Shahnawaz Khan Public Health Resource Society

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
Shahnawaz Khan
Public Health Resource Society
Impact of COVID-19 pandemic on nutritional status of
children between six months to three years enrolled
under crèche program in southern Odisha
Shahnawaz Khan1, Vandana Prasad2, Rupa Prasad3, Aditi Hegde4, Rishita Chandra5
1 Senior Programme Coordinator, PHRS, 2 Technical Advisor, PHRS, 3 Executive Director, PHRS, 4Senior Programme Coordinator, PHRS, 5 Programme Coordinator, PHRS
01.12.2021

2. “Mainstreaming crèches to reduce malnutrition in Odisha” is a collaborative effort
of Public Health Resource Society and Azim Premji Foundation supported by the
Government of Odisha.
Rationale
• Children under three years are most
vulnerable
• Poor feeding practices
• Programmatic challenges Assist
scale-up
150
crèches in
five districts
of south
Odisha
Continuum
of care

3. Conceptual Framework for Intervention
Care
(Prevention,
Maintenance and
Cure)
Health
Food and
Feeding
Early Stimulation
(education and
employability)
Safety and
Protection
Women’s own health, nutrition,
time and energy
CRÈCHE
(550 of 1000 days)
Reduction in drudgery,
improvement in health,
socioeconomic
empowerment
WOMEN
C
H
I
L
D
R
E
N
Liberated to go
to school
OLDER GIRLS

4. During COVID-19
Before COVID-19
Shift in strategy
Hot cooked meals at crèches,
thrice a day
Growth monitoring at crèche,
identification of growth faltering and
SAM, referrals and follow-ups
Continued growth monitoring and
referrals and follow-ups
Supervised feeding of boiled eggs
Door to door ration delivery
Early stimulation for growth &
development
Nation-wide
Lockdown
Anganwadis
and crèche
closure
WCD’s
Guidelines
Home visits and counseling

5. Continued
anthropometric
measurements
Supervised feeding of
eggs by crèche
workers
Door to door
counselling
Referral to NRC

6. Impact of COVID-19 on SAM children
Period Count Mean WHZ Diff Significance Relative change in mean
WHZ
Avg Duration at
creche
Min Duration at
creche
Max DAC
Pre COVID 90 1.10 Significant at p<0.0001 32.5% 8.0 4.0 12.1
During Lockdown 51 0.76 Significant at p<0.0001 21.7% 10.4 4.5 12.9
31.11%
53.33%
15.56%
19.61%
52.94%
27.45%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Percentage of children
shifted to normal
category
Percentage of children
shifted to moderate
category
Percentage of children
retained severe
category
Shift of wasting status in pre-COVID-19 period
Shift of wasting status during lockdown period
Comparison of percentage of SAM children shifting or
retaining their wasting status in pre-COVID-19 and during
lockdown period
Children identified as SAM between February 2019 to February 2020 and June 2020 to June 2021 have been taken for analysis for per-COVID-19 period and during COVID-19 period respectively
Each child has been enrolled in the creche for at least four months
Even though the
percent of SAM
children shifting their
wasting status has
decreased during the
lockdown period,
73% children had
positive grade shifts
in a community
based setup

7. Policy Recommendations
The findings reinforce
the need for supervised
feeding as a key
element of community-
based management of
malnutrition
Since the implementation
of such childcare
programme is at the village
level, the continued
functioning of such centres
are of utmost importance.
Adequate preventive
measures can be ensured.
Continued functioning of
childcare system
Community-based day care
centers can make sustainable
changes in the nutritional
status of malnourished
children
Community-based
management of malnutrition
Supervised feeding

8. Thank You