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Programmes for Mother and Child Nutrition


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Mother & Child Nutrition

More than half of all child deaths are associated with malnutrition, which weakens the body's resistance to illness. Poor diet, frequent illness, and inadequate or inattentive care of young children can lead to malnutrition.

If a woman is malnourished during pregnancy, or if her child is malnourished during the first two years of life, the child's physical and mental growth and development may be slowed. This cannot be made up when the child is older – it will affect the child for the rest of his or her life.

Children have the right to a caring, protective environment and to nutritious food and basic health care to protect them from illness and promote growth and development.

 

Deaths among children aged 28 days to 5 years - 6.6 million/year

Child deaths: Causes and epidemiological dimensions
Robert E. Black, M.D., M.P.H.
Johns Hopkins Bloomberg School of Public Health
Full text at The Lancet


 

Progress For Children: A Report Card on Nutrition


 




“ With our resources and the money we spend we could easily accomplish three times what we do, in half the time we normally take, if we were to operate in mission mode with a vision for the nation. ”

-- APJ Abdul Kalam - President of India - Ignited Minds

 



Malnutrition in India

Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India.

About 50 per cent of all childhood deaths are attributed to malnutrition. Malnutrition limits development and the capacity to learn.

In India, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished.

The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 per cent) and Kerala among the lowest (27 per cent).

Malnutrition in children is not affected by food intake alone; it is also influenced by access to health services, quality of care for the child and pregnant mother as well as good hygiene practices. Girls are more at risk of malnutrition than boys because of their lower social status.

Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults, at greater risk of disease and early death. Around one-third of all adult women are underweight. Inadequate care of women and girls, especially during pregnancy, results in low-birth weight babies. Nearly 30 per cent of all newborns have a low birth weight, making them vulnerable to further malnutrition and disease.

Vitamin and mineral deficiencies also affect children’s survival and development. Anaemia affects 74 per cent of children under the age of three, more than 90 per cent of adolescent girls and 50 per cent of women. Iodine deficiency, which reduces learning capacity by up to 13 per cent, is widespread because fewer than half of all households use iodised salt. Vitamin A deficiency, which causes blindness and increases morbidity and mortality among pre-schoolers, also remains a public-health problem.

 



Maharashtra, India Objectives

  1. Reduction in Grade 3 & 4 malnutrition in 0-6 age group
  2. Special focus on health, nutrition and immunisation aspects in 0-3 age group
  3. Reduction in Grade 1 & 2 malnutrition in 0-6 age group
  4. Newborn care initiatives
  5. Antenatal, perinatal and postnatal care for mothers
  6. Focus on pre-teen/adolescent girls: nutrition and health education
  7. Transfer of the management function to the community

Focus areas

  1. Antenatal care
  2. Feeding practices
  3. Complete immunisation
  4. Deworming
  5. Micronutrient supplementation
  6. Nutrition/health education

Issues for thought

  1. Still too much focus on food, too little on improving child-care behaviour, family nutrition patterns
  2. Children in 0-3 age group and from disadvantaged groups not served adequately by existing ICDS
  3. Lack of clear policy focus on areas with greatest levels of malnutrition

A need to put emphasis on

  1. Human change, relationships & partnerships (personal/interpersonal/systemic)
  2. Shared understanding of malnutrition in a holistic framework
  3. Interaction between actors concerned with malnutrition, especially the communities to be served
  4. Passion, commitment, orientation to action

 

Infant and Young Child Feeding and Nutrition

Feeding is a critical aspect of caring for infants and young children. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development. They lead to improved nutrition and physical growth, reduced susceptibility to common childhood infections and better resistance to cope with them. Improved health outcomes in young children have long-lasting health effects throughout the life-span, including increased performance and productivity, and reduced risk of certain non-communicable diseases.

Child Feeding and Nutrition ( 2-5 years age )

Malnutrition contributes to more than half of all childhood deaths, although it is rarely listed as the direct cause. For most children, lack of access to food is not the only cause of malnutrition. Poor feeding practices and infection, or a combination of the two, are both major factors of malnutrition. Infection – particularly frequent or persistent diarrhoea, pneumonia, measles and malaria – undermines nutritional status. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, giving insufficient quantities, and not ensuring that the child gets enough food, contribute to malnutrition.

Malnourished children are, in turn, more vulnerable to disease and the vicious circle is established.

Improved feeding practices to prevent or treat malnutrition could save 800,000 lives per year.

  • Counselling for mothers and caretakers
  • Micronutrient supplements
  • Management of severe malnutrition

Adolescent Nutrition

Adolescence represents a window of opportunity to prepare for a healthy adult life. During adolescence, nutritional problems originating earlier in life can potentially be corrected, in addition to addressing current ones. It is also a timely period to shape and consolidate healthy eating and lifestyle behaviours, thereby preventing or postponing the onset of nutrition-related chronic diseases in adulthood.

As adolescents have a low prevalence of infections such as pneumonia and gastroenteritis compared with younger children, and of chronic disease compared with ageing people, they have generally been given little health and nutrition attention, except for reproductive health concerns. However, there are nutritional issues, which are adolescent-specific, and which call for specific strategies and approaches.

The main issues in adolescent nutrition are:

  • Micronutrient deficiencies (iron deficiency and anaemia)
  • Malnutrition and stunting
  • Obesity and other nutrition-related chronic diseases
  • Adolescents eating patterns and lifestyles
  • Nutrition in relation to early pregnancy

What is needed

Enough food and the right kinds of food

Nutritional needs of young children

Protecting children from infections

Quality care when children fall ill

Micronutrient deficiencies

  • Iodine, Iron, Vitamin A, Zinc, ...

Nutritional needs of girls and women

What every family and community have a right to know

 


Programmes for Mother & Child Nutrition

No claim for originality of the programmes is made by HETV. We acknowledge our gratitude to the many people and sources whose work has been drawn freely upon. We thank them all. Programmes will be supplemented and supported by booklets, leaflets, posters and informational guides in Marathi and English, and made freely available at health worker stations, hospitals, schools, and more.

 


Enough Food and the Right Kind of Food

Chronically Undernourished Children

Chronically Undernourished
40% of both mothers and children in Maharashtra, India are chronically undernourished, and under-five mortality occurs at 58 deaths per 1000 live births, or 1 in every 17 children. A very large number of these deaths are caused by dehydration from diarrhoea, the most easily preventable cause of childhood mortality.


Nurturing newborns and their mothers

Nurturing Newborns
Skilled attendance during pregnancy, childbirth and the immediate postpartum period. Mothers will be provided with training for breastfeeding from the nurse or midwife, encouraged about the importance of providing colostrum within the first half hour after birth, and advised about other questions they may have about their newborn or postpartum period.


Nutritional Needs of Young Children

Breastfeeding

Breastfeeding
Protect against diseases through the promotion of clear guidelines about proper feeding practices and the benefits of immunity. Promote the practice of providing colostrum to the child within the first half hour after birth, exclusive breastfeeding during the first six months of a child’s life, with appropriate complementary feeding from six months and continued breastfeeding for two years or beyond, with supplementation of vitamin A and other micronutrients as needed.


Complementary Feeding

Complementary Feeding
Complementary feeding means giving foods in addition to breastmilk. Malnutrition can result from suboptimal breastfeeding practices, poor quality complementary foods, detrimental feeding practices, and contamination of complementary food and feeding utensils. The second half of an infant's first year is an especially vulnerable time because infants are learning to eat and must be fed soft foods frequently and patiently. If nutritional intake is inadequate, the consequences persist throughout life.


 

Child feeding practices

Continuous Feeding During Diarrhoea
Experience shows that food should not be withheld from infants and children with acute diarrhoea. Depending on their feeding status, children should receive breast-milk or diluted milk feeds; in cases of dehydration, these should be offered as soon as initial rehydration therapy has been completed. Appropriate locally available foods (cereals) should be offered as soon as the appetite returns. After the diarrhoea ceases, more than the usual amount of food should b given for a short period. The routine use of any special infant formula (lactose-free products) for diarrhoea cases should be strongly discouraged as they are only rarely necessary and are costly.


Protecting Children From Infections

Measles Immunization

Measles Immunization
Reduce incidence of diarrhoea by promoting measles vaccination within the first year of a child’s life. 100% immunization coverage against measles is the programme goal.


 

Diarrhoea Management

Diarrhoea Management
Intended to target mothers’ confusion and lack of understanding about how to recognize, assess the degree of, and treat diarrhoeal dehydration. Mothers will be taught the crucial need for immediate fluid replacement, increased fluids and food, how to correctly prepare home-made and packaged ORS, cereal-based ORS, when and why to use it, and continuous feeding, including breastfeeding.


 

Recognizing Dehydration

Recognizing Dehydration
If mothers could recognize and treat dehydration early on at home, the great majority of children would not need additional medical care. While only 41% of mothers in Maharashtra can correctly identify symptoms suggesting a child needs medical treatment for dehydration, 77% take a child with diarrhoea to a health facility. In this way, better practice and education would save mothers the trouble and expense of travelling to the health centre (and also prevent them from spending money on unnecessary drugs), and it would release some of the burden on health facilities, allowing better treatment for children who are severely ill.


 

Correcting Dehydration with Home-made Solutions

Correcting Dehydration with Home-made Solutions
Define and Promote Home-Made Solutions--define clear definitions for home-made solutions (tea, rice water with extra rice, etc.)

The first-level health worker, a community health worker who has a crucial role to play in disseminating knowledge and skills for the management of diarrhoea, as regards the use of both home remedies and ORS. ORS packets should be available in adequate supply at this level and throughout the entire health system. If this is not possible, maximum efforts should continue towards this end and, in the meantime, as complete a formulation as possibly should be used, recognizing its limitations. When potassium is a missing ingredient, patients should be encouraged to drink fluids that are rich in potassium (fruit juices). Increased fluids and Preparation of home-made and packaged solutions. For the preparation of ORS solution the safest water should be used.


 

Measuring Sugar and SaltMeasuring Water

Measuring Sugar, Salt and Water
Correct the confusion created by years of mixed messages regarding measurement of the ingredients in rehydration solutions. Mothers will receive a plastic one-litre bottle, with a label about how to recognize signs and degrees of dehydration, how to prepare home fluids for rehydration, and how to mix and prepare home-made and packaged ORS. Additionally, they will receive a 2-sided spoon to correctly measure salt and sugar.


 

Cereal based ORT

Cereal Based ORT
Oral rehydration therapy, if properly practiced, can cut infant and child mortality rates by at least half and obviate the need for countless millions of costly visits to hospitals, health centres, and clinics in all countries.  But is this feasible? Packets of oral rehydration salts (ORS) are not universally available and the simpler sugar-salt solution can have dangerous effects if it is improperly mixed or administered.  Cereal-based ORT can overcome both of these disadvantages by providing yet another option for oral rehydration therapy.


Safe Water, Hygiene and Sanitation Facilities

Safe Water Systems

Safe Water Systems
Safe Water Systems are water quality interventions that employ simple, inexpensive and robust technologies appropriate for the developing world. The objective is to make water safe through disinfection and safe storage at the point of use.

Point-of-use treatment of contaminated water using sodium hypochlorite solution purchased locally and produced in the community from water and salt using an electrolytic cell;

Behaviour change techniques, including social marketing, community mobilization, motivational interviewing, communication, and education, to increase awareness of the link between contaminated water and disease and the benefits of safe water, and to influence hygiene behaviours including the purchase and proper use of the water storage vessel and disinfectant.


 

 

Water Harvesting


 

Safe Water Systems

Safe Water Storage in plastic containers with a narrow mouth, lid, and a spigot to prevent recontamination.


 

Water disinfection

Solar Disinfection of Water

Disinfect soiled water with this free and easy technique using solar radiation. This simple process of filling transparent containers with water, and exposing them to full sunlight for about five hours, destroys pathogens in the water.


 

Solar Disinfection

Water Disinfection

Treat soiled water and prevent the spread of disease by promoting the practice of boiling water and the usage of chlorine, iodine, or even household bleach, to conduct home water disinfection. Health workers will be trained to use these practices, and will convey the techniques to mothers.


Toilet Facilities in all Schools

Toilet Facilities in All Schools
Encourage and contribute to developing the necessary partnership between the state of Maharashtra and the Government of India’s programmes to establish toilet facilities in all schools. The Indian government has launched a focused campaign to increase the households in the country that have toilets by 2010. Additionally, we will target the urgent need for separate toilets for boys and girls, together with a hand-washing facility in every school in Maharashtra.


 

Hand Washing with Soap and Water
 

Usage of Soap and Water

Promote the habit of Hand Washing with Soap and Water to decrease episodes of diarrhoea. To ensure the sufficient availability of soap, partnerships with local manufacturers will be used to promote this practice.


Quality care when children fall ill

 


Micronutrient deficiencies

Zinc Supplementation - ORS and Zinc : Treatment of diarrhoea is now more effective

Zinc Supplementation
ORS and Zinc : Treatment of diarrhoea is now more effective

Prevent deaths from diarrhoea and decrease child susceptibility to diarrhoea after episodes by educating all health-care providers and mothers about zinc supplementation. Through focused and integrated campaigns, and through partnerships with local manufacturers, we will increase availability of zinc supplements.


Health Education

Facts for Life Wall Calendar

Facts for Life Wall Calendar
This 13-month calendar, corresponding to the 13 Facts for Life messages, makes life-saving information easily available to everyone. It presents important health information about an issue or concern that every family has a right to know. The messages are simple, and people in Maharashtra can act on them. The calendar will also indicate state health days, and health educational mass media events.






 

 

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