This document discusses several large-scale nutrition programs run by the Indian government. It provides details on the Vitamin A Prophylaxis Programme, programs to address nutritional anemia and iodine deficiency, the Integrated Child Development Services (ICDS) program, and Mid-Day Meal programs. The ICDS is described as one of the world's largest programs for early childhood development, providing services like supplementary nutrition, immunization, health checkups, and preschool education to children under 6, pregnant and lactating women. It is implemented through anganwadi centers at the village level. The Mid-Day Meal programs aim to improve school attendance and nutrition by providing meals to children in primary schools.
Integrated child development services (icds) 2021Noddy Prabhat
Integrated child development services
1. introduction of icds.
2. describe the objectives of icds.
3. explain beneficiary of icds.
4. enumerate of icds team.
5. discuss the role of the health department.
6. elaborate the services under icds.
7. focuses of major achievement of icds .
8. Conclusion.
9. Bibliography.
Anaemia is a critical public health problem in J&K. Anaemia in adolescents can be prevented by regular consumption of iron and folic acid, a scheme called WIFS (Weekly Iron Folic Acid Supplementation) has been started by the MoHFW, Govt of India in J&K.
Integrated child development services (icds) 2021Noddy Prabhat
Integrated child development services
1. introduction of icds.
2. describe the objectives of icds.
3. explain beneficiary of icds.
4. enumerate of icds team.
5. discuss the role of the health department.
6. elaborate the services under icds.
7. focuses of major achievement of icds .
8. Conclusion.
9. Bibliography.
Anaemia is a critical public health problem in J&K. Anaemia in adolescents can be prevented by regular consumption of iron and folic acid, a scheme called WIFS (Weekly Iron Folic Acid Supplementation) has been started by the MoHFW, Govt of India in J&K.
National Nutritional Programs in India.pptxAkashDasgupta5
The National Nutritional programs and the evolution of the National Nutrition policy in order to adress the key nutritional challenges in India and reduce the burden of malnutrition.
POSHAN ABHIYAAN-Poshan 2.0 will concentrate on Maternal Nutrition, Infant and...sheeza38
A month-long celebration of the POSHAN Abhiyan mission places special attention on Severe Acute Malnourished (SAM) children. It is an umbrella scheme covering the Integrated Child Development Services (ICDS) (Anganwadi Services, Poshan Abhiyan, Scheme For Adolescent Girls, National Creche Scheme).
Poshan 2.0 will include three significant initiatives within its purview: Anganwadi Services, the Scheme for Adolescent Girls, and Poshan Abhiyaan. Moreover, Poshan 2.0 will concentrate on Maternal Nutrition, Infant and Young Child Feeding Norms, Treatment of MAM/SAM, and Wellness through AYUSH.
Nutritional deficiencies are very common in india as well as in other developing countries.both macro and micro nutrients are not eaten in adequate quantities in india due to poverty and ignorance. A number of national program are there to combat these deficiencies.But unfortunately effective implementation is lacking due to which nutritional deficiency is not being overcome in our country. Now due to covid -19 these are bound to increase
community nutrition programs in india,
• Integrated Child Development Services Scheme
• Midday Meal Programme
• Special Nutrition Programme (SNP)
• National Nutritional Anemia Prophylaxis Programme
• National Iodine Deficiency Disorders Control Programme
• National Goitre Control Programme
• Mid Day meal programme
• Applied Nutrition Programme
Organisation and Management of Eye Care Programme Service Delivery ModelsHarsh Rastogi
Eye care program management: Efficient models ensure accessibility, quality, and sustainability, promoting community engagement and optimal vision health.
Community Eye Care Programmes in India..Harsh Rastogi
Community Eye Care Programmes refer to initiatives aimed at providing comprehensive eye care services to communities, especially in underserved areas, through a combination of outreach activities, primary eye care services, and community involvement.
NPCBVI and DBCS
Rehabilitation restores normal or near-normal function after illness, injury, addiction, or imprisonment, through retraining and medical treatment.
Rehabilitation is crucial in comprehensive care, ideally starting at the moment a patient enters the healthcare system, with programs available in specialized hospital units or independent community centers.
“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability.”
The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention.
Levels of preventions:
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
5. Quaternary prevention
Pathogenic microorganisms proliferate and invade bodily tissue, causing tissue harm and disease.
The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites those are not normally present within the body.
An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.
An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic (body wide).
Microorganisms that live naturally in the body are not considered infections.
For example, bacteria that normally live within the mouth and intestine are not infections.
Infection prevention policies and practices are used in hospitals and other health care facilities to reduce the spread of infections.
“The study of the distribution and determinants of health-related states or events in specified population and the application of the study to control of health problems.”
Disaster preparedness & Management for Optometry.pptxHarsh Rastogi
Any occurrence that causes damage, ecological disruption, loss of human life, deterioration of health and health services on a scale, sufficient to warrant an extraordinary response from outside the affected community or area.
The body of policy and administrative decisions and operational activities that pertain to various stages of a disaster at all levels.
An applied science which seeks, by systemic observation and analysis of disasters, to improve measures relating to prevention, emergency response, recovery and mitigation.
Encompasses all aspects of planning for, and responding to disasters, including both pre and post disaster activities.
Role & responsibilities of mid level healthcare providersHarsh Rastogi
Role & responsibilities of mid level healthcare providers
Mid-level health providers (MLHPs) are health workers trained at a higher education institution for at least 2-3 years.
MLHP is a health provider who:
Who is trained, authorized and regulated to work autonomously,
Who receives pre-service training at a higher education institution for at least 2-3 years, and
Whose scope of practice includes (but is not restricted to) being able to diagnose, manage and treat illness, disease and impairments (including perform surgery, where appropriately trained), prescribe medicines, as well as engage in preventive and promotive care.
Population policy in general refers to policies intended to decrease the birth rate or growth rate.
Statement of goals, objectives and targets are inherent in the population policy.
History
National Population Policy 2000
Objectives
National Socio-Demographic Goals
Conclusion
An Expert Committee (1971) of the WHO defined family planning as "a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country“.
Basic Human Rights
Scope of family planning services
Health aspects of family planning:
1. Women's health: Unwanted pregnancies, Limiting the number of births and proper spacing, Timing of births
2. Foetal health
3. Child health: Child mortality, Child growth, development and nutrition, Infectious diseases
The welfare concept
Small-family norm
Eligible couples
Target couples
Couple protection rate (CPR)
A stoma is an opening that is created to allow stool or urine to pass out of the body.
INDICATIONS FOR OSTOMY
SITES OF STOMA
SELECTION OF APPROPRIATE STOMA POUCH
STEPS TO CHANGE POUCH
IRRIGATION
COMPLICATIONS
NURSING MANAGEMENT
meaning of small family norms: Small family norm connotes control over the number of children.
The rate of reproduction and the level of acceptance of family control methods are to a large extent influenced by what people consider as the ideal family size.
Adoption of small family norms is today not only desirable but It has become difficult to survive with a large family particularly because of rising cost of living, growing needs and necessities.
It is a fact that a small family is a happy family.
Lesser number of children is a boon not only to their parents but also to the country.
They have better chances of food, clothing and education.
almost a necessity
nature of small family norms
benefits of small family norms
barriers of small family norms
The term Women Empowerment refers to the increasing of the spiritual , social, political or economic strength of all women.
It is frequently seen that the empowered in their capacities develop confidence.
Empowerment of women is conceivably the sum of total of the points listed below or parallel capabilities:
Having the power of making decisions for self.
Having access to resources and information for proper decision making.
Need & importance of women empowerment
Definition
Women empowerment refers to increasing the spiritual, political, social or economic strength of women.
It often involves the empowered developing confidence in their own capacities.
Women empowerment refers to women invest with power, especially legal power or official authority.
Principles
Social Empowerment of Women
Research article on Violence Against Women
Population explosion is the phenomenon of the size of a population tending to a very large number in a finite interval of time is called population explosion i.e., rapid increase in population for a long time may be termed as "population explosion".
Birth rate is much higher than the death rate for long time may lead to population explosion.
The literal meaning of population is "the whole number of people or inhabitants in a country or region".
The main factors affecting the population change are the birth rate, death rate and migration.
Migration is the number of people moving in (immigration) or out (emigration) of a country, place or locality.
The population change is calculated by the formula:
Population change = (Births + Immigration) - (Deaths + Emigration)
Population explosion or overpopulation refers to a condition where an organism's numbers exceed the carrying capacity of its habitat.
Every sixth person on globe today is every Indian.
India adds about 10 lakh persons to its population every fortnight.
India adds one Australia every eight months.
By 2045 or earlier, India would overtake china as the world's most populous country.
49% of the increase in India's population is from four states Bihar, Madhya Pradesh, Rajasthan, UP.
Population growth, variation among nationsHarsh Rastogi
Group of individuals of species occupying a definite geographic area at a given time.
The population will continue to grow till equilibrium is achieved, i.e.
Number of births = Number of deaths
Population growing by 90 million/year.
Of which 93 % in developing countries .
Spread of public health programmes in developing countries.
Rise in food production after World War II.
Every second 4-5 children are born and 2 people die.
Nearly 2.5 persons get added every second.
Demography as the statistical study of human population with regard to their size & structure, their composition by sex, age, marital status and ethnic origin, and the changes to these population, like changes in their birth rates, death rates and immigration.
Demography is the branch of social size, structure, which deals with the study of size, structure and distribution of populations, along with the spatial and temporal changes in them in response to birth, migration, ageing and death.
In demography the following three elements of population are given special attention:
Change in the size of population (increase or decrease)
Structure of population (on the basis of sex or age groups)
Geographical distribution of population (on the basis of state or territory).
“Referral system is defined as a system of transferring cases which are beyond the technical competence of one infrastructure to a higher level infrastructure/institution having technical competency and all other resources to provide desired health services.”
Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals.
Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility.
Aging process is the process of growing old or developing the appearance and characteristics of old age.
The theories of aging are classified into -
Biologic theories
Psychosocial theories
Developmental theories
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Large scale supplementary nutrition programmes.
Main aim is to improve nutritional status in targeted
groups.
And overcome specific diseases to combat
malnutrition.
4. Vitamin A prophylaxis programme
Prophylaxis against nutritional anaemia
Control of iodine deficiency disorders
Special nutrition programme
Balwadi nutrition programme
ICDS programme
Mid-day meal programme
Mid-day meal scheme
4
5. 5
Programme Ministry
Vitamin AProphylaxis Programme
ProphylaxisAgainst Nutritional anaemia
IDDControl Programme
Health and family welfare
SpecialNutritional Programme
Balwadi Nutritional Programme
Social welfare
ICDSScheme
Women and child
development
Mid DayMeal Programme
Mid DayMeal Scheme
HumanResource
Development
7. 7
• Initiated in 1970
• Beneficiary: agegroup 6mo - 5year
• Objective: Prevent blindness due to VAD
• Implemented by: PHCandsubcenter
• Asingle massivedose of Vitamin-A2 lac IU
(retinol palmitate 110mg) orally every 6
months above 1 year
10. 10
• Initiated in 1970
• Centrally sponsored
• Over 50%pregnant woman suffer from anemia
• CausesLBWand perinatal mortality, maternal
death
• Objectives:Assessprevalence, Givetreatment,
Giveprophylaxis, Monitoring, Education
11. 11
• Beneficiaries:
– Children aged1 to 5years
– Pregnant and nursing mother
– Femaleacceptor of terminal method offamily
planning and IUDS
• Implemented by: PHCandsubcenters
12. 12
• Dosageof tablets:
– Pregnant women: 100 mg Fe& 0.5mg folic acid
– Children 6 to 60 months : 20mg Fe& 0.1 mgfolic
acid
– Should be given 100 days
– Adolescent girls: 100 mg Fe& 0.5mg folicacid
• Children between 1 to 5years
– Screening test for anemia done at 6 mo, 1, 2years
• Iron fortification of salt
14. 14
• National goiter control programme in1962
• IDDControl Programme
• Replacethe entire edible salt by iodidesalt
• Fortification of salt withiodine
16. 16
• Started in 1970 in urban slums, tribalareas
and backward rural areas
• Main aim is to improve nutritional statusin
– children <6years
– pregnant and lactating women
• Gradually being merged into ICDS
18. 18
• This project wasstarted in Orissaon1963
• Later extended to TNand UP
• Objectives:
– Promoting production and of protective foodsuch
vegetables and fruits
– Ensuretheir consumption by pregnant & lactating
women and children.
• In 1973 extended to all states inINDIA
19. 19
• Major components
– Nutritional Services
– Health services
– Communication
– Monitoring andevaluation
• Later converted into ICDS
21. 21
• This wasstarted in 1970 by the departmentof
social welfare
• Beneficiary:
– Preschool children 3-6 years of age
• Activities
– 300 kcal and 10 g protein
– Preschool education
• Phasedout becauseuniversalization of ICDS
23. 23
• Launched on 2nd October1975
• One of the world’s largest and most unique
programmes for early childhooddevelopment
• India’s response to the challengeof
– Providing pre-school education on one handand
– Breaking the vicious cycle of malnutrition, morbidity,
reduced learning capacity and mortality, on theother
• Foremost symbol of India’s commitment to her
children
24. Routine MCHservicesnot reachingtarget
Population
Nutritional component not covered by
Healthservices
Needfor communityparticipation
24
25. 25
• Improve the nutritional and health status of
children in the age-group 0-6years
• Foundation for proper psychological, physical and
social development of thechild
• Reduce the incidence of mortality, morbidity,
malnutrition and schooldropout
• Co-ordination of departments to promote child
development
• Nutrition and health education to the mother
26. 26
• Pregnant women
• Nursing Mothers
• Children lessthan 3 years
• Children between 3-6years
• Adolescent girls( 11-18years)
30. 30
Services TargetGroup
Supplementary Nutrition Children below 6 years,PLW
Immunization
Children below 6 years,Pregnant
Women
Health Check-up Children below 6 years,PLW
Referral Services Children below 6 years,PLW
Pre-School Education Children 3-6 years
Nutrition & Health
Education
Women (15-45 years), Children3-6
years,PLW
34. 34
• Immunization of pregnant womenand
children
• Protects against tetanus and reducesmaternal
and neonatal mortality
• Protects children from sevenvaccine
preventable diseases
• Provided by the healthdepartment
35. 35
• For children <6years, antenatal care,
postnatal care of nursingmothers
• Consists of weight recording, immunisation,
management of malnutrition, treatment of
diarrhea, de-worming, simple medicines for
common illnesses
36. 36
• Sickor malnourished children, in need of
prompt medical attention, are referred tothe
Primary Health Centre or itssub-centre
37. 37
• Anganwadi – avillage courtyard
• Backbone of the ICDS
• For 3-6 year olds
• Providing anatural, joyful andstimulating
environment
38. 38
• Keyelement of the
work of theanganwadi
worker
• Thisforms part of BCC
(Behaviour Change
Communication)
strategy
39. 39
• Toelicit communitysupport
• Weigh & record eachchild
every month
• Refer cases
• Organize pre-school
activities
• Provide supplementary
nutrition
• Provide health & nutrition
education andcounseling
• Make home visits
• Coordinate with otherstaff
40. 40
• Cook& servefood
• Cleanthe Anganwadi premises
• Cleanliness of smallchildren
• Bring small children toAnganwadi
41. 41
• For Rural/Urban Projects
– 400 to 800 - 1AWC
– 800 to 1600 - 2AWCs
– 1600 to 2400 - 3AWCs
– Thereafter in multiples of 800 perAWC
• For Mini-AWC
– 150 to 400 - 1 MiniAWC
42. 42
• Practically children 3-6year
• Pregnant & Lactating notcovered
• Irregular food supplies
• Quality of Nutrition supplement?
• Poor supervision
• Lackof community ownership/ participation
• Nutrition education only onpapers
• Children come only for food
46. 46
• akaNational Programme of Nutritional
Support to PrimaryEducation
• Objectives:
– Universalization of primary educationby
increasing enrollment (class1 to 5)and
– Improve nutritional status of children (class1-5)
– 300 kcal and 8-12 gprotein
47. Good for improving nutrition of the underprivileged
children
Butit requiressustainability
Repeatedincidenceof food poisoning in the mid daymeal
causingseriousthreat
47