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Child Malnutrition, Child Health and the Mid-Day Meal

This article discusses the issue of child malnutrition and the potential for action through the implementation of mid-day meal programs in schools. It explores the factors contributing to malnutrition, government schemes addressing the issue, and the role of school health programs in improving child health. The importance of nutrition counseling, health education, and social health support is also highlighted.

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Child Malnutrition, Child Health and the Mid-Day Meal

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  1. Child Malnutrition, Child Health and the Mid-Day Meal Opportunities for Action. By : Dr. T Sundaraman, Executive Director, NHSRC

  2. Malnutrition.. not child specific

  3. But Children Most Vulnerable… • Almost one third low birth weight at birth. • Improved by about 6th month • Then worsens and remains high in 0 to 6 • Peaks again in adolescence- for the first and only time being male predominant. • Then declines moderately- over next three decades • Rises again in old age.

  4. Malnutrition Rates • International comparisons show India performing very poorly • Adjusted for GDP per capita – it would be the worst performance. • Reasons relate to • Poverty and Economic Disparity. • Social inequities- gender, caste, geographic • Changing Dietary Patterns • Burden of ill health and sickness.

  5. Govt. Schemes that Address Malnutrition…. • Public Distribution System • NREGS • ICDS & Nutrition Supplement for Pregnant women, lactating mothers and children below 5 • Mid-day meals in schools. • The Creche Programme • Management of Severe Acute Malnutrition…. • Drinking water and sanitation schemes..

  6. The Mid-Day Meal • Major tool – that has helped boost enrolment and retention of school children. • Possibly helped in reducing absence and in improving learning. • Meant to cover 30% of the nutrition needs of the growing child. • However it has not been consciously leveraged as an opportunity for increased child health.

  7. School Health Programmes • As early as the Bhore Committee Report- A school healht service must include • Health Measures, preventive and curative, which include • Detection and treatment of defects and diseases • Creation and maintenance of a hygenic environment in and around schools • Measure for promoting positive health should include • Provision of supplementary food to improve the nutritional state of the child • Physical culture through games, sports and gymnastic exercises • Health education thru formal instruction and practice of the hygenic mode of life.

  8. Health Screening and Management.( 6 monthly) Six Monthly Annually Vision and Hearing Problems Heart defects Learning Disorders Psycho-social assessment and assistance for the child. Disability • Nutritional Status- BMI • Anemia. • Common Skin diseases • Ear discharge/Eye redness • Common dental conditions

  9. For Management of Malnutrition and Anemia. • Preventive measures- the mid-day meal plus a weekly Iron and Folic Acid Tablet as supplement. • One could add micronutrients onto locally prepared food where indicated. – eg using iodised salt. • But for children with moderate or severe malnutriton or anemia- Test and Treat and monitor till cured!!! • Add more to food supplements- either as a morning snack or as a extra-portions on the meal- to help correct the gap.

  10. Role of nutrition counseling… • Only within a setting where the school sees itself as responsible for addressing malnutrition and anemia. • Nutrition counseling and management is a complex skills- requires judgment, considerable subjective factors- individual dialogue, understanding of contexts…. • But with the mid day meal in hand – one could supplement with nutrition for the needy child.

  11. And Health Education… • Inclusion in the formal curriculum • Inclusion as special series of school health sessions- audited- not credited. • Informal methods- peer education • Promotion of Hygenic Practices • Physical education and Sports. • Adolescent Health- the whole area of sex education and sexual health.

  12. Social Health… • Support to the physically challenged child • Support to the child with learning difficulties- mental problems, • Dealing with violence in the school and in the homes • The role of cultural activities and building solidarity and the spirit of caring.

  13. In conclusion • The School is charged with not only producing an educated child – but a healthy child as well. • And Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity…. • And school is one of the best opportunities to achieve this.

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