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

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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

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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

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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.

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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.

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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