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Community Nutritional Programmes

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  • 1. Dr. Rupesh Kumar Agarwal DNB Pediatrics club activityJ.L.N. HOSPITAL AND RESEARCH CENTRE6 December 2012 JLNH&RC
  • 2. Community NutritionalProgrammes Large scale supplementary programmes Main aim is to improve nutritional status in targeted groups To overcome specific diseases through various ministries to combat malnutrition6 December 2012 JLNH&RC
  • 3. ProgrammesMinistryVitamin A Prophylaxis Programme Health and familyProphylaxis Against Nutritional anaemia. welfareIDDs Control Programme.Special Nutritional ProgrammeBalwadi Nutritional Programme Social welfareICDS ProgrammeMid Day Meal Programme EducationMid Day Meal Scheme Human Resource Development 6 December 2012 JLNH&RC
  • 4.  Wheat based nutrition program (human resource development) Nutrition program for adolescent girls (human resource development) Annapurna scheme (human rural development) Applied nutrition program National food for work program6 December 2012 JLNH&RC
  • 5. Vitamin A Prophylaxis Programme Initiated in 1970 Age group 1-5 year Priority to VAD geographical area OBJECTIVE Prevent blindness due to VAD ORGANIGATION PHC and subcenter6 December 2012 JLNH&RC
  • 6. ROLE OF VIT A IN HEALTH Prevent respi infection maintain git and gut epithelium integrity Immune function Prevent Nutritional blindness6 December 2012 JLNH&RC
  • 7. Vitamin A Prophylaxis Programme  Beneficiary group preschool children(6 months to 5 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 children6 December 2012 JLNH&RC
  • 8. Prophylaxis Against Nutritional Anaemia Pregnant woman <11 gm/dl nonpregnant woman <12gm/dl Initiated in 1970 Centrally sponsored Over 50%pregnant woman suffer from anemia 20% of maternal death Causes LBW and perinatal mortality6 December 2012 JLNH&RC
  • 9. OBJECTIVE Assess prevalence Give antianemic treatment Give prophylaxis Monitoring Education6 December 2012 JLNH&RC
  • 10. BENEFICIARIES Children age group 1to 5 Pregnant and nursing mother Female acceptor of terminal method of family planning and IUDS ORGANIGATION PHC and subcenters6 December 2012 JLNH&RC
  • 11. Iron and folic acid to 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 Adolescent girls : 100 mg Fe & 0.5mg folic acid Iron fortification in salt Children between 1 to 5 years. Screening test for aneamia done at 6 months,1 and 2 years of age.6 December 2012 JLNH&RC
  • 12. Iodine Deficency DisorderControl Programme  National goiter control programme in 1962  IDD Control Programme Replace the entire edible salt by iodide salt Double fortification of salt iodine and iron (40ppm and 1000ppm)6 December 2012 JLNH&RC
  • 13. Special Nutritional Programme in urban slums, This was started in 1970 is in operation 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 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 ICDS6 December 2012 JLNH&RC
  • 14. Applied Nutritional Programme This project was started in Orissa on 1963 Later extended to TN and UP Objectives:  Promoting production and of protective food such Vegetables and fruits  Ensure their consumption by pregnant & lactating women and children. 1973 it is extended to all states in INDIA  Mainly through nutritional education  Nutrition worth 25 paisa for children and 50 paisa for pregnant and lactating women for 52 days in a year6 December 2012 JLNH&RC
  • 15. Major components Nutritional Services Health services Communication Monitoring and evaluation Later it is converted as ICDS6 December 2012 JLNH&RC
  • 16. Balwadi Nutrition Programme  This was started in 1970 under the department of social welfare  Beneficiary group preschool children 3-6years of age 300kcal and 10gm protein Also provided with pre school education Balawadis are being phased out because universalization of ICDS6 December 2012 JLNH&RC
  • 17. 6 December 2012 JLNH&RC
  • 18. ICDS 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.6 December 2012 JLNH&RC
  • 19. Purpose for Initiation  Routine MCH services not reaching target Population  Nutritional component not covered by Health services  Need for community participation6 December 2012 JLNH&RC
  • 20. 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; and5. 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.6 December 2012 JLNH&RC
  • 21. Services: The above objectives are sought to be achieved through a package of services comprising:1. Supplementary nutrition,2. Immunization3. Health check-up4. Referral services5. Pre-school non-formal education and6. Nutrition & health education.6 December 2012 JLNH&RC
  • 22. Beneficiaries of ICDSChildren < 6 years Adolescent GirlsPregnant Woman Lactating women Women in Reproductive age group (15-44)6 December 2012 JLNH&RC
  • 23. Services and beneficiaries Services Target Group Service Provided bySupplementary Children below 6 years: Anganwadi Worker andNutrition Anganwadi Helper Pregnant & Lactating Mother (P&LM)Immunization* Children below 6 years: ANM/MO Pregnant WomenHealth Check-up* Children below 6 years: ANM/MO/AWW Pregnant & Lactating Mother (P&LM)Referral Services Children below 6 years: AWW/ANM/MO Pregnant & Lactating Mother (P&LM)Pre-School Education Children 3-6 years AWWNutrition & Health Women (15-45 years), Children 3-6 AWW/ANM/MOEducation years Pregnant & Lactating Mother (P&LM) 6 December 2012 JLNH&RC
  • 24. Supplementary Nutrition This includes supplementary feeding and growth monitoring; and prophylaxis against vitamin A deficiency and control of nutritional anaemia. Growth Monitoring and nutrition surveillance are two important activities that are undertaken.  Children <3 years of age 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. 6 December 2012 JLNH&RC
  • 25. Immunization: Immunization of pregnant women and infants protects children from six vaccine preventable diseases- poliomyelitis, diphtheria, pertusis, tetanus, tuberc ulosis and measles. Immunization of pregnant women against tetanus also reduces maternal and neonatal mortality6 December 2012 JLNH&RC
  • 26. 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.6 December 2012 JLNH&RC
  • 27. 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-centre6 December 2012 JLNH&RC
  • 28. Non-formal Pre-School Education(PSE)  anganwadi – a village courtyard  PSE is considered the backbone of the ICDS programme.  Its for the three-to six years old children and is directed towards providing and ensuring a natural, joyful and stimulating environment 6 December 2012 JLNH&RC
  • 29. Nutrition and HealthEducation It is a key element of the work of the anganwadi worker. This forms part of BCC (Behaviour Change Communication) strategy6 December 2012 JLNH&RC
  • 30. THE ICDS TEAM:The ICDS team comprises Anganwadi Workers, Anganwadi Helpers, Supervisors, Child Development Project Officers (CDPOs) and District Programme Officers (DPOs).6 December 2012 JLNH&RC
  • 31. Role of AWW  To elicit community support  Participation in running the program  Weigh & record each child every month  Refer cases  Organize non-formal pre-school activities  Provide supplementary nutrition  Provide health & nutrition education and counseling6 December 2012 JLNH&RC
  • 32. Role of AWW  Make home visits  Assist PHC staff  Guide ASHA  Assist in implementation of Kishori Shakti Yojana (KSY)6 December 2012 JLNH&RC
  • 33. Role of AW Helper  Cook & serve food  Clean the Anganwadi premises  Cleanliness of small children  Bring small children to Anganwadi6 December 2012 JLNH&RC
  • 34. Role of ASHA  Awareness generation  Counsel women  Community mobilization  Work with VHSC  Escort/accompany pregnant women & children requiring treatment  Provide primary medical care6 December 2012 JLNH&RC
  • 35. Role of ANM  Hold weekly / fortnightly meeting with ASHA  Participate & guide in organizing the Health Days at AWC  Utilize ASHA in motivating the pregnant women and married couples  Guide ASHA in motivating pregnant women for full ANC  Educate ASHA on danger signs of pregnancy and labor6 December 2012 JLNH&RC
  • 36. Role of Health Department  Health Check-ups  Handling Referral  Immunization  Nutrition & Health Education  Monitoring of Health components6 December 2012 JLNH&RC
  • 37. 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 AWC6 December 2012 JLNH&RC
  • 38.  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.6 December 2012 JLNH&RC
  • 39. Supplementary Nutrition per DayBeneficiary Pre-revised Revised w.e.f. Feb. 2009 Calories Protein Calorie Protein (KCal) (G) s (KCal) (Gm)Children (6-72 300 8-10 500 12-15months)Severely 600 20 800 20-25malnourishedchildren (6-72months)Pregnant & Lactating 500 15-20 600 18-206 December 2012 JLNH&RC
  • 40. Revised financial norms for food supplement Category Pre- Revised w.e.f revised June 2010 Children (6-72 Rs. 2.00 Rs.4.84 months) Severely Rs. 2.70 Rs.5.82 malnourished children (6-72 months) Pregnant & Lactating Rs. 2.30 Rs.6.006 December 2012 JLNH&RC
  • 41. International Partners  United Nations International Children’ Emergency Fund (UNICEF)  Cooperative for Assistance and Relief Everywhere (CARE)  World Food Programme (WFP)6 December 2012 JLNH&RC
  • 42. Major Initiatives  Revision in Population norms  Universalization and 3rd phase of expansion of the Scheme of ICDS  Increment in Budgetary allocation for ICDS Scheme  Introduction of cost sharing between Centre & States  Revision in financial norms of supplementary nutrition6 December 2012 JLNH&RC
  • 43. Monitoring System  Central level  State level  Block level  Village level (Anganwadi level)6 December 2012 JLNH&RC
  • 44. Failures  Practically children 3-6 Yrs and Pregnant & Lactating not covered  Irregular food supplies  Quality of Nutrition supplement?  Poor supervision  Lack of community ownership/ participation  Nutrition education only on papers  Children come only for food6 December 2012 JLNH&RC
  • 45. Mid Day Meal Programme Major Objective: improve the School attendance reduce school drop outs 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 frequently6 December 2012 JLNH&RC
  • 46. Mid-day meal scheme National programme of nutritional support to primary education Objective Universalization of primary education by increasing enrollment (class 1 to 5) and Improve nutritional status of children. 350 to 500 kcal and 8-12gm protein6 December 2012 JLNH&RC
  • 47. 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.6 December 2012 JLNH&RC
  • 48. Keep visiting dnbpaediatrics.blogspot.in6 December 2012 JLNH&RC

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