Above presentation has a nutrition related programmes and there few drawbacks.

2. Contents
• Introduction
• History
• Nutrition Related Programmes
• Current Status
• Pitfalls
• Nutrition Related Health Days ( Indian)
• Nutrition Related Health Days (International)
• Legislations Related to Nutrition/ Food
• Latest Initiatives
• Recommendations
• Conclusions
• Acknowledgement
• References

3. Introduction
• Nutrition:-
It is a branch of science which deals
with study of dynamic process in which the
consumed food is utilized for nourishment of
body.
• Nutritional status of a person not only
determined by quality & quantity of food
intake but also by physical health.

4. Continued….
• Under nutrition is by far most important single
cause of illness & death globally accounting
for 12% of all deaths & 16 % of disability-
adjusted life years lost. Low weight for age is
associated more than half of all deaths in
young children accounting for more than 6
million deaths per year.
• Malnutrition has multi-factorial causation
that are;

5. Causes of
Malnutrition
Inadequate Food
Production Inadequate
Production Of
Protective Foods
Unsatisfactory
Distribution
System
Lack of Purchasing
Power
Food Taboos &
Misbeliefs
Presence Of
Infections
Interfering With
Digestion &
Absorption

6. Continued….
• Ecological Factors related to malnutrition:-
1. Conditioning influence
2. Cultural influence
3. Socio-economic factors
4. Food production
5. Health & other services

7. Continued….
• A number of national & state programmes are
in operation for control of different type of
malnutrition of public health importance.
• These programmes use nutritional survey as
tool.

8. Pregnant
Mother &
Lactating
Mothers
Infants Under five
children's
Families
below
poverty line
Landless
Labourers
Tribal
MOST VULNARABLE GROUP

9. History
• Special Nutrition Programme (SNP)
• Balwadi Nutrition Program
• Applied Nutrition Program (ANP)
• Tamilnadu Integrated Nutrition Program
• Wheat Based Supplementary Nutrition
Program

10. Special Nutrition Programme (SNP)
• The program was launched in the country in1970-
71.
• It provided supplementary feeding of about 300
calories and 10 gms of proteins to preschool
children and about 500 calories and 25gms of
proteins to expectant and nursing mothers for six
days a week.
• This program was operated as under Minimum
Needs Program.
• Fund for nutrition component of ICDS program was
shared with SNP budget.

11. Balwadi Nutrition Program
• This program was launched by the ministry of
social welfare in 1970. This program is for the
welfare of children in the age group of 3-6
years in rural areas. The children are given
preschool education, diet supplementation by
providing 30 k cal and 10gms of protein per
day per child for 270 days a year and care for
their psychosocial development.

12. Applied Nutrition Program
• The Applied Nutrition Program was introduced
as a Pilot Scheme in Orissa in 1963 which later
on extended to Tamil Nadu and Uttar Pradesh
with the objectives of :-
1. Promoting production of protective foods
such as vegetables and fruits.
2. Ensure their consumption by pregnant and
nursing mothers and children.

13. Continued….
• During 1973, it was extended to all the states
of the country.
• The nutrition education was the main focus
and efforts were directed to teach rural
communities through demonstration how to
produce food for their consumption through
their own efforts.
• The beneficiaries were children between 2-6
years and pregnant and lactating mothers.

14. Continued….
• Nutrition worth Rs 25 paisa/child/day and 50
paisa per woman per day was provided for 52
days in a year.
• The idea was to provide better seeds and
encourage kitchen gardens, poultry farming,
beehive keeping etc. but this program did not
produce any effect.

15. Tamilnadu Integrated Nutrition
Program
• The Tamil Nadu Integrated Nutrition Project was
started in 1980 targeting 6-36 months and
children and pregnant and lactating women.
• The objectives of TINP was:
1. Nutrition surveillance through regular
growth monitoring of all children in the age
group 6-36 months
2. Help rehabilitate and prevent malnutrition
through short term food supplementation

16. Continued….
3. Reduce the mortality and morbidity due to
protein-energy malnutrition and specific
nutrient deficiencies
4. Improve the nutritional status of pregnant
and nursing women
5. Strengthen health services to provide
adequate back-up support to the nutrition
effort
6. Improve home child care and feeding
practices through education

17. Continued….
7. Improve the efficiency and the impact of the
above through sustained performance
monitoring and evaluation
8. To reduce anaemia in pregnant and lactating
women from 55% to about 20%.
9. To reduce vitamin A deficiency in the under five
from about 27% to 5%
10.To reduce infant mortality by 25%.

18. Continued….
• TINP had four major components
1. Nutrition Services
2. Health Services
3. Communication Services
4. Monitoring & Evaluation

19. What Based Supplementary
Nutrition Program
• Program was introduced in 1986.
• Program follows the norms of SPN or of the
nutrition components of ICDS.
• Central assistance of program consist of
supply of free wheat & supportive cost for
other ingredients, cooking, transport, etc.

20. Nutrition Related Programmes
• Integrated Child Development Services(ICDS)
Scheme
• Nutrition Programs For Adolescent Girls
• Nutrition Advocacy and Awareness General
Programs for Food And Nutrition Board (FNB)
• Follow Up Action For National Nutrition
Policy, 1993.
D
I
R
E
C
T

21. Continued….
• Ministry Of Health and Family Welfare-
1. Iron and Folic Acid Supplementation of
Pregnant Women.
2. Vitamin A Supplementation of Children
of 9- 36 Months Age Group.
3. National Iodine Deficiency Disorder
Control Program.
4. Department Of Elementary School and
Literacy.
5. Midday Meal for Primary School Children.
D
I
R
E
C
T

22. Continued….
• Department of Agriculture and Cooperation
1. National Food Security Mission
2. Increased Food Production
3. Horticulture Interventions
• Food & public Distribution
1. Targeted Public Distribution System
2. Antodaya Anna Yojana
3. Annapurna Scheme
I
N
D
I
R
E
C
T

23. Continued….
• Rural & Urban Development
1. Food for Work Program
2. Poverty Alleviation Program
3. Safe Drinking Water & sanitation Program
4. National Rural Employment Guarantee
Scheme
• Ministry of health
1. National Rural Health Mission (NRHM)
2. Integrated management of Neonatal &
Childhood Illness (IMNCI)
3. Various Public Health Measures
I
N
D
I
R
E
C
T

24. Continued….
• Department of Elementary Education &
Literacy
1. Sarva Siksha Abhiyan
2. Adult Literacy Program
• Department of Women & Child Development
Various Women’s Support Programs
I
N
D
I
R
E
C
T

25. INTEGRATED CHILD
DEVELOPMENTSERVICES (ICDS)
• Launched on 2nd October
1975(5th 5 year plan) in
pursuance of the National
Policy for children.

26. Continued….
• This is mainly a health intervention which adopts
a holistic approach aimed at improving both the
pre-natal and post-natal environment of the
child.
• It is a Centrally-sponsored, State-administered
scheme consisting of maternal health care in
pregnancy and growth monitoring and nutritional
supplements for children - services received at
community centres or anganwadis.

27. Continued….
Its objectives are:-
• To improve the nutrition and health status of
children aged 0-6 years
• To lay the foundations for proper psychological,
physical and social development of the child
• To reduce the incidence of mortality, morbidity,
malnutrition and school drop-out

28. Continued….
• To achieve effective coordinated policy and its
implementation amongst the various
departments to promote child development
• 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

29. Continued….
Beneficiaries
• Children's Below 6 years
• Pregnant & lactating Women
• Women in the age Group of 15 to 45 years
• Adolescent Girls in selected blocks

30. Continued….
COMPONENTS of ICDS
1. supplementary nutrition,
2. immunization,
3. health check-up,
4. referral services,
5. pre-school non-formal education and
6. nutrition & health education.

31. ACHIEVEMENTS New ICDS
• ICDS is effective in 5659 community
development blocks and major urban slums
throughout the country.
• As against 227 cores beneficiaries until March
1997 there were 3.4 core beneficiaries in April
2001.
• In 2006 the scheme reached out to about 95
lakhs expectant and nursing mothers and 244.92
lakhs preschool children and562.18 lakh
beneficiaries are getting supplementary nutrition.

32. SCHEME FOR ADOLESCENT GIRLS
(Kishori Shakti Yojana)
• A scheme for adolescent girls in ICDS was
launched by the Department Of Women And
Child Development, Ministry Of Human Resource
Development, 1991
• Common services:-
• Watch over menarche
• Immunization
• General health check ups
• Treatment for minor ailments

33. Continued….
• De-worming
• Prophylactic measures against anaemia,
goitre, vitamin deficiency etc
• Referral to PHC/ District hospital in case of
acute need.

34. PROGRAMS TO PREVENT SPECIFIC
DEFICIENCY STATES VITAMIN A
PROPHYLAXIS PROGRAM
• one of the components of National Programs for
Control of Blindness.
• This includes administration of 200,000 I.U of
vitamin A orally to all preschool children every six
months the programme was launched in 1970 by
the ministry of health and family welfare MCH
centres in urban areas, PHC in rural areas and
ICDS projects are engaged in the implementation
of the program.

35. PROPHYLAXIS AGAINST
NUTRITIONAL ANAEMIA
• The program was started by the ministry of
health and family welfare during the fourth 5
year plan to prevent nutritional anaemia the
program envisages distribution of iron and
folic acid to young children and expectant
mothers through MCH centres in urban areas
PHC in rural areas and Anganwadis in project
areas. The commercial production of iron
fortified common salt was started in1985.

36. CONTROL OF IODINE
DEFICIENCYDISORDER
• The production of Goitre attracts the maximum
attention & hence the national programme was
named as Goitre control Programme.
• The National Goitre control program was
launched by the government of India in 1962 in
the Goitre belt in the Himalayan region and
iodized salt was supplied in Goitre endemic
areas.

37. Continued….
• Later on in 1986 this program was changed to
National Iodine Deficiency Disorders Control
Program because the problem was found to be
widespread and more than the problem of Goitre.
• Objectives :-
1) To identify endemic areas by survey
2) To ensure production & supply of iodated salt
to endemic areas
3) To evaluate the effect of continuous supply of
Iodated salt in endemic areas by resurvey after
5 years.

38. PILOT PROJECT ON PROGRAM
AGAINST MICRONUTRIENT
MALNUTRITION
• The Pilot Project Program Against Micronutrient
Malnutrition was implemented in Assam along
with for other states namely Bihar, Orissa, West
Bengal and Gujarat. The program was launched in
the year 1995.
Objectives:
• To asses the and improve iron and vitamin A
status in school going children , adolescent boys
and girls, non pregnant women, adult males and
geriatric population.

39. Continued….
• To assess the magnitude of flourosis and
dental caries.
• To launch extensive information, education
and communication strategies through mass
media to improve the dietary habits of the
population
• To study zinc level in various food products
and soil.
• The program was implemented in one district
of each of the five states.

40. Continued….
The following activities were undertaken
• Advocacy and sensitization meetings with
people involved in policy making with elected
members, teachers, social workers etc.• A
baseline survey was conducted to assess the
socioeconomic status, food intake pattern,
estimation of Hb, soil, zinc, fluorine in drinking
water.
• Training was also organized at block level,
prior to field activity surveys.

41. WORLD FOOD PROGRAM
• World food program is the world’s largest
international food aid organization, serving in 84
counties with a goal of achieving.
• Founded in 1963 as the food aid arm of United nation
after the Rome declaration on world food security in
1996. WFP is committed to achieve a goal of reducing
half the number who are adequate access to food by
2015.
“ A world of which every man, woman and child has access
at all times to the food there can be no sustainable
peace, no democracy and no development”.

42. WORLD FOOD PROGRAM IN INDIA
WFP goals and objectives in India
• Improve nutrition and quality of life for the
most vulnerable population at critical times in
their lives.
• Make sustainable improvements in household
food security for the poorest, especially for
women and child and invest funds in
development for long term security.

43. Continued….
• Strengthen channels for locally produced food
grains and support local entrepreneurship.
• Advocate for restoration through participation
methods.
Beneficiaries
• Poor women, particularly mothers and children at
risk
• Poor forest dependent population
• WFP have included supplementary feeding and
supported forestry, livestock and dairy
development.

44. Continued….
• A blend of precooked maize and soya fortified
with micro nutrients called CSB (corn- soya-
blend) has been developed in India in the
name of ‘Indiamix’.

45. Continued….
• ACTIVITIES UNDER WFP’s
• Helping women to gain better access to food,
education.
• Involvement in community decisions.
• Access to maternal and child health care to
improve child survival.
• “Food for work” program in collaboration with
forest department providing food in emergencies,
access to health services,
• Potable water and sanitation proper caring
practices for young children.
• Education particularly girls and women

46. Continued….
• Supporting generation of biogas.
• Protection of forest through mass awareness
and active participation.
• Income generating products.
• Creating market by local manufacturing by
India Mix.
• Effective program implementation.

47. NATIONAL NUTRITIONAL GOALS
11TH FIVEYEAR PLAN
• Reduce the prevalence of the underweight in
children under 5 years up to 20%
• Eradicate the prevalence of under nutrition in
children after 5 years.
• First hour breastfeeding rates to increase to 80%.
• Exclusive breast feeding rates to increase to 90%
• Complementary feeding rate at six months to
increase to 90%.• Reduce prevalence of anaemia
in high risk group to 25%.

48. Continued….
• Eliminate vitamin A deficiency in children
under 5 years as a public health problem and
reduce subclinical deficiency of Vitamin A in
children by 50%.
• Reduce prevalence of iodine deficiency
disorders to less than 5%.

49. Current Status
• Supplementary food should be viewed and
used only as a vehicle for providing other
services under the ICDS scheme.
• Supplementary foods should be cereal based,
palatable and of good quality.
• Fortification of foods with micronutrients: it
should be mainly considered with iron and
iodine.

50. Continued….
• Nutritional counselling of mothers through
ICDS scheme for promotion of nutrition and
health of children.
• Community based rehabilitation of severely
malnourished children through integrated
health and nutrition interventions.

51. PITFALLS
• Community participation is difficult to ensure in
most areas.
• Lack of inter sectorial co-ordination.
• Intersectoral coordination becomes essential in
projects, which extends over the geographical area
covered by more than one primary health center.
• Determinants of low health & nutritional status are
not tackled under many scheme.
• Selection & motivation of Anganwadi worker may
be unsatisfactory.

52. Continued….
• Nutrition supplementation posses many
problems. (Logistic difficulties i.e if fuel is not available,
children do not get hot food)
• Coverage of expectant & nursing mothers is not
satisfactory under the scheme.
• In the large number of activities, children 0-3
years, the most vulnerable age group , do not
get adequate attention.
• Attendance for non-formal preschool education
is not satisfactory.

53. Continued….
• The supply of iron folic acid tablets. Vit-A & food
supplements is many times irregular &
unsatisfactory.
• Anganwadi workers are agitating for an increase
in honorariums, absorption into government
service & permanent status.
• the location of Anganwadi may not be suitable.
• With both parents working in the fields they may
have problem taking the child or bringing back
from Anganwadi, which is open. Only a part of
the day.

54. Continued….
• This overburdening with responsibilities result
in decrease in quality of work & coverage.
• The training of aganwadi workers has been
unsatisfactory at places, as expansion outstrip
training intakes.
• The supplies are not are not regular & below
standard.
• Misuse of funds.

55. Continued….
• Inter- departmental manipulation health
services used for desirable outcome.
• Socio-economic repercussion.

56. Nutritional Health Related Days
ORS Day July-29
National Nutrition week September - 1 to 7
World Food Day October-16
World Iodine Deficiency Day October-21

57. Nutritional Health Related Days
(International)
Healthy Weight Week January 19-25
Women’s Healthy Weight Day January 23
America’s National Nutrition
Month
March 1-31
Food Health Awareness Month April 1-30
Food Allergy Awareness Week May 11 - 17

58. Legislations Related to Nutrition/
Food
• Prevention of Food
Adulteration Act, 1954
• Food Safety & Standards
Act, 2006

59. Latest
Initiatives
Non Governmental
Initiatives
Some innovative approaches have
also been tried out on a small scale by
Non- Governamental Organizations
like; OXFAM, DANIDA, CARE,WFP.

60. • Strategies should be to close the gap between the
resources available & families who need them by
working closely with the Govt. to focus on
malnutrition awareness, identification , treatment, &
prevention & inserting simple but innovative
technologies & practices.
• The Government of India’s National Nutrition Policy,
apart from setting nutrition goals to control and
prevent malnutrition in the country, recommended
that a national nutrition surveillance system should be
developed.

61. Conclusion
• Malnutrion is a man made disease.
• Under nutrition continues to be a widespread
problem in India, despite significant
improvement in food production and
advancement in science during the last fifty
years, since Indian independence.

62. Continued….
• Nutrition affects growth and development of a person. At
least the development of International Standards and
national legislation, are essential to protect and promote
national food security and public health. Civil society will
have to play a more active role. The concept of food
security must be recaptured and reframed in public and
environment terms.
• The National and the State governments have been
implementing a number of poverty alleviation
programmes for the overall socioeconomic development
of the community and several nutrition programmes to
mitigate the sufferings of the vast multitudes of the
population at risk.

63. Continued….
• For the purpose of deciding policies and to
formulate programmes to control and prevent
malnutrition, it is essential to assess What?
Where? How? and Why? of the nutrition
problems in the country. Monitoring of the
nutritional status of population, therefore,
becomes an important aspect of any nutrition
programmes to assess the impact of these
massive inputs and to determine the direction in
which the community’s nutrition is progressing,
so as to initiate appropriate corrective actions.

64. Acknowledgment
• Dr. Abhay Mudey
• Dr. Minaxi Khapre
• Dr. Pramita Mutonde
• Dr. Abhishek Ingole
• Dr. Manish Prasad
• All the PG’s in the Dept.

65. References
• http://www.cfsan.fda.gov/~dms/flquiz1.html
• www.MyPyramid.gov
• http://hin.nhlbi.nih.gov
• Pralhad Rao, N., Sastry, J.G. Monitoring Nutrient intakes in India. Ind. J.Ped. 54,
1987, 495-501.
• Ramnath, T., Vijayaraghavan, K., Pralhad Rao, N. Nutritional Anthropometry –
Validation of cut-off points. J. Trop. Ped. 1993, 39: 200-204.
• Manual on health observances recognition days-2014/ www.nccc-online.org
• www.healthyweight.net/hww.htm#hww
• Naidu, A.N. and Pralhad Rao, N. Body Mass Index: a measure of the nutritional
status in Indian populations. European Jour. of Clinical Nutrition. 1994, 48,
Suppl. 3, 5131-5140.
• Community Medicine with Recent Advances-A. H. suryakantha
• Epidemiology & Management For Health Care For All- P. V. Sathe (3rd Edition)
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• Parks Text Book of Preventive & Social Medicine- K. Park ( 23rd Edition)
• Nutritional Rehabilitation- J. M. Bora