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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

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Contents
 Acknowledgement
 Abstract

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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 Malnutrition…………………………………11
Menace of Malnutrition…………………………………………..12
Case Stories of Malnutrition…………………………………….13
 Rakshita………………………………………………………………13
 Sudha…………………………………………………………………..14
 Charan………………………………………………………………….15
 Estharani………………………………………………………………16

1.7) Details and Key findings of malnourished children
In PAG areas………………………………………………………………17
a)
b)
c)
d)

Koromangala PAG ……………………………………………..18
Jeevan Beema Nagar PAG ……………………………………27
Yeshwantpur PAG………………………………………………..31
Madivala PAG………………………………………………………37

SECTION 2: Insight into MALNUTRITION AND HEALTH SCEMES
2.1
2.2

Introduction ………………………………………………………………..39
Background………………………………………………………………….40
 What is Nutrition and Malnutrition…??? …………………40
 Types of Malnutrition………………………………………………40
 What we come across in field..??? …………………………41
 Classification of Malnutrition ………………………………42
 Causes of Malnutrition ………………………………………..43
 Irony of Girl Child Malnutrition……………………………45
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2.3
2.4

Myths and Facts about Nutrition……………………………46
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 HOME………………………52

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 Norms…………………58
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

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.79 Annexure III: WHO Growth Standard Charts…………………90 1) Girls Weight for age 0-10 years 2) Boys Weight for age 0-10 years 4 .78 Annexure II: Composition of food items distributed under ICDS in Rajasthan and as recommended by Government of India……………………………………………………….Section 4: Annexure Annexure I: Excel Spreadsheets of data on malnourished children……………………………………………………………………….

Megha Raghvan for her immense help. Finally. would like to extend my thanks to CRY for giving me this opportunity of doing my internship with them. Ms. Without their time and effort. I learned a lot under their able guidance. 5 . A special thanks to intern. Dr. this report would not have been possible. Navneet Prakash and my mentor at IIHMR. Dr. I would like to express my heartiest gratitude to all the CRY volunteers in the different PAG areas who helped me collating the data. (Major) Vinod Kumar. Thangamma Monappa and Mr. I also extend my gratitude to all the anganwadi workers who cooperated to provide the data. Dr. I would like to thank my mentors at CRY. who helped and guided me throughout my internship.ACKNOWLEDGEMENT I. Megha Ranjan.

why and consequences) of malnutrition as well as details on each malnourished child in each anganwadi. discuss about how to proceed towards the management of malnutrition both at the health facility level and home level (Nutritional Rehabilitation at home). It is a follow up to the one written by Siddharth Jha1. Further. how. in which he undertook a detailed survey of malnourished children in various anganwadis in each PAG area. analysis on the data collected from the anganwadis.Abstract This report describes the project on Malnutrition that I did during my internship at CRY in Bangalore. 6 . and finally. This report provides additional details on the mechanisms (what. 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.

 Right to Participation. Essentially. 2) Madivala. 7 . each PAG is a group of enthusiasts. they monitor and intervene in cases of Child Rights violations.  Right to Development and  Right to Protection. conferring the 4 basic rights:  Right to Survival. Through their regular visits and interactions with the members of the Community. they have been successful in making a huge impact in the society. The sole purpose for them has become to ensure equal opportunities to all children. and 4) Jeevan Beema Nagar.from installing water filters to setting up a new anganwadi. members of the public who have come together to stand for what is right. And as a result of their continuous and effective interventions which included constant dialogues with the community as well as with the concerned authorities.1) CRY Public Action Groups (PAG) Areas There are four Public Action Group (PAG) areas in Bangalore – 1) Koromangala. And they have made a difference.Section 1: ANALYSIS OF DATA ON MALNOURISHED CHIILDREN IN DIFFERENT PAG AREAS (1. so opted to be the change to make a difference. They wanted a change. 3) Yeshwantpur.

Near Public Toilet EWS Quarters 38 29 10 No. Rajendra Nagar AWC-2. and Madivala) from the official records of children maintained by the anganwadis and again weighing the malnourished children in the anganwadis. of Severely Under weight Girls No. of Malnourished Children No of Under weight Girls Koromangala PAG L. 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.R. Near Government School Kannada Tamil School AWC-1.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. 2013¹ Area/Anganwadi Total No. Rajendra Nagar Ambedkar Nagar. Table 1: Complied Data on Malnourished Children from All the PAG Areas As on June 1. Yeshwantpur. Nagar. of Under weight Boys No. of Under weight boys under the age of 2 years 9 32 24 8 7 7 0 10 0 7 7 0 3 3 0 2 2 0 2 2 0 1 1 0 1 1 0 1 1 0 0 0 0 4 3 1 4 3 1 0 0 0 6 4 2 5 3 2 0 0 0 1 0 1 0 0 0 0 0 0 8 . Jeevan Beema Nagar. Severely under weight Children No. Following figures have emerged from the month long exercise.

1st Cross. Nellurupura AWC. 2013 9 . R. For Government Initiatives towards ending malnutrition i. Nellurupura MADIVALA PAG N S Palya 7 6 1 6 5 1 3 3 0 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 5 3 2 1 17 13 10 10 7 3 3 4 2 3 1 1 2 0 2 0 0 0 28 13 15 8 6 2 1 0 1 11 7 4 4 3 1 0 0 0 4 4 1 1 3 3 2 2 1 1 1 1 0 0 0 0 0 0 For management of malnourished childrenRefer to Section 2: Page No.4. various government health schemes Refer to Section 3: Page No. 56 2 1 Data collected from the official records of anganwadis in April. L.3. 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. 47 and 53 for Nutritional Rehabilitation.e.2 Nellurupura AWC.

clean water and sanitation. 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. poverty is at the root of under nutrition. Lack of adequate health services. education or health care they need to nourish themselves or their children.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. Very poor people are generally unable to afford the foods. 10 . Fundamentally.

Picture 1: Reasons for malnutrition Source: UNICEF. Save the Children 11 .

Pneumonia.com/2013/03/ 12 .wordpress.Complications of Malnutrition Inadequate Breastfeeding Frequent Bouts of Diarrhea. Malaria Picture 2: Complications of Malnutrition Source: http://challengedkidsinternational.

wordpress.Menace of Malnutrition Picture 3: Consequences of Malnutrition Source: http://challengedkidsinternational.com/2013/03/ 13 .

If he would have taken care of her mother and would not have run away. she could feed Rakshita well. She was curious as we were looking at her with wide eyes. Koramangala a) Rakshita² Anitha. trying to figure out what is so wrong with her to make some strangers stare at her.CASE STORIES OF MALNUTRITION 1) From Rajendra Nagar. Her mother has been counseled for 14 . She is 4 years old now and weighs just 9 Kgs. The girl frequently catches cold. A playful. its consequences. She cannot even provide her milk” mentions Anitha’s sister. Sunitha. Rakshita. Discussing with her aunt Sunitha about her health issue (brought to our notice by Urdu Anganwadi where Rakshita is though enrolled but rarely attend) . Megha Raghvan and Nischal) met her for the first time she was playing in the streets of Rajendra Nagar. With the little knowledge about malnutrition. John’s Medical College as well who visit the Koromangala once a year for health check ups. Sunitha takes care of Rakshita when her mother is at work and provides her with whatever little food she can. cough. robbed by diarrhea quite often and trap her more deeply in the paws of malnutrition. Dr. Megha Raghavan When we (Me. She has been checked by the doctor from St. frail and underweight got married at the age of 20 and soon gave birth to her first child. Anitha has ignored about this issue ever since was born. curious Rakshita Courtesy: Dr. Rakshita was small and malnourished ever since. Now she has to work and cannot take care of her in Rs 2500 per month. “Her father is the reason she is facing this menace of malnutrition. 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.

proper feeding practices and preparation of some low cost nutritious recipes. What a steep contrast is seen on the two side of the road. She has been put on the priority list of health care workers of Adugudi PHC who has promised to follow her up regularly. 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. 5years old and weight just 6. because she passed away 15 days back. 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. Finally she was seen by the Pediatrician at the Indra Gandhi Institute of Child Health Hospital. 3 2 Case stories compiled after discussion with the parents and anganwadi teachers 15 . 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. a dream seen by her mother for her.5 Kgs crippled by malnutrition to a point that she has developed irreversible brain damage and hooked with many other developmental disorders. YES used to live. where after check up doctor mentioned that due to chronic malnutrition. but also the basic resources to provide for a balanced diet for the child. On one side there is flourishing new age buildings and on the other side people are struggling to get one meal of the day. Sudha² Another small girl who USED TO LIVE in the urban slum of Koromangala opposite to National Games village. She was rushed to nearby hospitals where she was hospitalized twice due to frequent episodes of diarrhea which further deteriorated her health. Had the parents been acted on time. 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. Sudha could be saved from clutches of malnutrition. 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.

He was prescribed with a proper line of treatment which if would have been followed up. 16 .. 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. an extended pot belly. his parents are aloof over his health…………. 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. 2013.Prateek. we are welcomed by a locked door. Charan was on the radar of volunteers but they could not locate his house or meet him until today. Anganwadi worker is least bothered about his condition. We (Me and other volunteers. Madivala PAG Charan On April 13. Charan’s deteriorating health in spite of being seen by the IGICH Doctors is an issue of urgent concern. And when we came across the anganwadis of the area. We asked anganwadi worker. He peeked from behind his father and instantly we felt like we need to do something about this kid. Anganwadi helper guided us to Charan’s house where we had first glimpse of Charan. Charan represents the textbook picture of severe malnutritionextremely thin legs and hands. 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 is a 4 year old boy residing in one of the narrow lanes of G D Mara slum which houses population of about 10. in fact it is an emergency and we will have to find a way to help him out and soon. crackled skin and wide eyes. CRY kick started dropout survey in N S Palya area of South Bangalore. television but not able to feed his child properly. Shreoshi.000 people. The household can afford to maintain refrigerator. But his parents chose not to care and his condition has worsened over the period of time. Allen) were excited to have an opportunity to bring some changes in the life of the lesser privileged. talked to his father and the same old story came to our notice.2) N S Palya. We began house to house surveys to collect the information about the school drop-outs. then today Charan would have been fine by now. a cable connection. A year back. Akanksha.

it was found that the Child’s heart condition had been corrected and just needed treatment for Malnutrition. the PHC referred her to the requisite District Hospital in KR Puram. However on the morning of the appointment. The DHO recommended that she be treated for her Cardiac condition by a Government owned or aided facility. the Volunteers tracked down the house of the Child and finally succeeded in driving the Child with her Parents to the Hospital. Volunteer EAST PAG) Age: About 2 years Status: Malnourished Location: Anganwadi – GM Palya (CRY East PAG. to be a normal Child soon. supplies for 3 months were purchased and handed over to the Parents while dropping them off home that afternoon. and after much persuasion. As prescribed. 17 . Bangalore) Challenges: Diagnosed at birth with Congenital Heart Disease Esther Rani is the youngest amongst 3 siblings. At the MRI conducted in the OPD that morning. Her Father being a Casual Worker and Mother a Homemaker. the Parents agreed to accompany CRY Volunteers on the appointed date to the concerned hospital.Esther Rani (Compiled by Rajeev. the Parents appeared to have changed their mind and did not show-up at the Anganwadi in order to be ferried to the Hospital. A Plan was set into motion to rescue her from her condition under the Bala Sanjeevani Scheme of the ICDS. Contact was made by CRY with the Directors of Sri Jayadeva Institute of Cardiovascular Sciences and Research – Bangalore. Born on 13th June 2011 to Malamma (now about 43) and Sabanna (now about 53). for reference to the Primary Health Centre – Vibhutipura. the others being brother Anil (now about 13) and sister Sharada (now about 10). did not have the resources to treat her condition. 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. she was diagnosed with a Heart condition by Sri Jayadeva Institute of Cadiovascular Sciences and Research – Bangalore. The Anganwadi Teacher prepared the Enrolment Form for visiting the Public Health Worker visiting the Anganwadi. Esther Rani appears to be on the path of recovery from her SAM state and is gaining weight. Fearing the non-seriousness of the Parents to allow the Child to undergo any kind of corrective treatment at IGICH. CRY Volunteers then had to involve the Teacher to pressure the Father to allow for the Child to be examined. CRY Volunteers discovered her as a SAM child at the GM Palya Anganwadi in mid-2012. to examine and treat the Child under the relevant ICDS scheme. Consequently. Consequently. Taking the help of the Anganwadi Helper.

5 4 The Hindu.literally a courtyard play centre .thehindu. 20 April 2012 http://www. A plan was recently announced to expand this to providing milk and eggs to all children.Details of Malnourished Children in Each Anganwadi Brief Introduction to Anganwadi The Anganwadi . since a child born to a malnourished mother is likely to be malnourished himself. Every AWC is supposed to cater to two adolescent girls every 6 months. It is the focal point for the delivery of services at community levels to children below six years of age. The WCD has ordered that severely malnourished children be given eggs and milk four times in a week4 to combat the problem of malnutrition. 2013.is a childcare centre. everyday from January 1st. This is done both for the benefit of the girls as well as any future children of theirs.com/news/states/karnataka/milk-eggs-to-be-on-menu-for-anganwadichildren/article4112879.ece last accessed on 20th April 2013 5 18 . pregnant women. nursing mothers and adolescent girls of the age group 12-18. They are supposed to receive a take home ration of supplementary nutrition.

Eggs are provided four times a week while milk is provided twice a week. 7 are severely underweight for their age. they are given Chitrana/ Payasam alternatively. Details of Children in the Area (as on 1 June. Additionally. b) Out of 10. malnourished children are provided with a supplementary diet of milk and eggs. 2013) 1) L. R. They get a take-home ration of food. 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. Near Government School Teacher: Kaveri Key Findings: a) There are 10 malnourished children in the anganwadi and all are females. In each anganwadi.Koromangala PAG Area Each anganwadi in the area caters to two adolescent girls per six months. Nagar. 9 children have shown improvement over the period of 3 months though at a very slow pace 19 .  1 moderately underweight  2 mildly underweight d) Out of 10.

3 9.9 Female 11. Megha Raghavan was following her.S.4 Female 8.1 Ideal Weight for age (-1 SD) Grade of Malnutrition 8.3 Female 7.0 9.9 Shruthi 1.9 2 3 Severe 12.6 Female 9.7 Female 9.1 8.8 Manasaa 4.3 Female 9.2 6. 20 Mild .0 Vedavathi 3. Dr.6 9.6 Samara 3.9 Female 10.6 5 6 7 8 9 Severe 14.2012 31st March. Name of the child 1 Age in years as on 30th March. been to IGICH.9 16. Neurological abnormalities . No.6 Female 11.4 Sneha 2. 2013 Nirasha 1.2 Severe Very Severe Moderate Mild 10.7 Female 8.2 11.needs complete evaluation.7 Severe 10.2 10 6 6 * Mentally challenged.3 Severe 10.5 Benitha 5. For details refer to her database and manual .7 4 Severe 13.2 Female 5.3 9.5 Priyadarshini 1.3 Shalini 2.2 8.9 11.5 Anupriya*⁶ 3.3 10.8 8.8 13. 2013 Sex Weight in Kgs Weight in as on 21st Kgs as on December.

2013 Sex Weight in Kgs as on 21st December. Name 1 Aisha Kannu Age in Sex years as on 30th March.NO. 2012. S. Rajendra Nagar Teacher: Selvi – 9945075660 Key Findings a) Anganwadi has not been followed up since December.No. 2012 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Laxmi 1.2) Kannada Tamil School.2 Severe 3) AWC-1.3 21 Ideal Weight for age (-1 SD) 14.0 Female 9 12. 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. However no follow up has been done since then on these children. 3 Grade of Malnutrition Severe .9 Severe 2 Ammu 3.2 Weight in Kgs as on 21st December. 2012 S.5 Female 6 8. 2013 4. who were identified by Intern Siddharth Jha in December. Name of the Child Age in years as on 30th March. 2012 Female 9. Rajendra Nagar Teacher: Usha (8884761834) Key findings a) There are 2 malnourished children.

0 Female 9.2013 Shameen 3.4 Sadhna⁷* 3.3 Moni Ani 5. Has been seen by doctors in Pondicherry and recommended physiotherapy. 2012 Weight in Kgs as on 31st March.6 3 Severe 15. 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. For further details refer Dr.2 1 Severe 16. Name Age in years as on 30th March.4 Ideal Weight for age (-1 SD) Grade of Malnutrition 12. Raghvan’s Database and manual. S. 22 Severe .9 Female 10. c) All the children in the anganwadi are regularly followed up especially Sadhna. 2013 Sex Weight in Kgs as on 21st December.3 Female 11.9 Male 12 12.6 4 7 7 * Sadhna has Right Hand Deformity.8 11.4) AWC-2.5 11 Riyan 4. Her parents have also been counseled for proper feeding practices and she is improving though slowly.NO. 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.2 2 Severe 13.3 9.

5) Ambedkar Nagar. c) Bharth has been diagnosed with PEM and has been taken to Shantinagar PHC where he has been prescribed protein supplements by the Doctor. She has been seen by doctors at Indra Gandhi Hospital but they suggested that nothing can be done now as she developed irreversible damage.refer page no 15 of the report # Bharath. All the children are above 2 years of age.passed away in May.4 Severe 3.8 Severe Arogya Stella 4. 2013 Sex 1 Sudha*⁸ 4.8 Female 12. 2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 6.2 Moderate Shobha 4.0 Severe Bharth #⁸ Weight in Kgs as on 21st December.4 9.9 12. Name Age in years as on 31st March.seen by Doctor at Shantinagar Maternity center in April.0 11.6 Female 2 Sholo Breakmance 4. 2013 e) Sholo has been doing well with proper counseling of his parents. d) Sudha had progressed to advanced brain damage due to chronic malnutrition. Case story.0 Female 11.5 14. b) All children are doing fairly well and are being regularly followed up. Near Public Toilet Teacher: Manjula (8710075205) 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.2 15.3 14. 2012 Male 8 8 * Sudha. His family has also been counseled about proper feeding practices and he has shown some improvement since then but need regular follow up.2 13. S. She passed away in May. NO. 2013 23 .0 3 Sanjana 4 5 6 Weight in Kgs as on 31st March. Needs regular follow up.9 Very Severe Male 11 11.8 14.4 Female 9.8 6. 2013.

NO.7 10.6 7 Kaushik* ⁹ 3 Male April 15. Also his guardians have been counseled about proper feeding practices and he has been doing well S.4 Severe 6 Sara 4. nagar. 6 out of 7 children have moved from the area.8 Female 6 9. 2012 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Malin Bahno 3. Been to Chandrashekhar Speech and Hearing Institute (CSHI) 24 . 11th cross. 2013) Moderate 9 9 * Kaushik: Hearing and Speech difficulty. Jalali cross. Name Age in years as on 30th March.9 13. Only Kaushik is enrolled with EWS anganwadi. Sara has moved to Husor Road and Sarjapur Road respectively and are also not enrolled in any anganwadi.5 Severe 4 Madhumatti 2.8 Female 11. contact no is 88840027 c) Ferdoz Begum.1 15.5 14.R. d) Ruhi has moved to L. e) Kauhsik has been regularly followed up.0 Female 6.4 (taken on 12. b) Malin Bahno has moved to Ambedkar Nagar.2 Severe 11. No other contact details. 2013 Sex Weight in Kgs as on 21st December.2 Female 7.4 Severe 2 Ferdoz Begum 4.5 Male 8.5 10.2 Severe 5 Ruhi 1.5 Female 10.8 Severe 3 Ruhi Begum 2. Ruhi Begum and Madhumati.6) EWS Quarters Teacher: Sumathi (8904437493) Key Findings a) Due to demolition of Ejipura Slum.

2 Severe 4 Jayashree 1.2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Shankar 5.7 Female 7 7 9.0 Severe 3 Tejaswini 1. Name Age in years as on 30th March. 2013 Sex Weight in Kgs as on 21st December. NO.8 8.0 Very Severe 2 Priya 3. Also while talking to their mother.2 7 9.6 6. 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.4 Moderate 25 .5 16.9 9 11.7 Female 6. d) There is either drop in weight or weight is not improving in all the cases.1 10 13.5 Female 11. S. it has come to our notice that despite having BPL card.5 Female 10. R.st 7) 1 Cross L. c) The children are not doing well despite the best efforts on the part of Anganwadi teacher Regina.2 Severe 7 Keerti 2. b) 6 children are severely malnourished out of which 50% are under the age of 2years. Nagar Teacher: Regina (9900809567) Key Findings a) There are 7 malnourished children in the anganwadi out of which 6 are females.9 Severe 5 Sania Misra 5.7 Female 9.6 Male 10 11 17.5 Female 6. 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.5 Severe 6 Monisha 1.2 11. 2012 Weight in Kgs as on 30th March.

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. e) Sufian is the son of same Anganwadi teacher and is doing well. Therefore children are not given EGGS and MILK and occasionally supplementary food is provided. Name Age in years as on 30th March.4 Severe 26 .1 14.2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 3. d) Izaz and Aman has not been followed up. Aman has gone to his village and hence has not been seen since a month.NO. it does not have adequate funds from the concerned authorities for the provision of EGGS.7 14. S.7 14 Very Severe 3 Aman 4 Male 10.9 Very Severe 1 Izaz 2 Rakshita # 4 Female 8. MILK and supplementary food.1 Male 8 12. 2013 Sex Weight in Kgs as on 30th March. She needs to be regularly followed up. 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.4 Severe 4 Sufian 4 Male 11. Her mother was also counseled by us for proper feeding practices.

7 Severe 27 .8) Inside Urdu School Teacher: Pushpa Key Findings a) The anganwadi has one malnourished child.3 Female 9. S. He has been seen by the doctor at Sidhamaya Hospital and his mother has been counseled for proper feeding practice.NO. He needs to be regularly followed up. Name Age in years as on 30th March. 2013 2.9 11. Name 1 Sultan 10) Age in years as on 30th March. 2012.6 11. S. 2012.5 Sex Weight in Kgs as on 30th March.9 Female 8. c) However. we have been trying to meet the anganwadi teacher and the parents of these two children but could not. 2013 Sex Weight in Kgs as on 21st December.7 Severe Shastri Nagar Teacher: Padma (8453578256) Key Findings a) Anganwadi has not been followed up since December. Sultan who is severely underweight for his age and suffers from frequent infections due to low immunity.6 12. b) There are 2 malnourished children in the anganwadi who were identified by intern Siddharth Jha.NO.2012 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Kavya 3. b) Also the anganwadi has not been followed up since December.2013 Ideal Weight for age (-1 SD) Grade of Malnutrition Male 5.7 Severe 2 Franka 2.

7 Severe 3 Jeelan 1. S. b) Out of 4.1 Female 8 8. b) Though at a slow pace but all children are doing fairly well but still needs regular follow up. they are given Chitrana/ Payasam alternatively. They get a take-home ration of food. Name Age in years as on 30th March.4 Very Severe 2 Rihalia 2.8 Female 9. Additionally.Yeshwantpur PAG We have been covering only 4 anganwadis in the area.3 Female 8. malnourished children are provided with a supplementary diet of milk and eggs.5 9.5 12.4 Severe 4 Tasleem 2. Eggs are provided four times a week while milk is provided twice a week.6 Moderate 28 .2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Mehek 3. 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. 2013 Sex Weight in Kgs as on 21st December.5 10 11.1 10.5 9.8 Female 7 7. 2012 Weight in Kgs as on 30th March. NO. Each anganwadi caters to two adolescent girls per six months. In each anganwadi. 3 are still severely underweight for their age but one child Tasleem has made progress from being severely malnourished to moderately malnourished now.

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.5 11.4 Male 10 11.1 Severe 3) Akiappa Garden Teacher: Manjula (9739210980) Key findings a) The anganwadi is regularly followed up by the volunteers but anganwadi teacher is reluctant to share the information about the kids.5 Moderate 29 .6 Female 10. 2012 Ideal Weight Grade of for age (-1 Malnutrition SD) 1 Keerthana 2. Thus the volunteers have been unable to follow up the kids regularly. Although she has been followed up by the volunteers. 2012.5 Female 8 11. 1 moderately underweight and 1 mildly underweight. 2013 Sex Weight in Kgs as on 21st December. Name Age in years as on 30th March. NO. S. NO. Name Age in years as on 30th March. b) There are 4 malnourished children as identified by intern Siddharth Jha out of which 2 are severely underweight for their age. S. 2013 Sex Weight in Kgs as on 21st December.2 Mild 2 Sindhu 2. 2012 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Angel 2.

5 Moderate 2 Sultan 4.0 Mild 4 Hemad Ul 1.3 Female 12. Name Age in years as on 30th March. NO. 2 moderately underweight and 4 mildly underweight.5 Moderate 3 Umar 1.4 Mild Rehman 30 .4 Male 9 9.8 Male 14 15. 2013 Sex Weight in Kgs as on 21st December . b) Out of 12 children.7 Male 9 10.7 Sachin 4 Manikuntta 3.5 14. 2012 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Mehek 4.7 Male 11 Geetha 3. only 4 are females.7 Severe 4) AWC-2. it is difficult to say under which grade of malnutrition they can be categorized S.3 13. c) 5 children have been graded malnourished by the anganwadi teacher but since their age/Date of birth is unknown.3 Female 10 Severe 12. 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.

1 Female 10 10.5 Unknown 9 Shahid-2 Unknown Male 10 Unknown 10 Asif Unknown Male 10 Unknown 11 Sab Falaak Unknown Female 7.5 Ameenabi 2.3 Mild 6 Abdul 0.9 Male 12 12.5 Unknown 12 Rekha Unknown Female 8 Unknown 31 .5 6.5 Male 4.3 Mild 8 Shahid Unknown Male 10.7 Severe 7 Hanif 2.

Additionally. Eggs are provided four times a week while milk is provided twice a week.1 Severe 32 . NO. 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. Name Age in years as on 30th March.  3 are severely underweight for their age.2 9.8 Male 10 12.Jeevan Beema Nagar PAG In this area. c) Among the severely underweight children Estharani and Dinesh are being regularly followed up. 2012 S. Chaarulata has not been followed up since December. 2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Estharani# 1. they are given Chitrana/ Payasam alternatively.  14 are under the age of 5 years b) Out of 17.9 Female 7. In each anganwadi.  10 are moderately underweight and  4 are mildly underweight. They get a take-home ration of food. 2013 Sex Weight in Kgs as on 31st March. only GM Palya caters to adolescent girls – two of them per six months. malnourished children are provided with a supplementary diet of milk and eggs.6 Severe 2 Dinesh 2.

7 Moderate 8 Hema 3.9 Male 14 15.7 13.0 Severe 4 Giridhar 4.9 Female 9.7 Male 11.0 Moderate 9 Niket 5.8 16.5 Mild 10 10 # Estharani: has heart condition.9 14.5 Male 10.3 Chaarulata 4 Female 11 14.8 11.4 14.8 Female 13.4 10.4 Male 13.2 13.7 Moderate 12 Priyadarshini 4.4 Moderate 14 Mahesh 3.3 16.0 Mild 17 Sushmita 1.4 14.2 Moderate 7 Basavaraj 2.8 Mild 15 Kavitha 3.1 Female 11.5 Female 11.9 16. 2013 33 .2 Moderate 11 Vishal 3.4 Female 14.6 Female 12.0 Moderate 5 Pavithra 5.2 Male 14.3 Moderate 6 Vaishnavi 4.9 15.4 Mild 16 Sapna 4 Female 13. Seen by the doctors in March.2 Male 14.1 Female 11.4 Moderate 10 Sandhya 4.9 Moderate 13 Pavan 5.4 12.5 15.

9 14. Therefore she needs to be followed up regularly.2 14.2) AWC-2.5 Female 10. Though the decline is not so steep but it suggests that she suffers from infections frequently and looses weight with each episode of infection.  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.2 Severe 4 Pranavi 4 Female 8.2 12. 2013 Sex Weight in Kgs as on 31st March.0 Moderate 7 Sauolya 4 Female 12 14. Earlier she was 8. Name Age in years as on 30th March.2 Kgs.5 Male 8. NO. Nellurupura Teacher: Rajeshwari – 9916511827(Teacher’s husband) Key Findings a) There are 13 malnourished children in the anganwadi out of which  10 are females  11 are under the age of 5 years b) Out of 13.0 Mild 34 .8 Moderate 6 Nandini-2 4 Female 13 14.0 Moderate 8 Nandini 4 Female 13.4 Severe 2 Bhargavi 3. S.0 Severe 5 Spoorthy 4.2 13.1 13.5 14. 2013 Ideal Weight for age (-1 SD) Grade of Malnutrition 1 Surendra 3.0 Severe 3 Akhila 3 Female 10.4Kgs and reduced to 8. all have shown little progress except Pranavi who has lost weight over the period of time.5 Female 13.

2 14.4 14.8 Mild 12 Dharani 5 female 14.4 16.8 Female 13.2 Shalini 6.3 13. 2013 Jaswant 5.2 Mild 11 Laavanya 4. Nellurupura Teacher: Narayanamma (7795348456) Key Findings a) There are 28 malnourished children in the anganwadi out of which  13 are females  17 are under the age of 5 years 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.4 Monica 4.0 Female 12.5 Severe Severe Severe Severe Severe Severe .1 Manish Kumar 3.4 Mild Ideal Weight for age (-1 SD) Grade of Malnutrition 3) AWC-3. 2013 Sex Weight in Kgs as on 31st March.5 Male 9.0 Female 12.4 18. NO.5 female 13.4 Mild 10 Triveni 5 Female 15.5 Male 12.9 18.2 Mild 13 Vinay 3.5 Divya 5.9 17.2 Nandhini 5.8 14.3 Female 12.4 35 15.1 13.9 Siddhu 4 Male 12. 1 2 3 4 5 6 Name Age in years as on 30th March.2 Female 12.2 16.

8 12.5 18.3 12.2 13.7 20.1 Female 17.4 Venkatesh 4 Male 14.1 Male 12.8 Prithvi Narayana 3.2 Male 16.0 Female 13.9 Severe 14.1 Uday 3.3 Kushi 6.3 14.8 Ashok 4 Male 13.8 Male 13.4 14.5 Female Male 16.2 Ravi 6.7 16.2 Female 11 Srividhya 5.6 6.4 Kusuma 3.1 Male 16 Chakradhar 3.5 16.2 Shahin 2.2 Charantej 2.6 Female 11 Sathish 4 Male 13.5 Akash 5.4 Female 14.2 Severe 9.2 Aparna 3.7 16.5 15.0 Male 11.2 Male 12.9 Aishwarya 5.7 12.4 1.5 15.7 36 19.5 12.5 Chandru 3 Male 10.3 Moderate Moderate Moderate Moderate Moderate Moderate Moderate Moderate Moderate Mild Mild Mild Mild Mild Mild Mild Mild Mild Mild Mild .5 Male 17.7 14.4 Venkatesh 4.8 18.9 Female 11.7 18.7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Navya Nikhil 7.1 Male 12.7 Prasanna kumar 5.0 Female 10.3 Male 11 Sindhuja 2.3 12.7 Deekshith 4.

7 Ideal Weight for age (-1 SD) 15. Nellurupura Teacher: Sunanda (8861138455) Key Findings a) There are 11 malnourished children in the anganwadi out of which  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.9 Male 11.3 13.4) AWC-4.6 Male 11 Female 15 Female 10.2 Unknown Male 37 14.7 16.5 Female 10.5 Female 12.8 3 3.2 13.7 Unknown Grade of Malnutrition Severe Severe Severe Severe Moderate Moderate Moderate Moderate Unknown Unknown Unknown .4 12.2 13. 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.5 3.8 3 5.7 Unknown Female 14.9 Male 10.7 Unknown Unknown Unknown Sex Weight in Kgs as on 31st March. 2013 4.8 12. NO. 2013 Female 11.0 13.4 3.8 3.6 Female 8.

Church Madivala Hosur road 38 .MADIVALA PAG In each anganwadi. Anganwadi No of Name No of No of Pregnan Lactatin children Malnouri g below shed 3yrs children Children t Women Mother No of No of Total Anganwadi users s Siddhartha Nagara. There are two areas which the PAG covers. they are given Chitrana/ Payasam alternatively. a) Siddharth Nagar in Madivala Proper  Following information is available from CRY interns George and Ramya’s Report (November. No follow up has been done since then. Siddhartha Nagara opp. 20 6 7 25 3 58 20 5 5 23 2 53 20 6 5 22 3 53 Madivala Hosur road 1st floor Siddhartha Nagara Madivala Hosur road. malnourished children are provided with a supplementary diet of milk and eggs. Additionally. Eggs are provided four times a week while milk is provided twice a week. 2012).

N. The details of some of the kids we have come across are given below.??? 6) How should we manage the cases of malnutrition…???? (Refer to Page No. 2013 6 9 Unknown Unknown Ideal Grade of Weight Malnutrition for age (1 SD) 14.... 39 . we keep on acting haphazardly instead of going in a systematic manner.4 12. So for the answers Refer to Section 2. Palaya Area There are 4 anganwadis in the area. Name 1 2 3 4 Charan Charmi Joseph Appu Age in Sex years as on 30th March. 56) And answers to these questions are necessary to know to address the issue of malnutrition in a comprehensive manner. 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. Until we know the answers to above questions. 2013 4 Male 3 Female 14 Male Unknown Male Weight in Kgs as on 31st March.??? 5) What are perceptions about nutrition in the community.??? 4) Why the nutrition in girl child so important. S.2 Unknown Unknown Severe Severe Unknown Unknown So.b) N S Palaya Area  Volunteers have been working hard to get the information about malnourished children. Though only the following children have come to our notice S. NO. 47) 7) What are the initiatives by the Government…??? (Refer to Page no.

the status of nutrition in Karnataka is a matter of shame. It results from deficiencies in any or all nutrients. and other nutrients it needs to maintain healthy functions of the body. With SGDP of 8. India’s eighth largest State in terms of geographical size (191. The term malnutrition encompasses both under-nutrition and overnutrition (ex. It results from a deficiency of specific micronutrients such as Iron deficiency.?? Nutrition is the process of nourishing or being nourished.2% in 2010-11 (more than the national average). 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. minerals.2) What is Malnutrition…. Micronutrient deficiency diseases It co-exists with PEM but most commonly over looked in the absence of knowledge.000 according to Economic Survey 2010-11.3% of children in Karnataka are underweight. 40 . However more commonly it is used to denote under-nutrition. is home 5. 33.9% wasted.Energy Malnutrition (PEM) The common condition we come across in the field.4% stunted and 18. Despite the rapid progress made by the state on the economic front. 42. It is broadly classified as: Malnutrition Protein.1) Introduction to Malnutrition Karnataka. 60. Child malnutrition can manifest itself in several ways. 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. Vitamin A and Vitamin C deficiency In this report we are discussing about PEM.: obesity). According to National Family health Survey-3 conducted in 2005-06 by Government of India.791 sq km). (2.Section 2: Insight into Malnutrition (2. Karnataka is one of the fastest growing state having per capita income of Rs.1 % of India’s population.

(2. develops weight and height in range for the age Measured as: chronic malnutrition i. due to rapid weight loss Weight for height Height for age 41 to assess malnutrition in India.?? WHO has recommended certain indicators to assess malnutrition and given standard values to compare.e. A sign of Most commonly used malnutrition i. a sign of acute Normal Child with height. Weight for age . it develops over a long period of time.e. It shortness of stunting and wasting. The common indicators which are used are as follows: Underweight: Stunting or combination of both Wasting or thinness.3) What we come across in the field….

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. Please Refer to Annexure 1 for WHO Growth Standard Charts.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. 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 m² Classification of adult malnutrition (also called as chronic energy malnutrition) using BMI Classification Mild Moderate Severe Cut-off point using BMI 17< BMI< 18. 42 . the knowledge about under nutrition in mothers help us to address the issue in its wholeness.

ThousandDays.org 43 .Causes and Cycle of Malnutrition Picture 4: Causes of Maternal and Child Malnutrition Source: www.

Picture 5: Immediate and Underlying causes of Child Malnutrition 44 .

FAO. UNESCO.The Irony of Girl Child Malnutrition Picture 6: Vicious Cycle of Malnutrition in Girl Child in India Source: UNICEF. IFPRI 45 . SAVE THE CHILDREN.

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 children’s
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. Raghvan’s Manual

Talking to Healthcare Worker and Link
workers at PHC

47

WINDOW of OPPORTUNITY The 1,000 days from the start of a woman’s
pregnancy until her child’s 2nd birthday offer a unique window of opportunity.
The right nutrition during this 1,000 day window can have an enormous impact on a
child’s 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.

Hence hygiene and Sanitation comes into play. HOME BASED MANAGEMENT  The children with moderate malnutrition need to be taken care of at home also. 2) Milk – Milk is essential to provide energy and calcium which are responsible for the growth of the child 3) Green leafy vegetablesAdd Palaka. Children with complication like a) Fluid accumulation in the feet (checked by putting thumb pressure near the ankle. Gongura leaves to routine diet.  Since the immunity of the children is weak they are prone to infections very frequently. They are good source of iron and other necessary nutrients 4) Pulses like moong dal. episodes of diarrhea. And refer for further follow up with Anganwadi Teacher (AWW). They are good source of iron and other necessary nutrients d) Pulses like moong dal. Gongura leaves to routine diet. there is possibility of fluid accumulation a sign of PEM) b) Crackled and Rough textured Skin c) Frequent infections. Bengal gram.  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. Bengal gram.  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. Bananas 49 HOME BASED MANAGEMENT  The children with moderate malnutrition need to be taken care of at home also. black gram e) Fruits like Pomegranate.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.  Since the immunity of the children is weak they are prone to infections very frequently. 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). Hence hygiene and Sanitation comes into play. black gram 5) Fruits like Pomegranate. if the depression due to pressure doesn’t go away immediately. Bananas For Details of the Recipes . b) Milk – Milk is essential to provide energy and calcium which are responsible for the growth of the child c) Green leafy vegetablesAdd Palaka.

Satish Chandra Medical Superintendent Phone .in/. Bangalore.See Annexure I and II 1) Indira Gandhi Institute of Child Health ¹¹(under BAL SANJEEVANI SCHEME) For Details of the Recipes See Annexure I and II Near NIMHANS Hospital. Contact No.igch. Bengaluru Contact No. Krishna Rajendra Market.org/ .vanivilashospital.bmcri.org/bowring_hosp.PRO : 98452 – 02266 Phone: 080 2559 1325/1326 Fax: 080 2559 1325 bowringandladycurzonhospital E-Mail : @gmail. Khaja Mohideen (9845202266) For HOME Based management refer to Orange section.Bowring hospital 50 .html.Vani Vilas Hospital . Near Victory Hospital. Some Gowda Medical Superintendent Phone : 94482 73928 Dr. Bairasandra. 11 11 www.: 080 2670 2487 Dr. Nutritional Rehabilitation Center (NRC)¹¹ Fort Rd.Indira Gandhi Institute.: 26342421 / 2634314 2) Vanivilas Women and Child Hospital. Kalasipalyam.: 080-2670 5206 080-2670 5204 3) Bowring And Lady Curzon Hospital¹¹ Dr. H.com Public Relations Officer : Dr. www.Madhusudan Resident Medical Officer Ph : 99800 0667 Emergency No. www.

ASGARI (MO) A B SIDDQUI (STAFF NURSE) 26780191 NEELA (AWW-AWC 3) 9945539964 MAHALAKSMIAMMA (AWW. Nagar 51 .AWC 4) 9632092676 DR. Rajendra Nagar Usha (AWW) 8884761834 AWC-1. Rajendra Nagar Manjula (AWW) 7204785225 Ambedkar Nagar. SHIVLINGAM (MO) MAHADEVIAMMA (STAFF NURSE) 22975870 9986462707 Kannada Tamil School. Rajendra Nagar Selvi (AWW) 9945075660 AWC-2.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. L. Near Public Toilet Manjula (AWW) 8710075205 EWS Quarters Sumathi (AWW) 8904437493 Regina (AWW) 9900809567 1st Cross. R.

MEERA NAIK SUMITRA (STAFF NURSE) NISHA (LINK WORKER) 9448860796 9972241866 8861063663 G M Palaya Laxmiamma (AWW) 9740583215 AWC-2. Nellurupura Narayanamma (AWW) 7795348456 Sunanda (AWW) Manjula (AWW) 8861138455 9739210980 AWC-4. Nellurupura YESHWANTPUR Akiappa Garden SHERIFF NAGAR-1 Tahseen Taj 52 9591841468 . LAKSHMI (MO) 9341326023 KODIHALI DR.Shastri Nagar JEEVAN BEEMA NAGAR Padma (AWW) 8453578256 C V RAMAN NAGAR DR. Nellurupura Rajeshwari (AWW) 9916511827(Teacher’s husband) AWC-3.

Nutritional Rehabilitation at HOME To combat malnutrition. Simple and easy nutritional intervention at HOME can help to reduce the malnutrition. 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. daals like 53 . 6 months . millet mixed with cow milk. Give baby Colostrum (the first secreted yellow colored milk) 2) Exclusively Breastfeed the baby for SIX months. Age Birth . ground rice wheat flour. ragi. Note : 1) In case of Diarrhea.means only breast milk nothing else not even water.6 months Suggested Diet 1) Start breastfeeding after one hour of delivery. Initially start with 3-4 spoons and gradually increase to half a cup at a time.9 months Continue Breastfeeding but start complementary feeding. 2) Feed thick mixtures rather than thin gruels. 9 months . the first step starts at home only.12 months baby should be given the following: 1) Mashed vegetables (green vegetables like palaka). Do not stop breastfeeding and add rice water mixed with a pinch of salt and a teaspoon of sugar. Include the following: 1) Cereal based Porridge like suji. All food is not good for complementary feeding.

to taste Roast all the contents together and mix well.1 handful Mashed peanuts. bengal gram(Kadale Bele) and black gram(Udhina bele) 2) Mashed chappatti made of ragi and wheat softened in daal or milk 3) Eggs. Jaggery .1/2 cup. 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. At least one egg daily is given to baby from 12 months of age.moong dal (heasarubele).1 handful.make them an important part of baby’s routine meal. 54 . wheat. 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 .according to taste SAT Mix: Roasted and ground rice. LAPSI: Green millet. Can be made more energy dense by adding seasonal fruits and Vegetables.1 handful Jaggery.

Pregnant Above mentioned recipes can be fed except papaya. turmeric and coriander powder) 1 teaspoon each Water 5 cups 55 . dosas and idlis with Ragi. 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. Adolescent Girls. OR Prepare Upma. garlic. 4) Pomegranate seeds (Dalimba bijagalu) 5) Also add the above mentioned recipes to the routine diet. Add cumin Seeds to it. Women. 4) Wheat.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.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.

But prolonged use can be harmful.Note: All the recipes are easy to make and can be stored in dry form and water can be added later on. 3) For children. 3) Avoid un-mashed food items for infants as their swallowing reflex is not well developed and hence can cause obstruction in their airway. 5 per person. 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. 79 56 . 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. Refer to Annexure II on Page No. 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. NOTE: More nutritional recipes are attached in ANNEXURES which are distributed under ICDS in other states. So those recipes can also be advised.

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. ICDS Scheme represents India’s biggest response to the challenge of providing pre-school education on one hand and breaking the vicious cycle of malnutrition. on the other. morbidity.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. Services Supplementary Nutrition Target Group Service Provided by Children below 6 years: Anganwadi Worker and Anganwadi Helper Pregnant & Lactating 57 .htm Launched on 2nd October 1975. today. reduced learning capacity and mortality.in/icds.nic.

Hilly and other difficult areas/Projects 300-800 1 AWC For Mini AWC in above areas 150-300 1 Mini AWC 58 .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.Immunization* Mother (P&LM) Children below 6 years: ANM/MO Health Check-up* Pregnant & Lactating Mother (P&LM) Children below 6 years: ANM/MO/AWW Referral Services Pregnant & Lactating Mother (P&LM) Children below 6 years: AWW/ANM/MO Pre-School Education Nutrition & Health Education Pregnant & Lactating 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.

No. This scheme covers BPL families wherein 0.00 Nutritional Norms for Supplementary Nutrition (Revised vide letter No.2008) Sl. 5-9/2005-ND-Tech Vol. F.2. 2. 1.2009) SI. 3.00 Rs.II dated 07.00 Rs. 2. a sub scheme under the main scheme namely Bala Sanjeevani was conceived and implemented.5.Financial Norms for Supplementary Nutrition (Ministry’s letter No.11. to improve the child’s health.2.70 Revised rates (per beneficiary per day) Rs. II dated 24.00 Rs. Calories 1.6 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.30 Rs. Category Pre-revised rates Children (6-72 months) Severely malnourished children (6-72 months) Pregnant women and Nursing mothers Rs.No. 3. Category No.2. Children (6 months6years) Severely malnourished children (6 months.4.6 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 .per year is given to each severely malnourished child for meeting medical expenses for therapeutic food and medicines etc.6. Bal Sanjeevani Scheme Under ICDS During 2010-11. 750/.2. 4-2/2008-CD.

i) Hot Pongal ii) Broken Wheat Kichidi.. supplied by the Project Directors through District Purchase Committee. supplied by A. Kichidi Mix. 3.50 for eggs instead price of eggs is Rs. Take Home Ration is being given for 6M – 3Ys.rajasthan. Foods.50 in Bangalore. of Rajasthan Dep’t. Reason: High cost of Eggs during this period.4 times in a week all year except in the months of February.. For children less than 3 years of age.50 1) Ready to Eat Food (RTE) a) RTE / Modern Therapeutic Food supplied by A. Of Women and Child.google. and May.gov. Upma Mix. For children under 3 years of age given as THR Rajasthan Andhra Pradesh Dep’t. What happens with the funds for eggs has not been revealed by the AWW. 3) CM SNP: Supplied Jowar Mix by Mothers Groups. 1. Govt. Government provides Rs. 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.Comparison of Supplementary Nutrition Provided under ICDS in different States through Anganwadis Karnataka (Bangalore Urban) 1) Eggs.P. Average cost per person : Rs. 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. So anganwadis are unable to buy the eggs. given as THR. March. Milk In the afternoons: 2) Local Food Model: Ration is is given in form of the milk powder.2. Halwa Mix. 2) Milk: is given 2 times in a week. 60 .3. of Andhra Pradesh http://wcd. Pregnant & Lactating Women once in 15 days. Foods. 2.P. 1) Hot cooked meal: a) Khichadi b) Dalia Dalia and Khichadi are given alternatively.4 or Rs 4.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. April. b) Three types of Hot Cooked Food Premixes.in / Eggs and Milk are given in the breakfast along with the following: https://mail. Of Women and Child Govt.

coconut rice. For detailed Recipes of the food premixes and hot cooked meals See Annexure I 61 . 4) Kesaribath and bisibelebath twice a week is a provision: For Pregnant ladies. 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.  rava laddu. sambar rice. ragi kheer and rice kheer would be supplied six days in a week.  coconut rice and  sambar rice on different days of the week Ration Size: Increased Ration Size as per revised cost norms.  Puliyogere rice. 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.  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.  155gm Halwa under Decentralized Nutritional Supplement and Women empowerment Scheme  The scheme is the result of joint efforts by the ICDS. For malnourished Children 140 gms. rava ladu. 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. Lactating mothers and Adolescent Girls. Patil are:  avalakki (beaten) mixture. Halwa/ 125gm Panjiri Mix 4) 3-6years (Severely 5) Proposed changes in SNP in 2011 by then WCD minister C.  puliyogare rice. Lactating mothers and Adolescent girls (per day): For Pregnant & Lactating Mothers 140 gms. Provisions for Pregnant Ladies. DRDA and the Medical and Health Department.3) Chitrana/ Payasam: In the afternoon Chitrana and Payasam is given alternatively which are rice based meals.  140gm Halwa Premix/130gm Upma Premix under SABLA Scheme  Pregnant and lactating women will be provided “one full meal” under the program.C.

Distributed at AWCs on 15th of every month III. 6 /. 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 .0 1. fruits. Of Women and Child www.0 per cent).00 The ration cost under the scheme is fixed at Rs. Snacks Biscuits. 2 /.Bihar Orissa Dep’t.in/ Under ICDS a) Emergency Feeding Under ICDS Service Hot cooked meal Target Children 3-6 years Service Entitlement / Service Standards I. In addition to that.wcdorissa.5 Poorak Poshaahar Yojana: provides supplementary nutrition to the children between 6 months-6 years of age.gov. Each AWC provides supplementary nutrition at the rate of Rs.6 grams of protein II. of Bihar www. Wednesday & Saturday -Khichri Tuesday -Rasiyav Thursday Halwa Friday -Pulao Under this program BPL Rice is allocated by the Government of India. where the child is severely malnourished. Provided for 25 days in a month II.00 I.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. salt and condiments and The nutritional value of which is 812 K. Of Women and Child Govt. The Scheme is funded by the Centre and State Governments on a 50:50 ratio basis. with the help of World Food Program (an arm of United Nations) INDIAMIX is distributed to the beneficiaries INDIAMIX contains roasted.gov. Hot cooked meal served at 12 noon Monday.  30 gms of dal.icdsbih. Provided at AWC for 25 days a month Under this each beneficiary is provided with  250 gms of rice. 5. 5 /. Entitlement Nutritive value and cost per day Energy(Kcals) Protein(gms) Cost(Rs) Children 3-6 years 500 600 4. Entitlement . vegetables. milled maize (40 Dal (kg) Pregnant. of energy and 21.Food Age group Rice(kg) Children 6m to 3 years a. IV.25 2. Malnourished 2. Severely malnourished 4. This mix is comparable to a nutritious supplementary food that has been used throughout the world 1. pregnant and lactating women and adolescent girls. Cal.in/ Dep’t.Lactating women 3.per woman and girl per day and Rs.per day per child.5 b. oil. Rs. The centre provides these services for 25 days in a month. roasted grams to be served at 9 AM when preschool starts III. wheat (40 per cent) and full-fat soya (20 per cent) fortified with vitamins and minerals.per child per day. b) Supplementary Nutrition: Supplementary Nutrition is provided according to the ICDS norms.50 per day per beneficiary.

Maharashtra Dep’t.gov. h) In another 12 days the child with the mother will attend the NCCS.aspx The state of Maharashtra has implemented the concept of Village Child Development Centers (VCDCs). Medical officer and Child Development project officer should classify MAM and SAM children covered under the area of Primary Health Centre. This process continues till the child gains weight. f) Children should be weighed before & after attending the NCCS g) Next 18 days mothers practice the new ideas from NCCS at home. 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. Following criteria should be applied for the said classification: . Of Women and Child http://www.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.nutritionmissionmah. Districts of Bihar. make the children eat together. This has yielded good results in Mayurbhanj and Kalahandi. 63 Government of Maharashtra has opened Child Development Centers (CDC) and Village Child Development Centers (VCDC) to manage the malnourished children.in/Site/Home/Index. share with and learn from each other.

excluding holidays .  This centre will provide diet and healthcare services and facilities for empowerment of mothers. No. 2) Those SAM/MAM children who have minor complications Home diet 100 420 4 1 Boil Potato. 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. 1 Banana 8 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 .Nutritional Protocol for VCDC:1 to 30 Days Sr. 1 Banana / 1 Egg. Time Calories Protein Nutrition for each Requirement Child gm Amylase rich flour Shira / Upma / 100mg Lapshi 1 8:00 AM 2 10:00 Anganwadi food + 5ml oil AM 3 12:00 Anganwadi food + 5ml oil Noon 4 2:00 5 6 7 4:00 6:00 PM 8:00 PM Total Ideally Nutritive Nutrition 420 8 1) Those SAM/MAM children who do not suffer from any complication therefore do not require any medical treatment Village child development centre (VCDC). They function for 30 days.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.

htm . i. to provide a supportive atmosphere for self–development.in/index. 2) Balika Mandal (For Girls in the Age Group 15–18 Years) It has more focus on social and mental development of girls mainly in the age group 15-18 years 12 12 http://dwcdkar. Prophylaxis measures against anemia.php?option=com_content&view=article&id=62&Itemid=114&lang=en wcd. A general health check up every six months iv. ii. 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. and vitamin deficiencies etc. Immunization iii.in/KSY/ksyintro.Kishori Shakti Yozana¹² Kishori Shakti Yojana (KSY) – a special intervention has been planned for adolescent girls using the ICDS.nic. It is meant to break the cycle of nutritional and gender disadvantage. De worming vi. 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 11–15 years are identified. Convergence with Reproductive Child Health Scheme. Referral to PHC/District Hospital in the case of acute need viii. Treatment for minor ailments v. Services:– Educational activities through non–formal & functioned literacy pattern. goiter. vii.gov.Ministry of Women and Child Development 65 .

Bellary. Bangalore®.IFA supplementation. This scheme called Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) SABLA. child care practices . Nutrition Component: Take Home Ration or Hot Cooked Meal 11‐14 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) 11‐18 years .Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) SABLA¹³ Adolescence is a significant period for mental. Uttar Kannada.Nutrition & Health Education (NHE). 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). ARSH.php?option=com_content&view=article&id=62&Itemid=114&lang=en. Kolar .Health check‐up and Referral services. child care practices .in/schemes/sabla. has been implemented in 9 districts (Gulbarga.htm 66 .Life Skill Education and accessing public services b) 16‐18Years . . ‐ Counseling / Guidance on family welfare. Chickmaglur. Bijapur.nic. ARSH. Kodagu) of the state. emotional and physiological development of children. . http://wcd.gov.Life Skill Education and accessing public services 13 13 13 http://dwcdkar.in/index.Vocational training under National Skill Development Program • For In school Adolescent Girls: (twice a month – average) c) 11‐18 years ‐ Nutrition & Health Education (NHE).Counseling / Guidance on family welfare. . Dharwad.

000/. 14 14 http://pib.nic. 1.within 6 months of pregnancy. 1. Pregnant women would receive a) Rs. viz Dharwad and Kolar.in/ .  Pregnant and nursing mothers are given nutrition and health education.000/.after six months of child birth after following the norms laid down under the scheme. An amount of Rs.nic.  AWCs are used as the main platform for implementation of the scheme in the piloted ICDS projects. Government of India 67 . d) The above beneficiaries are also eligible for financial assistance under Janani Suraksha Yojana (NRHM).in/newsite/erelease. http://wcd. 1.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. health tips and IYCF guidance.aspx?relid=92392 .500/.within 3 months of delivery. and c) thereafter Rs.is paid in 3 installments.500/. 4.  IGMSY is a centrally sponsored scheme with 100% assistance from GOI.Ministry of Women and Child Development. b) Rs.

 This facility is extended to all xvi. cap and socks for baby One plastic kit bag. and delivered in government hospitals.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.Care for the pregnant MADILU . 15 15 NRHM Karnataka: http://stg2. xv. v. two deliveries. poverty line families  The benefit is limited to the first xviii. xix. vii.Karnataka¹ Prasooti Araike . 2000 paid through bearer cheque.in/healthnew/NRHM/PrPrasooti%20Araike.e. xii. between 7th and 9th month). The benefit is limited to two live deliveries.  The beneficiaries will get Rs.aspx 68 . xiii. x. iv.nic. 1000 during the 2nd trimester ANC (i. pregnant women belonging to below xvii.. ix. iii. 1000 during the 3rd trimester ANC (i. viii. vi.e. The beneficiaries must belong to below poverty line families. between 4th and 6th month) and Rs. xiv. ii. totaling Rs.kar.Schemes Under NRHM. 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. i. xi.

Janani Shishu Suraksha Yozana (JSSY)¹⁶ 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 .

No age constraint. 16  16  http://www. Government of India: http://pib.kar. Directorate of Health and Family Welfare.aspx?relid=72433. BPL pregnant women. health facilities. 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.thehindu.com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.(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. LIMITATIONS LPS HPS All births delivered in the govt. Karnataka http://stg2. http://www. health centers.ece dated May 22.org/userfiles/8GuidelinesforJSSK.nic. The compensation for ASHA or an equivalent worker if she stays with the pregnant woman in the health centre for delivery.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.in/newsite/erelease.nic. aged 19 and above All SC/ST women delivering govt.iapsmgc.pdf Ministry of Women and Child Development. 70 . 2013.aspx.

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. 2013. who needed JSY benefits. BPL women who prefer to deliver at home can also get JSY benefits.com/news/national/age-limit-relaxed-forjsy-benefits/article4736820.ece dated May 22. Additional Secretary and Mission Director.” Anuradha Gupta. National Rural Health Mission (NRHM). 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. The HINDU (http://www. 2013) All women from BPL category.thehindu. “The decision was taken after it was realized that a majority of women. told The Hindu on Tuesday. May 22. 71 .

the children in the anganwadi are to be provided with eggs and milk daily. 2013. What needs to be done further…. Moreover. eggs are not provided as they are costlier than the amount of funds provided for eggs.  According to the orders of Women and Child Development Department.Road Ahead….. Therefore. However at none of the anganwadis. To address this issue. this provision is followed.??????? The following key issues needs to be addressed:  From the details above. the ICDS scheme calls for each child to be given a supplementary nutrition of milk and eggs. a concerted effort has to be made to ensure that all children in the anganwadi – not just those who are malnourished – are supplied 72 . it is clear that there are a large number of severely malnourished children across the urban slums of Bangalore. during the period of February to May. since January 1.

with milk and eggs every day. and moves us further towards the goals of the ICDS. 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. This will be of great benefit to the health of all the children in the anganwadi. there are high numbers of malnourished female children. take the child to nearest Urban health centers (UHCs) in the respective PAG areas. 73 . We need to further identify the root cause of such a situation. Volunteers can follow up and ensure that the children are getting their quota of milk powder. 3) As from the analysis of the data available on malnourished children. 2) Follow the moderate cases at least once in two months and mild cases once in three months.

nlm.4) Also the malnutrition is linked to educational level of mothers. (http://www. We need to identify the educational level of malnourished children. with the corporators as children are not getting eggs regularly at the anganwadis because of this issue. Volunteers can raise the issue with the corporator of the area. 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.medwelljournals. 9) In Madivala PAG. no follow up has been done in Siddharth Nagar since November.ncbi.127. 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. The doctor at UHC checks the pregnant lady and accordingly recommends for entitlements from the anganwadis Thus. http://www.  Under ICDS. pregnant females are entitled to get Take Home Ration (THR). if volunteers come across such cases in the field as pregnant ladies are not getting THR. so follow up the anganwadis in Siddharth Nagar. please follow on this issue as well. Also the anganwadis in N S Palaya have not been cooperating well.com/fulltext/?doi=sscience. 7) Koromangala. To get the THR from the anganwadi. One such anganwadi is Urdu anganwadi in Rajendra Nagar.gov/pubmed/1879910 ) 5) The cycle of malnutrition can be broken by making the pregnant females healthy.20 09.. 74 . 2012 (CRY interns Ramya and George’s Report on ICDS).nih.118. pregnant female need to have THAYI card which is issued from the Urban Health center (UHC) by the Link Worker/Doctor. they are not getting enough funds for eggs and milk and other provisions of supplementary nutrition.

8. shockingly found that a) There were no weighing scales for children aged three to six at the most of the anganwadis. About 85% of children (without medical complications) can be managed through a community. they either did not plot the growth curves on them or they did not have sufficient training or knowledge on how to plot them. b) Even zero-to-three-year-olds were not being weighed regularly. Right to Food Campaign and the Janaarogya Andolana-Karnataka (JAAK) by weighing children in anganwadis in their work areas .and/or home-based care approach. d) If they had the growth charts. A Survey¹⁷ conducted in April.Conclusion In India. 2012 on 577 children done in 12 districts of Karnataka . 75 . In a state. the magnitude and serious consequences of SAM among children makes it unethical not to urgently initiate measures to prevent and treat SAM. c) Several anganwadis did not have charts to plot the children’s growth. STILL………. Protecting lives and promoting optimum development of SAM children is also a human rights issue. by the Civil society organizations such as those belonging to the Samajika Parivartana Janandolana. on the basis of latest evidence from the data collected from different PAG areas. marching ahead on the economic front.1 million children are estimated to suffer from severe acute malnutrition (SAM) and 50% of children in urban slums of Bangalore are malnourished. Thus requires an urgent need to update both facility and home-based care recommendations for the management of malnutrition among children in Bangalore.

17 17 Survey by JAAK and other civil societies : http://infochangeindia.html 76 . Thus we need to make little extra efforts so that things can be brought back on track for these children.” .org/agriculture/features/stealing-from-the-mouths-ofbabes. orator and statesman of ancient Rome So this is what we exactly need to follow and give these children a healthy life. 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.Marcus Tullius Cicero. as in giving health to men. Similar is the condition in several anganwadis and associated urban health centers in all the PAG areas.e) These children will never receive the medical attention they need or the additional nutrition at nutrition rehabilitation centers (NRC) under the Balsanjeevani scheme. “In nothing do men approach so nearly to the Gods.

com/news/national/age-limit-relaxed-for-jsy-benefits/article4736820.References  Women and child Welfare Department.ece last accessed on 20th December 2012  http://www.org/about/  http://www.com/news/states/karnataka/milk-eggs-to-be-on-menufor-anganwadi-children/article4112879.kar.html 77 .gov.in/healthnew/NRHM/PrJanani%20Suraksha%20Yojana.thehindu.gov.ece  Integrated Child Development Services http://wcd.ninindia.thousanddays. 2013  http://nutritionmissionmah.in/Site/Common/iec. Hyderabad www.com/todays-paper/tp-national/tp-karnataka/milk.rajasthan.ece dated May 22.who.int/childgrowth/standards/  http://infochangeindia.nic. Government of Maharashtra  http://www.thehindu.org/   WHO Growth Standard Charts www. GoR http://wcd.htm  Directorate of Health and Family Welfare.thehindu.aspx?lnk=1  Daijiworld Media Network .aspx National Institute of Nutrition. 20 April 2012 1 http://www.Bangalore   The Hindu.aspx .org/agriculture/features/stealing-from-the-mouths-ofbabes.dep’t of Women and Child Development.eggsbeing-regularly-supplied-to-children-in-anganwadis-acrossdistrict/article4107837. Karnataka http://stg2.html Story of malnutrition – Case studies  Survey by JAAK and other civil societies : http://infochangeindia.in/icds.in/Scheme_ICDS.nic.org/children/features/anatomy-of-child-starvation-deaths.

ANNEXURE I Excel Spreadsheets of compiled data on Malnourished children from the PAG areas Koramangala Yeshwantpur Jeevan Beema Nagar Madivala 78 .

00 3 Moong (Green gram) 35.00 3 Besan (Bengal gram dhal) 06.00 2 Soyabean 14.00 2 Defatted Soyabean 12.00 5 Salt.00 4 Sugar 36.00 4 Sugar 35.00 5 Edible oil 07.00 2 Defatted Soyabean 12. Contents of Poshahar (Upma Pre-Mix ) Gm per 130 gm 1 Wheat Whole 48.00 5 Edible oil 23.00 6 Micronutrients As Per Norms 79 .No Contents of Poshahar (Halva Pre-Mix ) Gm per 140 gm 1 Wheat Whole 35.Annexure II The composition of supplementary food given in Rajasthan Formulation/ Composition of Panjiri S. Spices & Dehydrated Vegetables 05.00 3 Moong (Green gram) 30.No.00 6 Micronutrients As Per Norms Formulation/Composition of Energy Dense Extruded Fortified Halva Pre-Mix (Deshi Mithai) S.No.00 6 Micronutrients As Per Norms Formulation/Composition of Energy Dense Extruded Fortified Upma Pre-Mix (Namkeen) S. Contents of Poshahar (Panjiri) Gm per 125 gm 1 Wheat Whole 62.00 4 Edible oil 35.

30 Spice 0.06 3.60 50 >0.80 Jaggery 25 383 0 95.04 3.5 59. Rice (Puffed) 14 325 7.11 Total 80 314.29 Edible Oil 5 900 0 45.5 59.89 19 0.88 Labour charges/margin for SHGs @10% 0.11 Total 80 304.Khichadi Ingredients Energy Protein Quantity Energy Protein Rate Amount per 100g per 100g (g) (Kcal) (g) Rs.26 8.80 Edible Oil 5 900 0 45.13 Labour charges/margin for SHGs @10% 0.00 60 0.63 Green Gram Dal 17 348 24.80< Total 55 200./Kg Rs.18 3.17 Dalia Ingredients Energy Protein Quantity Energy Protein Rate Amount per 100g per 100g (g) (Kcal) (g) Rs. (Kcal) (g) Rice 58 345 6.5 59.29 Grand Total 3.75 0.11 2.8 114./Kg (Kcal) (g) Amount Rs.00 0.16 4.29 Jaggery/Sugar 25 383 0 95./Kg Rs.02 Fuel 0.17 76 1.00 0.29 4.16 4.75 0. (Kcal) (g) Dalia 33 346 11.8 200.44 Rice (Puffed) & Roasted Chana With Jaggery Ingredients Energy Protein Quantity Energy Protein Rate per 100g per 100g (g) (Kcal) (g) Rs.5 45.00 32 0.10 3.16 Green Gram Dal 17 348 24.50 1.94 20 1.42 Roasted Chana 16 369/td> 22.00 32 0.05 30 0.02 .30 Fuel 0.17 76 1.09 8.31 Grand Total 3.00 60 0.65 80 2.

53 18 0.69 Labour charges/margin for SHGs @10% > Grand Total 2.22 34 0./Kg Rs.98 1.00 0.23 Soyabeen 5 432 4./Kg Rs.20 Grand Total 2.23 >2.76 2.00 Gur 15 383 0 57.00 50 2.48 Sugar 12 400 >0 48.5 147.00 205. (Kcal) (g) Wheat Flour 13 346 11.43 Total 50 228.00 60 0.32 21.32 > 0.45 32 0. (Kcal) (g) Roasted Chana 40 369 22.00 0.05 9.34 4.48 Total 55 0.60 9.8 >44.48 Labour charges/margin for SHGs @10% 0.55 81 .Labour charges/margin for SHGs @10% 0.5 41.25 Grand Total 2.00 2.17 Mung Daal 12 348 24.01 Edible Oil 8 900 0 72.22 Ready (Dry) Alternatives For Snanks (Roasted Chana With Gur) Ingredients Energy Protein Quantity Energy Protein Rate Amount per 100g per 100g (g) (Kcal) (g) Rs.00 36 0.73 Halwa Ingredients Energy Protein Quantity Energy Protein Rate Amount per 100g per 100g (g) (Kcal) (g) Rs.60 0.94 84 1.

The composition of supplementary food under ICDS 82 .

83 .

84 .

50 Total 95 gm 421.45 0.35 Above Nutritious food items with consideration of taste of beneficiaries are given but oil content is less.8 2.25 7.50 7 Elaichi Tested 0 0 0.45 0.60 2 Sugar 5 gm 20. Item Name Quantity Calories Protein Expenditure 1 Milk 25 ml 33.56 0.8 0.10 7 Til 5 gm 28.65 5 Oil 20 gm 180 0 1.00 00. Maharashtra 1) Upma Sr. No.3 1.00 00.Recipes of the supplementary food distributed under Rajmata Jijau Mother-Child Health and Nutrition Mission.55 6 Oil 20 gm 180 0 1.8 2.8 0.00 1.40 4 Amylase rich Moong Flour 10 gm 34.00 2.10 6 Til 5 gm 28.8 2.20 2) Shira Sr.60 2 Sugar 25 gm 100. 85 .73 4.05 10.52 0.00 3 Amylase rich Wheat Flour 20 gm 68.00 2.10 8 Water As per need 0 0 0 Total 105 gm 444. Item Name Quantity Calories Protein Expenditure 1 Milk 25 ml 33.15 0.3 1.20 3 Amylase rich Wheat Flour 20 gm 68. No.92 0.40 4 Amylase rich Moong Flour 10 gm 34.92 0.56 0.25 1.65 5 10 gm 56.00 0.15 0.

5 28. 2. Mix all the ingredients together that are milk powder. roasted groundnut powder. Wash hands properly under running water. Once Green Gram is sprouted it is sun dried and then it is roasted and grounded. Roast groundnuts and remove the cover. These laddoos are prepared from ingredients received through donations from the 86 . 4. powdered sugar. and prevent low birth weight of babies. Special Food Composition (100 gms) Ingredients Amount (gms) Energy (kcal) Proteins (gms) Fats (gms) Milk Powder 30 107. 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. it is kept in wet cloth/nylon bag till it gets sprouted (it takes minimum 2 to 3 days for sprouting).0 Procedure: 1. ensure adequate weight gain during pregnancy. The aim is to improve the quality of their diet. Measure all the ingredients.1 11. 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).Method of making Amylase rich flour: 1) Wheat:After soaking wheat in water for 24 hours. For that please follow the table below. 7. 3. vegetable oil and mineral and vitamin mix powder (CMV) (if available). Nutritious Laddoos for Pregnant Women Ahmednagar district has been in the forefront of community participation and localized innovations for reducing malnutrition.0 Sugar 28 112 Vegetable oil 20 180 20 CMV 1.4 Peanut 20 113.6 Total 100 512. Once wheat sprouted it is sun dried and then it is roasted and grounded. Special feed should be given as per the weight of the child.4 5.5 16.1 8. Take the required amount of sugar and grid it to make into powder 6. Grind roasted groundnuts and keep then in an air tight container 5.

5 gms Calcium 84.0gms 2. The recipes/ingredients are: 1. 87 .6 mcg All districts are being encouraged to distribute similar laddoos to all pregnant and lactating mothers through community contribution.25 kcal Proteins 12.92 mg Vitamin A 27. Groundnut.Jaggery Laddoos (Shengdana.75 mg 3.Garden Cress seeds (Aaliv) . Rajgira.community. 18.Soya.Gur Laddoo): Ingredients Amount Groundnut 50 gms Jaggery 50 gms Energy 476. Coconut. The cost of the 3 laddoos comes to about Rs.Gur.5 kcal Protein 13.Jaggery (Gur): Ingredients Amount Garden Cress Seeds (Aaliv) 20gms Coconut 80gms Jaggery 50gms Energy 213 kcal Proteins 7.8mg Vitamin C 24. Women come together at a suitable location in the village and prepare these laddoos for themselves.Ragi Laddoo: Ingredients Amount Ragi 50 gms Rajgeera 50 gms Soybean 5 gms Jaggery 50 gms Energy 222.75 gms Calcium 215.

.. 30 g Roasted Bengal gram flour . 10 g Leafy vegetables .. Sufficient water is added and cooked... Wheat Payassam Ingredients: Wheat . 30 g Roasted Groundnut . 2 t. Kheer Ingredients: Vermicelli/Rice .. 88 . groundnut and sugar. sp Fat ..... Water .. 20 g Method: Malted ragi.... roasted groundnuts and jaggery are powdered........ 15 g Roasted & crushed Groundnut .. 100 ml.. Leafy vegetables can be added when the cereal/pulse is 3/4th done. 15 g Jaggery . Add milk and bring to boil.. 35 g Green gram dhal . Cumin is fried in fat and added towards the end. 20 g Method: Boil rice/vermicelli in water till half done. 15 g Method: Roast whole wheat and powder. 30 g Milk .. 2 t.. As required Jaggery .. Malted Raggi Porridge Ingredients: Malted Ragi . Cook with sufficient water.COMPLEMENTARY FOODS suggested by National Institute of Nutrition. sp Cumin (jeera) Method: Clean rice and dhal and cook them in water with salt till the grains are soft and water is absorbed. Add roasted Bengal gram flour. 5 g Sugar . Hyderabad Khichdi Ingredients: Rice ... Add jaggery and cook well..

2 and 3 can be prepared and stored in airtight containers to be used whenever required. 3. minced meat may be introduced at the age of 6 months. Non-vegetarian foods such as soft boiled egg. Recipes Nos. Hyderabad 89 . Complete Document on Dietary Guidelines by NIN. 2. All these recipes provide approximately 250 Kcals. and 5 g proteins and amounts given are for 2 servings.Note: 1.

-3SD) represent under nutrition and values on the right side of the median (+1SD. Color Coding of the Charts Red : Severely malnutrition Orange: Moderate malnutrition Yellow: Mild malnutrition Green : ideal weight 90 . The WHO growth standard chart contains ideal weight (median weight) for each age (from 0-10 years of age separately for boys and girls). -2SD. Also the values on the left side of the median (-1SD. +3SD) represent over-nutrition. Underweight has been taken as the most important indicator to asses under nutrition and all the anganwadi centers use the same indicator.Annexure III WHO Growth Standard Charts In India. +2SD.

2 3.4 6.4 3.4 10.2 10.0 4.3 15.2 15.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 0 2.4 2.7 3.9 9.5 7.7 9.7 11.5 0: 3 3 4.7 18.5 13.9 10.6 7.3 14.6 10.9 6.7 9.7 6.5 8.4 12.8 5.4 5.4 7.7 17.6 0: 9 9 5.0 7.0 11.1 0: 8 8 5.6 14.5 10.4 10.1 9.2 9.3 0: 5 5 4.6 8.9 10.4 11.6 8.1 5.7 1: 9 21 7.5 9.0 5.9 7.2 9.2 9.1 1: 7 19 7.3 2: 2 2: 3 26 27 8.4 1:11 23 7.4 9.3 8.1 6.1 13.5 12.1 6.8 5.2 11.5 5.1 10.7 6.6 16.0 91 .6 12.7 8.7 4.3 10.6 10.2 8.0 6.1 12.6 10.2 3.5 6.4 14.8 10.8 11.3 8.3 16.9 7.5 14.0 7.0 14.1 11.8 3.1 12.6 8.2 12.8 8.5 13.7 15.7 7.8 17.9 8.2 0: 2 2 3.8 13.9 12.4 11.9 12.4 7.8 8.9 12.6 4.7 7.2 11.4 8.1 9.7 2: 0 24 8.5 8.8 7.2 9.5 13.4 0:11 11 6.8 1: 6 18 7.3 9.2 10.3 7.4 1: 8 20 7.5 8.6 6.2 4.0 10.0 0:10 10 5.3 8.3 11.8 6.6 7.1 9.9 12.8 6.9 4.9 10.0 2: 1 25 8.8 14.2 5.4 9.7 9.4 15.1 5.3 6.8 1: 0 12 6.7 8.8 13.5 0: 4 4 4.8 0: 1 1 2.7 13.3 12.0 1:10 22 7.2 8.5 15.6 9.9 11.2 4.0 0: 6 6 5.9 8.9 14.5 9.9 8.6 7.3 7.5 5.0 2.1 13.2 11.8 6.0 7.3 10.1 17.0 10.0 11.2 9.7 15.5 9.6 12.8 1: 3 15 6.1 1: 4 16 6.5 10.9 7.6 13.5 1: 5 17 7.2 10.1 13.4 8.8 11.5 1: 2 14 6.1 1: 1 13 6.3 8.6 9.6 0: 7 7 5.8 11.5 7.0 16.

8 25.6 17.9 14.4 27.5 16.8 16.7 11.2 14.3 13.2 18.9 16.9 14.0 12.9 23.3 20.8 12.6 10.8 13.9 11.4 9.6 22.2 19.7 17.0 12.5 9.4 24.0 27.2 11.8 11.1 15.9 25.6 20.2 14.5 10.7 12.1 12.7 9.8 29.8 15.8 18.9 21.3 13.7 11.5 24.1 24.9 3: 1 3: 2 3: 3 3: 4 3: 5 3: 6 37 38 39 40 41 42 9.5 11.7 16.6 11.5 13.3 20.6 12.3 10.5 92 .2 21.2 23.0 20.4 14.0 19.9 26.5 15.8 16.9 10.8 10.4 10.1 14.8 10.2 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 9.0 17.0 13.4 17.3 17.7 10.3 10.7 14.8 19.6 16.1 22.0 12.2 29.1 18.6 22.3 12.3 17.5 25.7 28.4 12.1 15.9 9.4 22.3 11.3 16.4 13.3 26.7 15.9 17.8 14.9 15.6 11.3 19.0 16.2 18.2 10.9 12.1 11.9 11.7 23.8 21.9 11.0 21.0 19.4 13.2 12.5 28.1 10.6 14.8 17.4 18.6 20.6 8.3 14.2 14.7 24.5 23.5 17.7 9.7 20.4 11.3 13.1 20.7 13.9 15.4 19.6 13.5 11.5 12.1 19.0 18.6 24.4 16.1 24.6 27.2 16.5 18.8 11.7 14.8 24.0 16.4 16.3 18.2 21.6 14.1 13.4 10.0 14.7 10.1 12.1 17.6 20.8 21.7 13.6 17.7 19.5 15.6 13.3 21.5 10.5 12.2 12.0 16.2 15.0 13.3 15.4 11.0 14.3 11.2 11.6 15.5 23.8 12.0 3: 7 3: 8 3: 9 3:10 3:11 4: 0 43 44 45 46 47 48 10.6 15.1 28.4 20.9 12.5 20.2 13.2: 4 2: 5 2: 6 28 29 30 8.3 15.2 15.9 13.9 18.9 13.0 22.8 22.1 17.3 16.7 11.0 9.3 22.2 17.1 11.1 11.3 13.7 14.5 13.4 23.4 15.5 14.7 19.1 9.8 9.0 15.6 10.9 20.0 2: 7 2: 8 2: 9 2:10 2:11 3: 0 31 32 33 34 35 36 9.8 17.6 12.5 19.2 12.1 20.1 10.0 11.8 8.7 12.9 18.4 12.2 19.3 18.7 19.0 10.

5 24.0 22.1 29.5 18.2 22.1 28.4 27.2 28.6 35.3 17.2 15.3 19.7 39.9 30.9 23.3 29.2 19.9 20.3 15.3 20.7 49.3 20.8 26.1 14.9 21.8 21.8 34.3 46.3 14.9 15.0 42.6 18.8 17.7 20.4 22.7 29.2 21.8 36.7 16.1 15.0 16.7 45.6 18.9 25.4 35.1 25.2 31.5 19.4 19.6 32.0 17.0 37.9 31.6 29.3 38.1 23.8 26.6 35.0 16.4 29.2 17.0 27.3 26.2 24.9 16.5 42.0 37.1 23.4 15.2 17.1 18.8 36.4 37.3 23.7 22.1 14.8 22.4 35.4 16.0 13.1 31.1 41.1 29.6 15.8 25.3 93 .6 24.9 15.6 26.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 12.3 18.2 13.6 18.4 14.9 17.9 24.0 26.2 30.6 40.0 19.1 33.0 14.8 27.4 14.1 40.4 18.6 16.9 34.5 25.8 46.9 13.0 14.6 30.7 20.3 38.7 30.2 36.5 12.2 14.8 14.0 22.6 17.8 25.8 20.5 22.4 16.8 31.5 17.4 37.5 23.3 27.2 34.5 15.4 27.3 25.0 35.4 25.9 28.8 16.3 16.6 21.8 19.2 34.9 16.2 16.0 18.1 39.1 43.2 18.8 33.6 14.5 30.2 16.8 17.6 37.1 15.9 23.1 16.4 31.6 25.5 20.4 13.3 16.7 13.2 15.9 19.5 26.2 45.8 14.5 17.1 19.3 18.2 26.0 21.5 32.8 28.8 32.6 14.3 25.6 19.8 15.2 32.6 26.1 25.8 29.3 30.8 18.9 21.3 22.0 24.8 38.5 33.1 27.8 19.3 19.3 17.6 21.0 17.6 15.5 16.6 12.4 21.3 31.7 14.6 37.9 18.6 21.1 19.7 15.0 23.9 16.8 12.9 17.0 21.6 44.4 18.8 24.5 15.3 26.6 41.6 19.2 23.7 33.5 17.4 21.5 28.2 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 15.6 16.7 27.5 20.8 22.6 43.0 29.5 13.9 47.1 48.6 18.5 30.7 12.0 25.9 31.4 33.9 32.8 18.0 32.6 31.3 19.0 16.4 12.1 44.5 14.3 32.2 17.2 21.2 36.2 14.8 16.3 18.5 16.8 20.9 17.2 20.6 13.3 16.1 26.1 19.8 38.4 15.4 21.5 22.2 21.0 15.3 23.6 23.9 26.7 17.6 39.2 30.6 25.5 48.0 20.3 24.1 20.6 27.2 22.7 39.0 20.9 14.0 14.4 24.6 22.6 17.8 24.6 32.6 16.3 17.6 27.3 14.1 13.0 35.7 22.3 13.5 19.1 24.8 30.4 28.9 18.1 27.5 29.8 22.1 33.0 30.0 22.4 23.9 19.8 13.

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

0 22.5 52.4 22.6 34.5 45.0 19.3 19.3 26.8 36.6 20.6 20.9 31.9 23.7 29.0 29.6 37.1 24.7 7: 7 7: 8 7: 9 7:10 7:11 8: 0 91 92 93 94 95 96 16.7: 3 7: 4 7: 5 7: 6 87 88 89 90 16.5 26.0 37.6 24.6 21.4 22.7 34.1 31.1 23.2 38.9 19.7 16.4 28.3 28.0 27.0 20.6 16.0 17.6 30.4 37.7 17.2 25.5 24.4 23.1 27.4 27.8 17.4 17.3 25.2 18.7 22.5 29.8 51.8 19.8 46.7 48.0 41.5 44.5 20.5 35.1 26.3 32.7 27.9 18.1 19.5 50.7 22.2 25.6 37.9 22.3 20.3 30.0 25.5 22.6 48.6 28.0 33.0 23.3 33.4 21.3 35.1 26.3 27.6 33.2 9: 1 9: 2 9: 3 109 110 111 18.6 25.2 27.6 43.3 34.0 32.7 23.5 33.4 21.8 22.9 24.0 55.7 8: 7 8: 8 8: 9 8:10 8:11 9: 0 103 104 105 106 107 108 18.1 22.1 40.7 19.0 23.8 30.5 18.5 23.2 25.1 25.0 42.9 28.4 47.7 18.8 25.3 40.1 17.7 25.6 18.9 20.7 20.1 50.0 42.1 30.5 19.3 22.9 28.0 34.1 32.1 24.8 49.9 31.9 26.2 28.1 43.6 30.1 18.8 32.7 29.8 38.3 29.2 41.1 21.2 35.7 20.4 32.4 97 .9 19.2 36.1 9: 7 9: 8 9: 9 9:10 9:11 10: 0 115 116 117 118 119 120 19.7 18.0 47.6 21.3 24.3 36.5 41.2 45.5 21.4 30.3 23.1 20.0 39.5 54.1 30.7 29.1 39.1 44.2 21.4 28.7 33.5 17.2 20.2 55.6 39.6 21.8 53.8 33.6 40.5 8: 1 8: 2 8: 3 8: 4 8: 5 8: 6 97 98 99 100 101 102 17.6 44.6 36.9 24.0 42.8 30.6 23.5 43.0 36.9 23.8 20.5 22.6 27.3 21.5 26.3 18.5 31.9 20.8 38.4 22.7 56.9 26.3 16.3 33.9 21.1 19.3 18.3 26.3 19.6 19.7 24.0 21.1 27.9 17.9 39.4 27.1 16.2 35.1 43.8 23.4 37.1 29.4 45.0 52.4 18.2 38.7 39.3 18.7 42.7 24.7 37.9 40.2 25.8 21.9 41.4 18.2 29.9 31.4 34.1 20.6 34.1 35.1 9: 4 9: 5 9: 6 112 113 114 19.0 44.2 16.7 32.2 19.

Growth Cards used by Anganwadis to track the weight for age of the children 98 .