New Delhi: Quarantine provides an opportunity for India’s POSHAN (Prime Minister’s Overarching Scheme for Holistic Nutrition) Abhiyaan. Safe and nutritious food during quarantine can address malnutrition and be an enabler to prevent stress eating, revitalise mental health and positive attitudes to tackle the negative health effects. Here is a strategic perspective on nourishing the undernourished during the current COVID-19 crisis.
Nutrition In Extraordinary Time
An invisible novel virus has engulfed the universe reminding everyone the power of priceless body immunity to fight this novel disease. The pandemic is being managed with utmost precaution and supportive care. However, people like the senior citizens and those having other coinfections and comorbidities like hypertension, diabetes, among others are more prone to infection and mortality.
Good nutrition is key to good health and is important for a good life. In the quarantine facility and for people in home quarantine, safe and nutritious diets are necessary to enhance the immunity and prevent deficiency diseases which could lead to compromised immunity and a host for associated diseases, increasing the risk for infection.
COVID-19 Has Potential To Compound Malnutrition In All Its Forms
Around 53 per cent of women in the age group 15-49 years are anaemic, as per the fourth National Family Health Survey (NFHS-IV) and more than 60 per cent children from 12-23 months of age are anaemic, as per the Comprehensive National Nutrition Survey (CNNS 2016-18). Similarly, as per the Comprehensive National Nutrition Survey(CNNS)-2016-18, 35 per cent of children under five, 17 per cent of children under ﬁve, 33 per cent of children under five are stunted, wasted and underweight respectively.
Rural areas have higher prevalence of underweight in children under ﬁve (36 per cent) compared to urban areas (26 per cent). Scheduled tribes had the highest prevalence of underweight (42 per cent) as compared to scheduled castes (36 per cent), other backward classes (33 per cent), and other groups (27 per cent). Like stunting, children under ﬁve from the poorest wealth quintile had a prevalence of underweight more than twice that of the children from households in the richest wealth quintile (48 per cent vs. 19 per cent).
41 per cent of pre-schoolers, 24 per cent of school-age children and 28 per cent of adolescents were anaemic and female adolescents had a higher prevalence of anaemia (40 per cent) compared to their male counterparts (18 per cent). Anaemia was most prevalent among scheduled tribes, followed by scheduled castes. More than half (53 per cent) of pre-schoolers and more than one-third of school-age children and adolescents (38 per cent each) belonging to scheduled tribes were anaemic.
Research studies suggest that infection/inflammation, iron deficiency, micronutrient deficiencies such as copper, zinc, Vitamins A, B12, C, riboflavin, folate, and some of the genetic factors like sickle cell anaemia contribute to overall anaemia prevalence. Malaria in some states compounds the anaemia prevalence.
20.7 per cent women and 18.6 per cent men are obese and overweight (NFHS-IV) which indicates a double burden of malnutrition (both undernutrition and obesity) in India and a broken food system. As per WHO (World Health Organisation), Non- communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70 per cent of all deaths worldwide and a risk factor contributing to the mortality due to COVID-19 infection. The data on deaths due to COVID-19 reveals the majority of deaths were of people suffering from NCDs (Non-Communicable Diseases) like diabetes, hypertension.
Micronutrient Deficiencies-All Pervasive
As per CNNS, the prevalence of vitamin A deﬁciency is 18 per cent among pre-school children, 22 per cent among school-age children and 16 per cent among adolescents. Vitamin D deﬁciency was found among 14 per cent of pre-school children, 18 per cent of school-age children and 24 per cent of adolescents. Nearly one-fifth of pre-school children (19 per cent), 17 per cent of school-age children and 32 per cent of adolescents had zinc deﬁciency. The prevalence of vitamin B12 deﬁciency was 14 per cent among pre-school children, 17 per cent among school-age children and 31 per cent among adolescents. Nearly one-quarter (23 per cent) of pre-school children, 28 per cent of school-aged children and 37 per cent of adolescents had folate deﬁciency. In the scheduled tribes, 9 per cent of pre-schoolers and 15 per cent of school-age children and adolescents had Vitamin D deficiency.
Quarantine During COVID-19 Times- A New Opportunity For Nutrition
India’s migrants, people with asymptomatic cases, health care provider or someone at has reason to believe s/he may have been exposed to COVID-19, are being asked to quarantine, which means staying in a specifically designated location (home or public/local government facilities) away from others, for the purpose of observing and monitoring health status for the development of symptoms. Typically, a COVID-19-related quarantine lasts for 14 days, but this length may vary if directed by a health care provider or the local health department. It is a period of isolation and sometimes disturbs the mental health the person is instructed not to leave the quarantine location for any non-essential reason use public transportation or go to shopping centres or not to have friends or family with you in your isolation room unless they have been approved by your health care provider. The Government is providing food and other essential items including sanitary pads and personal hygiene kits during the quarantine. It is impressive to know that the Government of Odisha which provided food four times a day during institutional quarantine increased food expenditure with Rs. 120/- per adult per day and Rs. 100/-per child per day. It provides the opportunity for a nutrition-rich diverse diet.
What Can Be Done: A Mission Mode Approach To Address Nutrition Inadequacy
There are a number of guidelines on how to eat safe and nutritious foods during the COVID-19 quarantine. It contains valuable information about nutrition and hygiene system to help keep the immune system strong. It also has tips for a diet that supports good health. In India, the national and state governments are taking stronger measures to offer safe and nutritious diets during the quarantine.
In order to ensure safe and wholesome food in the country, India’s food regulator, FSSAI issued guidelines and advisories on keeping food safe in times of social distancing, food safety measures for the handlers, industry and vendors and safety measures across the value chain including cooking and storing. In order to prevent, myths, the food regulators shared numerous facts and spread awareness messages.
With a high level of malnutrition and micronutrient deficiencies and specifically among the women and children and people from the marginalised community being hardest hit; their limited access to diverse diets during quarantine and otherwise may lead to increased consumption of unsafe diets and likely to have a negative effect on the immune system, overall physical and mental health, and the well-being. If we miss the first one thousand days (pregnancy to 2 years) of life of the child, we miss the potential growth and development opportunity of the child for entire life.
Nutrition is not the only factor essential for staying healthy during self-quarantine. For optimal health, it is also important to remain physically active. To support people in staying physically active, it is necessary to engage in home and facility-based exercises. Essential micronutrients such as vitamins and minerals are necessary to increase immunity which are most vital at this stage. Vitamin A and Zinc is necessary to prevent infections and impaired immune responses. Vitamin D is necessary for adequate bone health.
One of the important reasons of obesity and overweight is the consumption of unsafe diets specifically trans fats, high sugar, salt and fat in the diet. The people in quarantine facility mostly locked up in a facility without physical exercise needs diets with low, sugar and fat. This can prevent obesity and overweight and alternatively can prevent NCDs (Non-communicable diseases).
A. Dietary Diversity- Adding Colours To The Plate:
It is an excellent move that the Government has notified for distribution of supplementary nutrition and food through TPDS and MDM through home delivery or provides food security allowance wherever home delivery is not possible. Dietary diversity is the most sustainable approach to tackling malnutrition and micronutrient deficiency. It is good to observe that in some states, the local governments and women self-help groups are now engaged in quarantine management and provision of foods during facility-based quarantine. The government may issue suitable guidelines on provision of safe and nutritious foods during quarantine having essential calorie, protein, macro and micronutrients. The consumption of a minimum acceptable diet among the children between 6 to 23 months is abysmally low. As per CNNS, only 6 per cent of children receive a minimum acceptable diet. The policy and program delivery mechanism may facilitate for pregnant mothers to consume one additional meal and the children between 6-23 months to consume appropriate complementary feeding with a minimum four food groups along with breastfeeding. The diverse diets such as essential minor millets, fruits and vegetables may be procured locally through the community and women self-help groups and supplied to the facilities. It can strengthen the local value chain and increase earnings for the smallholder farmers. Some of the naturally biofortified crops and foods like minor millets, moringa, spinach, amla can be part of the prescribed diet.
Government programmes for Vitamin A supplementation of children under 6 years of age and Iron-Folic Acid supplementation for children under 6 years of age, pregnant women and adolescent girls and immunisation have been disrupted due to lockdown in many places. By following standard operating protocols, the health and nutrition service providers by visiting quarantine centres and homes should administer supplementation programs with adequate compliance. The persons in the quarantine should undergo essential tests on micronutrient (vitamin and minerals) and the health care providers may supply essential supplements to reduce morbidity.
C. Provision Of Fortified Foods:
Food fortification, a process by which vitamins and minerals are added to commonly consumed foods, offers a good opportunity to improve the micronutrient status of people without changing their food habits. Bio-fortified and Fortified staples mandated by the Government of India like fortified salt, wheat flour, refined vegetable oils and rice should be provided with adequate safety, quality assurance and quality control measures at the quarantine centres and India’s public-funded programmes like the targeted Public Distribution System (PDS), ICDS supplementary nutrition programme and the Mid-Day Meal (MDM) programme can also benefit pregnant and lactating mothers, and children (6-72 months) and people at home quarantine.
D. Jan Andolan To Janani Andolan: From People’s Movement To Women’s Movement
The Ministry of Women and Child, the nodal Ministry for nutrition issued a guideline on Infant and Young Child Feeding (IYCF) with precautionary measures to protect from infection and a coping strategy for Children and Caregivers. India’s Jan Andolan (People’s movement) mandated by POSHAN Abhiyaan (National Nutrition Movement) need to be reoriented during COVID times and from a community level to family and quarantine facility level with a focus on pregnant and lactating mothers and children under II years of age. The campaign needs to deal with myths and misconceptions and misinformation that is being spread during COVID times.
It will be a new campaign on behaviour change and social sanction activities by following social distancing measures concentrated on Infant and Young Child Feeding and safe and nutrient diets for the adults. India’s last-mile public health functionaries familiar with inter-personal counselling and home contact can lead the way here with additional guidance on virus spread. This campaign can be piloted at Coronavirus-free district and based on the evidence, can be scaled up across. Women should lead this at the forefront. Our 3.5 million women grassroots functionaries can lead this at the forefront.
India’s POSHAN Abhiyaan To Take A Lead
POSHAN Abhiyaan, Prime Minister’s Overarching Scheme for Holistic Nourishment with the targets to reduce stunting, under-nutrition, low birth weight (among young children) and anaemia and with the Mission to achieve fast-forwarded reduction in Stunting from 38.4 per cent to 25 per cent by 2022 need to steer the nutrition movement during this extraordinary COVID times. Apart from meeting the nutrition need, the nutritious food during quarantine can be an enabler to prevent stress eating, revitalise mental health and positive attitudes to tackle the negative health effects. With initiatives at scale during quarantine, India can demonstrate an exemplar model for the world to learn and replicate.
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