India has an estimated 61 million stunted children, accounting for more than 3 out of every 10 stunted children in the developing world. However, more than one-third of the developing world’s children who are wasted reside in India.
Researchers have reported that mean weights start to falter at about 3 months of age and decline rapidly until about 12 months, with a markedly slower decline until about 18 to 19 months and a catch – up the pattern after that. Growth faltering in weight-for-length is restricted to the first 15 months of life, followed by rapid improvement.
Faltering in length-for-age, starts soon after birth, falling more sharply up to 24 months; and this decline lasts well into the third year. Thus, interventions should be sustained until the third year of life because faltering continues until this age.
Consequences of malnutrition
Poor nutrition during the critical formative years of infancy and early childhood has both immediate and long-term consequences. Malnourished children are at increased risk of infection as their immunity is impaired. Underweight children also tend to have more severe illnesses, including diarrhea and pneumonia.
The high prevalence of undernutrition among young children is largely because of
(a) not exclusively breastfeeding, discarding colostrum and /or use of pre-lacteal feeds
(b) prolonged breastfeeding
(c) late introduction of complementary foods
(d) use of bulky staple cereals and over dilution of feeds
(e) infrequent feeding and
(f) feeding small amounts resulting in deficits in energy, protein, and micronutrients vis – a – vis the requirements of the growing child, and
(g) default hygienic practices, especially personal hygiene. If cleanliness is not observed, complementary feeding may harm the child by introducing infections to the infant.
Contamination of complementary foods is very common in developing countries due to contaminated water, poor personal hygiene (contaminated hands of the person cooking food and/or feeding the child), inadequate cleaning of eating utensils and inadequate storage of foods after preparation. The higher incidence of diarrhea during the first few years of life coincides with the increase in the intake of contaminated feeds.
Need for Intervention
Studies have reported that the caregiving behaviors of mothers especially those related to infant feeding practices including breastfeeding, complementary feeding and hygiene are inadequate in developing countries, especially in India. Infant feeding practices in developing countries like India require focus on the following aspects:
Importance of Nutrition Education in Behaviour Change
Nutrition education is important not only for delivering information about healthy practices but also it involves working with communities to understand their perceptions and constraints to identify solutions for addressing nutritional problems. Changes in behaviors related to feeding practices are possible through well - designed interventions based on nutrition education in order to improve infant and young child feeding practices in developing countries.
Communication of nutrition education messages based on locally appropriate feeding recommendations are found to be effective in improving feeding practices, even in environments where the availability or adequacy of complementary foods is limited. When context-specific infant feeding messages on promoting the use of local foods are delivered directly to mothers through counseling, significant improvements in complementary feeding practices and dietary intake are possible.
Messages should be specific, with clear and practical instructions; based on recommendations; promote behaviors that are culturally acceptable and feasible; promote locally available and affordable foods; be motivating and show the benefits of adopting behaviors; and suggest ways of overcoming constraints. Influential community members and family decision-makers should be considered when developing messages, as caregivers will be more likely to accept and use practices if they are supported at the community and household levels.
The most common educational messages included in various interventions are:
i) Timely introduction of complementary foods
ii) Sustained breastfeeding during complementary feeding
iii) Amount, frequency, and consistency of complementary foods
iv) Use of thicker porridges instead of thinner porridges or soup
v) Use of animal - source foods
vi) Responsive feeding, and
vii) Personal hygiene.
In India, the Government’s Integrated Child Development Services (ICDS) aims to provide nutrition education, growth monitoring, and promotion services through paid field workers i.e. Anganwadi sevikas. Providing nutrition education and counseling mothers is one of the duties of the sevikas.
Hence appropriate strategies along with nutrition education intervention should be adopted in order to alleviate the nutritional problems common in low socioeconomic communities from developing countries. The nutrition education interventions could be incorporated into the community - based programs organized by the Government or by voluntary agencies.
The growth and development of the child are largely determined by the care and feeding practices they receive during first formative years. The first two years of life is the most critical window when infants are most vulnerable to growth faltering. Culturally appropriate behavior change interventions that aim to improve complementary feeding and caring practices could have a substantial impact on preventing child undernutrition.
Nutrition education is a cost-effective strategy in the long-term not only in terms of resources such as money but also it enables to capacitate the manpower to bring about behavior change in the community and build up the task force for future training in contrast to supplementation or fortification that do not involve the community and do not empower its members.