Positive deviance study of malnutrition

validating deviance discipline of mal forageIntroductionMalnutrition is the key cause of either ace out of both finishs in kidren to a lower place 5 years of age.Bryce J, Boschi-Pinto C, Shibuya K, Black RE, and the WHO Child headspringness Epidemiology readererence Group. WHO counts of the causes of death in children. Lancet 2005 365 1147-52.It is a cosmicly pr unconstipatedtable cause of everywhither a third-3.5 one thousand million- of every child deaths. Four-Fifths of beneathnourished children live across 4 regions-Africa, Asia, Western Pacific and the Middle East-. These be high priority nations for action. The prototypical of the millennium development goals was to fractional among 1990 and 2015 the proportion of people who become from hunger.U.N.Mellinium Project 2005. Halving hungerIt exactlyt be through. London and Sterling, VATask ram on hunger, 2005.Nutrition is a neglected aspect of child swellness which is not justifiable as we know that it is a major take chances factor for disease.Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and hazard factors, 2001 systematic analysis of population wellness data. Lancet 2006 3671747-57.Inappropriate feeding exercisings and their consequences are major obstacles to back upable socio economical development and p everywherety reduction. Governments will be un made in their efforts to accelerate development in whatever probatory long-term sense until optimal child growth and development, especially with appropriate feeding designs, is ensured.WHO Global Strategy on Infant juvenile Child Feeding Report of the Secretariat 55th solid ground Health Assembly, April 2002(5)The indicator by which progress is measured is the preponderance of at a lower place pack in children at a lower place five, special(prenominal)ally, the per centumage of children aged 0-59 months who fall below minus ii standard deviations from the median w eight for age of the standard reference population.http//www.unicef.org/progressforchildren/2006n4/index_ chthoniannutrition.htmlWorld rely Report on 11th May 2006, on that point is a dominant rivet on food supplementation that detracts from aspects that are much(prenominal) crucial for up child nutritionary outcomes, such as improving vexs feeding and sympathize with behavior For example, l unity near(prenominal) 40 percent of Indian m others practice exclusive breastfeeding.Also delivery of services is not sufficiently focused on the youngest children (under three), who could potentially eudaemonia most from ICDS interventions Growth-faltering starts during gestation period, and approximately 30 percent of children in India are born with low birth weight, and by the age of two years most lifetime growth interim has taken place, and is largely permanentThe flowchart below depicts the interactions between key and immediate causes of malnutrition The dogmatic distort ion concept which forms the basis of this bailiwick focuses on two direct behavioural causes of malnutrition at the household level, namely curt dietary intake and disease prevention.This subscribe to measures childhood malnutrition using the parvenu growth standards that have been recently released by the World Health Organization. The new-fashioned standards are form on children from Brazil, Ghana, India, Norway, Oman and the US and adopt a essentially prescriptive draw close designed to describe how all children should grow quite a than merely describing how children grew in a single reference population at a specified time.Garza C, de Onis M. (for the WHO Multicentre Growth Reference matter Group). Rationale for development a new inter matter growth reference. Food Nutr Bull 2004 25 (Suppl. 1) S5-14.Magnitude of MalnutritionMalnutrition is a widely prevalent problem in India and one of astonishing magnitude. According to the National Family Health Survey 3 (NFHS ter cet, 2005-06), roughly a third of Indias children are born underweight, nearly 44 percent of children under five are underweight, 48 percent are stunted, 20 percent are wasted and 70 percent are anaemic. NFHS II (1992-93), more than than half (53%) of children below four years of age are under nourished. In 1998, 29.1% children between 1-5 years of age give birthed from moderate and 12.3% from impish under nutrition. This shows only a gradual decrease in the prevalence of under nutrition in India over twelve years. nutritional sufficiency is one of the key determinants of the wellness and well being of the children. Under-nourishment not only retardsphysical development further also hampers the learning and cognitive process, leading to sluggish readingal, loving and economic development, according to Sanjeev Kumar in his study Malnutrition in Children of the Backward States of India and the ICDS Programme.According to the NFHS III data, Tamil Nadu, although considered one of the better performing states, recorded to have intimately 35% of its rural children as undernourished. This value was certainly lower than the national rural average of 49%, but according to the NNMB espouse based on the NCHS standards in 2001, in that location was a rise in the levels of intemperate malnutrition in both boys and girls in the under 5 age convention in Tamil NaduTherefore the focus of this study is to investigate how around children living in the same surroundings escape the ill-effects of malnutrition and thrive in spite of poverty and limited resources, and use these practices to eliminate malnutrition among the rest.The validatory deviation Approach and its benefits irresponsible distortion is based on the fact that solutions to some participation problems already exist deep sight the alliance and need to be discovered. It is a strength-based or asset-based sexual climax based on the belief that in every community there are certain individuals ( c onfirmatory degenerates) whose special, or uncommon, practices and behaviours modify them to risk better ways to prevent malnutrition than their neighbours who share the same resources and await the same finds.Through a dynamic process called the Positive deflection Inquiry (PDI), these practices are discovered to contribute to a better nutritionary outcome in under nourished child This intervention is designed to enable families with give children to learn and practice these and other beneficial behaviours. The programme actively involves the mother and child in rehabilitation and learning in a menage like situation and work to enable the families to sustain the childs enhanced nutritional stance at home. The typical session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.The development of a community-based nutrition rehabilitation model called PD/ dwelling was promoted by USAID and other international organization s such as UNICEF.The Hearth approachIn the Hearth approach, caregivers of feed children practice new cooking, feeding, hygiene and caring behaviours shown to be successful for rehabilitating give children. The selected practices come from both the findings of the Positive Deviance Inquiry and emphasis behaviours highlighted by public wellness experts. The Hearth session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.The Hearth approach promotes behaviour change and empowers caregivers to take function for nutritional rehabilitation of their children using local knowledge and resources. After two weeks of being fed additional high-calorie foods, children become more energetic and their appetites increase. ocular changes in the child, coupled with the learning by doing mode, resolvings in cleansed caregiver confidence and skills in feeding, child care, hygiene and health-seeking practices. Improved practices, regardless o f mothers education levels, enhance child growth and development. This approach successfully reduces malnutrition in the print community by enabling community members to discover the wisdom of Positive Deviant mothers and to practice this wisdom in the daily Hearth sessions.Positive Deviance/Hearth is an potent tool in discovering the solutions from within. posit for the Studymaternal(p) and child under nutrition is highly prevalent in low and middle income countries like ours, resulting in increased mortality and overall disease burden.It is well recognised that among the basic and underlying causes of under nutrition include environmental and economic factors with poverty having a central role. therefore for a sustainable solution to this very common problem, there necessitate to be an ecological and holistic approach rather than the current and unremarkably used approach of the government giving supplementary feeds to those who are malnourished. The latter(prenominal) appro ach not only puts a financial strain on the government but also make the community members dependent on this external aid. Therefore this study concentrates on identifying affordable and sustainable solutions within a community which can be used to prevent undernutrition. This approach is also not resource hungry unlike the traditional approaches where the focus is on finding and fixing what is wrong and missing in the community rather than identifying what is already working and build on the strengths of existing heavy practices within the community that is protecting them from undernutrition even though they are confront with same constraints of resources. This approach is known as the Positive Deviance approach. association shared through this approach not only changes behaviour but also changes how a community perceives malnutrition and their ability to change the situation. The Positive Deviant approach has been shown in other studies and acoustic projections to quickly elimi nate malnutrition and through the sustainable new behaviour the younger siblings have also received these benefits. Positive deviance is a successful approach to decrease malnutrition and has enabled hundreds of communities the world over to reduce and prevent malnutrition. This approach is also culturally acceptable which helps encounter about change in our society.However, there are only a few studies that use this concept to reduce malnutrition in India, whereas the potential here is very high. And , although Tamil Nadu has shown gains in terms of reduction of the problem of malnutrition, it liquid has a high dowry of malnourished children and therefore this study was undertaken to estimate prevalence in fourteen villages within the rural field practice area of the department of community medicine of PSG Institute of Medical recognition and Research and explore the feasibility, sustainability and effectiveness of rubbishing the problem by using the Positive Deviance concept and approach.Tamil Nadu has a high prevalence of malnutrition. Recently, there has been a paradigm shift in the primary focus from worry of Malnutrition to Prevention of Malnutrition. Towards achieving this, strategies and activities have been proposed under various components for the year 2006-07 with priority for great attention on the health and nutritional consideration, by the Government of Tamil Nadu. One of the guiding principles suggested to help grasp Malnutrition free Tamil Nadu, is effective nutrition intervention, and communication to bring about behavioural change. To help achieve this goal, this study was undertaken in fourteen villages under the rural field practice area of the department of community medicine of PSG Institute of Medical cognition and Research using the Positive Deviance concept.ObjectivesTo estimate the prevalence of under 3yrs undernutrition in 14 villages of Vedapatti.To identify Positive Deviant practices in the community.To reconstruct unde rnourished children identified in the most affected village.To reassess families at their homes after 6 months and ensure sustainability of Positive Deviant practices.Review of booksClassification of under nutritionUnder nutrition is defined as the outcome of insufficient food intake and repeated infectious diseases. It includes being underweight for ones age, too short for ones age (stunted), dangerously thin for ones superlative (wasted) and deficient in vitamins and minerals (micronutrient malnutrition) according to UNICEF. Low weight for age is termed as underweight.Weight for age potpourris are widely used in assessing nutritional post of children as it gives a picture of both acute and degenerative onset malnutrition. The earlier classifications include Gomez, Indian Association of Paediatrics, and Welcome. These classifications use divers(prenominal) reference standards, but the current recommended standards are the WHO references.This study uses the WHO references to c lassify underweight. In a study done by Bridget Fenn and Mary E. Penny across three countries, fewer children were classified as underweight according to the WHO classification when compared to the NCHS reference standards.Another study done by Marc-Andre Prost et al showed contrast results. The WHO standards gave a prevalence of underweight 3.6 times higher early in infancy,0 4 months (6.1% against 1.7%) and half the estimated prevalence of the NCHS reference in the second half of infancy, 11 15 months(6.6% against 13.6%)Implication of sunrise(prenominal) WHO Growth Standards on appellative of Risk Factors and Estimated Prevalence of Malnutrition in homespun Malawian InfantsMarc-Andre Prost1*, Andreas Jahn1,2, Sian Floyd1, Hazzie Mvula2, Eleneus Mwaiyeghele2, Venance Mwinuka2, Thomas Mhango2, Amelia C. Crampin1,2, Nuala McGrath1,2, capital of Minnesota E. M. Fine1, Judith R. Glynn1In a study done by P.R. Deshmukh et al , in Anji, Maharashtra, the prevalence of underweight as assessed by WHO standards was of importly lower when compared with the judgement based on NCHS reference (p0.05). bleakly Developed WHO Growth Standards Implications for demographic Surveys and Child Health Programs P.R. Deshmukh, A.R. Dongre, S.S. Gupta and B.S. GargPrevalence of under nutritionThe World Bank estimates that India is ranked 2nd with 47% after Bangladesh for the most number of children who suffer with malnutrition (in 1998). The prevalence of underweight children in India is among the highest in the world, and is nearly double that of sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.According to the National family health survey -3 the percentage of under 3 children who were underweight in Tamilnadu were 33.2 % (31.3% in the urban areas and 34.8% in rural areas)The National Nutrition Monitoring Bureau sight that in about 40% of the households, the intake of dietary energy by preschool children was inadequate. Abo ut 55% of the preschool age children were underweight, 52% were stunted and 15% were wasted.In a study done by Bhanderi D et al, the prevalence of under weight (wt. for age below 2SD) was 43.67%.An epidemiological study of health and nutritional status of under five children in semi-urban community of Gujarat.Bhanderi D, Choudhary SK.A study done to find the prevalence of malnutrition in Uttar Pradesh showed that the maximum over all prevalence of malnutrition was in the age group of 13-24 months. The maximum number of mark IV malnutrition was found in the age group 25-36 months.Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia, Nutritional status of children under 6 years of age Indian ledger of prophylactic device and brotherly Medicine. Vol. 35 No.3 4 2004Methods of assessing nutritional statusNutritional assessments can be done by both direct and indirect methods. The method used can result in a wide chance variable in the prevalence of malnutrition.P. Mohanan et al i n their study evaluated the efficacy of physical structure Mass Index, Mid-Arm Circumference and Weight-for-age in detecting Malnutrition in terms of sensitivity, specificity and prognosticative value and concluded that weight-for-age is the beaver indicator.P.Mohanan, A.Kamath, B.Motha, M.Philip. Evaluation of anthropometric Indices of Malnutrition in under-five children. Indian journal of Public Health 1994 July-September28 (3) 91-94.A Comparison of Anthropometric Methods for Assessing Nutritional positioning of Preschool Children in the Philippines was done to identify the most trusty anthropometricmeasurements that reflect nutritional status and the Dugdales nutritional index, weight/height, was a received measurement for malnutrition. This is exceptionally useful when the age of the child is not know.A Comparison of Anthropometric Methods for Assessing Nutritional Status of Preschool Children The Philippines Study Marilyn D. Johnson, MS,William K. Yamanaka, PhDandCandelar ia S. Formacion, MSFactors associated with malnutrition sex activityA geek-controlled study conducted in a rural area in Tamil Nadu, India, on 97,000 children showed that womanly gender was a significant risk factor for malnutrition.YALE JOURNAL OF BIOLOGY AND MEDICINE 70 (1997), pp. 149-160. Copyright C 1997. All rights reserved. A Case-Control Study of Maternal Knowledge of Malnutrition and Health-Care-Seeking Attitudes in Rural South India Kaori Saito, Joshua R. Korzenika, James F. Jekel and Sara BhattacharjiAlso another study in Tamilnadu on a total of 2954 children attending the TamilNadu Integrated Nutrition Project (TINP), showed that there was an association between female sex and malnutrition. In this study the malnourished children were referred to as negative deviates.Use of Positive-Negative Deviant Analyses to Improve Programme Targeting and serve Example from the TamilNadu Integrated Nutrition ProjectMEERA SHEKAR, JEAN-PIERRE HABICHT AND MICHAEL C LATHAMGirls showe d only a slightly higher level of prevalence of malnutrition in the study done by The Research and Special Studies variance of the Department of Census and Statistics, Sri LankaA study done in the slums of Chandigarh on 1286 preschool children found no significant gender difference. This study shows similar reports as our study in Vedapatti.H.M. Swami, J.S.Thakur, S.P.S.Bhatia, Vikas Bhatia. Nutriotional status of preschool children in an ICDS block of Chandigarh. Journal og Indial Medical Association 99(10) 554-556The sex of the child was found to be significantly high in association to malnutrition. The percentage of female children that were malnurished was higher in school going children.Epidemiology of malnutrition in a rural field practice are of Navi Mumbai By Sumedha Joshi and Santosh S. Walgankar Indian Journal of Preventive and Social Medicine Vol 35, 1 and 2, 2004Mothers LiteracyThe Research and Special Studies Division of the Department of Census and Statistics, Sri Lan ka, undertook a methodological study to investigate the prevalence of malnutrition in children under five years of age, and the factors contributing to such a situation. The study found that 25% of pre-school children that were undernourished had mothers who had not gone beyond the primary level of school education. The effected proportion dropped to 11% when the mother has had at least secondary education.Mother literacy was found in this study to have a positive effect on bringing down the incidence of malnutrition in socio-economically backward villages around Agra.Positive Deviance determinants in Young Infants in rural Uttar Pradesh by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal, Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007.Sandip Kumar et al in a study among 600 under 5 children in West Bengal showed that illiteracy of both parents was a significant risk factor for malnutrition.Sa ndip Kumar Ray, Anima Halder, Biswajit Biswas, Raghunath Mishra, Satish Kumar. Epidemiology of Under Nutrition. Indian Journal of Pediatrics 2001 November 681025-1030.Socio-economic statusThis study in 2003 on 4187 children showed distinguish results in Nigeria. The southeast and southwest regions had large inequalities between the scurvy and the teeming whereas northeast and northwest regions had a considerably small gap between the rich and the lamentable on malnutrition.Using extended concentration and exploit indices to study socioeconomic disparity in chronic childhood malnutrition the case of NigeriaOlalekan A Uthmancorresponding author1,2A study done in one thousand under 5 children in Rajasthan showed that 82% of the malnourished children belonged to the socio economic classes 4 and 5.Nutritional dis governs in rural Rajasthan A.L.Soni1, R.N.Singh1and B.D.Gupta. Indian Journal of Peadiatrics, May, 1980,Vol 47 199-202.A case-control study of maternal knowledge of malnu trition and health-care-seeking attitudes in rural Tamilnadu, showed that socio-economic status was a stronger risk factor for malnutrition than health-care availability and health-care-seeking attitudes.A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India, Saito K,Korzenik JR,Jekel JF,Bhattacharji S.Birth orderThe study done by Vani Sethi et al also evaluated other factors that contribute to malnutrition in the society and found that third or earlier born infants escaped malnutritionPositive Deviance determinants in Young Infants in rural Uttar Pradesh by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal21Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007Another study in Uttar Pradesh observed that grade III malnutrition was absent in the children whose birth order was one and two. A significant rise in Malnutrition was found in the chil dren of birth order IV and above.Health and Population Perspectives Issues 4(2)106-112, 1981A community based, cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal, showed a significantly higher proportion of malnutrition was found to be present among female children of higher birth order and those belonging to families with lower per capita income compared to the males.Gender inequality in nutritional status among under five children in a village in Hooghly district, West Bengal. Dey I,Chaudhuri RN.PROTEIN ENERGY MALNUTRITION IN CHILDREN A CASEFOR THE fill OF A PLANNED FAMILY Deoki Nandan*, J. V. Singh** and B. C SrivastavaA study done by Harishankar et al showed that the highest percentage of malnourished children was seen in the first born children (47.2%) and the least in children with birth order 3 and above (17.8%)Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia,Nutritional status of children under 6 years of age Indian Jou rnal of Preventive and Social Medicine. Vol. 35 No.3 4 2004SpacingThe same study in Uttar Pradesh, by Deoki Nandan et al also studied the relationship to spacing and malnutrition showed that there was a direct association between Protein energy Malnutrition and less spacing between sibilings.Health and Population Perspectives Issues 4(2)106-112, 1981. Protein Energy Malnutrition In Children A Case For The Need Of A Planned Family Deoki Nandan*, J. V. Singh** and B. C SrivastavaStudies using Positive Deviance conceptsThe successful application of the PD approach has been documented in more than 41 countries in nutrition and a variety of other sectors from public health to education to business.Positive deviance is not specific to nutrition practices, but can be used for many other behaviours.Refhttp//www.positivedeviance.org/PD_Evaluation_Report_for_DEPKES_FINAL.pdfPositive Deviance was used in two Colombian hospitals to combat the circle of MRSA Infection. All hospital staff up to the security guard convoluted themselves by reminding the visitors to practice good hand hygiene. As a result the infection rates have dropped down my more than 75% from 1.1 infections per 1000 patient days to less than 0.2 infections per 1000 patient days.Ref http//www.positivedeviance.org/projects/healthcare.html?id=49In West Bengal, India, ICDS has undertaken pilots projects in the use of the PD approach in Nutrition and Child Care Program (NCCP) in 4 districts to improve the nutritional status of children under three years of age. The projects substantially decreased the number of malnourished children by promoting good care practices. The PD advised project enabled families to break the dependence on donated food, by identifying cheap topically available and bringing it daily to the NCC session to prepare and feed their malnourished children. Every month the malnourished child is weighed and in most cases, mothers find their children gaining weight between 100 and 600 gm .Refhttp//www.positivedeviance.org/projects/nutrition.html?id=77Refhttp//www.unicef.org/india/nutrition_1557.htmIn 1990 Save the Children initiated a PD program in Viet Nam to enable poor villages to address the pervasive problem of childhood malnutrition. At that time 60% of children under the age of 5 suffered from malnutrition in Viet Nam. The initial pilot project was in the first 4 villages. In each of the villages, six of the poorest families with well nourished kids were chosen and caretakers were questioned and observed. In every instance where a poor family had a well-nourished child, the mother or father was collecting tiny shrimps or crabs or snails (the size of one joint of one finger) from the rice paddies and adding these to the childs diet along with the greens from sweet potato tops. Although right away available and free for the taking, the conventional wisdom held these foods to be inappropriate, or even dangerous, for young children. Along with these food and at ypically strict hand hygiene in 5 of the 6 PD households, other positive deviant behaviors emerged, involving frequency and method of feeding and quality of care and health-seeking behaviors. Through the PD inquiries, community members had discovered for themselves what it took for a very poor family to have a well-nourished child. Rehabilitation started as for two weeks every month, mothers or other caretakers would bring their malnourished children to a neighbors house for a few hours every day. Together with the health volunteer, they would prepare and feed an extra nutritious meal to their children. This showed great success by cut down malnutrition by as much as 80%. The project was then applied in large scale reaching more than 2 million people and in 250 communities and sustainabily rehabiliteted 50,000 malnourished children under the age of 5. This is probably the best known and best documented large scale application of PD.Ref http//www.positivedeviance.org/projects/nutri tion.html?id=105In Nepal a PD project to cover more than 8000 children under 3 years of age from 15 very disadvantaged communities was started with an aim of reducing child malnutrition in a sustainable manner. Positive practices regarding child feeding, caring, health seeking and maternity care are identified from the poor families having well nourished children through the PDI and then are made accessible to the families with malnourished children through a learning by doing process.Ref http//www.positivedeviance.org/projects/countries.html?id=82In the year 2000 a Positive Deviance Inquiry to identify specific behaviors and strategies that contribute to healthy pregnancy outcomes amongst poor women was conducted. The inquiry determined that mothers-in-law compete a central role in assisting women in obtaining medical care. Low-income women with weight gain greater than 1.5 kg per month in the second trimester ofpregnancy reported multiple antenatal care contacts, increased rest d uring pregnancy, and more consumption of meat and vegetables. These results were incorporated into a program for 200 women that resulted in a decrease in the prevalence of low birth weight.Ref http//www.positivedeviance.org/projects/public_health.html?id=117The following is illustrative of the impact of Positive Deviance over the last 15 yearsSustained 65 to 80% reduction in childhood malnutrition in Vietnamese communities, reaching a population of 2.2 million people. Significant reduction in childhood malnutrition in communities in 41 countries around the world. Reduction in neo-natal mortality morbidity in Pashtun communities in Pakistan and minority communities in Vietnam with near universal adoption of protective behaviors and social change. Estimated 50% increase in primary school student storage in 10 participating schools in Missiones, Argentina.Community intervention methods to combat under nutritionTraditional nutrition interventions include growth monitoring, rede and t he provision of supplemental foods and micronutrients But over decades the weighing of children undertaken by some(prenominal) National health ministries has brought little or no change to the nutritional status. In fact, in a study done by Sridhar Seetharaman, in Uttar Pradesh and Rajasthan, it was found that the Mid Day Meal did not make any appreciable and significant impact on improving the nutritional status of the children.Impact Of Mid Day Meal On The Nutritional Status Of School Going Children, Sridhar Seetharaman, NIRD, HyderabadZulfiqar A Bhutta et al used a age bracket model to study the interventions that affect maternal and child undernutrition and nutrition-related outcomes. The interventions included forward motion of breastfeeding strategies to promote complementary feeding, with or without provision of food supplements micronutrient interventions general substantiating strategies to improve family and community nutrition. They found that these interventions could reduce stunting at 36 months by 36% mortality between birth and 36 months by about 25% and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. professor Zulfiqar A Bhutta PhDa, Tahmeed Ahmed PhDb, Prof Robert E Black MDc, Prof Simon Cousens PhDd, Prof Kathryn Dewey PhDe, Elsa Giuglianif, Batool A Haider MDa, Prof Betty Kirkwood PhDd, Saul S Morris PhDd, Prof HPS Sachdevg, Meera Shekar PhDhand for the Maternal and Child Undernutrition Study Group, Lancet Volume 371, 8 February 2008, Pages 417-440Reasons for age survival of the fittestCare is an important determinant of nutritional status. It determines the delivery of food and health care resources to the child by optimizing the existing resources to promote good health and nutrition in children.Ramakrishnan U. UNICEF-Cornell colloquium on care and nutrition of the young child-planning. F Nutr Bull 1995 16 286-92.The first two years o f life are the window of opportunity to prevent early childhood undernutrition that causes largely irreversible damage. This is proved by the following studies across the world.Study shows more benefit from reaching all at-risk children