national nutritional programme


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  •  Kesari Dhal caused by BOAAA unique symptom of lathyrism is the atrophy of gluteal muscles
  • . Today the world faces a double burden of malnutrition that includes both undernutrition and overweight, especially in developing countries.
  • - when children are too short for their age group compared to the WHO child growth standards.
  • Wasting demands emergency nutritional interventions to save lives.
  • Iron iodinevit a r public health important
  • to meet the nutritional needs;year at affordable cost through reduction in post harvest losses and appropriate processing;
  • Prevention, early detection and appropriate management of micronutrient deficiencies and associated health hazards through:Promotion of appropriate dietary intake and lifestyles for the prevention and management of obesity and diet-related chronic diseasesThe existing opportunities for improving nutritional status are fully utilized; and
  • 6m to 5 yrs-11 5 to 11 – 11.5 12 to 14 - 12
  • main focus and efforts were directed to teach rural communities through demonstration how to produce food for their consumption through their own efforts.
  • and prophylaxis against vitamin A deficiency and control of nutritional anaemia.
  • Its for the three-to six years old children and is directed towards providing and ensuring a natural, joyful and stimulating environme
  • Also known as school lunch prog
  • Cereals- 75Oil – 8 Pulses- 30Veg- 30 Leafy veg- 30
  • Successfully involved private sector participation in the programmeThe programme is managed with an ultra modern centralized kitchen that is run through a public/private partnership. Food is delivered to schools in sealed and heat retaining containers just before the lunch break every day
  • Food for eligible bachelor
  • To provide employment for rural people with below poverty line
  • national nutritional programme

    1. 1. Presenter: Dr. Preetham M
    2. 2. Major health problems in India 1. Communicable diseases 2. Population 3. Environmental sanitation 4. Medical care 5. Nutritional
    3. 3. 1. Nutritional anemia 2. Iodine deficiency disorders 3. obesity
    4. 4. 4. Protein energy malnutrition 5. Low birth weight 6. Xerophthalmia(dry eye) 7. Cancer 8. Lathyrism 9. Flurosis
    6. 6.  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.
    7. 7. 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
    8. 8.  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.
    9. 9.  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.
    10. 10.  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.
    11. 11.  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.
    12. 12.  Essential vitamins and minerals in the diet are vital to boost immunity and healthy development.  Maternal undernutrition.
    13. 13.  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.
    14. 14.  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
    15. 15.  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
    16. 16.  Special nutrition programme for pre-school children and expectant and nursing mothers.1970-71  Balwadi nutrition program(1970)  Applied nutrition programme(1963)
    17. 17.  National goiter control programme (ngcp)1986  National water supply and sanitation programme (1954)  Minimum needs programme(1974)
    18. 18.  20 point programme 1975  National diarrhoeal diseases control programme(1981)
    19. 19.  Tamil nadu integrated nutrition programme (1980)  Wheat based supplementary nutrition programme (1986)
    20. 20.  Mid Day Meal Scheme Human Resource Development  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
    21. 21.  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.
    22. 22.  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.
    23. 23.  Operationalising universal screening of all pregnant women, infants, preschool and school children for under-nutrition and nutritional intervention
    24. 24.  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.
    25. 25.  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
    26. 26.  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
    27. 27. 31 August 2013 JLNH&RC
    28. 28.  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
    29. 29. OBJECTIVE 1. Assess prevalence 2. Give anti anemic treatment 3. Give prophylaxis 4. Monitoring 5. Education
    30. 30. BENEFICIARIES  Children age group 1 to 10,  Pregnant and nursing mother,  Acceptors of family planning,  Adolescent girls.  ORGANIGATION  PHC and sub centers
    31. 31.  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.
    32. 32.  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.
    33. 33. Effect on people : HUMANS Health & Socioeconomic impact Effect on animals : LIVESTOCK Clinical & Reproductive disorders, decreased productivity Low Availability of iodine : PLANTS Iodine poor feeds & fodders Soil Erosion : WATER, SOILEnvironmental iodine deficiency Iodine Deficiency – A Disease of The Soil
    34. 34. Brain Cell Growth Iodine Deficiency Iodine Sufficiency Iodine Deficiency is the single most common cause of preventable mental retardation
    35. 35. 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
    36. 36.  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)
    37. 37. 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
    38. 38.  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.,
    39. 39.  Nutritional Services  Health services  Communication  Monitoring and evaluation It is being merged into ICDS
    40. 40.  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
    41. 41. 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
    42. 42. 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.
    43. 43.  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.
    44. 44.  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.
    45. 45.  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.
    46. 46.  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.
    47. 47. 1. Routine MCH services not reaching target Population 2. Nutritional component not covered by Health services 3. Need for community participation
    48. 48. 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.
    49. 49. Children < 6 years 31 August 2013 Pregnant Woman Lactating women Adolescent Girls Women in Reproductive age group (15-44) Children below 6 years
    50. 50.  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.
    51. 51. Services 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
    52. 52.  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.
    53. 53.  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
    54. 54.  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.
    55. 55.  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
    56. 56.  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.
    57. 57.  It is a key element of the work of the Anganwadi worker.  This forms part of BCC (Behaviour Change Communication) strategy
    58. 58.  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.
    59. 59.  This scheme for adolescent girls in ICDS was launched by the Department of Women and Child Development, Ministry of Human Resource Development in 1991.
    60. 60.  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. and 7. Referral to PHC. District hospital in case of acute need.
    61. 61.  Child Development Project Officers (CDPOs)  District Program Officers (DPOs)  Anganwadi Workers  Anganwadi Helpers  Auxiliary Nurse Midwife (ANM)  Accredited Social Health Activist (ASHA)
    62. 62. 1. Monitor growth of children, 2. Provide non formal pre-school education, 3. Provide supplementary nutrition 4. Give health and nutrition education 5. Referral for sick children 6. Elicit community participation 7. Provide health service in collaboration with ANM/ASHA 8. Implement adolescent girls’ scheme
    63. 63. 1. To cook and serve the food to children 2. 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.
    64. 64. 1. Awareness generation 2. Counsel women 3. Community mobilization 4. Escort/accompany pregnant women & children requiring treatment 5. Provide primary medical care
    65. 65. 1. Hold weekly / fortnightly meeting with ASHA 2. Participate & guide in organizing the Health Days at AWC 3. Utilize ASHA in motivating the pregnant women and married couples 4. Guide ASHA in motivating pregnant women for full ANC 5. Educate ASHA on danger signs of pregnancy and labor
    66. 66.  Health Check-ups  Handling Referral  Immunization  Nutrition & Health Education  Monitoring of Health components
    67. 67. 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
    68. 68.  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.
    69. 69. Beneficiary Pre-revised Revised w.e.f. Feb. 2009 Calories (KCal) Protein (G) Calorie s (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
    70. 70. 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
    71. 71.  United Nations International Children’ Emergency Fund (UNICEF)  Cooperative for Assistance and Relief Everywhere (CARE)  World Food Programme (WFP)
    72. 72.  Major Objective: 1. Improve the School attendance 2. Reduce school drop outs 3. 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
    73. 73.  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.
    74. 74. 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
    75. 75. 31 August 2013 JLNH&RC
    76. 76.  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.