[Answered] A new study suggests that nutrition and health counselling delivered under the Integrated Child Development Services (ICDS) scheme is one of the best possible investments that can be made by any government. Discuss how nutrition counselling can solve malnutrition problem in India. Provide some other measures to prevent malnutrition in children.

The Integrated Child Development Services (ICDS) scheme is one of the world’s largest programmes for early childhood care and development. A new study by India Consensus suggests that nutrition and health counselling delivered under the programme is one of the best possible investments that can be made by any government.

Nutrition Counselling as a solution to malnutrition:

1. Empowering the mother- As a behavioural change intervention, nutrition and health counselling is relatively low cost for every person that is reached. It’s important to note that this programme does not provide food, but instead provides information to the mother, making it more likely that the child will receive more and better food. And that in turn leads to lifelong benefits.
2. Many studies have now demonstrated that these benefits can be large. Improving the nutrition and health outcomes of the children of mothers reached makes this a highly cost-effective intervention.
3. Two analyses in Andhra Pradesh and Rajasthan, looking at a six-year campaign of nutrition counselling and hand-washing. It is estimated that counselling leads to a 12% reduction in stunting. This leads to better cognitive skills.
4. Quantifying the increase in earnings shows that the per unit benefit for Andhra Pradesh and Rajasthan comes to ₹71,500 and ₹54,000. What these figures mean is that the investment generates returns to society worth ₹61 and ₹43, respectively, for every rupee spent. While the analysis will differ for other States, these results show that nutritional counselling is a phenomenal investment.

Strategies to prevent malnutrition and improve nutrition:

• Nutritional planning: This involves political commitment by the government. A well planned and well executed long term project can accelerate the developmental process and the benefits can be rewarding and permanent. Nutritional planning involves formulation of a nutrition policy and overall long term planning to improve production and supplies of food, ensure its equitable distribution and programs to increase the purchasing power of people. This may include-
  • Land reforms
  • Proper guidance in agriculture to help farmers to get better yields from their lands
  • Help in proper marketing of farm produce.
  • Income generating activities for the weaker sections of the community.
  • Making available good quality food in affordable prices through proper public distribution system.

• Direct nutrition and health interventions:
  • Improved health care system: Infections like malaria, measles and diarrhoea are prevalent in our society and they precipitate acute malnutrition among children and infants. A good health care system that provides immunisation, oral rehydration, periodic deworming, early diagnosis and proper treatment of common illnesses can go a long way in preventing malnutrition in the society.
• Nutrition education: People can be educated on-
  • The nutritional quality of common foods.
  • Importance and nutritional quality of various locally available and culturally accepted low cost foods.
  • Importance of exclusive breastfeeding for six months and continuing to breast feed up to two years or beyond.
  • Damage caused by irrational beliefs and cultural practices of feeding.
  • Recipes for preparing proper weaning foods and good supplementary food from locally available low cost foods.
  • Importance of including milk, eggs, meat or pulses in sufficient quantities in the diet to enhance the net dietary protein value.
  • Importance of feeding children and adults during illness.
  • Importance of immunising their children and following proper sanitation in their day to day life.
• Early detection of malnutrition and intervention:
  • The longer the developmental delays remain uncorrected, the greater the chance of permanent effects and hence intervention must occur during pregnancy and first three years of life.
  • A well recorded growth chart can detect malnutrition very early. Velocity of growth is more important than the actual weight at a given time.
  • If growth of the child is slowed or is arrested, physician should be alerted and any hidden infection or any reason for nutritional deficiency must be evaluated and taken care of.
• Nutrition supplementation: Usually, biologically vulnerable groups like pregnant women, infants, preschool going and school going children are targeted by various welfare measures conducted by the government. Calories, proteins and micronutrients like iron, vitamin A and zinc can be supplemented.

Objective of nutrition supplementation of infants and children includes-

• To treat and rehabilitate severely malnourished subjects.
• Improve the general health and wellbeing of children.
• Increase the resistance to infectious illnesses and thereby decrease morbidity.
• Accelerate the physical growth and mental development of children.
• Improve the academic performance and learning abilities of children.

Objective of supplementing pregnant and lactating women include-

• Preventing anemia in the mother thus improving her health and the pregnancy outcome.
• Improving calorie intake and prevent low birth weight baby, thus breaking the vicious cycle of intergenerational cycle of growth failure.

With returns like this at stake, there are compelling reasons to look favourably at approaches including nutrition counselling. Malnutrition need a multi pronged approach.