ABSTRACT
Under-five child undernutrition in India, with consistently high rates of stunting (35.5%), underweight (32.1%), and wasting (19.3%), remains a significant concern. Inappropriate infant and young child feeding (IYCF) practices are recognised as one of the primary and direct contributory factors of child undernutrition. Though several national and state-level programmes in India have directed attention towards improving IYCF practices, there remain serious gaps and concerns.
The chapter describes field trials and interventions, which were systematically experimented with, researched, and documented to bridge the gaps between IYCF policy intentions and on-the-ground realities within the existing government systems of Integrated Child Development Services (ICDS) and Health. These trials were conducted in selected districts of Maharashtra and Gujarat (Nashik, Nandurbar, Washim, Banaskantha), including rural regions and urban slums (Mumbai). Through simple, innovative intervention processes, appropriate breastfeeding procedures were established and specific inputs administered, using cross cradle hold techniques (CCTs). Complementary feeding practices were improved, stressing the selection of quality protein food and regular use of homemade nutrient-dense mix as food supplements and effectively linking IYCF practices with regular monitoring of growth trends.
These interventions were effectively implemented through innovative training processes, including having a district team of Master Trainers cum Mentors (MTMs), extensive use of Health Spoken Tutorials (HSTs) in the local language for comprehensive training and home-level counselling, and the use of appropriate software to guide actions. Active leadership by district administration facilitated monitoring and enhancing the quality implementation of nutrition services and practices and rapidly reducing child undernutrition. Additionally, the project experience revealed that it is programmatically as well as technically important to revisit and correct the existing myths regarding the cut-offs for normal birth weight versus ‘at risk’ birth weight and for increasing the current acceptable target of daily weight gain in exclusively breast fed under-six-months’ infants.
In these trials, a substantial reduction in undernutrition in young children was observed. The underweight prevalence rate reduced from 28.5% to 9.4% in three months in Nashik and Washim districts in children adopted by the Master Trainers cum Mentors (TM), while in Nandurbar district, severe wasting decreased by 40% in a period of one year. The daily weight gain in infants under 14 weeks infants, following the adoption of cross cradle hold breastfeeding technique combined with monitoring weight gain, was reported to be as high as 30–40 grams per day in Banaskantha district, Gujarat.
The emerging key learnings from the field trials indicate the need for revisiting the existing Integrated Child Development Services (ICDS) and Health training policies, methodology, and supporting training and communication materials. For a substantial and rapid improvement in the child nutrition scenario, there is an urgent need to advocate that exclusive breastfeeding is undertaken using the cross cradle hold technique and appropriate complementary feeding practices that stress the selection of quality protein food and regular use of homemade nutrient-dense mix as food supplements. Additionally, IYCF counselling should be linked to regular monitoring of weight at defined time intervals.
