) N u tr it i on

(M al
P r im er

Around the world

'Development' market is abuzz,
And back home
Filled with water, lots and lots
Large pipkin ready to cook
With the handful of Daal,
To feed Chhutkoo & Munni
To feed their starving stomach..
And it goes day-in day-out,
Mother does it all around
My magic is getting torn apart
Whither goes your Call to Action
Measure up your MDG
With my magic,
my call..

Vikas Samvad

Integrated Community-based Management of Malnutrition - 6

My Story
I am Sunita. My mother
worked throughout her
pregnancy carrying me
in her womb. With no
food in plate she went
starved leaving me hungry
too. At birth my weight was
only 2.2 kg which should have
been 2.5 kgs to get recorded as
normal. This must have
happened because my mother
and consequently I did not receive
adequate food during her
pregnancy. Following my birth, I
needed breast feed from my mother.
However, I did not get it until after a day of
my birth resulting in the further decline in my
weight.
My Mum had to resume her wage work a week after I was born.
She had no option either. Whenever she would hold me to her
breast for three to four times in a span of 10 hours, I would feel
full of life and rejuvenated. Somehow, I kept growing, albeit in
age!
My dietary needs had substantially gone up by the time I was six
months old. I needed to have complementary food in addition to
my mother's breast milk. I felt that 'anything' would do! Whether
mashed daal-rice, Khichadi, bananas, boiled and mashed
vegetables, milk, I craved for something to satiate my hunger.
But alas, I did not get anything other than my mother's breast
milk. Deep within, I started feeling weakened.
Getting safe and clean drinking water in my village was also very
difficult. I started falling ill repeatedly. Every successive illness
would leave me much weakened. I could apparently see worries
on the faces of my parents. I would often hear them grumble,
'today also we did not get any work, and what would we feed
Sunita'. They would also say with anguish that they did not get
paid for the work they had done long back.
Soaked in rain, the fire wood had got wet. Kerosene oil was also
not available at the ration shop. Therefore, no food could be
cooked in the house for the last two days. How much could we
borrow from the market?
I went to the Anganwadi one day. The aunt (Anganwadi Worker)
weighed me in a swing (Salter scale). Then she measured my
length/height. When she entered my weight in the register and
marked me with a red sign, she felt sad. After all, I was too weak!
My battle to stay alive had had got off with a disadvantage!
 What is Malnutrition?
Hunger and illness
are the seeds of Malnutrition
We need food to keep our body and mind healthy and
active. unfortunately while talking about food, we only
consider wheat and rice which however, do not provide
adequate nutrition.
The lack of healthy, nutritious food for prolonged period,
thence, causes weakness in the children, weakens their
immune system and further leads to malnutrition.

8 Children become the first victims of malnutrition.

8 Every child can be taken out of the web of
malnutrition, provided we really want it.
8 Come and join the initiative of Community Based
Management of Malnutrition.
 How does Malnutrition
occur?
Malnutrition occurs
8 If the newborn is not exclusively breast fed for the
initial 6 months; and/or is given any feed other than
mother's breast milk during this vital period.
8 If from the six month onwards and well up to two
years and even beyond, the child is not fed soft
mashed complementary food whilst being
continued with the breast feed.
8 If from the age of two years onwards, the child does
not get stomach full balanced diet.
8 If the child suffers from repeated episodes of
diarrhea or has other illnesses.
8 If the child is kept only on grain based diet.
8 If in addition to food grains, the child's diet does not
include foods like pulses, edible oil, jaggery,
vegetables, milk or milk products, eggs and fruits.
8 If the pregnant woman does not get full and varied
diet, the child becomes malnourished whilst being
in the stage of fetus.

Neglecting these may invite

malnutrition !

We must ensure
8 Adequate food for every family.
8 No descrimintations and misbehaviours towards
women.
8 Growth monitoring of each and every child in
Anganwadi Centres.
8 Proper immunization and nutritious and healthy
food to every child.
 Types of Malnutrition?
Understanding malnutrition terms
8 Stunting : It refers to low height-for-age (H/A)
score. When child fails to gain the height given for age,
stunting is observed. It is often associated with long-
term factors such as insufficient protein-energy intake,
and frequent illness. It is therefore an indicator of past
growth failure and chronic malnutrition.
8 Wasting : It refers to low weight-for- height (W/H)
score. It is observed when child fails to gain sufficient
weight given for height. Wasting is referred to as "acute
malnutrition" because of its episodes of short duration in
contrast to stunting.
8 Underweight : It refers to extremely low "weight-
for-age" (W/A) score. By "underweight" it means a
situation where a child weighs less than expected, given
for age. It reflects current and acute as well as chronic
malnutrition. W/A is commonly used for monitoring
growth and to assess changes in the magnitude of
malnutrition over time.
8 Check MUAC Measurements
l MUAC less than 11.5cm, RED COLOUR, indicates
Severe Acute Malnutrition (SAM). The child
should be immediately referred for treatment.
l MUAC of between 11.5cm and 12.5cm, YELLOW
COLOUR, indicates that the child is at risk for
acute malnutrition
l MUAC greater than 12.5cm (125mm), GREEN
COLOUR indicates healthy satus

Adverse Impacts of Malnutrition

l Loss of energy.
l Compromised immune system making more
susceptible to infectious diseases.
l Frequent episode of illness.
l Limit total bone growth.
l Fatigue and lethargy etc.

We can help children preserve their energy and

prevent its loss. We can ensure that children
remain healthy and do not fall sick.
We can save our children's lives,
It's in our hands!
 How to identify
Malnutrition?
Malnutrition can be said to have set in
if the answers to the following
questions are in the affirmative
8 Is the child's body weight stagnant over time?
8 Does the child suffer from repeated episodes of
illnesses?
8 Has child's body weight declined over the previous
time?

Symptoms of Malnutrition
l Weight loss & stunted growth.
l Water retention (edema).
l Tight skin.
l Dry, unhealthy hair; hair de-pigmentation and hair
loss.
l Abdominal swelling.
l Fatigue & dizziness.
l Weak immune system.
l White tongue.
l A 'skeletal' look.
l Skin color loss and dull yellow skin;
l Pale finger's nails etc.
Treatment and Prevention
of Malnutrition
To prevent malnutrition following points need
to be taken care of
8 Providing health services and adequate nutrition to
adoelscent girls and pregnant women.
8 Newborn must be immediately breast-fed and should be
exlusively breast-fed for first six months.
8 Complimentary feeding should be started after six
months in form of mashed pulses, vegetables, fruits or
khichdi along with breast feeding.

8 Ensuring regular Growth Monitoring of a child right after

the birth.
8 Ensuring clean and safe drinking water and hygiene
practice.
8 Communtiy should ensure its role in taking care of
malnourished children.
8 SAM children should be taken to NRC if found with
aforestated symptoms.
8 Visitng AWCs on regular note and offering help to AWWs.
8 People should demand employment from proper
channels.

It might be other child who is malnourished

today, but, if proper steps are not taken now,
your child will be in the count too !
Forming understanding towards
Growth Monitoring and
Growth Promotion
The essential components of Growth Monitoring are :
a. Regular Weighing of the child periodically
(caretakers or by AWWs at AWCs).
b. Usually done by recording the weight for the age of
the child on the Growth Chart as growth curve.
c. Determining the adequacy of weight gain
observing the growth curve as upward, flat or
downward and interpreting childs growth as good
or bad.
Entering into Growth Monitoring and Promotion (GMP) :
Growth Monitoring Promotion is actions on the results
observed during Growth Monitoring. The essential
components of GMP are :
a. Discussing the childs growth and follow-up action
needed : The growth pattern and curve should be
discussed with the mother or other care takers to
determine the causes of problems or the reasons for
success over the past month.
b. Tailoring the counseling to fit the individual case
i.e. providing the counseling as per the status of
growth of child.
c. Referral to available services: the child should be
referred to NRC or community health centers as per
the demand.
d. Targeted messages on food practices, health and
hygiene, mother and child care, etc. should be
delivered.
e. Health follow-ups and defining the next steps and
when to return to check the outcomes and keeping
a tab on everything.

Proper Weight Gain in Kgs (Girl)

7.0
6.5 {.| kg.
{.z kg.
6.0 {.x kg.
{. kg.
5.5
5.0
7 Month 8 Month 9 Month 10 Month

7.0 Stagnant Weight in Kgs (Girl)

6.5
6.0
{.v kg. {.v kg.
5.5
5.0
7 Month 8 Month 9 Month 10 Month

7.0 Weight Reduction in Kgs (Girl)

6.5
6.0
{. kg.
5.5 z.{ kg. z.z kg.
z.w kg.
5.0
7 Month 8 Month 9 Month 10 Month
Regular Weighing of Child

74 cm.

68.9 cm.
66.3 cm.

8 Children are weighed in Anganwadi Centre every

month. It helps us to know whether the child's
growth is proper or not.
8 And, in case if growth faltering is observed
appropriate treatment can be taken at early stages
to safeguard the child against malnutrition.

Weighing scale not only measures but can even

monitor a child's growth !
Interpretation of Growth Faltering
8 Weighing helps us to appraise whether the child's
body weight has increased or not in comparison to
the previous months.
8 If the growth curve is showing an upward trend,
then it means that growth is taking place.
8 In case the weight remains stagnant over a period of
three months and does not show increase, it means
that the child is on the verge of becoming
malnourished.
8 If the child's body weight shows a decline, it means
that the situation is becoming precarious.
What to do when the child
is Acutely Malnourished!
Acute Malnutrition may create a permanent
problem, like disability, in children and can be
fatal also. We must save and protect the children
from being acutely malnourished.
Who are the children with Acute Malnutrition?
8 Those children who have low Weight (W)-for-Height (H) or
Length (L) are said to be suffering from Acute
Malnutrition. If W/H-L < -3SD, the child has Severe Acute
Malnutrition (SAM). If W/H-L is between < -3 and -2 SD,
the child has Moderate Acute Malnutrition (MAM).The
table at the end of this booklet prescribes the required
weight for height.
8 Mid Upper Arm Circumference (MUAC) is an alternative
measure of child thinness. Age independent, it is used for
assessing acute malnutrition amongst children from 6
months up to 60 months. It indicates muscle mass and fat
reserves.
8 Procedure for measurement with MUAC tape includes the
following :
l Locate tip of child's shoulder.
l Bend child's elbow to make right angle.
l Place tape at tip of shoulder at zero.
l Pull tape straight down to the tip of elbow.
l Read number to the nearest 0.1 cm.
l Divide number by 2 to get mid-point.
l Mark the mid-point with a pen.
l Straighten child's arm and wrap tape around the arm
at mid-point.
l Ensure proper tension of the tape-not too tight or too
loose.
l At correct position, with correct tension read
measurement to the nearest 0.1 cm.
l Record measurement immediately.

8 If the MUAC measure is <11.5 cm, the child is suffering from

Severe Acute Malnutrition. If the MUAC measure is between 11.5
cm and 12.5 cm, the child has Moderate Acute Malnutrition.
8 The child with SAM having illness like fever, cough or diarrhoea or
pneumonia or has oedema or is refusing to eat needs to be taken
to Nutrition Rehabilitation Centre (NRC) or the hospital for
urgent medical attention.
8 The child with MAM needs special care within the community by
giving appropriate special diet.
Malnutrition and Illnesses
Malnutrition and illness are directly linked and
can be understood in two ways
When malnutrition sets in, children's immune system to
fight the disease gets impaired. They get repeated
episodes of illnesses. This weakens the children further.
Consequently, even if they receive medical treatment, it
takes a longer time for them to recover.

Good nutrition, other hand, builds a security cover, both

inside and outside the children. This cover wards off the
illnesses and even if the child happens to contract an
infection/illness, the internal immune system does not
allow it to spread further. Thus, here we speak of a
vicious circle of malnutrition-illness-malnutrition. The
vicious circle can trap the child to such an extent of
severity that it may also become fatal.

According to the World Health Organisation (WHO), 1.20

crore 'under 5 children' die every year. Of these, 60 lakh
children become victims of diarrhoea, respiratory
infection, pneumonia, malaria and measles.

Though prevalence of malnutrition is widespread in our

country, it is not accounted as a causative factor for child
deaths. The WHO reports that probability of child's death
increases when s/he suffers from malnutrition which is
compounded by diarrhoea. Malnourished children
suffering from acute respiratory infection and
pneumonia have two-three times higher chance of dying
than those who are not malnourished.

Malnutrition can be the cause of illnesses and illnesses

can even lead to death. Medical treatment alone is not
sufficient. The right way is to build a protective cover of
nutrition. Whenever children fall sick, it is crucial to
check on attributive association of illnesses with
malnutrition.
 Malnutrition and
Agriculture
The food market has had extensive diversification.
However, for some reasons, agricultural production has
witnessed a shrinkage in variety of produce. Now, there
is need to bring in diversity in agricultural produce as
well. It is important that we accord a serious attention to
the rationale and need for widened base of agricultural
produce.

Just being stomach-full with wheat-rice can also lead to

the occurrence of malnutrition. We have to bring a host
of nutritious foods including coarse grains like ragi, kodo-
kutki, jowar, bajra and makka (maize) right from the
agricultural fields to the food serving plate.
As we aspire that our country should become self-reliant
in respect of food grains, fruits, vegetables and pulses; in
the same vein, our villages should have the capability to
fully meet their entire range of food needs. Just as the
import of food grains is painful for the country, so it is for
the villages as well.
 Malnutrition and
Food Culture
Yes, that's right! Food, particularly the nutritious food, is
a matter of our culture. It spans from production to
dietary intake practices. Pania made from maize, dal-
batee (a preparation made from pulses and wheat flour),
dosa-idlee (a typical and famous South Indian dish made
from fermented rice), chapatis (bread) made from Jowar
and Bajra (coarse food grains), dishes from biryani to
those made from gram flour like gatte are all associated
with our culture, food patterns and traditions. We must
keep up our traditions.

Some communities are vegetarians whilst some are non-

vegetarians. All communities should have freedom of
choice for foods of their liking. Whichever food is
culturally acceptable to them, they should have
economic and political access to it.

Edible oil, nutritious food grains, eggs, local beet roots,

pulses and edible forest produce can help eliminate
malnutrition. The moot question is whether we are ready
to free the children from malnutrition.

If yes, we must accept that food is directly associated

with community's right to natural resources. As these
associations become strengthened, malnutrition will get
repelled farther away. repelled farther away.
 Malnutrition and
Governance
The availability of food has to be necessarily ensured. It
is also essential that the food should be nutritious and
necessarily offer variety. Nutritionists affirm that our
food plate must contain food dishes in different colors,
like, white rice, yellow dal, green spinach and red
tomatoes! Accordingly, this has to do with agriculture
and seeds.
Food comes from the agricultural fields, rivers-lakes,
and from the sea and forests. It means that it is necessary
for us to save all of them-fields, lakes, rivers, sea and the
forests.
Food availability can be there if there is production.
However, in order to be able to buy dal, rice, edible oil,
vegetables, eggs and spices etc., we would require
livelihood and means of gainful employment which can
give us sufficient income to be able to meet our needs.
Gram Sabha and Panchayat have to take their decisions
with regard to the development of households in the
catchment village(s). Their decisions and initiatives,
taken in the best interests of the community, would go a
long way in freeing the children from the menace of
malnutrition.
The children must get prompt and complete treatment in
the event of an illness, lest it should become the cause
for malnutrition.
Now, if one adds up the number of factors and
government departments which must join up for forming
an integrated thrust to combat malnutrition, it becomes
clear that spectrum of development has an array of
sectors which have a bearing on Public Health Nutrition!

Children's
Nutrition
Malnutrition, Sanitation
and Safe Drinking Water
Flies contaminate our food, even if we seek to wave
them away. One would and should shiver with the
thought of places where the flies would have sat on
before coming in contact with our food and transmitting
contaminants to it.
Fly brings filth which we may not be able to notice with
our naked eyes. And, we become prone to contracting
infections and illnesses! Let's therefore, remember that
the journey of filth begins with open defecation and that
we are responsible for it. Let's also not forget that this
journey of open excreta culminates unto us too via these
carriers, the flies!
Likewise, the excreta which flows in to the river or lake
or wells, it reverts back to us with the water bodies
getting polluted! This raises the question of clean and
safe drinking water.
Hence, role of local civic bodies becomes pronounced in
preventing malnutrition.

Our hands come in contact with a host of things and

places. It implies that our hands are most prone to get
dirty. Therefore, it is very important to wash our hands
with soap to ensure that we ward off infections in all
forms.
Sanitation is not just a matter of personal hygiene. It is a
matter of policy too and that it is here that the
government departments responsible for the concerbed
sectors look at the issue of malnutrition and healthy
wellbeing from a synergistic and coordinated
perspective.
 Food Groups
Does it sound strange? Are there dynasties or families of
foods too? Yes, we can call them as families or tribes or
sects of food. Or we could even term them as gotras,
jatthhas or dynasties!

The following 7 food groups form a complete family of

food. In scientific language, we refer to it as complete
nutrition. Each group is a unit of the foods family :

8 Group One : Food grains; wheat, rice, ragi, bajra

and others.

8 Group Two : Pulses and legumes; dal, rajma, gram,

beans and others.

8 Group Three : Milk and meat; milk, curd, fish,

meat, and others.

8 Group Four : of fruits; papaya, guava, banana,

water melon, and others.

8 Group Five : of green leafy vegetables; spinach,

mustard, methi (fenugreek leaves), any leafy
vegetables.

8 Group Six : other vegetables; lady finger, tomato,

munga (Sesbania grand flora), 'sem phali' (broad
beans), cauliflower, and others.

8 Group Seven: Fats and sugar; edible oil, ghee,

sugar, and jaggery.

If during a day, a food item from each of these 7 groups is

part of the child's palate, it becomes a complete food. If
no, the food remains incomplete and so do the human
relationships!
 Food Rainbow
When rainbow appears in the sky, the multicolored spectrum
of light looks beautiful. It evokes a very pleasant feeling. The
question is whether there is a rainbow of foods also.
Yes, it is! When the rainbow of food gets broken, food groups of
different colors get missed out and malnutrition sets in. Well-
nourishing food means composite food consisting of different
colored food items. Each color group meets different
nutritional needs.
8 Red and saffron : Tomatoes, carrots, red lentil
(masoor dal), red leaves (chaulai bhhajee), meat
and others.
8 Yellow and orange : Pumpkin, papaya, mask
melon, gram dal and yellow pigeon peas (toor dal),
turmeric, mustard, soybean and others.
8 Dark brown : Jaggery, green berry, Madhuca
longifolia (mahua), sappotta (chekku), black cumin
(jeera) and others.
8 White : Milk, fresh cheese, curd, rice, banana, egg,
sugar, salt, garlic, jackfruit, coconut and others.
8 Green : Spinach, fenugreek leaves (methi), bitter
gourd, lady finger, bottle gourd, cabbage, goose
berry, chareta, chakoda and others.
8 Black : Black gram, black urad, brown mustard
seed, black grapes, black kidney beans (rajma) and
others.
8 Violet : Brinjal, jambu fruit (Jamun) and others.

When all of these colors together get included in our

food, malnutrition gets wiped off. We need to decorate
our food with such a rainbow color scheme of food
constituents.
Management of Malnutrition
within the Community
Malnutrition causes morbidity,
illness and disability. It is the
single direct and largest cause of
child deaths. By itself, malnu-
trition is not a diseases but causes
many diseases. Govern-ment and
the society are accountable
towards the wellbeing of the
children and that they must perform their efficacious roles
towards realizing the same.
The following steps when effectively pursued within the
community would greatly help mitigate the perturbing
situation of persistent malnutrition
8 Step One : Ensure availability of complete food to every
woman and every girl, with due respect for them.
8 Step Two : Proper care of the pregnant women and their
regular health checkups must be ensured.
8 Step Three : Ensure that immediately after the birth, the
newborn is definitely breastfed in all circumstances.
8 Step Four : Special priority care should be provided for
children up to the age of 2 years.
8 Step Five : The community must demonstrate a sense
that the Anganwadi Centre belongs to it so that children
feel at home while being away from their home.
8 Step Six : Regular growth monitoring of children must be
done, i.e., weighing, height measurement and measuring
Mid Upper Arm Circumference; in accordance with age-
specific schedules.
8 Step Seven : It would be add to community mobilisation
by observing the regular events of immunisation and
growth monitoring in a celebration mode.
8 Step Eight : The community must lead in the elimination
of discrimination in all its forms, i.e., gender, caste and
religion.
8 Step Nine : Struggle for securing safe clean drinking
water and sanitation for the community should receive
priority attention.
8 Step Ten : Make a plan for health surveillance and
monitoring of the deliverance of health services.
8 Step Eleven : Gram Panchayat should monitor health and
nutrition programmes through its standing committee on
health and nutrition.
8 Step Twelve : Nutrition, as an agenda, must be included
in the deliberations of Gram Sabha's meetings.
8 Step Thirteen : Production of food grains, vegetables,
fruits and milk products must receive careful attention in
community's reflections and initiatives.
8 Step Fourteen : An organised struggle should be
maintained to ensure equity in securing livelihood and
payment of timely and full wages for all.
8 Step Fifteen : The community must keep an eye on the
system of governance, raise questions and ask for
maintaining transparency in all development
programming and implementation.
Age-Weight-Length/Height
Tables
According to the World Health Organisation, it is critical
to monitor the three indicators of child growth and the
associations amongst them for children from 0 to 5 years
age. These three indicators are :

1. What is weight by age? If the child weighs lesser

than the stipulated weight, then that child will be
said to be 'underweight' or 'severely underweight',
as the case may be.

2. What is weight by height or length? If the child

weighs lesser by age as compared to the stipulated
weight, the child will be said to be 'wasted' or be in
a state of 'severely acute malnutrition', as the case
may be.

3. What is the height/length by age? If the child

measures lesser in height/length as compared to
the stipulated one, the child will be said to be
retarded in growth or being 'stunted'. It goes to
show that the impact of malnutrition has been
deeply adverse and has become chronic because of
which child's height is not increasing.

After this page, all those tables have been provided

which can be referred to identify the normal status, or
nascent stage or moderate or severe stages of
malnutrition. Alongside, we also get to know as to what
are the three different situations of underweight or
severe malnutrition and retarded growth or being
stunted. You can keep a tab on development of children
and monitor their growth in your areas by referring to
these tables.

Weight-by-age table is the same which is generally used

in the Anganwadi Centres. Weight by height/length table
is generally used in hospitals and Nutrition Rehabilitation
Centres.
 Weight-by-Age Table (Girls)
(In accordance with the new standards of
World Health Organisation)
Age Normal Weight Moderately Low Severely Low
Equoal to or Weight
Months more than kg Weight from - to kg Lesser than (kg)
At birth 2.5 2.0 to 2.4 2.0
1 3.2 2.7 to 3.2 2.7

2 4.0 3.4 to 4.0 3.4

3 4.5 4.0 to 4.5 4.0

4 5.0 4.4 to 5.0 4.4

5 5.4 4.8 to 5.4 4.8

6 5.7 5.0 to 5.7 5.0

7 6.0 5.3 to 6.0 5.3

8 6.3 5.6 to 6.3 5.6

9 6.5 5.8 to 6.5 5.8

10 6.7 5.9 to 6.7 5.9
11 6.9 6.1 to 6.9 6.1

12 7.0 6.3 to 7.0 6.3

13 7.2 6.4 to 7.2 6.4

14 7.4 6.6 to 7.4 6.6

15 7.6 6.8 to 7.6 6.8

16 7.7 7.0 to 7.7 7.0

17 7.9 7.1 to 7.9 7.1

18 8.1 7.3 to 8.1 7.3

19 8.2 7.5 to 8.2 7.5

20 8.4 7.6 to 8.4 7.6

21 8.6 7.7 to 8.6 7.7

22 8.8 7.9 to 8.8 7.9

23 8.9 8.0 to 8.9 8.0

24 9.0 8.1 to 9.0 8.1

25 9.2 8.3 to 9.2 8.3

26 9.4 8.4 to 9.4 8.4

27 9.6 8.5 to 9.6 8.5

28 9.7 8.7 to 9.7 8.7

29 9.9 8.8 to 9.9 8.8

30 10.0 9.0 to 10.0 9.0

31 10.2 9.1 to 10.2 9.1

32 10.3 9.2 to 10.3 9.2

33 10.4 9.3 to 10.4 9.3

34 10.6 9.4 to 10.6 9.4

35 10.7 9.5 to 10.7 9.5

36 10.8 9.6 to 10.8 9.6

37 11.0 9.8 to 11.0 9.8

38 11.2 9.9 to 11.2 9.9

39 11.3 10.0 to 11.3 10.0

40 11.5 10.1 to 11.5 10.1
41 11.6 10.2 to 11.6 10.2

42 11.7 10.3 to 11.7 10.3

43 11.9 10.4 to 11.9 10.4

44 12.0 10.5 to 12.0 10.5

45 12.1 10.6 to 12.1 10.6

46 12.3 10.7 to 12.3 10.7

47 12.4 10.8 to 12.4 10.8

48 12.5 10.9 to 12.5 10.9
49 12.6 11.0 to 12.6 11.0

50 12.8 11.1 to 12.8 11.1

51 12.9 11.2 to 12.9 11.2

52 13.0 11.3 to 13.0 11.3

53 13.1 11.4 to 13.1 11.4

54 13.2 11.5 to 13.2 11.5

55 13.3 11.6 to 13.3 11.6

56 13.4 11.7 to 13.4 11.7

57 13.4 11.8 to 13.4 11.8

58 13.5 11.9 to 13.5 11.9

59 13.6 12.0 to 13.6 12.0

60 13.7 12.1 to 13.7 12.1

 Weight-by-Age Table (Boys)
(In accordance with the new standards of
World Health Organisation)
Age Normal Weight Moderately Low Severely Low
Equoal to or Weight
Months more than kg Weight from - to kg Lesser than (kg)
At birth 2.5 2.0 to 2.4 2.0
1 3.0 2.6 to 3.0 2.6

2 3.8 3.3 to 3.8 3.3

3 4.4 3.8 to 4.4 3.8

4 4.9 4.3 to 4.9 4.3

5 5.3 4.6 to 5.3 4.6

6 5.6 4.9 to 5.6 4.9

7 6.0 5.2 to 6.0 5.2

8 6.2 5.5 to 6.2 5.5

9 6.5 5.7 to 6.5 5.7

10 6.7 5.9 to 6.7 5.9
11 6.9 6.1 to 6.9 6.1

12 7.2 6.3 to 7.2 6.3

13 7.3 6.5 to 7.3 6.5

14 7.5 6.6 to 7.5 6.6

15 7.6 6.8 to 7.6 6.8

16 7.9 6.9 to 7.9 6.9

17 8.1 7.1 to 8.1 7.1

18 8.3 7.2 to 8.3 7.2

19 8.4 7.4 to 8.4 7.4

20 8.6 7.5 to 8.6 7.5

21 8.8 7.6 to 8.8 7.6

22 9.0 7.7 to 9.0 7.7

23 9.1 7.9 to 9.1 7.9

24 9.3 8.0 to 9.3 8.0

25 9.5 8.2 to 9.5 8.2

26 9.6 8.3 to 9.6 8.3

27 9.8 8.4 to 9.8 8.4

28 9.9 8.5 to 9.9 8.5

29 10.0 8.7 to 10.0 8.7

30 10.2 8.8 to 10.2 8.8

31 10.3 8.9 to 10.3 8.9

32 10.5 9.1 to 10.5 9.1

33 10.6 9.2 to 10.6 9.2

34 10.8 9.3 to 10.8 9.3

35 10.9 9.4 to 10.9 9.4

36 11.0 9.5 to 11.0 9.5

37 11.2 9.7 to 11.2 9.7

38 11.3 9.8 to 11.3 9.8

39 11.4 9.9 to 11.4 9.9

40 11.5 10.1 to 11.5 10.1

41 11.7 10.2 to 11.7 10.2

42 11.8 10.3 to 11.8 10.3

43 11.9 10.4 to 11.9 10.4

44 12.1 10.5 to 12.1 10.5

45 12.2 10.6 to 12.2 10.6

46 12.3 10.7 to 12.3 10.7

47 12.5 10.8 to 12.5 10.8

48 12.6 10.9 to 12.6 10.9

49 12.7 11.0 to 12.7 11.0

50 12.9 11.1 to 12.9 11.1

51 13.0 11.2 to 13.0 11.2

52 13.1 11.3 to 13.1 11.3

53 13.2 11.4 to 13.2 11.4

54 13.3 11.5 to 13.3 11.5

55 13.5 11.6 to 13.5 11.6

56 13.6 11.7 to 13.6 11.7

57 13.7 11.8 to 13.7 11.8

58 13.8 11.9 to 13.8 11.9

59 13.9 12.0 to 13.9 12.0

60 14.0 12.1 to 14.0 12.1

Reference Chart: Weight by Height (less than 87 cm)
Boy's Weight (Kg)

Height (-) 1 (-) 2 (-) 3 (-) 4

(cm) Median Standard Standard Standard Standard
Deviation Deviation Deviation Deviation
45 2.4 2.2 2.0 1.9 1.7
46 2.6 2.4 2.2 2.0 1.8
47 2.8 2.5 2.3 2.1 2.0
48 2.9 2.7 2.5 2.3 2.1
49 3.1 2.9 2.6 2.4 2.2
50 3.3 3.0 2.8 2.6 2.4
51 3.5 3.2 3.0 2.7 2.5
52 3.8 3.5 3.2 2.9 2.7
53 4.0 3.7 3.4 3.1 2.9
54 4.3 3.9 3.6 3.3 3.1
55 4.5 4.2 3.8 3.6 3.3
56 4.8 4.4 4.1 3.8 3.5
57 5.1 4.7 4.3 4.0 3.7
58 5.4 5.0 4.6 4.3 3.9
59 5.7 5.3 4.8 4.5 4.1
60 6.0 5.5 5.1 4.7 4.3
61 6.3 5.8 5.3 4.9 4.5
62 6.5 6.0 5.6 5.1 4.7
63 6.8 6.2 5.8 5.3 4.9
64 7.0 6.5 6.0 5.5 5.1
65 7.3 6.7 6.2 5.7 5.3
66 7.5 6.9 6.4 5.9 5.5
67 7.7 7.1 6.6 6.1 5.6
68 8.0 7.3 6.8 6.3 5.8
69 8.2 7.6 7.0 6.5 6.0
70 8.4 7.8 7.2 6.6 6.1
71 8.6 8.0 7.4 6.8 6.3
72 8.9 8.2 7.6 7.0 6.4
73 9.1 8.4 7.7 7.2 6.6
74 9.3 8.6 7.9 7.3 6.7
75 9.5 8.8 8.1 7.5 6.9
76 9.7 8.9 8.3 7.6 7.0
77 9.9 9.1 8.4 7.8 7.2
78 10.1 9.3 8.6 7.9 7.3
79 10.3 9.5 8.7 8.1 7.4
80 10.4 9.6 8.9 8.2 7.6
81 10.6 9.8 9.1 8.4 7.7
82 10.8 10.0 9.2 8.5 7.9
83 11.0 10.2 9.4 8.7 8.0
84 11.3 10.4 9.6 8.9 8.2
85 11.5 10.6 9.8 9.1 8.4
86 11.7 10.8 10.0 9.3 8.6
*Median data and *Standard Deviation data in Kg.
Reference Chart: Weight by Height (less than 87 cm)
Girl's Weight (Kg)

Height (-) 1 (-) 2 (-) 3 (-) 4

(cm) Median Standard Standard Standard Standard
Deviation Deviation Deviation Deviation
45 2.5 2.3 2.1 1.9 1.7
46 2.6 2.4 2.2 2.0 1.9
47 2.8 2.6 2.4 2.2 2.0
48 3.0 2.7 2.5 2.3 2.1
49 3.2 2.9 2.6 2.4 2.2
50 3.4 3.1 2.8 2.6 2.4
51 3.6 3.3 3.0 2.8 2.5
52 3.8 3.5 3.2 2.9 2.7
53 4.0 3.7 3.4 3.1 2.8
54 4.3 3.9 3.6 3.3 3.0
55 4.5 4.2 3.8 3.5 3.2
56 4.8 4.4 4.0 3.7 3.4
57 5.1 4.6 4.3 3.9 3.6
58 5.4 4.9 4.5 4.1 3.8
59 5.6 5.1 4.7 4.3 3.9
60 5.9 5.4 4.9 4.5 4.1
61 6.1 5.6 5.1 4.7 4.3
62 6.4 5.8 5.3 4.9 4.5
63 6.6 6.0 5.5 5.1 4.7
64 6.9 6.3 5.7 5.3 4.8
65 7.1 6.5 5.9 5.5 5.0
66 7.3 6.7 6.1 5.6 5.1
67 7.5 6.9 6.3 5.8 5.3
68 7.7 7.1 6.5 6.0 5.5
69 8.0 7.3 6.7 6.1 5.6
70 8.2 7.5 6.9 6.3 5.8
71 8.4 7.7 7.0 6.5 5.9
72 8.6 7.8 7.2 6.6 6.0
73 8.8 8.0 7.4 6.8 6.2
74 9.0 8.2 7.5 6.9 6.3
75 9.1 8.4 7.7 7.1 6.5
76 9.3 8.5 7.8 7.2 6.6
77 9.5 8.7 8.0 7.4 6.7
78 9.7 8.9 8.2 7.5 6.9
79 9.9 9.1 8.3 7.7 7.0
80 10.1 9.2 8.5 7.8 7.1
81 10.3 9.4 8.7 8.0 7.3
82 10.5 9.6 8.8 8.1 7.5
83 10.7 9.8 9.0 8.3 7.6
84 11.0 10.1 9.2 8.5 7.8
85 11.2 10.3 9.4 8.7 8.0
86 11.5 10.5 9.7 8.9 8.1
*Median data and *Standard Deviation data in Kg.
Reference Chart: Weight by Height (more than 87 cm)
Boy's Weight (Kg)

Height (-) 1 (-) 2 (-) 3 (-) 4

(cm) Median Standard Standard Standard Standard
Deviation Deviation Deviation Deviation
87 12.2 11.2 10.4 9.6 8.9
88 12.4 11.5 10.6 9.8 9.1
89 12.6 11.7 10.8 10.0 9.3
90 12.9 11.9 11.0 10.2 9.4
91 13.1 12.1 11.2 10.4 9.6
92 13.4 12.3 11.4 10.6 9.8
93 13.6 12.6 11.6 10.8 9.9
94 13.8 12.8 11.8 11.0 10.1
95 14.1 13.0 12.0 11.1 10.3
96 14.3 13.2 12.2 11.3 10.4
97 14.6 13.4 12.4 11.5 10.6
98 14.8 13.7 12.6 11.7 10.8
99 15.1 13.9 12.9 11.9 11.0
100 15.4 14.2 13.1 12.1 11.2
101 15.6 14.4 13.3 12.3 11.3
102 15.9 14.7 13.6 12.5 11.5
103 16.2 14.9 13.8 12.8 11.7
104 16.5 15.2 14.0 13.0 11.9
105 16.8 15.5 14.3 13.2 12.1
106 17.2 15.8 14.5 13.4 12.3
107 17.5 16.1 14.8 13.7 12.5
108 17.8 16.4 15.1 13.9 12.7
109 18.2 16.7 15.3 14.1 12.9
110 18.5 17.0 15.6 14.4 13.2
111 18.9 17.3 15.9 14.6 13.4
112 19.2 17.6 16.2 14.9 13.6
113 19.6 18.0 16.5 15.2 13.8
114 20.0 18.3 16.8 15.4 14.1
115 20.4 18.6 17.1 15.7 14.3
116 20.8 19.0 17.4 16.0 14.6
117 21.2 19.3 17.7 16.2 14.8
118 21.6 19.7 18.0 16.5 15.0
119 22.0 20.0 18.3 16.8 15.3
120 22.4 20.4 18.6 17.1 15.5
*Median data and *Standard Deviation data in Kg.
Reference Chart: Weight by Height (more than 87 cm)
Girl's Weight (Kg)

Height (-) 1 (-) 2 (-) 3 (-) 4

(cm) Median Standard Standard Standard Standard
Deviation Deviation Deviation Deviation
87 11.9 10.9 10.0 9.2 8.4
88 12.1 11.1 10.2 9.4 8.6
89 12.4 11.4 10.4 9.6 8.8
90 12.6 11.6 10.6 9.8 9.0
91 12.9 11.8 10.9 10.0 9.1
92 13.1 12.0 11.1 10.2 9.3
93 13.4 12.3 11.3 10.4 9.5
94 13.6 12.5 11.5 10.6 9.7
95 13.9 12.7 11.7 10.8 9.8
96 14.1 12.9 11.9 10.9 10.0
97 14.4 13.2 12.1 11.1 10.2
98 14.7 13.4 12.3 11.3 10.4
99 14.9 13.7 12.5 11.5 10.5
100 15.2 13.9 12.8 11.7 10.7
101 15.5 14.2 13.0 12.0 10.9
102 15.8 14.5 13.3 12.2 11.1
103 16.1 14.7 13.5 12.4 11.3
104 16.4 15.0 13.8 12.6 11.5
105 16.8 15.3 14.0 12.9 11.8
106 17.1 15.6 14.3 13.1 12.0
107 17.5 15.9 14.6 13.4 12.2
108 17.8 16.3 14.9 13.7 12.4
109 18.2 16.6 15.2 13.9 12.7
110 18.6 17.0 15.5 14.2 12.9
111 19.0 17.3 15.8 14.5 13.2
112 19.4 17.7 16.2 14.8 13.5
113 19.8 18.0 16.5 15.1 13.7
114 20.2 18.4 16.8 15.4 14.0
115 20.7 18.8 17.2 15.7 14.3
116 21.1 19.2 17.5 16.0 14.5
117 21.5 19.6 17.8 16.3 14.8
118 22.0 19.9 18.2 16.6 15.1
119 22.4 20.3 18.5 16.9 15.4
120 22.8 20.7 18.9 17.3 15.6
*Median data and *Standard Deviation data in Kg.
 Reference Chart : Height by Age World Health
0 to 2 years (Boys) Organisation
Year : (-) 3 (-) 2 (-) 1
Month Standard Standard Standard Median
Month
Deviation Deviation Deviation

0: 0 0 44.2 46.1 48.0 49.9

0: 1 1 48.9 50.8 52.8 54.7

0: 2 2 52.4 54.4 56.4 58.4

0: 3 3 55.3 57.3 59.4 61.4

0: 4 4 57.6 59.7 61.8 63.9

0: 5 5 59.6 61.7 63.8 65.9

0: 6 6 61.2 63.3 65.5 67.6

0: 7 7 62.7 64.8 67.0 69.2

0: 8 8 64.0 66.2 68.4 70.6

0: 9 9 65.2 67.5 69.7 72.0

0:10 10 66.4 68.7 71.0 73.3

0:11 11 67.6 69.9 72.2 74.5

1: 0 12 68.6 71.0 73.4 75.7

1: 1 13 69.6 72.1 74.5 76.9

1: 2 14 70.6 73.1 75.6 78.0

1: 3 15 71.6 74.1 76.6 79.1

1: 4 16 72.5 75.0 77.6 80.2

1: 5 17 73.3 76.0 78.6 81.2

1: 6 18 74.2 76.9 79.6 82.3

1: 7 19 75.0 77.7 80.5 83.2

1: 8 20 75.8 78.6 81.4 84.2

1: 9 21 76.5 79.4 82.3 85.1

1:10 22 77.2 80.2 83.1 86.0

1:11 23 78.0 81.0 83.9 86.9

2: 0 24 78.7 81.7 84.8 87.8

*Median data and *Standard Deviation data in cm.

 Reference Chart : Height by Age World Health
2 to 5 years (Boys) Organisation
Year : (-) 3 (-) 2 (-) 1
Month Standard Standard Standard Median
Month
Deviation Deviation Deviation
2: 0 24 78.0 81.0 84.1 87.1
2: 1 25 78.6 81.7 84.9 88.0
2: 2 26 79.3 82.5 85.6 88.8
2: 3 27 79.9 83.1 86.4 89.6
2: 4 28 80.5 83.8 87.1 90.4
2: 5 29 81.1 84.5 87.8 91.2
2: 6 30 81.7 85.1 88.5 91.9
2: 7 31 82.3 85.7 89.2 92.7
2: 8 32 82.8 86.4 89.9 93.4
2: 9 33 83.4 86.9 90.5 94.1
2:10 34 83.9 87.5 91.1 94.8
2:11 35 84.4 88.1 91.8 95.4
3: 0 36 85.0 88.7 92.4 96.1
3: 1 37 85.5 89.2 93.0 96.7
3: 2 38 86.0 89.8 93.6 97.4
3: 3 39 86.5 90.3 94.2 98.0
3: 4 40 87.0 90.9 94.7 98.6
3: 5 41 87.5 91.4 95.3 99.2
3: 6 42 88.0 91.9 95.9 99.9
3: 7 43 88.4 92.4 96.4 100.4
3: 8 44 88.9 93.0 97.0 101.0
3: 9 45 89.4 93.5 97.5 101.6
3:10 46 89.8 94.0 98.1 102.2
3:11 47 90.3 94.4 98.6 102.8
4: 0 48 90.7 94.9 99.1 103.3
4: 1 49 91.2 95.4 99.7 103.9
4: 2 50 91.6 95.9 100.2 104.4
4: 3 51 92.1 96.4 100.7 105.0
4: 4 52 92.5 96.9 101.2 105.6
4: 5 53 93.0 97.4 101.7 106.1
4: 6 54 93.4 97.8 102.3 106.7
4: 7 55 93.9 98.3 102.8 107.2
4: 8 56 94.3 98.8 103.3 107.8
4: 9 57 94.7 99.3 103.8 108.3
4:10 58 95.2 99.7 104.3 108.9
4:11 59 95.6 100.2 104.8 109.4
5: 0 60 96.1 100.7 105.3 110.0

*Median data and *Standard Deviation data in cm.

 Reference Chart : Height by Age World Health
0 to 2 years (Girls) Organisation
Year : (-) 3 (-) 2 (-) 1
Month Standard Standard Standard Median
Month
Deviation Deviation Deviation

0: 0 0 43.6 45.4 47.3 49.1

0: 1 1 47.8 49.8 51.7 53.7

0: 2 2 51.0 53.0 55.0 57.1

0: 3 3 53.5 55.6 57.7 59.8

0: 4 4 55.6 57.8 59.9 62.1

0: 5 5 57.4 59.6 61.8 64.0

0: 6 6 58.9 61.2 63.5 65.7

0: 7 7 60.3 62.7 65.0 67.3

0: 8 8 61.7 64.0 66.4 68.7

0: 9 9 62.9 65.3 67.7 70.1

0:10 10 64.1 66.5 69.0 71.5

0:11 11 65.2 67.7 70.3 72.8

1: 0 12 66.3 68.9 71.4 74.0

1: 1 13 67.3 70.0 72.6 75.2

1: 2 14 68.3 71.0 73.7 76.4

1: 3 15 69.3 72.0 74.8 77.5

1: 4 16 70.2 73.0 75.8 78.6

1: 5 17 71.1 74.0 76.8 79.7

1: 6 18 72.0 74.9 77.8 80.7

1: 7 19 72.8 75.8 78.8 81.7

1: 8 20 73.7 76.7 79.7 82.7

1: 9 21 74.5 77.5 80.6 83.7

1:10 22 75.2 78.4 81.5 84.6

1:11 23 76.0 79.2 82.3 85.5

2: 0 24 76.7 80.0 83.2 86.4

*Median data and *Standard Deviation data in cm.

 Reference Chart : Height by Age World Health
2 to 5 years (Girls) Organisation
Year : (-) 3 (-) 2 (-) 1
Month Standard Standard Standard Median
Month
Deviation Deviation Deviation
2: 0 24 76.0 79.3 82.5 85.7
2: 1 25 76.8 80.0 83.3 86.6
2: 2 26 77.5 80.8 84.1 87.4
2: 3 27 78.1 81.5 84.9 88.3
2: 4 28 78.8 82.2 85.7 89.1
2: 5 29 79.5 82.9 86.4 89.9
2: 6 30 80.1 83.6 87.1 90.7
2: 7 31 80.7 84.3 87.9 91.4
2: 8 32 81.3 84.9 88.6 92.2
2: 9 33 81.9 85.6 89.3 92.9
2:10 34 82.5 86.2 89.9 93.6
2:11 35 83.1 86.8 90.6 94.4
3: 0 36 83.6 87.4 91.2 95.1
3: 1 37 84.2 88.0 91.9 95.7
3: 2 38 84.7 88.6 92.5 96.4
3: 3 39 85.3 89.2 93.1 97.1
3: 4 40 85.8 89.8 93.8 97.7
3: 5 41 86.3 90.4 94.4 98.4
3: 6 42 86.8 90.9 95.0 99.0
3: 7 43 87.4 91.5 95.6 99.7
3: 8 44 87.9 92.0 96.2 100.3
3: 9 45 88.4 92.5 96.7 100.9
3:10 46 88.9 93.1 97.3 101.5
3:11 47 89.3 93.6 97.9 102.1
4: 0 48 89.8 94.1 98.4 102.7
4: 1 49 90.3 94.6 99.0 103.3
4: 2 50 90.7 95.1 99.5 103.9
4: 3 51 91.2 95.6 100.1 104.5
4: 4 52 91.7 96.1 100.6 105.0
4: 5 53 92.1 96.6 101.1 105.6
4: 6 54 92.6 97.1 101.6 106.2
4: 7 55 93.0 97.6 102.2 106.7
4: 8 56 93.4 98.1 102.7 107.3
4: 9 57 93.9 98.5 103.2 107.8
4:10 58 94.3 99.0 103.7 108.4
4:11 59 94.7 99.5 104.2 108.9
5: 0 60 95.2 99.9 104.7 109.4

*Median data and *Standard Deviation data in cm.

 Hunger does not die,

It only sleeps for a while

Or goes in a lull,

With a pat by a 'Chapati'.

There is no way to let go free from it,

We are the permanent colonies of hunger,

Whatever these settlements receive,

it gets consumed within us.

'Chapati' or the intestines

where these get reared

And the empire of hunger goes on expanding.

The school of thought of management of

malnutrition in the community rests on the premise
that we take the rights-based perspective across the
spectrum of monitoring children's growth, our own
behaviors and practices, availability of essential
services, health, employment-livelihood and an
accountable governance.
Right to nutrition is not just an issue related with
distribution of food. It is also an issue associated
with concerns on system of production, distribution
and storage from the perspective of equality.

Produced and published by

Vikas Samvad
E-7/226, First Floor, Opposite Dhanwantari Complex,
Arera Colony, Shahpura, Bhopal

Contact : [email protected] / Ph. : 0755-4252789

www.mediaforrights.org
Supported by : POSHAN - Partnerships and Opportunities to Strengthen and
Harmonize Actions for Nutrition in India (IFPRI and IDS)

Group : SPANDAN, CDC, PARHIT, VIKAS SAMVAD