Reviewer: Shubhada J. Kanani, PhD (M.S. University of Baroda)
Description: This book explores the nutritional status (various dimensions of undernutrition), food intake, and its adequacy as well as the mid-day-meal-school health program in India. It is a comprehensive overview of the various anthropometric assessment methods used to measure nutritional status, both for preschool and school-aged children; a review of the growth profile of school children in India and their household food intake as well as school meal intake. A noteworthy feature is the analytical description of the socioeconomic and ecological context which influences their growth and food choices; for example, among tribal children. Policy directions are provided for strengthening programs for improving school health and nutrition.
Purpose: It appears to me that the book is primarily meant for those engaged in academics and research who have a primary interest in various nutrition-related dimensions of the school child in India. To this end, the book provides a comprehensive review, along with primary data (of Karnataka rural-tribal school children), related to methods of assessing growth and under-nutrition, nutrition profile, food choices, and school meals. Going beyond simply nutrition indicators, it highlights that socioeconomic and environmental factors are equally important an important message for program and policy. However, although the authors also state a policy objective for the book, this aspect gets less attention than it deserves. Further, a simplified, bulleted list of specific recommendations for policymakers and for program implementers in the government sector may have been useful.
Audience: The book will be useful to students and practitioners in public health nutrition, community medicine, social work, and allied disciplines, particularly those interested in pursuing research or implementing programs in school settings. It also has useful insights and programmatic guidance for practitioners in departments of education, health, and nutrition. Adding a summary box at the end of each chapter, with key insights and recommendations, would have further enhanced the usefulness of this work for practitioners.
Features: This comprehensive book on the nutrition profile of the school child in India first presents the various methods and indicators to measure various dimensions of under-nutrition (not malnutrition as is mentioned in the book): that is, underweight or BMI and stunting, with insights into their usefulness. It then presents primary data from research done by the authors and their teams on rural-tribal Karnataka schoolchildren in selected blocks of three districts, blending qualitative and quantitative methods. The data relating to undernutrition and its determinants and the food intake (from food frequency method) is especially well presented and discussed. The qualitative focus group discussion data on teachers' perspectives on the mid-day-meal program and the health of school children, makes interesting reading. Another noteworthy aspect is the discussion that goes beyond undernutrition, linking it to its immediate and underlying determinants in the family and community living conditions. There are some important missing pieces I noticed, having worked in the area of school child nutrition for several years. Firstly, as the primary school years cover the period of early adolescence (10 to 13 or 14), when there is the pubertal growth spurt (especially linear growth, known as peak height velocity or PHV), this aspect could have been briefly discussed in one section, namely, why adequate nutrition is critical for normal pubertal growth, how onset of menarche is affected in girls, the "catch up growth" seen in underprivileged young adolescents, prior to onset of puberty, and so on. The school meals, nutrition education, iron-folic acid to school children all these interventions not only enhance growth in all children, but ensure that growth retardation in early adolescence is minimized. Secondly, the important aspect of anemia is not presented or discussed, although anemia is rampant in school children (50-70%) and it affects cognition, learning, and the ability to benefit from schooling. Although passing mention is made of the Weekly Iron-folate Program (WIFS), its strengths, drawbacks, and recommendations, could have been discussed in the section on school health. Thirdly, India is facing the dual burden of malnutrition and the steadily increasing prevalence of overweight in school children and young teens. This has already become a challenge that needs to be addressed before it is too late, even in rural areas where junk food and soft drinks are showing fast penetration. Finally, nutrition education and communication in the school setting is an important but missing intervention in India that needs attention and advocacy, given that school children are a relatively easy-to-reach audience, and receptive to new information and practices.
Assessment: This book fills an important gap in recent knowledge regarding the nutritional status, determinants, and interventions for the school child in India and I recommend it for readers engaged in research and action for strengthening nutrition-health status and educability of the school child.