Micronutrient Malnutrition Control for Better Productivity

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Micronutrient Malnutrition Control for Better
Productivity Economic Growth

• Dr. Saraswati Bulusu
• National Program Manager, India
• The Micronutrient Initiative
• April 24, 2006

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Overview

• Micronutrient deficiencies is a major public
  health problem in India affecting productivity
  and overall economic development. Minimal loss to
  GDP due to VMDs per year Rs 27,720 crores
• ICDS is the largest program in the world for
  integrated child nutrition with a network of
  5,68,888 AWCs across the country.
• ICDS is targeted to reach the most vulnerable
  segments like lt2 children, 2-6 yrs and PLW, who
  suffer more from these micronutrient
  deficiencies.
• ICDS offers a scope for innovations to reach
  micronutrients to the at risk groups, leveraging
  the ICDS infrastructure.
• The fortification programs could be piggy backed
  to the supplementary nutrition component of ICDS.

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Proven Opportunities to Control Micronutrient
Deficiencies through ICDS

• Supplementation (Since 1970s)
• Strengthening Bi-annual Supplementation of Vit A
  for Children 9m-59ms
• IFA tablets to PLW, Adolescent Girls and
  children.
• Fortification
• Nutri Candies
• Fortified khichdi
• Fortified RTE Foods
• Fortified Wheat Flour ( ICDS TPDS)
• Multiple Micronutrient Sachets (Anuka)

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MI India Summary of Interventions
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Nutri-candies 5 Million Beneficiaries Covered
Per Day
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Advantages of Nutri-candies

• Simple distribution compliance is nearly 100
• Targeted delivery
• Centrally processed qty. of mns ensured,
• Packed attractively and hygienically
• Cost effective (Rs.55 to 60 per ben. per year
  with 4 micronutrients inclusive of indirect
  costs)
• Drawn the attention of policy makers
• Proven Sensory (IHE) Stability (NPIL)
  Effectiveness (CINI) Efficacy (AIIMS)

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Effect of candies on attendance of pre-school
children at AWCs - West Bengal (Udaynarayanpur
Block, Howrah dist)
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Efficacy Trials on Anemia Prevalence in
Pre-school Children
Prevalence of Anemia
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Vita Shakti to Fortify Khichdi-- An
Innovative Approach

• Khichdi -- Locally cooked at AWC with rice,
  lentil, oil salt. (Presently reaching 1.2
  million)
• Vita Shakti -- premix with iron(7mg), vit
  A(500iu) folic acid(50mcg)
• Packaging -- 1 kg pouch that can cater to 4000
  beneficiaries

• Mode of addition -- A small spoon measuring 1.25
  gms of the premix to be used for 5 beneficiaries,
  costing 3p per beneficiary per day.
• Training - Dilution, Mixing, Storage temp
  light
• Efficacy Study by Tufts University CINI

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Prevalence of Anemia for Non-Fortified Khichdi
(NFK) and Fortified Khichdi (FK) groups at 0, 12,
and 24 weeks.
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Serum Ferritin Conc.in Non-Fortified Khichdi
(NFK) and Fortified Khichdi (FK) groups at 0 and
24 weeks.
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ANUKA
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Wheat Flour Fortification for Control of IDA VAD

• Pilot project in Darjeeling Sadar Subdivision in
  West Bengal through TPDS reaching 0.6 million
• Scaled up in Kalimpong Kurseong through TPDS -
  today reaching 1.8 million
• Launched in Haryana, Punjab Chandigarh in 2005
  through open market - today reaching 2.5 million
  (Jan 05)
• Govt. Of AP initiated flour fortification through
  PDS (Nov 05)
• Govt of Gujarat Model Public Private
  Partnership for WFF (Jan 06)
• Advocacy meetings at West Bengal Orissa last
  week
• Commitment of GOI at the national level Policy
  Change??

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Iodized Salt Double Fortified Salt

• Use of adequately iodized salt in ICDS
• Salt fortified with iron iodine (DFS) is
  presently available NIN and MI formula.
• TNSC is presently manufacturing DFS which is
  being used in Mid Day Meal Program in Tamilnadu
  with support from MI
• Efforts to scale up in ICDS/MDM/PDS

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Thank You