Child Malnutrition Child Health and the MidDay Meal

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

Malnutrition. . not child specific Indicator Children< 3 Stunted NFHS- 2 45. 50 NFHS- 3 38. 40 Children <3 Wasted- 15. 50 19. 10 School Child Women 15 to 24 BMI < 18. 5 36. 0% 44. 1 Men 15 to 24 BMI <18. 5 Women 25 to 49 M en 25 to 49 34. 2 35. 6 34. 2

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

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

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

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

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

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

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

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

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

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

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