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Micronutrient Malnutrition Control for Better Productivity & Economic Growth. Dr. Saraswati Bulusu National Program Manager, India The Micronutrient Initiative April 24, 2006. Overview.

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micronutrient malnutrition control for better productivity economic growth

Micronutrient Malnutrition Control for Better Productivity & Economic Growth

Dr. Saraswati Bulusu

National Program Manager, India

The Micronutrient Initiative

April 24, 2006

overview
Overview
  • Micronutrient deficiencies is a major public health problem in India affecting productivity and overall economic development. Minimal loss to GDP due to VMDs per year: Rs 27,720 crores
  • ICDS is the largest program in the world for integrated child nutrition with a network of 5,68,888 AWC’s across the country.
  • ICDS is targeted to reach the most vulnerable segments like <2 children, 2-6 yrs and PLW, who suffer more from these micronutrient deficiencies.
  • ICDS offers a scope for innovations to reach micronutrients to the at risk groups, leveraging the ICDS infrastructure.
  • The fortification programs could be piggy backed to the supplementary nutrition component of ICDS.
proven opportunities to control micronutrient deficiencies through icds
Proven Opportunities to Control Micronutrient Deficiencies through ICDS
  • Supplementation (Since 1970’s):
    • Strengthening Bi-annual Supplementation of Vit A for Children 9m-59ms
    • IFA tablets to P&LW, Adolescent Girls and children.
  • Fortification :
    • Nutri Candies
    • Fortified ‘khichdi’
    • Fortified RTE Foods
    • Fortified Wheat Flour ( ICDS & TPDS)
    • Multiple Micronutrient Sachets (Anuka)
mi india summary of interventions

Fortified Candy

Anuka

Khichdi & RTE

Wheat Flour Fortifcation

VAS

Salt Initiatives

MI India – Summary of Interventions
advantages of nutri candies
Advantages of Nutri-candies
  • Simple distribution & compliance is nearly 100%
  • Targeted delivery
  • Centrally processed – qty. of mns ensured,
  • Packed attractively and hygienically
  • Cost effective (Rs.55 to 60 per ben. per year with 4 micronutrients inclusive of indirect costs)
  • Drawn the attention of policy makers
  • Proven : Sensory (IHE); Stability (NPIL); Effectiveness (CINI) & Efficacy (AIIMS)
slide7
Effect of candies on attendance of pre-school children at AWCs - West Bengal (Udaynarayanpur Block, Howrah dist)
vita shakti to fortify khichdi an innovative approach
‘Vita Shakti’ to Fortify ‘Khichdi’-- An Innovative Approach
  • Khichdi -- Locally cooked at AWC with rice, lentil, oil & salt. (Presently reaching 1.2 million)
  • Vita Shakti -- premix with iron(7mg), vit A(500iu) & folic acid(50mcg)
  • Packaging -- 1 kg pouch that can cater to 4000 beneficiaries
  • Mode of addition -- A small spoon measuring 1.25 gms of the premix to be used for 5 beneficiaries, costing 3p per beneficiary per day.
  • Training - Dilution, Mixing, Storage : temp & light
  • Efficacy Study by Tufts University & CINI
slide11

40

0 Weeks

36

32.6

12 Weeks

32

24 Weeks

28

24

20.7

19.1

20

16

Mean Prevalence Anemia

13.3

12

9.8

8

4.1

4

0

NFK

FK

Treatment Group

Prevalence of Anemia for Non-Fortified Khichdi (NFK) and Fortified Khichdi (FK) groups at 0, 12, and 24 weeks.
serum ferritin conc in non fortified khichdi nfk and fortified khichdi fk groups at 0 and 24 weeks

40

38

0 Weeks

µ

35.48

36

24 Weeks

34

32

30

28

Mean SF Concentration (µg/L)

25.7

26

25.12

24

22.91

22

20

FK

NFK

Treatment Group

Serum Ferritin Conc.in Non-Fortified Khichdi (NFK) and Fortified Khichdi (FK) groups at 0 and 24 weeks.
wheat flour fortification for control of ida vad
Wheat Flour Fortification for Control of IDA & VAD
  • Pilot project in DarjeelingSadar Subdivision in West Bengal through TPDS – reaching 0.6 million
  • Scaled up in Kalimpong & Kurseong through TPDS - today reaching 1.8 million
  • Launched in Haryana, Punjab & Chandigarh in 2005 through open market - today reaching 2.5 million (Jan 05)
  • Govt. Of AP initiated flour fortification through PDS (Nov 05)
  • Govt of Gujarat Model – Public Private Partnership for WFF (Jan 06)
  • Advocacy meetings at West Bengal & Orissa last week
  • Commitment of GOI at the national level – Policy Change??
iodized salt double fortified salt
Iodized Salt & Double Fortified Salt
  • Use of adequately iodized salt in ICDS
  • Salt fortified with iron & iodine (DFS) is presently available – NIN and MI formula.
  • TNSC is presently manufacturing DFS which is being used in Mid Day Meal Program in Tamilnadu with support from MI
  • Efforts to scale up in ICDS/MDM/PDS