Nutrition

Nutrition Crisis in Meghalaya

The Nutrition Component addresses the core challenge of improving child nutrition outcomes across Meghalaya, where stunting rates (46.5%) remain significantly higher than the national average. The component works to increase the average height of children through effective exclusive breastfeeding support, decentralization of Supplementary Nutrition Programme (SNP), and increased coverage of Iron Folic Acid (IFA) supplements for antenatal and postnatal mothers and adolescent girls.

Through a combination of direct nutrition delivery (egg procurement), community-led governance models (SNP decentralization), and protocol-based malnutrition management (CMAM), the component ensures that nutrition interventions reach every child across both AWC-covered and uncovered villages. The approach emphasizes local food systems, community ownership, and systematic identification and treatment of acute malnutrition.

Egg Procurement & Supply

Distribution of boiled eggs across 6,162 AWCs and 1,307 uncovered villages to combat malnutrition and support cognitive development. Eggs provide high-quality protein critical for the 6 months to 3 years age window—the opportunity period to reverse stunting and support brain development.

Procurement is conducted region-wise through annual contracts under ADB financing (Loan 4335-IND). Suppliers deliver eggs twice monthly to each AWC and uncovered village location. AWWs verify quality, distribute to registered beneficiaries, and submit receipts for payment processing through PFMS. The intervention also covers Pregnant and Nursing Mothers to support foetal development, lactation, and postnatal recovery.

• 6,162 AWCs receiving eggs across Meghalaya
• 1,307 uncovered villages covered
• ~40,000 children aged 6 months to 1.5 years
• ~1,40,000 children aged 1.5 to 3 years
• ~60,000 Pregnant & Nursing Mothers covered

SNP Decentralisation Pilot

Shifting Hot Cooked Meal (HCM) procurement from centralized SHG-based supply to village-level procurement through Village Nutrition Committees (VNC) or Village Organisations (VO), addressing delivery gaps including insufficient fuel funds, costly transport, and locally non-palatable food.

Two models are being piloted: VHC-led (Laitkroh, East Khasi Hills) and VO-led (Samanda, North Garo Hills). Village Nutrition Committees identify food items based on community preferences, manage procurement, and handle deliveries. CDPO/LS use the Optimization Tool to calculate nutritional requirements, costs, and quantities for each AWC based on community-requested food items, ensuring menu diversity with locally procured ingredients.

• VHC-led model in Laitkroh, East Khasi Hills
• VO-led model in Samanda, North Garo Hills
• Village Nutrition Committee with 4-6 members
• Optimization Tool for nutritional calculations
• Community preference-based food identification

Community Management of Acute Malnutrition (CMAM)

A protocol-based approach for identifying, assessing, and managing children with Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) at the AWC level. Children without medical complications are managed at AWC through enhanced supplementary nutrition; complicated cases are referred to Nutrition Rehabilitation Centres (NRC).

The protocol follows a systematic process from growth monitoring to follow-up care. Classification uses Z-scores: SAM (Weight-for-Height < -3), MAM (Weight-for-Height between -2 and -3). SAM children receive 120 kcal/kg/day enhanced nutrition. Medical management includes Albendazole, Vitamin A, and IFA administration. AWW home visits are weekly in the first month, then fortnightly for SAM/SUW children, with monitoring continuing up to age 6 years for recovered SAM cases.

• Growth monitoring and anthropometric assessment at AWC
• Z-score classification for SAM, MAM, and Stunting
• AWC management for uncomplicated cases with enhanced nutrition
• NRC referral for complicated SAM cases
• WASH counseling on breastfeeding, complementary feeding, and hygiene

District-wise Food Mapping & Surveys

Context-specific, culturally appropriate nutrition planning through identification of CGHAs and comprehensive district-level nutrition assessments.

The district food mapping research uses participatory methods to document locally available, culturally appropriate foods that can address nutrition challenges. Beyond listing 50+ local foods, the research captures traditional preparation methods, seasonal availability patterns, cost efficiency, and nutritional content. Cultural appropriateness is emphasized—recognizing that nutrition solutions must align with local food preferences, beliefs, and practices. The research generated both comprehensive 8-page and quick-reference 2-page factsheets for each district, making evidence accessible to programme implementers. This grounding in local context ensures that nutrition recommendations feel authentic and achievable for families, increasing adoption and sustained behavior change.

• District factsheets available for 8 districts (2-page and print versions)
• State-level factsheet for Meghalaya available
• Identification of Community Groups for Health Activities (CGHAs)
• Free listing of local foods and traditional recipes
• NFHS-5 data analysis and integration