Search

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6–59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS‐4 [2015–2016] and NFHS‐5 [2019–2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference‐in‐differences (DID) approach. Utilization of ICDS increased from 58% in 2015–2016 to 71% in 2019–2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%–12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6–59 months in this period. Key messages: Utilization of ICDS services among children aged 6–59 months increased from 58% (2015–2016) to 71% (2019–2021) nationally. The programme's expansion was prominent in urban areas, showcasing progress across states.The prevalence of underweight among children in India declined by 5 percentage points from 2016 to 2021, but almost one‐third of children are still underweight.Increase in coverage and service delivery strengthening of ICDS explained 9%–12% of the observed reduction in underweight between 2016 and 2021.The findings suggest that optimizing quality of interventions under ICDS can have a modest but meaningful contribution in reducing childhood underweight in India. [ABSTRACT FROM AUTHOR]

There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9–12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: 'fruits and vegetables', 'protein', and 'sugar and fat'. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height‐for‐age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the 'fruits and vegetables' pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes. [ABSTRACT FROM AUTHOR]

A quasiexperimental field study was undertaken in 576 exclusively breastfed (EBF) infants from 0 to 14 weeks in Gujarat, India to assess the effect of the use of appropriate breastfeeding techniques on daily weight gain rate and on reducing the underweight rate in early infancy. The interventions were delivered through the existing health system and focused primarily on counselling pregnant women during antenatal and post‐natal sessions for ensuring 'effective breastfeeding' by adoption of the technique of 'cross cradle hold', appropriate breast attachment, emptying of one breast before shifting to the other along with conducting regular monitoring of infant's weight. The intervention care group (ICG) of 300 EBF infants were compared with 276 EBF infants in the control standard care group (SCG). The findings revealed that median weight gain per day between 0 and 14 weeks was significantly higher (p = 0.000) in ICG (32.7 g) as compared with SCG (28.05 g). The median weight‐for‐age Z at 14 weeks of age was also significantly higher in ICG compared with SCG (p = 0.000). Underweight prevalence was three times lower in ICG (5.3%) compared with SCG (16.7%) at 14 weeks of age. Infants in the ICG were noted to be 2.65‐fold more likely to achieve a weight gain of 30 g or more per day compared with infants in SCG. Nutrition interventions, therefore, must aim not only on mere promotion of EBF for up to 6 months but stress on ensuring EBF is 'effective' for optimum transfer of breastmilk through adoption of appropriate techniques, including cross‐cradle hold, by mothers. Key messages: Breastfeeding, even if exclusive, can be suboptimal if the skills of mothers are not appropriate resulting in poor breastmilk transfer and poor intake of nutrients by a baby.Effective counselling on appropriate attachment to the breast, hold and positioning, is important to increase secretion of milk and optimise the transfer of breastmilk and thus improve infant nutritional status.This study shows that counselling mothers on cross cradle hold technique of breastfeeding during antenatal and post‐natal care periods combined with the frequent weighing of infants significantly escalates daily weight gain to over 30 g/day in 0–14 weeks of age. [ABSTRACT FROM AUTHOR]

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors. Key messages: The Comprehensive National Nutrition Survey (CNNS) 2016–2018 is the only nationally representative survey to measure haemoglobin, haemoglobinopathies, biomarkers of micronutrient deficiencies, diet and social factors in Indian adolescents aged 10–19 years.Using CNNS data, we found that 28.5% of adolescents (girls: 39.6%, boys: 17.6%) were anaemic, with variation by region or state.Our prevalence estimates translate to 72 million adolescents being anaemic, with Uttar Pradesh having twice as many anaemic adolescents as any other state.Iron deficiency, haemoglobinopathies, vitamin A deficiency and zinc deficiency were associated with an increased risk of anaemia; these associations may vary subnationally. [ABSTRACT FROM AUTHOR]

There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development. Key points: Feeding difficulties are common among children living in institution‐based care (IBC), particularly but not exclusively among those children with disabilities.Suboptimal feeding practices were common in IBC and encompassed inadequate hygiene, limited support for self‐feeding, reading children's feeding cues (especially around pacing and satiety), addressing feeding difficulties, such as difficulty chewing or swallowing. These should be prioritised in training and supervision for caregivers.Addressing the needs of this vulnerable group should include support for safe feeding techniques. These should be prioritised to help ease the transition into eventual family‐based care if we are to move towards deinstitutionalizing children and strengthening families. [ABSTRACT FROM AUTHOR]

Health at birth is an important indicator of human capital development over the life course. This paper uses longitudinal data from the Young Lives survey and employs instrumental variable regression models to estimate the effect of birth weight on cognitive development during childhood in India. We find that a 10 per cent increase in birth weight increases cognitive test scores by 0.11 standard deviations at 5–8 years of age. Low birth weight infants experience a lower test score compared with normal birth weight infants. The positive effect of birth weight on a cognitive test score is larger for girls, children from rural households and those with less educated mothers. Our findings suggest that health policies designed to improve birth weight could improve human capital in resource‐poor settings. [ABSTRACT FROM AUTHOR]