Andhra Pradesh – Making a difference ! i n ICDS and IYCF

1. Andhra Pradesh – Making a difference !inICDS and IYCF Warm Greetings !! Department for Women, Children, Disabled & Senior Citizens Government of Andhra Pradesh

2. Importance of Infant and Young Child Feeding (IYCF) practices Interventions for improving IYCF practices in Andhra Pradesh

3. Share of under-five deaths (%), 2011, by country 5 countries contribute towards 50% of child deaths globally http://www.childinfo.org/mortality_underfive.php

4. Neonatal Mortality Rate (NMR) - India Current: 29/1000 live births Accounts for almost ¾ thof IMR & >½ of U5-MR Source : SRS

5. Brain development 10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs. 2/3rd are related to poor feeding. Underweight (-2sd) NFHS-3 Over 60 million Why reduce Malnutrition ? • According to WHO estimates malnutrition is responsible for around 60% of child mortality • Malnutrition among children occurs almost entirely during the first two years of life and is virtually irreversible after that • As more than 90% of brain develops during first two years child undernutritionimplies cognitive development, intelligence, energy & productivity loss is tremendous even amongst the survivors • The global strategy on IYCF recognizes that malnutrition is related to inappropriate infant feeding practices 1 2 3 4 5

6. Optimal Infant and Young Child Feeding • Initiation of breastfeeding immediately after birth, preferably within one hour • Exclusive breastfeeding for 1st six months i.e., the infants receives only breast milk &nothing else, no other milk, food, drink or water • Appropriate and adequate complementary feeding after six months of age while continuing breastfeeding • Full Immunization for infants • Adequate nutrition for pregnant and lactating women

7. Trends of IYCF indicators in AP

8. Malnutrition among Women in A.P • Anaemia: The percentage of anaemic pregnant women has increased from 41.8% to 56.4% from 1998- 99 to 2005-06 • BMI : Between 1998-99 and 2005-06, there is a marginal decline from 37.4 % to 30.8 % of women who are having BMI below 18.5

9. Malnutrition among Children in A.P • Low Birth Weight Children • % of children born with low birth weight in A.P. is 19.4% which is highest among the southern states • every 5th child born has birth weight less than 2.5 kg • Underweight Children • % of children below 3 years in A.P who are underweight is very high at 29.8% • trends shows a slow decline in reduction of prevalence of under- weight • every 3rd child below 3 years is underweight

10. Interventions to improve IYCF Practices in AP • Special weaning food for children 7 months to 3 years and hot meal for children 3 to 6 years • Supervised feeding for malnourished children • One full meal for pregnant and lactating women 1 Meaningful Food Models in ICDS • Capacity building on skilled IYCF counselling through counselling courses • Two Nutrition and Health Days (NHD), one for growth monitoring and other for health services • A convergence initiative of allied depts. with community 2 Intensified Health & Nutrition Education

11. Revised Food Models for Children “Balamrutham” for 7 months to 3 years • The new weaning food consists of wheat, channa dal, sugar, oil & milk powder • “Balamrutham” is fortified & is a caloric dense food • is distributed in packets of 2.5 kg per child per month • is widely accepted by the mothers • “Hot meal” for Pre-School children • Hot meal consisting of rice, dal and vegetable • served in the afternoon • 4 eggs in a week served in the morning and • snacks served in the evening

12. Balamrutham: Weaning Food for Children < 3 Years Composition per 100 g Nutritive value per 100 gm

13. Supervised feeding for Malnourished Children upto 5 Years • Identification of malnourished children upto 5 yrs • children upto 5 years are categorized as • Severely Underweight (SUW) based on • “Weight for age” criteria • children are also categorized as Severe Acute Malnutrition (SAM)/ Moderately Acute Malnutrition (MAM) based on • “Weight for height” criteria • children are weighed once in a month & height • measured once in 3 months • Medical check-up of malnourished children

14. Supervised feeding-Model Menu for SUW/ SAM/ MAM Children of 7mths – 3 yrs

15. Supervised feeding - Model Menu for SUW/ SAM/ MAM Children of 3 – 6 yrs

16. “Spot feeding of One Full Meal” for Pregnant & Lactating women • Take Home Ration(THR) for Pregnant and Lactating women is inadequate & consumed by family members • “Spot feeding of one full meal” been introduced in 101 ICDS projects out of 254 for 3.35 lakh Pregnant and Lactating women • “One Full Meal” is likely to • improve maternal nutrition • reduce incidence of anaemia • reduce incidence of Low Birth Weight • quickly reduce IMR& MMR • Funding “One Full Meal” • Rs 7 per day per women under ICDS • Additionally Rs 13 per day per women under State budget

17. What does “One Full Meal” mean ….

18. What does “One Full Meal” mean ….

19. Concurrent Monitoring in Partnership with NGO Alliance, CESS & UNICEF • Improvement in the Postnatal care

20. Capacity Building on IYCF practices • Capacity building on skilled IYCF counselling through counselling courses been taken up by WCD • Nearly 400 plus people (AWTC Instructors, CDPOs, Supervisors) have been trained as middle level trainers in IYCF using BPNI material at Hindupur • Using these Middle Level Trainers the frontline workers have been trained

21. Nutrition and Health Days (NHDs) – Growth Monitoring & Counselling • Instead of one NHD in a month, two NHDs are being conducted • The focus of NHD-1 is on Growth Monitoring & THR • NHD-1 is conducted on 1st of every month • It allows focus on growth monitoring and categorization of children as SUW/SAM/MAM • It ensures availability of food stock before 1st of every month • The focus of NHD-2 is on providing immunization and ANC services by ANM • Counselling of mothers is conducted on both NHDs

22. Convergence – Reducing IMR, MMR, Malnutrition & improving IYCF practices PRIs SHGs Sanitation Maarpu - A Convergence Initiative Community Convergence A Key Safe Water Health Nutrition

23. Convergence Structure Institutionalized • Sarpanchas President • Other members of JB Committee (i.e. MPTC,SHG (2), Social Activists (2) • ASHAs, ANMs, VO chairpersons • GP Secretary as convener & AWW as co-convener 1 Gram Panchayat • MPP as President • Other members of JB Committee (i.e. ZPTC, MPTC(2), Sarpanches (2), Social Activists (2) , SHG member (1), MPDO) • Dy. DM & HO, ICDS Supervisors, MPHS (M&F), MPHEOs, AWW (RWS),AEE (PR), APM,MMS chairperson • MO(PHC) as convener & CDPO as co-convener 2 PHC Level • District Minister as chairperson, District Collector • ZP Chairperson, MLAs, CEO (ZP), PD(DRDA), PD(DWMA), PD(MEPMA),SE(RWS), SE(PR),PO(ITDA), Addl. DM&HO (MCH& Tribal) DPHN,ZMS chairperson • DM&HO as member convener & PD (ICDS) as co-convener 3 District Level

24. Focus on 20 identified key interventions • To improve service delivery, to create awareness & to enable behaviour change • Intensified Health & Nutrition Education by CRPs and health & nutrition • functionaries

25. Way forward….. • To prepare annual plans for imparting Nutrition and Health Education • Need to position additional staff of ICDS mission to strengthen counselling • To actively involve community, SHGs and PRIs as partners in these efforts • To have close coordination with Health Department for effective convergence • To re-design food models in particular for malnourished children & pregnant women • To continue the skilled IYCF Counselling training courses

26. Thank You