26 November 2010

Rajib K. Haldar

Additional Director, CINI

Malnutrition: Stumbling from the

Start

Child in Need Institute

www.cini-india.org

Outline of the Presentation

A. CINI: A Brief History

B. What We do?

C. Malnutrition: An Integrated Approach

D. Where We Work?

E. Outreach

F. Emergency Ward & Nutrition Rehabilitation Center

G. Community based Nutrition Security Programme

H. Success Stories

I. Key Achievements

J. Challenges and Constraints

K. Future Plans

L. Awards & Recognitions

CINI: A Brief History

In 1970, a national study conducted by Indian Council of Medical

Research(ICMR)/ AIIMS identified calorie deficit, Vitamin A and

Iron deficiency to be widely prevalent in children below 6 years.

The countrywide flagship ‘Integrated Child Development

Services’ (ICDS) Scheme was launched to address the situation.

CINI’s Founder Director, Dr. Samir Chaudhuri, a Paediatrician

by training, conducted the above research study at All India

Institute of Medical Sciences (AIIMS), New Delhi

Upon return to Kolkata, he founded CINI in 1974 with a multi-

disciplinary team of professionals

CINI started as a Child Health clinic for Under 5 malnourished

children on the outskirts of Kolkata city, continues to attract

patients from far and wide till today

CINI – award winning NGO, of 36 years of experience, works in

the most disadvantaged areas of the country

Child Malnutrition- Why does it matter? The Sign of

Shame

An estimated 40% of the World’s severely malnourished children under 5 live

in India, 49.5 % below age5 are severely or moderately underweight. 3 in

every 4 children are anaemic and 1 in 3 are stunted.

At least half of Indian infant deaths are related to malnutrition, often

associated with infectious diseases

In the districts of West Bengal, 51.8% of the children below 2 years of age

are malnourished. 22.09% of these children suffer from moderate to severe

anemia. The fourth worst State with malnutrition status and anaemia.

The most damaging effects of under-nutrition occur during pregnancy and

the first two years of a child’s life. These damages irreversible.

Malnutrition impedes motor, sensory, cognitive , inclusive social and

economic development. Malnourished children are less likely to benefit from

schooling, vulnerable to child exploitation and will consequently have lower

income as adults .

What we do?

CINI helps marginalised mothers and children in India

break free from the cycle of poverty.

CINI reaches out across all levels of Indian society

from door to door in the villages and slums as well as

talking to locally elected representatives and

influencing social sector policies

Multi-layered, Rights based approach towards

sustainable improvement in nutrition, healthcare and

education while protecting the children

CINI‟s work concentrates on the core areas of nutrition,

healthcare, education and protection and on helping

to establish Child and Woman friendly

Communities(CWFC) and achieve MDGs.

Mothers and children supported by CINI

Mission :

„Sustainable Development in Health, Nutrition, Education and Protection of Child, Adolescent and Woman in need‟.

What we do?

Nutrition

Healthcare

Education

Protection

Child & Women Friendly

Communties

Influencing & Outreach

Training

Other Activities

Education, Protection, Health and Nutrition facilities of CINI

Malnutrition: An Integrated Approach

Malnourishment can be addressed through adoption of

healthy child feeding and caring practices in

households –Frequency, Quantity and Quality

CINI recognizes nutrition as a key determinant of

health and tackles malnutrition by addressing all the

above in an integrated response

CINI‟s nutrition model focuses on educating women

to make the best of what is available. It also runs a

Nutrition Rehabilitation Centre which has been

adopted as a model by a number of state

governments under NRHM.

Life Cycle Approach

Children having nutritious food at CINI NRC

Child growth failure

Low Weight & Height in

Adolescence

Small adult women

Low birth weight baby

Early Pregnancy

Intergenerational Cycle of Malnutrition

Addresses risks and opportunities during critical stages of lifecycle,

starting with pregnancy and moving through birth, infancy, early

childhood and adolescence.

Pregnancy

Early childhood

(0-2 years)Adolescence

Early registration

Ensure adequate

weight gain

Ensure TT , IFA, 3

or more ANC

Attended delivery

Adequate nutrition

Reduce anaemia among

girls

Awareness regarding

pubertal changes

Develop life skills

Birth weight above 2500 gm

Proper feeding as well as

weaning

Early stimulation

Timely immunization

Prevent frequent illness

Reduce incidence of death

Life Cycle Approach:A Package of Interventions

Where We Work?

Children of the community in CINI work area

CINI reaches out to 2

million people in the area

of our operation

CINI has trained over 25,000

Government health workers

and representatives from over

hundreds of NGOs

Some of the poorest areas of

India – Jharkhand,

Chhatisgarh, West Bengal

Outreach

Community based Interventions (current):17,00,000

population

Reaches out to 9,000 children in urban slums on issues

of health, nutrition and hygiene

Training on health and malnutrition issues:

Total Government staff (1978-2003): 51,365

Anganwadi Workers (2003-2010): 1,658

ASHA workers (various batches): 42,687

Emergency Ward (EW) and Nutrition

Rehabilitation Centre (NRC)

About 21,000 severely acute malnourished

children treated and saved from deaths in 36years

Emergency Ward (EW) : The Institutional based Service

model

A 10 bed unit for treatment of

children with disease and acute

malnutrition related problem

Children nursed till they are strong

enough to join NRC

Feeding is one of the crucial

components of managing

moderate and severe malnutrition

related case management

The learning is, ‘go slow’ and

avoid ‘force feeding’. Emergency Ward

Nutrition Rehabilitation Center (NRC) model

12 bed unit for undernourished

children plus supportive care and

capacity building of mothers/care givers

A mother is provided with

accommodation, food and

counselling support as her child is

nursed back to health.

Health workers demonstrate and provide

training on health and hygiene,

breast feeding and complementary

feeding, home management of diarrhoea,

plus growth monitoring and promotion.

Parents , particularly fathers are also

informed about the value of primary

immunization and child care practices.

Nutrition Rehabilitation Centre (NRC)

CINI NUTRIMIX : The Social Business Model

Supplementary nutrition, is usually secured from the market and is mostly accessible to

households with high purchasing power.

Innovated in 1974, low cost supplementary nutrition made from locally. Now

awarded by World Bank as a Social Business model.

Nutrimix, an innovative product of balanced nutrition for the child at low cost. This social

business venture aim at improving nutritional status of the child on the basis of cost recovery

or more.

Available cereals and pulses

Easy to prepare

Versatile - can be prepared in sweet (e.g. laddoos, halwa) and salty (e.g. upma)

variants

NUTRIMIX Laddoos

Can be used as a fortifying agent in chappatis

Low cost- one kilogram packet costs Rs. 40 only

Is used in community and clinical settings

Marketed through Self-help Groups of Women

Success Stories

Anita Roy - Before

Anita Roy - After

Success Stories

Apu Mondal - Before

Apu Mondal - After

Key Achievements

Piloted and developed India’s first model for facility based

care of Severe Acute Malnourished (SAM) children(NRC).

A 10 bedded NRC operational in CINI Main campus in South 24

Parganas district. Government has now plans for scaling up

CINI’s NRC model in West Bengal and across country.

Community based Nutrition Security Programme : Positive

deviance and Community Health Care Management

Initiatives (CHCMI) projects to cover 5 districts in West

Bengal

Reduction of severe malnutrition among children <3 years

from 4% to 1% , including in the most backward villages.

Working on pilots in reduction of anaemia in West Bengal

and Jharkhand

Challenges and Constraints

Malnutrition is invisible in its early stages. Often, neglected bycare givers, family members.

Although the issue is now recognized, actual facilities of EW almostnon-existing for severely malnourished children.

Donors funding for NRC and EmergencyWard, a big challenge.

Monitoring and follow- up of cases – sustaining behaviour andfamily practices - the key to rehabilitation at the community level

Availability of Doctors and skilled manpower –payment ofsalary and compensation

Capacity building of service providers and governmentfrontline workers .

Finally, call for increased investment and funding support toend malnutrition

For them, Tomorrow is too Late. Please join us in

our work on ‘ Malnutrition Matters’.

Future Plans Purpose: Treatment, Management and Nutrition rehabilitation of

severely affected malnourished children

Focus: Reduce the incidence of child under-nutrition in the 0 – 2 yearsage group in South 24 Parganas district

Activities: Facility based management of Severe, Acute Malnutrition(SAM) through Nutrition Rehabilitation Centers (NRCs) in accordancewithWHO guidelines for management of SAM children.

Rehabilitation of a single child with one caregiver over an average stayof 15 - 21 days, costs nearly Rs 10,000.

Nutrition Rehabilitation Center: Rs. 4,47,500

OPD and Thursday clinic for 20,000 patients and mothers’ counselling/follow-up: Rs. 7,50,000

Emergency Ward for treatment of 600 severe, acute malnourished children’s cases @ Rs. 20,000 per child average: Rs. 55,02,500

Total annual budget of nutrition management programme Rs. 67 lacs

Awards & Recognitions 2008 Annual Rotary India Award (for making the most significant contribution in reducing child mortality)

2008 Ellis Island Medal of Honor, USA (to CINI‟s director and founder, Dr Chaudhuri)

2007 World of Children Award (to CINI‟s director and founder,Dr Chaudhuri)

2005 Parliament prize for infants from the Italian Parliament Commission for Infants (to CINI‟s director and

founder, Dr Chaudhuri)

2004 The National Award in the field of Child Welfare

(CINI is the only NGO to have won this award twice)

1994 Allen Feinstein Hunger Award, Brown University, USA

1991 Jal Modi Grant, Rotary Club of Calcutta

1991 The “Liguria” prize from the International Centre for

Development of Culture of People, Genoa, Italy

1985 The National Award in the field of Child Welfare, Government of India

CINI acts as the partner of the government :

CINI is a consulting member of the Drafting Committee of the National Council of Nutrition of the Prime Minister

of India

CINI Nutrimix is recognized as an innovative and sustainable Social Business model

Regional Resource Centre by Ministry of Health and Family Welfare, Government of India

State Nodal agency for ASHA training, National Rural Health Mission

Mother NGO by Ministry of Health and Family Welfare, Government of India

Collaborative Training Institute for Reproductive and Child Health Training by National Institute of Health and

Family Welfare

Dr Chaudhuri receiving award from erstwhile Hon’ble HRD

Minister Shri Arjun Singh

Thank you

Contact Us

Rajib K. Haldar

Additional Director

Child In Need Institute (CINI)

Daulatpur, Pailan, South 24 Parganas

West Bengal -700104

web: www.cini-india.org

Email: rajib@cinindia.orgcini@cinindia.org