Essential Interventions for Reducing Malnutrition

1.Frequent, appropriate, and active feeding for children during and after illness, including oral rehydration with zinc supplementation during diarrhoea: Every child should be actively and frequently fed with age-appropriate and nutrient dense foods, during and after illness, while frequent, on-demand breastfeeding continues to increase fluid and nutrient intake. Children with diarrhoea should receive use of low concentration oral rehydration salts (ORS) including routine use of zinc supplements at a dosage of 20mg per day for children older than 6 months or 10mg per day in those younger than 6 months for 10-14 days (WHO)

2.Timely and quality therapeutic feeding and care for all children with severe acute malnutrition: Every child with severe acute malnutrition (very low weight for height) should be provided with therapeutic foods andcare in a timely manner, for life-saving rapid recovery and appropriate weight gain. Care for children with severe acute malnutrition requires early case detection (before the development of medical complications), access to therapeutic foods, optimal therapeutic feeding and care protocols.

Opportunities to scale these essential interventions through existing programmes and schemes

There are specific opportunities for taking these eight essential interventions to State/national scale so as to reach every child, everywhere, to achieve an unprecedented impact on reducing child malnutrition and associated waste of human capital, poor health, growth and development. This will also have the impact onreducing povertyandfosteringeconomicgrowth.Themostimportant opportunities identified are listedbelow:

• ·Promote an evidence-based approach to the design and revision of key nutrition programs, considering replication of proven interventions and programmes from within Jharkhand and outside of state.
• Focus on evidence-based, low-cost, high-impact interventionsanddeliverthem from state level to GP level formaximum impact in reducing the burden ofmalnutrition.
• Strengthen advocacy and focus on1) deworming for children 1-5 years of age, and provision of immunisation and vitamin A supplementation,2) provision of iron and folicacid supplementation, twice yearly deworming and 3) standard, state-of-the art feeding and care for children with severe acute malnutrition, including theindigenousproductionandprovisionoftherapeutic foods.
• Improve the performance of service providers and counsellors (institutional as well as home visit) through focused training, communications materials, job aids, motivation, and supportive supervision for improved results. Harmonise nutrition communication guidelines and core messages across ministries and programmes.
• Initiate denominator-based planning and monitoring to expand coverage, starting with community-based micro- plans, anchored in good mapping of pregnant mothers and children 0-23 months old in thecommunity.
• Promote monthly coordination and convergence meetings between ICDS, Health, Water & Sanitation development partners, and other non-governmental organisations (NGOs) as appropriate, especially at district and block level.
• Support and expand Village Health Sanitation and Nutrition Days (VHSND) to deliver these essential nutrition interventions.

Jharkhand’s leadership in many fields is recognised nationally &globally. The questions now are: Can we show its strength and leadership in improving the nutrition and wellbeing of its children? Can India uphold the national and international commitments it has made to the basic rights of children to nutrition and life?

The evidence and expert opinion indicate that implementing these ten ‘Essential Interventions’ could halve the rates of child malnutrition in India over the next five years. Now is the time to combine the existing technical knowledge and political will to end the “curse” of malnutrition in Jharkhand.

The writer is Executive Director, The Coalition for Food and Nutrition Security, New Delhi.