Showing posts with label Maternal and child health. Show all posts
Showing posts with label Maternal and child health. Show all posts

Friday, 6 October 2023

The Twin Challenges for Maternal and Child Health in India: Iron & Proteins, and Technology driven Local Solutions












India accounts for the highest number of undernourished people in the world totalling close to 200 million. Steady improvements have been made between 2004-06 and 2018-20 with India recording one of the highest reductions in total number of undernourished in Southern Asia. Malnourishment is a multi-factorial challenge and the steady reduction in total number of malnourished individuals points to overall improvements in health practices and access to clean water and nutritious food. Nevertheless, the most profound effects of malnourishment are observed in children below 5 years and women of reproductive age. Nearly 30% children in the 0-5 year age-group are stunted while 53% women are affected by varying degree of anaemia.

The distribution of undernourishment is heterogeneous across the country. Interestingly, while the prevalence of stunting and underweight in children has decreased over the past 5 years, the total number of anaemic individuals has increased. These trends could be attributed to macro- and micronutrient intake with fewer than 1/3rd of all women consuming adequate amounts of both. Consumption of macronutrients in the form of carbohydrates and proteins is consistently below the recommended dietary allowance (RDA) levels prescribed by the Indian Council for Medical Research (ICMR). The household consumption of micronutrients in the form of vitamins and minerals such as iron ranges from inadequate to severely deficient. Iron deficiency is associated with the majority of anaemia prevalent in India. A mind-boggling 67% of children in 2019-21 had varying degrees of anaemia, an increase of 8% from 2015-16.

 

Advances in industrial food processing with an emphasis on “food safety”, but not nutrition, has produced an ecosystem of inexpensive processed foods. The World Health Organization (WHO) has qualified undernourishment as protein energy malnutrition, to better explain the imbalance in supply of protein and energy with the body’s demands. The consumption of disproportionately high levels of processed sugars and saturated fats has resulted in a sharp increase in obesity in children and young adults especially in urban centres. The sub-optimal levels of macro- and micronutrients in diet is ultimately associated with chronic non-communicable diseases such as hypertension, dyslipidemia and diabetes.

Notably, while the country has witnessed a systematic strengthening of policies governing food safety, nutritional security is yet to experience as much vibrancy. Considering the massive number of women and children in India who face severe macro- and micronutrient deficiencies, a case is to be made for looking beyond the simple prescription of healthy diet plans and eating habits. Innovations that allow “health foods” to be accessible for all economic segments of India are likely to address the challenges in nutrition while aligning with current global market forces. To begin with, protein and iron would be ideal core ingredients in such innovations.

 

It took a global pandemic to energize discussions surrounding nutritious food. People’s engagement in culinary activities and food entrepreneurship was visible throughout the pandemic-related disruptions. For some, this was a hobby that could be affordably pursued in one’s home. For many others, this emerged as a vital source of income and employment.

 

While food entrepreneurship during the pandemic relied heavily on innovations in logistics, an emphasis on healthy products was widely evident. The buzz around health foods during covid-19 was a reminder that ‘unhealthy foods’ are all around us, enjoying huge market share among consumers from across all geographic, demographic and economic classifications.

 

Over the past two decades, codification of food safety norms in the country and alignment with global standards such as in labelling of packaged foods have gradually improved consumer confidence. One example of enlightened food manufacturing is the fortification of packaged grains, cereals and oils with micronutrients such as vitamins and minerals. Further, the Indian government has announced that all rice distributed under public food security schemes will be fortified with iron and folic acid by 2024. In spite of these positive developments, two key aspects of food entrepreneurship and manufacturing need to be rejuvenated.

 

First, entrepreneurial efforts emerging from economically weaker sections need access to scientific and technological inputs to develop knowledge-driven products. Ventures that are commercializing cultural legacy food products may have a straightforward and assured revenue generation model but are unlikely to be competitive in nutritional value and market reach. For example, women microentrepreneurs in a low-income community preparing packaged farsan are unlikely to face challenges in product placement in their neighbourhoods. If the same group could develop a protein-rich and iron-containing farsan, they could also address the nutritional requirements of their primary consumers. In doing so, it is possible that their manufacturing and processing techniques need to be revised for  enhanced nutritional value of ingredients and avoid unsafe handling practices in their complete supply chain.

Large numbers of women in such socio-cultural contexts manage the food habits of their entire family. Training women microentrepreneurs in the art of assimilating scientific inputs is likely to amplify good health practices in their immediate families. Second, entrepreneurial efforts emerging from economically affluent sections need to be inclusive of customers from across all economic backgrounds. It is not uncommon to see a child of migrant labourers living significantly below poverty line eating a bag of purchased branded potato chips. If this kid can be happier, eating a similarly purchased bag of ‘health food’ with suitable amounts of protein and iron, it would signal a successful convergence of food safety and nutrition. Both of the above aspects require deep and pro-active engagement of food scientists and professionals. These could be further facilitated by academic and research institutions that identify challenges faced by the entrepreneurs as possibilities for collaborative problem-solving.

 

Food products that combine cultural culinary practices with scientific and technological inputs are likely to fulfil grassroots efforts to address prominent health challenges in the country, including the deficiency of iron and proteins among women and children. This will also generate local enterprises and a local circular economy, ensuring longterm sustainability and replicability.

 

 

Dr. Bhaskar Datta is an Associate Professor, Chemistry (jointly with Biological Engineering) at the Indian Institute of Technology, Gandhinagar, India. His group is working on developing protein and micronutrient-rich foods, in addition to other research projects in food. He can be contacted by clicking here

Friday, 11 June 2021

Training of Trainers – MATERNAL, INFANT AND YOUNG CHILD NUTRITION

 India is home to the largest number of hungry people in the world. The Global Hunger Index (GHI) 2018 ranks India at 103 out of 119 countries. Under recently released NHFS 5, 

A few important findings in the recently released NFHS 5 results illustrate this strongly:

  1. Increased % Stunting among children, in 13 out of 22 states and UTs surveyed.
  2. Increased % Wasting among children below 5, in 12 out of 22 states and UTs surveyed.
  3. Over 50% of women are anaemic.

As traditional Supply based programs have shown inadequate results, we need to look at it from Demand perspective – to create strong awareness and demand or Pull for nutritious food from mothers and communities.

Opportunity:

The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to shape healthier and more prosperous futures. The right nutrition during this 1000-day window can have a profound impact on a child’s ability to grow, learn, and rise out of poverty. It can also shape a society’s long-term health, stability, and prosperity. 

  • During pregnancy, under-nutrition can have a devastating impact on the health if the mother and healthy growth and development of a child. 
  • Babies who are malnourished in the womb or in first two years of life have a higher risk of dying in infancy and are more likely to face lifelong cognitive and physical deficits and chronic health problems. 
  • Giving mother focused and continuous counselling during both pre and post child birth, through well trained and motivated field health workers:
    • Prebirth period: counselling for nutrition, prenatal vitamins,  appropriate intake of calories during pregnancy can halt the onset of malnutrition right from the womb. 
    • Post childbirth: counseling on breast feeding skills and nutrients-dense complementary feeding post 6 months, educating her on importance of vaccination, hygiene and sanitation.

By focusing on above, mothers and family members are empowered to seek healthy food and hygiene practices for themselves and the young babies. This will also create a strong pull or demand for healthy food items or ingredients as well as better hygiene practices.

Thus investing in better nutrition in the 1000-day window will help families, communities, and countries break the cycle of poverty. 

Long Term Goal of Training

To work towards the WHO Sustainable Development Goals targets 2025, and to improve

maternal, infant and young child nutrition by capacitating healthcare workers at the grassroots to

achieve:

  • 40% reduction in the number of children under 5 who are stunted
  • 50% reduction in anemia in women of reproductive age
  • 30% reduction in low birth weight
  • No increase in childhood obesity
  • Increase the rate of exclusive breast feeding in the first 6 months to at least 50%
  • Reduce and maintain childhood wasting to less than 5%

Overall Training Objective

The programme aims to:

  • To empower Filed Health workers as master trainers with the technical knowledge of Infant & Young Child Nutrition & counselling techniques, including mother’s nutrition, breast feeding, and supplementary feeding after 6 months of birth.
  •  To make them confident to impart the same training to their colleagues and to caregivers of young infant and children.
  • To help caregivers to help their children to survive and thrive, so that they reach their

physical and intellectual potential, by improving their knowledge of health, hygiene and nutrition and child development.

  • To reduce the incidence of malnutrition through regular data collection on child growth, prevention, raise alters for early detection and treatment; thereby reducing the incidence of stunting, wasting and associated ill health.

Training Methodology and Content:

SMDT has developed  “First 1000 Days” Training of the Trainers (‘TOT”) module tailored to the Health Care workers. The training approach is based on the principles of Skill development in breast feeding and complementary feeding counselling as well as nutrition Counselling in pregnant and lactating mothers. In-depth learning of the critical window period, pregnancy and nutrition and its role in the growth and Prevention of disease in a child is included. This comprehensive knowledge of the science of breast-feeding and complementary foods empowers the participants to deliver evidence-based dietary guidelines to tackle malnutrition at every stage of the first 1000 days of a child and beyond, and subsequently track growth of children at regular intervals. An interactive Training approach involves hands-on practicals to prepare them to impart high quality training to their co-workers as well as their beneficiaries. The module employs a variety of training methods, including demonstrations, discussions, case studies, critical thinking, team building, drama, role-play and problem solving. Participants are encouraged towards inquiry-based learning and sharing of experiences. The focus is on behavior change communication training, so that they feel empowered to convince caretakers to adopt the latest evidence-based advice. 

Learning Materials

Extensive pictorial and easy to use learning materials includes printed large format guides, charts and easy to use videos. These materials are useful for: .

  1. Learning by Health workers / Master Trainers during the training, and to revise learning
  2. Use same materials to counsel mothers on regular basis.
  3. Videos are available to view or download which mothers can view by themselves later.

Topics covered during trainings are:

  1. Science of nutrition
  2. Importance of the first 1000 days 
  3. Essential nutrition action (ENA)
  4. Counselling techniques for behavior change
  5. Pregnancy support counselling on health and nutrition
  6. Breast crawl
  7. Breast feeding technique 
  8. Breast feeding difficulties
  9. Breast conditions
  10. Breast feeding counselling techniques
  11. Not enough milk: usual scenario
  12. New-born care
  13. Minor illness of new-born/young child
  14. Guideline of complementary feedings
  15. Foods rich in minerals and vitamins, and their recipes
  16. Nutrition guidelines in pregnancy and for lactating mothers
  17. Behaviour issues of children during meals
  18. Safe preparation of meals and importance of good sanitation
  19. Myths busting
  20. Growth charts
  21. Growth monitoring and how to pick up if growth falters

Benefits/Anticipated Outcomes

  • Empowerment of the whole community to promote and maintain health, through understanding the importance of early nutrition and hygiene practices  for infant and young child nutrition.
  • Evidence-based skill building of breast feeding and appropriate complementary feeding, thereby preventing devastating acute as well chronic malnutrition in children.
  • Understanding the techniques of breast feeding positioning and latching, thereby improving the weight and length gain in the baby.
  • Understanding the technicalities of beast crawl and importance of colostrums, hence initiating breast-feeding within half hour of birth.
  • Increased demand for nutritious food and food ingredient, reduced consumption of junk food and empty calories, thereby improving both short and long-term health outcomes.
  • With better nutrition, children will be more likely to reach their physical and intellectual potential.
  • Understanding the importance of eating traditional foods and recipes not only for pregnant and lactating mothers, but also for children starting from 6 months of age.
  • Knowledge of cooking techniques, which increases nutrient content as well as digestibility of food preparations.
  •  Understanding the behaviour issues of children in relation to food and managing them effectively and confidently.
  •  Understanding science- and evidence-based feeding practices to reduce myths and doubts.
  • Make this knowledge and practices owned by community, to improve health and nutrition of the children and others, and pass on this knowledge for future generations.

If you are keen to introduce Mother and Infant Child Nutrition training in your area or village for field health workers, and thus contribute towards fighting malnutrition, and want to know more about the above training, feel free to reach out to us at info@winfoundations.org

Food Safety for Nutrition Entrepreneurs

  Food Safety for Nutrition Entrepreneurs   Dr. Bhaskar Datta,Associate Professor, Chemistry  (Jointly with Biological Sciences and Engineer...