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: [email protected]@cinindia.org
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