of well-nourished and undernourished children when time to respond on ambiguous card was compared. Well nourished children took lesser time to respond on different ambiguous cards. Poor nutrition resulted in impaired perceptual abilities in children. The study suggested that efforts should be made to enrich the experiential base of children through which the basic skills of perception could be better developed among children from impoverished socio-cultural background in particular, and children in general.
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Vir, Sheila C. and Nigam, A. K. (2001). Nutritional status of children in Uttar Pradesh. Lucknow, 2001. 3 p.
Key Words : 1.NUTRITION 2.NUTRITIONAL STATUS 3.UP.
New Delhi
: UNICEF,
Abstract : The Survey was carried in five economic regions (Bundelkhand, Central, Eastern Hill, and Western regions) of Uttar Pradesh to collect data on the nutrition profile of children and women. The target groups were children 3-59 months and ever married women in the age group of 15-45 years. Data on feeding, hygiene/sanitation practices, utilization of health services, education, housing and other facilities was collected. Nutritional status of children was assessed by weight for age, height for age and weight for height using standard deviation classification. Results revealed that 52 per cent children were under weight, and 22.4 per cent were severely underweight and malnourished. The highest incidence of malnutrition was observed in the eastern belt followed by Bundelkhand region. The maximum incidence of underweight was observed among children aged 12-23 months. Malnutrition accelerates during the second half of infancy. The study suggests that feeding practices should be adapted to focus on child's abilities, with reference to how, when and where. Highest priority may be accorded to care and feeding of infants, breast feeding, complementary feeding and suitable intervention measures may be adopted. Counselling mothers, care givers and community on health and nutrition care of infants should be undertaken. ICDS and RCH infrastructure may be used for the purpose. The incidence of under weight among infants needs to be viewed as an important and measurable indicator of development by policy makers, along with IMR and under five child mortality.
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National Institute of Nutrition, Hyderabad. (1998). Development of nutrition surveillance system in Andhra Pradesh. Hyderabad : NIN. ~75 p.
Key Words : 1.NUTRITION 2.NUTRITION SURVEILLANCE IN ICDS 5.ICDS INFRASTRUCTURE 6.ROLE OF ICDS WORKER. 3.ICDS 4.SURVEILLANCE 7.ROLE OF ANGANWADI
Abstract : The National Institute of Nutrition (NIN) undertook an operational research project, on the request of the Department of Women and Child Development (DWCD), to assess the feasibility of developing a nutrition surveillance system NSS, using ICDS infrastructure; to develop a training module for use by implementing departments of other states; and to develop computer software package to help ICDS officials in initiating action based on information generated from the modified progress reports. The present nutrition surveillance system (NSS) involving National Service Scheme (NSS) volunteers was based on Triple A approach (assessment, analysis and action) at different levels, starting from the AWWs to the district and state level. The Triple A approach comprises assessment of the problem, analysis of the causes of the problem, and implementation of resources, relevant and feasible. This was followed by reassessment. A team of NIN scientists also visited different projects to reorient AWWs and sector supervisors, and hold review meetings. The implementation of NSS was carried out throughout the State, making use of the administrative infrastructure and with total involvement of the state government officials. A training module was also developed based on the experiences gained by the NSS in Andhra Pradesh. There were a total of 192 ICDS projects in the operations research study. These projects included 1334 sectors and 25,880 AWCs. The percentage of AWWs reporting on NSS formats in June 1996 was 77% and increased to 87.4% in March 1997. Only 46% of the sectors had regular supervisors in June 1996, which increased to 73.2% by March 97 because the post of District Programme Officer was sanctioned only in 21 of the 23 districts in the state. ICDS functionaries were able to identify the families and the areas at higher nutritional risk over a period of one year. More than 60% functionaries at the sector, project and district levels that were followed up submitted reports for 3 out of 4 quarters. Enrolment for surveillance was found to be as low as 30%. AWWs observed that there was no interaction with the mother regarding growth of the child. It was 132
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observed that at the beginning the correctness of reporting by AWWs was as low as 20% with regard to growth faltering, nutrition mapping, and reporting on nutrition deficiency signs. After repeated sessions of orientation and training, the quality of reports and reporting improved considerably. The coverage under Vitamin A supplementation was woefully low and negligible in some sectors. At the beginning of the study, very few AWWs recorded birth weights. This increased considerably during the last three months. As a part of the project, a 2 days workshop was organized at NIN, Hyderabad, to review various aspects of the operations research, and assess the feasibility of replication of a similar system in different states of the country. The attempts of NIN to involve NSS in the state of Andhra Pradesh for nutrition surveillance using ICDS infrastructure with the active involvement of DWCD, GOI, was considered to be successful. The group recommended that NSS should be extended to the other states. To improve the quality of data collection, a one day reorientation session should be conducted. Night blindness should be included as an indicator of Vitamin A deficiency. Nutrition and health education should receive more emphasis in the Training Module developed for nutrition surveillance system.
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Choudhary, Bakhtia and Kishore, Ajay. (2004). Are we making school children sedentary and obese? Intervention study of 6000 Indian school children. The Indian Journal of Nutrition and Dietetics, 41(6) : 250.
Key Words : 1.NUTRITION 2.OBESITY 3.SCHOOL CHILDREN.
Abstract : The present study surveyed the prevalence of obesity and other health related fitness parameters in children from both Affluent Schools (AS) (with international curriculum and children belonging to high socio-economic families) and Non-Affluent Schools (NAS) (schools run by Government Organisations and children belonging to low to medium socio-economic families). 6000 school children (2700 boys and 3300 girls, 3000 each from AS and NAS groups) from eight different schools of Hyderabad city were chosen for the study. Study revealed that most of the children had very poor cardio-respiratory endurance (86%), degree of obesity (>30% body fat) in all subjects was 30.19%; being 50.47% in affluent schools and 19.92% in non-affluent schools. Study also found poor flexibility in 29% children, and poor body posture in 36% children. About 13.1% children had dental caries, 2.4% had genuvalgum (knock knees), and 15.8% had pesplanus (flat feet of both congenital and acquired types). Gynaecomastia was found in 6.8% children. Study suggests that there is an urgent need for improving physical fitness in school children. Television viewing and playing computer/video games for long duration should not be encouraged. Body fat and important biochemical parameters of obese children should be monitored.
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Mallikharjuna Rao, K. et al. (2007). Diet and nutritional status of adolescent tribal population in nine states of India. Hyderabad : National Institute of Nutrition, National Nutrition Monitoring Bureau. 6 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.NUTRITIONAL STATUS ADOLESCENT 4.NUTRITIONAL STATUS TRIBAL 5.TRIBAL ADOLESCENT.
Abstract : Tribal population constitutes about 8% of the total population in India, with varying proportions in different states. A close relationship exists between the tribal ecosystem and their nutritional status. Inadequate health care facilities, ecological degradation, etc. further aggravate the situation. Community development blocks, where more than 50% of the population is tribal, are covered under Integrated Tribal Development Projects (ITDP), while Modified Area Development Approach (MADA) is adopted in smaller areas. In India, currently there are 194 ITDPs and 259 MADA Pockets functioning. The present study was carried out, NIN, Hyderabad during 1998-99 on the diet and nutritional status in tribal areas of nine states viz., Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu and West Bengal. Trained Medical Officers, nutritionists and social workers conversant with the local language were involved. In each state, 120 villages were selected randomly from the list of ITDP villages. From each selected village, 40 households (HHs) were covered, by adopting probability proportional to the size of different tribes. Anthropometric measurements such as weight, height, mid upper arm circumference and fat fold at triceps were taken of all the available individuals in the selected HHs. 24 hour food recall method was also adopted. Anthropometric data of 12,789 adolescents from 4,772 HHs was collected, 6,088 boys and 6,701 girls and dietary information of 5,562 adolescents (2,701 boys and 2,861 girls) was gathered. The average intake of all the nutrients by adolescent boys and girls of the various tribes was below the Recommended Dietary Allowances (RDA) in all age groups. The extent of deficit in the intake of micronutrients such as Vitamin A (80-85%), iron (70-80%), free-folic acid (50-55%), and riboflavin (4050%) was relatively more, compared to that of energy (10-40%) and protein (2030%). The deficit in the intake of energy was higher among boys than girls in older adolescents (13-17 years), compared to younger adolescents (10-12 years). Compared to their rural counterparts, the intake of all nutrients of tribal adolescents were 135
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lower except for Vitamin A and Vitamin C. More than 50% boys and girls had intakes of less than 70% RDI. The proportion was higher with regard to Iron (96% for boys and 90% for girls), followed by riboflavin (88% for boys and 80% for girls) and Vitamin A (78% each for boys and girls). Significant gender differentials were observed with regard to the intakes of energy, iron, thiamin, riboflavin and niacin, with higher proportion of boys consuming less than 70% of RDI. The prevalence of conjunctional xerosis and Bitot spots, the signs of Vitamin A deficiency, were found to be 4.9% and 2% respectively. About 3% of the adolescents had angular stomatitis, indicative of B Complex vitamin deficiency. The prevalence of Goitre was 3.5%, which was relatively higher among girls (5%) than boys (1.8%).The mean height and weights of tribal adolescents were below NCHS standards among all age/ sex groups and were comparable with rural adolescents. The median body mass index (BMI) by age/ sex, though comparable with their rural counterparts, was below the median NHANES reference values. The overall prevalence of stunting (height for age <median -2SD) was 42% among boys and 46% among girls, which was higher than that reported for their rural counterparts (39% each for boys and girls). The overall prevalence of underweight (weight for age <median -2SD) was significantly high (51%) among boys and girls (43%). The prevalence of underweight among tribal boys was comparable with that of rural boys, while it was relatively higher among tribal girls compared to rural girls. About 63% of the boys and 42% of the girls had BMI values less than 5th centile of age/ sex specific BMI values (NHANES), indicating high prevalence of under nutrition which was marginally lower among tribal boys compared to rural boys. Stunting was significantly higher among children of joint families (46.8%) compared to nuclear (44.5%) or extended nuclear families (40.6%). The proportion of children with stunting was relatively more (47%) among daily wage earner families. The study revealed that the tribal population is at a higher risk of under nutrition, because of socio-cultural, socio-economic and environmental factors influencing the food intake and health seeking behaviour. Low female literacy (14.5% against 47%), high maternal (992 against 195) and infant mortality (85 against 64) have been reported among tribal population as compared to their rural counterparts. The study concluded that the adolescents enter womanhood with poor nutritional status and are exposed to the risks of bad obstetric outcomes. Inadequate healthcare facilities, illiteracy and socio-economic disadvantage among the tribal population perpetuate the vicious cycle of under nutrition. Therefore the study recommended that there is a need to evolve comprehensive programmes for the overall development of tribals with special focus on adolescents.
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National Institute of Nutrition, Hyderabad. (2004). Food colours in ready to eat foods in unorganized sector : a case study. Hyderabad : NIN. 6 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.FOOD SAFETY 4.FOOD COLOUR 5.FOOD ADULTERATION 6.COLOUR FOODS 7.STREET FOOD 8.MALNUTRITION ORISSA 9.WASTING ORISSA 10.ORISSA 11.CHILDREN 1-5 YEARS.
Abstract : Data on usage of permitted synthetic food colours and the levels to which they can be used was evaluated in a variety of Ready-to-Eat (RTE) food samples collected from outlets in Hyderabad City. Tests for the quality, quantity and extent of use of colours in such foods produced by the unorganized sector were also conducted. A random sampling technique was followed. A total of 145 outlets, viz. supermarkets (23), sweetmeat stalls (45), wholesale markets (15), retail outlets selling only confectioneries and other coloured RTE foods such as deep-fried snack foods, sugar toys, coloured synthetic powders, etc. (10), bakeries (21), fast food centres (6) and small vendors (25) were surveyed. A total of 545 samples of coloured food items were purchased from these 145 outlets. Out of the 545 coloured RTE foods analyzed, 32% were sweetmeats, 40% were hard boiled sugar confectioneries, 21% were miscellaneous foods and 7% were non-alcoholic beverages. The analysis showed that 90% of these foods contained permitted colours, while 8% used non-permitted colours and 2% had a combination of permitted and nonpermitted colours. Findings indicated that permitted colours tartrazine along with brilliant blue F.C.F is the mostly widely used colour. The study showed that permitted colours were used in a majority of RTE foods. However, the quantities of colours detected ranged from 101 ppm to 18,767 ppm. The highest concentrations were found in sweetmeats (18767 ppm), non-alcoholic beverages (9450 ppm), miscellaneous foods (6106 ppm) and hard-boiled sugar confectioneries (3811 ppm). However, the use of non-permitted colours was found to be considerably low. It was also observed that some RTE foods which were not supposed to contain any added colours as per the PFA Act, contained colours. The Prevention of Food Adulteration (PFA) Act (1995) permitted eight colours to be added to specific foods but only six colours were being used. The usage of synthetic food colours is on the rise because of increased demand of ready-to-eat (RTE) foods. Excessive intake of synthetic colours may lead to toxic manifestations in humans. This observation necessitates the need for large scale multi-centric studies in the country to assess the usage of food colours in various RTE foods and help in effecting necessary modifications with regard to both, numbers and levels of permitted colours in foods to be allowed as per the PFA Act. There is also a need for strict vigilance and enforcement by the 137
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Food Health Authorities as per the PFA Act. Consumer education should be given due priority so that consumers could be vigilant and avoid the adverse effects on their health due to excessive intake of permitted as well as non-permitted food colours.
Nutrition Foundation of India, New Delhi. (2005). NFI Bulletin, 2005 Oct., 26(4) : Integrated Child Development Services : Body composition and BMI criterion for Indians. New Delhi : NFI. 8 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.BODY MASS INDEX 4.BMI INDIANS 5.ICDS NUTRITION 6.CHILD NUTRITION 7.NUTRITION IN ICDS 8.ICDS.
Abstract : Integrated Child Development Services (ICDS) aims at improving growth and development during the critical intrauterine period, infancy and early childhood by providing an integrated package of nutrition, health and education services right in the vicinity of both, urban and rural population. The study evaluated the impact of the nutrition component of various Government programmes dealing with nutrition. Data from National Family Health Survey-2 1998-99 (NFHS2) indicated that exclusive breastfeeding among infants in the age group of 0-3 months was only 55.2%, and 33.5% infants in the age group 6-9 months received breast milk and semi-solid food. In an attempt to improve appropriate complementary feeding, a nationwide programme Pradhan Mantri Gramodaya Yojana (PMGY) (Prime Ministers Rural Development Programme) for providing take-home weaning foods for one week to below poverty line (BPL) families with infants between 7-12 months of age, was initiated in 2002-03. Experience gain in the last three years indicates that merely making financial provisions does not result in increase in the number of under-three children getting food supplements, and improvement in timely introduction of complementary feeds. Surveys carried out by the National Nutrition Monitoring Bureau 1999 (NNMB) had shown that over the last three decades there was no increase in the dietary intake of pre-school children. Lack of knowledge on child feeding, rearing and caring practices were major factors responsible for the low dietary intake in pre-school children. Time trends in nutritional status of pre-school children from NNMB and NFHS (2001) surveys showed that over 45% of the pre-school children were under nourished. Budget of the Department of Women and Child Development for the year 2005-06 was Rs. 35000 million for ICDS. But increase in the number of children in the 6-36 months age group or 3-6 years age group receiving food supplements through ICDS
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during the nineties was not commensurate with increase in the number of ICDS blocks. Drought surveys carried out by NIN have shown that ICDS programme was fully utilized by the population to bridge the gap in food supply, prevent reduction in dietary intake, and prevent deterioration in nutritional status of pre-school children. It appears that the nutrition component is well accepted by the population, but it is functioning more as a social welfare programme rather than a nutrition programme. The norms for funding ICDS programmes are uniform. Currently it is envisaged that 102 individuals per anganwadi should receive food supplements. But, as there is great difference in the percentage of BPL families and birth rates between states and districts, the number of persons who require food supplements in the anganwadi would also vary. Often the most needy persons are not identified and food supplements are not given according to their need. The most needy segments, that is children aged 6-36 months and women who are not able to come to the anganwadi, do not receive the food. To bring about change in the nutritional status of children, screening of all pre-school children should be done at least once in 3 months for early detection of under nutrition. Therefore, the focus should be on strengthening the nutrition and health education programme, enhancing the quality and impact of ICDS, and improving community ownership of the programme. It will be possible to cover a large number of children with the same fund allocation if take home food grains are provided to the family, and coupled with appropriate nutrition education, this will enable the under nourished child to consume all the food, that is about 600 kcal spread over 2 or more meals. Nutrition Foundation of India, New Delhi. (2006). Integrated Child Development Services : World Bank review. New Delhi : NFI. 4 p.
Key Words : 1. NUTRITION 2.RESEARCH NUTRITION 3.ICDS 4.EVALUATION OF ICDS 5.LACUNAE ICDS.
Abstract : The Integrated Child Development Services (ICDS) programme has expanded over its 30 years of operation to cover almost all development blocks in India and offers a wide range of health, nutrition and education services to preschoolers, women and adolescent girls. Some recent evaluations of ICDS centres were done by the NFHS (National Family Health Survey), and other sources which focused on the quality of infrastructure and inputs, and the execution of activities. An analysis done by NFHS in 1992/93 showed that ICDS centre was associated with a 5% reduction of being underweight in boys but not significant association for girls. Data collected in Kerala, Rajasthan and Uttar Pradesh between 2000-02 found that
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children who live in villages with an anganwadi centre (AWC) were not significantly less likely to be underweight or ill than other children. When using data on actual attendance at AWCs in 6 states, only in Kerala was better nutritional status associated with attendance. Information related to mother and child care, feeding practices and supplementary nutrition was found to be poor in Kerala, Rajasthan and Uttar Pradesh, the exception being ICDS centres in Maharashtra. It was found that by December 2000, only one quarter of children aged between 6 months to 6 years benefited from the Supplementary Nutrition Programme (SNP) component of ICDS. Coverage was particularly high in the north-eastern states. World Bank undertook an end line survey of ICDS-II in Kerala, Maharashtra, Uttar Pradesh, Chhattisgarh, Madhya Pradesh and Rajasthan during 2000-02, which showed that in Kerala and Maharashtra, almost every child aged 4-6 years attended the AWC at least once a month, whereas attendance rates were less than half of that in the other 4 states. According to NFHS-II, only one-third of children in India were offered any semisolid food between 6 and 9 months, and in Uttar Pradesh, Bihar and Madhya Pradesh this figure was 40%. Greater clarity and focus are needed if the ICDS programme is to make a substantial dent on the problem of persistent under nutrition in India. Also bridging the gap between the policy intentions of ICDS and its actual implementation, with large fiscal and institutional implications, and a huge potential long term impact on human development and economic growth, calls for great foresight, flexibility, planning and commitment.
Prasad, M. P. Rajendra. (2003). Small at birth and chronic diseases in later life. Hyderabad : National Institute of Nutrition. 6 p. Published : Nutrition News, 2003, Jan 24(1) : 1-6.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.LOW BIRTH WEIGHT 4.LOW BIRTH WEIGHT BABIES 5.IMPACT OF LOW BIRTH WEIGHT 6.CHRONIC DISEASE 7.UNDER NUTRITION HIMACHAL PRADESH 8.MALNUTRITION CHILDREN 1-5 YEARS 9.UNDERNUTRITION CHILDREN 1-5 YEARS CHILDREN 1-5 YEARS.
Abstract : This study was undertaken by National Institute of Nutrition to see whether low birth weight had any correlation with being at risk with chronic disease in later life, namely adolescent period. In this longitudinal study, 95 low birth weight (LBW) and 154 normal birth weight (NBW) full term babies were studied in the follow-up study, out of the original cohort of 2134. They were residents of 7 semi-urban villages in the periphery of Hyderabad, Andhra Pradesh. Anthropometric measurements, parents educational status and other family history 140
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of chronic disease, blood pressure, and other biochemical parameters for being at risk such as diabetes, coronary heart disease, and cardio-vascular disorders were studies to compare the two groups. It was found that mean values of risk factors were essentially similar in the two groups. The present mean lean body mass and percentage of body fat were also no significantly different. Though there were small differences in blood pressure and cholesterol between Normal Nutritional Status of LBW and Normal Nutritional Status of NBW group, they were not significant. The blood pressure and biochemical profile of Normal Nutritional Status was also not significantly different from the Low Nutritional Status group in both LBW and NBW children. The odds ratio (OR) for risk of developing chronic diseases seem to be different between LBW and NBW children, but were not significant. The study suggests that LBW children were not at any greater risk at the juncture, but it was a small trial in a localized area, hence such population should be followed up regularly and periodically monitored. Regular physical exercise should be encouraged, along with consumption of fresh fruit and vegetables, to prevent or delay the onset of chronic diseases. Soman, C.R. (2007). NFI Bulletin, 2007 Oct, 28(4) : fifty years of primary health care : the Kerala experience. New Delhi : Nutrition Foundation of India. 8 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.PRIMARY HEALTH CARE KERALA 4.HEALTH SITUATION KERALA 5.ADOLESCENT EDUCATION 6.ADOLESCENT HEALTH 7.ADOLESCENT GIRL 8.HEALTH AND NUTRITION EDUCATION 9.KERALA.
Abstract : During the last 50 years, the health infrastructure in Kerala has shown significant growth in terms of manpower, beds and institutions. When Primary Health Centres (PHCs) were considered the number had increased from 369 in 1960 to 1356 in 2004. A major development in Keralas health scene was the virtual domination of the private sector. It was found that more than 70% beds and institutions were in the private sector, and over 70% professionals served in the private sector. According to Human Development Report Kerala 2005, the highest infant mortality rate was found in 2 districts of Kerala, Wayanad (22 deaths per 1000 live births) and Idukki (20 deaths per 1000 live births), whereas lowest IMR was found in 3 districts Kollam, Pathanamthitta and Alappuzha (8 deaths per 1000 live births) in each district. Complete immunization was found to be highest in Alappuzha (97.4%), whereas lowest was in Malappuram district (59.8%). There were 93 Anganwadi Centres (AWCs) in 2 districts of Kerala, 92 ANCs (Ante-Natal Care) centres in Kottayam district, 90 ANCs in 4 districts of Kerala namely Kollam,
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Ernakulam, Wayanad and Kannur, whereas the lowest number of Anganwadi centres were found in Trivandrum (72). The percentage of low birth weight was found to be highest in Wayanad (30%) and lowest in Trivandrum (11%). The report on vital statistics for Kerala estimated that there were over 49,000 deaths from heart attacks during the year 2004. Prevalence of Type-2 diabetes and hypertension was found to be high in both men and women in both rural and urban areas. Incidence of over weight and obesity emerged as significant health problems in Kerala. The risk factors related to cardio-vascular diseases was 48.3% in rural females and 42.9% in urban females, and 33.6% in rural males and 32.1% in urban males on the BMI25 scale. The mean serum cholesterol in Kerala population (both rural and urban areas) exceeded 230 mg/dl and was much higher than reported levels from the rest of India. Data showed that nearly 37% males in rural Kerala and 31% in urban areas were smokers. It was probable that the distorted profile of dietary fat, loaded heavily in favour of saturated fats, almost exclusively provided by fresh coconuts and coconut oil, was the principal reason for the observed cardio-vascular diseases in Kerala. The study of Kerala has not yet taken note of the magnitude or developmental consequences of the burden of non-communicable diseases. Simple dietary and lifestyle interventions like exercise, increased consumption of fruits and vegetables, and abstinence from tobacco and alcohol can make a substantial dent in the problem of non-communicable diseases in Kerala.
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Gopalan, C. (2008). NFI Bulletin, 2008 Jul, 29(3) : Vitamin A deficiency - overkill. New Delhi Nutrition Foundation of India. 8 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.VITAMIN A DEFICIENCY 4.DIETARY INTAKE 5.FOOD CONSUMPTION 6.NUTRITIONAL STATUS WOMEN.
Abstract : The nutrient that has been occupying centre stage in the international nutrition scene, for over 3 decades, has been Vitamin A. Vitamin A is an important essential nutrient involved in quite a wide range of metabolic functions. Data from National Nutrition Monitoring Bureau (NNMB) and Indian Council of Medical Research (ICMR) micronutrient surveys indicates that over decades there had been a reduction in the prevalence of Bitots spots which is caused due to the deficiency of Vitamin A. Vitamin A administration was associated with a reduction in childhood mortality and was taken up in 72 blocks in Uttar Pradesh, India between 1999-2004. In this study, children from different areas were given six monthly massive dose of Vitamin A, six monthly de-worming or both or neither. About 1 million children were followed longitudinally and mortality rates in 1-6 years old children were recorded. There was no significant difference in the death rates between children who received the massive dose of Vitamin A and those who did not. It was well known that massive doses of Vitamin A could lead to acute toxicity symptoms in a certain proportion of cases. These toxic symptoms consisted of signs of increased intracranial tension. It was found by a study in Assam that several children died as a result of massive dose of Vitamin A which attracted severe censure and condemnation from the judiciary. It was found that currently 38% of Indian children were stunted with linear growth levels below 2 SD of the international standard. The prevalence of stunting in India is higher than that in Sub-Saharan Africa. Detailed studies have shown that in children of poor communities, the downward deviation from normal growth sets in during the third and fourth months of infancy and progresses till the fifth year of age. According to available survey reports of the NNMB (National Nutrition Monitoring Bureau) Bitots spots, the mild form of Vitamin A deficiency, was seen in just 0.7% of children under 5 years of age in India. There were reports to show that 90% of children suffered from anaemia. The emergence of the dual nutrition burden should therefore be considered as an opportunity to improve nutritional status of the population by combating both Vitamin A deficiency and excess of Vitamin A through nutrition and health education. 143
Radhika, M.S. et al. (2006). Effect of Vitamin A deficiency during pregnancy on maternal and child health. Hyderabad : National Institute of Nutrition. 6 p.
Key Words : 1.NUTRITION 2.RESEARCH NUTRITION 3.VITAMIN A DEFICIENCY 4.MATERNAL AND CHILD HEALTH 5.UNDERNUTRITION CHILDREN 6.PREGNANCY OUTCOME 7.PRETERM INFANT 8.PREMATURE INFANT.
Abstract : Vitamin A has a critical role in normal vision, cell differentiation, proliferation and maintenance of epithelial cell integrity. The present study involved 736 women in their third trimester of pregnancy (32-36 weeks) and their infants from a local government hospital catering to low socio-economic status (LSES) and from a private nursing home for women belonging to high socio-economic status (HSES). All the women received 75-100 tablets of Fefol (60 mg iron and 500 mg folate). All the participants underwent a detailed obstetric, clinical, anthropometric and biochemical examination. Height and weight of pregnant women was measured, maternal postnatal weight was recorded within 48 hours of delivery, and the body mass index (BMI) was calculated. More than 33% women were primigravidae and approximately 32% had BMI<20 kg/ m2. Mean birth weight (SD) of the infants was 2.88 (0.51) kg while 9.4% were preterm. Night blindness (NB) was observed in 2.9% of the women studied. However all the women having night blindness belonged to LSES. Mean (SD) serum retinol was 27.1 (11.35) mg/ dl. 35% of the women had serum retinol 30mg/ dl while 3.5% of the study population had very low serum retinol (<10mg/ dl). Mean haemoglobin (SD) was 9.3 (1.93) g/ dl. 41.2% women had moderate to severe anaemia (<9g/ dl), while 45.4% had mild anaemia (9-10.9g/ dl). About 13.4% women were normal with Hb>11g/ dl. 116 women (15.8%) developed pregnancy induced hypertension (PIH) during the course of the study. Odds ratio (OR) for spontaneous preterm deliveries and PIH were significantly higher when serum retinol levels (kg/ dl) were <19 and <20 by univariate analysis which however, was not sustained after adjusting for the confounding variables. It was observed that Vitamin A deficiency was a problem at clinical as well as sub-clinical level in pregnant women in their third trimester. Mild as well as sub-clinical Vitamin A deficiency has been widely reported to be associated with an increased risk of morbidity and mortality in children. However, the impact of Vitamin A deficiency during pregnancy on maternal and fetal health has not been documented. There are no cut-off levels for serum retinol to define sub-clinical/ biochemical deficiency of Vitamin A in pregnant women, unlike in children. However, measuring serum Vitamin A concentration along with dietary intake and correlating them with breast milk
144
levels suggested a level of 30 mg/ dl below which the Vitamin A status may be defined to be deficient in pregnancy. A significantly increased risk for spontaneous preterm delivery (OR=1.74, 95% CL 1.03-2.96), moderate to severe anaemia (OR=1.82, 95% CI 1.28-2.60), and PIH (OR=1.56, 95% CI 1.02-2.38) was observed when the serum retinol levels were <20mg/ dl. Based on these functional effects, a level of serum retinol 20mg/ dl was suggested as the cut off to define Vitamin A deficiency in the third trimester of pregnancy. Even after adjusting for the various confounding factors spontaneous pre-term delivery and anaemia were significantly associated with serum retinol <20mg/ dl suggesting the role of Vitamin A deficiency. The observation of co-existence of anaemia and low retinol levels in this study is interesting particularly because all the women received iron supplements during pregnancy. It is well established that Vitamin A is essential for non-heme iron absorption and utilization. The mechanism of spontaneous pre-term deliveries in Vitamin A deficiency needs further studies. The study suggests that irrespective of iron intakes in pregnancy, low retinol levels may have a possible contributory role in limiting iron utilization and aggravating pregnancy anaemia. Nevertheless, due to the complex inter-relationship between anaemia, low BMI and low serum retinol levels, the contributory role of Vitamin A, if any, in the development of PIH may be difficult to be ruled out, and prospective intervention studies might provide an answer. The study concludes that Vitamin A deficiency with serum retinol <20mg/ dl appears to be an important problem in pregnancy, and is significantly associated with spontaneous pre-term delivery and moderate to severe maternal anaemia.
National Institute of Nutrition, Hyderabad. (2006). Prevalence of Vitamin A deficiency among preschool children in rural areas. Hyderabad : NIN. ~50 p.
Key Words : 1.NUTRITION 2.VITAMIN A DEFICIENCY 3.NNMB REPORT 4.NNMB REPORT 2006 5.PRESCHOOL CHILDREN 6.CHILD NUTRITION 7.RURAL AREAS.
Abstract : The National Nutrition Monitoring Bureau (NNMB) undertook exclusive surveys during 2002-03 in eight states viz., Andhra Pradesh, Karnataka, Kerala, Madhya Pradesh, Orissa, Tamil Nadu, Maharasthra, and West Bengal, to assess the prevalence of micronutrient deficiencies viz., Vitamin A Deficiency (VAD), Iodine Deficiency Disorders (IDD) and Iron Deficiency Anaemia (IDA) among the vulnerable groups of rural population. The investigations included assessment of prevalence of clinical forms of Vitamin A Deficiency among preschool children. The prevalence of sub-clinical VAD was significantly high among preschool children in
145
Muslim (69.3%), and Christian (68.8%) communities, scheduled tribe (74.1%) and other backward communities (62.9%), those engaged in other labour (64.1%), and business (65.4%). Only about 41% of the mothers of 1-5 years old preschool children were aware of night blindness. About 30% children reportedly received one or more massive doses of Vitamin A during the previous one year, while about 25% received two doses. Only about 1% of those children who received massive doses of Vitamin A reportedly experienced side effects such as fever/ vomiting (0.3%) or nausea (0.1%). Only about 13% of the women said that they received nutrition education on VAD. About 32% women stated that they would consult a doctor in case of VAD, about 7% said that they would get a massive dose of Vitamin A administered to the child, while about 3% said that they would use household remedies. None of them mentioned consumption of Vitamin A rich foods. The most common reasons cited by mothers for the child not receiving the massive dose of Vitamin A was that they were not aware. The overall prevalence of Bitots spots (0.8%) among preschool children was similar to that observed in earlier surveys (NNMB Repeat Survey 1999, NNMB Rural Survey 2001 and ICMR Survey). The prevalence of Bitots spots was higher than the WHO cut-off level of 0.5% in 6 out of 8 states surveyed, indicating that VAD continues to be a nutritional problem of public health. The prevalence of Bitots spots was nil in the state of Kerala, it was about 0.3% in Orissa. Several evaluations of national nutrition programmes carried out in the past have revealed that they failed in achieving the set objectives due to inadequate coverage of the target, individual supplementation and lack of nutrition education in the target groups. Nutrition education is considered to be a major component of all the national nutrition programmes. The present study revealed that the nutrition education component was unsatisfactory covering a mere 14% of the target beneficiaries. There is an urgent need to strengthen the programme of supplementation of massive dose of Vitamin A to young children and to extend the same to children up to 5 years of age. IEC activities have to be intensified to bring in dietary diversification by encouraging the community to grow kitchen gardens and to include locally available Vitamin A rich foods in their daily diets, more frequently. The scope of fortifying foods with Vitamin A wherever possible, should also be explored.
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VOLUNTARY ORGANISATIONS NUTRITION
Tikku, Nirmal. (2004). NGOs in three North Indian states. New Delhi : NIPCCD. 19 p.
Key Words : 1.NUTRITION 2.VOLUNTARY ORGANIZATIONS NUTRITION AND HEALTH 3.NUTRITION AND HEALTH VOLUNTARY ORGANIZATIONS 4.VOLUNTARY ORGANIZATIONS 5.NGOS 6.EVALUATION OF VOLUNTARY ORGANIZATIONS.
Abstract : NGOs have important lessons to offer, particularly on how to identify the poorest in the community and how to involve their participation in the process of development. The main aims of the study were to assess the nature and types of programmes being conducted by NGOs to improve the nutritional and health status of women and children; and suggest strategies to improve the functioning of NGOs in three states of north India, i.e., Delhi, Haryana and Rajasthan. It was found that all the selected NGOs were registered with some society. The universe comprised 429 NGOs, of which 222 were in Delhi, while 52 and 155 were operating in Haryana and Rajasthan respectively. Pre-testing was done on 238 of the 429 NGOs, and data showed that 45 NGOs were not involved in any related activity. Elimination of these 45 NGOs left 193 NGOs involved in health and nutrition activities. Only 65 NGOs finally responded and provided the required information, and of these 27 (42%) were in Delhi while 14 (21%) and 24 (37%) were in Haryana and Rajasthan. It was observed that there was no proper mechanism for obtaining and analyzing information on health and nutrition services being provided by voluntary organizations. Lack of coordination and support from Government departments, and inadequate and untimely release of funds were some of the problems faced by NGOs. These NGOs were involved in tackling endemic and emerging diseases like jaundice, TB, malaria and dengue. HIV/ AIDS/ STDs should be given more emphasis. Some of the current topics like oral health, stress management and diseases caused due to changing lifestyle (like mental illnesses), cardio vascular diseases (CVD), obesity, and anaemia among adolescents, etc. were not dealt with. Each state should have a data bank at district/ state level to obtain information regarding nutrition and health related activities taken up by NGOs. NGOs should take up projects related to the present challenges in the areas of health and nutrition. NGOs should 147
Voluntary Organisations Nutrition
develop skills/ capabilities of their staff as per their job requirements. NGOs should collaborate with academic and other allied institutions and medical colleges to take up projects related to emerging nutrition and health problems. Further, it was also suggested that NGOs should keep a portion of their budget for staff development, and ensure that it is used for the purpose for which it was earmarked. Funding agencies should ensure that appropriate project proposals, as per the requirement of the people, are prepared and approved by NGOs. Therefore, there is an urgent need to form a database on nutrition and health activities undertaken by NGOs, so that outreach of the needed health and nutrition services can be increased by collaboration between Government and NGOs.
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Index
Subject
Adolescent Girls Adolescent Mothers Anaemia Anaemia Adolescent Girls Anaemia Pregnant Women Anaemia Prevention Programme Breastfeeding Child Abuse Child Nutrition Children of Alcoholics Cost of Malnutrition Cows Milk Desert Areas Diabetes Diarrhoeal Illnesses Diet College Students
Page No.
1, 2, 11, 104, 135 1 3, 9, 83, 84 4, 5, 6, 7, 11 8, 88 3, 4, 5, 7 13, 14, 15, 16, 17, 18, 19, 20 77 22, 23, 26, 62 77 80 26 88, 128, 129 26 15 32
149
Subject
Diet School Children Food Colours Food Consumption/ Intake Food Fortification Food Security/ Insecurity Food supplements Fortified Candy Gender Differences Growth Monitoring Growth of Children Hunger Hunger Index ICDS Infant and Young Child Feeding
Page No.
32 137 27, 28, 29, 30, 32, 104, 106, 135 34, 35, 36 38,3 9, 40 12 34 92 77, 119 58 42, 43, 44 42 92, 138, 139 17, 32, 47, 48, 49, 51, 53, 54, 56, 57, 58 2
Information, Education and Communication (IEC)
Intervention Programmes Iodine Deficiency Disorders (IDD)/ Goitre Iodized Salt 150
3, 34, 48, 49, 111 60, 61, 63, 64, 68, 69, 70 65, 66, 67
Subject
Irion Supplementation Low Birth Weight Malnutrition
Page No.
12, 84 140 9, 44, 72, 73, 74, 75, 76, 77, 79, 80, 82, 121 36, 83, 84, 86, 87, 88, 90 91, 93, 94, 95, 96, 98, 99, 101, 102 72 105, 106 2 2 112 114 77 1, 2, 30, 104, 116, 117, 119, 121, 122, 123, 124, 126, 127, 128, 129, 130, 131 126
Micronutrients/ Micronutrient Deficiencies Mid Day Meals National Strategy Child Malnutrition Nutrition Education Nutrition Knowledge Nutrition Practices Nutrition Rehabilitation Nutrition Situation Nutritional Neglect Nutritional Status
Nutritional Status Differently Abled Children
Nutritional Surveillance Obesity Pregnant Women 151
132 134 8, 88, 144
Subject
Preschool Children
Page No.
32, 36, 39, 48, 49, 72, 76, 82, 84, 92, 117, 119, 121, 123, 124, 129, 138, 145 141 43, 44, 45 32, 35, 70, 93, 122, 134 2, 20, 73 107, 108, 109 135 83, 84, 143, 144, 145 147
Primary Health Care Right to Food School Children Slums Training of Manpower Tribal Population Vitamin A Deficiency Voluntary Organizations
152

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Research Abstracts on Nutrition

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Copyright: National Institute of Public Cooperation and Child Development, 2009

Guidance and Support

Dr. Dinesh Paul Dr. Sulochana Vasudevan

Subject and Titles

Anaemia/ Iron Deficiency/ Iron Supplementation

Food/ Dietary Behaviour/ Food Intake

Food Security/ Food Insecurity

Hunger/ Hunger Deaths/ Right to Food

Infant and Young Child Feeding/ Weaning Foods

Subject and Titles

Iodine Deficiency Disorders/ Goitre/ Iodized Salt

Malnutrition/ Undernutrition/ Protein Energy Malnutrition (PEM)

Micronutrients/ Micronutrient Deficiency

Mid Day Meals/ ICDS

Page No. 101

National Nutrition Monitoring Bureau

Nutrition Education/ Training Nutrition

Subject and Titles

Nutritional Status/ Dietary Pattern

Subject and Titles

Page No. 119

Subject and Titles

Page No. 127

Subject and Titles

Page No. 137

Voluntary Organisations Nutrition