DECLARATION

I declare that I a student of MASTER OF SOCIAL

WORK(MSW) under the _____________________________having enrolment

number -____________________________, ______________, session

____________________, this dissertation entitled 0 to 3 years severe moderate

and severe malnourished child at village-

___________________________________, under

____________________GRAM PANCHAYAT, BLOCK

_____________________ of district BANKURA WEST BANGAL, is a record

of independent dissertation work carried out by me under the supervision and

guidance of _____________________________, guide teacher. This has not

been previously submitted for the award of any __________________degree or

other similar title.

Place –____________ __________________

Date-

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Certificate

I certify that this dissertation entitled A SITUATION ANALYSIS STUDY

ON THE NATURE AN EXTENT OF MALNUTRITION AMONG THE

CHILD OF “0 to 3 years” IN ____________________BLOCK, West Bengal

submitted to the _________________________________is a record of

independent dissertation work carried out by____________________, student

of Master of Social Work with Enrollment Number-

__________________________, __________________,

_____________________________under my supervision and guidance. This

has not been previously submitted for the award of any degree, diploma or any

other similar title.

________________ Place: Bankura ________________________________ Date : Lecturer of

___________ Dissertation Supervisor

& Guide Teacher

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ACKNOWLEDGEMENT

It is with a deep sense of respect & gratitude that I acknowledge my

indebtedness to my teacher, guide & supervisor , _______________________,

Guide Teacher, Lecturer of________________________, without whose

excellent & invaluable guidance, it would have been impossible for me to

complete this work.

My sincere thanks to____________________, Pradhan of

_______________Gram Panchayat, they encouraged, me & helped me in all

respects for the preparation of this dissertation & without his constant

encouragement & help it was impossible for me to complete the work.

I was also thankful to my parents specially to my papa & mama to

complete my dissertation work properly & also thanks to my uncle to help me.

I was also very very thankful to my friend Rajib, Avi, chaiti & Srikanto

da, Asim da.

Place – Bankura __________________

Date- ________

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ABSTRACT

India, the 7th biggest republican country draws the limelight

for its pluralistic, multilingula and multiethnic society. Ironically it

also claimed its position for bringing forth a very immense number

of malnourished children. Malnutrition is a condition where the body

is deprived of minimum daily nourishment. India is renked second in

having malnourished children. There is a myth that the Indian

children are well nourished than the children in Africa, but the latest

statistics by the WHO and UNICEF reveals our ignorance. The

average rate of malnourishment in Sub - Saharan Africa is 30 where

as in India it is 37%. In spite of the many programs hosted by the

government, 47% of the children under the age of 3 years are

malnourished and 32 babies among 1000 born alive will not make it

even to their first birthday. You can come with a 1000 different

reasons like gender inequality, population explosion, poor education

status of the mothers or may be corruption, but it is difficult to find 1

proper executable solution for its eradication. Every politician quotes

that the future of the country rests in the hends of the youth but 47%

of the children are hardly making it to the youth. If so, imagine the

future of the country then. Innovative solutions or recommendations

to the existing solutions should be put down in order to save the

children and the country.

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-: CONTENTS :-

SL. NO CONTENT NAME PAGE CHAPTER – A

1 INTRODUCTION 1-26 I NUTRITION : THE FOUNDATION OF LIFE 1 II WHAT IS MALNUTRITION 1 III AD OPT A BLANCED DIET. PREVENT

MALNUTRITION

2

IV COSEQUENCES OF UNDERNUTRITION 2 V THE CYCLE OF UNDERNUTRITION 2-3 VI INTRODUCTION 4-5 VII ROLL OF FIRST 1000 DAYS APPROACH ACTIVITIS 6-7 VIII ROLL OF ICDS 8-11 IX ROLL OF THE ASHA 12 X ROLL OF AUXILIARY NURES MIDWIFE 12 XI ROLL OF UNICEF 13 XII INTERNATIONAL FEATURE 14-17 XIII MALNUTRITION IN INDIA 18-21 XIV WEST BENGAL PICTURE 22-23 XV MALNUTRITION IN BANKURA DISTRICT 24-25 XVI BLOCK WISE REPORT ON MAL-NUTRITION OF

CHILDREN 26

2 RATIONALITY OF THE STUDY 27-29 CHAPTER – B

3 OBJECTIVE OF THE STUDY 31 4 HYPOTHESIS 31

CHAPTER – C 5 REVIEW OF LITERATURE 33-36

CHAPTER – D 6 METHODOLOGE 37-40 I AREA OF STUDY 37 II SAMPLING METHOD 38 III SAMPLE SIZE 38 IV METHOD OF DATA COLLECTION 39 V SOURCES OF DATA COLLECTION 39 VI TOOLS OF DATA COLLECTION 40

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VII PERIOD OF STUDY 40 CHAPTER – E

7 DATA TABULATION & ANALYSIS 43-66 CHAPTER – F

8 MAJOR FINDINGS 68-69 CHAPTER – G

9 STRENGTH & WEAKNESS OF THE STUDY 71 CHAPTER – H

10 OBSERVATION & RECORMMENDATION 73-77 11 CASE STUDY 78-83 I SUCCESS STORY OF BAPI MALAKAR 78-79 II SUCCESS STORY OF SELF HELP GROUP 80-81 III A STORY OF KARAKDANGA, PAPUDIHI, &

ANCHURI VILLAGE 82-83

CHAPTER – 9 11 CONCLUSION 85 12 BIBLIOGRAPHY 86 13I SURVEY QUESTIONERY 87-88

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CHAPTER- 1

Around 475 B.C Anaxagoras stated that

food is absorbed by the human body and

therefore contained homogenizes suggesting

the existence of nutrients. Around 400B.C

Hippocrates sadi-Let food be your medicine

and medicine be your food.

On 1927 Adolf Otto Reinhold Windous

synthesized vitamin-D.for which he won the

Nobel Prize in Chemistry in 1928.

Gowland Hopkins Recognized accessory

food factors other than calories protein and

minerals as organic materials essential to

health, but which body can not synthesize.

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NUTRITION: THE FOUNDATION OF LIFE:-

1. Nutrition deals with the access and utilisation of food and nutrients for life, growth development and well-being.

2. Good nutrition is essential for improved

learning capacity, intellectual and cognitive performance.

3. Nutrition constitutes the foundation for

human development by reducing susceptibility to infections, illnesses and also the disability and mortality burden. Good nutrition enhances cumulative lifelong learning capacities and adult productivity.

4. Poor nutrition starts before birth, generally continues into adolescence

and adult life and can span generations. It is often irreversible. 5. The first two years of life and life before birth are most important. These

are periods of rapid growth and development, which lay the foundation of mental, physical and emotional development of a person.

6. Adequate nutrition during this ‘Critical Period’ is essential, as early

damage due to poor nutrition is only partially reversible in later life. WHAT IS MALNUTRITION?

1. Malnutrition is the inadequate or excess intake of protein, carbohydrates, fat, vitamins and minerals, to meet the daily nutritional requirements of an individual.

2. Malnutrition may be overnutrition or undernutrition. 3. Overnutrition leads to obesity and associated risks of non - communicable diseases. 4. Under nutrition leads to poor growth and development.

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ADOPT A BALANCED DIET PREVENT MALNUTRITION:- 1. A balanced diet contains foods that provide adequate amounts of carbohydrates, fat, protein, minerals and vitamins, which help the body to grow, develop and stay healthy. 2. There are four basic food groups : Group-1 - Cereals, millets pulses Group-2 - Vegetables and fruits Group-3 - Milk and milk products, eggs, meats and fish Group-4 - Oils, fats, nuts and oilseeds. CONSEQUENCES OF UNDERNUTRITION:-

Short - term adverse effects include recurring illness, weakness, delayed physical & mental development, irritability, poor appetite , low weight for age , etc. Long - term adverse effects are stunting or short height for age , poor learning ability , poor performance at school and poor general health. All of which reflect in poor working capacity , resulting in low income. stunting in girls can have effects on child bearing , resulting in low birth weight babies. THE CYCLE OF UNDERNUTRITION :- UNDERNUTRITION IS INTER - GENERATIONAL IN NATURE

An undernourished mother will give birth to a low birth - weight baby, the low birth baby will grow as an undernourished child, then to an undernourished teenager and finally to an undernourished pregnant woman. Negligence and lack of care for a girl child during childhood and adolescence, complicates this picture futher, and the cycle persists through generations.

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Challenge of intergenerational cycle of survival, growth & development

. Early and frequent pregnancy Undernourished . Improper child spacing Less aware, vulnerable . Physical stress and depletion Adolescentgirls. . Inadequate care during pregnancy . Inadequate foetal nutrition. Undernourished Mothers Low Birth Weight . Early marriage, Early and frequent pregnancy wiyh improper child spacing . Poor diet and inadequate care during pregnancy, Anaemia . Physical stress. . Inadequate child care . Improper IYCF practices . Inadequate food, nutrition & health care . Burden of diseases, infections . Anaemia . Inadequate catch up &growth . Inadequate education . Lack of awareness.

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INTRODUCTION

Indian was not self independent on producing food stuff during the period of early independence, It was natural that there was shortage in food supply. Poverty was terrible. Three-fourth of Indian were poor. They spent their three-

fourth for food. Stile their three-fourth of children were below the natural weight. Child-death was in large number. Gradually, child-health and nutrition were felt to build up the nation. Measures were taken in this regard. Special endeavour was wade so that the poor and the people of interior and rural areas may get this

service. Since the 70’s India become independent in producing food. Special arrangements were taken for providing people to get food in subsidy.

The insfra-structure of health and nutrition were built up. Luder its supervision the proper utilization of natural resources were confirmed. However, there is still a huge gap in term of periphery subject and quality. Often the poorest of the poor one being deprived of their facility. World’s largest food-distribution programme is running in India under the national care.

Poverty is the vital cause of malnutrition, starvation and detoratd child-health. According to UNICEF report each year 25000 children die in this world due to poverty. In the developing countries the percentage in 27% to 28%.

Besides the lack of pure water is one of the reasons of child-health decay. The number of child-death is also alarming. Population explosion is causing heavy pressure on land. Besides a large number of people one a prey to poverty for not running the system in a proper way.

As a result parents can not always provide their children nutritional food and drinks. According to the statistics of world Bank and “United Nations

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Development programme 37.2% (2010) people are below poverty line in India. UNICEF in its latest report have total that among every 4 children, from India it 1 who dies of malnutrition. The report also says that 42% of children who are within 5 years of age are under weight. According to Global Hunger Index what was 22.9% in 1996 has increaxed to 23.7% in 2011.

This survey is very important to draw out the reasons behind this misery.

India is the largest in term of number in children. Among every 5 children in this world 1 is Indian. There are 16 crores of children from 0 to 6 yeras. According to the census report in 2011,its about 13% of one children and child death is almost 50%.At least 40% of Indian childen are fighting against odds. In term of nutritional, Indian children’s state is not hopeful. The 2005 to 2006 survey tells that almost 69.5% of children 6 to 59 months are suffering from, Anemea and 42.5% of total baby are under weight.At the time of breeding 22%baby are under weight than normal rate of weight 2.5kg.According to the health research information 1992 to1993 52% of total child are short in hight and under eloped in health.The ration is decreased to 38.4% in 2005 to 2006.

It is indeed hopefull. But at the same time, it is a matter of suspense that number of mal-nutritious child is growing by 17.5% to 19.1%.Due to lack of nutrition the cell of the body of the child being destroyed. Around 1992- 93 to 2005- 06 number of under weight has not decreased remarkable. Rate of decrease is from 53.4% to 45.9%.Defeciency of nutritious food is every where. Diseases are increasing among the children due to want of vitamin A, iron and iodine.Rale of number of child above 9 months who have got minimum one dose of vitamin A is 54.5%from above discussion increasing. Rate of malnutrition child is came to know so through investigation on that matter is very important.

Safe handling of complementary foods & hygienic complementary feeding practices. Household using adequately iodised salt(>15 ppm). Frequent feeding &breastfeeding during & after illness, including oral rehydration therapy and zinc supplementation for children with diarrhoea. Improved food & nutrition intake for adolescent girl , particularly to prevent anaemia. Access to care of severely acute malnourished children.

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Roll of First 1000 Days Approach Activitis:- Introduction:-

The 1000 days between a women’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to shape helthier and more prosperous futures. The right nutrition during this 1000 day window can have a profound impact on a child’s ability to grow, learn, and hence rice out of poverty. It can also help in shaping a society’s long - term health, stability and prosperity. Shamayita Math have been engaged to implement the programme in

BANKURA SADAR sub division. Objectives:-

Focus on children under two and their mothers with essential nutrition intervention. Provide quality care for children with severe under nutrition - supplemented by prevention and treatment. To develop and follow up for first 1000 days for each child using IGMSY, PD & IYCF. Using ICDS platform for the first 1000 days approach. To strengthen existing system of ICDS, Health & PRI. To develop convergence among all key players, HEALTH,ICDS & PRI. To ensure quality services for maternal and child health & nutrition. To increase awareness &accessibility of target group to avail existing schemes (IGMSY , JSY) available during the critical 1000 days. To improve maternal & child feeding &caring practices in the community. Intervention:-

Early initiation of breastfeeding within one hour of birth. Exclusive breastfeeding during the first six months of life. Timely introduction of complementary food after sis months.

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Age - appropriate , energy and nutrient - dense complementary food for children 6 to 24 months of age with continued breastfeeding. Full immunization & bi - annual vitamin A supplementation (0 to 35 months) with de - worming. Safe handling of complementary foods & hygienic complementary feeding practices. Household using adequately iodised salt(>15 ppm). Frequent feeding &breastfeeding during & after illness, including oral rehydration therapy and zinc supplementation for children with diarrhoea. Improved food & nutrition intake for adolescent girl, particularly to prevent anaemia. Access to care of severely acute malnourished children.

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ROLE OF ICDS:-

The Integrated Child Development services (ICDS) Schemeis one of the major flagship programmes launched in 1975 in 33 blocks by the Government of India. It represents one of the world’s largest & unique programmes for Early Childhood Development. It is the symbol of our country’s commitment to its children and nursing mothers, as a response to the challenge of providing pre - school non - formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other. The beneficiaries of the Scheme are children in the age group of 0 - 6 years, pregnant women & lactating mothers. ICDS is the largest outreach programme operational through Anganwadi Centres (AWC) which serves as first outpost for health, nutrition & early learning services at the village level. These centres are manned by Anganwadi Worker & an Anganwadi Helper (AWH). The objectives of the scheme are:- 1. To improve the nutritional & health status of children in the age - group 0 -

6 years; 2. To lay the fiundation for proper psychological, physical & social

development of the child; 3. To reduce the incidence of mortality, morbidity, malnutrition & school

dropout; 4. To achieve effective co - ordination of policy & implementation amongst the

various departments to promote child development; 5. To enhance the capability of the mother to look after the normal health &

nutritional need of the child through proper nutrition & health education.

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Beneficiaries in ICDS:-

ICDS caters to the developmental needs of children below six years of age, pregnant women & lactating mothers. The scheme is self - selecting & universal. MAJOR ACTIVITIES IN ICDS A. Provision of Supplementary Nutrition:.

The beneficiaries avail of supplementary nutrition provision for 300 days in a year.By providing supplementary nutrition, the scheme attempls to bridge the calorie gap between the Recommended Dietary Allowance (RDA) & the Average Daily Intake (ADI) of children below 6 years & pregnant & lactating mothers.This pattern of feeding aims only at supplementing & not substituting for family food. It also provides an imporlant contact opportunity with pregnant women & morthers of infants & young children to promote improved behavioural actions for care of pregnant women & young children. On an average daily nutritional supplements are provided to the extent indicated below:

Age Group Calories (kilocalories)

Protein Cost norms (Rs)

Existing revised in phases Children (6 - 72 months)

500 12-15 4 6

Severely undernourished children

800 20-25 6 9

Pregnant women & nursing mothers

600 18-20 5 7

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Nutritional Norms of Supplementary Nutrition have been revised w.e.f 24.2.2009:

Under the revised Nutritional & Feeding Norms for Supplementary Nutrition State Governments / UTs are directed to provide more than one meal of the children who come to AWCs which include providing a morning snack in the form of mill / banana / egg / seasonal fruits / micro - nutrient fortified food followed by a Hot cooked Meal. For children below 3 years of age and pregnant and lactating mothers, age appropriate Take Home Ration (THR) is to be provided. Besides for severely underweight children in the age group of 6 months to 6 years States / UTs have been advised to give additional food items in the form of micronutrient fortified food and / or energy dense food as THR. These norms have also been endorsed by the Supreme Court in order dated 22nd April 2009.

B. Growth Monitoring & Promotion: All children are weighed by the Anganwadi Worker. Children under three

are weighed once a month and children in the 3 - 6 age group are weighed quarterly. Weight - for -age growth charts & Mother & child Protection Cards are maintained for all children below 6 years,as per WHO child Growth Standards. these geowth charts help to track the growth trajectory of children and identify those who are moderately & severely underweight. Care givers of those who are moderately undreweight are provided counselling while those who are severely underweight or sick are referred to health functionaries or facilities.

C. Nutrition & Health Education: It aims to enhance the knowledge & capacities of mother &community & tolook after the health and nutrition needs of children within the family environment & bring about a sustained improvement in maternal & child nutrition. Knowledge on basic health nutrition childcare & development is provided through group counselling & one to one counselling.

D. Pre - school Education / Early Childhood Care Education (ECCE): It aims at providing sustained learning activities through joyful play -

way method that helps to prepare the 3 - 6 years children for regular schooling & early care & stimulation for children below three years of age. In addition there are event based activities organised for promotion of child development related matters.

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E. Fixed Health & Nutrition Day: Popularly known as “Village Health Nutrition Days”, it is organized once

a month at the Anganwadi Centre. Health functionaries, Auxiliary Nurse Midwife (ANM) & Accredited Social Health Activist (ASHA) visit the anganwadi centre on this day a basket of services are providede on this day like immunization micronutrient supplementation Vitamin A & Folic Acid deworming registration of pregnant women antenatal care health check - up of sick and undernourished children ect. In addition counselling of pregnant women & care givers is conducted ANM & AWW. F. Home Visit:

Anganwadi worker visit the homes of children under three pregnant & lactating mother. Home based guidance is provided to mothers on infant & ycung child feeding ; early childhood stimulation & care during illness. This is also an opportunity to follow up on children who have dropout from routine immunization & growth monitoring sessions. G. Referral:

Children who are sick or severely undernourished are referred by the Anganwadi Worker to ANM or to health facilities. The anganwadi worker assists & arranges these referrals.

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ROLE OF THE ASHA:

The Accredited social Health Activists under National Rural Health Mission have been appointed to facilitate access to health services mobilize communities to realize health rights access entitlements & provide community level care for a number of health priorities. ASHA’s like the AWW’s are selected from the community & given incentives for the tasks they perform. Their prime responsibilities include promotion of Institutional deliveies management of common childhood illnesses mobilization for immunization & home based newborn care.

ROLE OF Auxiliary Nurse Midwife (ANM):

ANM is a permanent workes under the health system is responsible for

implementation of Reproductive Child Health component under NRHM. She is the key functionary at the Sub Health Centres. She is mandated to provide health services to women & children in all the villages under her jurisdiction. She ensures immunization &micronutrient supplementation of children & pregnant women antenatal & postnatal care health check up & management of sick & undernourished children. She counsels pregnant & lactating women & conducts health education.

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ROLE OF UNICEF:

Department of Women & Child Development is the nodal department for UNICEF. India is associated with UNICEF since 1949 & is now in the fifth

decade of cooperation for assisting most disadvantaged children & their mothers. Traditionally UNICEF has been supporting India in a number of sectors lick child development women’s development urban basic services support for community based convergent services, health, education, nutrition, water & sanitation, childhood disability, children in especially difficult

circumstances, information & communication, planning & programme support. India is presently a member on the UNICEF Executive Board till 31 December 1997. The board has 3 regular sessions & one annual session in a year.Stategies &other important matters relating to UNICEF are discussed in those meetings. A meeting of Government of India & UNICEF officials was concurred on 12 November 1997 to finalise the strategy & areas for programme of cooperation for the next Master Plan of operations 1999 - 2002 which is to synchronise with the Ninth Pian of Government of India. .

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INTERNATIONAL FEATURE

Good nutrition is the cornerstone for survival, health and development for current and succeeding generations. Well-nourished children perform better in school, grow into health adults and in turn give their children a better start in life. Well-nourished women face fewer risks during pregnancy and child birth

and their children set off on firmer developmental paths,both physically and mentally.

Under nutrition is implicated in more than half of all child deaths worldwide. Under nourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhea diseases and respiratory

infections and for those who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Their plight is largely invisible:three quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished showing no out word sign of their vulnerability. Malnutrition in early childhood has serious long-term consequences because it impedes motor, sensory, cognitive, social and em-1-otional development. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults, at greater risk of diseasse and early death.Around one-third of all adult women are underweight. Inadequate care of women and girls especially during pregnancy, results in low-birth weight babies.Nearly 30 parcent of all newborns have a low birth weight, making them vulnerable to further malnutrition and disease. Malnutrition in children is not affected by food intake alone;it is also influenced by access to health services, quality of care for the child and pregnant mother as well as good hygiene practices. Girls are more at risk of malnutrition than boys because of their lower social status.

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Poverty, low levels of education, and poor access to health services are major, contributors to childhood malnutrition a complex issue that requires tacking on a wide number of fronts.The underlying causes of under nutrition vary across regions.In many Asian countries poverty the low status of women poor care during. Pregnancy high rates of low birth weight, high population densities,unfavorable child caring practices,and poor access to health care are underlying causes.In sub-saharan Africa,extreme poverty,inadequate caring practices for children,low levels of education and poor access to health services are among the major factors causing under nutrition.50% of children across south asia continue to suffer from malnutrition,compared to 33% of children in sub-saharan Africa.The gap exists despite much higher levels of per capital national income,education and safe water access in south Asia than in sub-saharan Africa.conflicts and natural disasters in many countries have further exacerbated the situation.The increase in the number of under-nourished children in Africa also reflects a rapid rate of population growth. The Millennium Development Goals reflect the commitment of the global community and of the UN system to achieving major reduetions in maternal and child mortality,aqs well as in the prevalence of under nutrition by 2015.

In 1990 the world summit for children announced key requirements for improving child health,with a crucial focus on nutrition.Subsequently the UN incorporated the world summit’s childhood nutritional aims into its first Millennium Development Goal(MDG1:to eradicate extremepoverty).Atarget for MDG1 is to reduce by half between 1990 and 2015,the proportion of people who suffer from hunger.This aspect of MDG1 is to be measured by assessing the percentage of children under five years who are under weight.

UNICEF’s progress for children report shows how for the world has progressed towards achieving the nutritional target within MDG1,and more importantly how much is still left to do.

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The progress for children report identifies that in the developing world 146million children under five years are under weight, predisposing them to serious complications from common childhood illnesses. Consequently its estimated that under-nutrition contributes to the deaths of around 5.6 million children each year. Although nutritional deficiencies are epidemic throughout the developing world, south Asia (Bhutan, Maldives, Afghanistan, Srilanka, Bangladesh, Pakistan, India and Nepal)is home to more than half the total number of underweight children worldwide most of whom live India, Bangladesh or Pakistan. South Asian children are also affected by iron deficiency and iodine deficiency. These nutritional problems are compounded by the poor educational and social status of women and girls and by the fact that only around a third of infants are exclusively breast fed for six months or longer. Another region identified by the UNICEF report as a significant cause for concern is sub-saharan Africa where the prevalence of underweight children has remained essentially unchanged since 1990.Given the population growth in the region, this means the absolute number of underweight children has actually increased.

The news in not all bad however and even within the troubled south Asian region there are success stories. Bhutan for example has halved its number of under weight children from 38% in 1999.Bhutan is also the first country in south Asia to achieve universal salt iodination. Another country which has been notable for its success is china. Between 1990 and 2002,china managed to reduce the number of children who were under weight from 19% to 8%.This is no small under taking considering there are around 86 million Chinese children under 5 years. However regional variations are significant and Chinese children living in rural areas do not fare as well as their urban contemporaries in nutritional assessments.

Malnutrition does not only affect children in developing countries. In more developed areas of the world the prevalence of obesity in childhood is increasing rapidly and in Europe in 2004 there were an estimated 14 million over weight childern,3 million of whom were obese. Although at opposite ends of the nutritional spectrum under weight and obesity both lcad to long-term health problems and this double burden of disease may co-exist in the same region or even in the same family.

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Available evidence makes it clear that the substantial reductions in child mortality required for the achievement of the MDGs will not be met without significant acceleration of the progress in addressing under nutrition as one of the primary causes of newborn and child mortality. Father more there are critical interactions between child survival under nutrition and most of the other MDGs, in particular those related to maternal health HIV/AIDS and malaria education and gender equality. Without special efforts in improving child health and eliminating hunger and malnutrition many of the MDG will therefore be very difficult to achieve.

While focusing on achieving progress on all of these particular fronts, we should not lose sight that child health and nutrition need to be taken seriously as inputs to, and foundations for development rather then just outcomes. Improved health and nutrition empower individuals, as well as communities, and fuel the development process that leads to poverty reduction. Moreover evidence from both developing and industrialized countries suggests a link between foetal and early childhood health and nutrition and susceptibility in abult life to non communicable diseases. The risks of moving out of poverty and hunger directly into chronic diseases and ill health, should be seriously considered in rapidly urbanizing populations.

Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. Approximately 9% of children below 5 years of age suffer from wasting (weight - for - height below 22 standard deviations (22 SD) of the National Centre for Health Statistics (NCHS) / WHO reference values) and are at risk of death or severe impairment of growth and psychological development.

Vitamin and mineral deficiencies also affect children’s survival and development. Anaemia affects 74 percent of children under the age of three, more than 90 percent of adolescent girls and 50 percent of women. Iodine deficiency, which reduces learning capacity by up to 13 percent, is widespread because fewer than half of all households use iodized salt. Vitamin A deficiency which causes blindness and increases morbidity and among per - school goers, also remains a public health problem.

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Malnutrition in India

The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition, after Bangladesh (in 1998), where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub - Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth. The UN estimates that 2.1 million Indian children die before reaching the age of 5 every year - four every minute - mostly from preventable illnesses such as diarrhoea, typhoid, malaria, measles & neumonia. Every day 1,000Indian children die because of diarrhoea alone. According to the 1991 census of Indian it has around 150 million children constituting 17.5%of India’s population who are below the age of 6 years.

The 2011 Global Hunger Index Report ranked India 15th amongst leading countries with hunger situation. It also places India amongst the three countries where the GHI between 1996 & 2011 went up from 22.9 to 23.7 while 78 out of the 81 developing countries studied including Pakistan, Nepal, Bangladesh, Kenya, Nigeria, Myanmar, Uganda, Zimbabwe & Malawi, succeeded in improving hunger condition.

India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1,139.96 million (2009) and growing at 10 - 14% annually (freo 2001 - 2007) India’s Gross Domestic Product growth was 9.0% from 2007 to 2008 since Independence in 1947 its economic status has been classified as a low - income country with majority of the population at or below the poverty line .Though most of the population is still living below the National Poverty Line, its economic growth indicates new opportunities and a movement towards increase in the prevalence of chronic diseases which is observed in at high rates in developed countries such as United States, Canada & Australia. The combination of people living in poverty and the recent

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economic growth of India has led to the co emergence of two types of malnutrition: under nutrition & over nutrition.

Malnutrition refers to the situation where there is an unbalanced diet in which some nutrients are in excess lacking or wrong proportion. Simplify put which we can categorise it to be under - nutrition & over - nutrition. Despite India’s 50% increase in GDP since 1991 more than one third of the world’s malnourished children live in India. Among these, half of them under 3 are underweight and a third of wealthiest children are over - nutrient.

One of major causes for malnutrition in India is gender inequality. Due to the low social status of Indian women their diet often lacks in both quality and quantity. Women who suffer malnutrition are less likely to have healthy babies. In India mothers generally lack proper knowledge in feeding children. Consequently new born infants are unable to get adequate amount of nutrition from their mothers. Deficiencies in nutrition inflict long - term damage to both individuals and society. Compared with their better - fed peers nutrition - deficient individuals are more likely to have infectious diseases such as pneumonia and tuberculosis which lead to a higher mortality rate. In addition nutrition - deficient individuals are less productive at work. Low productivity not only gives them low pay that traps them in a vicious circle of under - nutrition but also brings inefficiency to the society especially in India where labour is a major input factor for economic production. On the other hand over - nutrition also has severe consequnces. In India national obesity rates in 2010 were 14% for women & 18% for men with some urban areas having rates as high as 40%. Obesity causes several non - communicable diseases such as cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.

Subodh Varma, writing in The Times of India, states that on the Global Hunger Index India is on place 67 among the 80 nations having the worst hunger situation which is worse than nations such as North Korea or Sudan. 25% of all hungry people worldwide live in India. Since 1990 there has been some improvements for children but the proportion of hungry in the population has increased. IN India 44% of children under the age of 5 are underweight. 72% of infants and 52% of married women have anaemia. Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases physical retardation and reduced cognitive abilities.

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Malnutrition rates by region:- Madhya Pradesh:- is the number one in child malnutrition In this state, 59.8%

of children are underweight, 23.4% of the population is undernourished and 9.4% of children who die under the age of 5 die from hunger.

Gujarat:- In this state, 44.7% of children are underweight, 22.3% of the population is undernourished and 6.1% of children who die under the age of 5 die from hunger.

Uttar Pradesh:- In this state, 42.3% of children are underweight, 14.5% of the population is undernourished and 9.6% of children who die under the age of 5 die from hunger.

Rajasthan:- In this state, 40.4% of children are underweight, 14.0% of the population is undernourished and 8.5% of children who die under the age of 5 die from hunger.

West Bengal:- In this state, 38.5% of children are underweight, 18.5% of the population is undernourished and 5.9% of children who die under the age of 5 die from hunger.

Karnataka:- In this state, 37.6% of children are underweight, 28.1% of the population is undernourished and 5.5% of children who die under the age of 5 die from hunger.

Identifying malnutrition:-

Malnutrition can be identified into two constituents, protein - energy malnutrition and micronutrient deficiencies where protein - energy malnutrition is clearly observed in India and other developing countries. There are different methods of identifying malnutrition. In identifying it early in the development malnutrition it is of advantage to allowing early rehabilitation. One of the classification of protein - energy malnutrition is done by Gomez, which uses anthropometric indices.

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Degrees of malnutrition:- Gomez classification of PEM: Degree of PEM % of desired body wt. for age & sex between 90 & 110% normal nutrition status Grade I (1st degree). Mild Malnutrition 75% - 89% Grade II (2nd degree). Moderate Malnutrition 60% - 74% Grade III (3rd degree). Severe Malnutrition <60%. Protein - energy malnutrition can also be classified as marasmus, kwashiorkor, or a combination of both. In marasmus conditions are characterised by extreme wasting of the muscles and a daunt experssion where kwashiorkor is identified as swelling of the extremities and belly which is deceiving to their actual nutritional status.

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WEST BENGAL PICTURE

West Bengal with a total population of 6 million is the fourth most populous state in India. As per NFHS - III report overall prevalence of undernutrition in children below 3 years of age was 44% & the IMR in the state is 48% with complete immunization rate of 64% & 43% institutional delivery.(Are all these NFHS - III data)

The data on nutrition overall indicates that the average level of nutrition in the state, & especially among women, is relatively low by several criteria. However, malnutrition among children is lower than the national average, & severe malnutrition is also low suggesting that distribution is better than in most other.

The nutritional status of children in the age group of under - 3 years is better in West Bengal, as compared to the all - India average for Weight for age (under nutrition) as well as height for age. By these criteria, West Bengal also has a lower percentage of severely malnourished (<-3SD) children (16.3%) as compared to the Indian average of 18%. West Bengal ranks sixth among the major states in India.

The nutritional status of women in West Bengal is a source of serious concern since it seems to be significantly worse than the national average. In a

survey conducted by the National Nutrition Monitoring Bureau West Bengal ranked eighth among 9 states in important variables such as chronic energy deficiency among women. In terms of the Body Mass Index the state ranks as low as twenty fourth among 25 states of NFHS - 2 survey, in West Bengal. this indicates a

very poor nutritional status of women clearly there is scope here for immediate target oriented intervention strategies to be planned.

In case of anemia as well (moderate & severe) West Bengal ranks below in NFHS - Survey. Whhile 63% of ever - married women in West Bengal were characterized as having iron - deficiency anemia in 1998 - 99 (NFHS - II) in

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NFHS - III the rate is still alarming with 64%. Side among children with in the age group between 6 - 36 months anemia rate is 72%.

Once again rural women tend to be worse off in terms of anemia with 64% of ever - married women in rural parts of the state with some anemia compared to 58% in urban areas & 60%in Kolkata. However the incidence of severe anemia shows the opposite pattern being the lowest in the rural areas at 1.4% compared to 1.8% in all urban areas & 2% in Kolkata. This higher incidence of severe anemia in Kolkata is worth noting suggesting that there are proportionately more cases of extreme nutritional deficiency in the metropolis which should be addressed through systematic policy intervention. Rates of anemia tend to be quite high all through life for girls & women in West Bengal. Interestingly anemia among men in West Bengal is also significantly high in fact severe anemia was higher among men above 60 years than among females of that age group. The highest rates of anemia tend to be found among women in the age groups 12 - 19 years & 19 - 45 years which are also the age groups for which the gender gap is greatest. While anemia among children is not different across gender girls tend to become more anemia after puberty. Obviously anemia is a critical problem for the state & suitable steps need to be taken at all levels to combat it.

However in terms of other nutritional supplements West Bengal is not so badly off. Thus the iodized salt programme in the state shows a better coverage compared to the all India levle.

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MALNUTRITION IN BANKURA DISTRICT

Malnutrition as in other parts of the country is also a chronic problem in Bankura. In Bankura more than 90% of children born (both institutional & home delivery) are normal (2.5kg). It is important to note that malnutrition curve remain constant till the age of 6 - 7 months. There after the curve

represents a sudden decrease of normal children from 90% to 30%. That means with in a period of 11 - 12 months the percentage of normal children comes down by 60%. Once the children reached 17 months of age the curve stabilize further & don’t represent further rise. But the fact remains that even if one feeds the child adequately after 17 months the condition doesn’t improve. Thus

the window of opportunity is between 6 months to 17 months. This is the period where the children need to be appropriately fed & taken care of. Experience says that once the children are severely malnourished it becomes very difficult to bring them back to normalcy unless theyget clinical assistance. So the challenge is to hold those children who were born as normal beyond 6 months of age.

The time the children reach the anganwadi centres more than half the children are malnourished. In order to make a sustainable dent in improving the nutritional status of children the major focus should be towards those children who are below 17 - 18 months old. Allnutrition related intervention needs sharpening. This suggests a radical change from pre - schooling to more & meaningful home contacts by service provider to take care of above age group.

Malnutrition problem in Bankura is multi - dimensional & hence demands a similar approach to address the complexities of the problem. The co-ordination between ICDS, Panchayat - raj, Institutions & Health & Family Welfare needsto be further strengthened at every level.

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Weighing efficiency was a big concern area in the district a couple of years ago but the district has significantly progressed in this respect. At present weighing efficiency on an average has reached over 70%. On an average in Bankura every second child is moderately or severely malnourished. The majority of the malnourished children belong to moderate group. It is important to note that as the severely malnourished children needs clinical support & is difficult to be managed at the community level & then the AWW has a very little role to play. She of course plays a vital role of referring the child at the appropriate level & time. Hence there needs to be a radical change in the way the AWW & ICDS supervisors are managing malnutrition. The major focus & resources needs to be towards those children who have taken birth as normal children & the children belonging to Grade I & Grade II. Holding the normal children as normal beyond 6 months holds the key as has been discussed earlier & that the window of opportunity is during the period between birth & 17 months of age of the children. Children belonging to Grade I & Grade II can be managed at the community level. Hence the majority of the resources & focus of ICDS could be channelized towards them & not on Grade III & Grade IV children.

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Block-wise report on malnutrition of children :

Sl Block Name Male (< 1 yrs)

Female (< 1yrs)

Total Male (1-3 yrs)

Female (1-3 yrs)

Total

1 Bankura-1 44.3o 62.87 53.16 60.44 75.10 67.35 2 Bankura-2 49.90 57.73 53.88 61.32 67.83 64.53 3 Chhatna 50.20 62.63 56.41 65.09 78.77 71.64 4 Saltora 42.12 54.94 48.16 57.20 70.59 63.52 5 Gangajalghati 49.27 57.33 53.03 62.46 68.89 65.49 6 Khatra 49.69 62.64 55.81 62.72 70.60 66.58 7 Ranibandh 49.77 51.11 50.46 60.44 64.52 62.47 8 Raipur 50.53 58.04 54.11 62.14 69.57 65.77 9 Indpur 55.70 62.76 59.15 64.25 70.10 67.17 10 Sonamukhi 43.80 50.84 47.50 53.82 65.00 59.44 11 Indus 53.93 58.15 56.06 64.03 68.11 66.08 12 Patrasayer 45.07 49.21 47.13 52.89 63.52 58.04 13 Kotulpur 12.81 7.51 10.49 14.53 7.57 11.42 14 Hirbandh 35.39 41.77 38.58 46.98 53.90 50.38 15 Taldangra 55.34 56.67 55.99 58.34 65.74 61.89 16 Sarenga 42.37 50.00 45.99 54.61 60.19 57.30 17 Simlapal 51.17 52.88 51.99 38.35 41.08 39.64 18 Mejhia 38.92 43.87 41.43 43.12 50.83 46.79 19 Onda 40.12 51.63 45.72 57.41 70.l49 63.85 20 Barjora 42.53 60.24 51.50 58.22 68.23 63.06 21 Bishnupur 53.37 62.51 57.82 63.17 70.43 66.71 22 Joypur 47.07 49.49 48.24 51.19 62.05 56.53

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RATIONALITY OF STUDY

The subject matter of my dissertation paper, that is A situation analysis study on the nature & extent of malnutrition among the children of “0 to 3 years”. According to my feeling this subject has an importance to work on this matter. It is the fruth that children are the future of a nation. So to build a ideal nation every welfare state of the world & each & every parents should take very careful duties to protect child’s early age. Because children are the future of nation, the builder of the state. This is why we should to the children so that they can like a healthy life in physical & mentally. This is

one of the most important motive of my investigation. The information coming out of this investigation will help to the people of society at a large. But I am sorry to say that due to various problem our lapped children are still laying in negligence. All there problems are destroying the spotless successful dreaming life. This is

why children are being annihilated. By degrees malnutrition is destroying the child’s of dreaming life.

Almost 50% of children & 64% of mothers are victim of malnutrition. Countries of third world are seriously affected by malnutrition. India is one of these countries the day at present children are being victim or affected by various problem. To investigate about the cause of these problems is a crying need. This is an effort to bring out the problems into light.

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According to the current report of UNICEF a large number of child of the world are growing up under poverty lack of nutrition and starvation.28% of total children are under weight in the under developed countries lick India.50% of children are the victim of malnutrition. Rate of such victimised children 55% in M.P,27%in Kerala,38.5% in West Bengal of India. Victimised one for each four malnutrition child in the world in Indian.

Beside this almost 15% of girls of our country are getting marriage bellow 13 years of age about 30% girls are bound to marry bellow 15 years of age.64% of girls are married at the early stage of 18 years. Approximately 55% of young baby are suffering from malnutrition and anaemia for want to knowledge on sexual health they are ignorant on breeding. As a result death of the comes at the time of delivery and unscientific abortion. As these are young generation who are gradually driving into the black whole of darger. Good nutrition is the cornerstone for survival health and development for current and succeeding generations. Under nutrition is implicated in more than half of all child deaths worldwide. Undernourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhoeal diseases and respiratory infections and for those who survive frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Malnutrition is more common in India than in sub-saharan Africa. One in every three malnourished children in the world lives in Indian. Malnutrition limits development and the capacity to learn. It also costs lives about 50 per cent of all childhood deaths are attributed to malnutrition. We are raising a generation which is debilitated which cannot contribute effectively to our country economically and otherwise. Malnutrition is adding to our mortality figures. Compared to a well nourished child,a mildly malnourished child has twice the risk of dying from common childhood diseases, moderately malnourished child has eight times the risk.

There was a reign when India was not independent. At the time of British rule Indians were slave like beast. Then there were various child health problem still now after independence the problem of child health is standing more or less in the same position. Every children has a right to live in healthy life. The

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stability of physically, mentally & social depend on child’s family. From the early age of childhood physically mentally & social development of a child depends on the role of family.

Around last twenty years India is knows as one of the developing countries. Huge amount are invested here by terns for the service on nutrition of child. Yet, the half of the children of premedical stage are under weighted & undeveloped. Under long term investigation under the child of Lower middle class family of Delhi, it is found that at the addle age their development can not reach perfection. Their body weight & BMI become to high.

At the 30 years of age 1/6 th part of men are being affected by high blood pressure & diabetis. According to the specialists openion the after crossing the middle age their health become frightful. Around last twenty years among the children of specialy in urban area under solvent family are growing over nutrition & fat. Immediate step should be taken to prevent this problem. Otherwise in nearer future these children must be affected by diabetise & heart disease this is the wire opevion of specialists.

Information coming out from my investigation will help for project & plan. Thus malnutrition will be prevented. In spite of minor deficiency in ICDS this project will undoubtedly play the role to prevent malnutrition. Beside this various govt. project & NGO can take part to prevent malnutrition. This will increase the scope for social work among students. Root cause of malnutrition will come out from this project of information which will help to fieldwork. This is why this project is so important.

Healthy baby is an precious asset for future civilization. As a social-

activist, we ought to tack a hard drive to overcome the hadde of the crucial problem. under thir filling I had to involve myself for such study.

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CHAPTER- B

& Hypothesis

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OBJECTIVE OF THE STUDY

1. Whether the mother is well aware about matter of does and does not during her antenatal stage.

2. To have clear idea about economical condition of her family. 3. Knowledge on food-habits during antenatal stage.

4. The clinical check up during antenatal stage. 5. To have clear conception about delivary of baby.

6. The conception about the health-hazards and diseases during the period of

pregnancy.7.Knowledge of vaceination / immunization of baby.

7. Knowledge of nutrius food habit for baby.

8. Knowing the diseases and disorder stage of baby.

9. Knowledge to take assistance from government and non government sectors.

HYPOTHESIS

1. Malnutrition affects physical & mental growth of a person.

2 . Malnutrition are increasing day to day due to lack of knowledge& poor feeding practices.

3 . Poor socio-economic condition plays an important role in this regard.

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CHAPTER- C

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REVIEW OF LITERATURE

Dr.Kuntal biswas, Secretary Jana Sasthya Commity:-

A child’s health is decided during his birth and secound birthday.Child specialists opine that a child’s first 1000 days are very important regarding his/ her health.Hence the 9 month stay in mother’s womb and the next two years set the child’s health will be in future.Nutrition is needed in this period.A way from infection and wental vigour according to the age should be take care of. This reflects in his future.Even in the grownup age the diseases line diabates, high blood pressure, cardiac problem, artherites cancer depends on the over weight whereas long - span of life depends on the care during that period. Prof. David Barker and his collegues have come to this point after researches. The malnutrition of the woned-be mother affect her child in the womb.Berides, smoking, anxiety taking drugs affect the foctus.Over or less than normal weight 2.5kg can beget immature death or non - infectous diseases in the grounup age. When the mother does not get adequate food, blood is circulated in the child’s brain, then to the heart,then finally to the bones and muscles. Hence, if the brains work and work go right the other parts get weakened. The reason behind diabetic lies in the womb because pancrious for the baby’s insuline is formed in the womb. The cells of the brain are also formed at that time. There non - infectious diseases cause both death and loss of money. The good and evil of a human body depends on the first 1000 days. The pregnant mom’s 270 days to childs 2 years nutritious food is needed very much. Because this 1000 day’s care will make the baby’s life healthy. The baby caned study well. Diseases woued not come earily.Even in the youth he caned earn well. It is found that from birth to 6 months children grow up on breast milk and the children become mare intelligent those get breast milk upto 2 years. so looking after of first 1000 days will build up the health of future generation.

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Hindal dutta, Jana Yudyog Jana Sasthya departmental assistant secretary:-

The proverb known to all that “Prevention is better than cure” that

means the prevention disease is more effective than treatment. It needed health consciousness to prevent disease. The main target of public health programme is to alert about prevention of disease among people. Two main aspect of this programme is firstly to inspire, the people to get public health seruice, including delivery, vaccination etc. Secondly people should be encouraged on the rules of hygiene in gendered as utilisation of fresh drinking water toilet system. On this project Rural Development Society on the basis of Gram Panchayet accept specific plan for the improvement of rural health system. Small infrastructure is taken as per needness to provide better health service and health camp is arranged to alert the people about various aspect of health consciousness so that every people can accept preventive method from each disease. Panchyet and rural development department are working on health consciousness during last few years. Officers of various department of gram panchayet level are ordered to supervise this performing meet on public health which will be held on for the satusday around the state. Molay ghous, Panchyet or Gram Unnayn Depertmental

member:-

Under the base of the a area birth and death of child for last month is recorded on public health meeting organised by public organization. From this enumeration rate of children death will come out. It is also reviewed to perform suitable condition so that mothers can do for the their babies without any trouble and to ensure deathless situation on delivery. On the other hand rural health contres should be provide suitable infrastructure. Role of gram panchayet in the field of arganwari service and how many families are accepting family planning service are discussed in the meeting and also discussed on the system of drinking water and sanitary manifestation of infeetins disease to prevent the another matter of discussion are that how many children from “0 to 3” years old suffering from malnutrition and among them how children in grade three and four. Staff of social welfare department discussed about how to overcome this

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difficulties. Chief of the family planning and the members of sub - samity of health centre are guided in various subject. Hindal dutta, Jana Yudyoga Jana Sasthya departmental

assistant Secretary:- “What step should be taken to prevent the death of child till one

year”? To prevent the children under one year from child killing disease vascination system is introduced. Death of child will be reduced if all there vascine are adopted. Beside this it is also thorerghly inuestigated about the cause of death under dirrhoea or palmonary infection. Molay ghous, Panchyet or Gram Unnayn departmental

member:- Jana yudyoga jana sasthya means only health care of mother and child?

The impoatant part of public health is to keep up the health of mother and child. Because children are the future of nation.So present mankind is liable to protect them. So it is needed to help the mother for bringing forth a healthy child. So our duty is to check up the weight of baby at the time interval and to prouide them nutritious food growing up. So carefull observation should be taken from the begining period of pregnancy to take care of mother and baby.

First 1000 Days Approach - Implemented by SHAMAYITA MATH :-

The 1000 days between a women’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to shape healthier and more prosperous future. The right nutrition during this 1000 day window can have a profound impact on a child’s ability to grow, learn, and rise out of poverty. It can also shape a society’s long - term health, stability and prosperity.

By focusing on improving nutrition for mothers and children in the 1000 days window, we can help to ensure a child’s healthier and productive life. Investing for better nutrition the 1000 day window can also help families, communities and countries to break the cycle of poverty.

From may 2012 Shamayita Math have been engaged for implementing first 1000 day’s programme in Bankura sub - division including all 75 GPs of 8 blocks. 75 GP facilitators, 1 Sub - division coordinator and 1 MIS coordinator as a team work in close coordination to fulfil the objectives of the programme.

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During the first 8 months of implementation the appropriate quality and quantity of diet was increased 1.58%, age appropriate immunization was increased 5.77%, attending of counselling sessions / VHND by AWW was increased by 0.78%, home visit conducted by AWW jointly with GP Facilitators was increased by 4.09%. The malnourishment in the total Bankura Sadar was documented to be reduced by 0.75% whereas the percentages of severely malnourished were reduced by 0.5%.

Besides this, different mechanisms for tracking of malnourished children, joint home visit including ASHA, ANM, AWWs, CHCMI group members, PD Facilitators & ICDS Supervisors is done on a regular basis to sensitize the community about the cycle of malnourishment.

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CHAPTER- D

Methodology

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AREA OF STUDYA

Study with special reference of village: Kapista, Jalhari, Badulara, Keranipur, Papurdihi, karakdanga1,2anchuri, under ANCHURI Gram Panchayat, Block-BANKURA-1 of District-BANKURA.WEST BENGAL OF INDIA

Population under ANCHURI Gram Panchayat, Block-BANKURA-1 of BANKURA district

Category population

Male 9876 Female 8770

Child Male 1038 Female 988

Total 20672

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Sampling Method

In order to get real outcome of the analysis I opted for purposive sampling technique.

Sampling Size

Total number of sample was 50.

METHOD OF DATA COLLECTION

Data collection anany type of information is an important subject. Perfect information help us to came to the point of decision & to know its cause method of information collection help a researcher to reach to the perfect decision. Through analysis the information we can come to the light of cause & problem of nature. There are various procedure of information collection. Among these my procedure

Interview method. Case study method.

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SOURCES OF DATA COLLECTION

The study consists of primary and secondary sources of data. Primary data

was collected by the structured interview schedule from child mother. It consists

of personal profile, socio-economic background, social status, health status,

immunization status concept of child.

Through direct and indirect observation also various kinds of information

were collected.

The secondary data were being collected from various books, journals,

magazines etc and from official sources lick panchayat office health sub-centre,

ICDS centre etc.

LIMITATIONS

The interview schedule were administered, there was a chance of

interference bother malnourished child. Small sample may be a barrier to go

into details of “0 to 3 years” severe moderate and severe malnourished child. It

is a small scale study, so the result may or may not be correct. It only shows the

trend. There is a scope for deeper study with sufficient large sample to yield

dependable results.

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STATISTICAL ANALYSIS

Data were manually tabulated followed by descriptive statistical frequency and present results. To represent the data, diagrams like pie charts were also used. PROCEDURE

Sample was selected using appropriate technique as mentioned previously. On that particular sample specially designed questionnaire was administered to collect the data. The collected data were tabulated and were subjected to suitable statistical analysis.

TOOLS OF DATA COLLECTION : The respondents were interviewed with the help of an interview schedule

consisting of both open ended & close ended questions. The interview was conducted in the houses of the respondents at the time that was fixed previously. The interviewed was conducted mostly in morning & evening as per the availability of the respondents. Apart from the scheduled questionnaires additional information were collected from non participatory observation technique which was necessary & related to the study.

PERIOD OF STUDY

Almost three & half month taken to complete the whole study. This study was held during the period from 24/04/2013 to 19/07/2013.

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“THE PROBLEM OF MALNUTRITION IS A MATTER OF NATIONAL

SHAME..........: APPEAL TO THE NATION TO RESOLVE AND

WORK HARD TO ERADICATE MALNUTRITION IN FIVE YEARS”

Dr. MANMOHAN SINGH

INDIAN PRIME MINISTER

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CHAPTER- E

Tabulation & Analysis

This chapter provides a brief biographical sketch of the respondent

parents in relation to their age education, socio – economic, background like

religion, caste, occupation ,income, type of family etc.

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Table No -1

Table of Age wise targeted children (In the survey area )

Age group No. of children % 0 to 6 months 3 6 6 to 12 months 5 10 12 to 18 months 10 20 18 to 24 months 8 16 24 to 30 months 16 32 30 to 36 months 8 16 Total 50 100

From the above table it is shows that 6% of the children are 0 to 6 months ,10% of the children 6 to 12 months ,20% of the children 12 to 18 months 16% of the children 18 to 24 & 30 to 36 months , 32% of the children 24 to 30 months.

6%

10%

20%

16%

32%

16%

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Table No -2

Distribution of the 0 to 3 years children according to their sex.

Sex No. of children % Male 18 36 Female 32 64 Total 50 100

The above table shows that majority of the female children, 64% of the female children are malnutrition , when 36% of the male children are malnutrition.

18

3632 %

64 %

0

10

20

30

40

50

60

70

Male Female

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Table No -3

Distribution of the status of malnourished.

Sex Severe malnourished

% Moderate malnourished

% Total

Male 13 26 5 10 18

Female 20 40 12 24 32

Total 33 66 17 34 50

From the above table it is shows that 66% of the children are severe malnourished, when 40% of the children are girls and 26% of the children are boys .34% of the children are moderate malnourished when 24% of the children are girls and 10% of the children are boys .shows that majority of the severe malnourished, moderate malnourished.

13

26

510

20

40

12

24

33

66

17

0

10

20

30

40

50

60

70

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Table No -4

Distribution of the Birth Weight and current weight status of children.

Sex Birth weight status Current weight status

Normal Moderate Malnourished

Normal Moderate Malnourished

Male 9(18%) 5(10%) 4(8%)

0 5(10%) 13(26%)

Female 13(26%) 13(26%) 6(12%)

0

12(24%) 20(40%)

Total 22(44%) 18(36%) 10(20%)

0

17(34%) 33(66%)

From the above table it shows that 44% of the children are Normal weight birth ,36% of the children are moderate malnourished weight birth,20% of the children are severe malnourished weight birth .But 66% of the children are severe malnourished in current weight status ,and 34% of children are moderate malnourished in current weight status.

913

0 0

22

0

18

26

0 0 05

13

5

12

18 17

10

26

10

24

34

4 6

13

20

10

33

812

26

40

66

0

10

20

30

40

50

60

70

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Table No -5

Distribution of the children according to their immunization level.

96

7587 87

100 100

50

8 8 818

8

0

20

40

60

80

100

120

48 6 7 7 18 8

Child Immunization Total No. of Applicable child

No. of child Immunization

received

%

B.C.G. has taken 50 48 96

D.P.T.1st to 3rd dose has taken.

8 6 75

O.P.V.1st to 3rd dose has taken.

8 7 87

Measles vaccine has taken 8 7 87 D.P.T.& O.P.V. Buster dose has taken

18 18 100

H.B. has taken 8 8 100

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The above table indicates that 96% of the children have completed BCG, 87% of the children have completed POLIO (0 to 3rd) dose ,and Measles vaccine ,75% of the children completed DPT (1st to 3rd ) dose 100% of the children completed DPT & Polio Buster dose and H.B. vaccine.

A basic concept of public health is that every individual who is protected from a disease as a result of an immunization is one less individual capable of transmitting the disease to others. Individuals who have been immunized serve as a protective barrer for other individuals who have not been immunized provided that the number immunized has reached a certain level. Reaching and maintaining that level ,which varies by communicable disease provides ‘’Herd immunity ‘’ to un-immunized individuals .

Immunization protect the children from seven killing diseases namely. BCG – against tuberculosis, OPV – against polio, H.B – against, Hepatitis B, DPT – against diphtheria ,whooping cough ,tetanus ,Measles –against Measles and vita A – against blindness. So immunization is an important preventive measures from these seven killing diseases .

Vitamin ‘’A’’ deficiency (VAD) occurs when an individual’s diet does not contain enough vitamin ‘’A’’ for growth ,development and physiological functions .If may be exacerbated by infections such as malaria and measles and by parasites such as hook worm. Related vitamin ‘’A’’ deficiency disorders (VADD) in clude sub – clinical and morbidity caused by these disorders increase with the severity of deficiency .

Iron deficiency anemia (IDA) is common across all age groups, but highest among children in developing countries. Inadequate iron stores as a newborn child , coupled with insufficient iron intake during the weaning period ,have been shown to impair intellectual development by adversely affecting language, cognitive , motor development and going to malnutrition.

Child Immunization Total No. of applicable children

No. of children Immunization receive

Immunization completed in time

50 44 (88%)

Immunization not completed in time.

50 6 (12%)

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Recommended childhood vaccination schedule -:

The Government of India adopted the Universal Immunization Program in 1985.This is given in the table below .This has been

Partly modified by the Indian Academy of Pediatrics, the official body of pediatricians, who look after the health needs of children.

Vaccine Govt. of India IAP Schedule BCG-against tuberculosis Birth or 6 weeks Birth – 2 weeks OPV –Against Polio Birth 6,10,14

weeks,15-18 months Birth 6, 10,14

weeks,15-18 months, 5 years.

H.B –Against Hepatitis B -- Birth 6 weeks , 6-9 months, 10 years.

DPT- Against diptheria ,whooping cough ,tetanus

6,10,14 weeks ,15-18 months

6, 10, 14 weeks , 15-18 months , 5 years.

Measles & vita –A 9 Months 9 Months plus. MMR-Against measles, mumps, rubella or German measles

--- 15-18 months

DT-Against diphtheria and tetanus

5 years ----

TT- Against tetanus 10 &16 years 10 &16 years

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Table No 6

Distribution of the children in accordance with the Place where they are delivered at during birth .

Delivery at place No. Of children % Home 19 38 Hospital 31 62 Total 50 100

From the above table revels that 38% of children were delivered at home are , mostly seen among muslim area and the familes of poor economic condition ,62% of children were delivered at Hospital.

It is very much influential factor in relation to child health were the child is delivered at whether in home , hospital.The above table reveals the place the children were delivered at.

38%

62%19

31

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Table No 7

Distribution of the according to the number of children they have.

From the above table shows that majority of the families has two children (34%) ,than one children (26%) ,14% of the three children families , 10%of the four children families ,and 8% of the five and 6 above children families.

1326%

1734%

714%

510%

48%

48%

No.of children in the family

No.of family %

One – child family 13 26

Two - – child family 17 34

Three - child family 7 14

Four - child family 5 10

Five - child family 4 8

6 above child family 4 8

Total 50 100

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Table No 8

Distribution of the colostrums feeding according to children .

Cholestrum feeding No. of children % Cholestrum taking 33 66 Cholestrum not taking 17 34 Total 50 100

The above table shows that majority of the children (66%) received colostrums feeding, and 34% of children are not received colostrums feeding .

Timely initiation of colostrums feeding – within one hour of birth. Mother’s first milk is best for the child : Mother’s milk called colostrums, should be given to the baby within one hour of delivery. It is an invaluable gift for the baby , full of vitamins and protein, which help the child in fighting illnesses like pneumonia and diarrhea. Colostrums intake by the baby is critical to avoid malnourishment .

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Table No 9

Distribution of the 0 to 3 year children whether they are exclusive breast feeding (up to 6 month of age ),complementary feeding started to children.

Indicators No. of children received

% No. of children not

received

% Total

Exclusive breast feeding

12 24 38 76 50

Complementary feeding started

21 42 29 58 50

From the above table it is shows that 76% of the children received exclusive Breast fading only 24% of the children received exclusive breast feeding .

The above table it shows that 42% of the children received complementary feeding when 58% of children not received complementary feeding.

What is the ideal food for babies?

Breast milk is the ideal food for the boby .The baby till 6 months of age requires no other food as breast milk is the only ‘’Standard’’ food for the infant.

What are the advantages of breast feeding?

There is no doubt that breast milk is the breast milk for babies .Not only does it provide maximum emotional satisfaction to both the mother and the child creating a bond between the two , it also has the following advantage.

1. It is safe, hygienic, and available to the infant at the correct temperature. 2. It meets the nutritional requirements of the infant fully in the first few months of life.

3. It contains antimicrobial factors that provide protection against diarrheal diseases and respiratory infections in the first months of life.

4. It is easily digested and utilized by both normal and premature babies.

5. Prevents malnutrition and reduces infant deaths.

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6. It is a wholesome food with protein, sugar ,fat and vitamins that the baby needs.

7. It helps protect the baby against certain diseases and infections like diarrhea and allergies.

8. It is easier for babies to digest than buffalo or formula milk .Even premature babies digest it with ease.

9 . It is cost effective does not need to be prepared and is in ample supply .Bottles need not be cleaned and there are no worries about the correct temperature .

10. Breast feeding makes the mother burn more calories and helps her get back to her pre- pregnancy weight more quickly.

11. Breast feeding delars the return of the mensfual period ,and so pregnancy is unlikely although this is not a foolproof method of contraception. 12. It reduces the risk of ovarian and breast cancer in women .The World Health Organization (WHO) recommends that breast feeding should be done for as long as possible 1 year or even longer.

Complementary Feeding started -:

1. When the baby accepts one slid feed in good amount (usually by 7 months age) introduced second solid feed.

2. Breast milk should be continued and a total of 5-6 feeds (solid+milk) are feeded slowly increased texture should be tolerated. Do not puree foods. 3. Maintain breast feeding throughout the first year.

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Table no 10

Distribution of the Birth status according to total no of children 50 in the survey.

Birth status No. of children % Immature 1 2 Mature O O Under weight 26 52 Standard weight 23 46 Total 50 100

From the above table it is shows that 2% baby are immature, 52% baby are under weight, only 46% baby standard weight.

Table no 11

Distribution of the children in according to the type of delivery.

Type of Delivery No. of children % Normal 31 62 Caesarian 19 38 Total 50 100

It may be observed that 62% of children were delivered through a normal way & 38% of children were delivered through a caesarian.

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Table no 12

Distribution of the status of service on Health, Nutrition, & New born care in the area.

Service centre

No. of children received

% No. of children not received

% Total No. of applicabal children

BPHC 31 62 19 28 50 PHC 23 46 27 54 50 SHC 50 100 00 00 50 ICDS 50 100 00 00 50 NGO 15 30 35 70 50 SHG 27 54 23 46 50

The above table shows that 62% of the child receive BPHC service, & 46% of the receive PHC service, 100% of child receive ICDS service, & 30% of baby receive NGO service.

Table no 13

Distribution of the respondent parents according to their religion.

Religion No. of respondent % Hindu 33 66 Muslim 17 34 Total 50 100

The above table shows that 66% of the respondent parents are Hinduism, & 34% of the respondent parents are Muslim.

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Table no 14

Distribution of the respondent according to their family type.

Type of family No. of respondent % Nuclear family 30 60 Joint family 20 40 Total 50 100

Keeping in the line with the present trend majority of the families (60%) are Nuclear family.

Table no 15

Distribution of the according to the status of House type.

Type of house No. of family % Hut 47 94 Building 3 6 Total 50 100

The above table shows that 94% of the respondents family belong to the hut & only 6% of the respondents family belong to the building.

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Table no 16

Distribution of families according to their level of income (monthly) & number of family members.

Level of income

3 family member

% 4 family member

% 5 family member

% 6 family member

% Total

800-2000 1 50 1 14 2 14 7 26 11 2000-4000 1 50 5 72 12 86 9 33 27 4000-6000 O 0 1 14 0 0 9 33 10 6000-8000 0 O 0 0 0 0 2 8 2 Total 2 100 7 100 14 100 27 100 50

It may be seen in the above table that majority of the low income group has bigger family size (between 4 to 10 above members ) in comparison to medium income group family, majority of who have smaller family size (vary between 2 to 7 member).

Malnutrition is a consequence of socio-economic deprivation. Poverty & malnutrition make a vicious cycle each lending to the other. Poverty in lack of purchasing power lending to inadequate diet. Malnutrition is therefore, not just a health of welfare problem, but it cuts at the root of all efforts for national development. Malnutrition, in other words is a development.

0

10

20

30

40

50

60

70

80

90

100

800-2000 2000-4000 4000-6000 6000-8000

Series1

Series2

Series3

Series4

Series5

Series6

Series7

Series8

Series9

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Table no 17

Distribution of families according to their level of income (monthly) & number of Incumbent member.

Level of income

1 to 3 member

% 4 to 6 member

% 6 above member

% Total

800-2000 9 22 2 29 0 0 11 2000-4000 25 61 2 29 0 0 27 4000-6000 6 15 3 42 1 50 10 6000-8000 1 2 0 0 1 50 2 Total 41 100 7 100 2 100 50

Table no 18

Distribution of families according to their level of income (monthly) & number of Dependent members.

Level of income

2 to 4 member

% 5 to 7 member

% 8 to 10 member

% 10 above member

% Total

800-2000 8 23 3 27 0 0 0 0 11 2000-4000 22 66 2 18 3 75 0 0 27 4000-6000 4 11 5 45 1 25 0 0 10 6000-8000 0 0 1 10 0 0 1 100 2 Total 34 100 11 100 4 10

0 1 100 50

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Table no 19

Distribution of the respondent fathers according to their Occupation.

Occupation No. of respondent fathers

%

Daily labour 10 20 Cultivation labour 6 12 Labour 4 8 Masson 5 10 Bakery labour 12 24 Car diver 6 12 PVT service 1 2 Business 1 2 Non govt. 1 2 Reksha chalok 4 8 Total 50 100

From the above table shows that 20% of respondent fathers are daily labour, 24% of fathers bakery labour, 12% of fathers cultivation labour, car diver,10% of fathers are Masson. 8% of the labour & ricksha chalok, 2% of the fathers are PVT service, business men, & non govt. service men.

Table no 20

Distribution of the respondent mothers according to their Occupation.

Occupation No. of respondent mothers

%

Daily labour 5 10 Cultivation labour 7 14 Masson 3 6 Maid servant 4 8 House wife 31 62 Total 50 100

From the above table shows that indicates the majority number 62% of the respondent mothers are engaged in house wife. 14% of the mothers are engaged cultivation labour. 10% of the mothers are daily labour, 6% 0f the mothers are Masson & 8% of the engaged in work outside the home.

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Table no 21

Distribution of the according to the Classification of children’s family.

Classification No. of family % BPL 22 44 ANTYODOY 20 40 APL 8 16 Total 50 100

The above table shows that 44% of the respondent families are BPL, 40% of the families are Antyodoy, & only 16% of the respondent families are APL.

Table no 22

Distribution of the respondent mothers according to their age of marriage in different age group.

Age group No. of respondent % 12 to 14 24 48 15 to 17 20 40 18 to 20 6 12 Total 50 100

From the above table it may be concluded that early marriage has been seen among 24 respondent mothers (48%) . 40% of the mothers marriage has been age of 15 to 17, % only 12% of the mothers marriage has been age of 18 to 20. This would therefore have some influence likely to be negative on the health of their first child. All below 18 years pregnant women are “AT RISK”. 30 to 40% 0f Indian infants are born with birth weights below 2.5 kg. They are malnourished due to early marriage & pregnancy.

48%

40%

12%

12 to 14

15 to 17

18 to 20

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Table no 23

Distribution of the pregnant women & lactating mother according to their Immunization level.

During pregnancy Total no. of applicable mother’s

No. of mother’s

immunization received

%

Mothers who had at least 3 ANC during last pregnancy

50 10 20

Mothers who had received immunization (TT)

50 10 20

Mothers who consumed IFA for 100 days during last pregnancy

50 9 18

During pregnancy Total no. of applicable mothers

No. of immunization

received

%

Immunization regular in time

50 29 58

Immunization irregular in time

50 21 42

The above table indicates that 20% of pregnant women have received TT injection & 20% 0f pregnant women have completed 3 – ANC, 18% of pregnant women have consumed 100 IFA tablets during last pregnancy for anemia control.

The next table shows that 58% of the pregnant women immunization has completed & 42% of the pregnant women immunization have not completed.

Maximum pregnant & lactating mothers are suffering on anemia due to hard work lack of supplementary nutritional food proper check up with TT, lack of IFA consumption, additional rest & food. Indeed, we see maximum baby born at home under weight below 2.5 kg it is observed that within 7 months, maximum baby are being suffered on Malnutrition.

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Table no 24

Distribution of families where family planning method have been adopted by the respondent mothers according to their age group.

Age group of the respondent mothers

No. of family

received FP

% No. of family not received

FP

% Total

12 to 14 5 42 19 50 24 15 to 17 5 42 15 39 20 18 to 20 2 16 4 11 6 Total 12 100 38 10 50

Here all the respondent mothers have not yet crossed their reproductive age, only 12 (24%) respondent mothers are used family planning method.

Table no 25

Distribution of the pregnant women & lactating mothers according to their entitlement when they are going to ICDS centre for receiving of supplementary food.

During pregnancy or lactating period

No. of mothers received

% No. of mothers not received

% Total no. of applicable mothers

Taking food from ICDS 48 96 2 4 50 Mothers taking nutrias food 3 6 47 94 50 Mother enjoyed rest 13 26 37 74 50 Mothers attended on IYCF, VHEND, Mothers meeting

30 60 20 40 50

The above table shows that 96% of pregnant, lactating mothers received supplementary food from ICDS centre. Only 6% of pregnant, & lactating mothers received nutritive food, 26% of mothers take rest, & 60% of mothers attended on IYCF VHNE Mothers meeting.

From the above table shows that 94% of moms not received nutritive food for during the pregnancy & lactating period. 74% of mothers are not received rest.

This is yet another issue which propped up the pregnant mothers who come to their parental place for her delivery do not enrolled in the AWC where she is migration.

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Table no 26

Distribution of the knowledge on self care according to respondent mothers.

Knowledge on self care

Total no. of applicable mothers

No. of respondent mothers

%

Sound 50 0 0 Average 50 3 6 A little 50 36 72 Innocent 50 11 22

The above table shows that 72% 0f the mother are a little knowledge on self care & 22% of the mothers are innocent of self care. Only 6% of the mothers are average knowledge on self care.

Table no 27

Distribution of the knowledge on new bore baby care according to respondent mothers.

Knowledge on new born baby care

Total no. of applicable mothers

No. of respondent mothers

%

Sound 50 0 0 Average 50 2 4 A little 50 34 68 Innocent 50 14 28

The above table shows that 68% 0f the mother are a little knowledge on new born baby care & 28% of the mothers are innocent of new born baby care. Only 4% of the mothers are average knowledge on new born baby care.

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Table no 28

Distribution of the knowledge on health & nutrition according to respondent mothers.

Knowledge on health & nutrition

Total no. of applicable mothers

No. of respondent mothers

%

Sound 50 0 0 Average 50 1 2 A little 50 14 24 Innocent 50 35 70

The above table shows that 24% 0f the mother are a little knowledge no health & nutrition & 70% of the mothers are innocent of health & nutrition. Only 2% of the mothers are average knowledge on health & nutrition.

Table no 29

Distribution of the educational qualification according to respondent mothers.

Educational qualification

Total no. of applicable mothers

No. of respondent mothers

%

Nil 50 46 92 <= madhyamik 50 3 6 Higher secondary 50 1 2 Graduate an above

50 0 0

From the above table indicates that only 2% of the mom higher secondary passed & 92% of mom illiterate.

A illiterate mom is more empowered & is able to decide about her fertility, the family size & child caring practices. She is more aware of the importance of hygiene & sanitation, the immunization & accessing health service when necessary.

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Table no 30

Distribution of the drinking water according to their families.

Source of drinking water

No. of families %

Tube - well 25 50 Tap – water 25 50 Total 50 100

From the above table shows 2 types of water sources available in the area. One is tube – well & another is tap – water.

Table no 31

Distribution of the lavatory facility according to their families.

Lavatory facility No. of families % Indoor facility 1 2 Outdoor facility 49 98 Total 50 100

From the above table shows that majority of the families (98%) have not any sanitation facility & sanitation facility available of the families only 2%.

Poverty resulting in low purchasing power is one of the main causes of worm infection because poor families can not constructed sanitation for themselves. Worm infection is a major factor for child malnutrition.

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CHAPTER- F

Major

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MAJOR FINDINGS

1 Though poverty is an important factor behind malnutTrition but it can not

only be directly responsible for malnutrition.

2 The socio economic, social nostalgia background of the community plays the pivotal role.

3 In case of children ,it has been observed that the prime factors are the poor feeding practices & improper care during feeding due to lack of knowledge.

4 Poor awareness level both at the service receiver & provider level.

5 In socio economic context of rural , India sons are still preferred & looked upon as way of earning as a result special care is paid to them.

6 Early marriage & (88%) early pregnancy before maturation of physiological organs, still, prevailing at a scale in rural India, the result of which giving birth of malnourished child.

7 Malnutrition retards the physical & mental growth of children & in future they become inactive both for the family& the nation.

8 Lacunae in the service in the community through proper monitoring.

9 Lack of inter- departmental convergence to address issue is also responsible to some extent.

10 Sanitation is essential for maintaining personal hygiene. But a few one is found in the G.P. the sanitary marts in the ICDS (where, present) are not used due to lack of practice & lack of water supply in few pocket.(like badulara ICDS at Anchuri G.P).

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11 Timely & routine Immunization become hampered due to supply problem during a long time.(Vit-A is not availble since one & half year.).

12 In few local community the idea of IYCF is not satisfactory.

13 In many cases, MCP card shows the age of the mother above 19 years old but practically that mother may be 14-15 years old.

14 Mother’s meeting is one of the elegant concepts in ICDS unfortunately beneficiaries are not interested due to lack of practice & irregularity.

15 Poor hygiene specially in few community pocket.

16 A better ICDS centre infrastructure can provide a better platform towards a better service. During summer & rainy seasons continuations of centre were pathetie.

17 Scarcity of efficient AWW. That’s why actual figure of malnourished children is hardly possible to identify.

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CHAPTER- G

& OF THE STUDY

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STRENGTH->

Malnutrition has become a serious concern to all of us & to address this issue an in depth study should be done in the community level.

Throughout the study the main emphasis was given to identify the knowledge, attitude & practice level of the community towards this serious problem so that the underlined factors can be traced. Additional impute was given to find out the immunization status, economic situation etc to establish the interlink malnutrition with this health issues & to give the study an appropriate shape.

WEAKNESS ->

1. Limited time & resources. 2. Not to make optimum rapport with the respondents in such a short time

span. 3. Findings done based on the information supplied by the respondents.

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CHAPTER- H Observation, Recommendation & Case Study

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OBSERVATION

The subject of my survey is about malnutrition of survey I have observed a few important & dangerous aspects. There are described as follows.

1. Vital causes on huse number of baby malnutrition are moms ingnorancy, illiteracy & negligency on baby specially on female baby.

2. Moms do not feed breast milk suffisciently. It causes the shortage of baby nutrition. Mom & baby bonding is also neglected.

3. In a few stage of society mothers are marged in superstition. There

mothers at the period of pregndncy take no vitamin or protin based food like, fish, meat, egg ect.

4. Accordind to hindu prejudice new moms are not allerwed to have lequid

food for first three days, that is called “Jhalbhat”. Their concept is that lequid food is not suitable for the new moms at that time to recover soon. As a result at the same time the new born baby is depriued from nutrition. Because breast milk is now its only food.

5. In the case of Caesarian

moma are not allued to take lequid food like milk, horlicks for there months to recover. As a result both mom & baby become weak & malnutried

6. Most of the family avoid Family Planning to geverate male baby. 7. Most of the mother & child are not neat & clean kilchev, bedroom,

clothes all are dirty. Specialy Muslim area is full of dirty.According to that Santal areas are very clean & clear.

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8. Mother s are so iegnorant that when she is three months pregnant then she has 7th months baby. But this fact creats no impression on her mentalily.

9. At the period of pregnancy monthers get no rest. Theer are too much

engaged in home work that they can not get full ANC check up facility. Even they do not take 100 pc IFA tables.In the reral area moms are used to engage in paddy production system.

10. They failed to take their childern to ICDS centre ,they do not attend

VHND,Mothers meeting regularly.They neither check up baby weight in proper time. They are less interested about babys body weight.

11. Most of the mothers are tender aged & educational standard is very low.

So they can not realise the importance of child care. Beside this hard labour of home work make them too tired to take care of her baby.

12. Another important factor is that the family members allow a little meal

for the pregnant mom. Because they think that if sufficient food makes a healthy baby so ceasor must be adopted at the time of delivery.

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RECOMMENDATION

The first two years of a baby’s life present a “ window of opportunity” to prevent under nutrition in children. Some key intervention can offer the best chance for a baby’s survival & optimal growth & development.

I suggest ->

1. Timely initiation of Breast feeding with in one hour of birth. i. Cholestrum, the yellowish, thick & sticky fluid secreted for the

first 3 – 5 days after birth is rich in nutrients & offers immunity to the baby.

ii. This helps to prevent neonatal & infant mortality & morbidity.

iii. Body contact helps to build a bond between the mother & the newborn & also keeps the baby warm.

iv. It stimulates milk production & the increased secretion of milk.

2. Exclusive Breast feeding during the first six months of life. There is no commercial formula food which equal to breast milk & there is no substitute for mother’s milk.

i. Mother’s milk is the best food for the child & contains all the nutrients needed by the infant for optimum growth & development. Even water

is not required as mother’s milk has adequate water.

ii. It ensures maximum protection for the baby against diseases & death.

iii. Breast milk is easier to digest than formula milk, and unlike formula milk does not cause constipation.

iv. Breast feeding does not require any pre – preparation or pose any risk of contamination, as long as the mother maintains a sufficient degree of personal hygiene.

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3. Timely introduction of complementary foods after six months. Age appropriate complementary feeding along with continued breast feeding for two years or beyond.

i. After six months of age breast milk alone cannot fulfill the nutritional requirements of growing infants as they are then undergoing a period of rapid growth & development. Hence semi – solid foods should be introduced along with breast feeding.

ii. Every child of 6 to 24 months should be fed age appropriate, energy & nutrient – dense, diverse complementary food with increased quantities & frequency as the baby grows in age.

iii. The child should be fed with love & care.

4. Timely & complete Immunization, Iron, Folic acid & Vitamin A supplementation with De – worming.

i. Immunization helps to protect the child against various preventable discases. Every baby should receive all primary immunization by the age of one & booster doses thereafter.

ii. Vitamin A supplementation helps to maintain good eyesight & develops strong immunity. Besides giving foods rich, in vitamin A, nine doses of supplementation must be given. First dose is given at 9 months & there after, one dose every 6 months, up to the age of five years.

iii. Iron Deficiency Anaemia (IDA) is commonly seen in infants & youg baby. It makes them lethargic, irritable, reduces their learning ability, subsequently affecting school performance. Foods rich in iron, along with supplementation of iron & folic acid, is necessary.

iv. Deworming, twice a year, helps to prevent worm infestation.

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5. Frequent & appropriate feeding for children during & after illnesses, including Oral Rehydration with Zinc Supplementation during Diarrhoea.

i. Diarrhoea, Acute Respiratory Infection & Malaria, all impact the nutritional status of a baby. An illness causes loss of body fluids & nutrients, leading to dehydration.

ii. Infection can be prevented by ensuring : Access to safe drinking water & sanitation facilities.

Adopting hand washing practices at critical times. Safe disposal of stool.

6. Improved food & nutrient intake for adolescent girls, particularly to prevent Anaemia.

i. Adolescence is a period of rapid growth & development. Nutrient stores are developed in the body for pregnancy & lactation. Iron deficiency anaemia is common among adolescent girls, but iron intake continues to remain poor. An inter – generational vicious cycle of poor nutrition, growth & development sets in spercifically, cases of early marriage & early pregnancy result in poor gestational weight gain, & hence,girls have low birth weight babies.

ii. Every adolescent girl should be given a proper & adequate diet, rich in iron, folic acid & other vitamins & minerals.

iii. The prevention of early marriage & delay in age at first pregnancy, are essential for good health of adolescent girls.

7. Improved care & nutrient intake, including iron, during pregnancy & iactation.

i. Pregnancy & lactation are periods of physiological stress when the food & nutrient requirements increase, since the foetus is dependent on the mother to meet its requirements. Proper intake of food & iron during this period can help in preventing low birth weight. Hence pregnant & lactating women should consurne a diet : with additional protein & energy. Rich in iron, folic acid & other minerals & vitamins. With iodised salt.

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CASE STUDY

CASE STUDY- 1

1. A SUCCESS STORY OF BAPI MALAKAR

Every moment of their life is full of struggle for this reason any type of acute situation in their life is not so serious. 58 years aged Sunil Malakar inhabitant of Karakdanga, Anchuri Gram Panchyat, Bankura 1 block, is a Riksha chalok . His monthly income is Rs 800/= . A piece of tand,four side covered with worn cloth, roof is covered by polythin cloth is called his den. A few dish are their utensils & a plank is their furniture. Manju Malakar of 49 years age is his house wife. Their living child 4 & dead 3. This is the starting point of the incident. For maleism mentality women & children of such family suffer very much. Subject of my survey is their little son . Manju got marry at 15 years age. She brought forth her fist child at 17 years of age. Her first male baby is now 18 years old. Her 2nd, 3rd, & 4th, baby dead before delivery. Due to ignorance and superstition they never adopt the help of family planning service. Her husband is also not interest .The age of manjus 5th & 6th baby are 8& 6 years . 7th male baby called Bapi is at 1 year. Bapi was bron at home when its weight was 2.150 gm. ICDS worker observe its weight . Bankura Medical college is at few distance . Baby was taken to hospital for schedule vaccination . But the baby was too weak to vaccinate. Bapi was very sick & weak . Due to affected by malnutrition bapi skin was wrinkled with the help of regular counciling by ICDS worker, 1000 days GP Facilitotar Bapi gradually become normal. At first the work was not so easy. Bapis mom manju had an concept that Bapis illness was due to keeping an eye on her child .Manjus health was also not well .yet still naw Manju is out of family welfare planning benefit .because of his husband unwilling .At first Manju never attend

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at ICDS centre .she neither present at mother meeting or VHND meeting In spite of rapid approach of ICDS worker Putul Dey,Manju was still unchanged . Manju was very much affected by illiteracy and superstition .she and her children were not clean and clear .Bapi was not bathed every day and properly food .Bapi was ware amulets , In spite of that his health improvement was zero .

Appearing an her door GP & facilitator and ICDS worker teach her to get firm conception on nutrition food at low cost .They also teach her about the knewledge of childs development for which body weight should be measured per month by growth chart . she was also well informed about family planning . she was also called on Mother meeting , VHND meeting . At fist Bapis welight reading was done at home gradualy Manju carried Bapi to the centre for weight reading . Thus Manju changed her life style day after day . Now Manju adopting family planning benefits .

Now she every day take her Bapi to the centre and feed him with others .she checks up Bapis body weight in every month .At the time of illness she goes to Bankura Medical Collage .Though , Bapi sill now under weighted yet he is improued much .Now Manju takes care of her Bapi about bathing and feeding at a low cost .she attends in every month acompaning other pregnant mothers . A health camp was held on 14 January at Anchuri panchayt under Bankura Block health is now move improved than before .

Beside this , at the time of my investigation Manju has carried out all the information paid by me 6.400 gm . At the commence of investigation Bapi weight was 6.400 gm that improved to 6.700 gm at the end .

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CASE STUDY- 2 A Story of Karakdanga-2, Papudihi, & Anchuri Village.

Bankura - 1 block is the Hindu, Muslim, & Tribal based block in which 60% population are depending on Agriculture based labour. Naturally it is plateau & red laterite zone. Geographically maximum wastelands are covered under farest area. The average rainfall is 1300 - 1400 MM, but due to undulating the water never logged in a place for long time. So agriculture is not sustainable livelihood due to plateau area. In this plateau area, minor forest products good are available but collection of goods is another problem for villages.

Man are being engaged for daily labour, masson, bakery labour, reskachalok, & working as agricultural labour for food security & source of livelihood. Maximum women specially pregnant & lactating women are being engaged for collection minor forest products goods, daily labour, masson, maid servant at the summer season & working as agricultural labour a the harvesting & sawing season for food security & source of

livelihood. Women collect different variety of seeds from forest Sal,Bahara, Amloki, Hartaki, Mahul flower &Kalmegh, TulsiSatmul, Anantamul ets as herbs from 6 A.M to 10 A.M & whenthey are engaged at the agricultural field spent already6 hours from 10 A.M to4 P.M without feeding their children. So pregnant women don’t take additional rest &feed in time. Before departure from home for collection of minor forest products goods, lactating women are habituated

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for feeding their children by juice of mahul flowers & their children are lying asleep for three hours at a stretch without taking breast milk & complimentary feeding. At this way from childhood every child is being addicted on country liquor & its traditional culture is hospitalizing through country liquor. After return from agricultural field they are being busy for preparation food & already tired mother is not growing more energy for look after their children health.

Secondlly, village people is to migrate one place to other places frequently for food scarcity & source of income. Seasonal migration is abserved twice in a year. They migrated to Burdwan & Howrha district with their family due to food for work. Pregnant & Lactating women are working at the field until the delivery. After delivery they take rest only fifteen to thirty days & after that they involved in house work. It is observed that the lactating women never tack supplementary nutritional food & never followed up exclusive breast - feeding adequate complementary feeding & preventive measure for their children in time & mothers. Maximum pregnant & lactating mothers are suffering on anemia due to hard work lack of supplementary nutritional food, proper Antinatal check up & Post natal check up, lack of IFA consumption additional rest & food. Indeed, we see maximum children borne at home undre weight below 2.500kg, it is observed that with in 7 months maximum children are being suffered on malnutrition.

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CASE STUDY- 3 “SUCCESS STORY OF SELF HELP GROUP”

Village- Badulara is situated in Bankura - 1 block at Anchuri GP of Bankura district. The village has high situated muslim population. Basic survinal for the common man was work in masson, bakery labour, agricultural labour, & women engaged for daily labour, masson, agricultural labour, collection minor forest products goods.

Years ago the village situation was some what different. The anganwadi centre located in the vicinity of the village was not accessed by the community members. The anganwadi worker helplessly moved from house to house for mobilizing community participation in accessing nutrition & health services from existing service delivery system.

The tide of time led to the emergence of forming self help groups. This brought Aphsana, Ayasha, Samrina, Najma together to believe in forming community based organization. They started to conduct community level meeting. However “Uhara ki zane”(what do they know) their initial approach faced resistance. But they were focused.

The anganwadi worker found in them therefore of change agents. They together facilitated mapping malnutrition in children. They followed home visits & ensured integration of all children into the ICDS centre. Keeping regular contacts with anganwadi worker helped them identify gaps. After noon meeting in the village involving “community mothers” were also conducted. The underlying objective was promotion of best practices. This common understanding brought them together to monitar community level practices towards behaviour change.

During this time they also made initiative to bring all children as well as pregnant & lactating mothers at the centre on a “fixed date” for accessing dual services of health & ICDS. Since the sub - centre of the village is located one & half km away the people were denied easy access to medicine specially in emergencies. They managed to be depo-holders of emergency medicine with support of health worker & anganwadi worker.

Asw part of group activities, they prepared plot for vegetable cultivation. They voluntarily contributed to anganwadi centre the vegetables cultivated to

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add quality to the cooked food. They also used the same for their own consumption & few for selling in the local market. This helped them make small savings. Livestock rearing was another venture they indulged in. To meet the exigencies of time they made the community graingola. These small attempts to fight adversity proved valiant. Now every morniing when the anganwadi worker steps into the village she is followed by child clusters. She feels happy today. The ceaseless efforts of samrina, najma, ayasha & the like minded others have helped in empowering communities towards sustainable community health & management initiative. Their move against age old beliefs & practices has been addressed & their entitlements regarding community level health & nutrition services have been ensured.

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CHAPTER- I

Conclusion,

& Survey Questionery

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CONCLUSION

Malnutrition in women & children in West Bengal is widespread & its

serious consequences for human survival & development are well known. High incidence of low birth weight perpetuates malnutrition across generations but there are opportunities for action to reverse this trend. Emphasis under ICDS should be shifted to young children below three years of age. Community based growth monitoring should be encouraged & nutrition caring practices promoted at all levels.

Adequate nutrition is a human right for women & children & the state government are obliged to fulfill this right. Widespread prevalence of malnutrition in children & women must be reduced on the basis of scientific knowledge, practical experience, international law & basic morality.

Despite many programs & efforts put down by the government the malnutrition rates still prevail high in the county. The programs were beneficial only to a certain class of people. I believe the government should develop a plan in eradicating poverty in the county & providing a strong campaign across the county about the “killer” with real facts & figures its treatment & its complications. I believe Malnutrition has drawn the least attention of the leaders to find a solution. India has succeeded in campaigning against the killing of the Tigers, I believe even the children in the county are endangered & an immediate effective campaign should be initiated right away. Proper amendments to the above existing programs or innovative programs should be thought of whose main target should be the poor sector. The government should at least provide the mineral & vitamin mix solution free of cost to the public rather than investing ransom into welfare programs which eventually go futile. These mixtures should also be made available in every hospital & PHC in every corner of the county along with a proper campaign about its importance. The children are the future of the country, unfortunately their future is at the mercy of the leaders. Let’s hope many more social activists like Anna Hazare change the fate of the children & the county & also make this fatal child killer a history.

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BIBLIOGRAPHY

SL. REFERENCES WEB SIDE

1 World Bank Report on Malnutrition in India 20011 http:// www. Worldbank . org

2 The Nutritional Anemia Prophylaxis Program. National Institute of Health & Family Welfare

http:// www. NDC

3 ICDS Maharashtra Commissionerate Women & Child Development www.icds.gov.in

4 National Plan of Action. Ministry of Women & Child Development Wcd.nic.in

5 India s Public Distribution System faulty. World Bank news 18.5.2013 www.inewsone.com

6 The Mid Day Meal Program. Government of India http:// india.gov.in

7 Amrita Paul. The Rural Health Mission http:// www.karavalitimes.com

8

Gabriela Mistral. WHO. Global Database on Child Growth & Malnutrition. Department of nutrition for health & development

http:// who.int

9 Rural Health Mission 2011. http:// post.jagran.com

10 K.R Venugopal . The National Food Security Act 2011. http:// www.peopleswatch.org

10 CHETNA. A child hood to every child 2011

http:// www.bernardvanleer.org

11 India ‘shamed’by child malnutrition, say PM Sing http://www.bbc.co.uk

12 HUNGAMA. Hungama Survey report 2011 – 2012 http:// hungamaforchange.org

13 Towards a new dawn. Ministry of Women & Child Development Government of India

www.india .in

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