1. CHILD NUTRITION : CURRENT CONCERNS Dr Shanti Ghosh

2. Figure 1: Undernutrition prevalence in South Asian countries is much higher than in Africa Source: De Onis and others (2004a); SCN (2004) Prevalence rates for under-nutrition in India, Bangala Desh and Pakistan vary between 38-51% while those in Sab- saharan Africa are around 26%.

3. The window of opportunity for improving nutritional status is small from before pregnancy though the first two years of life. There is consensus that the damage to physical growth, brain development and human capital formation occurs during this period is largely irreversible. Therefore interventions must focus on this window of opportunity

4. Intergenerational Cycle of Growth Failure Child growth failure Early Pregnancy Low Birth Weight Low Height and Weight in teens Small adult women

5. Maternal health and nutrition outcomes are key determinants to birth outcomes Birth outcomes are key determinants for child mortality, health and development outcomes (Early) childhood health, nutrition and development outcomes are key determinants for adolescent health, nutrition and development Adolescent health influences maternal mortality, health and nutrition outcomes and The cycle continues

7. There is a progressive increase in under-nutrition between 6-18 months

10. Why is malnutrition high ? Malnutrition is low(10-30%) until around 6 M Malnutrition peaks(50-80%) by around 18 M Less than 25% of 6-18 months-olds eat even half the amount that WHO recommends, despite availability of food at home Every 6-8 months-old falls sick once in three weeks

13. Enabling strategies for breastfeeding for 6 months Six months maternity leave for women working in the organized sector Monetary support for non-organized sector Day care centre (crèches) managed by community, supported by panchayat Role of fathers

14. WHO recommendations for Complementary feeding 2001 - Exclusive breastfeeding for 6 month - Complementary feeding in increasing quantity and frequency after that Months TotalKcal from complimentary foodRounded to 6-8 m615 Kcal/d202 Kcal/d200 Kcal/d 9-11 m686 Kcal/d307 Kcal/d300 Kcal/d 12-23 m894 Kcal/d548 Kcal/d550Kcal/d Based on WHO Complementary feeding: Family foods for Breastfed children WHO, Geneva 2000 and 2001 Kcal Requirement

15. State/Percentage Underweight Percentage Started Breastfeeding within One Day of Birth Timely Complementary Feeding Rate Percentage Underweight Group A States (50 per cent or more underweight)3221.4 Group B States (40-49 per cent or more underweight)47.648.3 Group C States (30-39 per cent or more underweight)58.156.9 Group D States (less than 30 per cent or more underweight)64.970.9 Child Feeding Practices by Percentage Underweight Group A: Madhya Pradesh, Bihar, Orissa, Uttar Pradesh and Rajasthan Group B: Maharashtra, West Bengal, Gujarat, Karnataka, Himachal Pradesh and Tripura Group C: Meghalaya, Andhra Pradesh, Tamil Nadu, Assam, Delhi, Haryana, and Jammu and Kashmir Group D: Punjab, Goa, Mizoram, Manipur, Kerala, Arunachal Pradesh, Nagaland and Sikkim

17. Consequences of under nutrition Increase morbidity, increase mortality Decrease cognitive & social development Decrease work capacity & productivity Risk of morbidity 8-fold increase in severe under new nutrition 2-3 fold increase in moderate & mild under nutrition

18. WHO 2001 Malnutrition has been responsible directly or indirectly for 60% of the 10.9 Million deaths annually among children under 5 years; most occurring during the first year.

19. Severely underweight children (60% of ref. weight for age) have greater than eight fold risk of mortality than normally nourished children Moderately underweight children (60-69% of ref. weight for age) have a 4-5 fold greater risk and even mildly underweight children (70-79% weight for age) have a 2-3 times greater risk

20. Malnutrition responsible for 60% deaths among children under five Ballagio meeting (Lancet 2003) concluded that breastfeeding could prevent 13 to 16 percent of childhood deaths in India

21. Critical period 6m-2years Exclusive breastfeeding 6 months Home based semisolids 3-4 times after that Access to health care, preventive and curative

23. Mean Energy Consumption- Children/Adolescents and Adults Age GroupMales Females KcalsRDIRDI %KcalsRDI RDI % Pre-school889135765.5897135166.4 School Age1464192975.91409187675.1 Adolescent2065244184.61670182391.6 Adults2226242591.819231874102.6 Source: NNMB, 2000

24. Average Weight Velocity, Stratified by intervention group Reference: Kilaru, Griffith, Ganapathy, Ghosh 2005

26. For the first time in its 10 th Five Year Plan, Government of India has included state specific goals to improve- infant and young child feeding practices to reduce infant and young child mortality rates and to improve nutrition.

27. Child nutrition goals by 2007 (Tenth five year plan 2003-2007) Exclusive breastfeeding at 6 months-80%. At present it is 40- 50%. Universal complementary food introduction at 6 months from the current 33%(varying from 17.3% to 87.3% in different states). Reduce severe malnutrition in children 0-6 years by about 50%. Reduce prevalence of anemia by 25% and moderate and severe anemia by 50%. Eliminate vitamin A deficiency as a public health problem. Reduce IDD to less than 10%.