final version_child nurition

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Global Issues Assignments/ Child Nutrition

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CHILD NUTRITION IN DEVELOPED

AND

NON DEVELOPED COUNTRIES

Prepared by: Tuba Muktadir

ID:324909

Submitted to :Abdur Rouf


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INTRODUCTION

Nutrition has major effects on health. Nutrition refers to the availability of energy and nutrients

to the bodys cells in relation to body requirements. Malnutrition refers to any imbalance in

satisfying nutrition requirements. Malnutrition among children is often caused by the synergistic

effects of inadequate or improper food intake, repeated episodes of parasitic or other childhood

diseases such as diarrhoea, and improper care during illness . Malnutrition is often cited as an

important factor contributing to high morbidity and mortality among children in developing

countries . The relationship between nutritional status and child mortality is not conclusive,

however.

Malnutrition during childhood can also affect growth potential and risk of morbidity and

mortality in later years of life. Malnourished children are more likely to grow into malnourished

adults who face heightened risks of disease and death. Poor nutritional status of women has

been associated with a higher age at menarche and a lower age at secondary sterility .A number

of factors affect child nutrition, either directly or indirectly. The most commonly cited factors

are food availability and dietary intake, breastfeeding, prevalence of infectious and parasitic

diseases, access to health care, immunization against major childhood diseases, vitamin A

supplementation, maternal care during pregnancy, water supply and sanitation, socioeconomic

status, and health-seeking behavior.

Demographic characteristics such as the childs age and sex, birth intervals (both preceding and

following), and mothers age at childbirth are also associated with child nutrition

Several studies indicate that inadequate or improper food intake and repeatedepisodes of

infectious diseases adversely affect childrens nutritional.. Lutter and colleagues (1989) found

that proper treatment of acute infectious diseases, especially diarrhoea, has beneficial effects for

childrens growth and nutritional status. Briend and colleagues (1988) found that breast-feeding

improves nutritional status and child survival. Esrey et al.(1988) and Mertens et al. (1990)

found that the presence of a clean water supply and sanitary facilities have beneficial effects on

child growth and nutrition. Vitamin A supplementation has been shown to reduce morbidity .

The evidence of beneficial effects of vitamin A supplementation on morbidity and mortality in

children is not conclusive, however (Vijayaraghavan et al. 1990). In a smuch as vitamin A

supplementation reduces morbidity in children, it may also improve their nutritional status.


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Discrimination against girls in feeding and health care are often cited as reasons for poorer

nutrition and higher mortality among girls than boys in many developing countries. However,

most studies based on anthropometric data do not find a higher prevalence of malnutrition

among girls .

Many of the factors associated with child nutrition are also associated with each other.

Consequently, any apparent effect of one factor on child nutrition may be due to the

confounding effects of one or more of these other factors. Therefore, when assessing the effects

of any one factor on malnutrition, a multivariate analysis is necessary to control for the effects

of other potentially confounding factors. This report analyzes the effects of selected

demographic and socioeconomic factors on various dimensions of malnutrition among children

below age four, as indicated by anthropometric measurements, after statistically controlling for

a number of potentially confounding variables. The report complements results presented in the

original NFHS national report, which, however, provides only simple cross- tabulations of

the prevalence of child malnutrit ion by selected demographic and socioeconomic

characteristics without controls.

Available child nutrition programs for children in households below 185% of povertyare underutilized.

While 70.3% of low-income children eat a free or reduced price lunch at school, only23.7% of the eligible children are served by the school breakfast program. Even fewer

areserved by the summer food program (19.8%), because there are so few sites

operating.

United States data reveals that while about half of two to five -year-olds in NewYork consume the recommended servings of fruit a day, only 3% consume the

recommended servings of vegetables a day.(9) Only 24% of adolescents indicate that

they eat at least five fruits or vegetables per day.(8)

In 2003, slightly over 22% of the two to five-year-olds participating in New York'sWomen, Infants and Children (WIC) program were obese or overweight. In 2004,

21% of third grade school children in upstate New York and 24% in New York City

were obese. (9)


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Burden of Poverty:

The 21% of New York children living in poverty are less likely to eat foods that provide

adequate nutrition than their more affluent peers. In lowin come families, the need to pay for

housing, utilities and health care can compete with the need for nutritious food ("heat or eat").

About 10% of New Yorkers, more than 2 million people, live in "food-insecure" households

those without the financial or other resources to buy enough food at some time during a

month.(4)Childrens Health Series April 2006 Factors in the social and physical environments

in which children live affect their health and development. Over time, multiple influences

determine whether children will reach their full potential as physically and emotionally healthy

adults. This paper is one in a series on children's health produced by

SCAA to explore programs and policy interventions that can support the development of

healthy children in New York State.

Childrens Nutrition:

Food insecure households are more likely to be located in neighborhoods that don't have stores

selling healthy foods or reliable transportation. Families often cope by visiting food

banks/pantries, relying on less expensive processed foods (which are often higher in fat and

lower in nutritional quality) and eating fewer fruits, vegetables and dairy products.

Children in households with limited incomes are at increased risk for various chronic diseases

because they eat fewer of the nutrients necessary to maintain good health.(3) Cultural norms or

lack of awareness about healthy eating can also lead to food choices that don't meet the

nutritional needs of children.

Children have poor nutrition for many different reasons but the negative impacts are magnified

by such factors as lack of parental support, social stressors and being uninsured.

Nutrition and Development :

Diet influences all facets of a child's growth: physical, mental, cognitive, and psychosocial.

Brain development can be restricted by even mild malnutrition but chronic under-nutrition can

lead to life-long cognitive limitations and behavioral impairments.(5 )

Malnourished children often exhibit extreme behaviors that can beaggressive or passive, anxious or apathetic, withdrawn, or characterized


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by irritability.(11) Continuous low nutritional intake may have a

negative effect on critical development stages including parent-child

interaction, attachment, play, and learning.(5)

Poor nutrition weakens the body's ability to fight off common infectionsleading to longer absences from school and increased medical costs.

Overweight children are stigmatized by their peers and sometimes evenby parents and teachers, leading to low self-esteem, negative body image and

depression. This can affect their ability to socialize well with others and to feel

comfortable in a classroom setting.(10)

Overweight children and adolescents have an increased frequency of risk factors forheart disease, such as high cholesterol and high bloodpressure, compared to children

with a healthy weight. For the samereason, Type 2 diabetes, previously considered an

adult disease, hasincreased dramatically in children and adolescents.(11)

Healthy mothers are fundamental to the growth and development oftheir children. Many nutrition programs target expecting and parenting

mothers to ensure children are born healthy and receive the nutrition

they need early in life.

Nutrition Programs for Women and Children in development countries like

United States:

1.Food Stamps

The Food Stamp Program helps low-income households buy the food they

need for a nutritionally adequate diet. The Federal Government funds programs that are

operated by state and local social services. An eligiblehousehold must meet certain standards of

income and resources, work requirements, and citizenship status.

2.Women, Infants and Children (WIC) Program

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides

nutritious foods to improve diets, information on healthy eating, and referrals to health care and


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other services to low-income women and children up to age 5. The program has been proven to:

increase the number of women receiving prenatal care, reduce the incidence of low

birth-weight and fetal mortality, reduce anemia, and enhance the nutritiona l

quality of the diet of participants.

3.National School Lunch and School Breakfast Programs:

The National School Lunch (NSLP) and School Breakfast (SBP) Programs reimburse schools

providing meals to eligible children. All children may participate although household income

determines whether they receive free or reduced price meals or whether they pay full cost.

Research shows that children who participate in these programs eat better than children who do

not participate. Studies also conclude that students who eat school breakfast

increase their scores on academic and cognitive tests.

4.Summer Food Service Program:

The Summer Food Service Program (SFSP) is anentitlement program that provides funds for

eligible sponsoring organizations to serve meals to lowincome children when school is not in

session. SFSP sites can provide up to two meals (breakfast and lunch or breakfast and dinner) or

one meal and a snack. Many sites provide educational enrichment and recreational activities

that help children continue to learn and stay safe when school is not in session.

5.Child and Adult Care Food Program:

The Child and Adult Care Food Program (CACFP) is a key source of support for nutritious

meals and snacks in child care centers, family child care homes, Head Start, after-school

programs, shelters and adult day care centers. The program provides reimbursement for food

and meal preparation costs, ongoing training in the nutritional needs of children, and onsite

assistance in meeting the program's nutritional requirements.

Recommendations:

Increase outreach efforts to ensure that more eligible children enroll in school lunch programs.


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Provide start-up grants for school breakfast and summer food programs to assist school

districts and sponsors who want to operate programs.

Create universal breakfast programs in all schools where 50% ofstudents are eligible for

reduced-price or free school meals.

Require school districts to make summer food programs availablein or near all elementary

schools if any school in the district meets the criteria. The programs can be operated either by

the school or another organization.

Increase funding for Nutrition Outreach and Education Programs (NOEP) to increase

enrollment in food stamps and child nutrition programs. Increase the number of Summer Food

Program sites available.

Provide funding to make transportation available to children who do not have a way to get to

summer food program sites.

Require only healthy snacks and foods in school vending machines.

General Role of Nutrition in Learning and Behavior in the United

States: Association of overweight with academic performance and social and behavioral

problems: an update from the early childhood longitudinal study

Childhood overweight is a condition that is prevalent within oursociety, affecting more and

more children each year. The purpose of this study was to examine the relationship between

child overweight and educational outcomes. Data are reported for 13,680 children in third grade

from the Early Childhood LongitudinalStudy, a set of data designed and carried out by the US

Department of Education. Studentswere individually administered reading and math

assessments. Teachers reported how often students exhibited certain social skills and behaviors.

A series of 1-way analyses of covarianceand multivariate analysis of covariance was used.

Overweight children had significantly lower math and reading test scores compared with

nonoverweight children in third grade. However, these differences became insignificant after

including socioeconomic and maternal education variables. Third grade overweight girls had

significantly more externalizing and internalizing problems as well as lower self-control scores

than nonoverweight girls even after including socioeconomic and maternal education variables.

Finding ssuggest that how we deal with children's overweight may have implications for the

future psychological health of a considerable proportion of US children.


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Breakfast and learning:

Description: Over the past five years, significant new evidence has documented the link

between eating breakfast and learning. Recent studies show that skipping breakfast is relatively

common among children in the U.S. and other industrialized nations and is associated with

quantifiable negative consequences for academic, cognitive, health, and mental health

functioning. When combined with new data on the prevalence and impact of hunger/food

insecurity, the preponderance of recent evidence is that lack of optimal nutrition is a problem

for millions of U.S. students and that increased breakfast eating could be part of a solution.

Literature reviews published in the late 1990's set the stage for understanding this new evidence

by showing the associations between regular breakfast consumption/skipping and student

outcomes. Research over the past five years has provided new evidence for these associations

and definitive evidence for others: most notably that universally free school breakfast programs

increase the rate of overall-breakfast eating and are judged to improve learning by teachers and

school principals. These findings, along with accumulating evidence for the danger of

nutritional risks, provide a clear rationale for continued efforts to promote breakfast eating for

children, schools, and the nation as a whole.

Effective multi-level, multi-sector, school-based obesity prevention programming

improves weight, blood pressure, and academic performance, especially among low-

income, minority children.

Description: Successfully addressing childhood onset obesity requires multilevel (individual,

community, and governmental), multi-agency collaboration.

The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys (OWG) quasi-

experimental controlled pilot study (four intervention schools, one control school, total

N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention

designed to keep children at a normal, healthy weight, and improve health status and academic

achievement. The HOPS/OWG included the following replicable, holistic components: (1)

modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity

component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]),

blood pressure, and academic data were collected during the two-year study period (2004-6).

Statistically significant improvements in BMI, blood pressure, and academic scores, among

low-income Hispanic and White children in particular, were seen in the intervention versus


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controls: Holistic school-based obesity prevention interventions can improve health outcomes

and academic performance, in particular among high-risk populations.

Food security, poverty, and human development in the United States

Description: Access to food is essential to optimal development and function in children and

adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security

Scale was developed and is administered annually by the Census Bureau in its Current

Population Survey. The eight child-referenced items now make up a Children's Food Security

Scale. This review summarizes the data on household and children's food insecurity and its

relationship with children's health and development and with mothers' depressive symptoms. It

is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and

behavioral potential of America's poor and near-poor children. Infants and toddlers in particular

are at risk from food insecurity even at the lowest levels of severity, and the data indicate an

"invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly

remediable through policy changes, which a country like the United States, unlike many others,

is fully capable of implementing. The food and distribution resources exist; the only constraint

is political will.

Growing children's bodies and minds: Maximizing child nutrition and development.

Description: For their optimal growth, and for greater long-term human capital development,

children profit not only from improved nutrition but also from improved learning opportunities

in the earliest years of life. This paper describes how actions to enhance optimal infant and

young child nutrition can be linked with child development interventions for children under 3

years of age. In countries with high rates of malnutrition, linking these two components will

result in synergies of program activities, and will bring about a greater impact at reduced cost

than either activity conducted separately. New understanding of social marketing and

communication strategies can increase effectiveness of linked interventions. Public-private

partnerships to improve both child development and nutrition offer promise for sustainable

interventions.

Role of Nutrient Status in Learning and Behavior in the United States


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Are dietary patterns in childhood associated with IQ at 8 years of age? A

population-based cohort studyDescription: Little is known about the effects of overall diet in

childhood and intelligence later in life. Methods - The current study, based on the Avon

Longitudinal Study of Parents and Children, uses data on children's diet reported by parents in

food-frequency questionnaires at 3, 4, 7 and 8.5 years of age. Dietary patterns were identified

using principal-components analysis and scores computed at each age. IQ was assessed using

the Wechsler Intelligence Scale for Children at 8.5 years. Data on a number of confounders

were collected, and complete data were available for 3966 children. Results - After adjustment,

the 'processed' (high fat and sugar content) pattern of diet at 3 years of age was negatively

associated with IQ assessed at 8.5 years of age - a 1 SD increase in dietary pattern score was

associated with a 1.67 point decrease in IQ (95% CI -2.34 to -1.00; p


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Description: Studies of neurodevelopmental outcomes in offspring exposed to MeHg from

maternal consumption of fish have primarily measured cognitive abilities. Reported associations

have been subtle and in both adverse and beneficial directions. Changes in functional outcomes

such as school achievement and behavior in exposed children and adolescents have not been

examined. We undertook an assessment of school success of children in the Seychelles Child

Development Study (SCDS) main cohort to determine if there were any associations with either

prenatal or recent postnatal MeHg exposure. The primary endpoints were Seychelles nationally

standardized end-of-year examinations given when the cohort children were 9 and 17 years of

age. A subgroup (n= 215) from the main cohort was also examined at 9 years of age using a

regional achievement test called SACMEQ. Prenatal MeHg exposure was 6.8 ppm in maternal

hair; recent postnatal exposure was 6.09 ppm at 9 years and 8.0 ppm at 17 years, measured in

child hair. Multiple linear regression analyses showed no pattern of associations between

prenatal or postnatal exposure, and either the 9- or 17-year end-of-year examination scores. For

the subgroup of 215 subjects who participated in the SACMEQ test, there were significant

adverse associations between examination scores and postnatal exposure, but only for males.

The average postnatal exposure level in child hair for this subgroup was significantly higher

than for the overall cohort. These results are consistent with our earlier studies and support the

interpretation that prenatal MeHg exposure at dosages achieved by mothers consuming a diet

high in fish are not associated with adverse educational measures of scholastic achievement.

The adverse association of educational measures with postnatal exposure in males is intriguing,

but will need to be confirmed by further studies examining factors that influence scholastic

achievement.

Iron supplementation brings up a lacking P300 in iron deficient children

Description: OBJ: A decrease in iron concentration is accompanied by alterations in

catecholaminergic and GABAergic neurotransmission systems, important in learning, memory

and attention. It was hypothesized that iron deficient children would present attention deficits. A

visual-event related potentials (ERPs) study is presented using an oddball paradigm in order to

determine the P300 in ID children. METHODS: After medical examination, blood was obtained

from 201 children for a complete hematological study. Two groups were selected, iron deficient


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(ID) (serum iron 60 microg/dl). In both groups

ERPs were recorded while executing a continuous performance task (oddball paradigm).

Afterwards iron levels were restored in ID children by iron supplementation (ID-IS group) and

all tests reapplied. RESULTS: ID children almost lacked a P300 in central and parietal regions.

After iron supplementation, P300 clearly became evident although its Pz amplitude remained

smaller compared to C children. CON: A clear and strong correlation was found between ID

and attention alterations in children. Iron supplementation nearly brings the P300 to normal

levels although it is not known if the P300 difference in Pz is due to other

nutritional/environmental deficits or to developmental psychomotor impairments in ID children.

SIG: It has been long known that iron deficient children have cognitive impairments but there is

an insufficient number of electrophysiological works allowing to identify the source of this

problem. In this work an attention deficit is demonstrated in ID children through a severely

reduced P300, which recovers substantially after iron supplementation.

Multivitamin/Mineral supplementation does not affect standardized assessment of

academic performance in elementary school children.

Description: Limited research suggests that micronutrient supplementation may have a positive

effect on the academic performance and behavior of school-aged children. To determine the

effect of multivitamin/mineral supplementation on academic performance, students in grades

three through six (approximate age range=8 to 12 years old) were recruited from 37 parochial

schools in northern New Jersey to participate in a double-blind, placebo-controlled clinical trial

conducted during the 2004-2005 academic school year. Participants were randomized to receive

either a standard children's multivitamin/mineral supplement (MVM) or a placebo. MVM or

placebo was administered in school only during lunch or snack period by a teacher or study

personnel who were blinded to group assignment. The main outcome measured was change in

scores on Terra Nova, a standardized achievement test administered by the State of New Jersey,

at the beginning of March 2005 compared to March 2004. Compared with placebo, participants

receiving MVM supplements showed no statistically significant improvement for Terra Nova

National Percentile total scores by treatment assignment or for any of the subject area scores

using repeated measures analysis of variance. No significant improvements were observed in

secondary end points: number of days absent from school, tardiness, or grade point average. In


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conclusion, the in-school daily consumption of an MVM supplement by third- through sixth-

grade inner-city children did not lead to improved school performance based upon standardized

testing, grade point average, and absenteeism.

Role of School Meals Programs in Learning and Behavior in the United States

11 Improving access to school-based nutrition services for children with special health

care needs.

Description: Schools are recognized as a key setting to address the increase in overweight

among youth. As part of the coordinated school health model, nutrition services can positively

impact the eating ha bits of Americas school children and play a role in reversing this trend.

The requirement for school districts participating in the US Department of Agricultures child

nutrition programs to implement local wellness policies in the 2006-2007 school year presents

opportunities for registered dietitians (RDs) to be directly involved in helping schools create

more healthful environments. Further opportunities exist for RDs to deliver school-based

nutrition services specifically for children with special health care needs. Many students come

to school with physical, mental, and emotional health concerns that can impede learning.

Nutrition has a critical influence on cognitive development and academic performance in

children and adolescents, as undernourished children are more likely to have low energy and

difficulty concentrating (1). Basic nutrition needs must be met for children to successfully learn

at school. Iron deficiency, even in the absence of anemia, places a child at risk for cognitive

delay and lower math scores (1 and 2). Therefore, lack of proper nutrition can be considered a

barrier to optimal learning, justifying nutrition services for school-aged children in the school

setting. Nutrition may be especially important for children with disabilities and special health

care needs (3). Children with disabilities and special health care needs often have more physical

health-related problems that impact their education and nutrition status. It is estimated that at

least 40% of children with special health care needs are at risk for nutrition-related challenges

(4). Common issues include growth alterations, oral-motor problems that adversely affect

feeding, medicationnutrient interactions, altered energy and nutrient needs, and partial or total

dependence on enteral or parenteral nutrition (5). In addition, children with special needs have

been shown to have three times as many school absence days as their age-matched peers (6).

Absenteeism further threatens the ability for students to meet educational goals and when


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absence results from illness, poor nutrition status may be a contributing factor. Unfortunately,

despite the documented need, access to and delivery of nutrition services for children with

special needs presents challenges.

School feeding for improving the physical and psychosocial health of disadvantaged

students.

Description: Early malnutrition and/or micronutrient deficiencies can negatively affect many

aspects of child health and development. School feeding programs are designed to provide food

to hungry children and to improve their physical, mental and psychosocial health. This is the

first systematic review on the topic of school feeding. Eighteen studies were included in this

review; nine were performed in higher income countries and nine in lower income countries. In

the highest quality studies (randomized controlled trials (RCTs) from low income countries,

children who were fed at school gained an average of 0.39 kg more than controls over 19

months; in lower quality studies (controlled before and after trials (CBAs)), the difference in

gain was 0.71 kg over 11.3 months. Children who were fed at school attended school more

frequently than those in control groups; this finding translated to an average increase of 4 to 6

days a year per child. For educational and cognitive outcomes, children who were fed at school

gained more than controls on math achievement, and on some short-term cognitive tasks.

Results from higher income countries were mixed, but generally positive. For height, results

from lower income countries were mixed; in RCTs, differences in gains were important only for

younger children, but results from the CBAs were large and significant overall. Results for

height from high Income countries were mixed, but generally positive. School meals may have

small physical and psychosocial benefits for disadvantaged pupils. We recommend that further

well-designed studies on the effectiveness of school meals be undertaken, that results should be

reported according to the socio-economic status of the children who take part in them, and that

researchers gather robust data on outcomes that directly reflect effects on physical, social, and

psychological health.

Relationship Between School-Based Physical Activity and Academic Performance in the

United States The association between school-based physical activity, including physical

education, and academic performance


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Description: There is a growing body of research focused on the association between school-

based physical activity, including physical education, and academic performance among school-

aged youth. To better understand these connections, this review includes studies from a range of

physical activity contexts, including school-based physical education, recess, classroom-based

physical activity (outside of physical education and recess), and extracurricular physical

activity. The purpose of this report is to synthesize the scientific literature that has examined the

association between school-based physical activity, including physical education, and academic

performance, including indicators of cognitive skills and attitudes, academic behaviors, and

academic achievement

General Role of Nutrition in Learning and Behavior in Non-U.S. Countries

Association between unhealthful eating patterns and unfavorable overall

school performance.

Description: The objective of this article is to evaluate the relationship between children's

unhealthful eating patterns and overall school performance. The Nutrition and Health survey in

Taiwan Elementary School Children, 2001-2002, was carried out by using a multistaged

complex sampling design. A total of 2,222 elementary school children who had complete data

on demographics, anthropometrics, diet and lifestyle, and overall school performance were

included in the analyses. Differences in characteristics between children with favorable and

unfavorable overall performance were compared using t test and chi(2) test. Using factor

analysis, food frequency of 22 food groups was grouped into five factors, which were used to

construct dietary patterns. The association between dietary patterns and unfavorable overall

performance was assessed by multiple logistic regression after adjustment for known risk

factors. Prevalence of unfavorable overall performance in Taiwanese elementary school

children was 7.1%. Unfavorable overall school performance was positively associated withunhealthful eating patterns, which included high intake of low-quality foods (eg, sweets and

fried foods) and low intake of dairy products and highly nutrient-dense foods (eg, vegetables,

fruit, meat, fish, and eggs). Children with a greater number of unhealthful eating patterns were

more at risk for unfavorable overall performance in school. The study shows that children with

unfavorable overall school performance were more likely to eat sweets and fried foods, and


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were less likely to eat foods rich in protein, vitamins, and minerals. A potential relationship

between eating patterns and unfavorable overall school performance is supported by a positive

relationship between frequency of food intake and food preferences in our study.

Breakfast eating habit and its influence on attention-concentration, immediate memory

and school achievement. N.S. Gajre, et al. Indian Pediatrics, 45(10):824-828. 2008.

Description: OBJECTIVE: To study the relationship of breakfast to the attention -

concentration, immediate recall memory, nutritional status and academic achievement of school

children. DESIGN: Cross-sectional study. SETTING: Two schools catering to middle class

families in Hyderabad city. METHODS: 379 urban 11 to 13 years old school children studying

in 6th, 7th and 8th grades. Data collected in a single way blind procedure using Letter

Cancellation test, immediate memory from the PGI Memory Scale, school marks of the

previous year and nutritional status. RESULTS: Comparison between groups indicated

significant differences in the letter cancellation (LC) total scores with the regular breakfast

group achieving the highest mean scores compared to the no breakfast group (P< 0.05). Marks

scored by the regular breakfast group in subjects - Science, English and total Percentage were

significantly higher compared to those scored by the children in the no breakfast group. Regular

breakfast eating habit and weight for age percent were significantly(P< 0.001) associated with

immediate recall memory score explaining 4.3 percent variation. CONCLUSIONS: Regular

habit of eating breakfast as opposed to irregular consumption or skipping breakfast altogether

had beneficial influence on attention-concentration, memory and school achievement

Consumption of a mid-morning snack improves memory but not attention in

school children.

. Description: Consumption of a mid-morning snack improves memory but not attention in

school children. Physiol Behav, 2006.This study aimed to determine whether consumption of

a mid-morning snack with appropriate energy compensation through a smaller breakfast or

lunch, resulted in improved cognitive performance of 79 year old children with a low and high

socioeconomic status (LSES and HSES, n = 35 and 34 respectively). The children were each

randomly assigned to three iso-caloric dietary interventions: control (standard breakfast, no

snack and standard lunch), intervention A (small breakfast, snack, and standard lunch) and

intervention B (standard breakfast, snack, and small lunch), using a cross-over design. The


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Diet and mental health in children. D. Tomlinson, et al. Child and Adolescent Mental Health,

14(3):148-155. 2009. Description: The role played by diet in mental health is of increasing

interest to patients, parents, health professionals and public policy makers. This review

examines the literature assessing the role of diet in childhood cognitive development, school

performance and behaviour. The effects of inadequate dietary intake and of nutrient

supplements are considered. Studies of diet and specific psychiatric diagnoses such as

depression and psychosis are discussed, with a focus on the evidence for the child and

adolescent population.

Dietary patterns in infancy and cognitive and neuropsychological function in childhood.

C.R. Gale, et al. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(7):816-

823. 2010. Description: Background: Trials in developing countries suggest that improving

young children's diet may benefit cognitive development. Whether dietary composition

influences young children's cognition in developed countries is unclear. Although many studies

have examined the relation between type of milk received in infancy and subsequent cognition,

there has been no investigation of the possible effect of variations in the weaning diet. Methods:

We studied 241 children aged 4 years, whose diet had been assessed at age 6 and 12 months.

We measured IQ with the Wechsler Pre-School and Primary Scale of Intelligence, visual

attention, visuomotor precision, sentence repetition and verbal fluency with the Developmental

Neuropsychological Assessment (NEPSY), and visual form-constancy with the Test of Visual

Perceptual Skills. Results: In sex-adjusted analyses, children whose diet in infancy was

characterised by high consumption of fruit, vegetables and home-prepared foods (infant

guidelines' dietary pattern) had higher full-scale and verbal IQ and better memory performance

atage 4 years. Further adjustment for maternal education, intelligence, social class, quality of

the home environment and other potential confounding factors attenuated these associations but

the relations between higher 'infant guidelines' diet score and full-scale and verbal IQ remained

significant. For a standard deviation increase in infant guidelines' diet score at 6 or 12 months

full-scale IQ rose by. 18 (95% CI .04 to .31) of a standard deviation. For a standard deviation

increase in 'infant guidelines' diet score at 6 months verbal IQ rose by .14 (.01 to .27) of a

standard deviation. There were no associations between dietary patterns in infancy and 4-year


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performance on the other tests. Conclusions: These findings suggest that dietary patterns in

early life may have some effect on cognitive development. It is also possible that they reflect

the influence of unmeasured confounding factors.

Role of School Meals Programs in Learning and Behavior in Non-U.S. Countries

Breakfast clubs: Availability for British schoolchildren and the nutritional, social and

academic benefits.

Description: Breakfast clubs are not a new resource for parents and children, but interest in

them has heightened, because of both the need for improvement in school food and political

interest in their availability across the devolved countries. It has been suggested that concrete

scientific evidence as to their benefits to academic performance be required before a breakfast

club should be available for children across the UK. It is inappropriate to correlate crude

measures such as Standard Assessment Test (SAT) scores and exam results with breakfast club

provision, and the focus of analysis should be individual pupil benefit (both scholastically and

socially), nutrient intake, meal provision and even assisting working parents with child care.

There is limited data available to investigate the adequacy of food provision in school breakfast

clubs, but there is now sufficient information available for breakfast club organisers to provide a

nutritionally balanced breakfast. A body of evidence is emerging that demonstrates the benefits

of breakfast club attendance to mental performance and social development. However, it is

unclear whether such benefits are derived from the consumption of breakfast per se, the

environment or a combination of the two. It is reasonably safe to conclude that the benefits of

breakfast clubs are more pronounced in deprived areas, and efforts of charities to support

breakfast clubs should focus in these areas. Given the role and importance of school breakfast

clubs, ContinYou, a leading national charity, pledged support in establishing 200 more school

breakfast clubs over 2009 and 2010.

The influence of the glycaemic load of breakfast on the behavior of children in school. D.

Benton, A. Maconie, C. Williams. Physiology & Behavior, 92(4):717-724. 2007. Description:

The impact of breakfasts of different glycaemic loads on the performance of nineteen children,

aged six to seven years, was explored. Over a four week period, children attended a school


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23

are encouraged to drink it.

Behavior and Socialization

Mealtime is relaxed and enjoyable a time when adults and children talk together and

share conversation and learning opportunities with each other.

Older children are involved in serving food as well as setting and cleaning tables.

Children are not forced or bribed to eat (food is not used as a reward or a punishment) and eat

only when seated.

Nutrition % of the population

Malnutrition, in children (birth to 59 months)

Wasting (weight-for-height) 17.42

Stunting (height-for-age) 43.22

Underweight (weight-for-age) 412

Low birth-weight 361

Exclusive breastfeeding (birth to 6 months) 432

Anemia, in children (6 - 23 months) 643

Chronic energy deficiency, in mothers 325

Night blindness (Vitamin A deficiency), in children

(18-59 months) 0.045

Iodine deficiency, in children (6 - 12 years) 33.86

Child and Maternal Nutrition in Bangladesh

done. Malnutrition rates have seen a marked decline in Bangladesh throughout the 1990s,

but remained high at the turn of the decade. Nationally, 41%2 of children under five years

are moderately to severely underweight and 43.2%2 suffer from moderate to severe


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24

stunting, an indicator for chronic malnutrition. Underweight prevalence decreased slightly

between 2004 and 2007. Of greater concern are the rates of wasting that increased over

the same period reaching 17.4 %, exceeding the WHO emergency threshold level (15%),

which indicates an urgent need for action.

Micronutrient deficiencies especially iron and folic acid deficiencies that result in nutritional

anemia in children and women and neural tube defects in newborns, remain a public health

problem in Bangladesh. Poor intake of foods rich in iron and folic acid and multiple

infections have resulted in high rates of anemia among pregnant women and children under

two years. Coverage of pre and postnatal iron and folic acid supplements is very low (only

15% of pregnant women in rural areas take at least 100 tablets during pregnancy7) due, in

part, to low compliance rates and low coverage of antenatal services. Coverage of multiple

micronutrient supplements formulated to address iron and other micronutrient deficiencies is

also very low.

ISSUES

In Bangladesh, crop production, predominantly rice, is characterized by fluctuations in yield

that are tied to climatic conditions. Recurrent natural disasters such as floods and cyclones

have affected rice production and the livelihoods of both urban and rural populations. Food

security and access of the poor to a diverse and balanced diet remains a challenge. Global

food price hikes have dealt a new blow to those who are already nutritionally insecure in

Bangladesh.An important dynamic in Banladesh that undermines nutrition outcomes, is

seasonality. Levels of malnutrition (wasting and underweight) follow a seasonal tendency,

increasing during the summer months and decreasing in the winter months. During summer

months,the increased levels of malnutrition are linked to rise in child morbidity and restricted

access to food resources. Diarrhoea and acute respiratory infections are major causes of illness


25/36


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26

international NGOs.

With the assistance of UNICEF and other development partners, the government has made

substantial investments in nutrition, including the National Nutrition Programme, which

provides comprehensive nutrition services to around 29 million people at community level.

As a result, the country has made considerable progress in addressing some forms of

malnutrition among children, including Vitamin A and iodine deficiencies.

Capitalizing on the benefits of Vitamin A

Very good progress has been made to reduce Vitamin A deficiency among children under

five years through Vitamin A supplementation. Night blindness in children under five years

has reduced from 3.76%8 in 1983 to 0.04%9 in 2005 and is being maintained well below the

WHO-recommended 1% threshold level. National Vitamin A campaigns, developed by the

government and UNICEF, deliver Vitamin A supplements twice each year to children aged

12-59 months. These campaigns reach 20.6 million children (95%10 of all Bangladeshi

messages. UNICEF is also supporting Vitamin A supplementation for children under

one year of age in order to improve coverage from 85% to more than 90%. However, the

number of mother receiving Vitamin A supplements within six weeks of delivery, remains very

low because most women give birth at home, without the assistance of skilled birth attendants.UNICEF is supporting the government to develop strategies to target these mothers, with the

aim of increasing postpartum Vitamin A coverage from 35% to at least 60% by 2010. Grains of

salt to reduce iodine deficiency disorders A successful campaign to iodize all salt is reducing

iodine deficiency in Bangladesh. Iodine deficiency causes intellectual impairment and lowers

IQ by as much as 10 - 15%6. The Universal Salt Iodization programme has made significant

progress in the past decade, reducing the prevalence of iodine deficiency disorders in school-

aged children to 33.8%6 (from 42.5% in 19996). With strong political commitment and

administrative support from the government and the private sector, household utilization of

iodized salt has increased to 84%11. However, only 51%6 of household salt is adequately

iodized. UNICEF supports amendments to the Salt Law, making it mandatory for livestock,

food and beverage industries to use only adequately iodized salt.

Addressing anemia


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27

UNICEF has supported the government to formulate a National Strategy of Prevention and

Control of Anemia. In the Chittagong Hill Tracts, UNICEF and the Integrated Child

Development Project have introduced a package of interventions designed to prevent

anemia in children, adolescent girls and pregnant and lactating women. The project

includes iron-folate supplements, deworming tablets and counseling to improve dietary

intake, control disease and improve iron-folate intake. A network of adolescent girls groups

is used to reach those who do not have regular contact with health services. In some urban

slums of Dhaka and seven selected upazillas, Multiple Micronutrient Powder is being

provided to families to prevent and correct anemia in children under five.

Feeding infants and young children

In Bangladesh, the overall rate of exclusive breastfeeding to six months of age is only 43%2

and initiation of breastfeeding within the first hour after delivery is 24% while, in most cases,

complementary foods are introduced too early or too late with insufficient quality and

quantity. Although there is a national Infant and Young Child Feeding (IYCF) strategy, there

is no implementation plan. Thus, the strategy has not led to the desired impact. Changing

norms and behaviours is a challenge as cultural norms discourage the use of breast milk for

the first three days after birth. Increasing women's knowledge of practical steps they can

take to improve the nutrition of their children and entire family is a key intervention. As

women are unlikely to be the key decision-makers within their families regarding food

purchases, awareness programmes also need to reach men. UNICEF supports the National

Nutrition Programme to scale-up community-based peer counseling through mothers'

support groups. The project aims to reach 100,000 mothers in 2009.

Responding to emergencies

As the UN body mandated to lead the nutrition response in emergencies, UNICEF

intervened immediately after Cyclone Sidr in December 2007. Special efforts were made to

promote optimum infant and young child feeding practices in difficult circumstances. 150

metric tonnes of high-energy biscuits benefiting were procured and distributed to more than


28/36


28

72,000 children and women in Sidr-affected areas. To complement WFP food rations, 5,550

metric tonnes of supplementary food was distributed to the same vulnerable groups,

benefiting to 269,800 children aged 6-59 months, 81,500 pregnant women and 29,300

lactating mothers in seven affected districts.

In 2009, UNICEF will support the roll-out of the national guidelines for treatment of severely

malnourished children and facilitate the development of emergency preparedness

measures, including capacity building to provide nutrition in emergencies. UNICEF will also

work towards the standardization of nutrition assessment tools.

IMPACT

It is estimated that 30,000 children's lives are saved in Bangladesh each year by

Vitamin A supplementation. The prevalence of night blindness, a symptom of Vitamin A

deficiency, has been kept below the level that indicates a public health problem. Over

20 million children aged 12 to 59 months received Vitamin A capsules during the last

National Vitamin A+ Campaign held in May 2008.

84% of all edible salt is now iodized, helping reduce iodine deficiency disorders. The

prevalence of goitre in school-aged children decreased from 50% in 199312 to 6% in

2004/05 in the last decade as a direct result of salt iodization. Prevalence of severe

iodine deficiencies in school-aged children were reduced from 23.4% in 199313 to 4% in

2004/0513.

Community-based models for preventing anemia in children, adolescent girls and

women have been piloted in selected upazilas of Chittagong Hill Tracts, seven National

Nutrition Programme convergence upazilas and selected slums of Dhaka and

Chittagong City Corporation areas. This pilot project is being expanded to other areas in

urban and rural Bangladesh, targeting 75,000 children, 15,000 adolescent girls and

6,000 women.

15 million young children are treated with deworming tablets twice a year, significantly

reducing intestinal worm infections, a direct cause of anemia and malnutrition.


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29

An estimated 50,000 pregnant women and lactating mothers are getting counseling on

Infant and Young Child Feeding through Mother Support Groups in ten upazilas covered

by the National Nutrition programme and supported by UNICEF. A total of 2,305

community nutrition promoters

Child nutrition in Bangladesh:

KEY STATISTICS

1 Statistical Yearbook of Bangladesh, Bangladesh Bureau of Statistics, 2004

2 Bangladesh Demographic and Health Survey, 2007

3 Helen Keller International / Institute of Public Health and Nutrition, 2002

4 Child and Mother Nutrition Survey of Bangladesh, 2005

5 Nutrition Surveillance Programme; Helen Keller International / Institute of Public Health andNutrition, 2005

Bangladesh Iodine Deficiency Disorder / Universal Salt Iodization Survey, 2005

The prevalence of malnutrit ion in Bangladesh is among the highest in the world. Millions of

children and women suffer from one or more forms of malnutrition including low birth

weight, wasting, stunting, underweight, Vitamin A deficiencies, iodine deficiency disorders

and anemia. Today malnutrition not only affects individuals but its effects are passed from

one generation to the next as malnourished mothers give birth to infants who struggle to

develop and thrive. If these children are girls, they often grow up to become malnourished

mothers themselves. Globally, malnutrition is attributed to almost one-half of all child

deaths. Survivors are left vulnerable to illnesses, stunted growth and intellectual impairment.

Although Bangladesh has made good progress in the past decade to achieve Millennium

Development Goal 1, the eradication of extreme poverty and hunger, more needs to be

Nutrition % of the population

Malnutrition, in children (birth to 59 months)

Wasting (weight-for-height) 17.42

Stunting (height-for-age) 43.22

Underweight (weight-for-age) 412

Low birth-weight 361

Exclusive breastfeeding (birth to 6 months) 432


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30

Anemia, in children (6 - 23 months) 643

Chronic energy deficiency, in mothers 325

Night blindness (Vitamin A deficiency), in children

(18-59 months) 0.045

Iodine deficiency, in children (6 - 12 years) 33.86

Child and Maternal Nutrition in

Bangladesh:

done. Malnutrition rates have seen a marked decline in Bangladesh throughout the 1990s,

but remained high at the turn of the decade. Nationally, 41%2 of children under five years

are moderately to severely underweight and 43.2%2 suffer from moderate to severe

stunting, an indicator for chronic malnutrition. Underweight prevalence decreased slightly

between 2004 and 2007. Of greater concern are the rates of wasting that increased over

the same period reaching 17.4 %, exceeding the WHO emergency threshold level (15%),

which indicates an urgent need for action.

Micronutrient deficiencies especially iron and folic acid deficiencies that result in nutritional

anemia in children and women and neural tube defects in newborns, remain a public health

problem in Bangladesh. Poor intake of foods rich in iron and folic acid and multiple

infections have resulted in high rates of anemia among pregnant women and children under

two years. Coverage of pre and postnatal iron and folic acid supplements is very low (only

15% of pregnant women in rural areas take at least 100 tablets during pregnancy7) due, in

part, to low compliance rates and low coverage of antenatal services. Coverage of multiple

micronutrient supplements formulated to address iron and other micronutrient deficiencies is

also very low.

ISSUES

In Bangladesh, crop production, predominantly rice, is characterized by fluctuations in yieldthat are tied to climatic conditions. Recurrent natural disasters such as floods and cyclones

have affected rice production and the livelihoods of both urban and rural populations. Food

security and access of the poor to a diverse and balanced diet remains a challenge. Global

food price hikes have dealt a new blow to those who are already nutritionally insecure in

Bangladesh.


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31

An important dynamic in Bangladesh that undermines nutrition outcomes, is seasonality.

Levels of malnutrition (wasting and underweight) follow a seasonal tendency, increasing

during the summer months and decreasing in the winter months. During summer months,

the increased levels of malnutrition are linked to rise in child morbidity and restricted access

to food resources. Diarrhoea and acute respiratory infections are major causes of illness

especially in children. Diarrhoeal disease has been repeatedly linked to increased risk of

malnutrition, underpinned by conditions such as lack of clean water, poor sanitation and

inadequate health services.

One of the challenges in the last couple of years has been the availability of timely,

appropriate and reliable nutrition information to identify needs, guide programme

implementation and function as an early warning system. There has been a lack of national level

nutrition surveillance data since 2006. it is hoped that recent funding will allow

this important component of nutrition programmes. The National Nutrition Programme

currently covers only 109 sub-district (upazilas) out of 482, covering approximately 20% of the

population of the country with plans to scale that up to over one-third in 2009.

Through this programme, volunteer Community Nutrition Promoters work in 24,000

community nutrition centers providing information, advice and counseling to improve the

nutritional status of children, adolescent girls and women. At the national policy level, there is

no dedicated nutrition policy and strategy. Nutrition is embedded within the existing food

policy, which is heavily focused on food-based approaches and gives scant attention to non

food-based strategies needed to address nutrition problems. To tackle malnutrition, a national

nutrition policy and a better integration of nutrition programmemes are required.

A multi-sectoral approach also needs to be considered.

Provision of treatment for severely malnourished children remains limited

despite national guidelines for facility based-treatment. Even if the guidelines

were fully implemented, only about 20% of the severely malnourished children

could be managed within health facilities. Guidelines for community-based

treatment need to be developed so malnourished children can also be

managed at home.

ACTION

UNICEF focuses its nutrition work in Bangladesh on high-impact interventions that improve


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32

nutrition across the entire lifecycle, from infancy through childhood, adolescence, and the

childbearing years. These interventions are implemented in close partnerships with the

Government of Bangladesh, UN agencies (FAO, WFP, WHO), development partners

(USAID, CIDA, BMGF, GAIN), the Micronutrient Initiative and more than 20 national and

international NGOs.

With the assistance of UNICEF and other development partners, the government has made

substantial investments in nutrition, including the National Nutrition Programme, which

provides comprehensive nutrition services to around 29 million people at community level.

As a result, the country has made considerable progress in addressing some forms of

malnutrition among children, including Vitamin A and iodine deficiencies.

Capitalizing on the benefits of Vitamin A

Very good progress has been made to reduce Vitamin A deficiency among children under

five years through Vitamin A supplementation. Night blindness in children under five years

has reduced from 3.76%8 in 1983 to 0.04%9 in 2005 and is being maintained well below the

WHO-recommended 1% threshold level. National Vitamin A campaigns, developed by the

government and UNICEF, deliver Vitamin A supplements twice each year to children aged

12-59 months. These campaigns reach 20.6 million children (95%10 of all Bangladeshi

children), and are an ideal platform for delivering deworming tablets and nutrition

messages. UNICEF is also supporting Vitamin A supplementation for children under

one year of age in order to improve coverage from 85% to more than 90%.However, the number

of mother receiving Vitamin A supplements within six weeks of delivery, remains very low

because most women give birth at home, without the assistance of skilled birth attendants.

UNICEF is supporting the government to develop strategies to target these mothers,

with the aim of increasing postpartum Vitamin A coverage from 35% to at least 60% by

2010.Grains of salt to reduce iodine deficiency disorders A successful campaign to iodize all

salt is reducing iodine deficiency in Bangladesh. Iodine deficiency causes

intellectual impairment and lowers IQ by as much as 10 - 15%6. The Universal Salt

Iodization programme has made significant progress in the past decade, reducing the

prevalence of iodine deficiency disorders in school-aged children to 33.8%6 (from 42.5% in

19996). With strong political commitment and administrative support from the government

and the private sector, household utilization of iodized salt has increased to 84%11.


33/36


33

However, only 51%6 of household salt is adequately iodized. UNICEF supports amendments

to the Salt Law, making it mandatory for livestock, food and beverage industries to use only

adequately iodized salt.

Addressing anemia

UNICEF has supported the government to formulate a National Strategy of Prevention and

Control of Anemia. In the Chittagong Hill Tracts, UNICEF and the Integrated Child

Development Project have introduced a package of interventions designed to prevent

anemia in children, adolescent girls and pregnant and lactating women. The project

includes iron-folate supplements, deworming tablets and counseling to improve dietary

intake, control disease and improve iron-folate intake. A network of adolescent girls groups

is used to reach those who do not have regular contact with health services. In some urban

slums of Dhaka and seven selected upazillas, Multiple Micronutrient Powder is being

provided to families to prevent and correct anemia in children under five.

Feeding infants and young children

In Bangladesh, the overall rate of exclusive breastfeeding to six months of age is only 43%2

and initiation of breastfeeding within the first hour after delivery is 24% while, in most cases,

complementary foods are introduced too early or too late with insufficient quality and

quantity. Although there is a national Infant and Young Child Feeding (IYCF) strategy, there

is no implementation plan. Thus, the strategy has not led to the desired impact. Changing

norms and behaviours is a challenge as cultural norms discourage the use of breast milk for

the first three days after birth. Increasing women's knowledge of practical steps they can

take to improve the nutrition of their children and entire family is a key intervention. As

women are unlikely to be the key decision-makers within their families regarding food

purchases, awareness programmes also need to reach men. UNICEF supports the National

Nutrition Programme to scale-up community-based peer counseling through mothers'

support groups. The project aims to reach 100,000 mothers in 2009.

Responding to emergencies

As the UN body mandated to lead the nutrition response in emergencies, UNICEF

intervened immediately after Cyclone Sidr in December 2007. Special efforts were made to

promote optimum infant and young child feeding practices in difficult circumstances. 150

metric tonnes of high-energy biscuits benefiting were procured and distributed to more than


34/36


34

72,000 children and women in Sidr-affected areas. To complement WFP food rations, 5,550

metric tonnes of supplementary food was distributed to the same vulnerable groups,

benefiting to 269,800 children aged 6-59 months, 81,500 pregnant women and 29,300

lactating mothers in seven affected districts.

In 2009, UNICEF will support the roll-out of the national guidelines for treatment of severely

malnourished children and facilitate the development of emergency preparedness

measures, including capacity building to provide nutrition in emergencies. UNICEF will also

work towards the standardization of nutrition assessment tools.

IMPACT

It is estimated that 30,000 children's lives are saved in Bangladesh each year by

Vitamin A supplementation. The prevalence of night blindness, a symptom of Vitamin A

deficiency, has been kept below the level that indicates a public health problem. Over

20 million children aged 12 to 59 months received Vitamin A capsules during the last

National Vitamin A+ Campaign held in May 2008.

84% of all edible salt is now iodized, helping reduce iodine deficiency disorders. The

prevalence of goitre in school-aged children decreased from 50% in 199312 to 6% in

2004/05 in the last decade as a direct result of salt iodization. Prevalence of severe

iodine deficiencies in school-aged children were reduced from 23.4% in 199313 to 4% in

2004/0513.

Community-based models for preventing anemia in children, adolescent girls and

women have been piloted in selected upazilas of Chittagong Hill Tracts, seven National

Nutrition Programme convergence upazilas and selected slums of Dhaka and

Chittagong City Corporation areas. This pilot project is being expanded to other areas in

urban and rural Bangladesh, targeting 75,000 children, 15,000 adolescent girls and

6,000 women.

15 million young children are treated with deworming tablets twice a year, significantly

reducing intestinal worm infections, a direct cause of anemia and malnutrition.

An estimated 50,000 pregnant women and lactating mothers are getting counseling on

Infant and Young Child Feeding through Mother Support Groups in ten upazilas covered

by the National Nutrition programme and supported by UNICEF. A total of 2,305

community nutrition promoters (CNP) are facilitating these groups, involving 18,440


35/36


35

community volunteers.

Child nutrition in India: India has disproportionately large numbers of malnourished and

severely malnourished

children below four years of age according to anthropometric data on stunting

(height- for-age), underweight (weight- for-age), and wasting (weight-for-height) from

the 199293 National Family Health Survey (NFHS). Fifty-two percent of all children

below age four are stunted, and 29 percent are severely stunted. Fifty-four percent

are underweight, and 22 percent are severely underweight. Seventeen percent

are wasted, and 3 percent are severely wasted. The lower prevalence of wasting than of stunting

or underweight indicates that chronic malnutrition is more prevalent in

India than acute malnutrition. However, the prevalence of wasting is about 8 times

and the prevalence of severe wasting is about 25 times the levels in the international

reference population.

There are considerable variations in the prevalence of malnutrition among states.

Bihar and Kerala are the states with the highest and lowest prevalence of malnutrition

in the country. Even in Kerala, which is also the state with the lowest infant and child

mortality rates, 27 percent of children below age four are stunted, 28 percent are

underweight, and 12 percent are wasted.

Multivariate analysis of the selected demographic and socioeconomic determinants

of child nutritional status indicates that the strongest predictors of child nutrition

in India, once other variables are controlled, are childs age and birth order,

mothers education level, and household standard of living. Older children and children

of higher birth order tend to have poorer nutritiona l status. Children whose mothers

are more educated and those who live in households with a relatively high standard of

living have better nutrition. Boys and girls have about the same level of stunting and

underweight, while wasting is somewhat higher among boys than among girls. In the

face of much evidence that girls receive inferior care in India, this finding that girls

fare at least as well if not better than boys in terms of nutrition is difficult to explain


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and warrants further investigation.

The findings of this study should be interpreted cautiously because of the problem

of age misreporting. Previous research indicates that some births that occurred

during the period 04 years before the NFHS tend to be erroneously reported as

having occurred during the period 59 years before the survey (Narasimhan et al.

1997). This means that some children below age four are reported as older than they

really are. To the extent that this kind of age exaggeration occurs, the estimates of

stunting and underweight, which are based on height-for-age and weight-for-age, may

exaggerate the extent of malnutrition. Moreover, to the extent that age exaggeration

is more pronounced among those with less education and lower socioeconomic status,

the age misreporting may exaggerate the estimated socioeconomic differentials

in stunting and underweight. On the other hand, the estimates of wasting, which are

based on weight-for-height, are not affected by age misreporting.

Despite this caveat, the findings of this study should be useful for identifying

categories of children who are at particularly high risk of malnutrition. The findings

also imply that the prevalence of malnutrition can be reduced by improving educational

levels of mothers, by raising household living standards, and by reducing higherorder

births by means of family planning. Such efforts should be combined with

programmes that raise womens awareness of the nutritional requirements of children.

Conclusion

A healthy child must have an adequate diet, rich in all the important nutrients. Emerging

research shows that even mild to moderate nutritional deficits early in life can diminish

developmental achievements. There are nutrition and food programs for mothers, infants and

children but narrow eligibility guidelines and inadequate funding make these programs

inaccessible to many in need. New York's policymakers must be creative in designing solutions

since the federal statutes and regulations governing these programs preclude some of the easy

fixes. Policies must enhance nutrition program availability and accessibility in neighborhoods.

Families, schools and communities must be engaged in developing and implementing solutions

for the d el problems of inadeq ate n trition and obesit

final version_child nurition

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