An Uphill Task for POSHAN Abhiyan: Examining the Missing Link of ‘Convergence’

Dasgupta, Rajib; Roy, Susrita; Lakhanpaul, Monica

doi:10.1007/s13312-020-1722-0

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…52 These initiatives could be optimised to accelerate improvements in maternal and child diet quality by incorporating nutrition objectives in agricultural videos, coupling this with nutrition-specific behaviour change interventions such as the videos and PLA meetings, and ensuring convergence of programmes from relevant sectors to tackle the key determinants of nutrition, as recommended in the Convergent Nutrition Action Plans under the National Nutrition Mission, Prime Minister's Overarching Scheme for Holistic Nutrition Abhiyaan. 53 …”

Section: Discussionmentioning

confidence: 99%

Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Kadiyala

Harris‐Fry

Pradhan³

et al. 2021

The Lancet Planetary Health

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Summary Background Almost a quarter of the world's undernourished people live in India. We tested the effects of three nutrition-sensitive agriculture (NSA) interventions on maternal and child nutrition in India. Methods We did a parallel, four-arm, observer-blind, cluster-randomised trial in Keonjhar district, Odisha, India. A cluster was one or more villages with a combined minimum population of 800 residents. The clusters were allocated 1:1:1:1 to a control group or an intervention group of fortnightly women's groups meetings and household visits over 32 months using: NSA videos (AGRI group); NSA and nutrition-specific videos (AGRI-NUT group); or NSA videos and a nutrition-specific participatory learning and action (PLA) cycle meetings and videos (AGRI-NUT+PLA group). Primary outcomes were the proportion of children aged 6–23 months consuming at least four of seven food groups the previous day and mean maternal body-mass index (BMI). Secondary outcomes were proportion of mothers consuming at least five of ten food groups and child wasting (proportion of children with weight-for-height Z score SD <–2). Outcomes were assessed in children and mothers through cross-sectional surveys at baseline and at endline, 36 months later. Analyses were by intention to treat. Participants and intervention facilitators were not blinded to allocation; the research team were. This trial is registered at ISRCTN, ISRCTN65922679. Findings 148 of 162 clusters assessed for eligibility were enrolled and randomly allocated to trial groups (37 clusters per group). Baseline surveys took place from Nov 24, 2016, to Jan 24, 2017; clusters were randomised from December, 2016, to January, 2017; and interventions were implemented from March 20, 2017, to Oct 31, 2019, and endline surveys done from Nov 19, 2019, to Jan 12, 2020, in an average of 32 households per cluster. All clusters were included in the analyses. There was an increase in the proportion of children consuming at least four of seven food groups in the AGRI-NUT (adjusted relative risk [RR] 1·19, 95% CI 1·03 to 1·37, p=0·02) and AGRI-NUT+PLA (1·27, 1·11 to 1·46, p=0·001) groups, but not AGRI (1·06, 0·91 to 1·23, p=0·44), compared with the control group. We found no effects on mean maternal BMI (adjusted mean differences vs control, AGRI −0·05, −0·34 to 0·24; AGRI-NUT 0·04, −0·26 to 0·33; AGRI-NUT+PLA −0·03, −0·3 to 0·23). An increase in the proportion of mothers consuming at least five of ten food groups was seen in the AGRI (adjusted RR 1·21, 1·01 to 1·45) and AGRI-NUT+PLA (1·30, 1·10 to 1·53) groups compared with the control group, but not in AGRI-NUT (1·16, 0·98 to 1·38). We found no effects on child wasting (adjusted RR vs control, AGRI 0·95, 0·73 to 1·24; AGRI-NUT 0·96, 0·72 to 1·29; AGRI-NUT+PLA 0·96, 0·73 to 1·26). Interpretation Women's groups using combinations of NSA videos, nutrition-specific videos, and...

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Section: Discussionmentioning

confidence: 99%

Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Kadiyala

Harris‐Fry

Pradhan³

et al. 2021

The Lancet Planetary Health

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“…India launched an integrated policy for tackling malnutrition titled the Prime Minister's Overarching Scheme for Holistic Nourishment (POSHAN) mission. The POSHAN mission is a multi-ministerial mission to monitor, supervise and fix targets, and guide nutrition-related intervention (Dasgupta et al 2020). POSHAN mission's goals are to improve child health through efforts to prevent and reduce stunting, undernutrition, anaemia and reduce low birth weight by taking a life cycle approach.…”

Section: Links Between Feeding Practices Environmental Factors and Child Healthmentioning

confidence: 99%

Linkages between environmental factors (WASH and energy) and Infant and Young Child Feeding practices in rural India: implications for cross-sectoral interventions for child health

Parikh

Kwami

Khanna³

et al. 2021

Journal of Water, Sanitation and Hygiene for Development

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As factors influencing the health and well-being of children are complex and cross-sectoral, integrated interventions are required to improve child health and hence address the Sustainable Development Goals. This paper explores linkages between environmental factors, feeding practices and potential infection pathways in India. The PANChSHEEEL project is a participatory interdisciplinary study, designed to explore HEEE (Health, Education, Engineering and Environment) factors influencing Infant and Young Child Feeding practices. This study uses data from observational transect walks and 445 household interviews from nine villages in Banswara district in India. Using the socio-ecological model, this study demonstrates how the lack of access to and quality of water resources, poor access to sanitation and hygiene practices, access to cook fuels and flooding can influence feeding practices. The study finds that access to water, sanitation and cooking fuels can affect the preparation of food, contaminate water and food and place added time burden on caregivers. For infants, insufficient and contaminated water can lead to a higher risk of infection, diarrhoea and ultimately malnutrition. Recommendations include efforts to address waterlogging, promote safe storage of water, establish a water quality regime with stakeholders and develop appropriate, affordable and acceptable sanitation solutions.

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“…Bringing together an interdisciplinary team comprised of public health, social sciences, microbiology, and civil and environmental engineering experts, allowed us to identify enteric infection factors from diverse natures. The PANChSHEEEL project [ 5 ] explored the linkages between health, education, engineering and the environment to identify the multiple determinants of suboptimal infant feeding at the household, community and governance levels in rural Banswara and co-develop an integrated intervention package. The proposed package components included a bundle of workshops and village activities such as knowledge building and demonstration & practice meetings, support groups, video shows, wall paintings and posters, as well as cooking classes and recipe books to improve infant and young child feeding and care practices [ 40 ].…”

Section: Methodsmentioning

confidence: 99%

“…Infant feeding practices and enteric infections are the two major contributors to the child undernutrition and stunting burden [ 41 ]. To get a more holistic picture, we built on the identified determinants of infant feeding under PANChSHEEEL [ 5 ], and further investigated the wider determinants of infant enteric infections across the socio-ecological levels, using the same integrated, interdisciplinary approach.…”

Section: Methodsmentioning

confidence: 99%

“…India, and particularly its rural areas with poor access to water, sanitation and hygiene (WASH), account for almost one-third of all the child stunting cases and one-fifth of child diarrhoeal deaths worldwide [ 3 , 4 ]. Significant work remains to achieve the 6th UN Sustainable Development Goal (SDG) of basic WASH access for all by 2030 and the Government of India’s target to reduce child stunting to 25% by 2022 [ 5 ]. However, despite clear linkages between poor access to WASH and enteric disease, the design of WASH interventions that block infection transmission pathways and reduce child diarrhoeal and stunting rates has proved challenging [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India

Vila-Guilera

Parikh

Chaturvedi³

et al. 2021

BMC Public Health

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Background Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India. Methods This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors). Results Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants’ exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers’ motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors. Conclusions Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant’s enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels.

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An Uphill Task for POSHAN Abhiyan: Examining the Missing Link of ‘Convergence’

Cited by 7 publications

References 12 publications

Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Linkages between environmental factors (WASH and energy) and Infant and Young Child Feeding practices in rural India: implications for cross-sectoral interventions for child health

Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India

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