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Importance of First 1000 Days in Mitigating Malnutrition among Children

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Malnutrition in India
 
Child mortality and child survival in India have improved over years because of the focused attention and investment by the government of India. The National Nutrition Strategy (2017) and Poshan Abhiyaan launched on March 8, 2018, has triggered Anganwadi Centers across India to make the abhiyaan a Jan Andolan (people’s movement) and has been able to sensitize and mobilize people towards nutrition of children and women.
NFHS 4 (2015-16) show a notable improvement in percentages of children (0 to 5 years age) in stunting and underweight, while wasting and severe wasting categories show an increase from that of NFHS 3 (2005-6).
India
Indicators
NFHS 3 (2005-06)
NFHS 4 (2015-16)
Children under 5 years who are stunted (height-for-age) (%)
48
38.4
Children under 5 years who are wasted (weight-for-height) (%)
19.8
21
Children under 5 years who are severely wasted (weight-for-height) (%)
6.4
7.5
Children under 5 years who are underweight (weight-for-age) (%)
42.5
35.8
There is still a long way to go to achieve Goal 2.2 of Sustainable Development Goals (SDG) – “by 2030 end all forms of malnutrition…”. As per some estimates, if India continues with the present pace, it would not be able to meet the challenge. NFHS 5 Data of 22 states released in 2020 proves this where we see a slight decrease, a stagnant or increasing trend in malnutrition categories. As an example, the following graph shows the comparison of NFHS 4 and 5 for Gujarat, where we can see a slight decrease in the wasting category while the other three categories show an increasing trend.

Malnourishment in children is observable in society in a loose sense, when we see some children very lean, thin, short or obese in comparison to their peers, whom we consider average. This is because of an imbalance in the intake of food, prolonged illness and/or lack of important macro and micronutrients. Our body needs a long list of macro and micronutrients like carbohydrate, protein, fat, iron, zinc, iodine, calcium, other minerals and vitamins to perform metabolic functions for physical and cognitive development. Lack or imbalance of any or more of these in our daily food intake results in malnutrition. Scientifically, Wasting is a category where children are too thin or their weight is below the average weight for their height. Similarly, stunted children are too short or their height is below the average height for their age and underweight children are those whose weight is below the average weight for their age.
Malnutrition takes toll on an individual throughout the life cycle. It travels from childhood to adolescence and to the adult thereby hampering his/ her physical and cognitive capacities and eventually reducing his/ her productivity thereby, continuing the cycle of poverty and malnutrition. It is more rampant and visible in women as a malnourished girl child is most likely to develop as a malnourished adolescent and malnourished mother giving birth to a low birth weight (LBW) baby (less than 2.5 Kg).
To bolster the government’s efforts to reduce malnutrition among children, girls, and pregnant women, many corporates are now working on several such campaigns.
As a part of its CSR activities, Adani Wilmar for instance has launched a targeted campaign to ensure the targeted beneficiaries get proper nutrition. The campaign is presently operating in more than 1,250 villages across 12 states, and covering over 3 lakh households. In five years, the campaign has touched a population of almost 16 lakh, which includes 1 lakh children in the 0-5 age group, 1 lakh adolescent girls, and more than 2 lakh women in reproductive age. The campaign is being driven by village health volunteers, who constantly direct their efforts and resources to reduce malnutrition.

First 1000 Days

First 1000 days of one’s life, right from the conception in the mother’s womb to completion of two years after childbirth, is considered worldwide as the golden period, as it put a firm footing for a child’s physical, mental and social health. Each day of this period is special and influences the way a baby develops, grows and learns – not only in childhood but for the entire life. 80% of a person’s brain develops during the first two years of his/ her life. To mitigate and revert the cycle of malnourishment, investment and focused interventions during this period are of crucial importance. The nurturing care (proper nutrition, stimulation, love and support) one gets during this period forms the foundation for further development. It is therefore very important to best utilize the potential of the first thousand days. During these days, the parents and family must adopt the practices of the “Maternal, Infant & Young Child Feeding (MIYCF)” laid down by GOI with support from UNICEF and WHO, along with maintaining general hygiene and using safe drinking water.

1. Mother’s Health and Nutrition

280 days (40 weeks) of pregnancy lays the foundation stone for safe childbirth and his/ her nutritional status. Since, the baby in the womb is dependent physically, mentally and emotionally on the mother, the nutritional status of the mother, before, during and even after pregnancy, is critical. An increase of 10 to 12 kgs weight of pregnant women during entire pregnancy is a good indicator of her health. It is the duty of the husband and family members to create a healthy, friendly and emotionally balanced environment around pregnant women.  Would-be mothers and mothers must be given a diverse diet in sufficient quantity and frequency. A mother’s diet must include-
1. Cereals – Rice, wheat, Ragi, Bajra, jowar in form of chapati, dosa, halua, poha, upama etc.
2. Fruits and vegetables – as a rich source of essential micronutrients and vitamins – a variety of seasonal fresh fruits like guava, papaya, apple, amla, anar, etc. One must eat an ample quantity of green leafy vegetables like palak, methi, bathua, sarso, and other seasonal vegetables like potato, carrot, beet, beans, cabbage, moringa, lady’s finger, brinjal, bottle guard, tomato etc.
3. Pulses – tur, chana, moong, masoor, rajma etc
4. Non-Veg diet – boiled eggs and properly cooked fish, meat etc.
5. Milk & milk products – milk, curd, paneer etc
6. Oils and pure ghee – containing omega 3 and omega 6 fatty acids
7. Water – must drink 10-12 glasses of safe water a day.
A would-be mother must eat 3 regular meals and at least 2 light snacks in between, along with 3-4 servings of vegetables, fruits and milk. National Health Mission, Government of India prescribes and provides Iron Folic Acid (IFA) and calcium tablets free of cost for a period of 12 months, 6 months before and 6 months post-delivery (1 IFA & 2 Calcium tablets per day). A pregnant woman must get herself registered at the earliest; get the pregnancy confirmed by ANM and get an MCP card. A pregnant woman must go for at least 4 health checkups and get the necessary immunization on Village Health and Nutrition Days (VHNDs) observed in every village every month on a pre-decided day or in any nearby health facility. The services in VHND are free of cost. It is important to identify the pregnancies with risk and providing immediate medical supervision.

2. Safe and Institutional Delivery

The remaining 720 days begin with safe and secure childbirth. Delivery must be conducted in a facility under the supervision of trained health personnel. Under PMMVY and JSS there are beneficiary schemes for women and the newborn. Institutional delivery ensures minimization of risk for both mother and child by observing vitals of the child; first-day immunization of child and counselling and education of mother and family on child feeding practices and birth spacing methods. Mothers must be supported to continue intake of balanced and diverse nutrient-rich diet in adequate quantities and frequency.

3. Early Initiation of Breastfeeding

Medical staff and family members must prepare and support the mother and newborn baby for breast crawl followed by breastfeeding within one hour (golden hour) of birth. The first yellow milk, colostrum, coming from breasts immediately after childbirth acts as a powerful agent to nourish the child and keep the baby away from many infections and induced morbidity and also increases the emotional bond between mother and child. It contains many essential micronutrients necessary for the growth and development of the child. Early breastfeeding supports the mother to minimize post-partum complications. The skin-to-skin contact, in this process, also keeps the baby warm and saves her from hypothermia. The more early the baby is facilitated to suck the breast, the more the milk will be produced and the mother will be saved from the complaints of problems in breastfeeding. Feeding newborn with formula milk and other things like honey, cow milk, water etc. must be strictly discouraged.

4. Exclusive breastfeeding

Babies must be exclusively breastfed during the first six months, even water must not be given during this period. Breast milk is a complete food for the newborn and contains all the essential nutrients required by a baby till six months. There is ample evidence that LBW babies gain good weight within 4-5 months if properly and exclusively breastfed. ASHA, Anganwadi and voluntary workers must teach pregnant women and lactating mothers to how to hold the baby during breastfeeding. The position of the baby is very important for full and satisfying breastfeeding.

5. Complementary feeding and continued breastfeeding

Immediately after the baby completes six months, she must be given balanced, diverse homemade and properly cooked food. Initially, it should be semi-solid paste 2-3 times a day gradually increased to a properly balanced diet 4-5 times a day. Remember, breastfeeding must be continued at least till the age of two years. Children must be given nutrient-rich food which can be described as a rainbow plate comprising of all-natural rainbow-coloured food items.
If a child is identified malnourished, his/ her diet needs to be modified immediately. Anganwadi worker, ASHA and voluntary worker must counsel the family, understand the barrier and suggest improving the diet of a child by adding necessary food group and increasing the frequency of feeding.

6. Immunization and hygiene management

National Immunization Programme (NIP) for the children includes all the vaccinations necessary for the children to save them from deadly diseases like tuberculosis (TB), polio, hepatitis, tetanus, diphtheria, meningitis, whooping cough, measles. These vaccinations are provided free of cost in VHNDs and in all government facilities. The NIP is designed to give protection to children till five years of age with booster doses of some vaccines. The vaccination programme is also coupled with deworming tablets and vitamin A supplementation twice a year for 5 years.
Children must be given safe drinking water and must be saved from repeated diarrhoea. Breastfeeding and complementary feeding must not be discontinued during diarrhoea and other illness. Zinc supplementation is introduced to build immunity during and after diarrhoea. Faeces of the child must be safely disposed of in closed toilets and flushed properly. Family members must wash their hands with soap and water before cooking food, feeding the child and after defecation and children too must be gradually taught to do so.

7. Growth monitoring and emotional development

Growth monitoring of each child is a prerequisite to understanding the nutritional status of the child. All the Anganwadi centres are equipped with tools to take and record anthropometric measures and early identification of malnutrition. All the children in 0-6 years must be enrolled at nearby Anganwadi centre and parents to be encouraged to monitor the growth pattern of their child and take appropriate measures to eliminate malnutrition at the earliest if detected. During the first 1000 days, emotional and cognitive development is also rapid in children. It is therefore important that parents give quality time to them caressing, talking and playing with them.
Thus to conclude, the first 1000 days in a person’s life determine the physical and mental status of the person throughout his/ her life. Parents, family members and health workers must understand the importance and plan to nurture the child accordingly.  ASHA and Anganwadi workers are trained to provide all support to the family of newly delivered mother in terms of immunization, nutrition, risk identification, counselling and other services. Nutrient-rich take-home ration is provided from Anganwadi centres for both mother and children up to 6 years. GOI and State Governments have launched many schemes for improving the nutrition status of children, but most of them lose focus because of the unawareness of people. The government often fails to reach rural people in their own language to make them aware of the facilities. If India really wants to achieve SDG 2, Anganwadi centres must be strengthened and the schemes must be thoroughly implemented, strictly monitored and reviewed.
Mr. Dattatraya Gokhale, Head – Health, Nutrition and Livelihood, Adani FoundationMr. Dattatraya Gokhale is the Head – Health, Nutrition and Livelihood at Adani Foundation.

Views of the author are personal and do not necessarily represent the website’s views.

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