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Background: In large supplementary feeding programs for children, it is challenging to create and sustain contextual, acceptable, nutritionally complete, and diverse supplemental foods. For example, the Indian Supplementary Nutrition Program (SNP) supplements the dietary intake of children, pregnant and lactating women, and severely acutely malnourished (SAM) children by offering dry take home rations (THRs) or hot cooked meals (HCMs) across India, but an optimization tool is necessary to create local contextual recipes for acceptable and nutritionally adequate products. Objectives: This study aimed to create a linear programming (LP) model to optimize diverse food provisions for a SNP to meet its program guidelines, using locally available foods, within budgetary allocations. Methods: A LP algorithm with appropriate constraints was used to generate an optimal THR based on raw foods, or an optimal weekly HCM menu comprised of a lunch meal with mid-morning snacks, based on user choices of foods and recipes. The database of foods used was created by a prospective survey conducted across all states of India for this purpose, such that the recipe and food optimization was diverse and specific to the guidelines for each beneficiary group. Results: An interactive web-based app, which can optimize feeding programs at any population level, was developed for use by program implementers and is hosted at https://www.datatools.sjri.res.in/SNP/. In the Indian example analyzed here, the recommended optimized diets met the guidelines for diversified and nutritionally complete SNP provision but at a cost that was almost 25% higher than the present Indian budget allocation. Conclusions: The optimization model developed demonstrates that contextual SNP diets can be created to meet macronutrient and most essential micronutrient needs of large-scale feeding programs, but appropriate diversification entails additional costs.
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BACKGROUND: Despite generally high agrobiodiversity, the Khasi and Garo indigenous people in Meghalaya have poor nutritional status among children and women. AIM: To assess the dietary diversity of the Khasi and Garo indigenous women of reproductive age in Meghalaya, while examining the associated factors that affect it and to map the diversity of local food plants. METHODS: A dietary survey was conducted through 24-hour recall with 276 women from 28 villages of Meghalaya. The mapping of local food plants was conducted through key informant interviews and focus group discussions in the same villages. RESULTS: The mean minimum dietary diversity for women is 4.22 (SD ±1.26); with one-third (37%) of the women attaining a minimum dietary diversity of five or more food groups in a day. There were significant differences in the dietary diversity among the indigenous groups, the Garo community attaining higher minimum dietary diversity for women. There was also an inverse association between the number of land uses and dietary diversity. The mean number of food plants (including crop varieties) found in each village is 203 (SD±45.7). CONCLUSIONS: There is potential to enhance dietary diversity through diversifying lesser consumed crops such as vitamin A-rich vegetables and fruits, nuts, seeds and green leafy vegetables in existing land holdings. Also, proper management and access to the commons will provide a sustainable resource base for diet and food security, enhance dietary diversity and bridge the hidden hunger among children and women.
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Dieta , Desnutrición , Niño , Femenino , Frutas , Humanos , India , VerdurasRESUMEN
OBJECTIVES: The government of India is promoting and increasing investment in the traditional medicine systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) in the northeast region of India. But there are few empirical data that support this policy decision. This study estimates the awareness and use of the different medical systems in rural Meghalaya, a state in north-east India with a predominantly ethnic tribal population. METHOD: We conducted a cross-sectional multistage random sample household survey across all districts of Meghalaya. To enable appropriate estimates for the whole of rural Meghalaya, the data were weighted to allow for the probability of selection of households at each stage of the sampling process. RESULTS: Both local tribal medicine and biomedicine were widely accepted and used, but the majority (68.7%, 95% CI: 51.9-81.7) had not heard of AYUSH and even fewer had used it. Tribal medicine was used (79.1%, 95% CI 66.3-88.0), thought to be effective (87.5%, 95% CI: 74.2-94.1) and given in a variety of disorders, including both minor and major diseases. In the 3 months prior to the survey, 46.2% (95% CI: 30.5-62.8) had used tribal medicine. Only 10.5% (95% CI: 6.1-17.6) reported ever using any of the AYUSH systems. CONCLUSION: Our comparative estimates of the awareness and use of tribal medicine, different systems of AYUSH and of biomedicine among indigenous populations of India question the basis on which AYUSH is promoted in the northeast region of India and in the state of Meghalaya in particular.