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Learn about interventions enhancing Infant and Young Child Feeding practices in Andhra Pradesh, aiming to reduce child mortality and malnutrition. Data on under-five deaths and strategies to address malnutrition are discussed.
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Andhra Pradesh – Making a difference !inICDS and IYCF Warm Greetings !! Department for Women, Children, Disabled & Senior Citizens Government of Andhra Pradesh
Importance of Infant and Young Child Feeding (IYCF) practices Interventions for improving IYCF practices in Andhra Pradesh
Share of under-five deaths (%), 2011, by country 5 countries contribute towards 50% of child deaths globally http://www.childinfo.org/mortality_underfive.php
Neonatal Mortality Rate (NMR) - India Current: 29/1000 live births Accounts for almost ¾ thof IMR & >½ of U5-MR Source : SRS
Brain development 10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs. 2/3rd are related to poor feeding. Underweight (-2sd) NFHS-3 Over 60 million Why reduce Malnutrition ? • According to WHO estimates malnutrition is responsible for around 60% of child mortality • Malnutrition among children occurs almost entirely during the first two years of life and is virtually irreversible after that • As more than 90% of brain develops during first two years child undernutritionimplies cognitive development, intelligence, energy & productivity loss is tremendous even amongst the survivors • The global strategy on IYCF recognizes that malnutrition is related to inappropriate infant feeding practices 1 2 3 4 5
Optimal Infant and Young Child Feeding • Initiation of breastfeeding immediately after birth, preferably within one hour • Exclusive breastfeeding for 1st six months i.e., the infants receives only breast milk ¬hing else, no other milk, food, drink or water • Appropriate and adequate complementary feeding after six months of age while continuing breastfeeding • Full Immunization for infants • Adequate nutrition for pregnant and lactating women
Malnutrition among Women in A.P • Anaemia: The percentage of anaemic pregnant women has increased from 41.8% to 56.4% from 1998- 99 to 2005-06 • BMI : Between 1998-99 and 2005-06, there is a marginal decline from 37.4 % to 30.8 % of women who are having BMI below 18.5
Malnutrition among Children in A.P • Low Birth Weight Children • % of children born with low birth weight in A.P. is 19.4% which is highest among the southern states • every 5th child born has birth weight less than 2.5 kg • Underweight Children • % of children below 3 years in A.P who are underweight is very high at 29.8% • trends shows a slow decline in reduction of prevalence of under- weight • every 3rd child below 3 years is underweight
Interventions to improve IYCF Practices in AP • Special weaning food for children 7 months to 3 years and hot meal for children 3 to 6 years • Supervised feeding for malnourished children • One full meal for pregnant and lactating women 1 Meaningful Food Models in ICDS • Capacity building on skilled IYCF counselling through counselling courses • Two Nutrition and Health Days (NHD), one for growth monitoring and other for health services • A convergence initiative of allied depts. with community 2 Intensified Health & Nutrition Education
Revised Food Models for Children “Balamrutham” for 7 months to 3 years • The new weaning food consists of wheat, channa dal, sugar, oil & milk powder • “Balamrutham” is fortified & is a caloric dense food • is distributed in packets of 2.5 kg per child per month • is widely accepted by the mothers • “Hot meal” for Pre-School children • Hot meal consisting of rice, dal and vegetable • served in the afternoon • 4 eggs in a week served in the morning and • snacks served in the evening
Balamrutham: Weaning Food for Children < 3 Years Composition per 100 g Nutritive value per 100 gm
Supervised feeding for Malnourished Children upto 5 Years • Identification of malnourished children upto 5 yrs • children upto 5 years are categorized as • Severely Underweight (SUW) based on • “Weight for age” criteria • children are also categorized as Severe Acute Malnutrition (SAM)/ Moderately Acute Malnutrition (MAM) based on • “Weight for height” criteria • children are weighed once in a month & height • measured once in 3 months • Medical check-up of malnourished children
Supervised feeding-Model Menu for SUW/ SAM/ MAM Children of 7mths – 3 yrs
Supervised feeding - Model Menu for SUW/ SAM/ MAM Children of 3 – 6 yrs
“Spot feeding of One Full Meal” for Pregnant & Lactating women • Take Home Ration(THR) for Pregnant and Lactating women is inadequate & consumed by family members • “Spot feeding of one full meal” been introduced in 101 ICDS projects out of 254 for 3.35 lakh Pregnant and Lactating women • “One Full Meal” is likely to • improve maternal nutrition • reduce incidence of anaemia • reduce incidence of Low Birth Weight • quickly reduce IMR& MMR • Funding “One Full Meal” • Rs 7 per day per women under ICDS • Additionally Rs 13 per day per women under State budget
Concurrent Monitoring in Partnership with NGO Alliance, CESS & UNICEF • Improvement in the Postnatal care
Capacity Building on IYCF practices • Capacity building on skilled IYCF counselling through counselling courses been taken up by WCD • Nearly 400 plus people (AWTC Instructors, CDPOs, Supervisors) have been trained as middle level trainers in IYCF using BPNI material at Hindupur • Using these Middle Level Trainers the frontline workers have been trained
Nutrition and Health Days (NHDs) – Growth Monitoring & Counselling • Instead of one NHD in a month, two NHDs are being conducted • The focus of NHD-1 is on Growth Monitoring & THR • NHD-1 is conducted on 1st of every month • It allows focus on growth monitoring and categorization of children as SUW/SAM/MAM • It ensures availability of food stock before 1st of every month • The focus of NHD-2 is on providing immunization and ANC services by ANM • Counselling of mothers is conducted on both NHDs
Convergence – Reducing IMR, MMR, Malnutrition & improving IYCF practices PRIs SHGs Sanitation Maarpu - A Convergence Initiative Community Convergence A Key Safe Water Health Nutrition
Convergence Structure Institutionalized • Sarpanchas President • Other members of JB Committee (i.e. MPTC,SHG (2), Social Activists (2) • ASHAs, ANMs, VO chairpersons • GP Secretary as convener & AWW as co-convener 1 Gram Panchayat • MPP as President • Other members of JB Committee (i.e. ZPTC, MPTC(2), Sarpanches (2), Social Activists (2) , SHG member (1), MPDO) • Dy. DM & HO, ICDS Supervisors, MPHS (M&F), MPHEOs, AWW (RWS),AEE (PR), APM,MMS chairperson • MO(PHC) as convener & CDPO as co-convener 2 PHC Level • District Minister as chairperson, District Collector • ZP Chairperson, MLAs, CEO (ZP), PD(DRDA), PD(DWMA), PD(MEPMA),SE(RWS), SE(PR),PO(ITDA), Addl. DM&HO (MCH& Tribal) DPHN,ZMS chairperson • DM&HO as member convener & PD (ICDS) as co-convener 3 District Level
Focus on 20 identified key interventions • To improve service delivery, to create awareness & to enable behaviour change • Intensified Health & Nutrition Education by CRPs and health & nutrition • functionaries
Way forward….. • To prepare annual plans for imparting Nutrition and Health Education • Need to position additional staff of ICDS mission to strengthen counselling • To actively involve community, SHGs and PRIs as partners in these efforts • To have close coordination with Health Department for effective convergence • To re-design food models in particular for malnourished children & pregnant women • To continue the skilled IYCF Counselling training courses