भारत में पोषण की समस्या और उनका हल

India needs to scale up direct nutrition interventions

Preconception  nutrition, maternal nutrition and child feeding practices in the first 1,000 days of life need priority

भारत को प्रत्यक्ष पोषण हस्तक्षेपों को बढ़ाने की जरूरत है.

जीवन के पहले 1,000 दिनों में गर्भधारण पूर्व पोषण, मातृ पोषण और बच्चे को दूध पिलाने की प्रथाओं को प्राथमिकता दी जानी चाहिए

source TOI 

05/07/2022 

As India launches the celebrations of its 75th anniversary of Independence, there is much to be proud about; 

💐significant advances have been made in science, technology, and medicine, 

💐adding to the country’s ancient, traditional, and civilisational knowledge base, wisdom and wealth.

क्या क्या मैं अभी खतरे 

1 Still, it is disconcerting that even after seven decades of Independence, India is afflicted by public health issues such as 

💐child malnutrition (35.5% stunted, 67.1% anaemic) attributing to 68.2% of under-five child mortality.

 Poor nutrition

💐not only adversely impacts health and survival 

💐but also leads to diminished learning capacity, 

💐and poor school performance.

💐 And in adulthood, it means reduced earnings and 

💐increased risks of chronic diseases such as diabetes, hypertension, and obesity.

POSHAN Abhiyaan

The good news is that the Government appears determined to set it right — with an aggressive push to the National Nutrition Mission (NNM), rebranding it the Prime Minister’s Overarching Scheme for Holistic Nutrition, or POSHAN Abhiyaan.

1  It has the objective of 

💐reducing malnutrition in women, children and adolescent girls.

align different ministries

 Ministry of Women and Child (MWCD) continues to be the nodal Ministry 

implementing the NNM with a vision to align different ministries

 to work in tandem on the “window of opportunity” of the first 1,000 days in life (270 days of pregnancy and 730 days; 0-24 months). 

Global and Indian evidence fully supports this strategy

which prevents the largely irreversible stunting occurring by two years of age. 

POSHAN Abhiyaan (now referred as POSHAN 2.0) 

rightly places a special emphasis on selected किस बात पर जोर

💐high impact essential nutrition interventions, 

💐combined with nutrition-sensitive interventions, 

💐which indirectly impact mother, infant and young child nutrition,

💐 such as improving coverage of maternal-child health services,

💐 enhancing women empowerment, 

💐availability, and access to improved water, sanitation, and hygiene and 

💐enhancing homestead / ,घर food production for a diversified diet.

NHFS data is a pointer

1 Data from the National Family Health Survey (NFHS)-5 2019-21, as compared to NFHS-4 2015-16, reveals a substantial improvement in a period of four to five years

 in several proxy indicators of women’s empowerment, 

for which the Government deserves credit. 

2 There is a substantial increase in antenatal/ care of pregnant women service attendance (58.6 to 70.0%); 

3 women having their own saving bank accounts (63.0 to78.6%);

4  women owning mobile phones that they themselves use (45.9 % to 54.0%); 

5 women married before 18 years of age (26.8 % to 23.3 %); 

6 women with 10 or more years of schooling (35.7% to 41.0%),

7  and access to clean fuel for cooking (43.8 % to 68.6%).

समस्या कहां पर है

But, alarmingly, during this period, the country has not progressed well in terms of direct nutrition interventions. 

1 to be effectively addressed

💐Preconception nutrition, 

💐maternal nutrition, 

💐and appropriate infant and child feeding remain to be effectively addressed. 

2 India has 20% to 30% undernutrition even in the first six months of life when exclusive breastfeeding is the only nourishment required. 

3 Neither maternal nutrition care interventions nor infant and young child feeding practices have shown the desired improvement.

4  A maternal nutrition policy is still awaited.

5 दूध पिलाना कितना सक्सेस हो पाया है 

💐Despite a policy on infant and young child feeding,

💐 and a ban on sale of commercial milk for infant feeding, 

💐there has only been a marginal improvement in the practice of exclusive breastfeeding (EBF). 

6 Child undernutrition in the first three months remains high. 

7 Creating

💐 awareness on EBF, 

💐promoting the technique of appropriate holding,

💐 latching and 

💐manually emptying the breast are crucial for the optimal transfer of breast milk to a baby. 

Recent evidence from the Centre for Technology Alternatives for Rural Areas (CTARA), IIT Mumbai team indicates 

💐that well-planned breastfeeding counselling given to pregnant women 

during antenatal checkup 

prior to delivery 

and in follow up frequent home visits makes a significant difference. 

The daily weight gain of a baby was noted to average 30 to 35 grams per day and 

underweight prevalence rate reduced by almost two thirds.

Another key intervention

1 NFHS-5 also confirms a gap in another nutrition intervention — complementary पूरक feeding practices,

जैसे 

 i.e., complementing semi-solid feeding with continuation of breast milk from six months onwards. दूध पिलाने के साथ साथ में सेमी सॉलि़ड फील्डिंग मैं गैप है

 2 Poor complementary feeding is often due to a lack of awareness to start feeding at six to eight months, 

💐what and how to feed appropriately family food items, 

💐how frequently, 

💐and in what quantity. 

3 The fact that 20% of children in higher socio- economic groups are also stunted indicates

💐 poor knowledge in food selection and feeding practices

💐 and a child’s ability to swallow mashed feed. 

Where are we going wrong?

सबसे ज्यादा प्राथमिकता किस बात को

1 So, creating awareness at the right time with the right tools and techniques regarding special care in the first 1,000 days deserves very high priority. 

2 We must act now, and invest finances and energy in a mission mode. 

3 The Prime Minister can give a major boost to POSHAN 2.0, like he did to Swachh Bharat Abhiyaan, using his ‘Mann Ki Baat’ programme.

प्रधान मंत्री पोषण 2.0 को एक बड़ा बढ़ावा दे सकते हैं, जैसे उन्होंने स्वच्छ भारत अभियान को अपने 'मन की बात' कार्यक्रम का उपयोग करके किया था।

4 There is a pressing need to revisit the system spearheading POSHAN 2.0 and overhaul it to remove any flaws in its implementation. 

इसको फिर से विचार करने और इसके कार्यान्वयन में किसी भी दोष को दूर करने के लिए इसे ओवरहाल करने की अत्यधिक आवश्यकता है

 5 We need to see if we are using opportunity of service delivery contacts with mother-child in the first 1,000 days to the optimum,हमें यह देखने की जरूरत है कि क्या हम पहले 1,000 दिनों में मां-बच्चे के साथ सेवा वितरण संपर्कों के अवसर का अधिकतम उपयोग कर रहे हैं

6  There is a need to revisit the nodal system for nutrition programme existing since 1975,

💐 the Integrated Child Development Scheme (ICDS) under the Ministry of Women and Child and 

💐examine whether it is the right system for reaching mother-child in the first 1000 days of life. 

7 By depending on the ICDS, we are in fact missing :

 the frequent contacts with pregnant mothers and children that the public health sector provides during antenatal care services and child immunisation services, आईसीडीएस पर निर्भर होने से, हम वास्तव में गर्भवती माताओं और बच्चों के साथ लगातार संपर्क खो रहे हैं जो सार्वजनिक स्वास्थ्य क्षेत्र प्रसवपूर्व देखभाल सेवाओं और बाल टीकाकरण सेवाओं के दौरान प्रदान करता है

8 There is also a need to explore whether there is an alternative way to distribute the ICDS supplied supplementary nutrition as Take- Home Ration packets through the Public Distribution (PDS) and 

9 free the anganwadi workers of the ICDS to undertake timely counselling on appropriate maternal and child feeding practices.

नए सिस्टम की जरूरत है 

We need to

💐 systematically review the status, and develop and test a new system

💐 that would combine the human resource of ICDS and health from village to the district and State levels. 

This would address the mismatch that exists on focussing on delivery of services in the first 1000 days of life for preventing child undernutrition by having an effective accountable system.यह उस बेमेल को संबोधित करेगा जो जीवन के पहले 1000 दिनों में एक प्रभावी जवाबदेह प्रणाली के माध्यम से बच्चों के कुपोषण को रोकने के लिए सेवाओं के वितरण पर ध्यान केंद्रित करने पर केंद्रित है।

It is time to think out of the box, and overcome systemic flaws and our dependence on the antiquated system of the 1970s that is slowing down the processes. 

Moreover, mass media or TV shows could organise discourses on care in the first 1,000 days to reach mothers outside the public health system.

यह लीक से हटकर सोचने और प्रणालीगत खामियों और 1970 के दशक की पुरानी प्रणाली पर हमारी निर्भरता को दूर करने का समय है 

जो प्रक्रियाओं को धीमा कर रही है। 

इसके अलावा, 

मास मीडिया या टीवी शो सार्वजनिक स्वास्थ्य प्रणाली से  माताओं तक पहुंचने के लिए पहले 1,000 दिनों में देखभाल पर debate आयोजित कर सकते हैं।

Source the hindu