Integrating MIYCN into medical college curriculums to address knowledge and practices gaps in India

At nine colleges in two states in India, faculty in medical colleges are learning how to better integrate maternal, infant and young child nutrition (MIYCN) practices into the undergraduate curriculum with Alive & Thrive support. The program is aimed at better equipping students to help pregnant mothers and young children in the future.
Faculty, doctors, senior residents, junior residents, interns and staff nurses at a two-day training at Government Medical College, Kannauj, Uttar Pradesh.

Emphasizing the importance of proper nutrition practices is a key learning initiative for faculty at the colleges, said Dr. Sebanti Ghosh, Country Program Director for Alive & Thrive India who has over 20 years of experience in the health, nutrition and development sector across India and South Asia.

“It was hands-on, sitting together with the faculty and some national experts, and we worked out this integrated curriculum using the existing approved format and a facilitated guide so the faculty can teach this integrated curriculum in a standardized manner,” Ghosh said. “This then got endorsed through the State Medical Education Directorate and the Health Department and we are now orienting all of the faculty in the colleges on this curriculum.”

The program is now reaching 500 faculty at the nine medical colleges located in Bihar and Uttar Pradesh states. Ultimately, they in turn will reach 1,100 students who are admitted to the colleges annually.

The program started with a 2017 baseline assessment of knowledge and practices around MIYCN. The assessment sought to evaluate: the degree to which MIYCN is addressed in the pre-service curricula of medical colleges; the degree to which MIYCN interventions are included in the routine delivery of services offered by the departments of Obstetrics and Gynecology, Pediatrics and Preventive and Social Medicine; and, medical colleges’ contributions to research, planning, implementation and monitoring of MIYCN programs.

Early Initiation of Breastfeeding being practiced in C-Section delivery in Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar. Photo Credit: SKMCH, Muzaffarpur.

The assessment had several findings:  first, among students – including undergraduate, post-graduate and nursing students – knowledge was lacking, especially knowledge on dosage of iron folic acid (IFA) and calcium tablets and diet diversity of pregnant women. However, most students were aware of early and exclusive breastfeeding, and there was a high rate of knowledge of breastfeeding during illness for 0 to 6-months-old infants.

Among department heads and teaching faculty, the survey found that 49% believed infant and young child feeding (IYCF) was adequately covered, while only 40% thought that maternal nutrition was adequately covered.

Knowledge among nursing staff from the OBGY department on maternal nutrition interventions was low overall and awareness about iron folic acid and calcium supplementation was below 20%. Knowledge of recommended weight gain and minimum diet diversity during pregnancy was below 40% among the nursing staff.

Further, the assessment found that research on MIYCN remains a neglected area: Only 23% of surveyed teaching faculty had published any paper on MIYCN topics in the last two years and only 25% of the post-graduate students presented their research at conferences or published it in journals.

Ghosh said maternal infant and young child nutrition was not well prioritized in the curriculum.

“There were missing components and the teaching was often not very standardized,” Ghosh said.

Creating a strategy  to work with faculty and national experts, the program seeks to prioritize the topics that have not been adequately covered, Ghosh said.

She said there were clear learning gaps among the students, which the program seeks to remedy through hands-on and coordinated, integrated learning across Pediatrics, Gynecology & Obstetrics and Community Medicine.

A&T will advocate  to scale-up the program across all medical colleges in Bihar and Uttar Pradesh as well as other states with government and partner support.

The nine colleges taking part in Bihar and Uttar Pradesh states include: GSVM Medical College, Kanpur; BRD Medical College Gorakhpur; MLN Medical College, Allahabad; and Government Medical College, Kannauj in Uttar Pradesh. In Bihar, the colleges are: Patna Medical College, Patna; Sri Krishna Medical College, Muzaffarpur; Darbhanga Medical College, Darbhanga; Anugrah Narayan Medical College, Gaya; and AIIMS, Patna.