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DO'S AND DON'TS OF SNAKE BITE
STEPS TO OVERCOME MALNUTRITION
Action Plan for Overcoming the Curse of Malnutrition Critical actions are recommended based on this holistic approach and analysis (also see a Nutrition Security Framework in Attachment 2). These actions are divided into two categories:
1) what needs to be done; and
2) how to do it.
The first set of recommendations (what needs to be done) are based on evidence of which interventions have been the most effective in India and other countries. There is also a need for some consensus about “how” to ensure these interventions are implemented. This leads to the second set of recommendations, which may be the most critical. These “how” recommendations are based on an analysis of the current situation and opportunities as well as on expertise and programming experience.
Recommendations: What Needs to be Done to Achieve Nutrition Security A significant body of Indian and global evidence indicates that the following are the most critical and effective actions to improve nutrition security in India:
1. Focus on proven, essential nutrition interventions, the timely initiation of breastfeeding within one hour of birth, exclusive breastfeeding during the fi rst six months of life, the timely introduction of age-appropriate complementary foods at six months (adequate in terms of quality, quantity and frequency), hygienic child feeding practices, improved nutrition for women (especially adolescent girls, pregnant women and lactating mothers), focusing on iron and folic acid supplements and deworming, and timely, high quality therapeutic feeding and care for all children with severe acute malnutrition (with leadership from the Ministry of Women and Child Development).
2. Focus on proven, essential primary health care interventions: full immunisation, bi-annual vitamin A supplementation with deworming for infants and young children, appropriate and active feeding of children during and after illness, including oral rehydration with zinc supplementation during diarrhoea and timely, high quality therapeutic feeding and care for all children with severe 19 A Leadership Agenda for Action acute malnutrition (with leadership from the Ministry of Health and Family Welfare).
3. Promote personal hygiene, environmental sanitation, safe drinking water and food safety (with leadership from Ministry of Rural Development).
4. Integrate household food and nutrition security considerations into the design of cropping and farming systems (with leadership from Ministry of Agriculture).
5. Expand and improve nutrition education and awareness as well as involvement and accountability for improved nutrition at the community level (with leadership from the Ministry of Women and Child Development and the Ministry of Panchayati Raj [local self government] and including others, such as the Ministry of Information and Broadcasting and the Department of Education).
How to Do It:
Based on the Indian context and signifi cant programming experience, the Coalition recommends the following methods to improve nutrition security.
1. Expand efforts to engage and empower vulnerable communities, particularly women in these communities, to overcome malnutrition (e.g., through Gram Sabhas, self help groups).
2. Ensure that nutrition related programmes focus on key nutrition outcomes and are reaching the priority target groups of children under two years of age, and women (especially adolescent girls, pregnant women and lactating mothers), in order to break the intergenerational cycle of malnutrition and to achieve the desired results.
3. Strengthen the focus on improving nutrition through a leadership and coordination mechanism with clear authority and responsibility, working from local to national levels (e.g., possibly through a mechanism like a Ministry of Nutrition).
Discussion of Recommendations What to Do...
1. Focus on proven, essential nutrition interventions (with leadership from MWCD programmes). A review of evidence and experience indicates that the country should focus on the most effective interventions: Overcoming the Curse of Malnutrition in India 20 • Timely initiation of breastfeeding within one hour of birth • Exclusive breastfeeding during the fi rst six months of life • Timely introduction of complementary foods at six months • Age-appropriate complementary feeding (adequate in terms of quality, quantity and frequency) • Hygienic infant and child feeding practices, safe drinking water and basic sanitation • Timely, high quality therapeutic feeding and care for all children with severe acute malnutrition (SAM), including ready to use therapeutic foods, through a community- based approach combined with a facility based approach for children with medical complications of SAM • Improved nutrition for women, including iron and folic acid supplements and deworming for adolescent girls, pregnant women and lactating mothers
2. Focus on proven, essential primary health care interventions (with leadership from the MHFW programmes). A review of evidence and experience indicates that the country should focus on the most effective interventions: • Full immunisation and bi-annual vitamin A supplementation with deworming for infants and young children • Appropriate and active feeding of children during and after illness, including oral rehydration with zinc supplementation during diarrhoea • Improved nutrition for women, including iron and folic acid supplements and deworming for adolescent girls, pregnant women and lactating mothers • Timely, high quality therapeutic feeding and care for all children with severe acute malnutrition, including ready to use therapeutic foods • Address micronutrient malnutrition in a holistic manner through a food cum fortifi cation of appropriate foods strategy; promote and improve consumption of iodised salt
3. Promote personal hygiene, environmental sanitation, safe drinking water and food safety (with leadership from the Ministry of Rural Development programmes). The proven priorities in this area should be: • Promote use of safe drinking water 21 A Leadership Agenda for Action • Encourage personal hygiene and environmental sanitation, especially use of toilets and hand washing with soap • Ensure safe food handling practices during storage, cooking and eating.
4. Integrate household food and nutrition security concerns into the design of cropping and farming systems (with leadership from Ministry of Agriculture). • Promote agricultural and horticultural programmes and policies to increase the supply and consumption of safe, nutritious foods and to promote food based remedies for nutritional maladies, with emphasis on addressing micronutrient defi ciencies • Mainstream nutrition considerations into the National Horticulture and Food Security schemes such as Rashritya Krishi Vikas Yojana • Expand availability of low cost nutritious foods in rural areas though the Universal Public Distribution System, public-private partnerships, women’s self help groups and other mechanisms (including high quality complementary foods for children ages 6-24 months) • Review and revise existing programmes, such as the Mid Day Meal Scheme to improve the quality of foods provided and the nutrition education elements of the programmes •
The National Commission of Farmers has produced important recommendations in this area, such as:
(1) defending the gains of the Green Revolution in intensive agriculture areas;
(2) developing contingency plans for different weather possibilities;
(3) states with unutilised yield reserve should be encouraged to improve production and productivity;
(4) more crop and income per drop of water continuing to work for completing the unfi nished agenda of Land Reform; and
(5) ensuring a remunerative price for farm commodities
5. Expand and improve nutrition education, awareness and involvement at community level (with leadership from the Ministry of Panchayati Raj and MWCD, together with assistance from others, such as the Ministry of Information and Broadcasting programmes). • Increase PRI leadership in nutrition security: - Improve sensitisation and training of PRI members on priority nutrition issues Overcoming the Curse of Malnutrition in India 22 - Promote the formation and active functioning of Village Health and Sanitation Committees, with oversight from Gram Sabhas, in order to focus on nutrition and engage and empower vulnerable families - Expand PRI role in monitoring the functioning and outcomes of nutrition programmes at community level - Increase awareness of entitlements among poor households, especially women, for example, by the distribution of entitlement cards listing the various health, nutrition and development programmes available • Promote the use of information technology platforms and innovations (e.g., Gyan Chaupal, e-governance, National Knowledge Mission) for nutrition education and monitoring efforts; Encourage the Grameen Gyan Abhiyan Movement (village knowledge movement) and Gyan Chaupal (village knowledge centres) to focus on nutrition; Establish Village Nutrition Literacy Centres • Issue clear Government guidelines on the priority interventions and target groups for improving nutrition, to encourage all programmes to focus on these evidence based, priority interventions • Improve the nutrition education and counselling skills of all frontline service providers (e.g., Aganwadi workers, Auxiliary Nurse Midwives, Accredited Social Health Activists); expand nutrition education for public health and medical professionals; promote the development of a public health nutritionist cadre • Expand nutrition education programmes in schools • Expand Government programmes to empower and educate women’s self help groups and other community-based organisations about nutrition issues and key actions they can take (e.g., community production of high quality foods, dietary diversifi cation, grain banks) • Expand NGO, community-based organisations, civil society, citizen’s charters and private sector involvement in nutrition, including public-private partnerships and corporate philanthropy, with appropriate regulations designed to protect the public’s health (e.g., corporate support for nutrition education programmes)
HEALTHY BALANCE DIET
- From birth to 6 months of age, feed babies exclusively with breast milk (i.e. give them no other food or drink), and feed them "on demand" (i.e. often as they want, day and night)
- At 6 months of age, introduce a variety of safe and nutritious foods to complement breastfeeding, and continue to breastfeed until babies are 2 years of age or beyond.
- Do not add salt or sugars to foods for babies and young children
On its own, breast milk provides all the nutrients and fluids that babies need for their first 6 months of healthy growth and development. Exclusively breastfed babies have better resistance against common childhood illnesses such as diarrhoea, respiratory infections and ear infections. In later life, those who were breastfed as infants are less likely to become overweight or obese, or to suffer from noncommunicable diseases, such as diabetes, heart disease and stroke.
- Eat a combination of different foods, including staple foods (e.g. cereals such as wheat, barley, rye, maize or rice, or starchy tubers or roots such as potato, yam, taro or cassava), legumes (e.g. lentils, beans), vegetables, fruit and foods from animals sources (e.g. meat, fish, eggs and milk)
Eating a variety of whole (i.e. unprocessed) and fresh foods every day helps children and adults to obtain the right amounts of essential nutrients. It also helps them to avoid a diet that is high in sugars, fats and salt, which can lead to unhealthy weight gain (i.e. overweight and obesity) and noncommunicable diseases. Eating a healthy, balanced diet is especially important for young children's and development; it also helps older people to have healthier and more active lives.
- Eat a wide variety of vegetables and fruit
- For snacks, choose raw vegetables and fresh fruit, rather than foods that are high in sugars, fats or salt
- Avoid overcooking vegetables and fruit as this can lead to the loss of important vitamins
- When using canned or dried vegetables and fruit, choose varieties without added salt and sugars
Vegetables and fruit are important sources of vitamins, minerals, dietary fibre, plant protein and antioxidants. People whose diets are rich in vegetables and fruit have a significantly lower risk of obesity, heart disease, stroke, diabetes and certain types of cancer.
- Use unsaturated vegetable oils (e.g. olive, soy, sunflower or corn oil) rather than animals fats or oils high in saturated fats (e.g. butter, ghee, lard, coconut and palm oil)
- Choose white meat (e.g. poultry) and fish, which are generally low in fats, in preference to red meat
- Eat only limited amounts of processed meats because these are high in fat and salt
- Where possible, opt for low-fat or reduced'fat versions of milk and dairy products
- Avoid processed, baked and fried foods that contain industrially produced trans-fat
Fats and oils are concentrated sources of energy, and eating too much fat, particularly the wrong kinds of fat, can be harmful to health. For example, people who eat too much saturated fat and trans-fat are at higher risk of heart disease and stroke. Trans-fat may occur naturally in certain meat and milk products, but the industrially produced trans-fat (e.g. partially hydrogenated oils) present in various processed foods is the main source.
Eat less salt and sugars
- When cooking and preparing foods, limit the amount of salt and high-sodium condiments (e.g. soy sauce and fish sauce)
- Avoid foods (e.g. snacks), that are high in salt and sugars
- Limit intake of soft drinks or soda and other drinks that are high in sugars (e.g. fruit juices, cordials and syrups, flavoured milks and yogurt drinks)
- Choose fresh fruits instead of sweet snacks such as cookies, cakes and chocolate
People whose diets are high in sodium (including salt) have a greater risk of high blood pressure, which can increase their risk of heart disease and stroke. Similarly, those whose diets are high in sugars have a greater risk of becoming overweight or obese, and an increased risk of tooth decay. People who reduce the amount of sugars in their diet may also reduce their risk of noncommunicable diseases such as heart disease and stroke.
Altogether 25 doctors from different fields were honoured at the function organized at Hotel Chanakya on Sunday evening. Whereas Dr Dilip Sen and Dr B K Chaudhary were honoured with lifetime achievement award, Dr Prakash K Mishra was felicitated for his contribution to community healthcare.
In the field of anaesthesia, Dr Ajit Gupta bagged the award while Dr Ajay Kumar Sinha was awarded in cardiology. Others who were felicitated are: Dr Man Mohan (cardiothoracic surgery), Dr Alok Kumar (dentistry), Dr Ajay Kumar (endocrinology), Dr Brijlal (ENT), Dr Bimal Kumar (gastroenterology), Dr Manoj Kumar (general and laparoscopic surgery), Dr Ramji Singh (general physician), Dr Ravindra Kumar Das (internal medicine), Dr Om Kumar (nephrology), Dr Mukund Prasad (neurosurgery), Dr Rahul Kumar (neurology), Dr Anita Singh (obstetrics and gynaecology), Dr Rajiv Sharan (oncology), Dr Bibhuti Prasan Sinha (ophthalmology), Dr Amulya Singh (orthopaedics), Dr Bindey Kumar (paediatric surgery), Dr Anil Kumar Jaiswal (paediatrics), Dr Prabhat Ranjan (pathology), D Prem Kumar (radiology) and Dr M N Singh (respiratory medicine).
The achievers were selected by an eminent jury comprising, among others, Justice (retired) S K Singh, Nalanda University VC Gopa Sabharwal, founder member-secretary of Asian Development Research Institute Shaibal Gupta and IGIMS director Dr N R Biswas.
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