Zero hunger and good nutrition have the power to transform and empower the present and future generations. Malnutrition (deficiency or excess of nutrients in a diet) remains a major threat to the survival, growth and development of children. Under nutrition (deficiency of nutrients i.e.calories, proteins, carbohydrates, vitamins or minerals in a diet) is most prevalent in India. The latest National Family Health Survey (NFHS-4, 2015-16) shows that 38.4 per cent of children under 5 years of age are stunted (low height for age), 21 percent are wasted (low weight for height) and 35.8 per cent are underweight (low weight for age).

Improving the quality of foods, feeding practices, and the nutrition situation of children in the first two years of life, represent a critical window of opportunity to break the inter-generational cycle of malnutrition.

 If this critical opportunity is missed,child malnutrition will continue to self-perpetuate: malnourished girls will become malnourished women, who give birth to low birth weight infants and these children suffer from poor nutrition in the first two years of life.

The best opportunity to break this vicious inter-generational cycle is to concentrate efforts on improving the nutrition of infants and young children from conception through the first two years of life. NFHS-4 figures in Jharkhand shows that 45.3 per cent of children under 5 years of age are stunted, 29 percent are wasted and 47.8 per cent are underweight. Deoghar, Palamu and Kodarma districts have the lowest levels of severe wasting.

 Four of the best performing districts of Jharkhand are situated in the Bihar border while four of the poor-performing districts in terms of wasting share borders with West Bengal highlighting the regional contiguity of the parameters and the need for separate planning for different districts.

West Singhbhum remains a poor-performing district in terms of Under-weight, Stunting and Wasting. Palamu and Koderma are the best-performing districts with better underweight and wasting figures. The next best performing districts are Deoghar and Ranchi. These are “positive deviants” within a state which we need to identify, celebrate and push systematically towards becoming malnutrition free. Such a shift of emphasis from high burden to low burden districts is necessary given the goal of achieving a malnutrition free India with emphasis on district level planning, convergent action and monitoring (Source: Nutrition Group, IIT Bombay)

There is no dearth of schemes to improve the nutritional status of children in 0-6 years and most of the interventions required are already covered under those varieties of schemes.

All the schemes need to operate cohesively and integrated in a way that they strongly focus on delivering the same messages. Convergence is therefore the key, also one of the pillars advocated by Poshan Abhiyaan. Listed below are the most essential interventions needed to reduce malnutrition in this most critical group: infants and young children:

1.  Timely initiation of breastfeeding within one hour of birth: Mothers should start breastfeeding their child within one hour of birth to take advantage of the newborn’s intense suckling reflex and alert state to stimulate breast milk production. Appropriate breastfeeding techniques including proper positioning and attachment are integral to increase the newborn’s suckling efficiency, mother’s breast milk production and therefore infant’s breast milk intake.

2.  Exclusive breastfeeding during the first six months of life and continued breastfeeding up to 2 years of age or beyond: Every infant should be exclusively breastfed till 6 months of age.

 The infant should be fed with only breast milk and not given any fluids, milk, or foods, not even water. Exclusive breastfeeding, with frequent, on- demand feeding and continuous breastfeeding up to 2 years of age or beyond ensures maximum protection against malnutrition, disease, and death, while also contributing to child spacing and lower fertility rates.

3.  Full immunization and bi-annual vitamin A supplementation with de-worming: Every child should be protected from vaccine preventable diseases through a full course of immunization delivered through the routine immunization system at set durations beginning from the first year of life. In addition, all children 6-59 months old should be further protected from mortality, morbidity, and malnutrition with preventive vitamin A supplementation and de-worming twice yearly.

4.  Timely introduction of complementary foods at six months: Every infant should start receiving complementary foods in addition to breast milk from 6 months on wards as breast milk alone cannot suffice infant’s energy and nutrient requirements at this time. Introducing complementary foods before 6 months is both unnecessary and fatal to child’s health.

5.  Age-appropriate complementary feeding (adequate in terms of quality, quantity and frequency for children 6-24 months): Every child n 6-24 months should be fed with age-appropriate, energy and nutrient-dense, diverse complementary foods initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired (WHO).Child feeding should be responsive and active.

Children should be given routine iron-folic supplementation to prevent anaemia. Hygienic practices are to be followed when feeding the children. 6.Safe handling of complementary foods and hygienic complementary feeding practices: Providing complementary foods for children in 6-24 months should be guided by safe handling (preparation and storage) and hygienic feeding practices.

Caregivers should wash their hands before food preparation, serve foods immediately after preparation, use clean utensils, wash hands of children before they eat and avoid feeding using bottles.

To be continued.....

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