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Dietary diversification through crop diversification in a farming community is a useful low-cost strategy for combating micronutrient (Mn) deficiencies (hidden hunger) in Indian diets. With advocacy and awareness, even farmers with small and marginal land holdings can be persuaded to divert small pieces of land from traditional crops, to MN-dense crops like vegetables, fruits, pulses, and millets. Backyard poultry with high egg-yielding birds is a good option to promote, since eggs are highly nutritious. To ensure that this farm produce is primarily consumed at home and only excess sold, there has to be a robust strategy of behavioural change communication. Educational intervention/technology transfer can be through a combination of centralised training programmes, hands-on training in farms, as well as through distribution of simple educational pamphlets. Since nutrition security goes beyond food security and includes safe environment, drinking water, and health care, the educational package should be a holistic one. Pregnant women and mothers with under 24-month-old children (the first 1000 days after conception) are the most effective group to target. Recent studies including the one reported here in a tribal community show that such a strategy can help crop diversification, as well as marked improvement in the mothers' understanding of health, food, and nutrition. Significant improvement in household vegetable consumption can also be achieved.

RESUMEN

Cereal-based diets of the people in developing countries are qualitatively deficient in micronutrients-vitamins and minerals-due to low intake of vegetables, fruits, legumes and foods of animal origin. Consumption of nutritious millets has also come down in India. Calorie sufficiency may ensure protein sufficiency (though not protein quality), but it does not ensure adequacy of micronutrients. Studies in several countries in Asia, and India show that with education and advocacy even farmers with small and marginal land holdings can be persuaded to raise homestead vegetables and fruits gardens and increase household vegetables consumption. Backyard poultry also has good acceptance and impact on household egg consumption. For best results, the community, especially the mothers have to be educated about the importance of nutrition for health and wellbeing. Studies done by the authors in the villages of Medak district, of the South Indian state of Telangana, show remarkable improvement in the knowledge of food, nutrition, hygiene and health of mothers with children under 3 years of age, with education-behavioural change communication. Impact of nutrition gardens and backyard poultry with high egg-yielding breeds had positive impact on the household consumption of vegetables and eggs.

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BACKGROUND & OBJECTIVE: Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. METHODS: Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. RESULTS: Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. INTERPRETATION & CONCLUSION: Significant association between signs and symptoms of malnutrition with perinatal, neonatal deaths may have been masked by high prevalence of malnutrition in the mothers of both the groups and the small study sample size. However, maternal malnutrition, may contribute indirectly through its effects on other pregnancy-related as well as delivery-related complications leading to adverse outcome of pregnancy. The HNEM experience of DCT suggests that a properly trained and supported village level worker can contribute to reduction in perinatal and neonatal mortality.

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BACKGROUND: Schoolchildren are good agents of change and need to be educated and sensitized to specific issues of hunger and malnutrition through a question-and-answer process. Feeding Minds and Fighting Hunger (FMFH), a global project initiated by the Food and Agriculture Organization and partner organizations, attempts to help schoolchildren learn about these issues by introducing concepts in the prevention of hunger and malnutrition to teachers, and by facilitating transfer of knowledge to the children through a set of model lessons. OBJECTIVE: To test the feasibility of the FMFH approach to improve the nutrition knowledge of rural schoolchildren in three rural schools in Medak District of the South Indian state of Andhra Pradesh. METHODS: Participatory workshops for teachers were conducted to facilitate knowledge transfer to the children through interactive classroom teaching and other activities. The change in knowledge and thinking of children in the seventh and eighth grades was assessed by a ques- tionnaire administered before and after the intervention. The questionnaire also assessed, in part, the status of local food security based on the sources of different food items in the households. RESULTS: The responses to the questionnaire suggested that the children's knowledge of nutrients and their functions was not good initially but improved after the intervention. However, their understanding of the social factors responsible for hunger and malnutrition was fairly good prior to the intervention. Improvement in responses to the question of what should be done to combat malnutrition also occurred after intervention. The community had village-level food security for rice and maize but depended partially or fully on outside sources for pulses, fruits and vegetables, and animal products. CONCLUSIONS: The FMFH approach can be applied in rural schools where "the poorest of the poor" children can improve their understanding of balanced diets, better nutrition, the causes of malnutrition, and approaches to combat malnutrition.

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