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National Nutritional Programmes
Presenter: Dr. Preetham M
Major health problems in India
1. Communicable diseases
2. Population
3. Environmental sanitation
4. Medical care
5. Nutritional
1. Nutritional anemia
2. Iodine deficiency disorders
3. obesity
Major nutritional problems in india
Cont..
4. Protein energy malnutrition
5. Low birth weight 6. Xerophthalmia(dry
eye) 7. Cancer8. Lathyrism 9. Flurosis
Cause of Nutritional problem
POOR NUTRITION• UNDER NUTRITION (MALNUTRITION)• OVERNUTRITION
Factors affecting nutritional status
Cont.. In the last five decades, the mortality rate has come
down by 50 percent and the fertility rate by 40 percent but the reduction in under nutrition is only 20 percent.
Around half of the pre-school children still suffer from under-nutrition.
Micronutrient deficiencies are widespread; More than half the women and children are anaemic; Reduction in Vitamin-A deficiency and iodine
deficiency disorders (IDD) is sub-optimal.
The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition
Under nutrition is found mostly in rural areas Under privileged section of the society like urban
slums, rural, and tribal are worst affected by malnutrition particularly pregnant and lactating women and children are at a higher risk
Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as
diabetes and cardiovascular disease), and longevity.
Healthy children learn better. People with adequate nutrition are more productive and can create opportunities to gradually break the cycles of poverty and hunger.
Malnutrition, in every form, presents significant threats to human health.
About 165 million children globally are stunted, according to 2011 figures, resulting from not enough food, A vitamin- and mineral-poor diet, inadequate child care and disease.
As growth slows down, brain development lags and stunted children learn poorly.
Wasting and bilateral oedema are severe forms of malnutrition - resulting from acute food shortages and compounded by illness.
Rising food prices, food scarcity in areas of conflict, and natural disasters diminish household access to appropriate and adequate food, all of which can lead to wasting.
Essential vitamins and minerals in the diet are vital to boost immunity and healthy development.
Maternal undernutrition.
Nutritional problems in adolescents start during childhood and continue into adult life. Anaemia is a key nutritional problem in adolescent girls.
Preventing early pregnancies and assuring adequate intakes of essential nutrients for developing girls can reduce maternal and child deaths later, and stop cycles of malnutrition from one generation to the next.
What are Community Nutritional Programmes..?? They are the large scale supplementary
programmes
Main aim is to improve nutritional status in targeted groups
To overcome specific diseases through various ministries to combat malnutrition
Government’s role in nutritional programmes
Cont…
Ministry of Health and Family Welfare Ministry of Social Welfare Ministry of Education and Culture Department of Food in the Ministry of Food
and Agriculture Ministry of Rural Reconstruction
History of nutritional programmes in india
Special nutrition programme for pre-school children and expectant and nursing mothers.1970-71
Balwadi nutrition program(1970)
Applied nutrition programme(1963)
Cont…
National goiter control programme (ngcp)1986
National water supply and sanitation programme (1954)
Minimum needs programme(1974)
Cont…
20 point programme 1975
National diarrhoeal diseases control programme(1981)
Cont…
Tamil nadu integrated nutrition programme (1980)
Wheat based supplementary nutrition programme (1986)
Present nutritional programmes
Programmes Ministry
Mid Day Meal Scheme Human ResourceDevelopment
Vitamin A Prophylaxis Programme Prophylaxis Against Nutritional anaemia. IDDs Control Programme.
Health and family welfare
Special Nutritional Programme Balwadi Nutritional Programme ICDS Programme
Social welfare
Mid Day Meal Programme Education
Interventions will be initiated to achieve:
Adequate availability of foodstuffs by:1. Ensuring production of cereals, pulses and
seasonal vegetables.2. Making them available throughout the year.3. More cost-effective and efficient targeting of
the PDS.4. Improving people's purchasing power through
appropriate programmes including food for work schemes.
Prevention of under-nutrition through nutrition education aimed at:
1. Ensuring appropriate infant feeding practices
2. Promoting appropriate intra-family distribution of food based on requirements;
3. Dietary diversification to meet the nutritional needs of the family.
Operationalising universal screening of all pregnant women, infants, preschool and school children for under-nutrition and nutritional intervention
Research efforts will be directed towards: Review of the recommended dietary intake of
Indians; Building up of epidemiological data on:
▪ Relationship between birth weight, survival, growth and development in childhood and adolescence;
Body mass index norms of Indians and health consequences of deviation from these norms.
Vitamin A Prophylaxis Programme
Cont…
Cont…
Initiated in 1970 Age group 6 months-6 year Priority to Vitamin A deficient geographical
area OBJECTIVE Prevent blindness due to Vitamin A
Deficiency ORGANIGATION PHC and subcenter
Cont…
Beneficiary group preschool children(6 months to 6 years)
A single massive dose of oily preparation of Vitamin A 200,000 IU (retinol palmitate 110mg) orally every 6 months for every preschool child above 1 year
half the amount in < than 1 year children
April 18, 2023 JLNH&RC
Prophylaxis against nutritional anaemia
Cont…
Pregnant woman <11 gm/dl non pregnant woman <12gm/dl Initiated in 1970 Centrally sponsored Over 85%pregnant woman suffer from
anemia (health and family welfare official site)
Causes LBW and perinatal mortality
OBJECTIVE1. Assess prevalence 2. Give anti anemic treatment3. Give prophylaxis4. Monitoring5. Education
BENEFICIARIES Children age group 1 to 10, Pregnant and nursing mother, Acceptors of family planning, Adolescent girls.
ORGANIGATION PHC and sub centers
Cont..
Pregnant women : 100 mg Fe & 0.5mg folic acid
Children 6 to 60 months : 20mg Fe & 0.1 mg folic acid Should be given 100 days
6 to 10 years of age : 30 mg iron and 0.25 mg folic acid
Adolescent girls : 100 mg Fe & 0.5mg folic acid Iron fortification in salt Screening test for aneamia done at 6 months,1 and 2 years of
age.
Iron Fortification Developed by National Institute of Nutrition,
Hyderabad
Addition of ferric ortho phoshapte or ferrous sulphate with sodium bisulphate was enough to fortify salt with iron.
When consumed for 12-18 months – reduce prevalence of anaemia.
Commercial production since 1985.
Iodine deficiency
Effect on people : HUMANS Health & Socioeconomic impact
Effect on animals : LIVESTOCK Clinical & Reproductive disorders,decreased productivity
Low Availabilityof iodine : PLANTS Iodine poor feeds &
fodders
Soil Erosion : WATER, SOIL Environmental iodine deficiency
Iodine Deficiency – A Disease of The Soil
Brain Cell Growth
Iodine Deficiency Iodine Sufficiency
Iodine Deficiency is the single most
common cause of preventable mental retardation
JLNH&RC
Iodine Deficiency = Goitre = Visible Swelling
No Pain = Not a cause of Mortality = Cosmetic problem
Cretinism rare
IDD – The Hourglass
Historic View
Current View
Mental & Physical growth
Loss of Energy-hypothyroidism
Learning Disability, Poor Motivation
Child Development and Child Survival
Human Resource Development
Iodine deficiency disorder control programme
National goiter control programme was started in 1962
Renamed it on 1992 as
National iodine deficiency disorder control programme
Replace the entire edible salt by iodide salt
Double fortification of salt iodine and iron (35ppm and 1000ppm)
Objectives
1. Surveys to assess the magnitude of the Iodine Deficiency Disorders
2. Supply of Iodated salt in place of common salt.
3. Re-survey after every 5 years to assess the extent of Iodine Deficiency Disorders and the impact of iodated salt.
4. Laboratory Monitoring of Iodated Salt and Urinary Iodine Excretion
5. Health Education & Publicity
Applied nutritional programme
This project was started in Orissa on 1963 Later extended to TN and UP. Objectives:
Promoting production of Vegetables and fruits Ensure their consumption by pregnant & lactating
women and children. In1973 it was extended to all states of INDIA The idea is to provide better seeds and encourage
kitchen gardens, poultry farming, beehive keeping, etc.,
Major components
Nutritional Services Health services Communication Monitoring and evaluation
It is being merged into ICDS
Special Nutritional Programme This was started in 1970 is in operation in urban
slums, tribal areas and backward rural areas.
It was launched under minimum need programme Main aim is to improve nutritional status in
targeted group.
Beneficiary group children below 6 years pregnant and lactating women
Cont…
Child : 300kcal and 10-12gm protein
pregnant :500kcal and 25 gm protein
Total of 300 days in a year This programme is gradually being merged into
ICDS
Balwadi Nutrition Programme
The Department of Social Welfare has a scheme to provide the nutritional services for children in the age-group 3-5 years provided through Balwadies.
What does BALWADI mean? A place where, the children in the age group
of 2 ½ to 5 years receive pre- primary education.
The balwadi teachers are usually local women.
Besides the education and recreational activities there are other regular programmes such as monthly meetings of the parents in which the parents are educated about childcare, health and nutrition etc.
There are regular medical health checks up.
Other cultural programmes which the balwadi children celebrate are Independence Day, Children’s Day, Teachers’ Day,etc. Also, every year a Sports Day is held and in some areas children are taken out on annual picnics.
Once the children reach the age of 5, they can be admitted to schools.
This programme was started in December 1970.
It gives the provision of supplementary nutrition of 300 calories and 10 grams of protein during 270 days in the age group of 3-5 years in a year for children attending Balwadis.
This program is being phased out due to universalisation of ICDS.
Integrated Child Development Services (ICDS) Scheme
Cont..
Launched on 2nd October 1975. ICDS Scheme represents one of the world’s
largest and most unique programmes for early childhood development.
India’s response to the challenge of Providing pre-school education on one hand and Breaking the vicious cycle of malnutrition, morbidity,
reduced learning capacity and mortality, on the other. ICDS is the foremost symbol of India’s
commitment to her children.
Purpose for Initiation
1. Routine MCH services not reaching target Population
2. Nutritional component not covered by Health services
3. Need for community participation
Objectives:
1. To improve the nutritional and health status of children in the age-
group 0-6 years;
2. To lay the foundation for proper psychological, physical and social
development of the child;
3. to reduce the incidence of mortality, morbidity, malnutrition and
school dropout;
4. To achieve effective co-ordination of policy and implementation
amongst the various departments to promote child development; and
5. To enhance the capability of the mother to look after the normal
health and nutritional needs of the child through proper nutrition and
health education.
Beneficiaries of ICDSChildren < 6 years
April 18, 2023
Pregnant Woman Lactating women
Adolescent Girls
Women in Reproductive age group (15-44)
Children below 6 years
Services:
The above objectives are sought to be achieved through a package of services comprising:
1. Supplementary nutrition, 2. Immunization 3. Health check-up 4. Referral services 5. Pre-school non-formal education and 6. Nutrition & health education.
Services and beneficiariesServices Target Group Service Provided by
Supplementary Nutrition
Children below 6 years:
Pregnant & Lactating Mother (P&LM)
Anganwadi Worker and Anganwadi Helper
Immunization* Children below 6 years:
Pregnant Women
ANM/MO
Health Check-up* Children below 6 years:
Pregnant & Lactating Mother (P&LM)
ANM/MO/AWW
Referral Services Children below 6 years:
Pregnant & Lactating Mother (P&LM)
AWW/ANM/MO
Pre-School Education Children 3-6 years AWW
Nutrition & Health Education
Women (15-45 years), Children 3-6 years
Pregnant & Lactating Mother (P&LM)
AWW/ANM/MO
Supplementary Nutrition
This includes supplementary feeding and growth monitoring;
Growth Monitoring and nutrition surveillance are two important activities that are undertaken. Children <3 years of age are weighed once a month children 3-6 years of age are weighed quarterly
They avail of supplementary feeding support for 300 days in a year.
Immunization: Immunization of pregnant women
and infants protects children from six vaccine preventable diseases-poliomyelitis, diphtheria, pertusis, tetanus, tuberculosis and measles.
Immunization of pregnant women against tetanus also reduces maternal and neonatal mortality
Health Check-ups
This includes health care of children less than six years of age, antenatal care of expectant mothers and postnatal care of nursing mothers.
Recording of weight, immunization, management of malnutrition, treatment of diarrhoea, de-worming and distribution of simple medicines etc.
Referral Services:
During health check-ups and growth monitoring, sick or malnourished children, in need of prompt medical attention, are referred to the Primary Health Centre or its sub-centre
Non-formal Pre-School Education (PSE)
Anganwadi – a village courtyard. Its for the three-to six years old children and is directed towards providing and ensuring a natural, joyful and stimulating environment
PSE is considered the backbone of the ICDS programme.
Nutrition and Health Education
It is a key element of the work of the Anganwadi worker.
This forms part of BCC (Behaviour Change Communication) strategy
Scheme for Adolescent Girls (Kishori Shakti Yojna)
There was a gap in between women and child age group which was not covered by any health and social welfare programme whereas girls in this crucial groups need special attention.
Their needs: appropriate nutrition, education, health education, training for adulthood, training for motherhood, etc.
This scheme for adolescent girls in ICDS was launched by the Department of Women and Child Development, Ministry of Human Resource Development in 1991.
Beneficiary : All adolescent girls in the age group of 11-18 years (70%) received the following
Common services: 1. Watch over menarche, 2. Immunisation,3. General health check-ups once in every six-months,4. Training for minor ailments, 5. Deworming, 6. Prophylactic measures against anemia, goiter, vitamin deficiency, etc. and7. Referral to PHC. District hospital in case of acute need.
The ICDS team
Child Development Project Officers (CDPOs) District Program Officers (DPOs) Anganwadi Workers Anganwadi Helpers Auxiliary Nurse Midwife (ANM) Accredited Social Health Activist (ASHA)
Anganwadi worker (AWW)
1. Monitor growth of children,2. Provide non formal pre-school education,3. Provide supplementary nutrition4. Give health and nutrition education5. Referral for sick children6. Elicit community participation7. Provide health service in collaboration with
ANM/ASHA8. Implement adolescent girls’ scheme
Role of AW helper
1. To cook and serve the food to children2. To clean the Anganwadi premises daily and
fetching water.3. Cleanliness of small children.4. To bring small children from the village to
the Anganwadi.
Role of ASHA
1. Awareness generation2. Counsel women3. Community mobilization4. Escort/accompany pregnant women & children
requiring treatment5. Provide primary medical care
Role of ANM
1. Hold weekly / fortnightly meeting with ASHA 2. Participate & guide in organizing the Health Days
at AWC3. Utilize ASHA in motivating the pregnant women
and married couples 4. Guide ASHA in motivating pregnant women for
full ANC5. Educate ASHA on danger signs of pregnancy and
labor
Role of Health Department
Health Check-ups Handling Referral Immunization Nutrition & Health Education Monitoring of Health components
Anganwadi Centre
Population Norms: For Rural/Urban Projects
400-800 - 1 AWC
800-1600 - 2 AWCs
1600-2400 - 3 AWCs
Thereafter in multiples of 800 1 AWC For Mini-AWC
150-400 -1 Mini AWC
For Tribal /Riverine/Desert, Hilly and other difficult areas/ Projects
300-800 - 1 AWC For Mini- AWC
150-300 1 Mini AWC
At present there are 5659 ICDS projects.
Supplementary Nutrition per Day
Beneficiary Pre-revised Revised w.e.f. Feb. 2009
Calories (KCal)
Protein (G)
Calories (KCal)
Protein (Gm)
Children (6-72 months)
300 8-10 500 12-15
Severely malnourished children (6-72 months)
600 20 800 20-25
Pregnant & Lactating 500 15-20 600 18-20
Revised financial norms for food supplement
Category Pre-revised
Revised w.e.f June 2010
Children (6-72 months)
Rs. 2.00 Rs.4.84
Severely malnourished children (6-72 months)
Rs. 2.70 Rs.5.82
Pregnant & Lactating Rs. 2.30 Rs.6.00
International partners
United Nations International Children’ Emergency Fund (UNICEF)
Cooperative for Assistance and Relief Everywhere (CARE) World Food Programme (WFP)
Mid day meal programme(1961)
Cont…
Major Objective:1. Improve the School attendance2. Reduce school drop outs3. Beneficial impact on Childs nutrition
Principles 1. Supplement, not substitute to home diet 2. 1/3 total energy requirement/day and ½ total protein requirement /day 3. Reasonably low cost 4. Easily prepared at schools 5. As for as possible locally available food 6. Change menu frequently
Mid-day meal scheme (1995)
Cont..
Also called as National programme of nutritional support to primary education
Hot and hygienic cooked meal is provided to all the children studying in classes 1 to 10 in the Government and aided Primary and high Schools all over the State.
JLNH&RC
Cont..
• Objectives:
1. To ensure enrollment of all children of school going age.
2. To enhance retention rate.
3. To facilitate academic excellence.
4. To improve child health and increase nutrition level. (350
to 500 kcal and 8-12gm protein)
5. To bring social equity.
April 18, 2023 JLNH&RC
Drawbacks
Programme is good as for as improving nutrition of the underprivileged children
But it requires sustainability for this requires political will, community participation, monitoring and evaluation
Repeated incidence of food poisoning in the mid day meal causing serious threat to existence of this programme.
Akshaya patra and private sector participation in mid-day meals : 2001
Other nutritional programme
VILLAGE GRAIN BANK SCHEME(2004)-Ministry of Tribal Affairs
WHEAT BASED NUTRITION PROGRAMME (WBNP)-ministry of Women &Child Development
ANNAPURNA SCHEME(2000-01)-Ministry of Rural Development
RAJIV GANDHI SCHEME FOR EMPOWERMENT OF ADOLESCENT GIRLS (RGSEAG) – SABLA(2010)- ministry of Women &Child Development
SC/ST/OBC HOSTELS -1994-ministry of consumer affairs
'NATIONAL FOOD SECURITY MISSION'- 2007-08-Ministry of Agriculture
THE SAMPOORNA GRAMEEN ROZGAR YOJANA-2001