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OPTIONS AND STRATEGIES TO
REACH THE AGE GROUP OF
UNDER-TWOS THROUGH
COMPLEMENTARY FEEDING IN
THE SOUTH ASIAN COUNTRIES
Tara Gopaldas, Director, Tara Consultancy Services,
Bangalore, India.
A commissioned report by MI for the Manila Forum on the Potential
For Protecting Populations from Mineral and Vitamin Deficiencies In
Asian Countries at the Asian Development Bank, Manila, The
Phillipines, February 22 - 24, 2000.
OPTIONS AND STRATEGIES TO REACH THE
AGE GROUP OF UNDER-TWOS THROUGH
COMPLEMENTARY FEEDING IN THE SOUTH
, ■
ASIAN COUNTRIES
T Contents
Page
Introduction
j
Section A : Nutritional needs, deficiencies and the role of
supplementary foods in the age group of under
“twos (macro and micro)
4
Section B : Options for providing nutrition to overcome
deficiencies
15
Section C : Technology for development of premix/
supplementary foods
23
Section D : Production/Packaging/Storage/Distribution
34
Section E : Delivery channels and mechanisms to improve
outreach
41
Section F : Cost implications
49
Section G : Communication and training needs
53
Section H : Monitoring and Evaluation
59
Section I: Opportunities for Public/Private/Academia/NGOs multisectoral collaboration
63
Section J : Global experiences on food delivery
66
Section K : Recommendations for programme development
and mechanism to strengthen policy
69
Abbreviations
73
A CKNOWLEDGEMENTS
I would like to start this report by thanking Mr. Venkatesh Mannar,
Executive Director, MI, Ottawa and Dr. Saraswati Balasu, National
Programme Officer, MI, India for giving me one more opportunity to
expound on Complementary Foods in general and my brain-child
namely, Amylase-Rich-Foods (ARF) in particular.
Having had the
good fortune in my professional career to have worked in industry,
academics and research, I appreciate the crucial need for an immediate
partnership between the three.
Fortification of Complementary
Foods for the needy, the helpless and the most vulnerable Under Two'
infant and toddler is the need of the hour.
It is indeed unfortunate that
this has not happened in a big way for Complementary Foods upto
now.
I sincerely hope that the Manila Forum to be held at the Asian
Development Bank, at Manila, in late February 2000, will kickstart the
whole process.
Most of our babies (6 months to 24 months of age) in
South Asia are in a chronic state of starvation, for both their macro as
well as micro-nutrients.
February . 2000.
Tara Gopaldas
Director
Tara Consultancy Services,
Bangalore. India.
OPTIONS AND STRATEGIES TO REACH THE
AGE GROUP OF UNDER-TWOS THROUGH
COMPLEMENTARY FEEDING IN THE SOUTH
ASIAN COUNTRIES
INTRODUCTION
Most of the 'malnutrition drama’ is already over by the time a South
Asian Child is two years of age (1). More than half the world’s
underweight children live in South Asia (2, 3, 4). In this report I shall
case study India which is one of the eight countries participating in this
important meeting.
India has about 45 million infants/toddlers (6-24 months) in 2000 A.D.
As against India’s 45 million Under Twos; Bangladesh would have about
5.6 million; Nepal about 1 million; and Sri Lanka about 0.86 million.
The target population for Complementary Foods in just these four South
Asian Countries is a staggering 52.5 million per annum.
My former University Department of Foods and Nutrition where I served
as Chair for several years, has been a WHO Collaborating Centre for
Nutrition (Weaning Technology) since 1992 - continuing. My research
group and I were able to bring out a number of research papers and
publications from 1980 - 1993.
The IDRC funded two international
Workshops - one in Seoul, South Korea, at the XIV International
Congress in 1990. This was followed by a National and International
Workshop on the ARF - Story, at Baroda, in end 1990.
The National Planning Commission./ of India has strongly endorsed the
use of my 'ARF - Technology'’ in its Ninth Plan period (1996 continuing). The National Institute of Nutrition (NIN) has endorsed it in
its Dietary Guidelines (1998). The Tamilnadu Nutrition Integrated
Project (TINP) of the World Bank has been using the ARF Technology’
for the past decade. So has Rajasthan.
Many countries namely, Iran, Tanzania, Bolivia, Malawi, South Africa,
Saudi Arabia, Thailand, Kenya, Sri Lanka, Bangladesh and Nepal have
been or are still in touch with us in regard to the ARF - technology.
OPTIONS AND STRATEGIES TO REACH THE
AGE GROUP OF UNDER-TWOS THROUGH
COMPLEMENTARY FEEDING IN THE SOUTH
ASIAN COUNTRIES
INTRODUCTION
Most of the ‘malnutrition drama’ is already over by the time a South
Asian Child is two years of age (1), More than half the world’s
underweight children live in South Asia (2, 3, 4). In this report I shall
case study India which is one of the eight countries participating in this
important meeting.
India has about 45 million infants/toddlers (6-24 months) in 2000 A.D.
As against India’s 45 million Under Twos; Bangladesh would have about
5.6 million; Nepal about 1 million; and Sri Lanka about 0.86 million.
The target population for Complementary Foods in just these four South
Asian Countries is a staggering 52.5 million per annum.
My former University Department of Foods and Nutrition where I served
as Chair for several years, has been a WHO Collaborating Centre for
Nutrition (Weaning Technology) since 1992 - continuing. My research
group and I were able to bring out a number of research papers and
publications from 1980 - 1993. The IDRC funded two international
Workshops - one in Seoul, South Korea, at the XIV International
Congress in 1990. This was followed by a National and International
Workshop on the ARF - Story, at Baroda, in end 1990.
The National Planning Commission,' of India has strongly endorsed the
use of my ’ARF - Technology'’ in its Ninth Plan period (1996 continuing). The National Institute of Nutrition (NIN) has endorsed it in
its Dietary Guidelines (1998). The Tamilnadu Nutrition Integrated
Project (TINP) of the World Bank has been using the ARF Technology’
for the past decade. So has Rajasthan.
Many countries namely, Iran, Tanzania, Bolivia, Malawi, South Africa,
Saudi Arabia, Thailand, Kenya, Sri Lanka, Bangladesh and Nepal have
been or are still in touch with us in regard to the ARF - technology.
1
This report consists of eleven sections as under :
• Section A : Nutritional needs, deficiencies and the role of
Supplementary' foods in the age group of under 2’s (Macro and
Micro).
• Section B : Options for providing nutrition to overcome
deficiencies
• Section C
: Technology for development of premix/supplementary
foods
• Section D
: Production/Packaging/Storage/Distribution
• Section E : Delivery channels and mechanisms to unprove
outreach
• Section F
: Cost implications
• Section G : Communication and training needs
• Section H : Monitoring and Evaluation
• Section I
: Opportunities for Public/Pri vate/Academia NGOs multisectoral collaboration
• Section J
: Global experiences on food delivery
• Section K : Recommendations for programme development and
mechanism to strengthen policy
Each section has been developed in a Question and Answer form which I
felt would be the best way for an interactive discussion among Senior
Public and Private Sector leaders from the eight Asian Countries. Tables,
Figures and References are attached section-wise.
India has been case - studied. Wherever possible comparative data
have been provided for Bangladesh, Nepal and Sri Lanka.
2
REFERENCES
1.
Nutrition and Poverty : Papers from the ACC SCN, 24lil Session
symposium , Kathmandu, Nepal, March 1997.
2.
Nutrition in South East Asia : World Health Organization
Regional Office for South-East Asia. New Delhi, 1999.
3.
Malnutrition in South Asia : A Regional Profile.
Regional Office for South Asia, 1997.
4.
Complementary Feeding of Young Children in Developing
Countries : a review of current scientific knowledge 228pp.
WHO, Geneva, 1998.
3
UNICEF
Section A : Nutritional needs, deficiencies and the role of
Supplementary foods in age group of under Twos (Macro and
Micro).
Section A provides answers to three questions as under :
What is the Nutritional Status of Children Under Two in South
Asia?
Q.2 What are the Nutritional Requirements for the Under Twos in
South Asia?
Q. 3 What is the Role of Supplementary or Complementary Foods for
the Under Twos?
Q. 1
Q. 1 What is the Nutritional Status of Children Under Two in South
Asia?
It is now well recognized that most of the children in A^ia under two
years of age, especially children 6 to 18 months ° are extremely
undernourished, underweight and stunted.
Generally, data on nutritional status is available for the Under Fives'
and not for the 'Under Twos’. From Table 1, it is noticed that
Underweight, Stunting and Wasting is very high in India, Bangladesh and
Nepal. The picture is slightly better in Sri Lanka.
In South Asia there are several factors operating synergistically to hasten
the Below Twos’ rapid decline into undemutrition, especially so from
his/her sixth month of life.
These are :
• the child may have been low birth weight (LBW| i.e. below 2500 g at
birth;
• lack of and/or total unsuitablility of complementary foods;
• repeated episodes of dirrhoeal & respiratory infections;
• unhygienic personal, maternal & envimonmental status;
• unsafe drinking water & poor sanitation;
• limited, distant, slow & non-affbrdable access to preventive &
curative health services;
• poor income levels, illiterate, and working parents;
ignorance of simple & doable caring practices & large families with
narrow or no birth spacing.
INDIA : India’s National Family Health Survey (1992-93) found the
prevalence of under-nutrition to be very high in the Under Twos. The
Survey found more than half (53%) of all children under the age of four
to be underweight and a similar proportion (63%) to be stunted. 21-29%
of children were severely undernourished according to weight-for-age and
height-for-age measures. One in every' six children was found to be
excessively thin (wasted). It further documented that undernutrition
varied substantially
the age of the child, being highest afterJnrsV'six
months. Undemutrition was particularly high in Bihar and Uttar Pradesh,
while the problem of wasting was most evident in Bihar and Orissa,
which also have among the highest infant mortality rates in the country
(1).
A study by Gopalan et al nearly three decades ago clearly showed that
the greatest increase in height in a preschool child (1-5 years) was
between the age of 1 - 2 years. It was much less there^ofto>(_<).
BANGLADESH (3) : Improper weaning practices were observed and
labelled as a cause of early childhood malnutrition in Bangladesh. Too
early commencement of complementary feeding (within a month of the
child’s birth) was also a problem. Semi-solid and solid food (mostly
boiled rice) was given to all children by the time they were a year old but in tiny amounts. The urban and rural poor were similar as regards
prolonged breast feeding. T^utthe urban poor gave more snacks, earlier
supplements such as rice, extra milk, fish, egg and vegetables to the
infant. More complementary food and a better level of hygiene improved
their growth even under impovrished conditions. Apparently IEC alone
did reduce malnutrition to some extent (4).
NEPAL (3) : A Nepal Nutrition Survey clearly showed that the most
critical age in the Nepali child’s life was 12-23 months,when 80% were
undernourished (weight for age), and 48% had a less than normal height
for age (5). Another study indicated that the prevalence of undemutntion
in the Under Twos was very high (6).
SRI LANKA (3) : In Sri Lanka about 25% of mothers in urban areas
begin giving semisolid food after the fourth month as compared to 6% in
rUra? areasSolids such as “rusks’ and “biscuits” are offered in
significant amounts only after the child is six months^).
a nutrition prevalence in children is lower in Sri Lanka than other
out i Asian countries. Rural children have a better exclusive
breastfeeding pattern compared to their urban counterparts.
The
Thnposha project which promotes a high protein fortified food began
in 1972, in collaboration with CARE. Wheat from PL480 programme
was diverted to prepare a weaning food “Thriposha” is a cereal-based
weaning food for the undernourished pre school children, undernourished
children in primary* grades, anemic, pregnant and lactating women and
ward patients. “Thnposha” contains wheat-based products such as flour
and wheat protein concentrate, defatted soy flour, refined soy oil,
vitamins and minerals, a percentage of pre-cooked local cereal-based
flour and soya. The promotion and intensive coverage of the supplement
will be a major task for health planners of Sri Lanka.
It can be seen from Table 2 that the child 1-3 years, of age is most
deficient in Vitamin A, Vitamin C, Riboflavin, Calcium, Niacin,
Thaimin, Energy and Iron. Since the nutrients are available to the child
from the staple cereal, much of the iron would not be available to the
child. (8). Recent studies indicate that most South Asian children are
deficient in zinc. The requirement is 5 mg/day (9).
In sum the child needs all the micronutrients to be provided in his
complementary food.
Q.2 What are the Nutritional Requirements for the Under Twos in
South Asia?
I have considered the Recommended Daily Allowances for the Indian
Child to be most applicable for South Asia.
The nutrient requirements for the early infants (6 - 12 months) &
children (1-3 years)as recommended by the Indian Council of Medica
Research, 1992 (10) is set out in Table 3.
for the infant (6-12 months) & the 1 - 3 year age
The Dietary- Guide
f
Nutrition (NIN), 1998 is repoduced
gr0TUP1£ 57 , n c£e no es straight away from Table 4, that most of our
R Jal Tnb'al 2 Uban children aged 6 to 24 months are m no way
6
North & West Ind’s
balanced diet recommended by NIN. In
dal-roti while in S th fhLdren under
receive miniscule amounts of
child, forhmatpl .ou h & East India they receive rice/sambhar/dal. The
Familv Health
1S on breast’m,lk right into his third year. The National
050/
11 L1jUrVe/ f°und breast feeding to be universal in India, with
hPPn k 3 Cr j er^ born ,n
four years preceding the survey having
en breast fed. However, among children aged 6-9 months, less than
one third were receiving solid or mushy food (amount not specified) in
addition to breast milk.
terns listed in the NIN Balanced Diet for
infants and young children
such as top milk, roots & tubers , green leafy vegetables, fruits, fats &
oils & sugar are luxuries beyond the means or comprehension of any
typical rural or urban, poor Indian household. These expensive items of
fruits, vegetables, milk & pluses are the dietary' avenue to supply
vitamins & minerals to the young child which almost all the LIG,or even
MIG, urban or rural households cannot afford.
Q. 3 What is the Role of Supplementary or Complementary Foods
for the Under Twos?
(i)
Importance of Complementary Feeding for the Under Twos :
Supplementary nutrition is a nutritional intervention, which aims to make
up for the deficit in the child’s diet. The supplement provides the child
with energy, proteins and micronutrients. Various nutritional programs
have demonstrated the importance of supplementary nutrition and the
difference it has made to the nutritional status of the vulnerable age
group.
Data from CARE-India’s Project Poshak revealed that:
• The experimental group (6-11 mths; 12-23 mths; and 24-36 mths)
which received Instant Com-Soya-Milk which was fully fortified with
vitamins and minerals, significantly improved their nutrient intake status
versus a matched control group.
• However one could see glaring deficits in the control group relating
to calories Vitamin C. calcium and iron, in the infant (6-11 months) The
deficit got accentuated with respect to calories. Vitamin A and C, calcium
and iron in the 12-23 months old child. This is because the volume of
brea^ milk drops and the amount of complementary home diet is very
7
himSLr^r't 5hoWJhat ,he 2’3 year old child is able to fend for
on fhp hn
,-r en^r f^an
/oun?er a?e groups as he/she is practically
me iet. Great deficiencies in Vitamin A and C persist (12).
Consequently most infants have to depend on fortified supplementary
oo to obtain their RDA of vitamins and minerals, at least partially.
very attempt should be made therefore to see that the complementary or
supplementary food;
fortified with 80% to 100% of the child’s RDA, especially that of
Vitamin A, B - complex, Vitamin C, iron, zinc;
• is low-bulk (soupy) yet high in nutrient density, so that the child can
consume all or atleast almost all of his/her ration in one or two
sittings; and
•
gets to the home of most children under two, through delivery
channels such as Take Home Rations (THR)
(i)
(ii)
(hi)
These three important conditions need to converge if children are
to benefit from supplementary food.
It is of utmost importance that policy makers, implementers and the
public health and nutrition community recognise these facts.
It is unfortunate that not even nutritionists and deiticians have
sufficiently realised that the consistency, nutrient-density and the
amountsan infant can consume at a sitting vary enormously for a 69 months old; a 9-12 months old; a 12-15 months old and so on till
the child reaches' his/her second birthday. More operational
research and field-testing need to be done in this area.
(ii) Timeiv Complementary Feeding Rates in India : The Indian
National Family Health Survey (1992-93) revealed a wide range among
the Indian states as to when food (liquid, semi solid or solid) was first
introduced into the diet of an infant 6-9 months of age. It ranged from a,
mere 9% in Rajasthan to relatively high 69% in Kerala. However, no
nation-wide survey has been able to quantify the amount of
complementary' food given to the infant.
Such a survey is urgently
required to be conducted.
(The results of the above survey are
reproduced in Table 5).
8
We end this section by reproducing relevant parts of the ACC/SCN
enl10
On
childhood (13); .
benefits of preventing growth failure in early
?
Growth in young children tends to falter very early in many developing
country' populations, usually beginning by four to six months and ending
by two to three years of age. This growth failure is often pronounced, so
that by three years of age the size of the majority of children is outside
the normal range expected in a well-nourished, healthy population”.
“Specially, some significant recent evaluations have shown that
supplementary feeding programmes, w-here enough food is delivered to
and consumed by young children in need are effective in :
• Preventing growth failure;
• Protecting against the negative effects of diarrhoeal diseases on child
growth;
• Improving educational performance, in later days.
ii) Programmes that integrate interventions designed to attack the multiple
causes of growth failure are most effective in improving child growth.
These programmes can be viewed as investments in the future, for they
lead to adults with a greater capacity for health, and productive lives.
Interventions that prevent growth failure in early childhood, it is now
clear, can be expected to have a range of important short and long term
benefits”.
Z/ * n : S?lc/teud Jndicators of the Nutritional Profile of the Under Fives’
in
Jngja^Bangladesh. Nepal and Sri Lanka :
'
INDICATOR
'
INDIA
1
BANGLADESH
NEPAL
SRI
LANKA
!
Children
underweight
Children stunted
(%)
(%)
(%)
____ (%)
------------ *I
i
50
56
49
31
63
51
51’
i
Children wasted
LBW babies
! (<2500 g)
■
i
Prevalence of
Vitamin A deficiency
16
t
___
17
15
9
NA
30
50
33
18
i
1
0.70
Night Blindness
0 78
Night Blindness
0.33
Bitot's spots
06
Bitot's spots
____________
56
73
78
School
Children
45
School
Children
23-65
50
40
School
Children
w
School
Children
| Exclusively Breast
i fed upto 3 rd month
51
54
36
24
Breast fed with
complementary food
(6-9 month)
31
30
80
60
Breast feeding until
20-23rd month
87
67
NA
66
l Prevalence of Iron
1 Deficicncv Anemia
I
•--------------- —--------- —
Prevalence of Iodine
Deficiency Disorder
i
t
^ihEHTAsia. SEARO.
Note : Adapted from N
South Asia : A Regional Profile. 1997.
ueim. 1^,.
in
~
Table 2 . Average Nutrient Intake in Indian Under Threes in India
Vs their RDA (8) :
Age
(years)
Energy
(Kcal)
Prot
_Jg>
Ca
(mg)
Fe
(mg)
Vit A 1 Thai min
B2
(ug) --- (mg)
I— Pz __ y(mg)
o'
1-3
908
23.7
256
10 2
117
1242
22.0
400
12 0
RDA
!-3
L
i
|
or!t
RDA
;
I
| 108%
1
i
1
0.37
0 60
0.70
)
j
1
73%
400
0.52
Naiun
__ v(mg)
VitC
(mg)
__
v *&*__
14
5.55
i
i
i
i
■
8 00
j
64? o I
1
i1
85%
■
29?'o
!
87%
53%
’
40
i
1
69%
•
|
35%
1
Note Adapted from the National Nutrition Monitoring Bureau
(1998-90), National Institute of Nutrition, Hyderabad
Repeat Surveys
Table 3 : Recommended Daily Allowances for the Infant ( 6 -12
months) & the Child (1-3 yrs)
Children
Infants
Group
6-12 (months) 1-3 (years)
Particulars
12 2
8.6
Bodv wt (Kg)
1240
843
Net Energy (kcal/d)
14
22
Protein (g/d)
25
25
Fat (g/d)
400
500
Calcium (mg/d)
12
12
Iron (mg/d)
5
5
Zinc (mg/d)
400
350
Vitamin A (ug/d)
1600
1200
p - Carotene (ug/d)
06
0.6
Thiamin (mg/d)
0.7
0.7
Riboflavin (mg/d)
8.0
8.0
Nicotinic acid (mg/d)
0
9
0.4
PvTidoxin (mg'd)
40
25
Ascorbic acid (mg/d)
30
25
Folic acid (ug d)
0
2-10
0.2
Vitamin B - 12 (ug/d)
Source Nutrient Requirements and Recommended Dietary
.Allowances for Indians The Indian Council of Medical
Research. New Delhi. 1992 (10)
11
i
1
1
Table 4 : Balanced Diet for Infants & Children
Food Groups
Infants
(6-12 months)
Amount/ day (g)
45
15
500
50
25
25
100
25
10
Cereals & Millets
Pulses
Milk (ml)
Roots & Tubers
Green Leafy Vegetables
Other Vegetables
Fruits
Sugar
Fats/Oils (visible)
Children
(1-3 years)
Amount/ day (g)
120
30
500
50
50
50
100
25
20
Note : Top milk of 200 ml has to be given even in case of
breastfed infants.
Source : Dietary Guidelines for Indians - A Manual. The
National Institute of Nutrition, 1998 (11).
Table 5 : Timely Complementary* Feeding Rates (%) in
Indian States (3) :
STATE
RATE % 1
Rajasthan
9.4
i Assam
39.2
■;
j Bihar_________________
18.1
!
Orissa;
30,2
j
West Bengal______________ 53.6
47.8
Andhra Pradesh
38.2
Karnataka
69.3
Kerala
56.5
Tamil Nadu
i
22.9
Gujarat
25.0
Maharashtra
19.4
Uttar Pradesh
27.7
Madhya Pradesh
31.4
All India
12
L.J
i
I
c
references
II
t
□
1
Gopalan C. et al : Effect of Calorie Supplementation on Growth
of Undernourished Children. Am J Clin Nutr 26, 563 - 566, 1973.
i
Li
il
c
jI
L
c
3.
S.K. Roy
:
Complementary Feeding in South Asia, in
Malnutrition in South Asia : A Regional Profile. Pg 51 - 73, 1997.
4.
Brown L. V. et al : Evaluation of the impact of weaning food
messages on infant feeding practices and child growth in rural
Bangladesh. Am. J. Clin. Nutr. 56, 994-1003, 1992.
5.
Nutrition in South East Asia
1999.
6.
Mortorell R., Leslie J., Mook P. R. : Characteristics and
Determinants of Child Nutritional Status in Nepal. Am. J. Clin.
Nutr. 39, 74 - 86, 1984.
7.
Sova P and Sennayeke M. : The introduction of a low-cost
weaning food, its acceptability and effectiveness in a well-baby
clinic, Ceylon J. Child Health, 14, 21-26, 1985.
8.
National Nutrition Monitoring Bureau : Report on the Repeat
Survey (1988-90). National Institute of Nutrition, Indian Council
of Medical Research, Hyderabad, 1991.
9
Sazawal S. et al : Zinc Supplementation in young children with
acute diorrehea in India. New England Journal of Medicine. 333,
839-844, 1998.
10
Nutrient requirements and Recommended Dietary Advances
for Indians : The Indian Council of Medical Research, New
I
r
E
F
F
c
E
p.he ?,a^onal Family Health Survey (MCH and Family
anning), India : Report of the International Institute for
Population Sciences, Bombay, India, 1992 - 93.
Delhi. 1992.
I I
I
: pg 57-60, WHO, New Delhi.
11.
Dietary Guidelines for Indians - A Manual
Institute of Nutrition. 1998.
12.
Gopaldas T. et al : Project Poshak, pg 73, Volume One. printed
by CARE - India, New Delhi, 1975.
13.
Nutritional Issues in Food Aid : ACC/SCN Symposium Report.
Nutrition Policy Discussion Paper No. 12, pg 36,1993.
14
: The National
L'
P
U.
Ue—*
I
p
r’
Q
b
Section B : OPTIONS FOR PROVIDING NUTRITION TO
OVERCOME DEFICIENCY
To restate from Section A, it is seen that a complementary food for the
Under Two has to be :
• ’fully fortified;
• liquefied or drinkable in consistency and;
• readily available in the home of the child.
This section will address the importance of Consistency of the
Complementary Food under the^uesfionb I
b
L
r
I
e;
c
r
r
c1i
r
I ;i
ii
Q 1
What is the problem about Feeding the Under Twos?
Q 2.
What is the concept of Amylase-Rich-Food (ARF)?
Q.3
What are the advantages of a fully mirconutrient-fortified ReadyTo-Eat (RTE) Complementary food with ARF?
Q.l
What is the problem about Feeding the Under Twos?
The vast majority of older infants (7-12 months) and
young toddlers
(13-24 months) in the developing world are chronically undernourished.
Most of the undemutrition is associated with growth faltering that occurs
in the so-called weaning period (6-24 months) (1). This condition is
associated with a high bulk, low energy diet (2), accompanied with bouts
of diarrhea contributed in large measure by the intake of contaminated
left over foods (3). The most common and first complementary' foods to
breast milk, which is fortunately one of the most energy and nutrient
dense foods (4) are small amounts of soft boiled rice or mashed chappati
or breads or most commonly, viscous cereal gruels or preparations made
from rice (Asia); sorghum, finger millet, maize, cassva and plantain
(Africa); rice, wheat, millets, tapioca, potato (India) or sweet potato
(Papua New Guinea) (5). The problem is that most poor mothers make a
5% gruel (5g of a staple cereal flour cooked in 100 ml of water), which
becomes thick and voluminous on cooking due to gelatinization and
water-binding capacity of the long chain carbohydrate component in the
I
i5
cereal flours. Such a gruel would contribute a mere 20 Cal/100 g gruel
or it vsou d have an extremely poor nutrient density whilst having a high
j
Further, the weaning age child has a poor swallowing
re ex an can consume only small portions of semi-solid preparations.
Hence, the dilemma is:how to feed enough of the traditional gruel
with a high energy density? How can one modify the form and
texture of a solid or semisolid weaning preparation to a pour batter
consistency? In fact, how can one literally 'thin’ an extremely thick
preparation and make it swallowable yet energy rich for the weaning
child?
Q 2. What is the concept of Amylase-Rich-Food (ARF)?
The concept of Amylase-Rich-Food or ARF (7) directly addresses the
twin problems of dietary bulk and poor energy density of most weaning
gruels of the poor. ARF is nothing but germinated cereal flours which are
extremely rich in the enzyme alpha-amylase.
Just tiny or catalytic
amounts of any germinated cereal flour can instantly liquefy or reduce the
dietary bulk of any viscous multi-mix gruel tn uihich cereal flour is the
main ingredient. The alpha-amylase cleaves the long carbohydrate chains
in the cereal flour into shorter dextrins. However, for enzymatic action
three conditions are required in the gruel or porridge, namely, it must be
homogenous, it must be moist, and it must be hot (at least 70° C). Just
half a flat teaspoon of any ARF can reduce even a very high solid
concentration of 45 g made up of 25 g flour, 15 g sweetener and 5 g oil
cooked in 100 ml of water to soupy consistency.
This remarkable
property makes it possible to offer the weaning child a low viscosity yet
high energy dense preparation from habitual ingredients that are used for
young child feeding even in poor homes. ARF will act equally well on
any gruel prepared from homogenized khichidi , or from chappati ,
biscuit or bread powder, or Soya-Fortified-Bulgor-Wheat powder. The
single and unique contribution of ARF is that it can permit the
mother to mix in much more flour into the gruel and consequently
make it high in energy density, yet low in viscosity and dietary bulk
(Table 1).
Germination of pulses and cereals are part and parcel of the culinary
culture of Asia and Africa. ARF preparation is relatively simple as it is
broadly based on germination. A small amount of any whole cereal
i
t
u
grain (100 g or so) is steeped overnight in 2-3 times its volume of water,
t e excess water drained, and the moist swollen seeds germinated in a
moist dark environment for 24-48 hours till the sprouts are evident. The
further steps are sun-drying for 5 to 8 hours and lightly toasting the grains
on a flat skillet to remove any surface moisture.
The sprouts are
removed by hand abrasion and the grains are milled or powdered. This is
stored in an air-tight bottle or plastic container. This small amount of
ARF for a cost of about Rs. 2/- to 3/- (in 2000 AD), will suffice for one
child s gruel for one month. It need be made also only once a month (812). Summing up the advantages of ARF preparations are :
i
I I
try
I I
LZ
I i
r”
I—
|
c
•
•
•
•
•
cheap cost;
widely known and practiced household technology;
small amounts to be made only intermitently, and;
adaptability of making at the household, the community
at the scaled-up commercial level.
or even
In fact a borL/j malt which sells from Rs. 16-20 per Kg. at current
rates, can be directly purchased from beer breweries, and be milled
and packaged into 5 g packets with or without the micronutrients,
which the mother can buy (13-18). Germinated soughum flour has
been used for the same purpose in Tanzania.
Q. 3 What are the advantages of a fully mirconutrient-fortified
Ready -To-Eat (RTE) Complementary food with ARF?
As explained at Answer 2, the transformation from a thick or pasty
complementary food to a drinkable consistency is the miracle of ARF.
An infant/toddler (6-24 months) can easily consume 3 to 5 times of an
isocaloric yet nutrient dense complementary food with ARF Vs one
without ARF (19-22). It stands to reason that unless the child
consumes his/her entire ration of the complementary food, the
vitamin and mineral fortificants will also go waste. The liquified yet
nutrient-dense complementary food, therefore becomes the conduit
or channel to deliver the entire RDA of micronutrients to the infant
and toddler.
L
! I
<1
REFERENCES
'
L
H 7tei9«Z J"’ Payne P‘
o3-o55
E
J-
E
L'
E
Protem ar,d calorie concentration. Nutr. Rev. 129;
3.
Rowland MGM, Barrell RATE, Whitehead R.G. : Bacterial
contamination in traditional Gambian Weaning Foods. Lancet
1:136-138,1978.
4.
Cameron M., Hofvander Y. : Manual on Feeding Infants and
Young Children, New York, United Nations, pg 73, 1971.
5.
Alnwick D., Moses S., Schmidt O. G. : Improving Young Child
feeding in Eastern and Southern Africa. Canada International
Development Research Centre, pp 1-380, 1987.
6.
Mellander O, Swanberg U., : Compact calories, malting and
young child feeding. In : Advances in International, Maternal and
Child Health. Eds Jelliffe, D. B., Jelliffe EFP, Oxford. Clarendan
Press, pp 84-85, 1984.
7.
Gopaldas T., Mehta P., Patil A., Gandhi H. : Studies on
reduction in viscosity of thick rice gruels with small quantities of
an amylase rich cereal malt. UNU Food Nutr Bull 8:42-47, 1986.
8.
Gopaldas T., Mehta P., John C. : Bulk reduction of traditional
gruels in : Improving Young Child Feeding in Eastern and
Southern Africa. Eds Alnwick D., Moses S., Schmidt O.G.
Canada, International Development Research Centre, pp 330-339,
1987.
9.
Gopaldas T. : Simple traditional methods for reducing the dietarv
bulk of cereal based diets in rural homes. Proceedings of the 20
Annual Meeting of the Nutrition Society of India, 73-84, 1988.
i
r
V
1971.
: 7116 Protem gaP- Nature, 258 : 113-
18
10.
Gopaldas T., Deshpande S., John C. : Studies on a wheat
amylase-rich-food (ARF). UNU Food Nutr. Bull 10:50-54, 1988.
11.
John C., Gopaldas T. : Studies on reduction in dietary bulk of
soya fortified bulger wheat gruels with amylase rich food. UNU
Food Nutr. Bull 10:1-7, 1988.
12.
Deshpande S., Nisar S. R., Gopaldas T. : A technology to
improve the viscosity, texture and energy density of commercial
weaning foods.
Abstracts 27th National Conference of Indian
Academy of Pediatrics, 1990.
13.
Mosha A.C., Svanberg U. : Preparation of weaning foods with
high nutrient density using flour of germinated cereals. UNU
Foods Nutr Bull 5:10-14, 1983.
14.
Desikachar HSR. : Development of weaning foods with high
calorie density and low hot paste viscosity using traditional
technologies. UNU Foods Nutr Bull 2:21-23, 1980.
15.
Brandtzaeg B., Malleshi N.G., Svanberg U., Desikachar HSR,
Mellander O. : Dietary bulk as a limiting factor for nutrient
intake in pre-school children. III. Studies of malted flour from
ragi, sorghum and green gram. J Trop Pediatr, 27: 184-189, 1981.
16.
Gopaldas T, Inamdar F., Patel J. B. : Malted versus roasted
young child mixes : Viscosity, storage and acceptability trials,
Indian J Nutr Dietet, 19:327-336, 1982.
17.
Gopaldas T. : The ARF story. A compendium of research of
Amylase-Rich-Food. National/Intemational Workshop on ARF
Technology, Baroda, p 12, 1990.
18.
Gopaldas T.
: Fighting Infant Malnutrition with amylase
complementary foods, Nutriview Issue 2, 1998.
19
Gopaldas T. : Technologies to improve weaning food in
developing countries. Editorial, Indian paediatrics, 28:217, 1991.
Gopaldas T. , John C. : Evaluation of a controlled six months
feeding trial on intake by infants and toddlers fed a high-energy.
low bulk gruel. J Trop Paediatr. 38: 278-283, 1993.
21.
John C., Gopaldas T. : Evaluation of the impact on growth of a
controlled six months feeding trial on children (6-24 months) fed a
complementary food of a high energy, low bulk gruel in addition
to their habitual home diet. J Trop Paediatr 39:16-22,1993.
22.
Gopaldas T. : Amylase Reactive Foods in the Improvement of
Young Child Diets., Proc. Nutr. Soc., India, 1992.
Table ±
Reduction in viscosity of 20% hot paste slurries with the addition of 0 8g wheat ARF
Viscosity in Centipoise Units
Hot paste slurries prepared with
Control gruel
Experimental gruel
1.
Soya Fortified Bulger Wheat
22400
1210
2.
Low fat Marie biscuits
8100
2460
3.
Medium fat g'ucose biscuits
15200
5000
4.
High fat biscuits (salty)
3800
2520
5.
Bread
9200
2360
6
Khichdi
18000
10700
7.
Chapati
14800
3600
Note : In all cases 20g of the powdered material was cooked to boiling in 100 ml.
water. When ARF was added it was at the expense of the substrate
powder.
Control
—H Experimental
Fig 1 Weight velocity of*6-24 months old children
Vol. No. 39, Proc. Nutr. Soc. India, 1992 (22) >
21
Final
Normal
Stwntod
Woatod
W*S
Normal
Stvnied
W»»wd
w*s
Fig 3. Nutritional status by combined weight for height and
height for age-Watorlow classification of 6-24 months old children
S8
Vol. No. 39. Proc. Nutr. Soc. India. 1992
SECTION C : TECHNOLOGY FOR DEVELOPMENT OF
PREMIXES AND SUPLLEMENTARY FOODS:
The above will be answered through the following questions :
Q 1.
Q 2.
Q 3.
Q 4.
Q 5.
Q 6.
Q 7.
What was India’s experience with making complementary foods in
the seventies?
What is India’s expertise in the commercialization of these
technologies in 2000 A.D.?
What were the major findings of the Baroda group (1980-1993)on
the ARF technology?
How can the Baroda group’s findings be applied to move forward
to the commercial production of approximate RTE complementary
foods and/or sachets that include micronutrients and ARF?
Who are currently the large manufacturers of vitamin-mineral
premixes in India?
Who are currently the large manufacturers of Commercial Barley
Malt in India?
Who are the manufacturers who would be interested in the Sachet
idea?
Q 1. Wbat was India’s experience with making complementary
foods in the seventies?
In India the technology for preparing simple roasted mixtures from
cereals, pulses, oilseeds' and jaggery (brown sugar) or sugar have been
formulated by many research groups for decades. Almost all have been
field tested, were found to promote growth in the child, and many have
found their way into community level or state level programmes. (Table
1). However, the great lacunae in these early attempts at formulating
these RTEs for infants, toddlers and preshcool children were :
. The concept of ARF the liquefier’was not even born
. The mixes were solid. Hence, the most vulnerable Under Twos could
consume very little of his/her ration.
• None of them were fortified with vitamin-mineral premixes.
23
Q 2. What is India’s expertise in the commercialization of these
technologies in 2000 A.D.?
n e present scenario of 2000 A.D., India and other countries have
a vance tremendously. Linear programming is used routinely for
evolving nutritious low-cost complementary foods. It has the state-ofthe art plants or factories in both the Private and Public sector with large
capacities for making complementary or weaning foods.
Technologies
such as extrusion; roller/drum drying; spray drying; addition of the entire
or a large proportion of the RDA of vitamins-minerals requirements; and
the ARF technology (Table 2).
In addition, the technique of Linear
Programming to obtain least cost multimixes to deliver a stated amount of
energy and protein is also possible.
Q 3. What were the major findings of the Baroda group (1980 1993) on the ARF technology?
Between 1980 and 1993, my research team in Baroda established the
following findings :
• Toddlers consumed significantly greater amounts of fully malted
mixes of w’heat flour, chick.
flour and powdered groundnut
flour than equivalent roasted mixes.
However, the task of
germinating, drying and powdering large quantities of cereal and
pulses was cumbersome and laborious (1).
• Catalytic amounts of any germinated cereal gram (malt) powder, such
as wheat, millet and barley, can liquefy virtually any cereal based
viscous gruel. This is because of their high content of alpha-amylase,
which has the power to break down starches into smaller units almost
instantlv at boiling temperatures. These malt powders were named
amylase-rich-food (ARF).
» By virtue of the drinkable consistency, a child could consume three to
five times more of the treated food per sitting.
Hence, the child
received more food energy/nutrients (2,3).
Traditional gruels were made more energy-dense by cooking 40 g of
staple flour + 5 g of ARF + 200 ml water. Toddlers were easily able
to consume this amount, so obtaining 180 calories from a typical
traditional gruel. Addition of oil and sugar raised the calorie intake to
200-250 KcaF200ml (4).
24
IhLtddltl°H °f ARF t0 donated foods such as soya-fortified bulgor
infante->°dHier ^lficantl-v increased calorie density and intake in
infants toddlers 6-24 months old (5).
Mothers in urban slums were taught to make wheat ARF. They found
the germination process laborious. However, thev were more than
willing to buy 5 g of ready-made ARF as an additive, even at Rs 2/per packet or Rs. 60/- per month (1 USD = 43 Rs.). Nevertheless,
they preferred to buy ARF-treated “fullfeed” packets of 50 g or 100 g
for Rs. 3/- or Rs. 5/- each respectively. (6).
• ARF was found to liquefy khichadi (a boiled rice/lentil food), chappati
pieces soaked in water, com-soya mix and soya-fortified bulgor wheat
powders (7).
• In a controlled six-month trial of infants and toddlers fed a highenergy, low-bulk gruel (with ARF) or an isocaloric high energy, highbulk gruel (without ARF) in addition to their habitual home diet,
intakes of the low-bulk gruel were significantly higher (91 ±28 ml or
148 ± 46 Kcal per ad-lib feed) than intakes of the high bulk gruel (26
±11 ml or 42 ± 18 Kcal) (8). Children on the low-bulk gruels also
grew faster (9).
• The ARF technology was very successful in nutritional rehabilitation
(10). A major breakthrough was achieved when commercial barley
malt powder was shown to have the most powerful ARF activity (11).
Q 4. How can the Baroda group findings be applied to move
forward to the commercial production of appropriate RTE
complementary foods and/or sachets that include micronutrients and
ARF?
Liquefrcation of complementary weaning foods with ARF promises to be
a valuable technology to reduce the burden of malnutrition in infants and
toddlers in developing countries. In India, for example, parents from an
enormous pool of increasingly mobile, low-income families are looking
for moderately priced weaning foods they can buy on a regular and
unstained basis They currently buy expensive brands but feed them tn
very small quantities. There is a strong habit among most Indians to buy
very bin* 4
d condiments in small amounts for the
Z participatory research assessments have shown that
day. Prehmmao- pan P
of Rs 4000/. 5000/.
even lo"’1“c°” 105USD) They are more than prepared to pay Rs. 3/Foerr"mgle feed i'f 50 g right through a child’s wean,ng penod (6-24
25
months).
The concept of '‘sachets of CBM + the entire RDA of
micronutrients” also appeals to them very much.
CBM can be sourced like any of the other ingredients in weaning foods in
the open market or from the local liquor or malt food industry. With
CBM at Rs. 20/- per Kg as against Rs. 16/- per Kg for sugar, there would
be hardly any extra cost. In fact the fuel costs of extrusion can be greatly
reduced if ARF is added to the slurry prior to extrusion as shown by
Buffa in 1971(12). CBM sells at only 20 US cents per Kg in USA; so
USAID, CARE and WFP should seriously consider sourcing this food
commodity in addition to soya oil, CSB and SFBW. The Government run ICDS weaning food plants would only require 2000 tonnes of CBM
for the 100J)00 tonnes of weaning food they produce per annum. The
ARF can be blended or mixed into the complementary food with the
vitamin-mineral mix at the last stage of processing.
The question might be posed as to why more research with commercial
barley malt ARF is needed? We feel there are cogent reasons for large
multi-country operational research studies in South Asia :
• Commercial barley malt is by far the most powerful ARF we have
tested. Just 5% CBM can liquefy a ready-to-eat ration (50 g in 100
ml boiling water) which wheat ARF can not do. Hence, a 50 g
complementary food in 100 ml of water can deliver an extra 200 Kcal
+ 6 g protein.
• An infant or toddler can easily consume about 100 ml of ARF treated complementary feed at one sitting.
• A low-bulk or “drinkable” feed fortified with the child’s entire RDA
of micronutrients (Table3) would also improve the child’s
micronutrient and nutritional status.
• The concept of a measurable and adequate amount of complementary
feed could be introduced through the concept of a daily 50 g packet
per day. The concept of hygiene could be introduced through the
'‘daily packed ration”. Since the entire amount can be consumed at
one sitting, much of the problem of microbial contamination will not
arise.
Extrusion and individual packing are recommended to ensure a shelf
life of more than a year. Simple roasted mixes have a shelf life of
onlv 3-4 months.
26
• Rice and green gram are accepted all over South Asia as being the
most digestible cereals for the infant.
•
The economic position of the low-income group is much better now.
The expectations are higher. They are prepared to pay for their child's
nutrition and health, provided such complementary food packets or
sachets are affordable and easily available.
The concept could be extended to any population or condition requiring ol.
high-energy, low-bulk food (e.g. geriatrics, tubal feedings, refugees,
pregnancy). What is now needed is an organisation or company that is
ready to take . . this initiative and bring the technology to a level that will
allow this complementary food to be produced commercially.
Q 5. Who are currently the large manufacturers of vitamin-mineral
premixes in India?
They are :
• Nicholas Piramal (I) Ltd
Vitamin and Fine Chemicals Division,
100, Center Point, Dr. Ambedkar road,
Parel, Mumbai 400 012.
Tel : 4134653, Fax : 4172881
• Jeevee Foods (P) Ltd.
No. 259, Tejas Arcade,
Sanjay Nagar Main road,
Ashwathnagar,
Bangalore 560 084
Tel 3410394, 3416310, 3410552
P’floor Premanand Sahitya Sabha Hall,
Dandiya Bazar, Baroda 390 001
Tel : 553319, Gram : LOCOM
27
• Rice and green gram are accepted all over South Asia as being the
most digestible cereals for the infant.
•
The economic position of the low-income group is much better now.
The expectations are higher. They are prepared to pay for their child’s
nutrition and health, provided such complementary food packets or
sachets are affordable and easily available.
The concept could be extended to any population or condition requiringa.
high-energy, low-bulk food (e.g. geriatrics, tubal feedings, refugees,
pregnancy). What is now needed is an organisation or company that is
ready to take; . this initiative and bring the technology to a level that will
allow this complementary food to be produced commercially.
Q 5. Who are currently the large manufacturers of vitamin-mineral
premixes in India?
They are :
• Nicholas Piramal (I) Ltd
Vitamin and Fine Chemicals Division,
100, Center Point, Dr. Ambedkar road,
Parel, Mumbai 400 012.
Tel : 4134653, Fax : 4172881
• Jeevee Foods (P) Ltd.
No. 259, Tejas Arcade,
Sanjay Nagar Main road,
Ashwathnagar,
Bangalore 560 084
Tel :3410394, 3416310, 341Oo52
1st floor, Premanand Sahitya Sabha Hall,
Dandiya Bazar, Baroda 390 001
Tel : 553319, Gram : LOCObi
27
Q 6. Who are currently the large manufacturers of Commercial
Barley Malt in India?
• Mr. P.K.. Jain or Mohit Jain
Malt Company
Khandsa road,
Gurgaon, Haryana.
• Mr Puran Chand
Bar Malt
Jharsa road,
Gurgaon, Haryana.
• United Brgwnes
Bangalore.
Q 7. Who are the manufacturers who would be interested in the
Sachet idea?
•
•
•
•
•
Jeevee Foods, Bangalore.
Biocon, Bangalore.
Hoffman-La Roche, Mumbai.
Ranabaxy, Delhi.
Hindustan Lever Ltd., Mumbai.
28
1 ’ /*k°te*n enr’ched RTEs for infants, toddlers and pre-school
children at the community and industrial level :
REFERENCE
i
PRODI CT
COMMUNITY LEVEL :
INGREDIENTS
i
1. Pasricha et al (1973)
Ready-to-mix powder
60g cereal (wheat, bajri or
ragi) 15g pulse (roasted
bengal-gram), an oilseed
and 40g sugar jaggery
2. Devadas et al (1974)
Weaning mix
Cereal (cholum, ragi or
maize), pulse (roasted
greengram or bengal gram
dal);oil seed (roasted
groundnut) and jaggery
3. Gopaldas et al (1975)
Poshak (a)
Cereal (wheat, maize, rice
or jowar), pulse (chana dal
or mung dal), an oil seed
(groundnut) and jaggery in
the proportion of 4.2 1 2
Poshak (b)
Same ingredients as
Poshak (a) but in the
proportion of 60 17 14 9
Kerala indigenous food
(KIF)
Tapioca rava. soya
fortified bulgar wheat
(SFBW) rava and
groundnut flour
Ready-to-consume mixture
Roasted cereal (cholam.
maize, ragi or bajra).
Pulse (roasted or sprouted
Qpr~O>
bengalgram, greengawi or
foxgram), oil seed
(groundnut,
groundnut/sesame cake
flour.)
5. Chandrashekhara et al
(1976)
6 ICMR(1977)
VS eaning food formulations developed in various countries
Product
Balanced malt food
Bal-ahar (dry-blend)
I
Country
India (CFTRI)
India ((FCI
formulated by
. CFTRI)
India (CFTRI)
Flakes (Macaroni
process)_____________
Precooked weaning
India (CFTRI)
food of different
formulae (Roller dned) 1
Bal-Amul and BalIndia (NDDB
Amul cereal with milk | formulated by
(Roller dned)
I CFTRI)
Nestum
India
Farex
India (Glaxo)
! Lactogen
India (Nestle)
> Incapanna
Columbia
Pronutro
! Com sova milk
Caplapro
Superamine
Faffa
Duryea
Peru vita
Laubma
Primary Ingredients
Cereal, malt, pulses, and skim milk
powder
Wheat flour, groundnut flour,
Bengalgram flour and skim milk powder
i
Edible groundnut cake flour, Bengalgram I
flour, greengram flour, wheat flour
j
Cereal flours, pulses and oilseed cakes
j
i
Cereal flours, pulses, soya flour, skim
milk powder
j
ii
Soyabean flour, milk powder
Cereals and milk powder
1
Wheat flour, milk
Maize flour, cottonseed flour, soyabean j
flour, vitamin A, calcium cabonate
•
S. Africa
| Maize flour, soya, groundnut wheat
germ, skim milk powder, fish flour
!
Precooked maize, defatted soya flour,
USA
i skim milk powder, CaCO3, vitamms_____ j
U.S.A.
■ De-germinated maize flour, wheat flour. I
soya flour, skim milk powder, CaCO3,
vitamins
i
Hard
wheat
flour,
chick-pea
lentil
flour,
i
' Algeria & Turkey skim milk pow'der, vitamins
1
J
Wheat
flour,
field
pea
flour,
skim
milk
Ethiopia
powder, chick-pea lentil________________
Defatted soya flour, high lysine com
Columbia
flour, com starch, milk powder, vitamins,
minerals__________________ __ _________
Cottonseed flour. Quinoa flour, skim
Peru
milk powder, sugar, spices, vitamins____
__________ _ ______ —*—
Wheat, chick-pea, and skim milk powder |
Beirut
______
L
L
30
Table3 : Nutrient value of CSB and Oil
65g Ration of
CQR _i_ Qn
Nutrient Value
Percentage
319 Kcal
11.7g
1105 IU
0.33 mg
13.00 mcg
26.00 mg
520.00 mg
11.70 mg
1.95 mg
32.50 ppm
26
53
69
47
43
65
130
98
39
108
r\-.i
Food Energy
Protein
Vitamin-A
Riboflavin
Folic acid
Vitamin C
Calcium
Iron
Zinc
Iodine
Source: Nutrient Requirements and Recommended
Dietary Allowances for Indians, The Council of Medical
Research, New Delhi, 1992.
31
GH- 'c O
references
1.
GopaldasT., Inamdar F., Patel J. : Malted versus roasted
young child mixes : Viscosity, storage, acceptability trials: Indian J
Nutr Diet, 19:327-336,1982.
Gopaldas T. :
Malted versus roasted weaning mixes.
Development, storage, acceptability and growth trials. In
Interfaces between Agriculture, Nutrition and Food Science. Ed.
K. T. Achaya. UNU Food Nutr Bull Suppl 9:293-307. 1984.
3.
Gopaldas T. Mehta P., Patil A, Gandhi H : Studies on reduction
in viscosity of thick rice gruels with small quantities of an amylase
rich cereal malt, UNU Food Nutr Bull Suppl 8:42-47, 1986.
4.
Gopaldas T. : Technologies to improve weaning food in
developing countries. Editorial, Indian Paediatrics, 28:217, 1991.
5.
John C., Gopaldas T. : Reduction in dietary bulk of soyafortified bulgar-wheat gruels with wheat amylase-rich food, UNU
Food Nutr Bull Suppl 10:50-53, 1988.
6.
Gopaldas T., Deshpande S., Vaishnav LT et al : The transfer of a
simple dietary bulk reduction technology of weaning gruels by
amylase-rich foods (ARFs) from laboratory to urban slum, UNU
Food Nutr Bull Suppl 13:318-321, 1991.
7.
Gopaldas T. : Simple traditional methods for reducing dietary
bulk of cereal based diets in rural homes. Proc. Nutr Soc India,
34:73-84, 1988.
8
Gopaldas T., John C. : Evaluation of a controlled six months
feeding trial on intake by infants and toddlers fed a high-energy,
low-bulk gruel. J Trop Paediatr 38. 278-283, 1992.
9
JohnC Gopaldas T. : Evaluation of the impact on growth of a
controlled six months feeding trial on children (6-24 months) fed a
complementary food of high-energy, low-bulk gruel versus a high-
3Z
energy, high-bulk gruel in addition their habitual home diet. J Trop
Paediatr39: 16-22, 1993.
10.
Tajjuddin K. M. : Studies on nutritional rehabilitation with ARF.
Unpublished PhD results, 1990.
II.
Mujoo R. : Studies on commercial barley malt.
PhD results, 1993.
12.
Buffa A.
:
Food Technology and Development, Part 1.
Processing low-cost nutritious foods for the world’s hungry
children. Factors, formulas, processes. Food Engineering : pg 79106, 1971.
33
Unpublished
This section will describe a 2000 AD effort to deliver a Complementary
r t a -r-+ * e RDA of all the required micronutrients for an Indian
child Under Two years of age.
The Food Manufacturer (in question) is Jeevee Foods Pvt. Ltd.,
Bangalore. Please refer to Table I in this Section for details of the
composition used for the production of one of the variants of the
Complementary Foods. Jeevee Foods is the first manufacturer who is
prepared to make tailormade complementary foods at reasonable cost.
The responses as listed have been given by the CEO himself.
However, a daily cost of some Rs. 14/- to deliver 400 Kcal + the RDA of
micronutrients, may well be unaffordable by the LIG and MIG families.
They may revert to their habit of making the product stretch by feeding
the child quantities well below the optimum.
How is the complementary food produced ?
?
Howl’ -Is
of the complementary food'•
How is the complementary food stored?
How will the product be distributed ?
How much RTE or complementary food does the Public Sector
produce per annum?
Q 6. What are the other countries/parties involved in Food Production?
Q 1.
Q2.
Q3
Q 4.
Q 5.
Q 1. How is the complementary food produced ?
Please refer to Fig. 1 for a flow sheet of the Extruded Complementary
Food Jeevee Foods also has a plant that produces 500 kg. of the Roasted
variety of the RTE/day. The Plant can produce 500 Kg of commentary
food or a total of 1 MT/day x 300 working days/annum = 300 MT. It has
the capacity to go to 3 shifls/daj if
and sales
upt0
expectation^ The launch date is IS* February , 2000.
They are test
52/ for a [racket of 400g. The instant or Extruded variety
34
all costs oforoductio
PnCe 'S the Market Retail Price and includes
an costs oi production, advertising, marketing etc.
Q 2. How about packaging of the complementary food?
The product is packed into 12 micron aluminium foiled laminate pouches.
The pouch is automatically sealed. The product at ambient temperature
has a shelflife of one year. Trials with 9 micronW not give a shelflife
or one year.
4
The CEO of the company stated that they. did try other packaging
materials such as paper, light to heavy density polythene etc. but these did
not have the desired shelf life. Type of packaging does push up costs but
the CEO is not prepared to compromise on this.
Q3
How is the complementary food stored?
The complementary food was stored in clean, air conditioned and a
dehumidified warehouse till it was ready to go out to the market place.
Since Bangalore has a cool climate, the product may well last for a year
or more. Simulated shelf life tests for hot climates was not done.
Q 4. How will the product be distributed ?
The usual distribution system of using reputed salesmen-'dealers will be
employed. They will receive a commission.
Q 5. How much RTE or complementary food does the Public Sector
produce per annum?
The ten RTE weaning food plants in India produce RTE food for the
ICDS The exact figure is not known but is about 100,000 MT per
annum The annual production of the Private Sector giants namely,
Heinz Pvt. Ltd and Nestle Pvt Ltd. is not known to us.
q 6.
What are the other countries/parties involved in Food
Production?
i Hvn
review
in this
Bangladesh andj xr
Nepal,
two nf the
b other countries
and under from
WFp
report, have received the necessary
P
3^
may be noted that 300 MT is the annual capacity
-that the Bangalore
manufacturer will produce for just 6 districts out of 20 intone state of
India. Sri Lanka has received food aid, equipment and grants for setting
up the Triposha’plant.
36
Tab el: A simple daily “Take-Home” ration for chldren below two
years of age, providing about 200 Kcal energy + 6 g protein for the
early infant, and 400 Kcal energy' + 12 g protein for the late infant, as
well as a complete RDA of key micronutrients
Item
Infants
6-12 months
(g)
Infants
12-24 months
(g)
Ragi or rice flour
30
60
i
Green gram flour
10
20
1
Sugar
8
16
.
2
4
50
100
i
CBM powder
;
1
1
I
TOTAL*
:
i_______________ ___________ 4
* Plus micronutrient mix calcium (?0(J mg), iron (20 mg), ^jnc (3 mg),
retinol (500 ug), thiamin (0.9 mg), riboflavin (1 mg), nicotinic acid (11
mg), pyridoxine (0.9 mg), ascorbic acid (40 mg), folic acid (30 ug),
vitamin B (1 ug).
37
FIGURE -1
Process Flow Chart For Instant Variety
Receiving of Raw Materials
c
T
r
1
Sampling. Inspection and Acceptance
c
. I
fumigation and Aeration
I
Cleaning and Grading
I
Destoning
I
Storage in Galvanised Bins
I
Roasting of M^ng Dal till the Material tempjature
Reaches
I
Cooling to Ambient temperature in a cooler
I
(---------------------------------
Pulverising raw rice and toasted dal to
fine flour mix (85% : 15%)
I
.
. ,
Extruded to puffed pellets m a single
Screw extruder
I
Dried at 104° - 106°Cto less than 40° moisture
in a continuous drier
I
Cooling to room temperature
Packed in HDPE bags
Pulverising the
extruded pellets.
Crystal sugar axlc/eJ -Se°v
c/i 60 mesh sieve
Continued
38
Blending whole milk powder, skim
milk powder, vitamin mineral premix,
malt powder and a plarkjtary mixer
For 10 minutes
Collecting the pow der
in SS bins
Weighed (calculated)
quantities put into
ribbon blender
Blending for 15 minutes
Unloading bulk SS bins/poly bags
Storage at air conditioned and dehumidified room
until', used for bulk blending
Thorough mixing/blending of all the lots of the days
production in blending tank by a mechanical mixer for 20 minutes
Unloading into poly bags
Filling into aluminium foiled laminate and sealing
the mouth
I
Packing and duplex carton and sealing
Printing of month and year of manufacture
and batch code
Joy
io « preprinted master corrugated fibre board carton
Sealing of the master carton
Strapping
I
Warehousing
31
FIGURE-Z
wCvN.1 R.ESAND PARSES INVOLVED IN INFANT*FOOD PRODUCTION
product Name_
" Africa
Benn*
Burundi
Ghana
Nc. of unites annual”
capacity (tor.)
Fartne Bebe
Musaiac
Vitamix
Nutrimix
Technical
assistance
Year of
implementation
1/100
6/800
1/100
1/25-75
KIT/DGIS
KIT/DGIS
KIT/NOVIB
KIT/Caritas
1979 1985 19871987-
2/1,000
4/600-800
1/500-1.000
1/30-100
1/250-250
KIT/WFP
KITAVFP
KIT/DGIS
KIT/DGIS
KIT/EC
19921991 1993 1990 1989 -
Kenya
Malawi
Mozambique
Niger
Sierra Leone
U-mix
Linkundi Phala
Farina Lactea
Bitamin
Bennimix
Asia
Banglaossh
Nepal
Unknown
Unknown
1/250 ’
1/250
KITAVFP
KITAVFP
19941993 -
Latin America
Dom.Republic
Jamaica
Prosur
Unknown
1/30-100
1/500-1 COO
KIT/Caritas
KIT/Caritas
1990 1993 -
N<2te. ’
'KIT ‘ = Royal Tropical Institute ~
EC " » European Community
■ DGIS = Dutch Directorate General International
WPF ■ World Pood Programme
NOVIB = Netherlands Organisation for International Development Cooperation
FLOW CHART "KIT APPROACH" INFANT FOOD MANUFACTURING
'
Note
This dfaram has been reproduced
Current practices, research and
V it a min/
ihe report on Micronutrient fatif'Catfa of fads:
Opportunities.
Ml, Ottawa, Canada .
SECTION
E:
MECHANISMS
TO
IMPROVE
ACCEPTABILITY, PALATABILITY
UTILIZATION AND
OUTREACH OF THE DONATED
COMPLEMENTARY
FOOD IN THE PUBLIC SECTOR
This section will be addressed through the following questions. ComSoya-Blend (CSB) is a food that is widely donated in all the four
countries under review to the Public Sector. I have therefore, taken it as
an example from a recent consultancy I had done for CARE - India.
Q 1.
How can the acceptability of CSB which is fully fortified with the
micronutrients be improved?
Q 2. How can the palatability of cooked CSB rations be improved?
Q 3. How can the utilization of CSB be improved?
Q 4. How can the outreach of donated foods be improved?
Q 1. How can the acceptability of CSB which is fully fortified with
the micronutrients be improved?
CARE - India supplies Com-Soya-Blend (CSB) and Salad oil (SO) to the
ICDS programme. Table 3, Section C, depicts the percentage
contribution of a single ration of 65 g CSB + 8 g salad oil to the RDA of
child Under Two years of age.
Assuming the child 6-24 months consumes his/her entire ration,this
would satisfy the GOI requirements of delivering 300 Kcal and 12 g
protein per child per feeding day and address the nutrient gap of calories
in their usual diet. However, the nutritional gap in vitamins and minerals
remains.
1.
CSB + Soya oil are excellent complementary foods. The only
problem with the CSB is that it is gritty or grainyJn texture. When
cooked
- it becomes pasty and non-homogenous to touch and taste. It
is not appropriate for the early infant or even the late infant. Due to its
bulk and pastiness, the ‘ Below 2’ cannot eat his full ration. Further,
children upto one year of age>and even upto two, have a poor swallowing
reflex and are slow feeders. Hence, feeds that are nutrient dense but
‘liquidy’ go down faster, without spillage or waste. There are many
options to enhance its acceptability.
41
• Fine grind it. This could be done in USA itself.
Extrude CSB rather than roast it. Extrusion will powder the product
& will thoroughly cook it. This could be done in^ISA too.
• Blend m Soya oil, extra vitamins, minerals & 5% ARF (AmylaseRich-Food). This should be done at the final stage.
• All these processing actions can be done at the manufacturing end
and the specially processed food can be separately bagged and
demarcated for children Under Two.
2.
If this is not possible, the composition of the RTE complementary
food, which is usually sweetened with sugar (25%), can be slightly
modified as under. 5% of the sugar can be replaced by 5% of CBM. The
entire micronutrient RDA of a one year-old-Indian-child (1) or 80% of it
should also be incorporated into the RTE.
3.
Both Project Poshak (2) & M/s IESSCO Pvt. Ltd. (3), have noted
that most Indians like a fried/roasted/caramelized smell & flavour. If
within manufacturing &/or processing costs, the addition of a
synthetic smell/flavour could be considered.
4.
M/s IESSCO Pvt. Ltd, (3) have also reported that about half the
U.P. mothers in Focus Group Discussions, felt that the CSB-RTE was not
suitable for the 'Below Two’. They felt it was too dry, caused diarrhea,
& the 'Below Two’ could not consume his ration. The RTE had to be
made semi-solid with milk or water. They felt the dry RTE choked the
young child. However, the CSB-RTE in gruel, halwa or dalia form was
suitable.
5.
The concept of 'hot’ & 'cold’ foods are firmly entrenched in most
rural & tribal populations. For instance, especially in M.P. & U.P. home
diets made out of wheat, ghee, milk, jaggery & pulses, all considered
'hot’ would be appropriate for the cold & rainy seasons. Whereas rice,
curd, lassi, goundnuts & sugar (cold foods) could be fed to the child in
summer. CSB/oil recipies & ingredients likewise could be adapted to the
seasons (4).
42.
Q 2. How can the payability of cooked CSB rations be improved?
R,eglonal Profile for 'Malnutrition in South Asia’, UNICEF,
19,7 strongly recommends the use of the ARF technology as a
managfib e, practical & traditional technology to increase energy intake of
traditional low energy-gruels (5). We would go a step further &
strongly endorse the adoption of the 'ARF Technology’ for the
immediate improvement of the CSB - THR ration (6). CSB - THR
ration without ARF are extremely bulky and pasty. Hence, the THR
becomes smooth and semi liquid while retaining all its good nutrition.
Adding amylase rich food to the CSB enables children under two to drink
the cooked ration in one or two feeds (Table 1).
2.
For the 'Below Twos’, especially the 'Below One’, it is the
consistency & texture of the complementary food that are of
paramount importance. But to a mother-child dyad, it is she who decides.
Most Indian mothers like a caramelized or roasted taste & flavouring.
Both the mothers & the babies like it sweet. Intakes by children
definitely are better with a sweet tasting preparation.
3.
Sweet tasting or Tiquidy’ dalia, rabadi or kheer type of recipes
would be most suitable for the early-infant in M.P. & U.P. It would be
the payasam counterpart in A.P.
4.
The older child (1-2 years) may like laddu, which the mother can
make by roasting the grainy CSB in the Soya-oil, add/sibme jaggery &
fashion^nto laddus, halwa, sattu or prashad. Salty prepartions would be
chappati paratha, dosai or uppumav. Our interactions with the mothers
in U.P. (particularly in U.P.) , M.P. & A.P. showed that most of the
mothers generally wanted to cook only rfeui(morning & evening)
-pe-rbcps due to fuel & time constraints. They usually chose to make the
same dish that was most convenient for them to make. For instance, roti
in U P & M P & uppumav in A.P. Even sweetening the CSM with
jaggery or suga^ was a special treat. In short, the mothers were not
enterprising about varying the CBM-oil recipes for the Below Twos .
43
Q 3. How can the utilization of CSB be improved?
Although there is clear evidence that THR has reached the homes of
the Below Twos , it is still a question mark as to how much of the THR
gets mto the stomachs of the 'Below Twos’. This is the current
problem. There is a lack of sufficient appreciation among all concerned,
namely, the ICDS Health & Non - Health Staff, the INHP - CARE Staff,
the community & the mothers, that unless a major portion of the THR is
fed to the intended Below Two’, he/she will not improve in weight or
health. At the moment, about a fourth to third of the ration may be
consumed by the Below Two5, while the rest is consumed by other
siblings & the family.
Possible solutions :
1. The concept of a full THR for the 'Below Two’ has to be actively
promoted by the ICDS - Staff, Health Staff, Panchayat, Village Health
Practitioners, Village School Teachers, Change Agents & adolescent
girls.
2. Change Agents, & adolescent girls can advice & ensure that the THR
is given to the 'Below Two’, when the 'Above Two’ is at the
Aanganwadi. This will greatly minimize sharing.
3. On the Nutrition Health days, repeated cooking demonstration or
'demos’ of the cooked up THR may be done. A single demo 'baby’ of 6,
9, 12 months etc. can be fed in front of the mother group. They will
then learn two important facts :
a) the amount that can be consumed by the infant;
b) that the amount consumed per sitting will increase with age.
Even a few months difference in age would make a big difference
in consumption. Probably by 18 months,, the entire THR ration
would be consumed by the child at a sitting.
4. Mothers can be requested to bring their home-tumblers or katoris.
These can be calibrated for CSB & oil single rations.
5 The mother should be encouraged &.counselled to give the full THR
ration over 2-4 feeds. She usually gives small amounts feu.<_e.
a
day. She must be told to feed the 'Below Two’ when the Above Two is
at the Anganwadi Centre (AWC) - preschool. Minimization in 'sharing’
can e ac leve m this way. The above concept was not found to be
®troP.g V
eVel (ICDS> NG0> Health Staffer even the CARE - INHP
Staii). It needs to be built into Training/Capacity Buildins.
6. All concerned should become familiar with the number of pieces a
particular Single Ration would yield e.g. how many laddoos, dosais or
the amount of halwa, sheera, payasam etc. This concept does not existat
present.
Q 4. How can the outreach of donated foods be improved?
As of March, 1996, 5614 ICDS - Projects covering 21.3 lakhs of
beneficiaries have been sanctioned by the GOI. The seven states where
CARE is assisting the ICDS have particularly large numbers of
projects.Interrupted delivery of supplementary nutrition has been a
perrenial problem in the ICDS. Delivering the food component from
the Block to the AWCs especially the farflung ones has also been a
perrenial logistical & monitoring problem. Even within the village, the
generally 'invisible’ categories of beneficiaries at the AWC have been the
Pregnant and Lactating & 'Below Threes’. J’he problem of outreach &
contact becomes aggravated during the A agriculturally Months/
Seasons.
The Planning Evaluation Organization (PEO), 1976, (7) and the ICDS
National Evaluation in 1992 (8), pointed out that children under three
could not make it on their own to the AWC. Project Poshak in MP, 1975
(2), also showed that the children below three could not be transported
every day to a feeding center for spot feeding. The problem is even more
accentuated for children Under Two especially in scattered tribal hamlets,
hilly areas or even within a village. CARE - India’s baseline survey,
1997 reports that 40% children Under Two years of age were brought to
the AWC in the past one week for spot feeding, a figure often grossly
over-reported by the AWC workers (9).
Possible solutions :
1. The mode of delivery has to be THR’ especially for the ’Below
Twos’.
45-
2. However the THR has to be made attractive & meaningful to the
mothers m order that they come regularly to collect the THR for the
Below Twos .
3. As stated earlier the THR has to be appropriate & demarcated for
the'Below Twos’.
4. CARE has show the way by organizing Nutrition - Health Days,
where both the functionaries of the ICDS (AWW & Supervisors) &
Health (ANM) are present. The Below Twos’ are'weighed & the THR is
distributed. Mothers willingly help & participate. This is an excellent
mechanism & strategy that needs to be taken-up by the entire
National ICDS.
5. Possible areas that can be strengthened are counselling on the child’s
weight & repeated demonstrations of cooking & feeding THR rations
to infants 6-9 mts; 9 -12 mts; 12 - 15 mts & so on. The Nutrition
Health Staff as well as the mothers will realise how much a cooked
portion of a single ration will be & how much of this an infant of a
specific age group can consume over a reasonable period of time (say 20
minutes). This is the kind of practical & visual education that will
immediately communicate to both ICDS staff & mothers.
6. It would be useful if the NH days are held every 15 days rather than
every month. One of the NH days should be exclusively for the'Below
Twos’ & one exclusively for the mothers ( P & L). The village elders &
members of the village Panchayat, should be encouraged to participate &
get actively involved.
7. The strategy of Change Agents to ensure that the services of ICDS are
understood by all; & to roundup all the 'Below Twos’, & their moms is
an excellent strategy for outreach. It could be universalized in the
ICDS.
8. The setting up of 'seasonal creches’ & enchancmg the THR may be
considered for both mothers & child beneficiaries. Since, mothers will
have to stay back on NH day/s, some monetary compensation for doing
so may be considered by the Village Panchayat.
Table 1 : Nutrient Value of CSB & Oil :
65g Ration of CSB + 8g
oil
Nutrient Value
Percentage
: RDA ■
319 Kcal
11.7 g
1105IU
0.33 mg
13.00 mg
26.00 mg
520.00 mg
11.70 mg
1.95 mg
32.50 ppm
26
53
69
47
43
65
130
98
39
108
Food Energy
Protein
Vitamin - A
Riboflavin
Folic Acid
Vitamin C
Calcium
Iron
Zinc
Iodine
Note : Source ICMR 1992(2).
47
references
Nutrient Requirements and Recommended Dietary Allowances for
Indians. The Indian Council of Medical Research, New Delhi,
2.
Gopaldas T. et al : Project Poshak, Vol. One, Printed by CARE India, New Delhi, 1975.
3.
Consultancy Report by IESSCO Pvt. Ltd. on Uttar Pradesh, India’s
RTE, Cited as an Appendix in Reference : Pillai G., CARE India’s Integrated Nutrition and Health Programme , 1995-2000.
4.
Gopaldas T. and Gujral Sunder : Addressing Nutritional Gaps
in Children Under Two in Rural India. Working Paper for CARE India, 1998.
5.
Plantation in South Asia : A Regional Profile. Edited by Stuart
Gillespie, UNICEF Regional Office for South Asia, 1997.
6.
Pillai G. :
CARE - India’s Integrated Nutrition and Health
Programme 1995-2000.
7.
Planning Commission Evaluation Report on the ICDS 1976-78
:
New Delhi, Planning Evaluation Organization, New Delhi,
1982.
8.
National Evaluation of the ICDS : National Institute of Public
Cooperation and Child Development, New Delhi, 1992.
9.
Johri N.
:
CARE - India’s INHP Results Reports.
Achievements versus plans (FY 1997 Vs FY 1996) 1998.
48
SECTION F : COST IMPLICATIONS
Fortifying foods of mass consumption with vitamins — —
■ minerals costs
from a mere 0.5 1 o ?0 ° of the total
cost of the commodity. It would
consequently be to the benefit of the Private Sector"which"haTthe
production, distribution, management and marketing expertise, to
demonstrate its social conscience and come to the aid of the Public
Sector.
This section deals with the following :
What is the cost of premium complementary foods in the Indian
market as of January, 2000?
Q. 2 What is the cost of the sachet or additive in the Indian market with
or without the child’s entire RDA (ICMR, 1992) as of January,
2000?
Q. 1
Q. 1 What is the cost of premium complementary foods in the
Indian market as of January, 2000?
Costs of all goods and services have risen very sharplydux/ythe last three
years in India. Even a LIG or MIG family knows it will have to spend
about Rs. 10/- to 15/- per day on medicines, doctors visits, baby food
(milk formula, if the child is off the breast), complementary food, family
food, feeding bottles, toiletries, infant clothing etc. About a third at the
very most will be set aside for its food. Hence, it is imperajjiy^ that an
alternative, affordable and adequate complementary food bndgesthe
gap between the 'haves’ who can purchase the premium brands in
adequate amounts to nourish their child Vs the have nots who
virtually starve their child on miniscule amounts of the very same
premium brands - be manufactured as soon as possible.
Table 1 sets out the current prices of (January 20, 2000), of cereal based
complementary foods in the Bangalore market. Of the three lots, Jevee
Foods may fit the purse of most LIG and MIG families However it is
yet to market its complementary food (with CBM
A F
a
micronutrients) in a big way. Cerelac (Nestle) and Farex (Heinz India
Pvt. Ltd) certainly have the lion’s share of the market despite the
relatively high cost of their products. We would request the Manda
Forum to senously consider our suggest.cn of one full feed pouch for
Rs. 5/- per pouch of 100 g that will deliver the infant’s entire RD A of
micronutrients ■„ a drinkable or soupy form. ln
such a complementary ftll-feed pouch’ will be a veritible boon to thos:
mothers who have to leave their infante
u
a n eu * a,
a.
,, ,
miants at creches or day care centers.
All that the mother would have to do is to make up the feed by adding
200 ml boiling water
and put it in a thermos flask.
Q. 2 What is the cost of the sachet or additive in the Indian market
with or w ithout the child’s entire RDA (ICMR, 1992) as of January,
2000?
The following were the costs of the ARF alone, ARF + the micronutrients
in bulk, or in sachet form.
Many small entreprenurial enterprises or small scale industries can be set
up. All that has to be done is to source commercial barley malt powder
(CBM). Source the vitamin-mineral premix. Mix well and package it
hygienically in small sachets. A local manufacturer has done this for me
for lecture cum demonstration purposes. The cost per sachet in
aluminium foil with a shelflife of one year is as follows :
• A 5 g sachet with only 5 g commercial barley malt (CBM) is
estimated to cost Rs. 1.50/- per sachet.
». A 5 g sachet of CBM with the entire micronutrient RDA of a oneyear-old child, would cost Rs. 2.50/- per sachet.
• A 1 Kg can ister of CBM - ARF which would last one child for 200
days would cost Rs. 25/- a cannister. Or a mere 12.50 paise per day.
• A 1 Ka can ister of CBM - ARF with all the micronutrients would
cost Rs^SOO/-. This would again last the 'Under Two’ for 200 days.
The cost would be Rs. 1.50/-per day.
. A 1 Kg can .ister of ragi (EKsine Coracana) powder or ARF would
cost Rs. 40/- or 8 paise per day. It would last a chile for 200 days.
. A 1 Kg cannister of wheat ARF would cost Rs. 50/- per Kg or 10
paise per day. It would last a child for 200 days.
Informal Participatory Research Assessments
tetZaTh el
MIG and LIG mothers showed a very pos.t.ve response to the sachet
of CBM - ARF + the micronutrients.
50
For Public Sector Feeding Programmes :
• Perhaps the well established food manufacturers could adopt ICDS
projects in a particular state or district and supply the 'full feeds’ or
sachets . They should not only be prepared to supply but also to
manage the whole operation through production, distribution and
measure its impact!
The Government should waive all taxes,
levies/duties (manufacturing, corporate etc). This would certainly be
a partnership.
• The Public Sector should realize that no RTE worth its name or
even local foods can be given at the assigned price of Re. 1/- per
child per day in the ICDS.
• In the poor non-ICDS rural settings perhaps partnerships could be set
up between the Village Panchayat, the Food Manufacturer and the
parent of the ‘under two’. The Village Panchayat, the Food
Manufacturer and the parent can share the costs in the proportion of
40 : 40 : 20. Operational Research on the financial viability and
sustainability of such arrangements should be tested out.
Si
Table 1 : The cost of Complementary Foods (400
g) at the Current
Market Retail Price :
v
Manufacturer
Price
I. Jeevee Foods Pvt. Ltd.
1. Cost of Sujeevi Instant
2. Cost of Sujeevi Roasted
Rs. 56/Rs. 52/-
IL Cerelac (Nestle)
1. Cerelac rice
2. Cerelac rice and dal
3. Cerelac wheat
4. Cerelac wheat and Honey
5. Cerelac wheat and Apple
6. Cerelac wheat and Orange
7. Cerelac wheat and Vegetable
8. Cerelac banana
Rs. 76/Rs. 79/Rs. 76/Rs. 82/Rs. 82/Rs. 82/Rs. 79/Rs. 79/-
j
IH. Farex (Heinz India Pvt. Ltd.)
1. Farex rice
2. Farex wheat
3. Farex wheat vegetable
4. Farex wheat apple
5. Farex wheat fruit
6. Farex wheat egg
Rs. 68/Rs. 79/Rs. 85/Rs. 85/Rs. 85/Rs. 90/-
SECTION
NEEDS :
G
COMMUNICATION AND TRAINING
Short, relevant and pitty communication is required at every level with
respect to complementary foods.
A disproportionate amount of
Information, Education and Communication (IEC) is given regarding
breast milk. By way of contrast, hardly any IEC is offered regarding
complementary foods in general and 'nutrient dense-low bulk and
fully fortified foods’ in particular. This is unfortunate as most South
Asian mothers feed their infants/toddlers as long as they possiblv can
(2 to 3 years from the infant’s birth).
What everyone needs to know . - (the Policy Maker, the Implementor, the
Master Trainers, the field functionaries and the father/mother dyad) is
how very important the intake of adequate amounts of energy, protein,
vitamins and minerals every day, are for the Under Two. Breast
milk and tiny amounts of complementary food just will not do. A
balance has to be struck between Breast Milk and Complementary
Food.
One’s IEC has to be country, region and culture sensitive and specific.
Even to this day most of the experts for South Asia come from the
Developed World. This needs to be changed. Use South Asian
Nutrition-Health IEC experts for South Asia? South East Asian experts for
South East Asia and so on.
The communication and training needs of the Public and Private Sector
are quite different. Hence, a different set of questions have been posed
for the Public Sector (ICDS in India), and the Private Sector (hypothetical
as no Private Sector food manufacturer has exhibited the social
commitment or conscience to ’sell’ a complementary food as discussed
in the previous section) to the LIG and MIG families.
The Public Sector :
Ql How potent an influencer is .. TV in India and South Asia?
Q 2. Who are the most important groups to be communicated with and
Q3
Are^there any success stories abou. IEC \ " tor improving infant
feeding practices or the use of complementary foods?
53
Q 4.
What about repeated demonstrations with the complementary food
with children aged 6,9,12 and 24 months?
Q 5. What are the usual advertising techniques used by the Private
Sector?
Q 6. Can the Public and Private Sector come together in IEC?
The Public Sector :
Q 1. How potent an influencer is
TV in India and South Asia?
The electronic media or TV is and probably will be the most potent
influencer for behaviour change at the household level. In our most
recent project on “An Information-Education-Communication (IEC)
Project For Working Girls (18-23 years) On Cultural Dietary
Practices To Increase The Iron Content Of Their Every-Day Diets”,
in peri-urban Bangalore, in 2000 AD, we found that over 90% of our
households (LIG & MIG) were using a brand of iodized salt. The
great influencer was TV. However, behaviour change can only be
sustained if the product advertised on TV. is readily available on
the shop shelf and is found affordable by the target population.
• At the present time (2000 AD) in India, the Central and State
Governments are strongly encouraging Public and Private Sectors to
beam generic messages on population, health and nutrition to the
lay public.
In the case of Complementary Foods, actual
demonstrations of feeding infants 6, 9, 12 and 24 months with and
without fullv micronutrient fortified complementary foods and
with and without ARF can dessimate vital information very fast.
TV is being used for flour, ■
fat/oils and milk. The same can be
used for the other commodities/products such as rice and sugar also.
• Village Panchayats do possess television sets. Hence, donors should
think of not only donating or giving computers but also TV sets to
the Village and Hamlet Panchayats
•
Q 2. Who are the most important groups to be communicated with
and how?
i
ail the
countries need to know in simple
Every population
group m all
he four
fou^cou
he
layman s language as to why ther Under Iw
of
needs not only calories and protei ,
t?
54
vitamins/minerals every day.
The enormous
advantage of having SucA
complementary food is that.'not only does it have all these advantages
but can also be drunk up happily by the child.
. The Policy-making Segment : From the Prime Minister to the
Ministers and high ranking officials in the concerned departments of
Women and Child; Health; Welfare; and Labour (many women carry
their Under Twos’ to the field or factory or employer’s home).
Special workshops and seminars with video-cassettes and
demonstrations should be arranged.
• The Influencer Group
The medical world reigns supreme,
especially the pediatrician at the state level to the Primary Health
Centre level in India. They need IEC regarding complementary
foods, more than anyone else. Medical students should be exposed
to much more practical nutrition including the need for a whole
complementary food for the 'Under Twos’. The Indian Academy
of Pediatrics should strongly support the concept of
whole
complementary food .
Most of them appear to get
in
neonatology, breast feeding and immunization schedules.
• The paramedicals : Such as the Lady Health Visitor, the Auxiliary
Nurse, Midwife do profit from IEC regarding child care and nutrition
(1). However, our experience is that the end receiver, namely, the
poor mother, does not (2,3). However, it is these grass root level
workers who are the real implement's of any Public Sector
program. Hence, it is a tremendous step forward if atleast they are
aware of facts such as “An infant of a year requires half what his
father eats3’
Elementary School or primary school education is going to become
universal in India. It already has in Sri Lanka. No doubt it will also
be so in a few years in Bangladesh and Nepal. The potential for
change is enormous if the primary schooler (6-14 years) can become
a childcare messenger and tutor to his illiterate family. In ndia
alone there are 200 million in this age group.
This avenue1 for
delivering Nutrition and Health Education (NHE) should be fully
exploited.
55
^re^^ere any success stories about IEC done for improving
infant feeding practices or the use of complementary foods?
• The Weaning Food Project A carried out by the Manoff group in
several countries in the late 1980s with the objective of developing
nutritionally sound, low-cost and sustainable methods to improve
young child feeding in several countries.
The Indonesian project
targetted the Under Twos”. The Baseline and Endline surveys did
show that IEC alone had brought about small yet significant changes
in increased home made weaning food intake and in weight-for-age
and height-for-age (4).
• The Bangladesh complementary feeding education programme, is
also an example of IEC alone being fairly successful in bringing
about a positive behaviour change with respect to feeding more home
made weaning foods to infants above 5-6 months of age. It was
concluded that culturally appropriate nutrition messages were
successful in changing complementary feeding practices. However,
my research group and I had noted on several occassions in our IEC
projects, that mothers stated that they were unable to make separate
food for their infants on a daily basis (5).
Q 4. What about repeated demonstrations with the complementary
food with children aged 6, 9,12 and 24 months?
In our experience, this approach worked with the senior managers of
CARE-India, the field workers, the literate and illiterate families. The
unanimous opinion was that “We were not aware that children in the age
group of 6 - 36 months were actually three different population segments
as far as the dietary habits and problems were concerned. Now we
are(6)”.
The Private Sector :
Q 5. What are the usual advertising techniques used by the Private
Sector?
The Private Sector relies a great deal on
commences on the manufacture ofpro uc
from Habits
Complementary Foods, the Pnvat
hat the ]ay public expects
Surveys and Motivation Research as to what
y p
56
from the new Complementary Food’. What could be the cutting edge
of its visual and copy? Then would come the Package Designs; Product
Tests with different Package Designs^and Focus Group Discussions
with different income groups.
Assuming an acceptable complementary food was available, a Test
launch would be planned in an urban setting. Here, the point-of-sale
display plays an important role. The package itself as well as its
arrangements and its various promotional aids are important in assessing
its off-take, purchase and repurchase. The electronic and print media
would announce the launch; promotion would continue on this front also.
Again, Market Research Surveys and Shop audits would give an
ongoing picture of the Complementary Food’s acceptance or otherwise.
In short, the Private Sector is prepared to spend a great deal on Market
Research and Advertising. The Public Sector usually does not.
Q 6. Can the Public and Private Sector come together in IEC?
• They certainly should. On the^25^^anuary, 2000, Hindustan Lever
Ltd., has acquired 14 units of„Modem Foods which are located in
different States of the Country. This venture should be a learning
lesson to both the sectors.
• The big Advertising Agencies could also show their social
commitment and conscience by adopting a country, say Bangladesh,
Nepal and Sri Lanka, or a State (in India) for Advertising the 'new
Complementary Food’. The advertising agencies should only charge
actual costs. The Public Sector should waive all taxes in respect to
the said complementary food for a stipulated period of time. It should
also recognize and reward the best advertising agencies in this
endevour.
57
references
Project Poshak, Vol 1 and 2. Printed by
1.
Gopaldas T. et al :
CARE - India, 1975.
2.
Gujral Sunder and Gopaldas T. :
Summary Report of the
USAID Assisted ICDS Impact Evaluation Project in Panchmahals
(Gujarat) and Chandrapur (Maharashtra).
Publication of the
Department of Foods and Nutrition, M.S. University, Baroda,
1991.
3.
Gopaldas T. and Gujral Sunder : Does Growth Monitoring
work as it ought to in Countries of low literacy? XXVII, National
Conference of the Indian Academy of Pediatrics, 1990.
4.
Manoff Group Inc. : The Weaning Project. Improving young
children feeding practices in Indonesia : Project overview.
Nutrition Directorate, Ministry of Health and the Manoff Group
Inc.
5.
Brown L. V. et al : Evaluation of the impact of weaning food
messages on infant feeding practices and child growth in rural
Bangladesh. Am J. Clin. Nutr. 56,994-1003, 1992.
6.
Gopaldas T. and Gujral Sunder : Addressing Nutritional Gaps
in children Under Two in Rural India. A Working Paper, 15 pp.
Printed by CARE - India, New Delhi, 1998.
53
SECTION H : MONITORING AND EVALUATION :
Monitoring : Monitoring or Process Evaluation as it is now called is
probably of evejx, greater use in the case of a product such as
Complementary Food. For example if the sequential steps in a Process
Evaluation show that the off-take of the product was extremely poor; or if
the feed-back received from the field showed poor shelf life and/or poor
acceptability by the purchaser or target population, then there is hardly
any point in proceeding to an Impact Evaluation. On the other hand if the
Process Evaluation showed a good off-take and a purchase/repurchase
picture over a reasonable period of time, say one year, then one could opt
for an Impact Evaluation in a representative sample of the target
population.
Impact Evaluation : Impact Evaluations, are expensive and require
technical and trained teams. Especially so when the target population are
the 'Under Twos’.
This is generally not realized by the Public or
Private Sectors.
Monitoring and Evaluation with respect to Complementary Foods can be
explained with the help of following questions :
For a commercial complementary food what would be the
sequential monitoring steps?
Q 2. In the case of a donated food such as fortified Com-Soya-Blend
which generally goes into India’s ICDS programme, what would
be the Monitoring or Process Indicators?
0 3 Are there any Market Research or other agencies that could collect
the Monitoring Data for*^manufacturer of a commercial
Q 1.
Q 4.
complementary food?
What would the Impact Indicators be?
Q 1. For a commercial complementary food what might be the
sequential monitoring steps?
•
• j■ *
Monitoring or Process for a Commercial
The major indicators of Monitoring
Complementary Food might be .
™
59
• Acceptability of the product by the general public as judged by its off
take from a representative % of stockists.
What are the purchase/repurchase patterns over a reasonable period of
time (1 year) in the High, Middle and Low Income Groups?
• If the product is stocked with institutions such as Children’s Hospitals,
Orphanages/Foundling Homes or Schools, what is its acceptability and
purchase/repurchase picture?
• What is its shelflife at the shop, household and institutional level?.
• If advertised on TV or in the print media, whether the frequency and
reach schedules were adhered to?
x
• Feed back, especially about the ease of use and cost-effectiveness
from a representative number of stockists, Institutions and a
representative number of households?
Q 2. In the case of a donated food such as fortified Corn-Soya-Blend
which generally goes into India’s ICDS programme, what would be
the Monitoring or Process Indicators?
The Evaluation Indicators could be as under :
• Anthropometric weight and length for age.
• Dietary and Nutrient Intake Surveys.
• Clinical assessment especially for micronutrient status of Vitamin A,
Vitamin C, Riboflavin, Iron and Zinc.
• Biochemical status.
This would be the most difficult to do as
anywhere from 2 to 5 ml of blood will have to be drawn from the
infant. Most parents vehemently object to this. If blood samples are
available the autoan alysers of today can give a complete picture of the
infant’s micronutrient status.
. KAP or behaviour change in the parents and their willingness to spend
regularly on the complementary food.
Pre-post surveys will have to be done on large and representative samples
of mother-child dyads drawn from household—ns tthat have
been known to purchase the complementary food fairly regularly
immediate past year.
renort for the four countries under
A search of the- literature for t
P
data.baSe of relevant
review revealed the urgent need to buna
60
information for the Under Two’. Most often it is far more economical
and useful to hire a professional agency to do the Pre-Post Surveys.
Q 3. Are there any Market Research or other agencies that could
collect the Monitoring Data for a commercial complementary food?
The Operations Research Group (ORG), Baroda collects information on
various commodities of common use, namely, food stuffs, detergents,
common medicines etc. through a continuous process of shop audit
throughout India. ORG is a consultancy firm and charges a fee for its
services. For instance, this is how I came to know that Cerelac of Heinz
Pvt. Ltd., India and Nestle Pvt. Ltd., India have about 70% and 30% share
of the Commercial Complementary Food Market, respectively.
Q 4. What would the Impact Indicators be?
Please refer to an example of an ICDS Evaluation Matrix for Nutrition,
Health and Hygiene in Children (0-6 years) developed by me (Table 1)
for a M. S. Swaminathan Foundation brain-storming meeting.
TABLE
- 1
EVALUATION MATRIX FOR NUTRITION, HEALTH AND HYGIENE IN
CHILDREN (0-6 YRS) IN THE ICDS
1
1
input
INDICATORS
PROCESS INDICATORS
1 A. NUTRITION :
DELIVERY
COVERAGE
PARTICIPATION
1 1.
1
1 2.
1
1 3.
1 4.
1
1 5.
1
1 6.
% efficiency in
timely
procurement
and delivery
on time, in
adequate
amounts to the
AWCs
% efficiency in
coverage :
06 participation by
the child - mother
dyads
1 7.
1
Supplementary
food
Nutrition-Health
Education
Iron Supplement
Vitamin A
supplement
Use of iodized
salt
Growth
monitoring
Safe water
availability
•
0-1 yrs
•
1-2 yrs
•
2-3 yrs
•
3-4 yrs
•
4-5 yrs
•
5-6 yrs
children
•
0-1 NTS
•
1 -2 yrs
•
2-3 yrs
•
3-4 yrs
•
4-5 >ts
•
5-6 yrs
children
MEASUREMEN T OF
IMPACT
IMPACT
INDICATORS
* Anthropometry
•
Wt and I It for age
4 Dietary'
•
- Clinical
•
Consumption of
ration
For PEM, I. FE &
Vit A
1 Biochemical
•
For lib
« Knowledge Altitude - Practice
•.
By participatory
researd i
assessment
SECTION I : OPPORTUNITIES FOR PUBLIC/PRIVATE
ACADEMIA/NGOS MULTISECTORAL COLLABOMTWN
H
bec°m® apParent from
foregoing sections of this report that
unless the Public Sector and Private Sector join hands there is not going
to be much discernible improvement in any sector, especially the one
concerning the young child. Much precious time will be saved if
Academia and NGOs with experience and expertise are included.
Some examples of collaborations are in operation in the four South Asian
Countries in this report. The questions that arise are as under :
Q 1.
Can Public — Private sector collaborations make a dent in reducing
the Hidden Hunger for Micronutrients in the Under Twos?
Q 2. To what extent has~Private sector played a significant role with
respect to complementary foods in South Asia?
Q 1. Can Public - Private sector collaborations make a dent in
reducing the Hidden Hunger for Micronutrients in the Under Twos?
A recent meeting was held in Ottawa in end 1995 on Sharing Risk and
Reward, where representatives of the Public Sector, Private Sector,
International Agencies, Food Technologists got together to address the
problem of global malnutrition and see how it could be resolved.
Fortifying foods of mass consumption with vitamins-minerals at 0.5 to
2% of the total cost of the commodity, emerged as the front runner (1).
The Mircronutrient Initiative, Ottawa has been organizing and bringing
out publications on how crucial it is to forge these Partnerships (2,3).
The other important Conferences held in this regard are the International
conference on Nutrition held in Rome in 1992; and the World Summit for
children held in New York in 1990. The Programme Agamst
Micronutrient Malnutrition (PAMM) is another excellent examp eoe
Task Force for Child Survival and Development■ (Acadetma . UNICEF
(International), USAID (bi-lateral) and the World Bank (Internationa)
forging a partnership.
63
Q 2. To what extent has Private sector played a significant role with
respect to complementary foods in South Asia?
India : In the seventies there was a spurt in setting-up Complementary
Food Plants. The Government of India (Public Sector) set up ten such
plants all over the country with funding from UNICEF, WFP, CARE etc.
CARE - India sought the help of Amul Pvt. Ltd. to make RTE-school
snacks fortified with micronutrients. This NGO-Private Collaboration
did very well for about a decade in the eighties and nineties. As an
example the Karnataka Com Agro Pvt. Ltd. (KCP), a state owned (Public
Sector) was identified to make RTE-complementary food fortified with
micronutrients, named Energy-Food, for the 'Under Threes’ in the ICDS.
It also obtained sizable funding for plant and machinery and Food Aid
(CSB, SFBW etc) from CARE-India.
It is in the red now due to
numerous reasons.
No major multinational food manufacturer in
Karnataka has come into this collaboration upto now.
Sri Lanka : The Triposha project again was a Public (Government of
Sri Lanka) USAID (bi-lateral) and CARE - Sri Lanka (NGO)
collaboration. Wheat from PL 480 was used to make a RTE food which
was fortified with vitamins and minerals for a whole range of
undernourished populations that included the preschool child, the primary
schooler, pregnant and lactating women etc.
Bangladesh : A collaboration has been forged between the Ministry of
Health and Family Welfare (Public) with the Bangladesh Rural
Advancement Committee (NGO).
The focus of this we
own
partnership to reduce malnutrition among children an mot ers.
Nepal : The Nepalese Department of Health (Public) and the Shanta
Bhawan Committee Health Project (NGO) has deve oped and propagated
a traditional weaning food.called ‘‘Sa=
Research Laboratory, the Nutrition Re
food
(Public) has been developing low^°
ARJ? _8 Technology for making
cereal legume multimlxeS,^T8the ^nder Two’. Since Nepal is a
nutrient dense, yet soupy feeds for th
supply CBM barley crop grower, it could become
Net.working amOng these four
ARF to the other countries of South A
countries itself will bring many rewar s.
references
1.
A report on “Sharing risk and reward : public and private
collaboration to eliminate micronutrient malnutrition”
MI/Keystone Center/PAMM, 1996.
2.
Lotfi M. et al :
Micronutrient fortification of foods : current
practices, research and opportunities. Micronutrient Initiative,
Canada, pp 108, 1996.
3.
Stuart Gillespie : Major issues in the control of Iron Deficiency.
Joint Report of the Micronutrient Initiative and UNICEF, pp 104,
1998.
bG
SECTION J : GLOBAL AND NATIONAL EXPERIENCE
OF THE DELIVERY OF COMPLEMENTARY FOODS :
There are virtually only three types of delivery
complementary foods to the Under Twos. These are :
systems
for
• The Public Distribution System/ the Food Stamp System
• The Fed-on Site System
• The Take-Home-Rations (THR) System
The above issue is discussed under the questions of:
Q 1. How about delivering complementary foods through India’s Public
Distribution System (PDS) or through Foods Stamps?
Q 2. What is the Global and National experience of the Fed-On-Site Vs
the Take-Home Delivery Systems with regard to the Under Twos?
Q 1. How about delivering complementary foods through India’s
Public Distribution System (PDS) or through Foods Stamps?
The performance of the PDS in India, depends on the level of governance
in the country. It could certainly serve as an effective channel to deliver
the 'fully processed and fortified’ complementary foods to those holding
ration cards.
Sri Lanka has introduced the Food Stamps Plan. It gives much greater
freedom to the recipient family to buy their food entitlements as per
convenience.
Q 2. What is the Global and National experience of.^^^-On-Site
Vs the Take-Home Delivery Systems with rega
Beaton and Ghassemi in their excellent
Countries, 1982
Programmes
for Young Children n Developing
concluded that 'Take Home
achieving greater coverage of childre
In the seventies, there was a SPU
66
at much lower cost (1).
testing various types of
supplementary feeding programmes, namely, On-Site, Take-Home and
Nutritional Rehabilitation Programmes.
Anthropometric gains
attributable to Take-Home’ feeding programms ranged from 21% to
75 /o (2). Moffat, in Uganda and Aiderman et al in Jamaica; The Asia
Research Organization in the Phillippines; Khare et al in Maharashtra;
and Gopaldas et al in MP(3), were able to show extremely impressive
reduction in grade II and III degree malnutrition ranging from 27% to
75%. The major Indian studies on THR are : CARE - India’s Project
'Poshak’ in MP, (4); The Sidney Cantor/ATAC Study on 'Take-Home’
dry food as a distribution system in Tamil Nadu (5); The Evaluation of
the India Population Project, Karnataka (6); and the Maharashtra study by
Khare et al (7). The findings of all the national and international studies
went heavily in favor of the THR for the children under three, except for
the one fact that there was some 'sharing’ or dilution of the THR at home.
Advantages of the THR :
• Very high geographic outreach
• Covers majority of under two population
• Convenient for the mothers
• Less expensive than fed-on-site
• Minimizes cross infections
• More realistic child care education and caring practices for the mother
• Mother can feed what the child likes in frequent feeds
• Treats malnutrition in its milieu
» Child is more emotionally secure at home
» Ensures weight gain in spite of 'sharing’ of the THR
REFERENCES
1.
Beaton G. H., and Ghassemi H. :
£
Supplementary Feeding
Programs for young children in Developing Countries. Am. J~
Clin. Nutr. 23, 707-15, 1982.
2.
Austin J. E. and Zeitlin M.F. : Nutrition Interventions in
Developing Countries — An Overview.
Published by
Oelgeschlager, Gunn and Hain, Publishers Inc., Cambridge Mass
USA, 1981.
3.
Gopaldas T. et al : Project Poshak, Vol. One, and Printed by
CARE - India, New Delhi, 1975.
4.
Gopaldas T. et al : Project Poshak, Vol. Two, Printed by CARE
- India, New Delhi, 1975.
5.
Devadas R. P. : Take Home System Vs On-the-Spot feeding Proc.
Nutr. Soc., India. 15, 68, (As a part of the Sidney Cantor Study,
TN) 1973.
6.
India Population Project, Karnataka : Nutrition Component.
National Institute of Nutrition, Hyderabad, 1981.
7.
Khare R. D., Shah P. M. and Junnarkar A. R.: Management of
Kwashiorkor in its milieu; a follow-up for fifteen months. Ind. J.
Med. Res. 64 (8), 1119, 1976.
SECTIONK : RECOMMENDATIONS FOR PROGRAMME
DpE
olicyMENT AND mechani™ t°oRst^thEE
n
There are approximately 56 million children/annum in the most
vulnerable age group of 6-24 months in just the four countries under
review in this report. India alone would have about 45 million;
Bangladesh about 6 million; Nepal and Sri Lanka about 1 million each’
Most of these children (90%) would be outside the welfare net of the
Public Sector programmes. Hence, the recommendations that follow are
essentially for the children (6-24 months) outside this welfare net. There
would be about 80% or some 40 million 'Under Twos’, of LIG and MIG
families who would greatly benefit from an appropriate and affordable
complementary food.
• Advocacy : The Public Sector of the four countries under review do
have MCH programmes with strong compenents of Nutrition.
However, there is little knowledge or realization at any level that the
mighty micros’ (vitamins and minerals) are as important as the
‘mighty macros’, namely, calories and protein. Also, even very good
programmes, be it India’s ICDS, only cover about 10% of the target
population. A series of sensitization workshop/seminars could be held
on the importance of fully fortified, adequate and suitable
complementary foods for representatives of both the Public and
Private Sector. This is where Academia, Food Technologists, Field
and Operational Researchers should also be roped in as lecturers or as
organizers of such fora. Advocacy should not fight shy of proving
how fortification of complementary foods in the Developed World is
the cheapest and most cost-effective way of eradicating the Hidden
Hunger for the 'micros’. At these 'advocacy fora the participants
must be made aware that 'micros’ are not just iron, iodine and
Vitamin A’ but a whole array of other vitamins, minerals and trace
elements. Nor should Advocacy fight shy of painting a grim picture
of the consequences to the helpless childjOr taking an imme ia*e> :
unanimous and positive view followed by immediate action or t
full fortification of complementary foods.
Show of Commitment from the Private Sector ' n *and
giants in the complementary food area are einz n
Nestle India (Pvt) Ltd..
Very recently Hindustan Lever Ltd.
64
taken over 14 units of Modem Foods fr™
r
The National Dairy Development Board is anota^dableld
socially committed giant in the cooperative sector. If a consortium
could be formed for a social product, even between these fo”r
corporates, tremendous strides in producing a suitable nutrient dense
low bulk, and fully fortified complementary food could be
manufactured m no time. Further there would be no price wars as all
four would be operating together.
Show of commitment from the Public Sector : The Public Sector
on its part should fully endorse and support the Private Sector’s social
commitment in concrete ways. It could waive all taxes/duties/levies
connected with the category of complementary foods. It could
simplify the present Food Protection Standards. It could recognize
and reward the committed and the achievers in this area.
Show of commitment from the Parents of the Under Twos : If the
product is good and affordable it will sell.
This enormous grey
market of neither the ‘not desperately poor’ nor the ‘rich’ has been
waiting for a long, long time for such a complementary food
(described in detail in the previous sections).
Private Sector’s sponsorship of relevant operational-research on
complementary foods : This has hardly received any support. Net
working and multi-centric studies within the region should be strongly
supported.
Private and Public Sector’s Support to Social Market Research
and Social Marketing : What has been proposed in this report is a
large social-marketing programme for complementary foods linking
the four countries under review. For example, Hindustan Lever t .,
invests huge amounts on Market Research and Advertising esearc .
It could spear-head a movement to determine what are the
opportunities or barriers to the two new concepts o
A single feed, fortified, high-nutrient-density, low-bulk cerealfor a reasonable
pulse-based-complementary foods in Sout
sia
and Rs. 5/- for a
cost of say Rs. 3/- for a 50 g single fee pouc
100 g pouch.
Pnwder(ARF) + the entire
The idea of a sachet of 5 g Barley
(ICMR 1992) for a
RDA of micronutrients for a one year old child (ICMK.
cost of Rs. 2/- per sachet.
70
A Systems approach for the Producation nr r
.
Foods: Both Private and Public
c ",of Complementary
an integrated approach to covej
hands ‘° “Sure
packaging, transportation, storage and marketi™ o"f °f P|°ductlon’
foods.
Procurement of raw maX “11oTZ'XT
mmeral premixes and/or ARF may be difficult to obtam on an'
uninterrupted basis in some of the countries of the region.
Market
Reseych should precede and follow the production of th
compkmentary food Reasonable levels of food safety and hygiene
should be followed.
Reasonable levels of cleanliness dunng
transportation, storage and use have to be adhered to.
It is suggested that a high powered committee headed by the Prime
Minister of the Nation, head the Complementary Food Mission. Only
then does any Mission get some clout and aura!
It is suggested that the International Agencies namely, MI, WHO,
WFP, UNICEF or bi-lateral agenices such as USAID, CIDA,
DANIDA etc. or NGOs like CARE, fund and support the
Complementary Food Programme in a big way.
Primary Education is going to be made compulsory in most of the
South Asian countries. In India alone there would be 200 million girls
and boys in school.
The Private and Public Sector could set-up
cooperatives in the District Primary Education Programme (DPEP)
schools where all basic necessities of life, namely, fully fortified food
items like salt, flour, sugar, fats/oils, common medicines and
complementary foods could be stocked or displayed.
IEC on the
benefits of each item could be explained or even given as a subject to
the schooler. The potential for behaviour change could be substantial.
Parents listen to their child, not to outsiders however learned. The
parents could then go and purchase the said item/s from t e
or
ration shop.
,
,
The Public Sector should permit free of cost, generic t ernes an
advertisements in the electronic and print media on a soci
fortified food items, including complementary oo s.
rather
Public Policy should elevate Human Resource Devetopment rather
than just Defence or Information Technology as is currently bang
done in many countries of South Asia.
girl for
The emphasis on just the pregnant woman an
primary
Nutritional Improvement, should be on
parents of
Schoolers and the Secondary Schools aretarget
tomorrow, very soon. They are a
g
71
population themselves. The Private and
e
by joining hands and concentrating on 'the horses than1W°“ld
"e11
their stables (yet)’ namely, the school boy and girl L7
households, everyone is undernourished for macro as wellT^
nutrients. Fortification effortlessly improves the health and nu«Z°
status of the entire family. Fortification is a dietary interandon
Government Policy (Public Sector) should give status to this type of
Dietary Intervention.
This section is not intended to be nor is it exhaustive. Some of the points
made above is from my practical experience of working with the
Planning Commission of India (Public); Hindustan Lever Ltd. (Private),
and M.S. University Baroda (academia and research). The intention of
this report was to give some insights into the present-day-situation (2000
A.D.) with respect to Complementary Foods, in India.
There is a
tremendous unmet demand for a Complementary Food for the
common man’s 'Under Twos’. The Public Sector has not and cannot
entirely meet this demand.
Will the Private Sector take up the
challenge?
72
ABBRE VIA TIONS
ACC/SCN :
ARF
AWC
CARE
CFTRI
CIDA
CSM
DANIDA
DPEP
FCI
HDPE
HIG
ICDS
ICMR
IDRC
IEC
INHP
KCP
KIF
LBW
LIG
MCH
MI
MIG
NDDB
NHE
NIN
PAMM
PDS
PEG
PRA
RDA
RTE
SFBW
thr
TINP
USAID
:
:
:
:
:
:
:
;
Administrative Committee on Coordination / Sub Committee on Nutrition.
Amylase-Rich-Food.
Anganwadi Centre.
Cooperative for Relief Everywhere.
Central Food Technical Research Institute.
Canadian International Aid.
Com Soya Blend.
Danish International Aid.
District Primary Education Programme.
Food Corporation of India.
High Density Poly Ethylene.
High Income Group.
Integrated Child Development Services.
Indian Council of Medical Research.
International Development Research Centre.
Information Education Communication.
Integrate & Nutrition Health Programme.
Karnataka Com-Agro Pvt. Ltd.
Kerala Indigenous Food.
Low Birth Weight.
Low Income Group.
Maternal Child Health.
Micronutrient Initiative, Ottawa.
Middle Income Group.
National Dairy Development Board.
Nutrition Health Education.
National Institute of Nutrition.
Programme Against Micronutrient Malnutrition.
Public Distribution System.
Programme Evaluation Organisation.
Participatory Research Assessment.
Recommended Daily Allowances.
Ready-To-Eat.
Soya Fortified Bulger Wheat.
Take Home Rations.
p • t
Tamilnadu Nutrition Integrated P J
United Status Aid.
73
USD
WFP
WHO
US Dollar
World Food Programme.
World Health Organisation.
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