PREVENTION OF UNDERNUTRITION
Undernutrition is more of a socio-economic problem, rather than the medical disease. A comprehensive approach is required, especially in developing countries to overcome it. Important preventive steps against PEM include:
I.
Promotion of general health and nutrition:• Actions at family level to promote:
- Correct breastfeeding and weaning practices
- Consumption of cheap, local, nutritive foods
- Correct cooking practices
- Avoidance of wrong food taboos and habits
- Equitable food distribution in the family
- Setting of kitchen gardens/poultry keeping
- Correct feeding practices during illnesses
- Nutrition in pregnant/lactating mothers
- General child health/hygiene
- Family planning practices
• Action at community level:
- Nutritional surveillance
- Nutritional education
- Development of local low-cost foods
- General measures to improve child health, e.g.
#9632; Improved water supply and sanitation
#9632; Widespread immunization services
#9632; Preventive/curative healthcare facilities
- Creation of local job opportunities
• Action at national level to promote:
- Agricultural production
- Food-storage facilities and public distribution
- General rural/urban-slum development
- Poverty-alleviation measures,
- Food subsidies to high-risk population
- Targeted health and nutritional programs
• Action at international level:
- International aids for socioeconomic development.
- World Food Program (1963) to meet food requirements in needy countries.
- International cooperation during emergencies, e.g. natural disasters and wars.
II. Specific protection to high-risk children:
• Nutritional surveillance in preschool children
• Nutritional supplementation/food fortification
• Periodic deworming and iron supplements, etc.
• Immunization to control infections
III.
Early diagnosis and management:• Growth monitoring of under-5 children
• Nutritional assessment at all contact points
• Early diagnosis and management of PEM
• Early diagnosis and treatment of infections
IV. Follow-up and rehabilitation:
• Nutritional rehabilitation centers/services
• Follow-up of recovered cases
National Nutrition Policy, (1993) to tackle problem of undernutrition, has four major components:
a. Nutritional intervention for vulnerable groups, e.g.
children, pregnant mothers and adolescent girls,
b. Fortification of essential foods,
c. Popularization of low-cost nutritious food,
d. Control of micronutrient deficiencies among vulnerable groups.
Many supplementary nutrition programs are operational in India to achieve these objectives, some as follows:
Mid-day Meal Programme was first launched in 1925 for disadvantaged children in Madras Municipal Corporation. In 1995, it was converted to a centrally- sponsored scheme for children in classes I-V of the government, government-aided and local body schools. Coverage was later extended to alternative educations institutions and then to children in upper primary classes (VI-VIII) in 2004.
Objectives: Mid-day meal program aims to provide ~1#8725;3rd of the calories and frac12; of the protein requirements, using low-cost, locally available and acceptable food items, to: (a) improve the nutritional status of children, and (b) to encourage them to attend school regularly and prevent drop-outs.
Beneficiaries include all children up to 8th standard, studying in government or government-aided schools, including alternative education centers, e.g. madarsa.
Activities: Under this scheme, only cooked lunch with minimum 300 calories and 8-12 grams of protein is provided to primary school children (classes I-V); and 700 calories and 20 grams of protein to those in higher classes. Mid-day meal should be considered only as a supplement and not the replacement of regular meals.
Organization: Central government provides free food grains @ 100 grams per child per school day, along with transport and cooking costs. However, the program is carried out by local authorities. Non-government organizations or self-help groups are used for cooking, under supervision of local committees or parent-teacher associations.
Integrated child development scheme (ICDS) provides supplementary nutrition is to children lt;6 years and pregnant mothers, along with other services for children 6 months -6 years, it provides 500 cal and 12-15 gm proteins/day (800 cal and 20-25 gm proteins/day to children with SAM) (for details See Ch 28.4).
Poshan Abhiyaan (Prime Minister's Overarching Scheme for Holistic Nutrition), previously termed as National Nutrition Mission, was launched in 2018 to:
• To reduce prevalence of undernutrition, stunting, anemia and low birth weight by 2% annually,
• To enhance nutritional status of children, adolescents, pregnant women and lactating mothers.
Implemented by Ministry of Women and Child Development under policy directions from National Council for Nutrition, Poshan Abhiyaan involves:
• Mapping of various schemes related to malnutrition and develop a robust convergence between them,
• Real-time monitoring of data and encouraging Anganwadi workers to use IT-based tools for this purpose,
• Measurement of height of children at Anganwadi centers,
• Scaling up of the interventions under World Bank assisted ICDS.
• Setting-up Nutrition Resource Centres, social audits and involving masses for participation in nutritional activities.
6.2