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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 [...], 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.

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.

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 aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77-0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ¤6 months with ¥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64-0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ¤6 months with ¥90 supplements were used. [ABSTRACT FROM AUTHOR]

Objectives: Increasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0-23 months in rural India. Setting: India. Participants: A total of 10 364, 34 639 and 1282 under-2s who participated in the 2005-2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis. Primary outcome measures: The association between WASH indicators and child stunting was assessed using logistic regression models. Results: The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16-39% reduced odds of stunting among children aged 0-23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, p<0.05). Conclusions: Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association. [ABSTRACT FROM AUTHOR]