AGENDA for MALNUTRITION
Tackling malnutrition of all types 🐙
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India has fought well in mitigating malnutrition due to protein & calories but has long-neglected malnutrition caused by deficiencies of micronutrients (eg iodine, iron, vitamins). It is necessary that all sections of people consume nutritious foods, and steps should be taken for the production and distribution of nutritious foods.
Malnutrition becomes well-entrenched and difficult to cure if it is left unattended. There is a vicious cycle that reinforces the ill-effects through other burdens. It is pernicious as it crosses life-phases and generations to become entrenched in families and communities. Govt officials say that it costs 20-30 times less for prevention than cure. Poverty plays a role in malnutrition. Govt has to reduce poverty across the board ─ which means supporting agriculture for rural welfare, and much more.
1. ─> Poor nutritional status ─> high disease burden ─> increased poverty ─> unhygienic living ⮌
2. ─> Young children (high child morbidity) ─> School (illness, poor attainment) ─> Work (absenteeism, low productivity) ─> Family (⇘ next generation: poor, malnourished, unhealthy, unhygienic living ⮌) ─> Early death
National Nutrition Mission 🐙
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NNM or Poshan Abhiyaan (Rs 9000cr, incl $200m loan from WB), is a flagship programme under the Ministry of Women & Child Development, that aims for sustained corrective measures. It is highly intensive as it must ensure good nutrition for each targeted beneficiary. Continuous monitoring is done at an individual level and beyond -- with timely intervention & multi-faculty co-ordination, (eg. ministries work with equal zeal, esp. Women & Child dev, Health, Water & Sanitation). Indicators are inter-linked, so many small measures add up to a big impact -- eg. stunting, under-nutrition, low birth babies, child mortality, anaemia.
https://plus.google.com/100789863972538583352/posts/ZGXXA93ycWH
1. Indicators are recorded and monitored against targets, eg.
─ lower under-nutrition and low birth-weight by 2% pa
─ lower anaemia (esp women, adolescent girls and young children) by 3% pa
─ target a dramatic reduction in child stunting rates, from 38.4% to 25%
2. Apex body will deliberate on matters, frame interventions & guidelines for ministeries, monitor, survey and report (reconciles progress with targets), and finally revisit targets and decisions.
3. Basic set up for the mission:
─ Phased manner from 2017-18 to 2019-20
─ IT-based real-time monitoring at an individual level
─ Aadhaar card is mandatory for receiving benefits (able to track transient people)
─ Nutrition resource centres (available to beneficiaries, where their status is updated using IT tools).
─ Incentives to Anganwadi workers for using IT-based tools and smartphones
─ Social Audits (mix of IT data and surveys)
─ Incentives to States for meeting or exceeding targets
http://iasscore.in/ias-prelims/national-nutrition-mission
National Nutrition Strategy 🐙
------------------------------
NNS will target 100 most backward districts for stunting. It comes under the NITI Aayog.
Swachh Bharat Abhiyan 🐙
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The success of Swachh Bharat Abhiyan should positively contribute to improving malnutrition. SBA is credited for using the private sector to build infrastructure (see comments).
NO CHILD LEFT BEHIND 🐙 (article)
====================
25% of India’s children less than 5 years old are still malnourished. 1/2 of adolescent girls and women are anaemic. 191m people still sleep hungry every night. Thus, the writer welcomes any initiative that will urgently and aggressively alter the situation. It is particularly important to address poor nutrition in children, and women up to childbirth.
Proposed new model is comprehensive in all aspects, and focused single-mindedly on implementation. Apex body is mandated to relentlessly pursue malnutrition objectives. It can also revisit policies where necessary. An unsuccessful attempt in 2008 led nowhere, despite extensive consultations and a 2010 report titled, "Addressing India’s Nutrition Challenges”. (cont./ comments).
Tackling malnutrition of all types 🐙
India has fought well in mitigating malnutrition due to protein & calories but has long-neglected malnutrition caused by deficiencies of micronutrients (eg iodine, iron, vitamins). It is necessary that all sections of people consume nutritious foods, and steps should be taken for the production and distribution of nutritious foods.
Malnutrition becomes well-entrenched and difficult to cure if it is left unattended. There is a vicious cycle that reinforces the ill-effects through other burdens. It is pernicious as it crosses life-phases and generations to become entrenched in families and communities. Govt officials say that it costs 20-30 times less for prevention than cure. Poverty plays a role in malnutrition. Govt has to reduce poverty across the board ─ which means supporting agriculture for rural welfare, and much more.
1. ─> Poor nutritional status ─> high disease burden ─> increased poverty ─> unhygienic living ⮌
2. ─> Young children (high child morbidity) ─> School (illness, poor attainment) ─> Work (absenteeism, low productivity) ─> Family (⇘ next generation: poor, malnourished, unhealthy, unhygienic living ⮌) ─> Early death
National Nutrition Mission 🐙
NNM or Poshan Abhiyaan (Rs 9000cr, incl $200m loan from WB), is a flagship programme under the Ministry of Women & Child Development, that aims for sustained corrective measures. It is highly intensive as it must ensure good nutrition for each targeted beneficiary. Continuous monitoring is done at an individual level and beyond -- with timely intervention & multi-faculty co-ordination, (eg. ministries work with equal zeal, esp. Women & Child dev, Health, Water & Sanitation). Indicators are inter-linked, so many small measures add up to a big impact -- eg. stunting, under-nutrition, low birth babies, child mortality, anaemia.
https://plus.google.com/100789863972538583352/posts/ZGXXA93ycWH
1. Indicators are recorded and monitored against targets, eg.
─ lower under-nutrition and low birth-weight by 2% pa
─ lower anaemia (esp women, adolescent girls and young children) by 3% pa
─ target a dramatic reduction in child stunting rates, from 38.4% to 25%
2. Apex body will deliberate on matters, frame interventions & guidelines for ministeries, monitor, survey and report (reconciles progress with targets), and finally revisit targets and decisions.
3. Basic set up for the mission:
─ Phased manner from 2017-18 to 2019-20
─ IT-based real-time monitoring at an individual level
─ Aadhaar card is mandatory for receiving benefits (able to track transient people)
─ Nutrition resource centres (available to beneficiaries, where their status is updated using IT tools).
─ Incentives to Anganwadi workers for using IT-based tools and smartphones
─ Social Audits (mix of IT data and surveys)
─ Incentives to States for meeting or exceeding targets
http://iasscore.in/ias-prelims/national-nutrition-mission
National Nutrition Strategy 🐙
NNS will target 100 most backward districts for stunting. It comes under the NITI Aayog.
Swachh Bharat Abhiyan 🐙
The success of Swachh Bharat Abhiyan should positively contribute to improving malnutrition. SBA is credited for using the private sector to build infrastructure (see comments).
NO CHILD LEFT BEHIND 🐙 (article)
====================
25% of India’s children less than 5 years old are still malnourished. 1/2 of adolescent girls and women are anaemic. 191m people still sleep hungry every night. Thus, the writer welcomes any initiative that will urgently and aggressively alter the situation. It is particularly important to address poor nutrition in children, and women up to childbirth.
Proposed new model is comprehensive in all aspects, and focused single-mindedly on implementation. Apex body is mandated to relentlessly pursue malnutrition objectives. It can also revisit policies where necessary. An unsuccessful attempt in 2008 led nowhere, despite extensive consultations and a 2010 report titled, "Addressing India’s Nutrition Challenges”. (cont./ comments).
5
2
- Closing in on 100% household toilets across India (Gramin)
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BLUE - Number of toilets. Target is ~ 97m. Has been decreasing a little.
ORANGE - Household coverage. Target is 100%REPLY 30w - India is fast becoming Open Defecation Free -- it's building toilets at a frenetic pace
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Numbers that openly defecated in Indian villages fell from 637m to 595m, from 2010 to April 2014. That's a fall of 42m over 4 years. In the next year, OD numbers had fallen by 71m to 524m. It marked a vigorous start to Govt's Swachh Bharat Mission (Gramin).
In October 2014, Govt had targeted the building tens of millions of toilets, enough to eliminate open defecation in just its first 5-yr term. Latrine coverage has since raced ahead, so much so that most states have already completed their entire ODF programmes (well ahead of 2nd October 2019 target date).
Below is the chart of the worst performers of old. Building work had taken off strongly, as these states added 20% coverage in 2.5 years. This left a lot to do in the next 2.5 years. But work has been done at a frenetic pace since then.
In the last 16 months, household toilets coverage has skyrocketed by 32.6%, to 81.3%. Only Odisha and Bihar among these laggards seem unable to complete their ODF programmes by 2018!!
STATS : Among the worst performers
% Latrines 2001 2011 9-2014 3-2017 7-2018
==============================
Odisha 15 23 11.7 44.2 58.7
Jharkhand 20 23 28.7 46.7 84.1
Bihar 20 23 21.6 34.5 60.6
Chhattisgarh 21 24 40.3 69.0 100.0
MP 24 30 27.5 64.3 94.0
UP 31 37 35.3 43.7 82.9
AP+ Tel 33 33 32.3 58.6 94.9------------------------------------------------------------------------------
Combined 26 30 29.2 48.7 81.3
Combined takes account of size of the State
http://pib.nic.in/PressReleaseIframePage.aspx?PRID=1518055
UP is on overdrive to complete toilets early-----------------------------------
UP needs 7.4m rural & 0.52m urban toilets as of May 2018. It has decided to complete the task one year early, or by Oct 2018. This means building 2m toilets per month!! "UP is showing great speed since BJP came into power in Feb 2017. It will complete it well ahead of 2019 deadline".
From the end of April 2017 when coverage was 47%, it has risen to 74% on 16th June 2018. As of 24-7-2018, coverage has gone to 83.2%. Regards urban toilets, it has completed 0.37/ 0.89m, and 0.15m are under construction.
https://economictimes.indiatimes.com/news/politics-and-nation/ups-turnaround-from-laggard-to-best-performer-in-building-toilets/articleshow/64642420.cms
For updated information, see: http://swachhbharatmission.gov.in/
My links:
https://plus.google.com/100789863972538583352/posts/RroH8N4rSC3
https://plus.google.com/100789863972538583352/posts/RZNZrK7nH4e
REPLY 30w - No child left behind (cont.)
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Critical summary of the write-up. The author raises points that inform but don't change realities. The scheme does this and more.
1. Economic growth is a key driver for better development. This is a truism. Successful development programmes will also lead to economic growth. Besides Govt is expected to provide essential needs and amenities -- it has to serve people in order to get re-elected.
2. Capacity building and IT hardware infra must be built. Fortification of staple foods should be done, and private sector supply chain established for same. Professional nutritionists must devise the nutrition programme. States must oversee operations of SHG, private sector and NGOs. There is a high chance of pilferage and of poor food preparation at Anganwadi Centres.
In August 2017, M. of Women & Child D. mandated the use of fortified salt, wheat flour and edible oil. NNM is designed with IT & training at its core. Several States have successfully piloted PPP supply-chains for edible oil and wheat flour. Individuals are tracked so discrepancies can be investigated. Anganwadi Centres should be under close scrutiny, eg checks on hygiene, food quality inc adulteration of foods, food procurements and finances. However, problems will arise as standards in India are not high across the board (eg milk adulterations is 40+% in places).
3. Multiple nutritional campaigns are needed — on breastfeeding, diet diversity, hand-washing, de-worming, safe drinking water, hygiene and sanitation — and the private sector should undertake most tasks. All these points should be part of the programme's action plan. A campaign can happen after progress is made or NNM is reasonably established. The private sector is involved (eg SHGs) and can get more involved eg Aspirational districts programme.--------------------------------
NNM & NNS will be a huge undertaking and will require a large & diverse manpower to expedite the work. The author asks why ministries are not making proposals to use the private sector, NGOs and development agencies. The author asks for data tracking in real-time down to district level, etc, but does not realise that it is part of NNM protocol. He demands major changes in 3 existing nutrition schemes:
1. Integrated Child Dev. Sevice (1.4m Anganwadi C. for 100m people, mothers and for children up to 6yrs)
2. Mid-day meals for 120m pupils
3. PDS for feeding 800m
REPLY 29w - EXAMPLE: Tackling multi-headed hydra that is malnutrition and its ill-effects
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Encephalitis has no cure. In Eastern UP, Bihar, Odisha, etc, a proportion of children, presenting with encephalitis die each year. UP govt has dramatically reduced both the no. of new cases and recovery rates, in its 1st full year!! It attacked encephalitis on several fronts like better nutrition, cleanliness, sanitation, drinking water, vaccination & hospital care. If so, this will help fight other diseases like dengue fever.
Fight against encephalitis in UP was not just about vaccinating every child (which in itself is a difficult undertaking). As per this article, UP govt succeeded by:
1. Improving feeding of young families and children at risk of malnutrition, in a comprehensive manner
2. Cleanliness to stop vectors from flourishing
3. Improved sanitation, esp ODF in villages next to Ganga River.
4. RO plants were set up in all the primary and upper primary schools so children could get clean drinking water.
5. As a result, children maintained better health and become more resistant to infection
6. Hospitals had more ICU beds, specialist equipment (eg ventilators & warmers) and trained paramedic staff.
Good nutrition + Clean environment + Clean water + Hygienic living + Health --> dramatic improvement in child morbidity
Yr Hospital referrals Deaths %
2016 4,353 715 16.4
2017 5,400 748 13.9
2018- 9/Aug 1,427 111 7.8
Halving of death rates in just the 1st full year of the change. NB. BRD Medical College Hospital is a speciality hospital and gets referrals from all UP districts, and neighbouring states. With better facilities, more referrals are likely. Vaccination and improvements in all states should reduce incidents of encephalitis even further.
REPLY 27w - Fighting malnutrition due to Parasitic infestation
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Open defecation free is a big step in fighting parasitic infestations. National Deworming day (introduced in 2015) has dramatically reduced parasitic infestations. However, many children get re-infected due to unhygienic habits and by living in unhygienic conditions. High-risk individuals with probable symptoms of parasitic infestations must be treated for both worms and anaemia. A cleanliness drive is also warranted.-------------------
Deworming and control of worm infestation will make a big dent in malnutrition. For good control, it is necessary to work at improving bad hygiene, open-air defecation & lack of footwear.
1. Anaemia, caused by parasitic infestation (tapeworms, roundworms, and hookworms), is a leading cause of malnutrition. Symptoms of worm infestation in a high-risk group should be combated with deworming (albendazole tablets) and treatment of anaemia (iron and folic acid tablets).
2. In 2015, Govt introduced National Deworming Day. It has dramatically reduced no. of cases of worm infestations.
3. But there are those who are getting reinfected due to poor hygiene or unhygienic living conditions.
4. ODF will make a decisive impact. Cleaning hands after toileting & before eating is crucial in unhygienic living conditions.
5. Beyond ODF, cleanliness drive is required by authorities, communities and households, along with solid & liquid waste management.
REPLY 27w
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