India has one of the highest maternal and child malnutrition rates in the world, given, an estimated 200 million children are underweight at any given time, with more than six million of those children suffering from the worst form of malnutrition, severe acute malnutrition. Experts estimate that malnutrition constitutes over 22% of India’s disease burden, making malnutrition one of the nation’s largest health threats.
Among all the Indian States, Uttar Pradesh (UP) is home to the largest number of malnourished children. Nearly 40% of all children (more than 63 million) in UP are malnourished. According to National Family Health Survey III (NFHS 3), more than half of children (57%) under five years of age in UP are stunted, 42% are underweight and 15% are wasted. (NFHS-3, 2005-06). For a large number of children in UP, under-nutrition begins very early in life with about 27% of the newborns in UP have low birth weight (NFHS-3, 2005-06). Low birth weight, in turn, is determined by a number of factors, but the most important among them is maternal nutrition.
The University of Manitoba and its consortium partner India Health Action Trust has set up a TSU to support the GoUP in achieving its ambitious nutrition goals. The TSU will strengthen existing systems for the prevention and treatment of childhood malnutrition leveraging three platforms:
The project implementation period is from November 2015 – March 2019 with the overarching goal to provide high quality, well-coordinated techno-managerial support to the government’s Integrated Child Development Services (ICDS) to reduce under 5 morbidity and mortality due to childhood malnutrition in Uttar Pradesh
The TSU has strengthened robust platforms at the cluster, block, district and state levels to improve the health and nutritional status of women and children in UP by working in an embedded manner with the GoUP. Strengthening IYCF practices has been the major focus area of the UP-TSU’s nutrition activities.
At the Community level, the TSU has developed new check lists (has redesigned the Village Health Index Register to include tools to track IYCF practices, micronutrient intake and referral, treatment and follow up of children with SAM in the ASHA catchment areas), protocols (redesigned Village Health and Nutrition Day) and platforms (ASHA, Anganwadi Worker and ANM platform), and supported the adoption of Alive and Thrive tools and job aids for FLW. VHND checklists have been developed in coordination with the State Nutrition Mission and UNICEF, which are currently being used to enhance accountability at VHND.
At the Facility level, 25 Nutrition Rehabilitation Centers (NRCs) have been set up and 150 nurse mentors have been trained, in IYCF and SAM identification. Nine District Technical Specialists (DTS) have been trained in the facility based management of SAM children (FMAM).
At the Systems level, the TSU has been supporting the Micronutrient (Vitamin A, iron syrup and Albendazole) supplementation program, has conducted community based survey, has facilitated the preparation of state IYCF plan, guidelines on the Identification, referral and management of malnourished children and pregnant women at VHND and the regular meetings of the nutrition partners in the state. The TSU is also supporting the government in monitoring of micronutrient supply, weighing scales and Mid-Upper Arm Circumference (MUAC) tapes at State, District and Block levels .
The Nutrition Project is also providing technical support and supportive supervision to the ICDS and ICDS System Strengthening Nutrition Improvement Project (ISSNIP) activities. The support focuses on system strengthening and improving nutritional services mandated under ICDS programs. It also supports ISSNIP in monitoring and supervision of community based local rituals and events like Godh Bharai, Anna Prashan.