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The First 1000 days






Why are “the first 1000 days” so significant?


The critical Window of Opportunity for ensuring a Child’s optimal physical and mental development is “#1000days”, starting from Conception to 2 years of age.


These “1000 days” are a crucial period for Maternal and Infant services and it must be attended to with utmost care. This period is a provision to create a good impact and to enable every child to lead a hale and healthy life.


Almost 50% of morbidity occurs during the “first 1000 days”, particularly among children under the age of 5. Also, in general, this period of “1000 days” is the phase of high susceptibility to malnutrition and infections, which further leads to stunted growth. Undernutrition during this phase can cause long-lasting physical and mental damage.



Growth defects profile:


Maternal undernutrition and infant undernutrition lead to FGR, stunting, wasting and undernutrition among children.

  • #FoetalGrowthRestriction (FGR) refers to a condition that limits the growth of the foetus in the womb

  • #Stunting refers to non-attainment of the required height for age

  • #Wasting refers to a deficiency in weight for corresponding height


Actions that are taken after 2 years post-birth are futile, as these conditions become irrevocable. In support of this statement, Cerebral atrophy is prevalent on the scans of the undernourished children.


#CerebralAtrophy is the degeneration in the volume of the brain due to the loss of brain cells. It has severe effects on body awareness, balance, motor coordination, hearing and speech.

Growth potential of a baby at the time of its birth is almost the same in a developed country when compared to that of a developing or underdeveloped country. However, the gap in potential growth widens after the 24 months post-birth of any baby. Due to this fact, interventions or rectifying measures must be done within this decisive “1000 days” itself, else it becomes too late, too little and too expensive.



When does stunting occur and why it has to be prevented?


#Stunting in the foetus is evident by 8 weeks, which leads to low birthweight children.

The rapid increase of height in the Foetus happens around the 20th week, while the rapid gain of weight in the foetus happens around the 30th week. And the detailed “growth in inches” can be assessed through common ultrasound scans. After these specified periods, both the weight and height does not change so rapidly.



Why growth faltering must be prevented?


Growth faltering with a height deficit of 2 cm in an infant at the time of birth can successively lead to a 4 cm height deficit in 6 months, 6 cm height deficit in 12 months, 9 cm deficit in 24 months and 10 cm deficit in 36 months of age.

The deficit increases mainly due to improper breastfeeding practices.


As per the National Family Health Survey (NHFS-5), among children below 5 years,

  • 35.5% are stunted (low height for that age),

  • 32.1% are underweight (low weight for that age) and

  • 19.3% are wasted (underweight for that height)

This is a huge challenge for a developing country like India.


As per a publication in Lancet (a globally acclaimed medical journal), child deaths can be prevented to a certain extent i.e., up to

  • ~20% with known preventive interventions (13% through Breastfeeding and 6 % through Complementary feeding practices)

  • 7% through Insecticide-treated bed nets and

  • 5% through Zinc supplements.


Successful interventions:


The three best and most cost-effective Interventions to improve livelihood in “Critical 1000 days” are

  • Maternal nutrition practices

  • Breastfeeding practices

  • Complementary Breastfeeding practices

These recommended high-impact nutrition interventions are needed to be included in the services of medical colleges or any other dedicated platform.


Know more about our Technology MAAP (Malnutrition Assessment and Action Plan) to prevent Malnutrition linked Stunting and Wasting


Maternal nutritional interventions overview:


Dietary practices during Pregnancy are very crucial for improving maternal nutrition. This involves

  • Diet counselling including maternal diet diversity (to enhance nutrition by consumption of variety of food)

  • Provision of iron, folic acid and calcium supplements with counselling (to improve essential micronutrients)

  • Pregnancy weight gain monitoring (to assess the growth of the child)



Child nutrition interventions overview:


Breastfeeding ensures nutrition and bonding between a mother and her infant and strengthens the child’s immune system. It also prevents allergies, respiratory problems, obesity and #SIDS (sudden infant death syndrome). And so, it should be started immediately after infant birth.

  • Exclusive breastfeeding refers to providing “only breastmilk” to the baby till the first six months of life, as it contains all the necessary nutrients for the child.

  • Complementary breastfeeding refers to breastfeeding alongside the administration of solid foods, after 6 months.

  • Timely introduction of breastfeeding, diet diversity of mother and child and age-appropriate feeding(frequency/quantity) are important.

  • Consistent feeding even during illness is essential.

  • Continued breastfeeding at least for 2 years is also important.


1. First intervention-Antenatal Nutrition:




Antenatal nutritional intervention is essential for improving birth outcomes in pregnant women and classified into two categories, such as Macronutrient supplementation interventions and Micronutrient supplementation interventions.


These two broad categories are facilitated in the following 3 ways.


Providing balanced protein-energy content with diet diversity:
  • Reduction of 32% in the risk of Low Birth weight (#LBW) babies

  • Reduction of 34 % in Small for Gestational Age (#SGA) babies

  • Reduction of 38 % in the risk of stillbirth babies

These effects are more seen in undernourished women.


Iron-Folic Acid (IFA) supplementation:
  • Reduction of 19% in the risk of Low Birth weight (LBW) babies

  • Reduction of 16 % in Small for Gestational Age (SGA) babies

Supplementation with multiple micronutrients:
  • Reduction of 12% in the risk of Low Birth weight (LBW) babies

  • Reduction of 10 % in Small for Gestational Age (SGA) babies.


2. Second intervention – Breastfeeding:




As per Lancet 2018 report, around 8,23,000 children under 5 years can be saved every year by breastfeeding. And as per Lancet 2016, the relevance of breastfeeding in the 21st century is it

  • decreases development of diarrhoea and pneumonia in infants

  • increases children's intelligence scores

  • prevents maternal cancer deaths by 20,000 per year

  • decreases the risk of ovarian and invasive breast cancer

  • decreases the likelihood of adult chronic diseases such as obesity and diabetes

  • plays significant role on birth spacing


3. Third intervention - Complementary feeding practices:





Providing complementary feeding and offering nutritional counselling alone has resulted in a significant increase in weight and linear growth in children below 2 years.


Providing appropriate complementary foods in children aged 6 - 24 months has resulted in an extra gain of 0.25kg(± 0.18) in weight and 0.54(±0.38) in height

Education of the mother about complementary feeding has led to an positive outcome of extra weight gain of 0.30 kg(±0.26) and a gain of 0.49 cm(±0.50) height in children aged 6 - 24 months.


Platforms for MICYN programmes:

Some of the Platforms that contribute to improvement of Maternal Infant Young Child Feeding Nutrition (MICYN) programs are

  • Health platforms

  • Self-Help Group (SHG) platforms

  • Child Development Services (CDS) platforms

  • Medical College platforms

  • Private sector platforms


Medical college institutions being highly specialized care facilities and teaching points, have a critical role in providing #MICYN programs.

They have different contact points for “1000-days” period. The “1000-days” window is further divided into two parts

270 days from conception until the discharge of the mother and baby after labour and

730 days from discharge until the baby reaches 2 years.


Programs in the 1st 270 Days from conception:

  • In Antenatal Care Outpatient Department (ANC OPD), the pregnant woman’s husband and other family members are provided counselling on the mother’s nutrition, Iron-Folic acid (IFA) and Calcium (Ca) supplementation and on preparation for breastfeeding. It is done during every ANC OPD visit, which happens at least for 4 times.

  • Counselling on nutrition and breastfeeding is also provided at the prep room which is visited at the onset of labour.

  • In the Labour room, the new mother is educated on Early initiation of breastfeeding, Kangaroo Mother Care (KMC) which is the practice of providing skin-to-skin contact for LBW and preterm babies and Exclusive Breastfeeding.

  • In Prenatal Care (PNC Ward), until discharge, counselling is provided.

Programs in the next 730 Days:

  • Vaccination and counselling on breastfeeding in the immunization clinic,

  • Counselling on complementary breastfeeding and continued breastfeeding in Paediatric OPD, with both the mother and father.


These are the high-impact interventions along with the aspect of nutritional counselling.



Summary:


Thereby, the three main interventions for the critical #1000days are Maternal Nutrition, Breastfeeding and Complementary feeding. The MICYN practices must be delivered in efficient ways for the prevention of undernutrition.
Doctors, Healthcare workers, Nurses and Counsellors need to be trained and oriented on these MICYN concepts.
Nutrition is not the individual obligation of mothers. It is the collective obligation of the entire society to establish the maternal nutrition.

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