**13.3 Plans, programmes and missions**

Sustainable Development Goals (SDGs) were released by the UN in 2016 (till 2030) showing unfinished agenda of Millennium Development Goals (MDGs) ended in 2015. SDG 2 calls to end hunger, achieve food security and improved nutrition and promote sustainable agriculture whereas SDG 3 calls to ensure healthy

**Child health goals under NHP-2017 and SDG-2030 Child health indicator Current status NHP 2017 SDG 2030** Neonatal mortality rate (NMR) 24 16 by 2025 <12 Infant mortality rate (IMR) 34 28 by 2019 — Under-5 mortality rate (U5MR) 39 23 by 2025 ≤25

**13. Policy level nutritional interventions to fight against malnutrition**

trition among children, the policy called for the adoption of a multi-sectoral

Based on understanding towards a wide range of factors responsible for malnu-

approach along with multiple measures to achieve the goal of optimum nutrition for all. Important government led policy level interventions and programmes to combat

a. Inclusion of all vulnerable groups (children, adolescent girls, mothers,

b. Fortification of essential food items with legal provisions (e.g. twin

d. Control of micro-nutrient deficiencies with special focus on vulnerable

a. Guarantee of food security to citizens by increasing production of food grains.

b. Improve dietary pattern by promoting production and increasing per capita

e. Improving purchasing power of landless, rural and urban poor.

expectant women) under the safety cover of ICDS.

fortification of salt with both iodine and iron).

c. Popularize low cost nutritious food.

availability of nutritionally rich food.

c. Prevention of food adulteration by law.

f. Improving public distribution system (PDS).

d. Strengthening nutrition surveillance.

lives and promote well-being for all at all ages (**Table 2**).

malnutrition are as follows:

*Targets for child mortality in India.*

*Perspective of Recent Advances in Acute Diarrhea*

*Source: Ref. [33]*

**Table 2.**

**13.1 Direct policy measures**

groups.

**24**

**13.2 Indirect policy measures**


newer strategies of tackle anaemia, focused on six target beneficiary groups, through six interventions and six institutional mechanisms; to achieve the envisaged target under the POSHAN Abhiyaan. The strategy focuses on testing & treatment of anaemia in school going adolescents and pregnant women using newer technologies, establishing institutional mechanisms for advanced research in anaemia, and a comprehensive communication strategy including mass/mid media

*National De-worming Day (NDD)*: recognising worm infestation as an important cause of anaemia, National Deworming Day (NDD) is being observed annually on 10th February targeting all children in the age group of 1–19 years (both school

*Biannual Vitamin A Supplementation* is being done for all children below 5 years

*Village Health and Nutrition Days (VHNDs)* are also being organized for imparting nutritional counselling to mothers and to improve child care practices. A few schemes and services rendered by them are tabulated (**Table 3**) below as

• Akshaya Patra—the world's largest NGO-run mid-day meal programme

serving wholesome school lunch to over 1.76 million children in 15,668 schools

• Feeding India works to eradicate hunger, malnutrition and food wastage in India

• *Indian Impact*—It offers individuals and corporations an easy way to help improve their nearest Anganwadi centre, and supports NGOs that are working

communication material.

*Childhood Malnutrition in India*

*DOI: http://dx.doi.org/10.5772/intechopen.89701*

enrolled and non-enrolled).

**14.1 NGO's working to combat malnutrition**

• Salaam Baalak Trust Health and Nutrition

• Cry NGO in India to Support Child Rights

• The Hunger Project India—The Hunger Project

• Avantha Foundation Fighting malnutrition in Bihar

across 12 states in India.

• Nutrition CINI India

• CARE India

• Save the Children India

• Yashoda Foundation

• SNEHA—Society for nutrition

• Real Medicine Foundation

to reduce malnutrition.

**27**

• Freedom From hunger India trust

• FMCH India—Foundation for Mother and Child Health

of age.

per target group.

**Figure 11.** *Multi ministerial involvement showing political commitment and intersectoral approach to end malnutrition.*


**Figure 11** depicts multi ministerial involvement showing political commitment and intersectoral approach to end malnutrition.

### **14. Strategic nutrition related interventions rolled out by government of India**

Various community nutritional programmes are running in India to combat child malnutrition and to get nutrition on track. These are based on strategic nutrition related interventions. A few of them are discussed below.

*Promotion of Infant and Young Child feeding practices (IYCF)*: exclusive breastfeeding for first 6 months, complementary feeding beginning at 6 months and appropriate infant and young child feeding practices (IYCF) are being promoted. Mother's Absolute Affection (MAA) programme was launched in 2016 to promote breastfeeding and infant feeding practices by building the capacity of frontline health workers and comprehensive IEC campaign.

*Establishment of Nutritional Rehabilitation Centres (NRCs)*: NRCs have been set up at facility level to provide medical and nutritional care to Severe Acute Malnourished (SAM) children under 5 years of age who have medical complications. In addition, the mothers are also imparted skills on child care and feeding practices so that the child continues to receive adequate care at home.

*Anaemia Mukt Bharat (AMB)*: to address anaemia, NIPI has been launched which includes provision of supervised bi-weekly Iron Folic Acid (IFA) supplementation by ASHA for all under-5 children, weekly IFA supplementation for 5– 10 years old children and annual/biannual De-worming. The AMB strategy—Intensified Iron Plus Initiative—aims to strengthen the existing mechanisms and foster

*Childhood Malnutrition in India DOI: http://dx.doi.org/10.5772/intechopen.89701*

newer strategies of tackle anaemia, focused on six target beneficiary groups, through six interventions and six institutional mechanisms; to achieve the envisaged target under the POSHAN Abhiyaan. The strategy focuses on testing & treatment of anaemia in school going adolescents and pregnant women using newer technologies, establishing institutional mechanisms for advanced research in anaemia, and a comprehensive communication strategy including mass/mid media communication material.

*National De-worming Day (NDD)*: recognising worm infestation as an important cause of anaemia, National Deworming Day (NDD) is being observed annually on 10th February targeting all children in the age group of 1–19 years (both school enrolled and non-enrolled).

*Biannual Vitamin A Supplementation* is being done for all children below 5 years of age.

*Village Health and Nutrition Days (VHNDs)* are also being organized for imparting nutritional counselling to mothers and to improve child care practices.

A few schemes and services rendered by them are tabulated (**Table 3**) below as per target group.

## **14.1 NGO's working to combat malnutrition**


w. Bi-annual Vitamin-A Supplementation

*Perspective of Recent Advances in Acute Diarrhea*

and intersectoral approach to end malnutrition.

health workers and comprehensive IEC campaign.

that the child continues to receive adequate care at home.

**of India**

**26**

**Figure 11.**

x. Village Health & Nutrition Days (at Anganwadi centres)

nutrition related interventions. A few of them are discussed below.

y. Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy

*Multi ministerial involvement showing political commitment and intersectoral approach to end malnutrition.*

**Figure 11** depicts multi ministerial involvement showing political commitment

**14. Strategic nutrition related interventions rolled out by government**

Various community nutritional programmes are running in India to combat child malnutrition and to get nutrition on track. These are based on strategic

*Establishment of Nutritional Rehabilitation Centres (NRCs)*: NRCs have been set up at facility level to provide medical and nutritional care to Severe Acute Malnourished (SAM) children under 5 years of age who have medical complications. In addition, the mothers are also imparted skills on child care and feeding practices so

*Anaemia Mukt Bharat (AMB)*: to address anaemia, NIPI has been launched which includes provision of supervised bi-weekly Iron Folic Acid (IFA) supplementation by ASHA for all under-5 children, weekly IFA supplementation for 5– 10 years old children and annual/biannual De-worming. The AMB strategy—Intensified Iron Plus Initiative—aims to strengthen the existing mechanisms and foster

*Promotion of Infant and Young Child feeding practices (IYCF)*: exclusive breastfeeding for first 6 months, complementary feeding beginning at 6 months and appropriate infant and young child feeding practices (IYCF) are being promoted. Mother's Absolute Affection (MAA) programme was launched in 2016 to promote breastfeeding and infant feeding practices by building the capacity of frontline



Project (BINP). TINP-II (1991–1997) covered all non-ICDS blocks in the Tamil Nadu state. TINP-II was replaced by World Bank assisted ICDS III (WB-ICDS III)

hunger and malnutrition under Integrated Child Development Services (ICDS) program through Anganwadi centres (AWCs). Anganwadi means 'courtyard

Approximately 1.25–2.40% points per year (ppt/year) drop in underweight prevalence was noted among beneficiaries. On comparing drop in underweight prevalence between TINP areas and non-TINP areas, it was noticed that drop was approximately 0.83–1.12 ppt/year in TINP areas whereas reduction in underweight

At the same duration, reduction in the underweight prevalence was estimated as 0.7 ppt/year for the whole of India. Therefore it can be stated that quarter to half of the reduction in underweight prevalence was attributable to the TINP project.

Having achieved a significant reduction in severe early childhood malnutrition, TINP-1 became inspiration for others as a 'success story' during the 1980s. Evaluations indicated a decrease in underweight prevalence of about 1.5% points per year in participating districts, twice the rate in non-participating districts. Several factors contributed in the success story of TINP I viz. selective feeding (the careful focus on supplementing the dietary intake of young children when their growth faltered and until their growth resumed), clarity in job responsibilities and description, positive

TINP II was rolled out to move beyond reducing severe malnutrition and with a more ambitious objective to significantly reduce the burden of moderate malnutrition. In other words, it shifted towards a more preventive focus. Core strategies adopted in TINP II were regular growth monitoring, nutrition education, health check-ups, supplementary feeding of malnourished children and growth-faltering

Approximately 6.0 ppt/year drop in underweight prevalence was noted among TINP II beneficiaries. It was also noticed that drop was approximately 1.1 ppt/year in TINP areas. As per estimates of World Bank, the current underlying trend in the

In the nutshell, TINP II achieved its objective to decrease severe malnutrition

Take home massage from TINP I was, interventions that are targeted using nutritional criteria, integrated within a broader health system and effectively supervised and managed can significantly reduce severe malnutrition. TINP II

state was to be 5.0–7.0 ppt/year, which is most certainly an overestimate.

A few lessons were learned from TINP II before planning a next phase nutritional intervention. For example, need to work on localized capacity building, improved home-based care by intensifying community mobilization and targeted interpersonal communications, and feeding of 6–24 months old children. Next phase of nutritional programme must incorporate improved service delivery, supportive counselling of caregivers, social mobilization and participatory

but failed to achieve its objective for moderate malnutrition.

prevalence was approximately 0.26–1.12 ppt/year in non-TINP areas.

worker-supervisor ratio and robust monitoring system.

children, high-risk pregnant and lactating women.

Since 1975, Indian government is providing a package of services to combat child

from 1998.

shelter' in local language.

*Childhood Malnutrition in India*

*DOI: http://dx.doi.org/10.5772/intechopen.89701*

**15.2 TINP I (1980–1989)**

**15.3 TINP II (1990–1997)**

learning.

**29**

#### **Table 3.**

*Selected nutritional schemes and services rendered as per target group.*

#### **15. Case study**

The following case study from Tamil Nadu, a southern state of India focuses on the complex challenges faced and the progress made so far as part of efforts towards combating malnutrition. It also demonstrates how lessons are being learned along the way.

#### **15.1 The Tamil Nadu integrated nutrition project (TINP)**

The Tamil Nadu Integrated Nutrition Project (TINP), a World Bank assisted intervention program in rural south India, offered nutrition and health services to children under-5 and pregnant and lactating women. TINP-I (1980–1989) eventually covered 174 blocks. It was a forerunner of the Bangladesh Integrated Nutrition

#### *Childhood Malnutrition in India DOI: http://dx.doi.org/10.5772/intechopen.89701*

Project (BINP). TINP-II (1991–1997) covered all non-ICDS blocks in the Tamil Nadu state. TINP-II was replaced by World Bank assisted ICDS III (WB-ICDS III) from 1998.

Since 1975, Indian government is providing a package of services to combat child hunger and malnutrition under Integrated Child Development Services (ICDS) program through Anganwadi centres (AWCs). Anganwadi means 'courtyard shelter' in local language.
