India is home to the largest number of hungry people in the world. The Global Hunger Index (GHI) 2018 ranks India at 103 out of 119 countries. Under recently released NHFS 5, 

A few important findings in the recently released NFHS 5 results illustrate this strongly:

1. Increased % Stunting among children, in 13 out of 22 states and UTs surveyed.
2. Increased % Wasting among children below 5, in 12 out of 22 states and UTs surveyed.
3. Over 50% of women are anaemic.

As traditional Supply based programs have shown inadequate results, we need to look at it from Demand perspective – to create strong awareness and demand or Pull for nutritious food from mothers and communities.

Opportunity:

The 1,000 days between a woman’s pregnancy and her child’s 2nd birthday offer a unique window of opportunity to shape healthier and more prosperous futures. The right nutrition during this 1000-day window can have a profound impact on a child’s ability to grow, learn, and rise out of poverty. It can also shape a society’s long-term health, stability, and prosperity. 

• During pregnancy, under-nutrition can have a devastating impact on the health if the mother and healthy growth and development of a child. 
• Babies who are malnourished in the womb or in first two years of life have a higher risk of dying in infancy and are more likely to face lifelong cognitive and physical deficits and chronic health problems. 
• Giving mother focused and continuous counselling during both pre and post child birth, through well trained and motivated field health workers:
  • Prebirth period: counselling for nutrition, prenatal vitamins,  appropriate intake of calories during pregnancy can halt the onset of malnutrition right from the womb. 
  • Post childbirth: counseling on breast feeding skills and nutrients-dense complementary feeding post 6 months, educating her on importance of vaccination, hygiene and sanitation.

By focusing on above, mothers and family members are empowered to seek healthy food and hygiene practices for themselves and the young babies. This will also create a strong pull or demand for healthy food items or ingredients as well as better hygiene practices.

Thus investing in better nutrition in the 1000-day window will help families, communities, and countries break the cycle of poverty. 

Long Term Goal of Training

To work towards the WHO Sustainable Development Goals targets 2025, and to improve

maternal, infant and young child nutrition by capacitating healthcare workers at the grassroots to

achieve:

• 40% reduction in the number of children under 5 who are stunted
• 50% reduction in anemia in women of reproductive age
• 30% reduction in low birth weight
• No increase in childhood obesity
• Increase the rate of exclusive breast feeding in the first 6 months to at least 50%
• Reduce and maintain childhood wasting to less than 5%

Overall Training Objective

The programme aims to:

• To empower Filed Health workers as master trainers with the technical knowledge of Infant & Young Child Nutrition & counselling techniques, including mother’s nutrition, breast feeding, and supplementary feeding after 6 months of birth.
•  To make them confident to impart the same training to their colleagues and to caregivers of young infant and children.
• To help caregivers to help their children to survive and thrive, so that they reach their

physical and intellectual potential, by improving their knowledge of health, hygiene and nutrition and child development.

• To reduce the incidence of malnutrition through regular data collection on child growth, prevention, raise alters for early detection and treatment; thereby reducing the incidence of stunting, wasting and associated ill health.

Training Methodology and Content:

SMDT has developed  “First 1000 Days” Training of the Trainers (‘TOT”) module tailored to the Health Care workers. The training approach is based on the principles of Skill development in breast feeding and complementary feeding counselling as well as nutrition Counselling in pregnant and lactating mothers. In-depth learning of the critical window period, pregnancy and nutrition and its role in the growth and Prevention of disease in a child is included. This comprehensive knowledge of the science of breast-feeding and complementary foods empowers the participants to deliver evidence-based dietary guidelines to tackle malnutrition at every stage of the first 1000 days of a child and beyond, and subsequently track growth of children at regular intervals. An interactive Training approach involves hands-on practicals to prepare them to impart high quality training to their co-workers as well as their beneficiaries. The module employs a variety of training methods, including demonstrations, discussions, case studies, critical thinking, team building, drama, role-play and problem solving. Participants are encouraged towards inquiry-based learning and sharing of experiences. The focus is on behavior change communication training, so that they feel empowered to convince caretakers to adopt the latest evidence-based advice. 

Learning Materials

Extensive pictorial and easy to use learning materials includes printed large format guides, charts and easy to use videos. These materials are useful for: .

1. Learning by Health workers / Master Trainers during the training, and to revise learning
2. Use same materials to counsel mothers on regular basis.
3. Videos are available to view or download which mothers can view by themselves later.

Topics covered during trainings are:

1. Science of nutrition
2. Importance of the first 1000 days 
3. Essential nutrition action (ENA)
4. Counselling techniques for behavior change
5. Pregnancy support counselling on health and nutrition
6. Breast crawl
7. Breast feeding technique 
8. Breast feeding difficulties
9. Breast conditions
10. Breast feeding counselling techniques
11. Not enough milk: usual scenario
12. New-born care
13. Minor illness of new-born/young child
14. Guideline of complementary feedings
15. Foods rich in minerals and vitamins, and their recipes
16. Nutrition guidelines in pregnancy and for lactating mothers
17. Behaviour issues of children during meals
18. Safe preparation of meals and importance of good sanitation
19. Myths busting
20. Growth charts
21. Growth monitoring and how to pick up if growth falters

Benefits/Anticipated Outcomes

• Empowerment of the whole community to promote and maintain health, through understanding the importance of early nutrition and hygiene practices  for infant and young child nutrition.
• Evidence-based skill building of breast feeding and appropriate complementary feeding, thereby preventing devastating acute as well chronic malnutrition in children.
• Understanding the techniques of breast feeding positioning and latching, thereby improving the weight and length gain in the baby.
• Understanding the technicalities of beast crawl and importance of colostrums, hence initiating breast-feeding within half hour of birth.
• Increased demand for nutritious food and food ingredient, reduced consumption of junk food and empty calories, thereby improving both short and long-term health outcomes.
• With better nutrition, children will be more likely to reach their physical and intellectual potential.
• Understanding the importance of eating traditional foods and recipes not only for pregnant and lactating mothers, but also for children starting from 6 months of age.
• Knowledge of cooking techniques, which increases nutrient content as well as digestibility of food preparations.
•  Understanding the behaviour issues of children in relation to food and managing them effectively and confidently.
•  Understanding science- and evidence-based feeding practices to reduce myths and doubts.
• Make this knowledge and practices owned by community, to improve health and nutrition of the children and others, and pass on this knowledge for future generations.

If you are keen to introduce Mother and Infant Child Nutrition training in your area or village for field health workers, and thus contribute towards fighting malnutrition, and want to know more about the above training, feel free to reach out to us at info@winfoundations.org

WIN Foundation is a non-profit organization and provides guidance on above at no cost.