The State of Health and Development
A woman working in a salt factory in Gujarat.
- 43%1 of children under five are malnourished.
- The mortality rate of children under the age of five is 522 per 1,0007 live births down from 118 in 1990.
- 58.7% of pregnant women, 63.2% lactating mothers and 69.5% of pre-school children are anaemic3.
- 9%4 of children under five are affected by diarrhoeal disease.
- Only 71%5 of households currently consume adequately iodized salt.
- Vitamin A is reaching 65%6 of children aged 12 to 23 months in priority states.
MI is working to achieve the following priority objectives:
- Increase biannual administration of Vitamin A syrup to all children 9-59 months in priority states.
- Expand zinc supplementation along with Low Osmolarity (LO) Oral Rehydration Salts (ORS) for the treatment of childhood diarrhoea in priority states.
- Improve production, monitoring and consumption of iodized salt and provide technical support to salt producers.
- Introduce and promote the use of double fortified salt (DFS), fortified with iodine and iron, especially through programs that target the most vulnerable.
- Expand iron and folic acid (IFA) programs for preschool children, adolescent girls, pregnant and lactating women.
Child Survival: Reducing under-five mortality
MI is focusing on reaching children in hard-to-reach areas and provides technical and program support at district, state and national levels. MI supports vitamin A supplementation, delivered by state governments in the high burden states of Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh and Jharkhand.
MI is working towards sustainable scale-up of zinc and ORS through public channels by ensuring their wide availability to healthcare providers and caregivers and by increasing awareness on the health benefits of each.
MI has initiated large zinc and Oral Rehydration Salts (ORS) programs for the treatment of diarrhoea among children to improve child survival in Bihar, Gujarat and Uttar Pradesh. Lessons learned from the pilot projects in Chhattisgarh and Bihar, with support from the Department of Biotechnology; Government of India; and BIBCOL; a public sector zinc manufacturer, were useful in shaping larger programs.
Field Story: Using zinc to save children´s lives in an emergency setting in India
MI has developed first-of-its-kind training modules for healthcare workers and members of the Integrated Child Development Services (ICDS).
Using MI´s technical expertise, the operational guidelines for the Ministry of Health and Family Welfare for the scale-up of use of Zinc and ORS in childhood diarrhea management, have been developed.
Quarterly Newsletter on Childhood Diarrhoea Management in Bihar Issue 1, Issue 2, Issue 3, Issue 4, Issue 5, Issue 6
Women´s and Newborn Survival and Health
MI works closely with the Office of the Salt Commissioner, Ministry of Health & Family Welfare, Government of Indiaand other partners to ensure all households consume iodized salt. MI focuses on promoting salt iodization at the production levelunder the overall guidance of National Iodine Deficiency Disorder Control Program (NIDDCP). The program of Universal Salt Iodization (USI) includes working with approximately 400 small and medium-scale salt processors in Gujarat, Rajasthan, Tamil Nadu, Andhra Pradesh, Odisha and Karnataka by improving their capacity to produce adequately iodized salt and improving their internal quality control mechanisms. MI also actively advocates for better enforcement of quality standards and increased availability of adequately iodized salt in the Public Distribution System (PDS).
MI´s work has contributed to the iodization of more than 25% of the total non-refined edible salt produced in India during 2009 to 2012. MI actively supported setting up of 5 Salt Upgradation Plants (SUPs)/ salt washeries at strategic salt producing locations to promote the use of technology leading to better salt iodization.
Field Story: Laxmi Salt: Adding Wisdom to a Simple Staple
Salt Coverage Study 2010
The Iodized Salt Coverage Study 2010, undertaken by MI and the International Council for the Control of Iodine Deficiency in 2010 in rural areas of eight states in India revealed a significant 20% increase in the use of adequately iodized salt in rural households. MI will use the survey to continue to gather support for its efforts to scale up production and consumption of adequately iodized salt in India.
Double Fortified Salt
To reduce iron and iodine deficiency, MI, in collaboration with the University of Toronto, has developed a DFS formulation using encapsulated ferrous fumerate (EFF). The encapsulation increases the bio-availability of iron.Using the momentum of the iodized salt program, double fortified salt (DFS) could provide iron on a regular basis as well. As part of its efforts to reduce iron and iodine deficiencies in children, MI provided technical support to the Tamil Nadu Salt Corporation (TNSC), in producing EFF DFS. TNSC continues to provide EFF DFS to school children as part of the Mid-Day-Meal Program in Tamil Nadu.. This alternative formulation for producing DFS has been approved by the Food Safety & Standards Authority of India (FSSAI).
Field Story: Double Fortified Salt: Smartening and strengthening a school lunch
In the News: Micronutrient Initiative President Venkatesh Mannar wins Tech Award in Health for Double Fortified Salt
Report: Solutions in a Pinch: Micronutrient Initiative´s Double Fortified Salt strategy tackles two problems in one go (PDF)
MI is providing technical support to State Governments for the Weekly Iron Folic Acid supplementation (WIFS) programtargeting adolescent girls and school children. MI has helped trained government employees involved in this program in Madhya Pradesh. Following a successful pilot project in select districts of Chhattisgarh, MI is a technical partner for the scale up of the program to all districts of the state. MI´s pilot project showed a reduction in anemia prevalenceby about 14 percent and 7 percent amongst school going and out of school adolescent girls respectively.
Field Story: District administrators´ innovativeness channels efforts to reduce adolescent anaemia
Brochure: Iron deficiency anaemia control for adolescent girls in Chhattisgarh, India (PDF)
Progress and Challenges
- Vitamin A syrup is now reaching 65%8 of children aged 12 to 23 months in priority states, however, the supply chain needs improvement.
- MI recently secured new grants to support zinc and ORS programming in India and has sustained advocacy efforts. MI is also providing refresher training for health care workers and constant messaging and ongoing supportive supervision for mothers, caregivers and health care workers.
- The Iodized Salt Coverage Study 2010 reported a 20% increase in the use of adequately iodized salt in rural households in Gujarat, Rajasthan, Tamil Nadu, Andhra Pradesh, Orissa and Karnataka. Given that only 47.3% of these households are consuming iodized salt, much work remains to be done.
- More than half of women and children in India are anaemic and the current supply of iron folic acid supplements needs to be streamlined.
- Though 26% diarrhoea cases in children are treated with ORS, only 0.3% receive zinc supplements9.
- NFHS 3
- SRS 2012
- NFHS 3
- NFHS 3
- CES 2009
- CES 2009
- SRS July 2011
- CES 2009
- NFHS 3
Contact MI in India
The Micronutrient Initiative
B-28, Qutab Institutional Area, Tara Crescent
New Delhi 110016, India
Tel: + 91 11 46862000 (x 16)
Fax: +91 11 46862048