Final Report On Malnutrition PDF

Malnutrition: An Invisible and Silent
Emergency
A Report on Malnourished Children
IN Urban Slums of Bangalore
DATE: June 07, 2013

Dr. Megha Ranjan
Post Graduate Diploma in Health Management
Institute of Health Management Research, Jaipur
Contents
Acknowledgement
Abstract
4
5
SECTION 1: - ANALYSIS OF DATA ON MALNOURISHED

CHIILDREN IN DIFFERENT PAG AREAS
1.1) Introduction to CRY PAG Areas ..6
1.2)
1.3)
1.4)
1.5)
1.6)
Summary of Results 7
Reasons for Malnutrition in PAG areas.9
Complications of Malnutrition11
Menace of Malnutrition..12
Case Stories of Malnutrition.13
Rakshita13
Sudha..14
Charan.15
Estharani16
1.7) Details and Key findings of malnourished children

In PAG areas17
a)
b)
c)
d)
Koromangala PAG ..18

Jeevan Beema Nagar PAG 27
Yeshwantpur PAG..31
Madivala PAG37
SECTION 2: Insight into MALNUTRITION AND HEALTH SCEMES

2.1
2.2
Introduction ..39
Background.40
What is Nutrition and Malnutrition??? 40
Types of Malnutrition40
What we come across in field..??? 41
Classification of Malnutrition 42
Causes of Malnutrition ..43
Irony of Girl Child Malnutrition45
2
2.3
2.4
Myths and Facts about Nutrition46

Management of Malnourished children..47
Severe Malnutrition: Red color
Moderate Malnutrition: Orange color
Mild malnutrition: Yellow color
2.5 Contact Details of Anganwadi Teachers and Urban
Health Centers (UHCs)..50
2.6 Nutritional Rehabilitation at HOME52
Governments Initiatives to fight Malnutrition

3.1 Introduction to Various Health Schemes.57
Integrated Child Development Scheme (ICDS)..58
SECTION 3:
Introduction to scheme.56
Services Offered Under Scheme..56
Population Norms for anganwadi centers..57
Financial and Nutritional Norms58
Comparison between ICDS in states of Karnataka,
Rajasthan, Andhra Pradesh, Bihar and Orissa 59
Kishori Shakti Yozana (KSY) .64
SABLA 65
Indra Gandhi Matritva Sahyog Yozana (IGMSY).66
Schemes Under NRHM Karnataka 67
Janani Shishu Suraksha Yozana (JSSY) .68
3.2 Road Ahead: Volunteer Action.72
Conclusion.75
References.77
Section 4: Annexure
Annexure I: Excel Spreadsheets of data on malnourished
children..78
Annexure II: Composition of food items distributed
under ICDS in Rajasthan and as recommended by
Government of India.79
Annexure III: WHO Growth Standard Charts90
1) Girls Weight for age 0-10 years
2) Boys Weight for age 0-10 years
ACKNOWLEDGEMENT
I, Dr. Megha Ranjan, would like to extend my thanks to CRY for giving me this
opportunity of doing my internship with them.
I would like to express my heartiest gratitude to all the CRY volunteers in the different
PAG areas who helped me collating the data. Without their time and effort, this report
would not have been possible.
I also extend my gratitude to all the anganwadi workers who cooperated to provide the
data. A special thanks to intern, Dr. Megha Raghvan for her immense help.
Finally, I would like to thank my mentors at CRY, Ms. Thangamma Monappa and Mr.
Navneet Prakash and my mentor at IIHMR, Dr. (Major) Vinod Kumar; who helped and
guided me throughout my internship. I learned a lot under their able guidance.
Abstract
This report describes the project on Malnutrition that I did during my
internship at CRY in Bangalore. It is a follow up to the one written by
Siddharth Jha1, in which he undertook a detailed survey of malnourished
children in various anganwadis in each PAG area. This report provides
additional details on the mechanisms (what, how, why and consequences)
of malnutrition as well as details on each malnourished child in each
anganwadi, analysis on the data collected from the anganwadis, and finally,
discuss about how to proceed towards the management of malnutrition
both at the health facility level and home level (Nutritional Rehabilitation
at home). Further, it gives an insight into the various health schemes at the
national and state (Karnataka) level particularly a comparison of Integrated
Child Development Scheme (ICDS) among Karnataka and 5 other states.
Section 1: ANALYSIS OF DATA ON

MALNOURISHED CHIILDREN IN
DIFFERENT PAG AREAS
(1.1) CRY Public Action Groups
(PAG) Areas
There are four Public Action Group (PAG) areas in Bangalore
1) Koromangala,
2) Madivala,
3) Yeshwantpur, and
4) Jeevan Beema Nagar.
Essentially, each PAG is a group of enthusiasts, members of the public who have come
together to stand for what is right. They wanted a change, so opted to be the change to
make a difference. And they have made a difference- from installing water filters to
setting up a new anganwadi.
Through their regular visits and interactions with the members of the
Community; they monitor and intervene in cases of Child Rights violations. The sole
purpose for them has become to ensure equal opportunities to all children, conferring
the 4 basic rights:
Right to Survival,
Right to Participation,
Right to Development and
Right to Protection.
And as a result of their continuous and effective interventions which included

constant dialogues with the community as well as with the concerned authorities, they
have been successful in making a huge impact in the society.
Summary of Results from Data collected on

malnourished children from the
Anganwadis in different Public Action
Group (PAG) Areas
Data has been collected from the anganwadis in all the four PAG areas
(Koramangala, Jeevan Beema Nagar, Yeshwantpur, and Madivala) from the
official records of children maintained by the anganwadis and again
weighing the malnourished children in the anganwadis. Following figures
have emerged from the month long exercise.
Table 1: Complied Data on Malnourished Children from All the PAG Areas
As on June 1, 2013
Area/Anganwadi
Total No.
of Malnourished
Children
No of
Under
weight
Girls
Koromangala
PAG
L.R. Nagar, Near
Government
School
Kannada Tamil
School
AWC-1, Rajendra
Nagar
AWC-2, Rajendra
Nagar
Ambedkar Nagar.
Near Public
Toilet
EWS Quarters
38
29
10
No. of
Under
weight
Boys
No.
Severely
under
weight
Children
No. of
Severely
Under
weight
Girls
No. of
Severely
under
weight
Boys
No of
children
under
age of 2
years
No of
under
weight
girls
under
the age
of 2
years
No. of
Under
weight
boys
under
the age
of 2
years
32
24
10
1st Cross, L. R.
Nagar
Urdu Anganwadi
Inside Urdu
School
Shastri Nagar
Yeshwantpur
PAG
Sheriff Nagar
Gayathri Slum
Akiappa Garden
AWC-2, Sheriff
Nagar
Jeevan Beema
Nagar
G M Palaya
AWC- 2
Nellurupura
AWC- 3,
Nellurupura
AWC- 4,
Nellurupura
MADIVALA PAG
N S Palya
4
1
1
0
3
1
4
1
1
0
3
1
0
0
0
0
0
0
2
21
2
11
0
10
2
7
2
5
0
2
0
4
0
1
0
3
4
1
4
12
4
1
2
4
0
0
2
8
3
1
2
1
3
1
1
0
0
0
1
1
1
0
0
3
1
0
0
0
0
0
0
3
69
40
29
19
14
17
13
10
10
7
3
3
4
2
3
1
1
2
0
2
0
0
0
28
13
15
11
4
4
1
1
3
3
2
2
1
1
1
1
0
0
0
0
0
0
For management of malnourished childrenRefer to

Section 2: Page No. 47 and 53 for Nutritional
Rehabilitation.
For Government Initiatives towards ending malnutrition
i.e. various government health schemes Refer to Section
3: Page No. 56
Data collected from the official records of anganwadis in April, 2013

9
Reasons for the high number of

malnourished children in the PAG areas
a)
b)
c)
d)
e)
f)
g)
h)
Low level of education among mothers

Lack of Knowledge towards healthy diets
Cultural beliefs about discarding the colostrum and
breastfeeding
Care: Poor maternal care and child care practices due to a
lack of knowledge about infant care on the part of mothers
and other caregivers in the family
Lack of knowledge about the importance of complementary
feeding.
Lack of commitment towards health issues
Lack of political commitment towards providing funds and
other provisions to anganwadis which are the important
pillars to combat Malnutrition.
Lack of adequate health services, clean water and sanitation.
Fundamentally, poverty is at the root of under nutrition. Very

poor people are generally unable to afford the foods, education
or health care they need to nourish themselves or their children.
10
Picture 1: Reasons for malnutrition

Source: UNICEF, Save the Children
11
Complications of Malnutrition
Inadequate
Breastfeeding
Frequent
Bouts of
Diarrhea,
Pneumonia,
Malaria
Picture 2: Complications of Malnutrition

Source: http://challengedkidsinternational.wordpress.com/2013/03/
12
Menace of Malnutrition
Picture 3: Consequences of Malnutrition

Source: http://challengedkidsinternational.wordpress.com/2013/03/
13
CASE STORIES OF MALNUTRITION

1) From Rajendra Nagar, Koramangala
a) Rakshita
Anitha, frail and underweight got married at the age of 20 and soon gave birth to her
first child, Rakshita. Rakshita was small and malnourished ever since. She is 4 years old
now and weighs just 9 Kgs. Her father is the reason she is facing this menace of
malnutrition. If he would have taken care of her mother and would not have run away,
she could feed Rakshita well. Now she has to work and cannot take care of her in Rs
2500 per month. She cannot even provide her milk mentions Anithas sister, Sunitha.
Sunitha takes care of Rakshita when her mother is at work and provides her with
whatever little food she can.
With the little knowledge about malnutrition, its consequences,
Anitha has ignored about this issue ever since was born. The girl frequently catches cold,
cough, robbed by diarrhea quite often and trap her more deeply in the paws of
malnutrition.
A playful, curious Rakshita
Courtesy: Dr. Megha Raghavan
When we (Me, Dr. Megha Raghvan and Nischal) met her for the first time she was
playing in the streets of Rajendra Nagar. She was curious as we were looking at her with
wide eyes, trying to figure out what is so wrong with her to make some strangers stare
at her. Discussing with her aunt Sunitha about her health issue (brought to our notice by
Urdu Anganwadi where Rakshita is though enrolled but rarely attend) ; she got
convinced that Rakshita needs to see a doctor and requires proper nutrition.
Ever since we have been trying that some positive change can be brought into her life.
She has been checked by the doctor from St. Johns Medical College as well who visit
the Koromangala once a year for health check ups. Her mother has been counseled for
14
proper feeding practices and preparation of some low cost nutritious recipes. She has
been put on the priority list of health care workers of Adugudi PHC who has promised to
follow her up regularly.
We hope with our efforts we can bring her out of the red zone soon and
give her a new healthy start with her enrollment in PARIKRAMA School next year, a
dream seen by her mother for her.
Sudha
Another small girl who USED TO LIVE in the urban slum of Koromangala opposite to
National Games village; YES used to live, because she passed away 15 days back.
5years old and weight just 6.5 Kgs crippled by malnutrition to a point that she has
developed irreversible brain damage and hooked with many other developmental
disorders. What a steep contrast is seen on the two side of the road. On one side there
is flourishing new age buildings and on the other side people are struggling to get one
meal of the day.
Parents were worried that their little girl is not growing well, she
is fragile, weak and mostly lies silently on the floor but when they recognized the
situation it was already too late. She was rushed to nearby hospitals where she was
hospitalized twice due to frequent episodes of diarrhea which further deteriorated her
health. Finally she was seen by the Pediatrician at the Indra Gandhi Institute of Child
Health Hospital, where after check up doctor mentioned that due to chronic
malnutrition, her brain has been irreversibly damaged and she is also suffering from an
array of developmental disabilities due to improper nutrition during her growth years.
Sudha is not alone, as most of the children who fall under the category of severely
malnourished have parents who are ignorant about malnutrition, what causes it and its
dire consequences and lack resources for providing not only the medical attention
required when there is an emergency, but also the basic resources to provide for a
balanced diet for the child.
Had the parents been acted on time, Sudha could be saved from clutches of
malnutrition.
From preventing any other child suffering from such situation we must act swiftly
towards making the community aware that if they wont act in a responsible manner
Next can be their child.
2 Case stories compiled after discussion with the parents and anganwadi teachers
15
2) N S Palya, Madivala PAG

Charan
On April 13, 2013; CRY kick started dropout survey in N S Palya area of South Bangalore.
We (Me and other volunteers- Prateek, Shreoshi, Akanksha, Allen) were excited to have
an opportunity to bring some changes in the life of the lesser privileged. We began
house to house surveys to collect the information about the school drop-outs. And
when we came across the anganwadis of the area. Charan was on the radar of
volunteers but they could not locate his house or meet him until today.
Anganwadi helper guided us to Charans house where we had first glimpse of
Charan. He is a 4 year old boy residing in one of the narrow lanes of G D Mara slum
which houses population of about 10,000 people; sandwiched between residential skyscrappers on one side and upcoming five star hotel on the other which also threatens to
demolish the disputed G D Mara slum.
Charan represents the textbook picture of severe malnutritionextremely thin legs and hands, an extended pot belly, crackled skin and wide eyes. He
peeked from behind his father and instantly we felt like we need to do something about
this kid. We asked anganwadi worker, talked to his father and the same old story came
to our notice. The household can afford to maintain refrigerator, a cable connection,
television but not able to feed his child properly.
A year back, when Charan had a severe bout of diarhhoea he was admitted
in Indira Gandhi Institute of Child Health Hospital where he was diagnosed with Protein
Energy Malnutrition PEM). He was prescribed with a proper line of treatment which if
would have been followed up, then today Charan would have been fine by now. But his
parents chose not to care and his condition has worsened over the period of time. We
always encounter him in the streets of G D Mara slum sitting next to a vegetable vendor
and every time when we visit his house, we are welcomed by a locked door.
Anganwadi worker is least bothered about his condition, his parents are aloof over his
health..
Charans deteriorating health in spite of being seen by the IGICH Doctors is an issue of
urgent concern, in fact it is an emergency and we will have to find a way to help him out
and soon.
16
Esther Rani
(Compiled by Rajeev, Volunteer EAST PAG)
Age: About 2 years
Status: Malnourished
Location: Anganwadi GM Palya (CRY East PAG, Bangalore)
Challenges: Diagnosed at birth with Congenital Heart Disease
Esther Rani is the youngest amongst 3 siblings, the others being brother Anil (now about
13) and sister Sharada (now about 10). Born on 13th June 2011 to Malamma (now about
43) and Sabanna (now about 53), she was diagnosed with a Heart condition by Sri
Jayadeva Institute of Cadiovascular Sciences and Research Bangalore. Her Father
being a Casual Worker and Mother a Homemaker, did not have the resources to treat
her condition. CRY Volunteers discovered her as a SAM child at the GM Palya
Anganwadi in mid-2012.
A Plan was set into motion to rescue her from her condition under the Bala Sanjeevani
Scheme of the ICDS. The Anganwadi Teacher prepared the Enrolment Form for visiting
the Public Health Worker visiting the Anganwadi, for reference to the Primary Health
Centre Vibhutipura. Consequently, the PHC referred her to the requisite District
Hospital in KR Puram. The DHO recommended that she be treated for her Cardiac
condition by a Government owned or aided facility. Contact was made by CRY with the
Directors of Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore,
to examine and treat the Child under the relevant ICDS scheme. Consequently, and after
much persuasion, the Parents agreed to accompany CRY Volunteers on the appointed
date to the concerned hospital. However on the morning of the appointment, the
Parents appeared to have changed their mind and did not show-up at the Anganwadi in
order to be ferried to the Hospital. CRY Volunteers then had to involve the Teacher to
pressure the Father to allow for the Child to be examined. Taking the help of the
Anganwadi Helper, the Volunteers tracked down the house of the Child and finally
succeeded in driving the Child with her Parents to the Hospital. At the MRI conducted in
the OPD that morning, it was found that the Childs heart condition had been corrected
and just needed treatment for Malnutrition. Fearing the non-seriousness of the Parents
to allow the Child to undergo any kind of corrective treatment at IGICH, a request was
made immediately to the concerned Doctor at the Hospital to recommend Tonics and
Supplements that will help the Child come out of the SAM state. As prescribed, supplies
for 3 months were purchased and handed over to the Parents while dropping them off
home that afternoon.
Esther Rani appears to be on the path of recovery from her SAM state and is gaining
weight, to be a normal Child soon.
17
Details of Malnourished Children

in Each Anganwadi
Brief Introduction to Anganwadi
The Anganwadi - literally a courtyard play centre - is a childcare centre. It is
the focal point for the delivery of services at community levels to children
below six years of age, pregnant women, nursing mothers and adolescent
girls of the age group 12-18.
Every AWC is supposed to cater to two adolescent girls every 6 months.
They are supposed to receive a take home ration of supplementary
nutrition. This is done both for the benefit of the girls as well as any future
children of theirs, since a child born to a malnourished mother is likely to
be malnourished himself.
The WCD has ordered that severely malnourished children be given eggs
and milk four times in a week4 to combat the problem of malnutrition. A
plan was recently announced to expand this to providing milk and eggs to
all children, everyday from January 1st, 2013.5
The Hindu, 20 April 2012

http://www.thehindu.com/news/states/karnataka/milk-eggs-to-be-on-menu-for-anganwadichildren/article4112879.ece last accessed on 20th April 2013
5
18
Koromangala PAG Area

Each anganwadi in the area caters to two adolescent girls per six months. They get a
take-home ration of food. In each anganwadi, malnourished children are provided with
a supplementary diet of milk and eggs. Eggs are provided four times a week while milk is
provided twice a week. Additionally, they are given Chitrana/ Payasam alternatively.
Details of Children in the Area (as on 1 June, 2013)

1) L. R. Nagar, Near Government School
Teacher: Kaveri
Key Findings:
a) There are 10 malnourished children in the anganwadi and all are females.
b) Out of 10, 3 are below the age of 2 years which is the critical window of opportunity
to treat malnutrition and 9 are under the age of 5 years
C) Out of 10,
7 are severely underweight for their age.
1 moderately underweight
2 mildly underweight
d) Out of 10, 9 children have shown improvement over the period of 3 months though
at a very slow pace
19
S.
No.
Name of the
child
Age in
years as
on 30th
March,
2013
Sex
Weight in Kgs
Weight in
as on 21st
Kgs as on
December,2012 31st
March,
2013
Nirasha
1.2
Female
5.2
6.4
Sneha
2.4
Female
8.1
8.5
Anupriya*
3.3
Female
9.3
9.3
Shalini
2.3
Female
7.8
8.0
Vedavathi
3.9
Female
10.3
10.8
Manasaa
4.6
Female
11.2
11.5
Benitha
5.7
Female
9.3
9.6
Samara
3.9
Female
11.9
11.9
Shruthi
1.7
Female
8.2
8.5
Priyadarshini
1.6
Female
9.0
9.1
Ideal
Weight
for age
(-1 SD)
Grade of
Malnutrition
8.3
Severe
10.9
Severe
12.7
Severe
10.7
Severe
13.6
Severe
14.9
16.8
13.6
9.2
Severe
Very Severe
Moderate
Mild
10.2
10
* Mentally challenged, Neurological abnormalities - needs complete evaluation; been to IGICH, Dr.
Megha Raghavan was following her. For details refer to her database and manual .
20
Mild
2) Kannada Tamil School, Rajendra Nagar

Teacher: Usha (8884761834)
Key findings
a) There are 2 malnourished children, who were identified by Intern Siddharth Jha in
December, 2012. However no follow up has been done since then on these children. I
tried to follow these children but found anganwadi closed every time I have visited the
area.
b) All are females and are severely malnourished.
S.No.
Name of the
Child
Age in
years as
on 30th
March,
2013
Sex
Weight in Kgs as
on 21st
December, 2012
Ideal Weight
for age (-1 SD)
Grade of
Malnutrition
Laxmi
1.5
Female
8.9
Severe
Ammu
3.0
Female
12.2
Severe
3) AWC-1, Rajendra Nagar

Teacher: Selvi 9945075660
Key Findings
a) Anganwadi has not been followed up since December, 2012
S.NO.
Name
Aisha Kannu
Age in Sex
years
as on
30th
March,
2013
4.2
Weight in Kgs as
on 21st
December, 2012
Female
9.3
21
Ideal Weight
for age (-1
SD)
14. 3
Grade of
Malnutrition
Severe
4) AWC-2, Rajendra Nagar

Teacher: Manjula (7204785225)
Key Findings
a) There are 4 malnourished children in the anganwadi out which 3 are females
and all are severely underweight for their age.
b) Children are not doing well as there is drop in weight of one child and one
child has shown no improvement over the time.
c) All the children in the anganwadi are regularly followed up especially Sadhna.
Her parents have also been counseled for proper feeding practices and she is
improving though slowly.
S.NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in
Kgs as on
21st
December,
2012
Weight in
Kgs as on
31st
March,2013
Shameen
3.0
Female
9.3
9.3
Moni Ani
5.3
Female
11.8
11.4
Sadhna*
3.9
Female
10.5
11
Riyan
4.9
Male
12
12.4
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
12.2
Severe
16.2
Severe
13.6
Severe
15.6
* Sadhna has Right Hand Deformity. Has been seen by doctors in Pondicherry and recommended
physiotherapy. For further details refer Dr. Raghvans Database and manual.
22
Severe
5) Ambedkar Nagar, Near Public Toilet

Key Findings
a) There are 6 malnourished children in the anganwadi out of which 4 are
females and 3 females are severely underweight for her age. All the children are
above 2 years of age.
b) All children are doing fairly well and are being regularly followed up.
c) Bharth has been diagnosed with PEM and has been taken to Shantinagar PHC
where he has been prescribed protein supplements by the Doctor. His family has
also been counseled about proper feeding practices and he has shown some
improvement since then but need regular follow up.
d) Sudha had progressed to advanced brain damage due to chronic malnutrition.
She has been seen by doctors at Indra Gandhi Hospital but they suggested that
nothing can be done now as she developed irreversible damage. She passed
away in May, 2013
e) Sholo has been doing well with proper counseling of his parents. Needs
regular follow up.
S.
NO.
Name
Age in
years as
on 31st
March,
2013
Sex
Sudha*
4.6
Female
Sholo Breakmance
4.0
Sanjana
4
5
6
Weight in
Kgs as on
31st March,
2013
Ideal
Weight
for age
(-1 SD)
Grade of
Malnutrition
6.8
6.8
14.9
Very Severe
Male
11
11.5
14.4
Severe
3.4
Female
9.4
9.9
12.8
Severe
Arogya Stella
4.8
Female
12.2
13.2
15.2
Moderate
Shobha
4.0
Female
11.0
11.3
14.0
Severe
Bharth #
Weight in
Kgs as on
21st
December,
2012
Male
* Sudha- passed away in May, 2013. Case story- refer page no 15 of the report
# Bharath- seen by Doctor at Shantinagar Maternity center in April, 2013
23
6) EWS Quarters
Teacher: Sumathi (8904437493)
Key Findings
a) Due to demolition of Ejipura Slum, 6 out of 7 children have moved from the area.
Only Kaushik is enrolled with EWS anganwadi.
b) Malin Bahno has moved to Ambedkar Nagar, Jalali cross, contact no is 88840027
c) Ferdoz Begum, Ruhi Begum and Madhumati, Sara has moved to Husor Road and
Sarjapur Road respectively and are also not enrolled in any anganwadi.
d) Ruhi has moved to L.R. nagar, 11th cross. No other contact details.
e) Kauhsik has been regularly followed up. Also his guardians have been counseled
about proper feeding practices and he has been doing well
S.NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in Kgs
as on 21st
December,
2012
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Malin Bahno
3.5
Male
8.9
13.4
Severe
Ferdoz Begum
4.5
Female
10.5
14.8
Severe
Ruhi Begum
2.2
Female
7.7
10.5
Severe
Madhumatti
2.0
Female
6.5
10.2
Severe
Ruhi
1.8
Female
9.4
Severe
Sara
4.8
Female
11.1
15.2
Severe
11.4 (taken on
12.6
7
Kaushik*
Male
April 15, 2013)
Moderate
* Kaushik: Hearing and Speech difficulty. Been to Chandrashekhar Speech and Hearing Institute (CSHI)
24
st
7) 1 Cross L. R. Nagar
Teacher: Regina (9900809567)
Key Findings
a) There are 7 malnourished children in the anganwadi out of which 6 are females.
b) 6 children are severely malnourished out of which 50% are under the age of
2years.
c) The children are not doing well despite the best efforts on the part of Anganwadi
teacher Regina.
d) There is either drop in weight or weight is not improving in all the cases.
e) Mother of Shankar and Priya (seen by doctors at IGICH) has been counseled
about the diet for the children and needs a regular follow up. Also while talking
to their mother, it has come to our notice that despite having BPL card, the
family was charged for laboratory investigations at Indira Gandhi Hospital and
the medicine prescribed by the Doctor is not available at the Hospital Pharmacy.
S.
NO.
Name
Age in
years
as on
30th
March,
2013
Sex
Weight in
Kgs as on 21st
December,
2012
Weight in
Kgs as on
30th
March,2013
Ideal
Weight
for age (-1
SD)
Grade of
Malnutrition
Shankar
5.6
Male
10
11
17.0
Very Severe
Priya
3.5
Female
10.1
10
13.0
Severe
Tejaswini
1.7
Female
9.2
Severe
Jayashree
1.5
Female
6.6
6.8
8.9
Severe
Sania Misra
5.5
Female
11.2
11.5
16.5
Severe
Monisha
1.7
Female
6.2
9.2
Severe
Keerti
2.7
Female
9.9
11.4
Moderate
25
7) Urdu Anganwadi
Teacher: Name Unknown
Key Findings
a) There are 4 malnourished children in the anganwadi out of which 2 are
females and all the children are severely malnourished.
b) Since the anganwadi is newly opened, it does not have adequate funds from
the concerned authorities for the provision of EGGS, MILK and
supplementary food. Therefore children are not given EGGS and MILK and
occasionally supplementary food is provided.
c) # Rakshita has been regularly followed up. She has been taken to Adigudi
PHC where her mother was counseled by the Link Worker with respect to
regular visits to PHC. Her mother was also counseled by us for proper feeding
practices. She needs to be regularly followed up.
d) Izaz and Aman has not been followed up.
Aman has gone to his village and hence has not been seen since a month.
e) Sufian is the son of same Anganwadi teacher and is doing well.
S.NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in Kgs
as on 30th
March,2013
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
3.1
Male
12.9
Very Severe
Izaz
Rakshita #
Female
8.7
14
Very Severe
Aman
Male
10.7
14.4
Severe
Sufian
Male
11.1
14.4
Severe
26
8) Inside Urdu School

Teacher: Pushpa
Key Findings
a) The anganwadi has one malnourished child, Sultan who is severely
underweight for his age and suffers from frequent infections due to low
immunity. He has been seen by the doctor at Sidhamaya Hospital and his mother
has been counseled for proper feeding practice. He needs to be regularly
followed up.
b) Also the anganwadi has not been followed up since December, 2012.
S.NO.
Name
Sultan
10)
Age in
years as
on 30th
March,
2013
2.5
Sex
Weight in Kgs
as on 30th
March,2013
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Male
5.6
11.7
Severe
Shastri Nagar
Teacher: Padma (8453578256)
Key Findings
a) Anganwadi has not been followed up since December, 2012.
b) There are 2 malnourished children in the anganwadi who were identified by
intern Siddharth Jha.
c) However, we have been trying to meet the anganwadi teacher and the parents
of these two children but could not.
S.NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in Kgs
as on 21st
December,2012
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Kavya
3.3
Female
9.6
12.7
Severe
Franka
2.9
Female
8.9
11.7
Severe
27
Yeshwantpur PAG
We have been covering only 4 anganwadis in the area. Each anganwadi caters to two
adolescent girls per six months. They get a take-home ration of food. In each
anganwadi, malnourished children are provided with a supplementary diet of milk and
eggs. Eggs are provided four times a week while milk is provided twice a week.
Additionally, they are given Chitrana/ Payasam alternatively.
Details of Malnourished children in the area

1)
Sheriff Nagar
Teacher: Tahseen Taj (9591841468)
Key Findings
a) There are 4 malnourished children in the anganwadi and all are females.
b) Out of 4, 3 are still severely underweight for their age but one child Tasleem has
made progress from being severely malnourished to moderately malnourished
now.
b) Though at a slow pace but all children are doing fairly well but still needs regular
follow up.
S.
NO.
Name
Age in
years
as on
30th
March,
2013
Sex
Weight in
Kgs as on
21st
December,
2012
Weight in
Kgs as on
30th
March,2013
Ideal
Weight
for age
(-1 SD)
Grade of
Malnutrition
Mehek
3.1
Female
8.5
12.4
Very Severe
Rihalia
2.3
Female
8.5
9.1
10.7
Severe
Jeelan
1.8
Female
7.5
9.4
Severe
Tasleem
2.8
Female
9.5
10
11.6
Moderate
28
Gayathri Slum
2)
Teacher: Shobha Rani B

Key Findings
The anganwadi has been followed up recently and from the growth charts given by the
anganwadi teachers it came into light that angel has not been weighed since December,
2012. Although she has been followed up by the volunteers.
S.
NO.
Name
Age in years
as on 30th
March,
2013
Sex
Weight in
Kgs as on
21st
December,
2012
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Angel
2.5
Female
11.1
Severe
3) Akiappa
Garden

Key findings
a) The anganwadi is regularly followed up by the volunteers but anganwadi teacher is
reluctant to share the information about the kids.
Thus the volunteers have been unable to follow up the kids regularly.
b) There are 4 malnourished children as identified by intern Siddharth Jha out of which 2
are severely underweight for their age, 1 moderately underweight and 1 mildly
underweight.
S.
NO.
Name
Age in
years
as on
30th
March,
2013
Sex
Weight in
Kgs as on
21st
December,
2012
Ideal Weight
Grade of
for age (-1 Malnutrition
SD)
Keerthana
2.6
Female
10.5
11.2
Mild
Sindhu
2.4
Male
10
11.5
Moderate
29
13.7
Sachin
Manikuntta
3.7
Male
11
Geetha
3.3
Female
10
Severe
12.7
Severe
4) AWC-2, Sheriff Nagar

Teacher: Not Known
Key findings
a) There are 12 malnourished children in the anganwadi out of which only 1 child is
severely underweight for his age, 2 moderately underweight and 4 mildly underweight.
b) Out of 12 children, only 4 are females.
c) 5 children have been graded malnourished by the anganwadi teacher but since their
age/Date of birth is unknown, it is difficult to say under which grade of malnutrition they
can be categorized
S.
NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in
Kgs as on
21st
December
, 2012
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Mehek
4.3
Female
12.5
14.5
Moderate
Sultan
4.8
Male
14
15.5
Moderate
Umar
1.7
Male
10.0
Mild
Hemad Ul
1.4
Male
9.4
Mild
Rehman
30
Ameenabi
2.1
Female
10
10.3
Mild
Abdul
0.5
Male
4.5
6.7
Severe
Hanif
2.9
Male
12
12.3
Mild
Shahid
Unknown
Male
10.5
Unknown
Shahid-2
Unknown
Male
10
Unknown
10
Asif
Unknown
Male
10
Unknown
11
Sab Falaak
Unknown
Female
7.5
Unknown
12
Rekha
Unknown
Female
Unknown
31
Jeevan Beema Nagar PAG

In this area, only GM Palya caters to adolescent girls two of them per six months. They
get a take-home ration of food. In each anganwadi, malnourished children are provided
with a supplementary diet of milk and eggs. Eggs are provided four times a week while
milk is provided twice a week. Additionally, they are given Chitrana/ Payasam
alternatively.
Details of Malnourished Children in the area

1) G M Palaya
Teacher: Laxmiamma (9740583215)
Key Findings
a) There are 17 malnourished children in the area out of which
10 are females.
14 are under the age of 5 years
b) Out of 17,
3 are severely underweight for their age,
10 are moderately underweight and
4 are mildly underweight.
c) Among the severely underweight children Estharani and Dinesh are being regularly
followed up. Chaarulata has not been followed up since December, 2012
S.
NO.
Name
Age in years
as on 30th
March,
2013
Sex
Weight in
Kgs as on
31st March,
2013
Ideal
Weight for
age (-1 SD)
Grade of
Malnutrition
Estharani#
1.9
Female
7.2
9.6
Severe
Dinesh
2.8
Male
10
12.1
Severe
32
Chaarulata
Female
11
14.0
Severe
Giridhar
4.4
Male
13.9
15.0
Moderate
Pavithra
5.4
Female
14.3
16.3
Moderate
Vaishnavi
4.1
Female
11.9
14.2
Moderate
Basavaraj
2.5
Male
10.8
11.7
Moderate
Hema
3.5
Female
11.2
13.0
Moderate
Niket
5.2
Male
14.8
16.4
Moderate
10
Sandhya
4.8
Female
13.5
15.2
Moderate
11
Vishal
3.7
Male
11.7
13.7
Moderate
12
Priyadarshini
4.6
Female
12.4
14.9
Moderate
13
Pavan
5.2
Male
14.9
16.4
Moderate
14
Mahesh
3.9
Male
14
15.8
Mild
15
Kavitha
3.1
Female
11.4
12.4
Mild
16
Sapna
Female
13.4
14.0
Mild
17
Sushmita
1.9
Female
9.4
10.5
Mild
10
10
# Estharani: has heart condition. Seen by the doctors in March, 2013
33
2)
AWC-2, Nellurupura
Teacher: Rajeshwari 9916511827(Teachers husband)
Key Findings
a) There are 13 malnourished children in the anganwadi out of which
10 are females
b) Out of 13,
4 are severely underweight for their age of which only 1 is male
3 are moderately underweight of which 0 males
6 are mildly underweight of which 2 are males
c) Among the severely malnourished children, all have shown little progress except
Pranavi who has lost weight over the period of time. Earlier she was 8.4Kgs and
reduced to 8.2 Kgs. Though the decline is not so steep but it suggests that she
suffers from infections frequently and looses weight with each episode of
infection. Therefore she needs to be followed up regularly.
S.
NO.
Name
Age in
years as
on 30th
March,
2013
Sex
Weight in
Kgs as on
31st March,
2013
Ideal Weight
for age (-1 SD)
Grade of
Malnutrition
Surendra
3.5
Male
8.1
13.4
Severe
Bhargavi
3.5
Female
10.2
13.0
Severe
Akhila
Female
10.2
12.2
Severe
Pranavi
Female
8.2
14.0
Severe
Spoorthy
4.5
Female
13.5
14.8
Moderate
Nandini-2
Female
13
14.0
Moderate
Sauolya
Female
12
14.0
Moderate
Nandini
Female
13.9
14.0
Mild
34
Siddhu
Male
12.2
14.4
Mild
10
Triveni
Female
15.9
18.2
Mild
11
Laavanya
4.5
female
13.4
14.8
Mild
12
Dharani
female
14.4
18.2
Mild
13
Vinay
3.5
Male
12.1
13.4
Mild
Ideal Weight
for age (-1 SD)
Grade of
Malnutrition
3)
AWC-3, Nellurupura
Teacher: Narayanamma (7795348456)
Key Findings

13 are females
b) Out of 28
8 are severely under weight for their age of which only 2 are males
9 are moderately underweight of which 5 are males
11 are mildly underweight of which 8 are males
S.
NO.
1
2
3
4
5
6
Name
Age in
years as on
30th
March,
2013
Sex
Weight in
Kgs as on
31st March,
2013
Jaswant
5.0
Female
12.4
Monica
4.2
Female
12.1
Manish Kumar
3.5
Male
9.5
Divya
5.3
Female
12.2
Nandhini
5.8
Female
13.2
Shalini
6.0
Female
12.4
35
15.8
14.3
13.4
16.2
16.9
17.5
Severe
Severe
Severe
Severe
Severe
Severe
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Navya
Nikhil
7.4
1.5
Female
Male
16.2
Severe
9.6
6.7
Deekshith
4.2
Male
12.8
Ashok
Male
13.4
Venkatesh
4.1
Male
12.5
Chandru
Male
10.9
Aishwarya
5.4
Female
14.2
Aparna
3.2
Female
11
Srividhya
5.0
Female
13.2
Ravi
6.5
Male
17.4
Kusuma
3.0
Female
10.2
Shahin
2.9
Female
11.7
Prasanna
kumar
5.1
Male
16
Chakradhar
3.8
Male
13.5
Akash
5.2
Male
16.3
Kushi
6.1
Female
17.2
Charantej
2.3
Male
11
Sindhuja
2.6
Female
11
Sathish
Male
13.8
Prithvi
Narayana
3.1
Male
12.4
Venkatesh
Male
14.1
Uday
3.0
Male
11.7
36
19.9
Severe
14.7
14.4
14.5
12.7
16.3
12.5
15.8
18.8
12.2
13.5
18.5
15.7
18.7
20.3
12.7
12.7
16.3
14.5
16.3
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
Mild
Mild
Mild
Mild
Mild
Mild
Mild
Mild
Mild
Mild
Mild
4) AWC-4, Nellurupura
Teacher: Sunanda (8861138455)
Key Findings
7 are females
7 are below the age of 5 years and
Age of 3 children is not known
b) Out of 8 children
4 are severely underweight for their age of which only 1 is male
4 are moderately underweight of which 2 are males
S.
NO.
1
2
3
4
5
6
7
8
9
10
11
Name
Ramya
Varalakshmi
Aradhana
Gagan
Adi
Pavani
Priya
Charan
Aruna
Ponispuri (name
not sure)
Appu
Age in
years as
on 30th
March,
2013
4.8
3.8
3
3.8
3
5.4
3.5
3.7
Unknown
Unknown
Unknown
Sex
Weight in Kgs
as on 31st
March, 2013
Female
11.5
Female
10.6
Female
8.9
Male
10.6
Male
11
Female
15
Female
10.9
Male
11.5
Female
12.7
Unknown
Female
14.2
Unknown
Male
37
14.7
Ideal
Weight
for age (-1
SD)
15.2
13.4
12.2
13.8
12.7
16.3
13.0
13.7
Unknown
Grade of
Malnutrition
Severe
Severe
Severe
Severe
Moderate
Moderate
Moderate
Moderate
Unknown
Unknown
Unknown
MADIVALA PAG
In each anganwadi, malnourished children are provided with a supplementary diet of
milk and eggs. Eggs are provided four times a week while milk is provided twice a week.
Additionally, they are given Chitrana/ Payasam alternatively.
There are two areas which the PAG covers.
a)
Siddharth Nagar in Madivala Proper
Following information is
available from CRY interns George and Ramyas Report (November, 2012). No
follow up has been done since then.
Anganwadi
No of
Name
No of
No of
Pregnan
Lactatin children
Malnouri
below
shed
3yrs
children
Children t
Women Mother
No of
No of
Total
Anganwadi
users
s
Siddhartha Nagara,
20
25
58
20
23
53
20
22
53
Madivala Hosur road

1st floor Siddhartha
Nagara
Madivala Hosur road.
Siddhartha Nagara opp.
Church
Madivala Hosur road
38
b)
N S Palaya Area
Volunteers have been working hard to get the information
about malnourished children. The details of some of the kids we have come across are
given below.
N. S. Palaya Area
There are 4 anganwadis in the area. Though only the following children have come to
our notice
S.
NO.
Name
1
2
3
4
Charan
Charmi
Joseph
Appu
Age in
Sex
years as
on 30th
March,
2013
4
Male
3
Female
14
Male
Unknown Male
Weight in
Kgs as on
31st March,
2013
6
9
Unknown
Unknown
Ideal
Grade of
Weight Malnutrition
for age (1 SD)
14.4
12.2
Unknown
Unknown
Severe
Severe
Unknown
Unknown
So, the volunteers now really need to look into the following
necessary questions:
1) What is Malnutrition????
2) How it presents itself in the children????
3) What causes malnutrition..???
4) Why the nutrition in girl child so important..???
5) What are perceptions about nutrition in the
community..???
6) How should we manage the cases of malnutrition????
(Refer to Page No. 47)
7) What are the initiatives by the Government??? (Refer to
Page no. 56)
And answers to these questions are necessary to know to
address the issue of malnutrition in a comprehensive manner.
Until we know the answers to above questions, we keep on
acting haphazardly instead of going in a systematic manner. So
for the answers Refer to Section 2.
39
Section 2: Insight into

Malnutrition
(2.1) Introduction to Malnutrition
Karnataka, Indias eighth largest State in terms of geographical size (191,791 sq km), is
home 5.1 % of Indias population. With SGDP of 8.2% in 2010-11 (more than the
national average), Karnataka is one of the fastest growing state having per capita
income of Rs. 60,000 according to Economic Survey 2010-11. Despite the rapid progress
made by the state on the economic front, the status of nutrition in Karnataka is a matter
of shame. According to National Family health Survey-3 conducted in 2005-06 by
Government of India, 33.3% of children in Karnataka are underweight, 42.4% stunted
and 18.9% wasted. Though there has been some reduction in malnutrition as shown in
the NFHS1 and 2 but it is far cry from the Millennium Development Goals (MDG) goals
that have to be achieved by 2015.
(2.2) What is Malnutrition.??

Nutrition is the process of nourishing or being nourished, especially by which a living
organism assimilates food and uses it for growth and development and Malnutrition is
the condition that develops when the body does not get the right amount of the
vitamins, minerals, and other nutrients it needs to maintain healthy functions of the
body.
The term malnutrition encompasses both under-nutrition and overnutrition (ex.: obesity). However more commonly it is used to denote
under-nutrition.
Child malnutrition can manifest itself in several ways. It is broadly classified as:
Malnutrition
Protein- Energy Malnutrition (PEM)

The common condition we come across in the
field.
It results from deficiencies in any or all
nutrients.
Micronutrient deficiency diseases

It co-exists with PEM but most commonly
over looked in the absence of knowledge.
It results from a deficiency of specific
micronutrients such as Iron deficiency,
Vitamin A and Vitamin C deficiency
In this report we are discussing about PEM.
40
(2.3) What we come across in the

field.??
WHO has recommended certain indicators to assess malnutrition and given
standard values to compare. The common indicators which are used are as
follows:
Underweight:
Stunting or
combination of both
Wasting or thinness. It
shortness of
stunting and wasting.
a sign of acute
Normal Child with
height.
A
sign
of
Most commonly used
malnutrition i.e. develops
weight and height in
range for the age
Measured as:
chronic malnutrition
i.e. it develops over a
long period of time.
due to rapid weight loss
Weight for
height
Height for
age
41
to assess malnutrition
in India.
Weight for
age
Classification of malnutrition for

weight for age based on z-scores
Classification
Adequate
Moderately malnourished
Severely malnourished
z-score values
-2SD< Z-score< +2SD
-3SD< z-score<-2SD
z-score<-3SD
Z scores mentioned here refer to mean weight scores in WHO Growth

Standard Charts-2006. Please Refer to Annexure 1 for WHO Growth
Standard Charts.
In adults BMI (Body Mass Index) is used to assess the malnutrition
BMI is calculated as = weight of adult in Kgs/ height of adult in m
Classification of adult malnutrition (also called as

chronic energy malnutrition) using BMI
Classification
Mild
Moderate
Severe
Cut-off point using BMI

17< BMI< 18.5
17< BMI< 16
BMI< 16
The knowledge of BMI is important in the context of child malnutrition as

persistence of malnutrition among pregnant females and nursing mothers
directly leads to under nutrition in children and thus, the knowledge about
under nutrition in mothers help us to address the issue in its wholeness.
42
Causes and Cycle of Malnutrition
Picture 4: Causes of Maternal and Child Malnutrition

Source: www.ThousandDays.org
43
Picture 5: Immediate and Underlying causes of

Child Malnutrition
44
The Irony of Girl Child

Malnutrition
Picture 6: Vicious Cycle of Malnutrition in Girl Child in India
Source: UNICEF, SAVE THE CHILDREN, FAO, UNESCO, IFPRI
45
Myths and Facts

Myths
Facts
1) If the mother is not being able to

produce enough milk to breast feed the
baby during first six months, give the baby
with milk powder.
Milk powder makes the baby more prone to

infections as the immunity of the baby is not well
developed. Besides that during to poor feeding he
is 10 times more likely to get the frequent bouts
of infections.
2) If the baby/ child is active mentally,

playful and respond normally despite
being underweight; the child is fine and
does not need attention.
Instead counsel the mother to take proper

nutrition and take cumin seeds which helps in
formation of milk and ask them to try to
breastfeed the baby as much as possible. Suckling
reflex itself stimulated the milk glands to produce
more milk. OR give the baby cow milk.
This is not true. Even at the moment, the child is
mentally active, playful and responding, he/she
needs nutritional attention. Reason
Underweight children have low immunity and
are more prone to infections like diarrhea,
pneumonia and malaria.
A single bout of such infections robs the
children of vital nutrients and make them
malnutrition in turn, decreases the ability
of the immune system to fight further infections,
making diarrheal episodes more frequent.
Repeated bouts of diarrhea stunt childrens
growth and the cycle continues.
46
Management of the Malnourished

Children
In the management of malnutrition, the very first step involves Community
Outreach and Identification of the cases. It includes the following:
a) Mobilization of the community through information, education and

communication (IEC) on malnutrition.
IEC includes posters, flash cards, videos on nutrition to be shown to the
community on health days or days of mothers meeting with anganwadi teachers
Talking to Anganwadi Teachers: encourage

them to fix the days to weigh the children
so that community is aware of it and no
child is missed.
After identifying the case: Separate visit to the

parents/family and ask them about the following:
1) Further details on the condition of the kid i.e.
since when is the child like this or any other
associated problems like frequent infections or
diarrhea or fever.
Talking to School Principal
2) If the child has been seen by the PHC doctor or

taken to any hospital
House to House Survey (whilst Drop out

data)
3) If yes then what did the doctor say and any

problems faced during treatment. For BPL card
application see Dr. Raghvans Manual
Talking to Healthcare Worker and Link

workers at PHC
47
WINDOW of OPPORTUNITY The 1,000 days from the start of a womans

pregnancy until her childs 2nd birthday offer a unique window of opportunity.
The right nutrition during this 1,000 day window can have an enormous impact on a
childs ability to grow, learn, and rise out of poverty. It also has a profound effect on
the long-term health, stability, and development.
TREATMENT Referral of the severe and moderate cases

to the PHCs
Severely Underweight for

Age
Step1 Hospital Based Management
a) Inpatient Care
b) Outpatient Care
Step 2 Home based Management
Hospital Based
Management
Identification + Discussion with
parents
Register child with PHC
No
Complication
Moderately
underweight for
Age
Step 1 Outpatient Care
Step 2 Home based
Management
Outpatient Care
1) After identifying the cases,
refer the cases to nearby PHC in
the respective PAG areas.
a) The child is registered
with the PHC
b) The PHC doctor prescribes
the protein powder and
other vitamin
tablets/syrup (should be
available at the PHC
pharmacy) and
Complications
c) Link workers counsel the
accompanying
parents/guardians about
the diet and monthly
check ups. And refer for
further follow up with
Anganwadi Teacher
48
Mildly
underweight for
Age
Home Based Management
Children who are mildly

underweight for their age
seems to be fine and do not
require any intervention.
However they are at the risk of
becoming moderately or
severely malnourished if not
taken care of.
Thus, home based management
of such children is necessary to
prevent them moving into the
danger zone.
No
Complication
PHC doctor prescribes
the protein powder and
Other vitamin tablets/syrup
(should be available at the PHC pharmacy)
Link workers counsel the accompanying
parents/guardians about the diet and
monthly check ups. And refer for further
follow up with Anganwadi Teacher
(AWW).
Children with complication

like
a) Fluid accumulation in the feet
(checked by putting thumb
pressure near the ankle, if the
depression due to pressure doesnt
go away immediately, there is
possibility of fluid accumulation
a sign of PEM)
b) Crackled and Rough textured Skin
c) Frequent infections, episodes of
diarrhea, or fever reported by the
parents/guardians of the children
Refer to the Under listed

Hospitals
Can be taken directly or referred by the

PHC doctor to the following hospitals :
(AWW).
HOME BASED
MANAGEMENT
The children with moderate
malnutrition need to be taken
care of at home also.
Since the immunity of the
children is weak they are prone
to infections very frequently.
Hence hygiene and Sanitation
comes into play.
Parents/ Guardians should be
counseled about proper feeding
practices and should be advised
to include the following to the
regular diet:
a) Eggs at least 1 Egg daily
or 4 times in a week in
addition to what is
provided at anganwadi.
b) Milk Milk is essential to
provide energy and
calcium which are
responsible for the growth
of the child
c) Green leafy vegetablesAdd Palaka, Gongura
leaves to routine diet.
They are good source of
iron and other necessary
nutrients
d) Pulses like moong dal,

Bengal gram, black gram
e) Fruits like Pomegranate,

Bananas
49
HOME BASED
MANAGEMENT
The children with moderate
malnutrition need to be taken
care of at home also.
Since the immunity of the
children is weak they are prone
to infections very frequently.
Hence hygiene and Sanitation
comes into play.
Parents/ Guardians should
be counseled about proper
feeding practices and should be
advised to include the following
to the regular diet:
1) Eggs at least 1 Egg
daily or 4 times in a
week in addition to
what is provided at
anganwadi.
2) Milk Milk is essential
to provide energy and
calcium which are
responsible for the
growth of the child
3) Green leafy vegetablesAdd Palaka, Gongura
leaves to routine diet.
They are good source of
iron and other necessary
nutrients
4) Pulses like moong dal,

Bengal gram, black gram
5) Fruits like Pomegranate,
Bananas
For Details of the Recipes
See Annexure I and II
1) Indira Gandhi Institute of

Child Health (under BAL
SANJEEVANI SCHEME)
For Details of the Recipes

See Annexure I and II
Near NIMHANS Hospital, Bairasandra,

Bangalore.
Contact No.: 26342421 / 2634314
2) Vanivilas Women and Child

Hospital, Nutritional
Rehabilitation Center (NRC)
Fort Rd, Near Victory Hospital, Krishna
Rajendra Market, Kalasipalyam,
Bengaluru
Contact No.: 080 2670 2487
Dr. Some Gowda
Medical Superintendent
Phone : 94482 73928
Dr.Madhusudan
Resident Medical Officer
Ph : 99800 0667
Emergency No.:
080-2670 5206
080-2670 5204
3) Bowring And Lady Curzon Hospital
Dr. H. Satish Chandra
Medical Superintendent
Phone - PRO : 98452 02266
Phone: 080 2559 1325/1326
Fax:
080 2559 1325
bowringandladycurzonhospital
E-Mail :
@gmail.com
Public Relations Officer : Dr. Khaja

Mohideen (9845202266)
For HOME Based management refer to
Orange section.
11
11
www.igch.org/ - Indira Gandhi Institute; www.vanivilashospital.in/- Vani Vilas Hospital ;

www.bmcri.org/bowring_hosp.html- Bowring hospital
50
Contact Details of Urban Health Centers in

different PAG Areas
AREA
MADIVALA
UHC/
ANGANWADI
N S PALYA
KORAMANGALA ADUGUDI
NAME OF THE
PERSON
CONTACT DETAILS
DR. ASGARI (MO)

A B SIDDQUI (STAFF
NURSE)
26780191
NEELA (AWW-AWC 3)
9945539964
MAHALAKSMIAMMA
(AWW- AWC 4)
9632092676
DR. SHIVLINGAM (MO)

MAHADEVIAMMA (STAFF
NURSE)
22975870
9986462707
Kannada Tamil
School, Rajendra
Nagar
Usha (AWW)
8884761834
AWC-1, Rajendra
Nagar
Selvi (AWW)
9945075660
AWC-2, Rajendra
Nagar
Manjula (AWW)
7204785225
Ambedkar Nagar,
Near Public Toilet
Manjula (AWW)
8710075205
EWS Quarters
Sumathi (AWW)
8904437493
Regina (AWW)
9900809567
1st Cross, L. R. Nagar
51
Shastri Nagar
JEEVAN BEEMA
NAGAR
Padma (AWW)
8453578256
C V RAMAN NAGAR
DR. LAKSHMI (MO)
9341326023
KODIHALI
DR. MEERA NAIK

SUMITRA (STAFF NURSE)
NISHA (LINK WORKER)
9448860796
9972241866
8861063663
G M Palaya
Laxmiamma (AWW)
9740583215
AWC-2, Nellurupura
Rajeshwari (AWW)
9916511827(Teachers
husband)
AWC-3, Nellurupura
Narayanamma (AWW)
7795348456
Sunanda (AWW)
Manjula (AWW)
8861138455
9739210980
AWC-4, Nellurupura
YESHWANTPUR Akiappa Garden
SHERIFF NAGAR-1
Tahseen Taj
52
9591841468
Nutritional Rehabilitation at HOME

To combat malnutrition, the first step starts at home only. Simple and easy nutritional
intervention at HOME can help to reduce the malnutrition.
Age
Birth - 6 months
Suggested Diet
1) Start breastfeeding after one hour of delivery.
Give baby Colostrum (the first secreted yellow colored milk)
2) Exclusively Breastfeed the baby for SIX months- means only
breast milk nothing else not even water.
6 months - 9 months
Continue Breastfeeding but start complementary feeding. All

food is not good for complementary feeding. Include the
following:
1) Cereal based Porridge like suji, ground rice wheat flour, ragi,
millet mixed with cow milk, sugar/salt to taste and enriched
with ghee/oil
2) Mashed fruits like Banana (balehannu) or other seasonal
fruits like papaya or mango mixed with cow milk or mashed
potatoes (alugade) mixed with a pinch of salt are acceptable.
Note :
1) In case of Diarrhea, Do not stop breastfeeding and add rice
water mixed with a pinch of salt and a teaspoon of sugar.
2) Feed thick mixtures rather than thin gruels. Initially start
with 3-4 spoons and gradually increase to half a cup at a time.
9 months - 12 months
baby should be given the following:

1) Mashed vegetables (green vegetables like palaka), daals like
53
moong dal (heasarubele), bengal gram(Kadale Bele) and black

gram(Udhina bele)
2) Mashed chappatti made of ragi and wheat softened in daal
or milk
3) Eggs- make them an important part of babys routine meal.
At least one egg daily is given to baby from 12 months of age.
After 12 months
Continue with the above diet and add the following ready to
eat food :
Nutrimix: Wheat/rice 4 handful and Bengal gram (Kadale Bele)
/ Moong - 1 handful.
Can be made more energy dense by adding seasonal fruits and
Vegetables.
LAPSI: Green millet- 1 handful
Mashed peanuts- 1/2 cup,
Jaggery - according to taste
SAT Mix: Roasted and ground
rice, wheat, black gram and sugar in ratio
1 bowl rice
1 bowl wheat
1 bowl black gram
2 bowls sugar
Halwa
Wheat flour (atta)
200 g
Lentils (mashur dal)
100 g
Oil (soya)
100 ml
Jaggery
100 g
Water (to make a thick paste) 600 ml
Rice Suji
Rice powder (g) 60
White of eggs (g) 100 (4 eggs)
Sugar (g) 35
Soya oil (g) 30
Sattu Maavu :
Wheat flour -1 handful
Maize flour -1 handful
Ragi flour -1 handful
Bengal gram flour- 1 handful
Jaggery- to taste
Roast all the contents together and mix well.
54
After 2 years
Feed the baby with

1) Eggs
2) Green leafy vegetables like palaka
3) Pumpkin Seeds (Poosani Vidhai) Make a paste of poosani
vidhai and add to boiled milk and add sugar and rice to it.
4) Pomegranate seeds (Dalimba bijagalu)
5) Also add the above mentioned recipes to the routine diet.
Adolescent Girls, Pregnant

Above mentioned recipes can be fed except papaya.
Women, And Nursing Mothers In addition to that add the following to the diet:
1) Coconut water and Nimbu Pani to compensate for fluid
loss
2) Gongura bhaaji
3) Ragi chapaties stuffed with potatoes and tomatoes at least
3 chapaties daily. Add cumin Seeds to it. OR Prepare Upma,
dosas and idlis with Ragi.
4) Wheat- Green Gram Laddus (suggested by NIN)
Ingredients
Ingredient Quantity
Whole wheat
2 handful
Moong Dal
2 Handful
Ragi ( Nachani )
1 handful
Groundnuts
half bowl
Pure Ghee/ Mustard Oil 5 teaspoons

Jaggery
250gms
Khichuri
Rice
2 handful
Lentils
(mashur dal/ moong daal)
1 handful
Oil Mustard
5 teaspoon
Potato
1 potato
Pumpkin
100 gm
Leafy vegetable (Soppu)
250gm
Onion (2 medium size)
1 onion
Spices (ginger, garlic, turmeric
and coriander powder) 1 teaspoon each
Water
5 cups
55
Note:
All the recipes are easy to make and can be stored in dry form and water can be added
later on.
1) The above mentioned quantities of Ingredients serves the enough amount of
nutrients for an adult for a day at an average cost of Rs. 5 per person.
2) For infants start with 2-3 spoons initially at a time and then gradually increase the
amount to half a cup at a time.
3) Avoid un-mashed food items for infants as their swallowing reflex is not well
developed and hence can cause obstruction in their airway.
3) For children, feed them with the above mentioned recipes initially half a cup at a time
and gradually increase
4) Cook in Iron Utensils: It also increases the iron content of the food. But prolonged use
can be harmful.
NOTE: More nutritional recipes are attached in ANNEXURES which are distributed under
ICDS in other states. So those recipes can also be advised. Refer to Annexure II on Page
No. 79
56
Section 3: Government Initiatives

to fight Malnutrition
What the Government is doing to
improve the nutritional status of the
country??
Government of India has introduced its flagship program Integrated Child
Development Scheme (ICDS) in 1975 to comprehensively address the
malnutrition issue. Other Schemes of the central and state (Karnataka)
include:
a) Integrated Child Development Scheme (ICDS)

b) Kishori Shakti Yojana (KSY)
c) Rajiv Gandhi Scheme for Empowerment of Adolescent Girls
(RGSEAG) SABLA
d) Indira Gandhi Matritva Sahyog Yozana (IGMSY)
e) Janani Shishu Suraksha Yozana (JSSY)
Integrated Child Development

Scheme (ICDS): According to Government of India
ICDS website http://wcd.nic.in/icds.htm
Launched on 2nd October 1975, today, ICDS Scheme represents Indias biggest response
to the challenge of providing pre-school education on one hand and breaking the vicious
cycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.
Services
Supplementary
Nutrition
Target Group
Service Provided by
Children below 6 years: Anganwadi Worker
and Anganwadi Helper
Pregnant & Lactating
57
Immunization*
Mother (P&LM)
Children below 6 years: ANM/MO
Health Check-up*

Mother (P&LM)
Children below 6 years: ANM/MO/AWW
Referral Services

Mother (P&LM)
Children below 6 years: AWW/ANM/MO
Pre-School Education
Nutrition & Health
Education

Mother (P&LM)
Children 3-6 years
Women (15-45 years)
AWW
AWW/ANM/MO
Revised Population Norms for setting up AWC/Mini AWCs

For Rural/Urban Projects ( Anganwadi Centers- AWC)
400-800
1 AWC
800-1600
2 AWCs
1600-2400
3 AWCs
Thereafter in multiples of 800
1 AWC
For Mini AWC

150-400
1 Mini AWC
For Tribal/Riverine/Desert, Hilly and other difficult areas/Projects

300-800
1 AWC
For Mini AWC in above areas

150-300
1 Mini AWC
58
Financial Norms for Supplementary Nutrition

(Ministrys letter No. F.No. 4-2/2008-CD.II dated 07.11.2008)
Sl.No.
1.
2.
3.
Category
Pre-revised rates
Children (6-72 months)

Severely malnourished children
(6-72 months)
Pregnant women and Nursing
mothers
Rs.2.00
Rs.2.70
Revised rates (per

beneficiary per day)
Rs.4.00
Rs.6.00
Rs.2.30
Rs.5.00
Nutritional Norms for Supplementary

Nutrition (Revised vide letter No. 5-9/2005-ND-Tech Vol. II dated 24.2.2009)
SI. Category
No.
Calories
1.
2.
3.
Children (6 months6years)
Severely malnourished
children (6 months- 6
years)
Pregnant women and
Nursing mothers
Revised (per
Pre-Revised
Protein (g)
(K Cal)
300
8-10
beneficiary per day)

Calories
Protein (g)
(K Cal)
500
12-15
600
20
800
20-25
500
15-20
600
18-20
During 2007-08 a new scheme has been introduced by the Government of

Karnataka in which Rs. 750/- per year is given to each severely
malnourished child for meeting medical expenses for therapeutic food and
medicines etc. to improve the childs health.
Bal Sanjeevani Scheme Under ICDS

During 2010-11, a sub scheme under the main scheme namely Bala
Sanjeevani was conceived and implemented. This scheme covers BPL
families wherein 0- 6 yr children who are registered in AWC and suffering
from acute diseases requiring tertiary treatment are treated free in 8
selected hospitals in the State
59
Comparison of Supplementary
Nutrition Provided under ICDS in
different States through Anganwadis
Karnataka
(Bangalore Urban)
1) Eggs- 4 times in a week all year
except in the months of February,
March, April, and May.
Reason: High cost of Eggs during this
period. Government provides Rs.3.50 for
eggs instead price of eggs is Rs.4 or Rs
4.50 in Bangalore. So anganwadis are
unable to buy the eggs. What happens
with the funds for eggs has not been
revealed by the AWW. For children
under 3 years of age given as THR
Rajasthan
Andhra Pradesh
Dept. Of Women and Child,

Govt. of Rajasthan
Dept. Of Women and Child

Govt. of Andhra Pradesh
http://wcd.rajasthan.gov.in
/
Eggs and Milk are given in the
breakfast along with the following:
https://mail.google.com/mai
l/u/0/?shva=1#inbox
3 types Food Models are given to the
Children 6 Months to 6 years and
Pregnant & Lactating Women.
1) Rice (Puffed) & Roasted Chana

With Jaggery
2) Ready (Dry) Alternatives For
Snanks (Roasted Chana With Gur)
3) Halwa
All the three options are given
alternatively on three days of the
week.
Average cost per person : Rs.2.50
1) Ready to Eat Food (RTE)

a) RTE / Modern Therapeutic Food
supplied by A.P. Foods.
b) Three types of Hot Cooked Food

Premixes, supplied by A.P. Foods,
1. Halwa Mix.
2. Kichidi Mix.
3. Upma Mix.
2) Milk: is given 2 times in a week. Milk
In the afternoons:
2) Local Food Model: Ration is
is given in form of the milk powder. For

children less than 3 years of age, given
as THR,
1) Hot cooked meal:

a) Khichadi
b) Dalia
Dalia and Khichadi are given
alternatively.
supplied by the Project Directors

through District Purchase Committee.
i) Hot Pongal
ii) Broken Wheat Kichidi.
2) Panjiri Mix containing Sattu

3) Halwa PremIx
4) Upma Premix
5) Indiamix
Hot Cooked Food is supplied through

Anganwadi Centers for the Children
age group of 3-6 years.
3) CM SNP: Supplied Jowar Mix by
Mothers Groups.
Take Home Ration is being given for 6M
3Ys, Pregnant & Lactating Women
once in 15 days...
60
3) Chitrana/ Payasam: In the

afternoon Chitrana and Payasam
is given alternatively which are
rice based meals.
4) Kesaribath and bisibelebath twice

a week is a provision: For Pregnant
ladies, Lactating mothers and
Adolescent Girls. Though nothing has
been provided at AWC instead they
are given rice as THR
Provisions for Children per day

1) 6 months 3years: 125gm
Panjiri mix/120gm halwa
2) 6 months-3years (Severely
Malnourished kids) : 240gm
3) 3-6 years : 51gm halwa/ 42gm

upma in breakfast and Hot
cooked meal in lunch
Malnourished) : In breakfast
51 gm Halwa/ 42 gm Upma
and in Lunch Hot cooked meal
plus 78gm halwa / 70 gm of
Upma
For children below three years of

age, rava ladu, ragi kheer and rice
kheer would be supplied six days in a
week.
Provisions for Pregnant Ladies,

Lactating mothers and Adolescent
girls (per day):
For Pregnant & Lactating Mothers

140 gms.
For malnourished Children

140 gms.
Indiramma Amrutahastam:
The program is aimed at poor
140gm Halwa/ 130gm Upma

under ICDS
women as they were not able to

consume the required quantity of
nutritious food.
155gm Halwa under

Decentralized Nutritional
Supplement and Women
empowerment Scheme
The scheme is the result of joint

efforts by the ICDS, DRDA and the
Medical and Health Department.
140gm Halwa Premix/130gm

Upma Premix under SABLA
Scheme
Pregnant and lactating women

will be provided one full meal
under the program.
Puliyogere rice, coconut rice,

sambar rice, multigrain chapathi and
protein rich ragi mudde would be
provided twice a week for pregnant
women and lactating mothers
For detailed Recipe of Chitrana See

Annexure I
For Children 6 Months to 6 Years

90 gms.
Halwa/ 125gm Panjiri Mix
4) 3-6years (Severely
5) Proposed changes in SNP in 2011

by then WCD minister C.C. Patil are:
avalakki (beaten) mixture,
rava laddu,
puliyogare rice,
coconut rice and
sambar rice on different days
of the week
Ration Size: Increased Ration Size as

per revised cost norms.
Rs 100 will be given to the women

who lose their daily wages when in
hospital after delivery and another
Rs 50 towards nutritious food.
For detailed Recipes of the food

premixes and hot cooked meals
See Annexure I
61
Bihar
Orissa

Govt. of Bihar www.icdsbih.gov.in/

www.wcdorissa.gov.in/
Under ICDS
a) Emergency Feeding
Under ICDS
Service
Hot
cooked
meal
Target
Children 3-6
years
Service Entitlement / Service Standards

I. Provided at AWC for 25 days a month
Under this each beneficiary is provided

with
250 gms of rice,
30 gms of dal, vegetables,
oil, salt and condiments and
The nutritional value of which is 812 K. Cal.
of energy and 21.6 grams of protein
II. Snacks
Biscuits, fruits, roasted grams to be
served at 9 AM when preschool starts
III. Hot cooked meal served at 12 noon
Monday, Wednesday & Saturday -Khichri
Tuesday
-Rasiyav
Thursday
Halwa
Friday
-Pulao
Under this program BPL Rice is allocated by

the Government of India.
IV. Entitlement
Nutritive value and cost per day
Energy(Kcals) Protein(gms) Cost(Rs)
Children
3-6 years 500
600
4.00
Adolescent
Girls
12-15
b) Take
Home
Ration
(THR)
Women
Pregnant
&
Lactating
mothers
Children
6 months -3
years
a) Malnourish
ed
b) Severely
malnourished
20-25
5.00
I. Provided for 25 days in a month

II. Distributed at AWCs on 15th of every
month
III. Entitlement - Food
Age group
Rice(kg)
Children 6m to 3 years
a. Malnourished
2.5
b. Severely malnourished 4.0
1.25
2.0
per cent), wheat (40 per cent) and full-fat soya

(20 per cent) fortified with vitamins and
minerals. This mix is comparable to a nutritious
supplementary food that has been used
throughout the world
1.5
Poorak Poshaahar Yojana: provides supplementary nutrition to the

children between 6 months-6 years of age, pregnant and lactating women
and adolescent girls.
The Scheme is funded by the Centre and State Governments on a 50:50
ratio basis. Each AWC provides supplementary nutrition at the rate of
Rs. 2 /- per child per day,
Rs. 5 /- per woman and girl per day and
Rs. 6 /- per day per child, where the child is severely malnourished.
The centre provides these services for 25 days in a month.
b) Supplementary Nutrition:
Supplementary Nutrition is
provided according to the ICDS
norms. In addition to that, with the
help of World Food Program (an
arm of United Nations) INDIAMIX
is distributed to the beneficiaries
INDIAMIX contains roasted, milled maize (40
Dal (kg)
Pregnant- Lactating women 3.00
The ration cost under the scheme is fixed

at Rs. 5.50 per day per beneficiary.
New initiative :
Aame Bi Paribu Positive Deviance
approach to reduce malnutrition rapidly
The main features of the program are as
follows:
a) Survey and identification of
malnourished children
b) Form a group of 10-15 children
62
c) Take steps to de-worm the children

d) Give them a lesson of 12 days in
Nutritional Care &
e) Counseling Cession (NCCS) cook

together, make the children eat
together, share with and learn from
each other.
f)
Children should be weighed before &

after attending the NCCS
g) Next 18 days mothers practice the new

ideas from NCCS at home.
h) In another 12 days the child with the
mother will attend the NCCS.
This process continues till the child gains

weight.
This has yielded good results in Mayurbhanj
and Kalahandi. Districts of Bihar.
Maharashtra
http://www.nutritionmissionmah.gov.in/Site/Home/Index.aspx
The state of Maharashtra has implemented the concept of Village Child
Development Centers (VCDCs).
Malnutrition is measured by method of Weight according to length or
height instead of Weight according to age standard which is used for
admitting children in Village Child Development Centre (VCDC) and Child
Development Centers (CDC) and accordingly these children are classified
into Severe Acute Malnourished SAM and Medium Acute Malnourished
MAM categories.
63
Government of Maharashtra has

opened Child Development Centers
(CDC) and Village Child Development
Centers (VCDC) to manage the
malnourished children.
Medical officer and Child
Development project officer should
classify MAM and SAM children
covered under the area of Primary
Health Centre. Following criteria
should be applied for the said
classification:
Nutritional Protocol for VCDC:1 to 30 Days

Sr. No.
Time Calories Protein
Nutrition for each Requirement

Child
gm
Amylase rich flour
Shira / Upma /
100mg
Lapshi
8:00
AM
10:00
Anganwadi food + 5ml oil
AM
12:00
Anganwadi food + 5ml oil
Noon
2:00
4:00
6:00
PM
8:00
PM
Total
Ideally
Nutritive
Nutrition
420
1) Those SAM/MAM children who

do not suffer from any
complication therefore do not
require any medical treatment
Village child development centre
(VCDC).
2) Those SAM/MAM children who

have minor complications
Home diet
100
420
1 Boil Potato, 1
Banana / 1 Egg, 1
Banana
Shira / Upma /
Lapshi which
100
containing amylase
rich
100
Home diet
940
20
Calories in kg
calories & Protein
in gm / dose in gm
Please note - If sweet dish is given in morning then same

dish should not be repeat in evening
VCDC HOME concept

Special diet charts for mothers of
SAM and MAM children
A diet chart has been prepared to

feed the baby every 2 hours
Mothers trained to prepare

prescribed recipes which are easy
to prepare
WHO growth charts distributed and

mothers trained to track the weight
of children
Anganwadi workers visit these mothers daily to ensure proper

supervision and support
64
CDC at primary health centre

(PHC)/ village hospital / district
hospital according to nature of
their illness
3) Those SAM/MAM children, who

have serious complications and
need special medical services
Medical college / super specialty

hospital.
VCDC are set up at every

Anganwadi at the village level and
headed by the Anganwadi worker.
This centre will provide diet and
healthcare services and facilities for
empowerment of mothers. They
function for 30 days, excluding
holidays
Kishori Shakti Yozana

Kishori Shakti Yojana (KSY) a special intervention has been planned for adolescent girls
using the ICDS. It is meant to break the cycle of nutritional and gender disadvantage, to
provide a supportive atmosphere for selfdevelopment.
i.
Services:
Educational activities through
nonformal & functioned literacy
pattern.
ii.
Immunization
iii.
A general health check up every

six months
iv.
Treatment for minor ailments
v.
De worming
vi.
Prophylaxis measures against

anemia, goiter, and vitamin
deficiencies etc.
vii.
Referral to PHC/District Hospital

in the case of acute need
viii.
Convergence with Reproductive

Child Health Scheme.
Approaches
1) Girl to Girl Approach (For

Girls in the Age Group of 11
15 Years)
In each selected Anganwadi area 2 girls
in the age group of 1115 years are
identified. These adolescent girls are
provided with a meal on the same scale
of the pregnant women or nursing
mother namely one that would provide
500 calories of energy and 20gms.
2) Balika Mandal (For Girls in

the Age Group 1518 Years)
It has more focus on social and mental
development of girls mainly in the age
group 15-18 years
12
12
http://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=en
wcd.nic.in/KSY/ksyintro.htm - Ministry of Women and Child Development
65
Rajiv Gandhi Scheme for

Empowerment of Adolescent Girls
(RGSEAG) SABLA
Adolescence is a significant period for mental, emotional and physiological development of
children. A need has emerged to formulate a new comprehensive scheme with richer content
merging the erstwhile two schemes Kishori Shakthi Yojana (KSY) and Nutrition Program for
Adolescent Girls (NPAG). This scheme called Rajiv Gandhi Scheme for Empowerment of
Adolescent Girls (RGSEAG) SABLA, has been implemented in 9 districts (Gulbarga, Kolar
Bangalore, Bellary, Bijapur, Dharwad, Chickmaglur, Uttar Kannada, Kodagu) of the

state.
Nutrition Component: Take Home Ration or Hot Cooked Meal

1114 years: Out of school girls
14 18 years: both out of school and in school girls
Non Nutrition Component
For Out of school Adolescent Girls: (2 3 times a week)
a) 1118 years
- IFA supplementation,
- Health checkup and Referral services,
- Nutrition & Health Education (NHE),
- Counseling / Guidance on family welfare, ARSH, child care practices
- Life Skill Education and accessing public services
b) 1618Years
- Vocational training under National Skill Development Program
For In school Adolescent Girls: (twice a month average)
c) 1118 years
Nutrition & Health Education (NHE),
Counseling / Guidance on family welfare, ARSH, child care practices
- Life Skill Education and accessing public services
13
13 13
http://dwcdkar.gov.in/index.php?option=com_content&view=article&id=62&Itemid=114&lang=en;
http://wcd.nic.in/schemes/sabla.htm
66
INDIRA GANDHI MATRITVA

SAHAYOG YOJANA (IGMSY)
From 2010-11 a new scheme called Indira Gandhi Matritva Sahayog Yojana (IGMSY) is
being implemented on a pilot basis in 2 districts of the state, viz Dharwad and Kolar.
Pregnant and nursing mothers are given nutrition and health education, health tips and IYCF
guidance.
AWCs are used as the main platform for implementation of the scheme in the piloted ICDS
projects.
IGMSY is a centrally sponsored scheme with 100% assistance from GOI.
An amount of Rs. 4,000/- is paid in 3 installments.

Pregnant women would receive
a) Rs. 1,500/- within 6 months of pregnancy,
b) Rs. 1,500/- within 3 months of delivery, and
c) thereafter Rs. 1,000/- after six months of child birth after following the norms laid
down under the scheme.
d) The above beneficiaries are also eligible for financial assistance under Janani Suraksha
Yojana (NRHM).
14
14
http://pib.nic.in/newsite/erelease.aspx?relid=92392 ; http://wcd.nic.in/ - Ministry of

Women and Child Development, Government of India
67
Schemes Under NRHM- Karnataka

Prasooti Araike - Care for the
pregnant
MADILU - Caring For the mother and

the child
Under this scheme a kit containing
The benefits and conditions of the

scheme are as follows:
The pregnant women have to
register their names with the Junior
Female Health Assistant of the area.
The beneficiaries will get
Rs. 1000 during the 2nd trimester
ANC (i.e. between 4th and 6th
month) and
Rs. 1000 during the 3rd trimester
ANC (i.e., between 7th and 9th
month), totaling Rs. 2000 paid
through bearer cheque.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
Mosquito curtain
Medium sized carpet
Medium sized bed sheet
A thick blanket for mother
Bathing Soap
Washing soap
Cloth to tie abdomen of mother
Sanitary pads
Comb and coconut oil
Towel
Tooth paste and brush
bed spread over rubber sheet for the
baby
Bed sheet for baby
Bathing soap for baby
Rubber sheet for baby
Diaper
Baby vest
Sweater, cap and socks for baby
One plastic kit bag.
xiii.
xiv.
xv.
This facility is extended to all
xvi.
pregnant women belonging to below
xvii.
poverty line families
The benefit is limited to the first xviii.
xix.
two deliveries.
The beneficiaries must belong to below

poverty line families, and delivered in
government hospitals.
The benefit is limited to two live deliveries.
15
15
NRHM Karnataka: http://stg2.kar.nic.in/healthnew/NRHM/PrPrasooti%20Araike.aspx

68
Janani Shishu Suraksha Yozana

(JSSY)
Features of Cash Assistance

(a) States/UTs have been classified into two categories based on the institutional delivery
rate. The 10 states namely the eight EAG states and the states of Assam and Jammu & Kashmir
would constitute Low Performing States (LPS) and the rest High Performing States (HPS).
(b) Cash assistance linked to Institutional Delivery: The benefits under the scheme would be
linked to availing of antenatal check ups by the pregnant women and getting the delivery
conducted in health centers/hospitals.
69
(c) Cash Assistance in the graded scale

The assistance will be available as per the following rates:
Rural Areas
Category
of states
Urban Areas
Package
for ASHA
Total
LPS
Assistance
package to
mother
1400
Package
for ASHA
Total
2000
Assistance
package to
mother
1000
600
400
1400
HPS
700
600
1300
600
400
1000
Eligibility Criteria
LPS
HPS
LPS & HPS
All pregnant women

delivering in govt.
health centers.
BPL pregnant women;

aged 19 and above
All SC/ST women

delivering govt. health
facilities.
No age constraint.
LIMITATIONS
LPS
HPS
All births delivered in the govt.

health centers
Up to 2 live births
Note 1: The package for ASHA or an equivalent worker provided in the scheme
includes:
The referral transport assistance for ASHA and the expectant woman to
go to the nearest health centre,
The compensation for ASHA or an equivalent worker if she stays with the pregnant woman in
the health centre for delivery,
16
16
http://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ece
dated May 22, 2013;
Directorate of Health and Family Welfare, Karnataka
http://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspx;
http://www.iapsmgc.org/userfiles/8GuidelinesforJSSK.pdf
Ministry of Women and Child Development, Government of India:

http://pib.nic.in/newsite/erelease.aspx?relid=72433;
70
May 22, 2013; The HINDU

(http://www.thehindu.com/news/national/age-limit-relaxed-forjsy-benefits/article4736820.ece dated May 22, 2013)
All women from BPL category, Scheduled Castes and Scheduled Tribes in all States and
Union Territories will be eligible for JSY benefits if they have given birth in a government
or private accredited health facility. BPL women who prefer to deliver at home can also
get JSY benefits.
The decision was taken after it was realized that a majority of women, who needed JSY
benefits, remained out of the purview of the scheme because they had to prove they
were 19 years of age and had no more than two children, Anuradha Gupta, Additional
Secretary and Mission Director, National Rural Health Mission (NRHM), told The Hindu
on Tuesday.
71
Road Ahead.
What needs to be done
further..???????
The following key issues needs to be

addressed:
From the details above, it is clear that there are a large number of severely
malnourished children across the urban slums of Bangalore. To address this issue, the
ICDS scheme calls for each child to be given a supplementary nutrition of milk and eggs.
According to the orders of Women and Child Development Department, since
January 1, 2013; the children in the anganwadi are to be provided with eggs and milk
daily. However at none of the anganwadis, this provision is followed. Moreover, during
the period of February to May, eggs are not provided as they are costlier than the
amount of funds provided for eggs.
Therefore, a concerted effort has to be made to ensure
that all children in the anganwadi not just those who are malnourished are supplied
72
with milk and eggs every day. This will be of great benefit to the health of all the
children in the anganwadi, and moves us further towards the goals of the ICDS.
Volunteers can follow up and ensure that the children are getting their quota of milk
powder.
Volunteers please have a look at

this too
1) Follow up regularly at least the severe cases (twice a month)

about their health condition and if need to be checked by the
doctor, take the child to nearest Urban health centers (UHCs)
in the respective PAG areas.
2) Follow the moderate cases at least once in two months and

mild cases once in three months.
3) As from the analysis of the data available on malnourished
children, there are high numbers of malnourished female
children. We need to further identify the root cause of such a
situation.
73
4) Also the malnutrition is linked to educational level of

mothers. We need to identify the educational level of
malnourished children.
(http://www.medwelljournals.com/fulltext/?doi=sscience.20
09.118.127; http://www.ncbi.nlm.nih.gov/pubmed/1879910 )
5) The cycle of malnutrition can be broken by making the
pregnant females healthy.
Under ICDS, pregnant females are entitled to get Take Home
Ration (THR). To get the THR from the anganwadi, pregnant
female need to have THAYI card which is issued from the Urban
Health center (UHC) by the Link Worker/Doctor. The doctor at
UHC checks the pregnant lady and accordingly recommends for
entitlements from the anganwadis
Thus, if volunteers come across such cases in the field as pregnant ladies
are not getting THR, please inform the Link workers in the nearby UHCs and
ask them to make THAYI card for such females
6) Since some of the anganwadis are new, they are not getting
enough funds for eggs and milk and other provisions of
supplementary nutrition. One such anganwadi is Urdu
anganwadi in Rajendra Nagar,
7) Koromangala. Volunteers can raise the issue with the

corporator of the area.
8)
Volunteers can also take up the issue of difference between

the actual price of the eggs in the market and the funds
provided by the government for the eggs.; with the
corporators as children are not getting eggs regularly at the
anganwadis because of this issue.
9) In Madivala PAG, no follow up has been done in Siddharth

Nagar since November, 2012 (CRY interns Ramya and Georges
Report on ICDS), so follow up the anganwadis in Siddharth
Nagar. Also the anganwadis in N S Palaya have not been
cooperating well, please follow on this issue as well.
74
Conclusion
In India, 8.1 million children are estimated to suffer from severe acute malnutrition (SAM)
and 50% of children in urban slums of Bangalore are malnourished. In a state, marching
ahead on the economic front, the magnitude and serious consequences of SAM among
children makes it unethical not to urgently initiate measures to prevent and treat SAM.
Protecting lives and promoting optimum development of SAM children is
also a human rights issue.
About 85% of children (without medical complications) can be managed
through a community- and/or home-based care approach. Thus requires an
urgent need to update both facility and home-based care
recommendations for the management of malnutrition among children in
Bangalore, on the basis of latest evidence from the data collected from
different PAG areas.
STILL.
A Survey conducted in April, 2012 on 577 children done in 12 districts of
Karnataka ; by the Civil society organizations such as those belonging to the
Samajika Parivartana Janandolana, Right to Food Campaign and the
Janaarogya Andolana-Karnataka (JAAK) by weighing children in anganwadis
in their work areas ; shockingly found that
a) There were no weighing scales for children aged three to six at the most
of the anganwadis.
b) Even zero-to-three-year-olds were not being weighed regularly.
c) Several anganwadis did not have charts to plot the childrens growth.
d) If they had the growth charts, they either did not plot the growth curves
on them or they did not have sufficient training or knowledge on how to
plot them.
75
e) These children will never receive the medical attention they need or the
additional nutrition at nutrition rehabilitation centers (NRC) under the
Balsanjeevani scheme.
f) What was also highlighted was the fact that doctors from primary
healthcare centers (PHCs) did not visit anganwadis due to lack of vehicles at
the PHC.
Similar is the condition in several anganwadis

and associated urban health centers in all the
PAG areas. Thus we need to make little extra
efforts so that things can be brought back on
track for these children.
In nothing do men approach so

nearly to the Gods, as in giving
health to men.
- Marcus Tullius Cicero, orator and
statesman of ancient Rome
So this is what we exactly need to follow and give these
children a healthy life.
17
17
Survey by JAAK and other civil societies :

http://infochangeindia.org/agriculture/features/stealing-from-the-mouths-ofbabes.html
76
References
Women and child Welfare Department, GoR
http://wcd.rajasthan.gov.in/Scheme_ICDS.aspx?lnk=1
Daijiworld Media Network - Bangalore
The Hindu, 20 April 2012

1
http://www.thehindu.com/news/states/karnataka/milk-eggs-to-be-on-menufor-anganwadi-children/article4112879.ece last accessed on 20th December
2012
http://www.thousanddays.org/about/
http://www.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.ece
dated May 22, 2013
http://nutritionmissionmah.gov.in/Site/Common/iec.aspx - dept of Women and Child

Development, Government of Maharashtra
http://www.thehindu.com/todays-paper/tp-national/tp-karnataka/milk- eggsbeing-regularly-supplied-to-children-in-anganwadis-acrossdistrict/article4107837.ece
Integrated Child Development Services http://wcd.nic.in/icds.htm
Directorate of Health and Family Welfare, Karnataka

http://stg2.kar.nic.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.aspx
National Institute of Nutrition, Hyderabad
www.ninindia.org/
WHO Growth Standard Charts

www.who.int/childgrowth/standards/
http://infochangeindia.org/children/features/anatomy-of-child-starvation-deaths.html Story of
malnutrition Case studies
Survey by JAAK and other civil societies :

http://infochangeindia.org/agriculture/features/stealing-from-the-mouths-ofbabes.html
77
ANNEXURE I
Excel Spreadsheets of compiled data on

Malnourished children from the PAG areas
Koramangala
Yeshwantpur
Jeevan Beema Nagar
Madivala
78
Annexure II
The composition of supplementary food given in
Rajasthan
Formulation/ Composition of Panjiri
S.No.
Contents of Poshahar (Panjiri)
Gm per 125 gm
Wheat Whole
62.00
Soyabean
14.00
Besan (Bengal gram dhal)
06.00
Sugar
36.00
Edible oil
07.00
Micronutrients
As Per Norms
Formulation/Composition of Energy Dense Extruded Fortified Halva Pre-Mix (Deshi

Mithai)
S.No
Contents of Poshahar (Halva Pre-Mix )
Gm per 140 gm
Wheat Whole
35.00
Defatted Soyabean
12.00
Moong (Green gram)
35.00
Sugar
35.00
Edible oil
23.00
Micronutrients
As Per Norms
Formulation/Composition of Energy Dense Extruded Fortified Upma Pre-Mix (Namkeen)

S.No.
Contents of Poshahar (Upma Pre-Mix )
Gm per 130 gm
Wheat Whole
48.00
Defatted Soyabean
12.00
Moong (Green gram)
30.00
Edible oil
35.00
Salt, Spices & Dehydrated Vegetables
05.00
Micronutrients
As Per Norms
79
Khichadi
Ingredients
Energy
Protein
Quantity
Energy Protein Rate Amount
per 100g per 100g
(g)
(Kcal)
(g)
Rs./Kg
Rs.
(Kcal)
(g)
Rice
58
345
6.8
200.10 3.94
20
1.16
Green Gram Dal
17
348
24.5
59.16
4.17
76
1.29
Edible Oil
900
45.00
0.00
60
0.30
Spice
0.02
Fuel
0.11
Total
80
304.26 8.11
2.88
Labour
charges/margin for
SHGs @10%
0.29
Grand Total
3.17
Dalia
Ingredients
Energy
Protein
Quantity
per 100g per 100g
(g)
(Kcal)
(g)
Rs./Kg
Rs.
(Kcal)
(g)
Dalia
33
346
11.8
114.18 3.89
19
0.63
Green Gram Dal
17
348
24.5
59.16
4.17
76
1.29
Jaggery/Sugar
25
383
95.75
0.00
32
0.80
Edible Oil
900
45.00
0.00
60
0.30
Fuel
0.11
Total
80
314.09 8.06
3.13
Labour
charges/margin for
SHGs @10%
0.31
Grand Total
3.44
Rice (Puffed) & Roasted Chana With Jaggery

Ingredients
Energy Protein
Quantity
Energy Protein Rate
per 100g per 100g
(g)
(Kcal)
(g)
Rs./Kg
(Kcal)
(g)
Amount
Rs.
Rice (Puffed)
14
325
7.5
45.50
1.05
30
0.42
Roasted Chana
16
369/td>
22.5
59.04
3.60
50
>0.80
Jaggery
25
383
95.75
0.00
32
0.80<
Total
55
200.29 4.65
80
2.02
Labour
charges/margin
for SHGs @10%
0.20
Grand Total
2.22
Ready (Dry) Alternatives For Snanks (Roasted Chana With Gur)

Ingredients
Energy Protein
Quantity
per 100g per 100g
(g)
(Kcal)
(g)
Rs./Kg
Rs.
(Kcal)
(g)
Roasted Chana
40
369
22.5
147.60 9.00
50
2.00
Gur
15
383
57.45
32
0.48
Total
55
0.00
205.05 9.00
2.48
Labour
charges/margin for
SHGs @10%
0.25
Grand Total
2.73
Halwa
Ingredients
Energy Protein
Quantity
per 100g per 100g
(g)
(Kcal)
(g)
Rs./Kg
Rs.
(Kcal)
(g)
Wheat Flour
13
346
11.8
>44.98 1.53
18
0.23
Soyabeen
432
4.32
21.60
0.22
34
0.17
Mung Daal
12
348
24.5
41.76
2.94
84
1.01
Edible Oil
900
72.00
0.00
60
0.48
Sugar
12
400
>0
48.00
0.00
36
0.43
Total
50
228.34 4.69
Labour
charges/margin for
SHGs @10%
>
Grand Total
2.32
>
0.23
>2.55
81
The composition of supplementary food under ICDS
82
83
84
Recipes of the supplementary food distributed under

Rajmata Jijau Mother-Child Health and Nutrition Mission,
Maharashtra
1) Upma
Sr. No.
Item Name
Quantity Calories Protein Expenditure
1
Milk
25 ml
33.3
1.8
0.60
2
Sugar
5 gm
20.00 00.00 0.20
3
Amylase rich Wheat Flour 20 gm 68.00 2.56
0.40
4
Amylase rich Moong Flour 10 gm 34.8
2.45
0.65
5
10 gm 56.8
2.52
0.55
6
Oil
20 gm 180
0
1.10
7
Til
5 gm
28.15 0.92
0.50
Total
95 gm 421.05 10.25 1.20
2) Shira
Sr. No.
Item Name
Quantity Calories Protein Expenditure
1
Milk
25 ml
33.3
1.8
0.60
2
Sugar
25 gm
100.00 00.00 1.00
3
Amylase rich Wheat Flour 20 gm
68.00 2.56
0.40
4
Amylase rich Moong Flour 10 gm
34.8
2.45
0.65
5
Oil
20 gm
180
0
1.10
6
Til
5 gm
28.15 0.92
0.50
7
Elaichi
Tested
0
0
0.10
8
Water
As per need 0
0
0
Total
105 gm
444.25 7.73
4.35
Above Nutritious food items with consideration of taste of beneficiaries are given but oil
content is less.
85
Method of making Amylase rich flour:

1) Wheat:After soaking wheat in water for 24 hours, it is kept in wet cloth/nylon bag till it gets
sprouted (it takes minimum 2 to 3 days for sprouting). Once wheat sprouted it is sun
dried and then it is roasted and grounded.
2) Green Gram (Moong):After soaking Green Gram in water for 24 hours, it is kept in wet cloth/nylon bag till it
gets sprouted (it takes minimum 1 to 2 days for sprouting). Once Green Gram is
sprouted it is sun dried and then it is roasted and grounded.
Special Food Composition (100 gms)

Ingredients Amount (gms) Energy (kcal) Proteins (gms) Fats (gms)
Milk Powder 30
107.1
11.4
Peanut
20
113.4
5.1
8.0
Sugar
28
112
Vegetable oil 20
180
20
CMV
1.6
Total
100
512.5
16.5
28.0
Procedure:
1. Wash hands properly under running water.
2. Measure all the ingredients.
3. Roast groundnuts and remove the cover.
4. Grind roasted groundnuts and keep then in an air tight container
5. Take the required amount of sugar and grid it to make into powder
6. Mix all the ingredients together that are milk powder, roasted groundnut powder,
powdered sugar, vegetable oil and mineral and vitamin mix powder (CMV) (if available).
7. Special feed should be given as per the weight of the child. For that please follow the
table below.
Nutritious Laddoos for Pregnant Women

Ahmednagar district has been in the forefront of community participation and localized
innovations for reducing malnutrition. One of its recent initiatives is the free
distribution of 3 different types of laddoos (sweet nutritious balls) to pregnant women
and lactating mothers in villages. The aim is to improve the quality of their diet, ensure
adequate weight gain during pregnancy, and prevent low birth weight of babies. These
laddoos are prepared from ingredients received through donations from the
86
community. Women come together at a suitable location in the village and prepare
these laddoos for themselves. The cost of the 3 laddoos comes to about Rs. 18.
The recipes/ingredients are: 1. Groundnut- Jaggery Laddoos (Shengdana- Gur Laddoo):

Ingredients Amount
Groundnut 50 gms
Jaggery
50 gms
Energy
476.5 kcal
Protein
13.0gms
2. Rajgira- Soya- Gur- Ragi Laddoo:
Ingredients Amount
Ragi
50 gms
Rajgeera 50 gms
Soybean 5 gms
Jaggery
50 gms
Energy
222.25 kcal
Proteins 12.75 gms
Calcium
215.75 mg
3. Coconut- Garden Cress seeds (Aaliv) - Jaggery (Gur):
Ingredients
Amount
Garden Cress Seeds (Aaliv) 20gms
Coconut
80gms
Jaggery
50gms
Energy
213 kcal
Proteins
7.5 gms
Calcium
84.8mg
Vitamin C
24.92 mg
Vitamin A
27.6 mcg
All districts are being encouraged to distribute similar laddoos to all pregnant and
lactating mothers through community contribution.
87
COMPLEMENTARY FOODS suggested by National Institute

of Nutrition, Hyderabad
Khichdi
Ingredients: Rice ... 35 g
Green gram dhal ... 10 g

Leafy vegetables ... 2 t. sp
Fat ... 2 t. sp
Cumin (jeera)
Method: Clean rice and dhal and cook them in water with salt till the grains
are soft and water is absorbed. Leafy vegetables can be added when the
cereal/pulse is 3/4th done. Cumin is fried in fat and added towards the end.
Malted Raggi Porridge

Ingredients: Malted Ragi ... 30 g
Roasted Groundnut ... 15 g
Jaggery ... 20 g
Method: Malted ragi, roasted groundnuts and jaggery are
powdered. Sufficient water is added and cooked.
Wheat Payassam
Ingredients: Wheat ... 30 g
Roasted Bengal gram flour ... 15 g
Roasted & crushed Groundnut ... 5 g
Sugar ... 15 g
Method: Roast whole wheat and powder. Add roasted
Bengal gram flour, groundnut and sugar. Cook with sufficient water.
Kheer
Ingredients: Vermicelli/Rice ... 30 g
Milk ... 100 ml.
Water ... As required
Jaggery ... 20 g
Method: Boil rice/vermicelli in water till half done. Add milk and bring to
boil. Add jaggery and cook well.
88
Note:
1. All these recipes provide approximately 250 Kcals. and 5 g proteins and
amounts given are for 2 servings.
2. Recipes Nos.2 and 3 can be prepared and stored in airtight containers to
be used whenever required.
3. Non-vegetarian foods such as soft boiled egg, minced meat may be
introduced at the age of 6 months.
Complete Document on Dietary Guidelines by NIN,

Hyderabad
89
Annexure III
WHO Growth Standard Charts

In India, Underweight has been taken as the most important indicator to
asses under nutrition and all the anganwadi centers use the same indicator.
The WHO growth standard chart contains ideal weight (median weight) for
each age (from 0-10 years of age separately for boys and girls). Also the
values on the left side of the median (-1SD, -2SD, -3SD) represent under
nutrition and values on the right side of the median (+1SD, +2SD, +3SD)
represent over-nutrition.
Color Coding of the Charts

Red
: Severely malnutrition
Orange: Moderate malnutrition

Yellow: Mild malnutrition
Green : ideal weight
90
Weight-for-age GIRLS
Birth to10 years (z-scores weight in Kgs
Year:
Month
Month
-3 SD
-2 SD
-1 SD
Median
1 SD
2 SD
3 SD
0: 0
2.0
2.4
2.8
3.2
3.7
4.2
4.8
0: 1
2.7
3.2
3.6
4.2
4.8
5.5
6.2
0: 2
3.4
3.9
4.5
5.1
5.8
6.6
7.5
0: 3
4.0
4.5
5.2
5.8
6.6
7.5
8.5
0: 4
4.4
5.0
5.7
6.4
7.3
8.2
9.3
0: 5
4.8
5.4
6.1
6.9
7.8
8.8
10.0
0: 6
5.1
5.7
6.5
7.3
8.2
9.3
10.6
0: 7
5.3
6.0
6.8
7.6
8.6
9.8
11.1
0: 8
5.6
6.3
7.0
7.9
9.0
10.2
11.6
0: 9
5.8
6.5
7.3
8.2
9.3
10.5
12.0
0:10
10
5.9
6.7
7.5
8.5
9.6
10.9
12.4
0:11
11
6.1
6.9
7.7
8.7
9.9
11.2
12.8
1: 0
12
6.3
7.0
7.9
8.9
10.1
11.5
13.1
1: 1
13
6.4
7.2
8.1
9.2
10.4
11.8
13.5
1: 2
14
6.6
7.4
8.3
9.4
10.6
12.1
13.8
1: 3
15
6.7
7.6
8.5
9.6
10.9
12.4
14.1
1: 4
16
6.9
7.7
8.7
9.8
11.1
12.6
14.5
1: 5
17
7.0
7.9
8.9
10.0
11.4
12.9
14.8
1: 6
18
7.2
8.1
9.1
10.2
11.6
13.2
15.1
1: 7
19
7.3
8.2
9.2
10.4
11.8
13.5
15.4
1: 8
20
7.5
8.4
9.4
10.6
12.1
13.7
15.7
1: 9
21
7.6
8.6
9.6
10.9
12.3
14.0
16.0
1:10
22
7.8
8.7
9.8
11.1
12.5
14.3
16.4
1:11
23
7.9
8.9
10.0
11.3
12.8
14.6
16.7
2: 0
24
8.1
9.0
10.2
11.5
13.0
14.8
17.0
2: 1
25
8.2
9.2
10.3
11.7
13.3
15.1
17.3
2: 2
2: 3
26
27
8.4
8.5
9.4
9.5
10.5
10.7
11.9
12.1
13.5
13.7
15.4
15.7
17.7
18.0
91
2: 4
2: 5
2: 6
28
29
30
8.6
8.8
8.9
9.7
9.8
10.0
10.9
11.1
11.2
12.3
12.5
12.7
14.0
14.2
14.4
16.0
16.2
16.5
18.3
18.7
19.0
2: 7
2: 8
2: 9
2:10
2:11
3: 0
31
32
33
34
35
36
9.0
9.1
9.3
9.4
9.5
9.6
10.1
10.3
10.4
10.5
10.7
10.8
11.4
11.6
11.7
11.9
12.0
12.2
12.9
13.1
13.3
13.5
13.7
13.9
14.7
14.9
15.1
15.4
15.6
15.8
16.8
17.1
17.3
17.6
17.9
18.1
19.3
19.6
20.0
20.3
20.6
20.9
3: 1
3: 2
3: 3
3: 4
3: 5
3: 6
37
38
39
40
41
42
9.7
9.8
9.9
10.1
10.2
10.3
10.9
11.1
11.2
11.3
11.5
11.6
12.4
12.5
12.7
12.8
13.0
13.1
14.0
14.2
14.4
14.6
14.8
15.0
16.0
16.3
16.5
16.7
16.9
17.2
18.4
18.7
19.0
19.2
19.5
19.8
21.3
21.6
22.0
22.3
22.7
23.0
3: 7
3: 8
3: 9
3:10
3:11
4: 0
43
44
45
46
47
48
10.4
10.5
10.6
10.7
10.8
10.9
11.7
11.8
12.0
12.1
12.2
12.3
13.3
13.4
13.6
13.7
13.9
14.0
15.2
15.3
15.5
15.7
15.9
16.1
17.4
17.6
17.8
18.1
18.3
18.5
20.1
20.4
20.7
20.9
21.2
21.5
23.4
23.7
24.1
24.5
24.8
25.2
4: 1
4: 2
4: 3
4: 4
4: 5
4: 6
4: 7
4: 8
4: 9
4:10
4:11
5: 0
49
50
51
52
53
54
55
56
57
58
59
60
11.0
11.1
11.2
11.3
11.4
11.5
11.6
11.7
11.8
11.9
12.0
12.1
12.4
12.6
12.7
12.8
12.9
13.0
13.2
13.3
13.4
13.5
13.6
13.7
14.2
14.3
14.5
14.6
14.8
14.9
15.1
15.2
15.3
15.5
15.6
15.8
16.3
16.4
16.6
16.8
17.0
17.2
17.3
17.5
17.7
17.9
18.0
18.2
18.8
19.0
19.2
19.4
19.7
19.9
20.1
20.3
20.6
20.8
21.0
21.2
21.8
22.1
22.4
22.6
22.9
23.2
23.5
23.8
24.1
24.4
24.6
24.9
25.5
25.9
26.3
26.6
27.0
27.4
27.7
28.1
28.5
28.8
29.2
29.5
92
Year:
Month
5: 1
5: 2
5: 3
5: 4
5: 5
5: 6
5: 7
5: 8
5: 9
5:10
5:11
6: 0
6: 1
6: 2
6: 3
6: 4
6: 5
6: 6
6: 7
6: 8
6: 9
6:10
6:11
7: 0
7: 1
7: 2
Month
-3 SD
-2 SD
-1 SD
Median
1 SD
2 SD
3 SD
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
12.4
12.5
12.6
12.7
12.8
12.9
13.0
13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8
13.9
14.0
14.1
14.2
14.3
14.4
14.5
14.6
14.8
14.9
15.0
14.0
14.1
14.2
14.3
14.4
14.6
14.7
14.8
14.9
15.0
15.2
15.3
15.4
15.5
15.6
15.8
15.9
16.0
16.1
16.3
16.4
16.5
16.6
16.8
16.9
17.1
15.9
16.0
16.2
16.3
16.5
16.6
16.8
16.9
17.0
17.2
17.3
17.5
17.6
17.8
17.9
18.0
18.2
18.3
18.5
18.6
18.8
18.9
19.1
19.3
19.4
19.6
18.3
18.4
18.6
18.8
19.0
19.1
19.3
19.5
19.6
19.8
20.0
20.2
20.3
20.5
20.7
20.9
21.0
21.2
21.4
21.6
21.8
22.0
22.2
22.4
22.6
22.8
21.2
21.4
21.6
21.8
22.0
22.2
22.5
22.7
22.9
23.1
23.3
23.5
23.8
24.0
24.2
24.4
24.6
24.9
25.1
25.3
25.6
25.8
26.1
26.3
26.6
26.8
24.8
25.1
25.4
25.6
25.9
26.2
26.5
26.7
27.0
27.3
27.6
27.8
28.1
28.4
28.7
29.0
29.3
29.6
29.9
30.2
30.5
30.8
31.1
31.4
31.8
32.1
29.5
29.8
30.2
30.5
30.9
31.3
31.6
32.0
32.3
32.7
33.1
33.4
33.8
34.2
34.6
35.0
35.4
35.8
36.2
36.6
37.0
37.4
37.8
38.3
38.7
39.2
7: 3
7: 4
7: 5
7: 6
7: 7
7: 8
7: 9
7:10
7:11
8: 0
8: 1
8: 2
8: 3
8: 4
8: 5
8: 6
8: 7
8: 8
8: 9
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
15.1
15.2
15.4
15.5
15.6
15.7
15.9
16.0
16.2
16.3
16.4
16.6
16.7
16.9
17.0
17.2
17.3
17.5
17.7
17.2
17.3
17.5
17.6
17.8
17.9
18.1
18.3
18.4
18.6
18.8
18.9
19.1
19.3
19.5
19.6
19.8
20.0
20.2
19.8
19.9
20.1
20.3
20.5
20.7
20.9
21.0
21.2
21.4
21.6
21.8
22.0
22.3
22.5
22.7
22.9
23.1
23.3
23.0
23.2
23.4
23.6
23.9
24.1
24.3
24.5
24.8
25.0
25.3
25.5
25.8
26.0
26.3
26.6
26.8
27.1
27.4
27.1
27.4
27.6
27.9
28.2
28.5
28.8
29.1
29.4
29.7
30.0
30.3
30.6
30.9
31.2
31.6
31.9
32.2
32.6
32.5
32.8
33.1
33.5
33.9
34.2
34.6
35.0
35.4
35.8
36.2
36.6
37.0
37.4
37.8
38.3
38.7
39.1
39.6
39.6
40.1
40.6
41.1
41.5
42.0
42.6
43.1
43.6
44.1
44.7
45.2
45.8
46.3
46.9
47.5
48.1
48.7
49.3
93
8:10
8:11
9: 0
9: 1
9: 2
106
107
108
109
110
17.8
18.0
18.1
18.3
18.5
20.4
20.6
20.8
21.0
21.2
23.6
23.8
24.0
24.3
24.5
27.6
27.9
28.2
28.5
28.8
32.9
33.3
33.6
34.0
34.4
40.0
40.5
41.0
41.4
41.9
49.9
50.5
51.1
51.8
52.4
9: 3
9: 4
9: 5
9: 6
9: 7
9: 8
9: 9
9:10
9:11
10: 0
111
112
113
114
115
116
117
118
119
120
18.7
18.8
19.0
19.2
19.4
19.5
19.7
19.9
20.1
20.3
21.4
21.6
21.8
22.0
22.2
22.4
22.6
22.8
23.0
23.3
24.7
25.0
25.2
25.5
25.7
26.0
26.2
26.5
26.8
27.0
29.1
29.4
29.7
30.0
30.3
30.6
30.9
31.2
31.5
31.9
34.7
35.1
35.5
35.9
36.2
36.6
37.0
37.4
37.8
38.2
42.4
42.9
43.3
43.8
44.3
44.8
45.3
45.8
46.4
46.9
53.1
53.7
54.4
55.0
55.7
56.4
57.1
57.8
58.5
59.2
Weight-for-age BOYS
Birth to 10years (z-scores weight in Kgs)
Year:
Month
Month
-3 SD
-2 SD
-1 SD
Median
1 SD
2 SD
3 SD
0: 0
0: 1
0: 2
0: 3
0: 4
0: 5
0: 6
0
1
2
3
4
5
6
2.1
2.9
3.8
4.4
4.9
5.3
5.7
2.5
3.4
4.3
5.0
5.6
6.0
6.4
2.9
3.9
4.9
5.7
6.2
6.7
7.1
3.3
4.5
5.6
6.4
7.0
7.5
7.9
3.9
5.1
6.3
7.2
7.8
8.4
8.8
4.4
5.8
7.1
8.0
8.7
9.3
9.8
5.0
6.6
8.0
9.0
9.7
10.4
10.9
0: 7
0: 8
0: 9
0:10
0:11
1: 0
1: 1
1: 2
1: 3
1: 4
1: 5
1: 6
7
8
9
10
11
12
13
14
15
16
17
18
5.9
6.2
6.4
6.6
6.8
6.9
7.1
7.2
7.4
7.5
7.7
7.8
6.7
6.9
7.1
7.4
7.6
7.7
7.9
8.1
8.3
8.4
8.6
8.8
7.4
7.7
8.0
8.2
8.4
8.6
8.8
9.0
9.2
9.4
9.6
9.8
8.3
8.6
8.9
9.2
9.4
9.6
9.9
10.1
10.3
10.5
10.7
10.9
9.2
9.6
9.9
10.2
10.5
10.8
11.0
11.3
11.5
11.7
12.0
12.2
10.3
10.7
11.0
11.4
11.7
12.0
12.3
12.6
12.8
13.1
13.4
13.7
11.4
11.9
12.3
12.7
13.0
13.3
13.7
14.0
14.3
14.6
14.9
15.3
94
1: 7
1: 8
1: 9
1:10
1:11
2: 0
19
20
21
22
23
24
8.0
8.1
8.2
8.4
8.5
8.6
8.9
9.1
9.2
9.4
9.5
9.7
10.0
10.1
10.3
10.5
10.7
10.8
11.1
11.3
11.5
11.8
12.0
12.2
12.5
12.7
12.9
13.2
13.4
13.6
13.9
14.2
14.5
14.7
15.0
15.3
15.6
15.9
16.2
16.5
16.8
17.1
2: 1
2: 2
2: 3
2: 4
2: 5
2: 6
25
26
27
28
29
30
8.8
8.9
9.0
9.1
9.2
9.4
9.8
10.0
10.1
10.2
10.4
10.5
11.0
11.2
11.3
11.5
11.7
11.8
12.4
12.5
12.7
12.9
13.1
13.3
13.9
14.1
14.3
14.5
14.8
15.0
15.5
15.8
16.1
16.3
16.6
16.9
17.5
17.8
18.1
18.4
18.7
19.0
2: 7
2: 8
2: 9
2:10
2:11
31
32
33
34
35
9.5
9.6
9.7
9.8
9.9
10.7
10.8
10.9
11.0
11.2
12.0
12.1
12.3
12.4
12.6
13.5
13.7
13.8
14.0
14.2
15.2
15.4
15.6
15.8
16.0
17.1
17.4
17.6
17.8
18.1
19.3
19.6
19.9
20.2
20.4
3: 0
36
10.0
11.3
12.7
14.3
16.2
18.3
20.7
3: 1
3: 2
3: 3
37
38
39
10.1
10.2
10.3
11.4
11.5
11.6
12.9
13.0
13.1
14.5
14.7
14.8
16.4
16.6
16.8
18.6
18.8
19.0
21.0
21.3
21.6
3: 4
3: 5
3: 6
40
41
42
10.4
10.5
10.6
11.8
11.9
12.0
13.3
13.4
13.6
15.0
15.2
15.3
17.0
17.2
17.4
19.3
19.5
19.7
21.9
22.1
22.4
3: 7
3: 8
3: 9
3:10
3:11
4: 0
43
44
45
46
47
48
10.7
10.8
10.9
11.0
11.1
11.2
12.1
12.2
12.4
12.5
12.6
12.7
13.7
13.8
14.0
14.1
14.3
14.4
15.5
15.7
15.8
16.0
16.2
16.3
17.6
17.8
18.0
18.2
18.4
18.6
20.0
20.2
20.5
20.7
20.9
21.2
22.7
23.0
23.3
23.6
23.9
24.2
4: 1
4: 2
4: 3
4: 4
4: 5
4: 6
4: 7
4: 8
4: 9
4:10
4:11
5: 0
49
50
51
52
53
54
55
56
57
58
59
60
11.3
11.4
11.5
11.6
11.7
11.8
11.9
12.0
12.1
12.2
12.3
12.4
12.8
12.9
13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8
14.0
14.1
14.5
14.7
14.8
15.0
15.1
15.2
15.4
15.5
15.6
15.8
15.9
16.0
16.5
16.7
16.8
17.0
17.2
17.3
17.5
17.7
17.8
18.0
18.2
18.3
18.8
19.0
19.2
19.4
19.6
19.8
20.0
20.2
20.4
20.6
20.8
21.0
21.4
21.7
21.9
22.2
22.4
22.7
22.9
23.2
23.4
23.7
23.9
24.2
24.5
24.8
25.1
25.4
25.7
26.0
26.3
26.6
26.9
27.2
27.6
27.9
95
5: 1
5: 2
5: 3
5: 4
5: 5
5: 6
5: 7
5: 8
5: 9
5:10
5:11
6: 0
6: 1
6: 2
6: 3
6: 4
6: 5
6: 6
6: 7
6: 8
6: 9
6:10
6:11
7: 0
7: 1
7: 2
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
12.7
12.8
13.0
13.1
13.2
13.3
13.4
13.6
13.7
13.8
13.9
14.1
14.2
14.3
14.5
14.6
14.7
14.9
15.0
15.1
15.3
15.4
15.5
15.7
15.8
15.9
14.4
14.5
14.6
14.8
14.9
15.0
15.2
15.3
15.4
15.6
15.7
15.9
16.0
16.2
16.3
16.5
16.6
16.8
16.9
17.1
17.2
17.4
17.5
17.7
17.8
18.0
16.3
16.4
16.6
16.7
16.9
17.0
17.2
17.4
17.5
17.7
17.8
18.0
18.2
18.3
18.5
18.7
18.8
19.0
19.2
19.3
19.5
19.7
19.9
20.0
20.2
20.4
18.5
18.7
18.9
19.0
19.2
19.4
19.6
19.8
19.9
20.1
20.3
20.5
20.7
20.9
21.1
21.3
21.5
21.7
21.9
22.1
22.3
22.5
22.7
22.9
23.1
23.3
96
21.1
21.3
21.5
21.7
22.0
22.2
22.4
22.6
22.8
23.1
23.3
23.5
23.7
24.0
24.2
24.4
24.7
24.9
25.2
25.4
25.6
25.9
26.1
26.4
26.6
26.9
24.2
24.4
24.7
24.9
25.2
25.5
25.7
26.0
26.3
26.6
26.8
27.1
27.4
27.7
28.0
28.3
28.6
28.9
29.2
29.5
29.8
30.1
30.4
30.7
31.0
31.3
27.8
28.1
28.4
28.8
29.1
29.4
29.8
30.1
30.4
30.8
31.2
31.5
31.9
32.2
32.6
33.0
33.3
33.7
34.1
34.5
34.9
35.3
35.7
36.1
36.5
36.7
7: 3
7: 4
7: 5
7: 6
87
88
89
90
16.1
16.2
16.3
16.5
18.1
18.3
18.4
18.6
20.6
20.7
20.9
21.1
23.5
23.7
23.9
24.1
27.1
27.4
27.7
27.9
31.7
32.0
32.3
32.6
37.4
37.8
38.2
38.7
7: 7
7: 8
7: 9
7:10
7:11
8: 0
91
92
93
94
95
96
16.6
16.7
16.9
17.0
17.1
17.3
18.7
18.9
19.0
19.2
19.3
19.5
21.3
21.4
21.6
21.8
22.0
22.1
24.3
24.6
24.8
25.0
25.2
25.4
28.2
28.4
28.7
29.0
29.2
29.5
33.0
33.3
33.7
34.0
34.4
34.7
39.1
39.6
40.1
40.5
41.0
41.5
8: 1
8: 2
8: 3
8: 4
8: 5
8: 6
97
98
99
100
101
102
17.4
17.5
17.7
17.8
17.9
18.1
19.6
19.8
19.9
20.1
20.2
20.4
22.3
22.5
22.7
22.9
23.0
23.2
25.6
25.9
26.1
26.3
26.5
26.7
29.8
30.1
30.3
30.6
30.9
31.2
35.1
35.5
35.8
36.2
36.6
37.0
42.0
42.5
43.1
43.6
44.1
44.7
8: 7
8: 8
8: 9
8:10
8:11
9: 0
103
104
105
106
107
108
18.2
18.3
18.4
18.6
18.7
18.8
20.5
20.7
20.8
21.0
21.1
21.3
23.4
23.6
23.8
23.9
24.1
24.3
27.0
27.2
27.4
27.6
27.9
28.1
31.5
31.8
32.1
32.4
32.7
33.0
37.4
37.8
38.2
38.6
39.0
39.4
45.2
45.8
46.4
47.0
47.6
48.2
9: 1
9: 2
9: 3
109
110
111
18.9
19.1
19.2
21.4
21.6
21.7
24.5
24.7
24.9
28.3
28.6
28.8
33.3
33.6
33.9
39.9
40.3
40.7
48.8
49.5
50.1
9: 4
9: 5
9: 6
112
113
114
19.3
19.5
19.6
21.9
22.1
22.2
25.1
25.3
25.5
29.1
29.3
29.6
34.3
34.6
34.9
41.2
41.7
42.1
50.8
51.5
52.1
9: 7
9: 8
9: 9
9:10
9:11
10: 0
115
116
117
118
119
120
19.7
19.9
20.0
20.1
20.3
20.4
22.4
22.5
22.7
22.9
23.0
23.2
25.7
25.9
26.1
26.3
26.5
26.7
29.8
30.1
30.4
30.6
30.9
31.2
35.3
35.6
36.0
36.3
36.7
37.0
42.6
43.1
43.5
44.0
44.5
45.0
52.8
53.5
54.2
55.0
55.7
56.4
97
Growth Cards used by Anganwadis to track the weight for age of

the children
98

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Malnutrition: An Invisible and Silent

DATE: June 07, 2013

SECTION 1: - ANALYSIS OF DATA ON MALNOURISHED

1.7) Details and Key findings of malnourished children

Koromangala PAG ..18

SECTION 2: Insight into MALNUTRITION AND HEALTH SCEMES

Myths and Facts about Nutrition46

Governments Initiatives to fight Malnutrition

Section 1: ANALYSIS OF DATA ON

Right to Development and

And as a result of their continuous and effective interventions which included

Summary of Results from Data collected on

For management of malnourished childrenRefer to

Data collected from the official records of anganwadis in April, 2013

Reasons for the high number of

Low level of education among mothers

Fundamentally, poverty is at the root of under nutrition. Very

Picture 1: Reasons for malnutrition

Picture 2: Complications of Malnutrition

Picture 3: Consequences of Malnutrition

CASE STORIES OF MALNUTRITION

A playful, curious Rakshita

Courtesy: Dr. Megha Raghavan

2) N S Palya, Madivala PAG

Details of Malnourished Children

The Hindu, 20 April 2012

Koromangala PAG Area

Details of Children in the Area (as on 1 June, 2013)

2) Kannada Tamil School, Rajendra Nagar

3) AWC-1, Rajendra Nagar

4) AWC-2, Rajendra Nagar

5) Ambedkar Nagar, Near Public Toilet

April 15, 2013)

8) Inside Urdu School

Details of Malnourished children in the area

Teacher: Shobha Rani B

Teacher: Manjula (9739210980)

4) AWC-2, Sheriff Nagar

Jeevan Beema Nagar PAG

Details of Malnourished Children in the area

# Estharani: has heart condition. Seen by the doctors in March, 2013

a) There are 28 malnourished children in the anganwadi out of which

Siddharth Nagar in Madivala Proper

Madivala Hosur road

Volunteers have been working hard to get the information

Section 2: Insight into

(2.2) What is Malnutrition.??

Protein- Energy Malnutrition (PEM)

Micronutrient deficiency diseases

In this report we are discussing about PEM.

(2.3) What we come across in the

due to rapid weight loss

Classification of malnutrition for

Z scores mentioned here refer to mean weight scores in WHO Growth

Classification of adult malnutrition (also called as

Cut-off point using BMI

The knowledge of BMI is important in the context of child malnutrition as

Causes and Cycle of Malnutrition

Picture 4: Causes of Maternal and Child Malnutrition

Picture 5: Immediate and Underlying causes of

The Irony of Girl Child

Picture 6: Vicious Cycle of Malnutrition in Girl Child in India