1. Emerging needs for growth monitoring and promotion Presentation by Dr. Prakash V. Kotecha Professor and Head Preventive & Social Medicine Government Medical College Vadodara Presentation at India Habitat Center, New Delhi 8 th February 2007

2. 8-2-2007 Dr. P. V. Kotecha 2 Indian Scenario: Are we comfortable? Malnutrition is more common in India than in Sub-Saharan Africa… One in every three malnourished children in the world lives in India… Close to 50 per cent of U5 deaths occur in first month… Majority of them die at home...but have history of contact health personnel once at least..

3. 8-2-2007 Dr. P. V. Kotecha 3 India 20% of births of the world in India 30% of neonatal deaths in India 40% of LBW babies birth in India

4. 8-2-2007 Dr. P. V. Kotecha 4 Trend in children’s Nutritional status: NFHS reveals….

5. 8-2-2007 Dr. P. V. Kotecha 5 Why Growth Charts? Malnutrition is not the result of poverty alone It is a problem of feeding rather than food Poorer countries have shown better nutritional status If the problem identified early and then appropriate action taken on time, growth monitoring can help… Challenge remains.. Our approach needs to be consistent and simple and easy…at least at AW and Health worker level.. Till now, it is NOT…..

6. 8-2-2007 Dr. P. V. Kotecha 6 Example to see the difficulties The study was conducted among children registered and attending Vadodara Urban Slum Aanaganwadi From 30 Aanganwadi, children were studied from 0-59 months by visiting home of the registered children.. Data then were compiled for comparing IAP and NCHS standards and now extended to WHO growth standards to get a comparative idea Let us examine them..

7. 8-2-2007 Dr. P. V. Kotecha 7 What do AWW see in these data 2.2% are in grade 3 & 4 Rest 97.8 are largely NOT Malnourished…. More girls are malnourished than boys.. When grade 2 is counted as malnourished, 22% are needing extra attention, 78% are NORMAL..

8. 8-2-2007 Dr. P. V. Kotecha 8 Comparing Charts Gender Difference WA on 1914 children (Vadodara ICDS)

9. 8-2-2007 Dr. P. V. Kotecha 9 Comparing Charts Gender Difference WA on 1914 children (Vadodara ICDS)

10. 8-2-2007 Dr. P. V. Kotecha 10 Comparing Charts Underweight on 1914 children (Vadodara ICDS): By Age

11. 8-2-2007 Dr. P. V. Kotecha 11 Comparing Charts : Underweight on 1914 children (Vadodara ICDS)

12. 8-2-2007 Dr. P. V. Kotecha 12 Comparing Charts Underweight on 1914 children (Vadodara ICDS)

13. 8-2-2007 Dr. P. V. Kotecha 13 Comparing Charts HA on 1914 children (Vadodara ICDS) Stunting will always be higher with WHO Standards

14. 8-2-2007 Dr. P. V. Kotecha 14 Comparing Charts HA on 1914 children (Vadodara ICDS)

15. 8-2-2007 Dr. P. V. Kotecha 15 Comparing Charts HA on 1914 children (Vadodara ICDS) Stunting will always be higher with WHO Standards

16. 8-2-2007 Dr. P. V. Kotecha 16 Comparing Charts HA on 1914 children (Vadodara ICDS)

17. 8-2-2007 Dr. P. V. Kotecha 17 To Conclude: The goals of growth monitoring charts used by AWW/Health worker are different than used by scientists and give very different pictures Charts used to classify rather than action on individual child Longitudinal data of monitoring not very clear to AWW/HW Recommendations for malnourished child (giving double ration is not practical.. Did we set ourselves up for failure in the first place?

18. 8-2-2007 Dr. P. V. Kotecha 18 To Conclude: The targets have been not achieved in reducing malnutrition in many areas Failure to use growth monitoring meaningfully is one of the reason.. Our commitments (political, social and cultural) need to be more firm and our actions focused to our ultimate aims That is why we are here..

19. 8-2-2007 Dr. P. V. Kotecha 19 Thank you