Introduction
Every child has the fundamental right to adequate nutrition. Children who are fed enough of the right foods, in the right amounts, and at the right time in their development have a better chance of surviving, growing, developing, and learning. They are better prepared to thrive in the face of disease, disaster, or crisis. Breastfeeding and access to a wide variety of healthy foods provide children with the necessary nutrients, vitamins, and minerals they need to grow to their maximum physical and cognitive potential between the ages of 6 and 23 months – the complementary feeding period – with benefits that last long into adulthood. The complementary feeding cycle is also an important opportunity to avoid all types of childhood malnutrition, such as stunting, wasting, micronutrient deficiencies, overweight, obesity, and diet-related non-communicable diseases. (UNICEF 2020) 1
Globally, only 19% of children (6-23 months) are getting a minimum acceptable diet. We can see that 69% children (6-8 months) were introduced of solid, semi-solid or soft foods. Whereas, only 29% of children (6-23 months) receive minimum diet diversity (UNICEF, 2019).The NFHS-5 data shows that only 5.9% and 7.7% of children receive minimum adequate diet for Gujarat and Bharuch respectively. Whereas, NFHS-4 data of India shows that only 9.6% children has received minimum acceptable diet.
GAIN and UNICEF 2020 has come up with Comprehensive Nutrient Gap Analysis report. As per the report, nutrient requirements for an infant after the first six months exceed what breastmilk alone can supply. Along with breastfeeding, babies should be exposed to nutrient-dense firm, semi-solid, or soft foods at six months of age to satisfy growing nutrient requirements and ensure proper growth and development. Despite this, only 21% of infants and young children aged 6–23 months in India eat a diet that includes the required number of food groups, rising their risk of micronutrient deficiency and growth halting.
Findings from nationally representative and high-quality sub-national studies, grey literature, and journal papers on infant and young child feeding habits, micronutrient shortages, dietary intake, household use and spending, and food availability were analysed and summarised. The literature was reviewed to assess the burden of gap and the certainty of available evidence for 11 micronutrients typically deficient in the diets of young children. (Table 1) 2, 3, 4, 5, 6
Objective
Comprehensive Nutrient Gap Analysis of children (6-23 months) and capacity building of frontline workers of selected villages of Jambusar block in Bharuch district
Specific objectives
To assess socio- demographic profile of households of children (6-23 months)
To document complementary feeding practices of children (6-23 months)
To document the utilization of services of Annaprasan diwas under ICDS programme by the mothers of children (6-23 months) To document the compliance of Balshakti supplied under ICDS programme.
To calculate the CONGA for selected macro and micro nutrients based on ICMR RDA 2020.
Materials and Methods
To fulfill the above objectives a University-NGO collaborative study was conducted in the villages which comes under working of aatapi seva foundation in Jambusar block. Aatapi Seva Foundation is a social developmental institute, incorporated under the companies act, 2013 (section 8) working towards holistic and sustainable community development through promotion and strengthening of community based organizations.
Location of the Study
Jambusar block was purposively selected and the study was conducted in anganwadi centers of 5 villages where aatapi seva foundation is currently working. These 5 villages are Daabha, Kareli, Kahanva, Piludra, Vedach.
Sample size
In this study, 13 Anganwadi centers of 5 villages where Aatapi seva foundation is working were enrolled. All the children aged between 6 months to 23 months who were registered in the anganwadi centers were included for the study.
Data collection tools
A pre-tested semi structured questionnaire in vernacular language was prepared. Data on socio demographic profile, anthropometric measurements and ANC information, utilization of Annaprasann diwas and compliance of Bal Shakti, complementary feeding practices was collected. Data on both quantity and quality of food given to the child was elicited through 3 day 24 hour dietary recall to assess CONGA (comprehensive nutrient gap analysis) and complementary feeding indicators.
Dietary information
Data on dietary practices of children was taken through a 24-hour dietary recall method. A three day dietary recall of quality and quantity of food consumed by all the children were collected. Standard cups and spoons were used to elicit information about the quantity of food consumed by children.
Breastfeeding information
The main focus was to assess nutrient gap among children of 6-23 months age, it is necessary to calculate breastmilk consumption by the child. Information on frequency of breastmilk given to child was taken in 24-hour dietary recall data to calculate nutrient contributed by breastmilk. The nutritive values of breastmilk was calculated according to Nutrition composition of human milk by Gopalan et al. 1989 (Table 2). We allocated breast milk volumes based on the child's age in months using the available literature. Information available through research paper by Butte et al.3 2010 was considered (Table 3).
Table 2
Nutrient composition of Human milk (per 100g)
Table 3
Calculation for nutrient contribution by Breastmilk consumption.
Data collection
Six Arogya Sathis of Aatapi seva foundation who are from the same villages where the study area was who are supposed to carry out interpersonal counselling to vulnerable groups was trained to elicit required information using pretested semi structured questionnaire in vernacular language to avoid unnecessary exposure due to COVID19 pandemic. Research Investigator had monitored and accompanied each ArogyaSathi during data collection phase.
Nutrient calculation
All the data of 24-hour dietary recall and breastfeeding was entered and analysed using DietCal software to arrive at per day and average nutrient intake by children. CONGA will be calculated for selected macro and micro nutrients based on recent RDA given by ICMR (2020).
Nutrients calculated using DietCal software
Highlights of findings
Findings about IYCN practices and utilisation of ICDS services are depicted in Table 5 below
According to the findings of 232 surveyed household s' socioeconomic data, 48.3 % of them fall into the general category. Nearly 68.5 % of households have a below poverty line card that allows them to receive public distribution services. 64.2 % of mothers had completed at least ten years of schooling.
Data on service utilization of ICDS (Integrated Child Development Scheme) showed that only 41.4% mothers are having knowledge about annaprashan diwas and 96.6% children received supply of balshakti packets regularly.
Breastfeeding was started early for 67.2 % of the children, which implies that they were put on the breast within one hour of birth. In contrast, 54.3 % of children were exclusively breastfed until they were six months old. At the completion of six months age, around 47% of children were introduced to complementary foods. (Table 5)
Table 4
Coverage particulars and findings of various indicators
Nutrient Gap analysis
Median intake of nutrients such as protein, energy, niacin, vitamin-B6, folate, calcium, iron, and iodine shows a decrease as compared to mean intake of nutrients by children. (Table 6)
Table 5
Mean and Median intake of Nutrients among all the children.
After comparing average intake of children with the RDA, percent nutrient gap was derived for all the children.
Percent energy gap was 13.4% among 6-12 months old children and 48.8% among 1-2 years old children. For 6-12 month old children, a high percent nutrient gap of nutrients such as Niacin, Vitamin-B6, Folate, zinc and iodine is seen. For 1-2 year old children, nutrients of concern were Niacin, Vitamin-B6, folate, iron, showing high nutrient gap. Whereas other nutrients also show more than 50% nutrient gap.
From the data nutrient gap of only 2 micronutrients Niacin and Folate showed significant difference in both the age groups.(p-value>0.05) (Table 7) (Figure 1)
Table 6
Average of percent Nutrient gap among 6-23 months old children
Discussion
In the present study, we calculated the nutrient intake of young children based on average of food quantity consumed by children in 3 days including breast milk. The results showed the nutrient gap of Nutrients such as Niacin, Vitamin-B6, Folate, Iron, Zinc and Iodine are found in the diets of 6-12 months old children. Whereas, for 1-2 years old children almost all the nutrients are having more than 50% gap.
A study by Beal et al. 2021 showed high burden of nutrient gap for nutrients such as Iron, Zinc and Folate. A comprehensive nutrient gap analysis by GAIN-UNICEF 2020 showed the high nutrient gap burden of Iron and Moderate nutrient gap burden of Vitamin-A, Zinc, Folate, Calcium and Niacin. NIN report 2021 showed that the deficit intake reported to be high with respect to vitamin C (87%) followed by riboflavin (83%), calcium (77.5%), niacin (73.8%),vitamin A (71.8%) folic acid (62.9%) and iron (61.1%). 7, 8, 9, 10, 11
Conclusion
It can be concluded that breastfeeding practices and complementary feeding practices needs to be strengthen more among young mothers as Infant and Young Child Feeding (IYCF) Practices was suboptimal. Nutrient gap was found for all the micronutrients among young children. Nearly half of energy deficit was seen in older 1-2 years old children. To achieve targets of POSHAN Abhiyan and SDG goal 3, we need to prioritised optimal practices of IYCN through multipronged strategies.