UPSC Essentials: Case Study of the week- Combating malnutrition the ‘Bharuch’ way

The Case

—One of the most fundamental building blocks of good health is Nutrition. It impacts development during childhood and adolescence.

—It is important to keep in mind that nutrition can have long-term effects on productivity, cognitive ability, and quality of life.

—But many children and adolescents do not have access to adequate nutrition in regions across India even today. This results acute malnutrition, anaemia and other similar disorders.

The Issue

—The high burden of malnutrition.

The Problem

—The article informs us that Gujarat has a high burden of malnutrition. The lack of nutrition often stems from poor nutrient diversity rather than low access to food.

—Often, traditional diets lack diversity, making it important to educate families about the need to incorporate foods that contain adequate protein, vitamins, iron and folic acid and other key micro-nutrients that aid growth.

The Solution

Reproductive health and child health are complementary

—In Bharuch, Gujarat, government programmes have taken a comprehensive approach to safeguarding reproductive health and child health, as these are complementary. Once the health and nutrition of the mother is ensured, the child is more likely to be born healthy and grow up within adequate health and nutrition parameters.

—The government machinery actively reaches out to women and girls at multiple stages of their development to safeguard their health. The cycle starts with adolescent girls, with whom outreach is conducted at Anganwadi Centres and by ASHAs.

—After birth, neonatal care is provided immediately, and between six months and six years, growth monitoring is conducted to ensure healthy development in children. Nutrition supplementation is also provided. While this takes place primarily through schools, Anganwadi Centres cater to those children who are not enrolled in school.

—Integrated Child Development Services (ICDS), Education, and Health departments target one or the other aspect of health and nutrition.

Innovative community- centric approaches

—In Bharuch’s Hansot block, a series of innovative, community-centric approaches have been introduced to address more specific issues.

—These targeted interventions aim to create an enabling ecosystem for parents, teachers, community members, and health care providers to safeguard child and adolescent nutrition.

—Collaborating with diverse partners, government departments in the block strengthened existing programmes in the block and rolled out new ones to engage these various stakeholders.

Building capacity and increasing awareness

—Data from implementation projects in the region show that building health worker capacity and increasing awareness of and accountability within existing schemes and programmes can make a marked difference in the nutritional status of children.

—Home visits to the families of children suffering from acute malnutrition has significantly improved nutrition outcomes.

—The sharing of guidance on feeding practices, such as highlighting the importance of consuming Take-Home Ration (THR) provided by the Anganwadi Centres, ensuring a balanced diet, and seeking timely and specialized treatment, has made an enormous impact.

Routine health screenings

—Hansot was the first block in the district to restart routine health screenings in schools and Anganwadi Centres, ensuring that children aged six months to eighteen years receive free medical services.

—All schools in the block and all Anganwadi Centres have been equipped to administer Weekly Iron and Folic Acid Supplementation (WIFS), in the form of syrups to infants and tablets to older children, in the presence of schoolteachers, to prevent anaemia.

—Anganwadi Centres also hold routine recipe demonstrations that have resulted in the improved consumption of Take-Home Rations in making healthy meals that suit local tastes.

SMART Anganwadi Centres

—To further strengthen early childhood nutrition and development, SMART Anganwadi Centres have been introduced in the block recently. These centers are equipped with safe and hygienic food storage and cooking equipment to provide daily meals to children between six months and five years old.

—These centers also cater to adolescent girls and mothers, and by teaching them about nutrition, conducting routine check-ups, and distributing supplements and fortified food, we hope to disrupt the inter-generational cycle of malnutrition.

According to Yogesh Chowdhary and Anuj Ghosh –

“Since healthy adolescents grow up to be healthy mothers who bear healthy children, it is critical that we adopt and scale up best practices to prevent malnutrition. By not only strengthening health systems but also creating bridges between providers and the communities they serve, we can build a health future where no child or young person is left behind.”

Beyond the case

What does WHO say about Malnutrition?

—Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization.

—The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases. Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies.

—Wasting is defined as low weight-for-height. It often indicates recent and severe weight loss, although it can also persist for a long time. It usually occurs when a person has not had food of adequate quality and quantity and/or they have had frequent or prolonged illnesses. Wasting in children is associated with a higher risk of death if not treated properly.

—Stunting is defined as low height-for-age. It is the result of chronic or recurrent undernutrition, usually associated with poverty, poor maternal health and nutrition, frequent illness and/or inappropriate feeding and care in early life. Stunting prevents children from reaching their physical and cognitive potential.

—Underweight is defined as low weight-for-age. A child who is underweight may be stunted, wasted or both.

—Micronutrient deficiencies are a lack of vitamins and minerals that are essential for body functions such as producing enzymes, hormones and other substances needed for growth and development.

What did the government say?

—In a reply to a question revolving around Malnutrition in Lok Sabha on July 22, 2022, the minister of women and child development Smriti Irani pointed out:

1. As per the recent report of NFHS-5 (2019-21), the prevalence of malnutrition among children under 5 years and women aged 15-49 years has reduced as compared with NFHS-4 (2015-16).

2. The efforts under the Supplementary Nutrition Programme under Anganwadi Services, Scheme for Adolescent Girls and POSHAN Abhiyaan have been re-aligned as ‘Saksham Anganwadi and POSHAN 2.0’for maximizing nutritional outcomes. It seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity.

—However, despite the decrease, nutrition experts have said that India has one of the highest burdens of malnutrition in the world.

Know some Government initiatives:

ICDS

—Integrated Child Development Services (ICDS) Scheme is one of the flagship programmes of the Government of India, implemented by Ministry of Women and Child Development.

—It is the foremost symbol of country’s commitment to its children and nursing mothers, as a response to the challenge of providing pre-school non-formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other.

—The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers.

Poshan Abhiyan

—The objective of POSHAN Abhiyaan is to reduce stunting in identified Districts of India with the highest malnutrition burden by improving utilisation of key Anganwadi Services and improving the quality of Anganwadi Services delivery.

POSHAN 2.0

—It is an umbrella scheme covering the Integrated Child Development Services (ICDS). It is aimed at strengthening nutritional content, delivery, outreach and outcome, with renewed focus on developing practices that nurture health, wellness and immunity to disease and malnutrition in the country.

Mid-Day Meal Scheme

—The Midday Meal Scheme is a school meal programme in India designed to better the nutritional standing of school-age children.

—It covers all school students studying in Classes 1 to 8 of government schools, government-aided schools, special training centres, including madrasas supported under Samagra Shiksha Abhiyan.

National Nutrition Strategy

—The Strategy aims to reduce all forms of malnutrition by 2030, with a focus on the most vulnerable and critical age groups.

—The Strategy also aims to assist in achieving the targets identified as part of the Sustainable Development Goals related to nutrition and health.

Other notable initiatives are- Pradhan Mantri Matru Vandana Yojana, Infant and young child feeding practices Kangaroo Mother Care (KMC) and optimal feeding of low-birth-weight infants etc.

Point to ponder: India faces a huge burden of malnutrition rooted in its social, economic, and cultural asymmetries and challenges. Discuss.

MCQ:

Consider the following statements and answer the question below

1. Stunting is defined as low weight-for-height and prevents children from reaching their physical and cognitive potential.

2. Wasting is defined as low height-for-age and is associated with a higher risk of death if not treated properly.

Which of the following statements are true?

a) Only 1                                           b) Only 2
c) Both 1 and 2                               d) Neither 1 nor 2

(sources: How this health programme is helping end intergenerational malnutrition in Bharuch, PIB, loksabhaph.nic.in)