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Problem In India, adequately iodized salt needs to be made accessible to the most marginalized. Approach In an effort to provide adequately iodized salt to the most vulnerable, in 2009 Madhya Pradesh launched a state-wide initiative through two national flagship nutrition programmes: the Supplementary Nutrition Programme of the Integrated Child Development Services and the Midday Meal Scheme. Programme staff members were taught how to correctly store salt and monitor its iodine content. Field monitors assessed the iodine content of the salt in the common kitchens of participating schools and anganwadi centres monthly. Local setting Madhya Pradesh, a state in central India, is home to a substantial proportion of India's poor. In 2009, household coverage of adequately iodized salt in the state was nearly 90% among the richest but only about 50% among the poorest. Relevant changes Two hot meals prepared with adequately iodized salt were served daily for more than 21 days per month to approximately 89% of the 12113 584 children aged 3 to 6 years enrolled in anganwadi centres (June 2011 to March 2012). One meal on school days was served to 78% of 5 751 979 primary-school children and to 79% of 2 704 692 secondary-school children (April 2011 to March 2012). Most of the kitchens visited in 2010 (79%) and 2011 (83%) were consistently using adequately iodized salt to prepare hot meals. Lessons learnt India has large-scale social safety net programmes for the poorest. Both national and state policies should mainstream the use of adequately iodized salt in these programmes. Probleme En Inde, il est necessaire cl'assurer aux populations les plus marginalisees l'acces a un sel suffisamment iode. Approche Dans un effort visant a fournir du sei suffisamment iode aux populations les plus vulnerables, une initiative a ete lancee dans tout le Madhya Pradesh, en 2009, au travers de deux programmes nutritionnels nationaux phares: le programme de nutrition complementaire des services integres pour le developpement de l'enfant et le systeme de distribution de repas scolaires. Les membres du personnel implique dans ces programmes ont appris a stocker correctement le sel et a controler sa teneur en iode. Tous les mois, des inspecteurs sur le terrain ont evalue la teneur en iode du sel utilise dans les cuisines communes des ecoles et des centres anganwadi participants. Environnement local Le Madhya Pradesh, un etat de l'lnde centrale, abrite une part considerable de la population demunie de l'lnde. En 2009, le pourcentage de menages ayant acces a un sel suiffisamment iode dans cet etat etait de 90% parmi les plus riches, mais a peine de 50% parmi les plus demunis. Changements significatifs Deux repas chauds prepares avec du sel suffisamment iode ont ete servis tous lesjours pendant plus de 21 jours par mois a pres de 89% des 12 113 584 enfants ages de 3 a 6 ans inscrits dans des centres angonwadi (dejuin 2011 a mars 2012). Lesjours d'ecole, un repas a ete servi a 78% des 5 751 979 enfants de l'enseignement primaire et a 79% des 2 704 692 enfants de l'enseignement secondaire (d'avril 2011 a mars 2012). La plupart des cuisines controlees en 2010 (79%) et en 2011 (83%) utilisaient regulierement du sei suffisamment iode pour preparer les repas chauds. Lecons tirees L'lnde dispose de programmes de protection sociale a grande echelle pour les plus demunis. Les politiques nationales et locales doivent integrer l'utilisation de sei suffisamment iode dans ces programmes. Situacion En la India, la sal correctamente yodada debe estar disponible para los mas marginados. Enfoque En su afan por suministrar sal correctamente yodada a los mas vulnerables, Madhya Pradesh lanzo en 2009 una iniciativa en todo el estado a traves de dos programas nacionales de nutricion principales: el Programa de Nutricion Complementaria de los ServiciOs Integrados de Desarrollo Infantil y el Programa de Almuerzos. Los miembros del personal que participaron en los programas aprendieron como almacenar correctamente la sal y controlar su contenido en yodo. Los monitores de campo evaluaron mensualmente el contenido en yodo de la sal en las cocinas comunes de las escuelas participantes y los centros anganwadi. Marco regional En Madhya Pradesh, estado situado en el centro de la India, vive una gran parte de los pobres de la India. En 2009, la cobertura domestica de sal correctamente yodada en el estado era de cerca del 90% entre los mas ricos, pero solo de un 50%, aproximadamente, entre los mas pobres. Cambios importantes Se sirvieron dos comidas calientes preparadas con sal correctamente yodada ai dia durante mas de 21 dias al mes a aproximadamente un 89% de los 12 113 584 ninos de edades com prendidas entre los 3 y los 6 arcos matriculados en centros anganwadi (desde junio de 2011 hasta marzo de 2012). En los dias lectivos, se sirvio una comida a un 78% de los 5 751 979 ninos de la escuela primaria y a un 79% de los 2 704 692 ninos de la escuela secundaria (desde abril de 2011 hasta marzo de 2012). La mayoria de las cocinas visitadas en 2010 (79%) y 2011 (83%) utilizaban sistematicamente sal correctamente yodada para preparar comidas calientes. Lecciones aprendidas India tiene en marcha programas de proteccion social a gran escala para los mas necesitados. Las politicas tanto nacionales como estatales debecian incorporar el uso de sal correctamente yodada a estos programas., Problem India's salt iodization programme has a 50 year history and has made remarkable progress towards the achievement of universal salt iodization. A national policy of universal salt iodization was [...]

South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi‐Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts. [ABSTRACT FROM AUTHOR]

The cut-off values for diagnosis of anemia by hemoglobin concentrations in people living at high altitudes should be revised upward as many who are actually anemic are not being recognized as such. People living at high altitudes have higher concentrations of hemoglobin and hematocrit than people who live nearer to sea level. However, the standard linear increase per 1000 meters is incorrect and the increase is exponential. The presence of anemia at high altitudes was shown by the rate of hemoglobin response to iron-folate supplements.

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies., Voir page 413 le resume en francais. En la pagina 414 figura un resumen en espanol. Introduction Although it is generally recognized that good nutrition is a desirable goal of [...]

Abstract: In South Asia, childhood undernutrition persists while overweight is increasing. Internationally recommended infant and young child feeding (IYCF) practices promote healthy nutritional status; however, little is known about IYCF in Bhutan, investigated here using 2015 National Nutrition Survey data. WHO/UNICEF IYCF indicators, anthropometry and household socio‐economic status were available for 441 children <24 months. Stunting, wasting, and underweight prevalence (<−2Z length‐for‐age [LAZ], weight‐for‐age, [WAZ] and weight‐for‐length [WLZ], respectively) were 15%, 9%, and 5%, respectively, whereas overweight (WLZ >2) prevalence was 6%. In survey‐design‐adjusted analyses, 52% of mothers of 0‐ to 5‐month olds reported exclusive breastfeeding (EBF), with EBF less common for girls than boys (OR: 0.2 [95% CI: 0.1–0.9]). Although 61% of children were breastfed at 2 years and 75% of children >6 months met a minimum daily meal frequency, only 18% of children 6–23 months met minimum dietary diversity. IYCF was unassociated with risk of stunting, wasting, or underweight, possibly due to relatively low prevalence of anthropometric failure and small sample size. However, currently‐breastfed children were less often overweight [OR: ~0.1 (95% upper limit ≤1.0)]. Neither breastfeeding nor most complementary feeding practices differed by socio‐economic status, but children in the highest two fifth of a wealth index had 7.8 (1.3–46.9) and 5.3 (1.1–25.2) times greater odds than children in the lowest fifth of meeting minimum dietary diversity criteria. Low rates of EBF, given possible protection of breastfeeding against overweight, and inadequate dietary diversity offer evidence to guide future program interventions to improve nutritional status of young children. [ABSTRACT FROM AUTHOR]