 Hello everybody, thank you for attending my first session, first part. Now I am going to talk about growth chart a little bit, just a portion not so deep because I will be going deep diving in my last session but I will be discussing about how children grow, what are the standard reference curve as per WHO growth charts and I will also show some of the success stories that we have had, that how just by teaching proper breastfeeding technique mothers can have really good milk transfer from her to the baby and children grow remarkably beautifully, not only on weight and height also. I will be also discussing about some of the data which has come from our projects in urban slum as well as in some of the district like Banaskata district, Sabarkata district and also from our program in urban slums. So thank you so much for watching and I hope you enjoy this session. So basically when you go to a pediatrician and if when you bring your small children what pediatricians they do is they basically plot children's height and weight, if they are small children under 2 years of age they take a length 4-H chart and when they are you know when they are older, older than 2 years they check a height for age, length means they check a length of a child while baby is in the lying down position okay and height is when the you know when children are in the upright position. So here what we are trying to do is you know here we are taking the length of a child because child is under 2 years of age and we are checking the weight okay and then they use this WHO growth chart which I will discuss in detail in my last session but just quickly showing you what kind of growth chart we have. So basically this is the World Health Organization you can see it on the right side corner. So those are WHO growth chart and these are basically standard reference okay what they have there are about 5 lines over here you know 58th percentile, 85th percentile, 97th percentile and this chart is weight 4-H okay and it's for a girl child so that's why it's in pink and color okay on x-axis you have this so you know basically months and year and on y-axis you have weight in kg okay and basically your average children should be on 58th percentile okay so 50% of the children are on this percentile on green line and that's what my target is my target is to bring all these children who are undernourished or malnourished I want to bring them at least to 58th percentile to bring that's my target okay but in that target what happens is so many children they do so beautiful on mothers milk when mothers are taught proper breastfeeding technique and then once they know what food to start at six months of age this children just do amazingly well that they not only they grow in weight but they also grow in lengths okay so this is what my whenever I say the target weight can target weight can I talk about bringing children to 58th percentile okay and this is a weight of the child and this is the age of the child and say what happens is suppose any child who comes to me suppose child is three months old and basically I would plot I would take three months old and then I will look at what is the weight of the child okay and then I plot it okay so this is what I follow and I do recommend all the pediatricians everybody including mothers families you know healthcare workers they have to start plotting this growth chart then only you know how children grow okay so you know that how since first three months children grow very fast okay weight wise they grow almost a kg a month you know and then they slow down okay so if you have slow growth in first three months itself right then you will have underweight remember I mentioned to you in my first slide that you know we have so much of underweight and you know wasting like you know children are low on weight as per height and that's because they are not growing as much as they should in first three months and that's why you sing so much of you know underweight and so much of Sam and all our weight you know standard children are not coming out of malnutrition okay and this is the chart that I've plotted for this particular child so what we are seeing over here this baby has been put in a supine position in a in a lying down position okay and we are checking the length of this child and we're also checking the weight of this child okay and from date of birth we can find out what is the if the child has reached a target or not whether length is okay or not whether height is you know whether weight is okay or not so that's what we are trying to do over here okay and there is a particular way of checking the height and length and that we will I will also mention how to do it okay and then we basically plot this child so whenever I ask this question to any healthcare worker or even doctors that what do you think the weight what do you think the age of this child and they all by and large you know 90% of them they say oh this child looks like a one year old child but no this child is not one year old and look at it this child is only six months old and because mother was taught proper technique look at the weight has gone to maybe like 9.42 kg okay and then as the child is growing beautifully on mother's milk and this is 97 percentile what does it mean it means that baby is growing very beautifully okay and has become big and has gone about 97 percentile okay which is absolutely fine for me because this is breastfed baby now if this baby was on formula feed or on cows milk then I would have been worried because formula milk and cow milk will cause a lot more obesity you know and yeah it will cause under nutrition also but you know if suppose there is no diarrhea or pneumonia you know then this children will become obese and you know they will have issue with the pre-diabetes and diabetes later on okay so if baby is on breast milk then this children are protected from all kind of diseases okay including infections including n-cities non-communicable diseases so I'm not at all worried if child is beautifully breastfeeding and growing well okay now as baby is growing fast okay look at the length look at this only three percent of children are of her or for length okay now in India as I mentioned to you in India what is the issue we have almost 36 percent children who are below third percentile okay below third percentile means only three percent children should be below third percentile but in India we have almost 36 percent children who are below third percentile so this is what we need to change we need to change this you know this narrative that you know Indian children are small and they'll be they are short and you know they're not short they're short because we are not doing the right thing for them okay so look at this child length is 97 percent to learn if she continues to get and so the girl child if she continues to get good nutrition in first six months and of course after that also and if she doesn't get any you know childhood illnesses like diarrhea pneumonia then this child will do very well I mean she will be extremely tall for her for her age and this is what we want because as per latest Lancet article which had come out you know a couple of months a few months ago I would say and that article said that average height of a girl okay 19 year old woman is only five feet in India and the average height of a man is only five four can you I mean this is what I want you guys to understand that why do we have such short people in our country because they are not taking care of in first six months 12 months of age I would say 12 months because you know even if this child is suppose if this child same child you know this is a weight and if this child does not get proper nutrition after six months of age says she gets only watery dal and watery rice and you know hardly anything no protein you know no eggs or no proper thick you know dal then they will not grow they will basically continue on the same weight and eventually they'll come down okay but length takes time so child may become stunted little bit you know kind of they fall on the growth if they don't get enough food okay but as I mentioned that if you can really work hard on mother's breast milk techniques then they children they do pretty well because even after six months of age they continue to get a lot of milk but it's very detrimental to start proper food after six months of age okay so I'm going to show another case study this is a boy child okay look at her eyes you can see her see his eyes mother is looking so happy you know child is look looks pretty tall looks pretty healthy right and if you look at this child eyes are looking so sharp looking directly into the camera this is the beauty of well grown children okay because because the breastfeeding has gone so right and breast milk has so many ingredients which are so important for IQ development for development you know just physical growth for brain development for everything right and you can just make out just looking at the eyes they just look so sharp and very very attentive right this is again the six months old baby child baby boy okay look at the weight 10 kg weight okay now in my WHO growth chart session I will be discussing about the target weight gain okay but if I basically plop this 10 kg for six months old boy child so let's see this is the WHO growth chart okay this is the weight for each chart for boys okay it's a percentile chart means basically tells us the percentile of each child and then basically that where he falls and then basically you know your age and your weight so I plotted the six months old child with 10 kg weight okay and look where look where he is he's above 50 97 percentile which means only three percent children come over here in this area and normally only three percent children should come below but as I mentioned in India we have 36 almost 30 probably with the latest data I would say about 32 percent children one third children are below this third percentile okay so this is important and same child if I plot his length look at the same child as the child has grown beautifully on mother's milk I'm talking about the weight now look at the length look at this child is tall now he's going to be tall there is no doubt about it because whatever length that you have gain you know if you continue to give good nutrition this child is going to keep growing tall and tall you know and if if if you know if there are no other medical issues if there are you know if she doesn't get severely sick with diseases you know then he will become tall okay so this is what I wanted to explain what what needs to be done in India is basically you saw that focus on your node not at only just maternal nutrition but breastfeeding skills and complementary feeding okay now one more thing I wanted to mention over here now again if this child is not supposed not given proper food after six months of age complementary foods then they will not gain weight their muscle will start melting okay and that I will explain in my second session that how this muscle start starts melting okay and once their muscle start waiting they start becoming leaner and leaner and leaner and then the stage comes where they become underweight moderately underweight or severe underweight or you know as per the age so again it's very very important that after you start proper breastfeeding that six months mother needs to know what food to start specifically I focus on protein rich diet okay here so this is the target weight offered basically these are WHO tables that is given on their website WHO website and we have picked up you know WHO table for a male child okay because I personally believe that girls can grow as big as male children okay so if mothers know how to breastfeed that baby at least in first six months I've noticed that they grow as beautifully as boys you know so generally I always talk about the target weight gain for male child and I do kind of expect because I've seen those results in my projects that this children even girls shouldn't should gain that much weight okay so here is the basically Asian weeks so these are basically why first week second week third week fourth week you know and here you see the average weight gain per week okay as per WHO growth chart so here you know you can see that average weight gain in first week is 200 grams now what we are taught in pediatrics that you know first two weeks you know babies don't gain weight and first week by seven days they come back to birth weight and all that but the thing is if you look at WHO growth chart that's not what it suggests what WHO is suggesting is basically baby gain 200 gram in first week okay and in just two weeks babies are gaining 500 gram already by second week of age so and this is when does this happen when mothers are taught proper breastfeeding technique so I really insist that mothers should be taught breastfeeding technique before pregnancy I mean or before delivery so that she understand how to do it and during during delivery time or maybe just immediately after delivery you know that baby needs to come on mother's breast so that they can learn how to latch and then for two days while mother is in the hospital you know you need proper guidance to teach her how to breastfeed okay and then you can see like literally by four weeks child has already gained 1100 grams do you see over here so by four weeks not even one month complete so this is what my target weight gain is okay and if you're doing really well you will see that this children grow not just 1.1 kg you know in first month but sometime they grow 1.5 kg and I've seen that in my low birth with babies also okay and if you look at the weight gain per day see look at the weight gain you know when I talk to again all the healthcare workers their weight gain target is just 15 to 20 grams okay 15 to 20 grams that's it their weight can target per day and look at the weight can target which is recommended by WHO look at this okay you cannot have just if your baby needs to be gaining 42.8 grams per day then if you expect only 20 gram weight gain then right then three months your baby will become malnourished okay so please understand that the this is a weight gain per day this one is weight gain per week and this is your weight kg you know what what will be the expected weight you know at first week second wing and this is in babies who are born 3.3 so babies who are not born 3.3 kg because that's the average birth weight of a boy child okay so if that is not happening then you what you will see is that then those babies need to catch up very fast and what have again experience in my projects that if it's low birth weight babies if they are again taught proper techniques they are gaining much higher weight than even average babies normal babies okay so please focus on the technique of breastfeeding okay so these are some of the growth charts you know which we have tracked on child growth records app which I will discuss in my last session okay and here this are basically z score chart again that I'll discuss in our presentation in the last session so here what has happened that this baby is has come just 1.8 kg at birth and then for first two and a half months mother's mother didn't know how to breastfeed so you can see there's hardly any weight gain do you see there is no catch up at all whatsoever now I would have expected a lot of catch up growth in first one month two months right but here because mothers didn't know proper technique you know that growth growth is not there but as soon as at two and a half months one of our student held mother you know how to breastfeed this was a male student actually in fact you know and he taught this mother using the using our health spoken tutorial and look at the weight catch up right and this is the mother from slums of Bhuneshwar Odisha and so this is this is our result okay and same thing it's a similar kind of baby born small you know less than 2.5 kg but basically this mother was taught breastfeeding technique right at birth okay so when when she knew that technique at birth look at the catch up growth right from from minus 2.5 minus 2.5 standard deviation as jump to mean okay mean is where the 58 percentile is okay so that's our goal so within two and a half months this baby reached the 58 percentile and look at this child struggling to get into you know 58 mean or even the last line just because child mother was taught much later okay so we don't want this because this is what happens in all most of our children if they are not supported mothers are not supported there is tremendous amount of growth failure you know and then there is no growth catch up and this children then they suffer because you know that weight gain in first three four months are very important because that will improve their IQ level later on and this children they don't do you know if they don't reach their mean they don't do well physical growth also so they are small and this children have high risk of developing metabolic diseases later on okay so here it's the same child that I explained earlier now eventually you know you can see the child has is reaching the you know minus 2.5 deviation deviation standard deviation and then you know eventually this child will come slowly and steadily because of course it's it's chronic malnutrition for almost two and a half months so this child will reach you know at least a tenth percentile in next probably two or three months or so so this is water this is our case study okay coming from slums of orisa okay now this is another case study where you can see that this is the in fact my case study in urban slums of Mumbai where you know this this is wait for age okay and this is wait for length chart okay so here age I saw this baby at one month of age and baby's weight was 3 kg so was born pretty good size okay in slums but because there was no support look at how that weight went down so at one month this baby fell to almost 2.5 kg so lost about 500 grams in first one month can you imagine now if we had not seen this baby would this baby would have died of diarrhea or pneumonia or any of this because how long can baby survive without proper latching right proper milk transfer so fortunately we we saw this baby as soon as we saw we taught mothers proper breastfeeding technique and then see babies going up you can see you know now goal is to bring this baby to you know to 58 percentile which is your you know average okay now if you look at the wait for length child in this child okay so we also check the length and we wanted to see where was that baby's weight as per length okay and because it was early on you know length was still okay but look at this weight so basically baby was Sam so we could malnutrition which I will discuss in other sessions what is Sam what is ma'am and then you know just in the matter of two weeks the child came from Sam to average just in a matter of two weeks this is what I mean is you know the conversion of Sam to normal is so fast in babies when they come early in your in your intervention okay more you wait harder it becomes for baby to come out of acute malnutrition okay so this is this is the this is a slide on that okay now this is some of the other growth charges I wanted to show because it's all longitudinal growth chart when I was working in urban slums of Mumbai okay so this again percentile growth chart you can see five lines over there you know 97 percentile 85 percentile 58 15 third okay so this child basically this is weight for each chart and this is length for each chart for the same child okay so this child was basically born not so bad urban slum so was born at around 80 15 percentile okay and then length was basically average so about 58 percentile okay so as baby was growing in weight you can see how fast baby is growing this is all only on mother's milk okay see how how catching up is occurring even if baby is born you know not so bad okay 15 percentile but look at the weight going up right and as the weight is going up you can see the length picking up okay so length picked up at almost seven months baby became almost 97 percentile okay and then then as baby was on that after seven months probably mother started complimentary food as per our advice you know so weight continued to stay on 85 percentile and the length basically is also an 85 percentile so if you now plot this child's graph for length for weight this child will have perfect BMI because child is tall so tall children will be bigger okay remember I don't want a short child to be bigger short child if they are bigger or they are heavier those children have a high risk of metabolic diseases here we are talking about BMI okay so in this child although he's heavy but he's tall so so this child imagine coming from urban slum you know like I would say the poorest quintile as far as well well cause and you know this child is doing amazingly well and he will definitely do well in school also because look at the weight you know length and weight increment or catch up growth you know okay now this was about just different growth charts individual child okay now I want to discuss some of the data from one of the NGO that you know we were working in basically I was a founding medical director of this NGO foundation for mother and child health and we had started this NGO in 2007 okay and in that NGO I stayed for almost till 2017 and over a period of time we saw thousands of children you know and we learned a lot from the children how they grew what was working what was not working you know because we had very sophisticated software program to monitor the children coming from US for that it was very very important for me to to plot all these children you know on digital graphs all the digital data because you know I was not used to writing anything on the paper whatever in US we did we did everything on the laptop or on the computer or on the phone especially we had computer in each and every room where we would see you know all these children okay so we did similar kind of data collection in a software which was customized for this for this program so what happened is first six seven years we were not seeing results okay so we were not seeing results in a sense should babies were not gaining good amount of weight babies were not developmentally doing too well you know even after six months in spite of telling them they were not gaining length also you know and weight also so those seven eight years was learning period for us okay once we figure out whether problems were we tried to get the solution okay so there was a lot of solutions that we worked on and this all kind of hands-on solution which came from learning from the field okay we did not want to start formula we did not want to start cow's milk you know even if babies didn't gain weight initially what we were doing we were kind of telling we felt that mothers are not listening so we kind of kept blaming mothers but that was not the case and then we started reflecting that whatever we are saying to mothers whether that is effective or not and we realized it was not you know so once we fix those loop holes once we fix those issues then we were just starting amazing results and this is so then after seven eight years we said we need to now document all this children's data perfectly and we should basically see how the children do after one year of intervention after two years of intervention the reason we did one year of intervention because many of the children we worked in Dhobi Ghat area and in many of this many of the children were basically migrated from UP and Bihar for just for say maybe six months one year because you know the fathers came as Dhobis in this area and they would go back again in a year time you know so we took about 286 children and we took only those children who came to us under two months of age because we wanted to see how did the children do when they came very early on remember I told you that we will be able to you know give very good results if they came early on okay so we took only those two it is we took all the children who were under two months of age okay we did not leave any child of course we had many many children who came about two months of age also but again you know we just wanted to see the effect when they came early on so here this was effect we had basically a 286 children who came between 2013 to 2016 okay and this was the data that we present in a world press meeting conference and here what we are seeing is the children who were severely wasted at the time of admission we could decrease this the severe wasting or we call it SAM severe good malnutrition by 66.7 percent okay and overall wasting overall malnutrition we decreased by 16.7 okay severe no weight decreased by 67 percent which is remarkable okay under we decreased by almost 50 percent okay but most remarkable thing was about stunting so you know right now government has this mission to decrease stunting by 2 percent every year okay but look at the stunting we reduced in just one year 18 percent so imagine if we have this kind of protocol of framework that we use in a program imagine what result it would bring in India you know and this is in one year of age and I wanted to I mean many children moved back to UPPR because most of them had come from that area but some of the children continued coming till two years of age so I wanted to see what happened if the children continue to come till two years of age okay so there was a significant reduction of malnutrition at the end of two years okay so the severe wasting reduced by 40 percent okay wasting basically wasting increase and I'll tell you why wasting increase I'll come back to that severe underway to decreased in this 80 children who came up to two years of age by almost 50 percent underway decreased by 33 percent and severe stunting decreased by 50 percent look at the severe stunting reversal 50 percent that's remarkable okay and you're even just a regular stunting decreased by 28 percent okay now again so two years so government plan is to decrease stunting by like by four points like four percent right but like you know say like four points but here we could decrease in two years we could decrease from 40 to 28 that's almost 12 points okay that's reduction of 28 percent stunting the reason we had increase in wasting and this is kind of shown in many other studies that when children grow tall okay when they start growing tall lot of time what happens that whatever nutrients they are eating they are going into their height development in the growth development you know and they then the height grows much faster than the weight okay and that's why a lot of the children they kind of stayed under weight you know not necessarily Sam because Sam children came out of many children came out of Sam but some of the children they kind of they were lean and tall you know but this children I was not worried at all because you know they were growing tall they had no infection they were doing well you know developmentally they were doing well so this is what I want to explain that you know it's important that you know we look at wasting more in a holistic way not just point blank that oh my god wasting increased okay wasting increased because children were getting taller now this is another learning for us you know what I would recommend is that when children are gaining fast when they're gaining height fast I would like to give them lot more energy but not in the form of carbohydrate okay because when you give too much of carbohydrate in this children we have a risk of metabolic diseases in this children and NFHS 6 data NFHS 5 data shows that that you know this children are becoming much bigger and there's a risk of metabolic diseases okay so I would give them a lot more fat which are good fat which will give them energy and that the protein will be used for you know other functions okay so this was our data from one of the project in urban slum now that was data from urban slum I also want to discuss we did one case control study in Banaskata district because it's one point one thing that you know you show results in one small slum community okay where you have a doctor you have a nurse when you have nutritionist you have field workers social workers so there's it's like a lot of resources are required to take care of that child right but we wanted to see that if we strengthen government infrastructure okay then what would happen what would happen if you have amazing strengthening of the government infrastructure how would that translate to so Banaskata district this was the data initial data comparing NFHS 4 versus NFHS 5 data okay here what we are showing is that there was a reduction in you know first hour breastfeeding from 49.6 to 47.9 exclusive breastfeeding rate went up from 47 to 57.5 percent okay basically you know frequency of breastfed child was basically I would say now this is adequacy of breastfed child went down from 7.7 to 4.5 percent and adequacy in all children including breastfed and non breastfed I'm talking about the complementary feeding it went down from 7.6 percent to 3.8 percent so obviously the complementary feeding you know was not they were not doing well in terms of complementary feeding okay and here this is the data from different you know areas okay so our talukas so america data these are the different talukas of you know your Banaskata and this was again NFHS 4 and NFHS 5 data of nutrition indicators okay so you can see stunting went down just a little bit not too much your you know your wasting uh wasted children like severely malnourished children went same there is no change in it okay this is your probably under wasting data not severely wasted but just regularly wasted children uh so it includes both moderate and severe okay and here you can see basically wasting went up but look at the underweight okay underweight went up too okay so this is the issue so we had started the study in uh 2020 uh around November time and this was the data which had which was collected for NFHS 5 during November 2019 so we started the study with this kind of background okay uh it was a you know basically quantitative analysis it was experimental initially we had started as a randomized control trial but we had to switch to case control for some administration in his administration issue okay and then basically we did randomized trial of intervention and non-intervention group and we took about 20 PhD uh and each PhD had about 16 mothers you know uh 15 to 16 mothers and uh basically we had 280 mothers uh from uh actually it was yeah so 218 mothers from each PhDs uh so what we did basically I'll tell you about the intervention non-intervention group so in an intervention group what we did we asked mothers to come during uh you know during pregnancy now during pregnancy we taught this mother's proper breastfeeding technique so we showed them four tutorials okay what are those four tutorials during that time we had cross cradle hold we had latching we had sideline hold and we had a laid back hold uh actually in in Banaskata we had uh physical methods to increase breast milk supply so this are some of the tutorials that we showed you know uh in ANC time and then during PNC time when mother delivered we immediately did uh one hour breastfeeding and we also did uh you know uh kind of live demonstration of how to breastfeed the baby okay so they were taught the 45 points of counseling okay and then uh this was a number of boys and girls so 273 children in boys and 259 uh girls okay so total of 532 now this was the data here this is what I want to show you so basically the you can see here this are boys and girls combined here only boys so this is your uh intervention I mean at birth and this is at closing visit at six months okay so this is uh intervention this is non-intervention this is intervention non-intervention this is intervention non-intervention okay so this is what uh we can see that uh you know babies who are in non-intervention area okay they had lot more growth faltering so you can see the underweight went up to from 10.4 to almost 18.10 so almost basically you know it was kind of uh 1.7 time increase and uh growth faltering okay they became underweight in non-intervention group here in boys you know we could decrease some amount of malnutrition uh in intervention group but look at this non-intervention group you know uh it got worse okay similarly in girls unfortunately in girls uh you know we still have this issue of girl child you know not been taken care of in Gujarat so you can see that girl children in intervention group did not do well you know they had some amount of growth faltering but look at the growth faltering occurring in uh non-intervention group on a 2.3 time increase in faltering in those girls okay uh we also need to see prevalence of moderate underweight so that was uh basically your underweight now we want to see uh moderate underweight mu w okay where where they you know their weight falls between minus two minus six hundred deviation so everywhere you can see uh you know there is a growth faltering occurring much more in uh non-intervention group uh same thing for girl children in intervention there was some amount of faltering in uh girl girls uh cohort okay uh this is for stw see if we are underweight uh you know look at the difference now as babies are growing small our babies are born small you know uh and if those babies are not taught proper latching and look at the growth faltering occurring tremendous amount of growth faltering occurring you know uh when boys as well as girls okay and this is what we need to stop uh this is the prevalence of wasting okay wasting means i told you too thin too thin for height or length okay so again this is all six with uh six weeks visit so at uh six months i would say uh like a closing visit so in uh six months these are boys and girls you can see uh you know the at the end of the study in intervention group there was 14.6 percent uh wasting and in non-intervention group there was 25 percent of wasting so similarly in all age group you know uh in not all age group but in all different uh kind of boys and girls there was a tremendous faltering uh of uh when it comes to wasting okay so children were becoming more wasted in uh uh non-intervention group so non-intervention group what we did basically we just continued what what it is done at the government level at government level mothers are not brought during uh pregnancy time to teach them on complete i mean on uh cross cuttle hole or any of those breastfeeding skills uh they are not being supported as much which they should be uh healthcare workers have no clue how to uh lash the baby so in those all those uh we can like we just continued same what it was the standard of care uh but our uh you know in our intervention group we did everything whatever that helped needed to the mother just to learn the proper technique okay and then we follow up these babies on a weekly basis till six months of age okay so this was another result from the last city palghar okay and then there were 500 healthcare workers were trained from 2016 to 2019 and you can see this is the last city we did the training and you can see much better results than other uh you know um other blocks uh that children were doing you know children were breastfed at birth children uh exclusively breastfed you can see all green uh yes they still need some amount of training more training on dietary diversity uh but otherwise you learned it pretty well uh when it came to you know IYCF okay and this was done uh almost four four five years ago and we continued kind of training them on a regular basis another thing is we also had done much uh saberkata uh district training and we had implemented this latching project uh in all the phcs of saberkata saberkata is another district in gujarat okay it's the second biggest district uh after banaskata banaskata is the biggest district and uh what we saw the result of that actually there was no other program going on you know we did not even focus on complementary feeding latching was the first project actually so just by focusing on latching latching means the proper breastfeeding technique how bb latches on to mother's areola uh we could see the reduction of stunting by 13.6 percent in nfhs5 data okay so uh nfhs5 data which came out saberkata uh we saw tremendous reduction of stunting okay that's all because and initially the saberkata district had 51 percent stunting rate as per nfhs4 so uh you know dho confirmed that this was the only program which was going on uh so if you look at the nfhs5 data for saberkata nfhs5 actually the minimum adequate diet is only 3 percent okay so we did not focus on those diet at all so if we had focused on complementary feeding if we had focused on mother's nutrition this this reduction would have been remarkable it would have gone up to 25 to 30 percent reduction in just maybe one year okay because we continue this project basically from 2018-19 okay and uh and there was a i wise i mean nfhs5 uh you know survey was done in November 2019 November December okay so it was just basically result of one year of intense latching uh project you know in that in that district so i think we can do much better in india okay so i'm going to end my presentation over here uh thank you for watching this uh part two of my first session and uh i'm sure you kind of understood how children grow you know how they do and uh i'm sure it must be really heartening to see those you know healthy babies baby stall babies you know and looking so beautiful and bright um you also must have seen our data you know coming from uh urban slum to like a small community versus you know different blocks and district level and hopefully now we will see data in nfhs6 for gujarat because you know we have already started working on this different breastfeeding techniques and complementary foods and maternal nutrition so i'm looking forward to that data coming in nfhs6 for you know for gujarat now third session i'll be discussing about the framework okay so what worked in a program so i'll see you then thank you