India’s top nutrition panel has recommended that severely malnourished children must be fed freshly cooked food prepared from locally available cereals, pulses and vegetables, and distributed by anganwadi centres, as part of the country’s first-ever guidelines for nutritional management of children suffering from severe acute malnutrition (SAM).
“The National Technical Board on Nutrition (NTBN) has approved guidelines proposed by our Ministry for severe acute malnutrition,” Secretary, Women and Child Development, R. K. Shrivastava told The Hindu .
The measures are part of the community-based health management of children suffering from SAM. The government had, till now, only put in place guidelines for the hospitalisation of severely wasted children who develop medical complications. Those norms were made public in 2011.
The norms were okayed by a scientific sub-committee under the NTBN, according to the minutes of the meeting issued last week.
The guidelines outline the role of anganwadi workers and auxillary nurse midwives (ANMs) in identifying severely wasted children, segregating those with oedema or medical complications and sending them to the nearest health facility or nutrition rehabilitation centres.
The remaining children are enrolled into “community based management”, which includes provision of nutrition, continuous monitoring of growth, administration of antibiotics and micro-nutrients as well as counselling sessions and imparting of nutrition and health education.
According to the recommendations, anganwadi workers have to provide modified morning snacks, hot cooked meals and take home ration for SAM children.
The morning snacks and hot-cooked meals, which are served at anganwadis to children between the age of three to six years, should be “prepared freshly and served at the centralised kitchen/ anganwadi centres. Locally available cereals, pulses, green leafy vegetables and tubers, vitamin C rich fruits, as well as fresh milk and 3-4 eggs every week” have also been prescribed.
It is also suggested that local self-help groups, mothers or village committees be engaged for the preparation of these meals.
Similarly, the take home ration, which is given to children between the ages of six months and three years, has to be prepared from “locally available and culturally appropriate food ingredients”. Use of extra oil/ ghee in these food items is also suggested in order to ensure these are “energy dense”.
The emphasis on freshly prepared food as well as locally procured ingredients clears the air on differences within the government on what form of food should be given at anganwadis, with Women and Child Development Minister Maneka Gandhi having backed “energy dense nutrient packets”.
Importantly, the government has also revised the method to be used to measure wasting and advised calculating weight based on the height of children instead of the mid-upper arm circumference.
According to the National Family Health Survey-4, 7.5%, or 8 million, of children aged under five years have severe wasting.