ABSTRACT
Objectives: Adequately iodized salt needs to be made accessible to the most marginalized. Madhya Pradesh, a state in central India, is home to a substantial proportion of India's poor. In 2009, the coverage of adequately iodized salt in the state was nearly 90% among the richest households, but only about 50% among the poorest. Methods: In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative to ensure the use of iodized salt in two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centers monthly. Results: Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12,113,584 children aged 3-6 years enrolled in anganwadi centers (June 2011-March 2012). One meal on school days was served to 78% of 5,751,979 primary-school children and to 79% of 2,704,692 secondary school children (April 2011- March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals. Conclusions: India has successful large-scale social safety net programmes targeting the most deprived population. Both national and state-level policies should mainstream the use of adequately iodized salt in these programmes.
ABSTRACT
This community-based cross-sectional study was undertaken to develop a complementary feeding index (CFI) to assess the adequacy of complementary feeding (CF) practices and determine its association with growth of infants, aged 6-12 months, in rural Indian population. The study was conducted in six villages of Ghaziabad district, Uttar Pradesh, India. A structured interview schedule was used for eliciting information from 151 mothers of infants, aged 6-12 months, on CF practices. Data on CF practices were scored using the CFI developed. Measurements of weight and length were taken. Bivariate and multivariate analyses were done using the SPSS software (version 13). The results revealed that the CF practices were suboptimal in the sample. The mean±standard deviation (SD) CFI scores ranged from a low value of 7.09±3.21 in 6-8 months old infants to a comparatively-higher value of 9.69±2.94 in 9-12 months old infants. Using the CFI it could be identified that infants (n=151) had poor dietary diversity, with only 31% and 18% of the infants reportedly being fed the recommended number of food-groups during 6-8 and 9-12 months respectively. The food-frequency scores of the CFI showed that cereals and diluted animal milk were the major foodgroups fed to the infants in this setting. Analysis of nutritional status revealed that 24.5% of the infants were stunted (length-for-age [LAZ] <-2SD), 25% were underweight (weight-for-age [WAZ] <-2SD), and 17% were wasted (weight-for-age [WLZ] <-2SD). Significant associations (p<0.05) were observed between the meal-frequency and the dietary diversity of the CFs of infants aged 6-8 months and 9-12 months and the WAZ and LAZ indices of their nutritional status. On multivariate analysis of factors affecting the LAZ, WAZ and WLZ scores, the CFI was significantly associated (p<0.05) with LAZ whereas maternal education and breastfeeding frequency were significantly (p<0.01) associated with WAZ and WLZ. Per-capita income, parity, and birth-order were the significant (p<0.05) determinants of the CFI. The CFI developed is an exploratory attempt to summarize and quantify the key CF practices into a composite index, which would reflect the CF practices holistically. This index can be used as an easy tool by programme planners for identifying, targeting, and monitoring the deficient CF practices and also advocating the importance of the CF at policy level.
ABSTRACT
OBJECTIVE: To assess the nutritional status and dietary practices among underprivileged pregnant women, identify the lacune, outline implement and assess the effect of nutritional counseling on their dietary intake, anthropometric status and anemia status. METHODS: Hundred pregnant women belonging to low socio-economic status were interviewed. Based on lacune, nutrition education (NE) was given in the form of simple messages to 50 subjects (NE-group) over 10-16 weeks period, while the remaining 50 formed the comparison group (Non-NE group). Tools used were individual counseling, weekly home visits and group meetings. Anthropometric measurements taken were height and weight. Dietary data was collected using 24-hour recall and food frequency questionnaire. Hemoglobin estimation was done. Effect of intervention was assessed by monitoring changes in dietary practices, weight gain, and nutritional status of the subjects. RESULTS: Baseline findings--low mean maternal body weight (51.05 +/- 7.26 kg), 96.3% anemia prevalence and severely sub-optimal dietary intakes. Post-NE results revealed a significant increase in quality and quantity of the diets consumed. Mean hemoglobin levels significantly increased (Post-NE vs Non-NE = 9.65 +/- 0.97 vs 7.85 +/- 1.58, p < 0.001) and anemia prevalence reduced (Post-NE vs Non-NE = 78.7% vs 96%) in post-NE group. CONCLUSION: Individual counseling with weekly reinforcement can bring about improvement in nutritional status during pregnancy.