MI India continues to focus on the priority of saving lives and improving the health of women and children.
- Increase biannual administration of vitamin A syrup to all children 9-59 months in priority states.
- Ensure vitamin A supplementation to all children 9-59 months.
- (1st and 2nd dose through routine immunization campaigns and 3rd-9th doses through biannual rounds).
- Expand zinc supplementation in India, along with oral rehydration salts, for the treatment of childhood diarrhoea in priority states.
- Improve production, monitoring and consumption of iodized salt.
- Provide technical support to salt producers.
- Expanded iron and folic acid programs for preschool children, adolescent girls, pregnant and lactating women.
- Vitamin A syrup is now reaching 65% of children aged 12 to 23 months.
- Zinc and ORS programs in India are being supported through new grants with sustained advocacy efforts by MI. MI India is also providing refresher training for healthcare workers and making efforts to handhold and provide supportive supervision for mothers, caregivers and health care workers.
- The Iodized Salt Coverage Study 2010 has reported a 20% increase in the use of adequately iodized salt in rural households in Gujarat, Rajasthan, Tamil Nadu, Andhra Pradesh, Orissa and Karnataka.
- In 2013, MI India helped ensure 1.3 million cases of diarrhoea in children were treated with zinc and ORS.
Vitamin A supplementation is one of the most cost-effective interventions for improving the vitamin A status of populations, as it is associated with a significant reduction in all-cause childhood mortality.
India’s national program for the prevention and control of nutritional blindness due to vitamin A deficiency aims for all children nine months to five years of age to receive biannual massive dose of vitamin A, with nine mega doses of vitamin A.
MI India is at the forefront of this aim, supporting governments with vitamin A supplementation programs in states where the under 5 mortality rate continues to be high.
We provide technical and programmatic support to state governments to improve their ability to assure adequate and timely supplies of vitamin A, capacity building, monitoring and review endeavors to establish as a norm the biannual delivery of a package of child health and survival interventions.
MI India focuses on improving vitamin A supplementation coverage in poor-performing areas, including under-served and un-served areas and areas affected by urban agglomeration that have sub-optimal health infrastructure.
We are also supporting vitamin A supplementation delivered by state governments in the high burden states of Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh and Jharkhand.
In India, diarrhoeal diseases are a leading cause of morbidity and mortality in children below five years of age.
MI India is supporting the national and state governments to ensure the treatment of childhood diarrhoea with both zinc and oral rehydration salts (ORS) is reaching the hands of caregivers.
To achieve this, we are implementing large-scale zinc and ORS programs to impact overall child survival rates in the states of Bihar, Gujarat and Uttar Pradesh.
Key lessons learnt from pilot projects completed in Chhattisgarh and Bihar, with the support of the Department of Biotechnology, Government of India, and BIBCOL, a public sector zinc manufacturer, have contributed to shaping larger programs for tackling childhood diarrhoea.
MI India is also focusing on scaling-up interventions through the public healthcare channels. Our work to ensure long-term sustainability includes facilitating better accessibility of zinc and ORS for healthcare providers and caregivers, while enhancing their awareness on health benefits of this co-adjunctive treatment. Specifically, MI India has developed first-of-its-kind training modules for health workers and personnel of the Integrated Child Development Services.
At the national level, MI India has provided its technical expertise for drafting the operational guidelines issued by the Ministry of Health and Family Welfare for scaling-up the use of zinc and ORS for childhood diarrhoea management.
Through the Diarrhoea Alleviation through Zinc and ORS Therapy (DAZT) project, the Micronutrient Initiative (MI), partnered with FHI 360, Johns Hopkins School of Public Health (JHSPH) and UNICEF from 2010 to 2015 to work together to increase oral rehydration salt (ORS) and zinc coverage for the treatment of diarrhoea in two states of India: Gujarat and Uttar Pradesh, which had low care-seeking and treatment coverage.
The main strategy was to strengthen public sector capacity to ensure improved usage of zinc and ORS at both facility and community levels.
Key components included building the capacity of health providers and frontline health workers, as well as ensuring supplies where there, allowing so that delivery could be extended to communities through frontline workers and at health facilities by trained service providers.
Prior to the project, there was little reason for caregivers to seek care for their child’s uncomplicated diarrhea from public sector frontline health workers.
Based on project demonstration, Accredited Social Health Activists (ASHAs) were made responsible for service delivery at village level by respective state Governments for management of childhood diarrhea. They were also given supplies of zinc and ORS and adequate training.
This shift raised public confidence in seeking treatment from ASHAs and provided the poorest members of the community an avenue through which to seek treatment for their children at their door step. This, along with improved services provided through public health facilities, lead to increased service accessibility by the community and increased credibility of the public health system resulting in increased coverage.
By the end of the project, there was an increase in use.
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MI India works closely with the Office of the Salt Commissioner, Ministry of Health and Family Welfare, Government of India and other partners to ensure all households consume adequately iodized salt to reduce iodine deficiency disorders and ensure a healthier country population.
We focus on promoting salt iodization at the production level via the government’s National Iodine Deficiency Disorder Control Program. Working with approximately 400 small and medium-scale salt processors in Gujarat, Rajasthan, Tamil Nadu, Andhra Pradesh, Odisha and Karnataka, the Universal Salt Iodization program helps to improve their capacity to produce adequately iodized salt as well as improve their overall internal quality control mechanisms.
MI India also advocates for better enforcement of quality standards and increased availability of adequately iodized salt in the Public Distribution System. We have successfully advocated for the establishment of five Salt Upgradation Plants / salt washeries at strategic locations, which are promoting the use of technology leading to better salt iodization.
MI India’s efforts have contributed to the iodization of more than 25% of the total non-refined edible salt produced in India between 2009 and 2012.
Salt Coverage Study 2010
The Iodized Salt Coverage Study 2010, undertaken by MI and the International Council for the Control of Iodine Deficiency in eight states in rural India, revealed a significant 20% increase in the use of adequately iodized salt in rural households. The survey enables us to continue to gather support for our efforts to scale-up production and consumption of adequately iodized salt across India.
Double Fortified Salt
Salt could be used as an effective vehicle to provide iron as well as iodine on a regular basis and can contribute to the reduction of both iron and iodine deficiencies. MI, in collaboration with the University of Toronto, has developed a Double Fortified Salt (DFS) formulation.
Between 2003 and 2009, the Tamil Nadu Salt Corporation produced Encapsulated Ferrous Fumerate (EFF) DFS and supplied the same to the Integrated Child Development Scheme (ICDS) and Mid-Day Meal (MDM) programs of the government, operational in the state of Tamil Nadu, reaching 1.5 million children each day. Food Safety and Standard Authority of India (FSSAI) has approved production of EFF DFS in 2014.
MI India is providing technical support to state governments for India’s National Iron Plus Initiative.
Following the Weekly Iron and Folic Acid Supplementation program, which is a successful pilot project in select districts of Chhattisgarh targeting adolescent girls and boys, MI India has assisted the state government in scaling-up of the program to all districts of Chhattisgarh.
Our pilot project has shown a reduction in the prevalence of anaemia among school-going and out-of-school adolescent girls by about 14% and 7%, respectively.
Multiple Micronutrient Powders
Both good nutrition and early learning opportunities are necessary for the best outcome in child development, but little research exists on the impact of combining these two essential components for improving the lives of the world’s most vulnerable children.
MI India is working with the National Institute of Nutrition, University of Maryland, Johns Hopkins University, and the Mathile Institute for the Advancement of Human Nutrition on a study comparing the effect of providing essential micronutrients through Multiple Micronutrient Powders (MNP) with an early learning intervention, versus ‘stand-alone’ interventions – either MNP or Early Learning.
The results will generate much-needed evidence on how best to invest and equip children to realize their full potential.