Child Undernutrition Research Articles

Childhood and adolescent nutrition outcomes among girls exposed to gender-based violence: A rapid evidence assessment of quantitative research.

An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls' nutrition. We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls' exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity. In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive. Given that only 18 studies were included, the relationship between girls' direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.

The gut microbiome and early-life growth in a population with high prevalence of stunting

Stunting affects one-in-five children globally and is associated with greater infectious morbidity, mortality and neurodevelopmental deficits. Recent evidence suggests that the early-life gut microbiome affects child growth through immune, metabolic and endocrine pathways. Using whole metagenomic sequencing, we map the assembly of the gut microbiome in 335 children from rural Zimbabwe from 1–18 months of age who were enrolled in the Sanitation, Hygiene, Infant Nutrition Efficacy Trial (SHINE; NCT01824940), a randomized trial of improved water, sanitation and hygiene (WASH) and infant and young child feeding (IYCF). Here, we show that the early-life gut microbiome undergoes programmed assembly that is unresponsive to the randomized interventions intended to improve linear growth. However, maternal HIV infection is associated with over-diversification and over-maturity of the early-life gut microbiome in their uninfected children, in addition to reduced abundance of Bifidobacterium species. Using machine learning models (XGBoost), we show that taxonomic microbiome features are poorly predictive of child growth, however functional metagenomic features, particularly B-vitamin and nucleotide biosynthesis pathways, moderately predict both attained linear and ponderal growth and growth velocity. New approaches targeting the gut microbiome in early childhood may complement efforts to combat child undernutrition.

Unconditional Cash Transfers Do Not Prevent Children's Undernutrition in the Moderate Acute Malnutrition Out (MAM'Out) Cluster-Randomized Controlled Trial in Rural Burkina Faso

Unconditional Cash Transfers Do Not Prevent Children's Undernutrition in the Moderate Acute Malnutrition Out (MAM'Out) Cluster-Randomized Controlled Trial in Rural Burkina Faso

A community-based cross-sectional study to assess the burden of prevalence of undernutrition in 0-6 Years Anganwadi Children of Panvel Block, Raigad District, Maharashtra.

An impaired nutritional status in preschool children leaves significant impact on their overall childhood development. A community-based, cross-sectional study was conducted in Panvel, Maharashtra, over 15 months to assess the overall prevalence and patterns of undernutrition in preschool children using the composite index of anthropometric failure (CIAF). The sample size of 8542 was obtained from randomly selected 132 Anganwadis. Conventional indices (underweight, stunting, and wasting) and CIAF classification were used to assess the prevalence of undernutrition. Statistical analysis was performed using the SPSS version 27. About 50.6% of children were detected as "anthropometric failure" by CIAF method which is higher than conventional indices for underweight (32.9%), stunting (35.7%), and wasting (16.4%). The 13-25 months' age group was most significantly affected (57%) as per the CIAF. Undernutrition prevalence was similar for both genders across all age groups. A comprehensive policy is needed to identify and treat all anthropometrical failure children with special emphasis on 13-25 months' age group.

Role of Nutrition in Pediatric Patients with Cancer.

Children with cancer are at high risk for developing short-term and long-term nutritional problems related to their underlying disease and side effects of multimodal treatments. Nutritional status (NS) can influence several clinical outcomes, such as overall survival (OS) and event-free survival (EFS), treatment tolerance, risk of developing infections and quality of life (QoL). However, the importance of nutrition in children with cancer is still underestimated. This review focuses on alterations of NS that occurs in children during cancer treatment. In particular, we reviewed the pathogenesis of undernutrition in oncological children, as well as how NS affects treatment tolerance and response, the immune system and the risk of infections of children with cancer. Thanks to recent advances in all types of supportive therapy and to the progress of knowledge on this topic, it has been realized that NS is a modifiable prognostic factor that can be intervened upon to improve the outcome of these patients. Currently, there is a lack of a systematic approach and standard recommendations for nutritional care in the pediatric cancer population. Literature analysis showed that it is essential to define the NS and treat any alterations in a timely manner ensuring proper growth and development. Nutritional follow-up should become an integral part of the care pathway. Regular nutritional monitoring should be performed at diagnosis, during treatment and during follow-up. A close collaboration and sharing of expertise between pediatric oncologists and nutrition specialists, combined with careful and participatory sharing of the feeding experience with the family and the child (after age 6 years), is strongly required.

Prevalence of under nutrition among under-5 children in the urban field practice area of a medical college in Muzaffarnagar, Uttar Pradesh

Background: In India, undernutrition in children mal the age of five is a serious public health issue. Despite India's expanding economy, both urban and rural areas still have significant rates of undernutrition-related child mortality. There are hardly many studies that concentrate on cities. In order to determine the prevalence of undernutrition in the urban field practice area of a medical college in Muzaffarnagar, Uttar Pradesh, the current study was conducted. Objective of the study was using World Health Organization (WHO) growth standards, to determine the prevalence of undernutrition among children under the age of five. Methods: A community-based cross-sectional study was conducted in the urban field practice region of the medical college Muzaffarnagar, India, from August 2022 to November 2022. From 1875 registered families, 400 under-five-year-old children were randomly chosen, and a house-to-house survey was used to collect the study's data. The study's goals were explained to the parents, and their written agreement was obtained. The children who were accessible during the study period had their anthropometric measurements taken in accordance with WHO criteria. For nutritional deficits and other morbidities, the kids were checked. Data analysis was performed using the statistical package for the social sciences (SPSS) 23 programme and the Chi square test. Results: A total of 400 under 5 were examined by going from house to house, and 257 (64.2%) of them were underweight. Boys had significantly (p=0.001) more undernutrition than girls. In the age range of 49 to 60 months, it peaked. Conclusions: Children's malnutrition continues to be a problem for public health, especially among underprivileged populations.

Association Between Parental Education and Simultaneous Malnutrition Among Parents and Children in 45 Low- and Middle-Income Countries

Parental education is known to be associated with the health status of parents and their offspring. However, the association between parental education and the simultaneous manifestation of multiple forms of malnutrition within households remains underinvestigated globally. To assess the association between parental education and the simultaneous manifestation of malnutrition of both parent and child (either overnutrition or undernutrition)-referred to as the double burden of malnutrition (DBM)-at the household level in mother-child and father-child pairs in low- and middle-income countries (LMICs). This cross-sectional study used data from the US Agency for International Development Demographic and Health Surveys (January 1, 2010, to December 31, 2021) to identify mother-child pairs and father-child pairs from LMICs. The eligibility criteria were as follows: (1) children aged 0 to 59 months; (2) nonpregnant mothers at the time of the survey in the sample of mother-child pairs; and (3) valid measures of the weight, height, and hemoglobin level for the child and at least 1 of their parents. Highest level of parental education obtained and number of years of education completed. Four sets of multivariable logistic regression models were constructed to assess the association between parental education and DBM, and analysis was performed between March 10 and May 15, 2022. This study included 423 340 mother-child pairs from 45 LMICs and 56 720 father-child pairs from 16 LMICs. The mean (SD) age of the mother-child pairs was 28.2 (6.1) and 1.9 (1.4) years, respectively; 48.8% of the children were female. We observed that 49.0% of mother-child pairs experienced DBM. Compared with mother-child pairs with no maternal education, higher maternal education was associated with a lower risk of DBM. For example, the odds ratio (OR) for tertiary maternal education was 0.71 (95% CI, 0.67-0.74). However, the association differed by DBM subtypes: higher maternal education was associated with a lower risk of both mothers and children being undernourished but with a higher risk of almost all DBM subtypes involving overnutrition. For example, compared with mother-child pairs with no maternal education, those with secondary education were less likely to develop simultaneous maternal and child undernutrition (OR, 0.83 [95% CI, 0.80-0.86]) but were more likely to experience simultaneous maternal and child overnutrition (OR, 2.20 [95% CI, 1.61-3.00]); similar results were observed for pairs with primary and tertiary education. The results in mother-child pairs remained consistent after controlling for paternal education. Among the father-child pairs, 26.5% had DBM, with fathers with tertiary education significantly more likely to experience simultaneous paternal overnutrition and child undernutrition (OR, 1.55 [95% CI, 1.23-1.95]) compared with pairs with no paternal education; they were also less likely to have both paternal and child undernutrition (OR, 0.70 [95% CI, 0.59-0.84]). In this study, maternal education and paternal education were independently associated with DBM, and the associations differed by DBM subtypes. These findings suggest that the different risks of malnutrition faced by households with various levels of education should thus be considered in policy evaluation.

Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis.

Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear. In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting. Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months. The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.

Relationship Between Nutritional Status and Severity of Cerebral Palsy: A Multicentre Cross-Sectional Study

Nutritional problems are common in children with cerebral palsy (CP), yet the relationship between nutritional status and the severity of CP is unclear. To describe the nutritional status and characteristics of children with CP, and to explore the relationship between severity of CP and nutritional status in children. This multicentre cross-sectional study included children with CP in China. Weight and height were measured and converted to z-scores. Gross Motor Function Classification System (GMFCS), Eating and Drinking Ability Classification System (EDACS), Subjective Global Nutritional Assessment (SGNA), social life ability, and blood indicators were tested. All 1,151 participants were given oral-feeding and 50.8% of them demonstrated undernutrition. Compared with those in GMFCS or EDACS levels I-III, the odds of moderate and severe undernutrition were 2.6 and 8.9 times higher in GMFCS levels IV and V, and 4.3 and 12.6 times higher in EDACS levels IV and V, respectively. Except for serum 25-hydroxyvitamin D, no significant differences were found in blood indicators among normal, undernourished and overnourished groups. Degrees of undernutrition in children with CP are correlated with the severity of eating and drinking dysfunction and with gross motor impairment. Blood indicators may not reflect nutritional status in children with CP.

Comparative Study on the Prevalence of Malnutrition among Public Primary School Pupils in Rural and Urban Communities in Warri South

Malnutrition among primary school-age children has continued to pose a major public health issue, especially in developing countries. Nigeria is ranked amongst the top ten countries with the highest prevalence of undernutrition in children while about 2,300 children die daily in Nigeria as a result of malnutrition. Hence, the study was conducted to determine and compare the prevalence of malnutrition among public school pupils in rural and urban communities in Warri South LGA. This school-based comparative cross-sectional study made use of a bio-data form that collected socio-demographic details and anthropometric measurements of the pupils. The nutritional status of the pupils was obtained using WHO AnthroPlus software, while the resulting data were analysed and presented accordingly. The result showed that a total of 330 pupils (165 each from urban and rural public primary schools) were recruited, out of which more of the pupils in urban areas were younger, had parents who were better educated and employed while those from rural areas had higher family sizes. However, there was no difference in the sex and type of family of the pupils. The prevalence of malnutrition was reported as 36.7% with the prevalent form of malnutrition discovered as underweight (35.0%), followed by stunting (13.9%), overweight/obese (8.5%), and wasting (7.2%). Wasting, stunting, and overweight were higher among urban pupils, while the rate of underweight was higher among rural children. This high prevalence of undernutrition among urban pupils could be attributed to poor nutrition arising from a myriad of interrelated circumstances such as poor feeding, eating practices, and recurrent infection. Hence, the need for improved sensitisation of mothers concerning correct childhood feeding and provision of balanced nutrition.

Common factors influencing childhood undernutrition and their comparison between Sylhet, the most vulnerable region, and other parts of Bangladesh: Evidence from BDHS 2007-18 rounds.

Undernourishment is disproportionately spread within Bangladesh, making some regions like Sylhet more vulnerable than the rest of the country. We aimed to assess the trend of diverse associated factors related to childhood stunting, wasting, and being underweight. Furthermore, we have compared the estimated factors between Sylhet, the most vulnerable region, and other parts of Bangladesh. We performed a secondary data analysis where data were derived from the nationally representative cross-sectional surveys: Bangladesh demographic and health survey (BDHS) 2007, 2011, 2014, and 2017-18 rounds. The outcome variables were childhood undernutrition, including stunting, wasting, and being underweight. Descriptive statistics such as mean, standard deviation, frequency, and proportion were used to summarize the data. All variables were summarized by BDHS survey time points. We used multiple logistic regression models to measure the associated factors with childhood stunting, wasting, and being underweight. The percentage of children under the age of 5 years who were stunted declined from 40% in 2007 to 31% in 2018. Similar trends are observed in the decrease in the percentage of underweight children, dropping from 39% in 2007 to 22% in 2018. Wasting dropped to 8% in 2018 after years of critically high levels (17%). According to the results of the regression analyses, urban residence, child's age and gender, morbidity, maternal BMI, maternal and paternal education, decision-making ability, use of contraceptives, the occurrence of domestic violence, antenatal care, c-section, and birth interval, as well as geographic region, were all linked to childhood malnutrition. The Sylhet division falls short in several critical associated indicators, including parental education, maternal BMI, obtaining at least four ANC, women empowerment, and usage of contraceptives. Policymakers must concentrate on region-specific planning and proper intervention to achieve a more uniform improvement across the country.

Association between Ascaris lumbricoides infection and undernutrition in children: a systematic review and meta-analysis

Introduction: Ascariasis is the most common soil-transmitted helminths (STH) infection in children, with prevalence ranging from 6 to 60%, especially in an endemic region in Indonesia such as East Nusa Tenggara, Sumatera, and other remote areas. Ascariasis effects toward undernutrition were still unclear because there were differences between studies. This study aimed to investigate the association between Ascariasis and undernutrition in children. Methods: Six authors reviewed and analyzed eligible studies from PubMed and MEDLINE, Google Scholar, ProQuest, EBSCO-Host, and Springer Link, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines with Reference manager was used, and the data analyzed using Revman 5.4. Newcastle-Ottawa Scale adapted for cross-sectional studies was used to examine the publication bias. Results: This review included 15 studies and 12 studies used for meta-analyses. Pooled data indicates that Ascariasis is significantly associated with stunting (OR = 2.22, 95% CI = 1.31;3.77, p = 0.003) and underweight (OR = 1.27, 95% CI = 1.01;1.60, p = 0.04), meanwhile not significantly associated with wasted (OR = 1.11, 95% CI = 0.87;1.40, p = 0.40) of children aged 0-19 years. Conclusion: Ascariasis increases the risk of stunting and underweight among other parameters of undernutrition. Therefore, early screening, diagnosis, and intervention must be taken to prevent stunting and underweight in children.

Linkages between malaria and malnutrition in co-endemic regions of India

IntroductionMalaria and malnutrition are key public health challenges in India. However, the relationship between them is poorly understood. Here, we aimed to elucidate the potential interactions between the two health...

The Influence of Maternal Social Deprivation on Undernutrition in Children Under 5 Years in Northern and Southern Nigeria

The Influence of Maternal Social Deprivation on Undernutrition in Children Under 5 Years in Northern and Southern Nigeria

Assessment of mother and child protection card utility in a rural block of Odisha

Background: Mother and Child Protection card was introduced for accelerating reduction in maternal, neonatal, and infant mortality and child under-nutrition & meant to be used by both beneficiaries and health care providers. It is a folding pictorial tool designed to assist mothers' understanding and monitor individual progress of maternal and child health and also enable the large networks of ASHAs, AWWs, and ANMs to converge their efforts and utilize the critical contact opportunities more effectively. Objective: To assess the completeness of information in MCP card filled by the AWW, ANM, and Beneficiary. Material and Methods: Twelve villages in mendhasal block of Khurdha district were selected for this study by multistage stratified random sampling method. MCP cards of Pregnant women from the second trimester onwards and Mothers of children 0-2 years of age were assessed for completeness using a Checklist. Results: A total of 34 and 46 items were checked for completeness in the MCP cards of Antenatal and post-natal women. The median entries found to be complete in Antenatal and Post-natal women were 34 and 26. Recording information on demographic details and antenatal care details was high but there was poor maintenance of other records like post-natal care, immunization, and growth chart. It was also found that beneficiaries are not marking the circles in the tablets consumption part. Conclusion: The study reported a gap in the maintenance of records in the Mother & Child Protection Card. Training for both the health care providers and mothers is needed for adequate use of the MCP card.

Predisposing and reinforcing factors of undernutrition among 0- to 59-months-old children in rural communities of central Malawi

BackgroundChild undernutrition is a public health problem in Malawi. In 2015, about 23% of child mortality was linked to the phenomenon. Child undernutrition is more prevalent in rural areas and there is limited data to inform rural-specific programs. The aims of this study are to examine the prevalence and predisposing factors of undernutrition among 0–59 months-old children in rural central Malawi. MethodsA cross-sectional study design was used. A total of 538 child/mother dyads were systematically selected from postnatal clinics. Anthropometric assessment techniques and socio-demographic questionnaire was used to collect data. Child Z-scores for anthropometric data were calculated using Anthro v3.2.2. Logistic regressions were used to determine correlates of undernutrition. ResultsThe rates of stunting, underweight, and wasting were 42%, 11%, and 3%, respectively. In multivariable logistic regression models, limited access to safe water, and maternal exposure to intimate partner violence (IPV) were risk factors of child stunting (OR = 1.72, CI: 1.13–2.61) and (OR = 1.505, CI: 1.001–2.261) respectively. Child deworming, born at a low weight, and food insecurity were some of risk factors of child underweight (OR = 2.14, CI: 1.18–3.89), (OR = 2.41, CI: 1.23–4.71), and (OR = 1.89, CI: 1.01–3.51) respectively. Households that were near domestic water supply had low risk of registering wasted children (OR = 0.18, CI: 0.41–0.79). ConclusionsOnly the prevalence of child stunting is greater in central Malawi compared to national level. This study suggests that child nutrition planners in Dowa district should pay attention to water access, food security, child deworming, childbirth weight, and IPV.

LABOUR PRODUCTIVITY IN ADO-EKITI COMMUNITY: IMPLICATIONS FOR CHILDHOOD MALNUTRITION-MICRO VIEW PERSPECTIVES

Recent studies affirmed that inability for children in low-and-middle-income countries (rural area mostly concerned) to develop to their full cognitive potential and perhaps having adverse effects on physical and mental development, thus led to poor labour productivity in rural communities, had been traced to malnourished syndrome. Given this scenario, this paper is out to investigate the effect of childhood malnutrition on labour productivity as evidence in Ado-Ekiti community, Ekiti State, Nigeria using micro data analysis. The data was sourced from respondents across population samples (Ado Ekiti) State Capital of Ekiti State from Ekiti Central Senatorial District. The study was descriptive in nature. Simple random and purposive sampling techniques are used to select fifty (50) respondents out of 152 selected sampled. The research instrument adopted a wellstructured questionnaire for the study. The data gathered was analyzed using of simple percentage. Results from the study showed that under-nutrition (wasting, stunting and underweight), inadequate vitamins or minerals, overweight, obesity and mental health conditions are the prevalence of childhood malnutrition affecting labour productivity output of rural area in Ado Ekiti. Findings from the study indicates that under-nutrition in early childhood makes an individual more prone to non-communicable diseases later in life, including but not limited to diabetes and heart diseases that exhibits negative influence on labour productivity output in the communityAdo Ekiti; education gap and consequent lower skill-level of workforce substantially derail the development of countries affected by malnutrition; mortality and morbidity rates associated with malnutrition represented a direct loss in human capital and productivity of the economy as well as poor cognitive function and reduced school attainment that originate in early childhood undernutrition. Based on the findings of the study, it is therefore recommended that breast feeding mothers should be well educated on the significance of proper child breast feeding. This will go a long way to boost the immune system of the children and reduce illness, thus lead to labour productivity improvement of Ado Ekiti community’s growth and development and by extension to the country’s economy.

Divergence in time trends between nutrition and health status of Indian children: an enigma?

India has been food secure and children had access to essential health and nutrition services for four decades but under-nutrition rates in children continue to be high. Despite the high prevalence of low birthweight (LBW) and under-nutrition, under-five mortality rates are relatively low: the ‘South Asian enigma’. Data from research studies and large-scale nutrition and health surveys were analysed and reviewed to assess: dimensions, determinants and time trends of under-nutrition in under-five children, functional decompensations associated with LBW and under-nutrition, factors responsible for ‘South Asian enigma’, and progress towards Sustainable Development Goals (SDG) for child nutrition and health. Neonates born with low weight and length, follow a lower trajectory of growth throughout childhood; this was the major factor responsible for the high under-nutrition rates in children. Breast feeding was nearly universal; about 2/3rd of infants were solely breast-fed at 5 months; but both complementary feeds and adult food given to children were inadequate and lacked diversity. This resulted in a rise in under-nutrition rates between 12-23 months. In 24-59 months there was no further rise in under-nutrition rates. Moderate under-nutrition is not associated with increase in risk of infections; health care for infection was available and utilised; therefore, mortality rates were low. India will not be able to achieve the SDG targets for reduction in low birthweight or under-nutrition but is likely to achieve the targets for reduction in food insecurity and under-five mortality.

Implications of Young Child Malnutrition on Health and Development: Prioritize Nutrition Interventions in the First 1000 Days of Life

Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the ’at risk’ households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of ‘at risk’ households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India’s National Nutrition Mission/Poshan2.0.

Assessing the multi-sectoral convergence of interventions impacting nutrition at the household level: Lessons from Sundarbans, West Bengal, India

Background: Malnutrition is a multifaceted problem requiring interventions that address the multi-sectoral determinants contributing to it. As per National Family Health Survey - 5 (2019-21), with 33.8% stunted, 20.3% wasted, and 32.2% underweight children, West Bengal is one of the high burden states for childhood undernutrition in India.&#x0D; Objectives: The objective of the study was to assess household-level access (i.e. the percentage of households availing select services) to various nutrition-specific and nutrition-sensitive interventions and understand the extent to which convergent action has taken place in the most hard-to-reach areas of the Sundarbans.&#x0D; Methods: Cross-sectional survey following 30 x 30 cluster sampling; the sampling was done based on population proportion to size (PPS) methodology. A total of 912 households were recruited for a quantitative survey, and the data was collected through computer-assisted personal interview (CAPI) tools. Data was collected from October 15-25, 2021 from households having at least one child in the age group of 6 – 24 months.&#x0D; Result: The study focused on 19 nutrition-specific and sensitive interventions. Household-level coverage of 13 of these interventions was 1.5%; coverage of the six others was 4.2%. The estimated coverage of all 19 interventions was found to be almost non-existent (0.2%).&#x0D; Conclusion: The conspicuously low coverage of services at the household level is a clear indicator of poor convergence of government schemes and programs, reflecting, in turn, disjointed action on the part of the various departments of the government. The results suggest the need for reconsidering the household-level delivery of services as a wholesome package of interventions rather than seeing them as discrete departmental deliverables.