Fortified Multigrain and Millet based Supplementation to Address Malnutrition in 3-5 years old Children in Rural Communities of Maharashtra (Phase-II)

Adequate nutrition during early childhood is essential to ensure healthy growth, proper organ function, a strong immune system, and neurological and cognitive development. Despite a decade of rapid economic growth, India’s progress in tackling child malnutrition has been slow. In Maharashtra, which has over 112 million people, the prevalence of under-five stunting, underweight, and wasting stands at approximately 35%, 36%, and 26%, respectively, contributing to a high burden of morbidity and mortality among children. In Pune district, the situation is more severe, with wasting rates reaching 31.4%, exceeding both national (19.3%) and state (25.6%) averages. This highest rate of wasting is driven by inadequate dietary intake, poor hygiene, and sanitary practices that lead to recurrent infections.

Mildly malnourished children who are not adequately or timely treated may progress to moderate or even severe forms of acute malnutrition, a condition associated with higher fatality rates. Studies conducted in Guatemala and Mexico has shown that supplementary feeding combined with caregiver counseling, is effective in resolving mild acute malnutrition among preschool children.

Given the high incidence of wasting among children in Pune, this project aims to address mild acute malnutrition among 3-5-year-old children by providing fortified multigrain and millet-based supplementation. This supplementation, delivered in the form of "Panjiri," a traditional food fortified with 18 micronutrients, is designed to prevent progression from mild undernutrition to moderate acute malnutrition. Clinical studies in Mexico have shown that supplementation in the form of cookies, containing nutrients similar to those in *Panjiri,*can significantly improve weight and height in children with moderate acute malnutrition.

The first phase of the project, implemented across 321 Anganwadi Centers in Maval and Mulshi blocks of Pune district, provided “Panjiri” to 1,000 mildly malnourished children for six months. This intervention resulted in a 55% improvement in nutritional status, bringing children up to normal growth standards. Furthermore, caregivers’ knowledge and behaviors regarding nutrition, health, and hygiene showed a significant improvement, increasing from 21.5% at baseline to 96.9% after targeted education and engagement sessions were conducted with them.

The positive outcomes of phase-1 suggest that expanding the initiative could amplify its impact and provide a robust model for addressing child malnutrition in other blocks of Pune district. Government authorities from Integrated Child Development Scheme (ICDS), Department of Women and Child development and Zilha Parishad, Pune district have also recognized the need to address malnutrition in the hard-to-reach areas of Junnar and Ambegaon blocks. These regions, characterized by challenging terrain, hamper regular access to essential healthcare and nutrition services. Expanding this program would provide a comprehensive approach to improving the nutritional status of mildly malnourished children, ultimately contributing to the long-term well-being and development of these communities.

Objectives

·     To assess the impact of additional nutrition supplementation for 3-5 years’ children of mild acute malnutrition [WHZ between -1 SD and -2SD and or MUAC for age Z score between -1 SD and -2SD], along with focused nutrition education intervention to their parents on the nutritional status of children;

·     To assess changes in the Knowledge of nutrition, health, hygiene and sanitation practices among mothers/caretakers of children with mild acute malnutrition.

Expected Outcomes

·         High compliance with fortified multigrain & millet based supplementation may reduce the prevalence of mild acute malnutrition, improving children’s nutritional status to normal grade.

·         Improved child feeding practices of mothers of children aged 3-5 years.

Two thousand mildly malnourished children will be identified through screening, including standard anthropometric measurements. Identified children will be enrolled in the intervention to receive additional supplementation, in addition to their regular diets, both at home and at Anganwadi Centers (AWCs), along with nutrition education sessions for their caregivers. The effectiveness of the program will be evaluated through repeated anthropometric measurements at 3 and 6 months.