Large-scale staple food fortification as a complementary strategy to address vitamin and mineral vulnerabilities in India: A critical review.

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling-up scientifically proven, cost-effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost-effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large-scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.

Influence of Social Inequalities on Dietary Diversity and Household Food Insecurity: An In-Depth Nutrition Baseline Survey Conducted in Madhya Pradesh, India.

Home to a significant proportion of the world's population, India is one of the hardest hit countries when it comes to malnutrition. While the magnitude of malnutrition in India is vast, it is also unevenly spread due to inequalities of the social, political, and economic situation. As part of the special initiative of the German Ministry for Economic Cooperation and Development (BMZ), "One World - No Hunger," GIZ is implementing a Global Program on "Food and Nutrition Security, Enhanced Resilience" (FaNS) in 12 countries, including India. The GIZ FaNS program, in agreement with the Department of Food and Public Distribution, Ministry of Consumer Affairs, Food and Public Distribution on a central level, and the Department of Women and Child Development in Madhya Pradesh, aims to improve food security and nutrition diversity for women in the reproductive age group (15-49 years) and young children (6-23 months) in the districts of Sheopur and Chhatarpur in Madhya Pradesh. The present study, conducted in the state of Madhya Pradesh in India, describes the nutrition situation of women and children belonging to disadvantaged socioeconomic backgrounds and aims to assess how underlying factors are influencing the nutrition diversity and food security situation. The findings highlight low dietary diversity with more than 80% of women and 77% of children consuming less than the daily recommended food groups. A high level of food insecurity (49.9%) was also reported in the study area (https://www.snrd-africa.net/wp-content/uploads/2017/07/GIZ_Nutrition-Baseline-Survey-Summary-Report.pdf). Furthermore, the study affirms that caste status negatively influences dietary diversity, especially among women and those with household food insecurity. A better educational status and income stability resulted in a better nutrition status for mothers and children. Access to food and nutrition services (OR 1.5; p = 0.04), exposure to nutrition counselling (OR 1.323; p = 0.001), and hygiene practices (OR 1.8; p = 0.002) can be instrumental in improving the dietary diversity and food security status of families, irrespective of prevailing inequalities.

Understanding Barriers and Facilitators for Human Milk Banking Among Service Providers, Mothers, and Influencers of Preterm and Sick Neonates Admitted at Two Health Facilities in a Metropolitan City in India.

BACKGROUND: Scaling-up human milk banks (HMBs) is a promising solution for saving vulnerable newborns. Exploring perceptions and practices on donor human milk (DHM) and HMBs is essential to strengthen and scale-up an integrated HMB system resting on a model called the "Mother Baby Friendly Initiative Plus" (MBFI+), which includes promoting breastfeeding, encouraging kangaroo mother care, and providing safe DHM to vulnerable babies without access to mother's own milk. MATERIALS AND METHODS: A qualitative research was conducted among 56 service recipients including mothers and key influencers and 9 service providers to understand their perceptions and practices on DHM and HMBs. RESULTS: Service providers opined that DHM is safe and lifesaving for vulnerable babies. Challenges shared were limited supply of DHM because of low awareness on milk donation, shortage of trained staff, and risk of milk contamination. They stated that although most mothers were comfortable in donating milk, few were reluctant to donate milk as they feared shortage of milk for their own babies, or milk expression may cause weakness. Recipient mothers accepted use of DHM as per facility norms but had concerns about donor mothers' health and hygiene and measures for ensuring milk safety. Most grandmothers were resistant toward donating or receiving DHM for their grandchildren. Many fathers were comfortable with donating once they knew it is lifesaving and did not compromise supply for their babies. Service providers shared opportunities for scale-up, like improving awareness and infrastructure, lactation counseling by skilled personnel, supportive hospital environment, and establishing HMBs in every city and district. CONCLUSIONS: Human milk banking should be strengthened as part of the MBFI+ model. For this, behavior change communication targeted at mothers and influencers about breastfeeding and HMB from the antenatal period, capacity-building among service providers, and government ownership is necessary.