India’s national feeding programmes may hold the key, says study
It is a cheap and simple public health intervention that’s intended to prevent iodine deficiency, one of the leading causes of preventable mental retardation and disfiguring goitre: iodised salt.
By 2009, over 70 per cent of Indian households had access to salt containing medically recommended levels of iodine (around 15 parts per million) added to it following a national policy of universal salt iodisation.
But the latest issue of Bulletin of the World Health Organisation points out that it leaves out around 249 million Indians, including eight million children born every year, who remain susceptible to iodine deficiency disorders (IDDs). And this group comprises the country’s most socio-economically disadvantaged population. In Chhattisgarh for instance, only 30 per cent of the population consumes an adequate amount of iodine.
The authors recommends that an effective way to create access to iodised salt is through India’s national flagship feeding programmes and cites the example of Madhya Pradesh, where a significant proportion of India’s socially and economically marginalised population lives.
Here, Sanjha Chulha (community kitchen), a state-wide joint feeding programme converged the two existing national programmes, the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme, with promising results. According to the paper, between 2011 and 2012, as many as 89 per cent of children aged three to six years enrolled in anganwadi centres received two meals a day cooked with adequately iodised salt for more than 21 days a month.
Meals served at anganwadi centres and schools are prepared in a common kitchen, where programme staff are taught to correctly use, store and monitor iodine content in salt.
This was a particularly significant outcome in the case of Madhya Pradesh, where over 37 per cent of the population belongs to India’s lowest economic quintile, half the children less than five years old are stunted and over a third are ‘wasted’ by WHO Child Growth Standards.
“Without the joint feeding programme, this segment of the population would have had little access to adequately iodised salt and would have remained at risk of IDDs,” say the authors.
It cautions that the planning and implementation of the feeding programme is however “fraught with challenges,” one being that the feeding programme lacks a standard monitoring mechanism.
The research paper was co-authored by Child Development and Nutrition Programme, UNICEF and the Women and Child Development Department, Government of Madhya Pradesh.