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1) Introduction 2) Prevalence 3) Review Of Literature 4) Methodology Of Study 5) Observation Study 6) Results & Discussion 7) Summary & Conclusion 8) References

Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India.It said that an average of 6,000 children died every day in India; 2,000 to 3,000 of them from malnutrition.

Despite India's recent economic boom, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished.The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading countries with hunger situation.

Since 1991 GDP has more than doubled, while malnutrition has decreased by only a few percentage points. Meanwhile, under fives in rural areas are more likely to be underweight than urban children, low-caste children than highercaste children, girls rather than boys. And the disparities are growing. India seems certain to miss one of its key Millennium Development Goals: halving malnutrition by 2015.

The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 per cent) and Kerala among the lowest (27 per cent). Status of Malnourishment in Maharashtra-14.6% of children under three years in Maharashtra are acutely malnourished (wasted). This means that they have a 5-20 times higher risk of dying from common diseases like diarrhoea or pneumonia than normally nourished children. The World Health Organization considers 10% a threshold for serious concern and 15% a critical situation!

Michael Anderson, the head of Department of International Development in India, which has spend 500 million pounds on health and nutrition in India between 2008 and 2012, said, "There is no shortage of ideas about what to do to tackle malnutrition. But leadership from the top and joint action across the government are needed to turn these ideas into practical solutions. The challenge is urgent: the lives of millions of children depend on it.

The government, however, has largely failed in important areas. Two big, expensive schemes designed to reduce malnutritiona public distribution system (PDS) that provides subsidised food to the poor and a vast midday-meal scheme, to which 120m schoolchildren are signed upare hampered by inefficiency and corruption. But the governments main effort to tackle child malnutrition, the Integrated Childhood Development Service (ICDS), has failed for rather different reasons.

The ICDS, launched in 1975, is the worlds biggest early-childhood scheme. It provides, in theory, an anganwadi centre with one teacher and an assistant for every 1,000 people. Each centre is responsible for providing nutritional care to pregnant women and all children up to six, the age at which Indian children start school. Anganwadi centres also provide daily pre-school child care and education, as well as keeping a dozen-odd registers recording everything from childrens weights to financial accounts. Overburdened by this long list of responsibilities, anganwadi workers have tended to focus on the group they see every day: children over the age of two whose mothers take advantage of free child care and daily meals offered by the centres. While these meals supposedly providing each child with an extra 500 calories a dayare certainly beneficial, they do not replace the nutritional guidance the parents of young children need. More seriously, this emphasis on older children means that the under-twos and pregnant women barely get a turn.

Unfortunately, this is precisely the group the government should be targeting. Most growth retardation occurs by the age of two and is irreversible. Often, it starts during pregnancy. More than half the women of childbearing age in India are anaemica condition that can be much improved by fortifying foodand 30% of Indian children are born underweight. In healthy infants, this could be corrected with six months of exclusive breastfeeding. But especially in rural India, where women often go back to the fields mere days after giving birth, babies diets are often supplemented with cows milk and water, which exposes them to infection.

The quality and reach of ICDS centres varies from state to state: the most impoverished states, with the highest rates of malnutrition, also have the lowest numbers of centres. Recently the production of daily meals served at anganwadi centres was taken out of the hands of pilfering contractors and given to groups of local women. A complicated system of payments, however, means that even in a state like Maharashtra, which has done more than most to improve ICDS services, centres must wait four months for cash to buy pay food bills. The two meals served at anganwadia plate of puffed rice dotted with a few nuts and a serving of sprouted moong dalseem unlikely to give him 500 calories.

% of infants with low birthweight, 1998-2005* % of children (1996-2005*) who are: exclusively breastfed (<6 months) % of children (1996-2005*) who are: breastfed with complementary food (6-9 months) % of children (1996-2005*) who are: still breastfeeding (20-23 months) % of under-fives (1996-2005*) suffering from: underweight, moderate & severe % of under-fives (1996-2005*) suffering from: underweight, severe % of under-fives (1996-2005*) suffering from: wasting, moderate & severe % of under-fives (1996-2005*) suffering from: stunting, moderate & severe Vitamin A supplementation coverage rate (6-59 months), 2004 % of households consuming iodized salt, 1998-2005*

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37 44

66 47

18 16

46

51 57

Locally trained women who go from house to house, advising mothers how to add supplementary foods available at home such as rice/chapatti and dal with mashed, locally-grown green leafy vegetables to a childs diet from six months onwards, while maintaining breastfeeding as long as possible. The best way of conveying this simple message is by saying that all one needs is a fistful of food every day to meet the calorie and protein gap of a child under three.

Indian mothers tend to breastfeed until about two years and do not add semisolid supplementary foods to childrens diets, perpetuating the calorie and protein gap. Under-nutrition, diarrhoea and respiratory infections act together as a vicious cycle to lead to further malnutrition, higher morbidity and mortality in this age group. The Objective is to breaks this cycle by training and motivating mothers to access health care at the first sign of illness from nearby health centre and give more food to their child at regular intervals during the day to improve the immune response. A trained health worker has about 100 to 150 such children and families under her direct supervision and she monitors their growth.

But still a more better approach is needed & better strategy to adjuvant this simple solution proposed above.

Objectives 1. Reduction in Grade 3 & 4 malnutrition in 0-6 age group 2. Special focus on health, nutrition and immunisation aspects in 0-3 age group 3. Reduction in Grade 1 & 2 malnutrition in 0-6 age group 4. Newborn care initiatives 5. Antenatal, perinatal and postnatal care for mothers 6. Focus on pre-teen/adolescent girls: nutrition and health education 7. Transfer of the management function to the community Focus areas 1. Antenatal care 2. Feeding practices 3. Complete immunisation 4. Deworming 5. Micronutrient supplementation 6. Nutrition/health education Issues for thought 1. Still too much focus on food, too little on improving child-care behaviour, family nutrition patterns 2. Children in 0-3 age group and from disadvantaged groups not served adequately by existing ICDS 3. Lack of clear policy focus on areas with greatest levels of malnutrition A need to put emphasis on 1. Human change, relationships & partnerships (personal/interpersonal/systemic) 2. Shared understanding of malnutrition in a holistic framework 3. Interaction between actors concerned with malnutrition, especially the communities to be served 4. Passion, commitment, orientation to action

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http://en.wikipedia.org/wiki/Malnutrition_in_India http://news.rediff.com/slide-show/2009/sep/17/slide-show-1-3000-kids-dieof-malnutrition-everyday.htm http://www.economist.com/node/17090948 http://www.unicef.org/india/children_2356.htm http://hetv.org/programmes/nutrition.htm http://www.hindustantimes.com/India-news/Mumbai/Malnourished-kids-toget-new-diet/Article1-649267.aspx