The document discusses several community nutrition programmes in India that aim to improve nutrition among vulnerable groups. It describes the objectives and services provided by key programmes like the Integrated Child Development Services (ICDS) programme and Mid-Day Meal Scheme. ICDS provides supplementary nutrition, immunization, health check-ups and education to children under 6, pregnant/nursing mothers. It has shown positive impacts like reduced malnutrition and school dropout rates. The Mid-Day Meal Scheme provides free lunches to over 100 million school-going children, improving nutrition and increasing school attendance and completion.

1. Community Nutrition ProgrammesCommunity Nutrition Programmes

2. Community Nutrition ProgrammesCommunity Nutrition Programmes
(Objectives)(Objectives)
 To improve overall nutritional statusTo improve overall nutritional status
vulnerable groupvulnerable group
 To overcome specific nutritionalTo overcome specific nutritional
deficiencies among mothers and childrendeficiencies among mothers and children
 To help to achieve better nutrition throughTo help to achieve better nutrition through
indirect schemesindirect schemes

3. ProgrammeProgramme MinistryMinistry
•Vitamin-A prophylaxisVitamin-A prophylaxis
programmeprogramme
MHFWMHFW
•Prophylaxis against nutritionalProphylaxis against nutritional
anaemiaanaemia
MHFWMHFW
•Iodine deficiency disorderIodine deficiency disorder
control programmecontrol programme
MHFWMHFW
•Special nutrition programmeSpecial nutrition programme MSWMSW
•Balwadi nutrition programmeBalwadi nutrition programme MSWMSW
•ICDS programmeICDS programme MSWMSW
•Midday meal programmeMidday meal programme MEME

4. Integrated ChildIntegrated Child DevelopmentDevelopment
Services(ICDS) -1975Services(ICDS) -1975

5. objectivesobjectives
 To improve the nutritional and health status ofTo improve the nutritional and health status of
pre-school children in the age-group of 0-6 yearspre-school children in the age-group of 0-6 years
 To improve the physical, mental and socialTo improve the physical, mental and social
development of the childdevelopment of the child
 To reduce the incidence of mortality, morbidity,To reduce the incidence of mortality, morbidity,
malnutrition and school drop-out;malnutrition and school drop-out;
 To enhance the capability of the mother to lookTo enhance the capability of the mother to look
after the normal health and nutritional needs ofafter the normal health and nutritional needs of
the child through proper nutrition and healththe child through proper nutrition and health
educationeducation

6. Administrative set upAdministrative set up
 At state level -state ICDS programme officer whoAt state level -state ICDS programme officer who
report to DPHreport to DPH
 District level ICDS programme officerDistrict level ICDS programme officer
 Block level(100 Villages) – Child DevelopmentBlock level(100 Villages) – Child Development
Project OfficerProject Officer
 For every 20-25 ICDS center 1 supervisor (mukhyaFor every 20-25 ICDS center 1 supervisor (mukhya
sevika)sevika)
 At ICDS centre – Anganwadi worker (every 1000At ICDS centre – Anganwadi worker (every 1000
pop)pop)
 In tribal areas 1 Anganwadi for 700 popIn tribal areas 1 Anganwadi for 700 pop

7. Targeted BeneficiariesTargeted Beneficiaries
 The Scheme targets the most vulnerable groupsThe Scheme targets the most vulnerable groups
of populationof population
 include children upto 6 years of age,include children upto 6 years of age,
 pregnant women and nursing mothers belongingpregnant women and nursing mothers belonging
to poorest of the poor families and living into poorest of the poor families and living in
backward rural areas, tribal areas and urbanbackward rural areas, tribal areas and urban
slums.slums.
 The identification of beneficiaries is doneThe identification of beneficiaries is done
through surveying the community and identifyingthrough surveying the community and identifying
the families living below the poverty line.the families living below the poverty line.

8. Package of ServicesPackage of Services
 Supplementary NutritionSupplementary Nutrition
 ImmunizationImmunization
 Health Check-upHealth Check-up
 Treatment & Referral ServicesTreatment & Referral Services
 Non-formal Pre-school EducationNon-formal Pre-school Education
 Nutrition & Health EducationNutrition & Health Education

9. Supplementary nutritionSupplementary nutrition
 All children below 6 years of ageAll children below 6 years of age
 Adolescent girlsAdolescent girls
 expectant mothers belonging to scheduleexpectant mothers belonging to schedule
caste and tribes who’s monthly incomecaste and tribes who’s monthly income
less than 300 and land less agriculturistless than 300 and land less agriculturist
 Given for 300 days ( lunch)Given for 300 days ( lunch)

10. RecipientsRecipients CaloriesCalories GramsGrams
ofof
ProteinProtein
Children upto 6Children upto 6
YearsYears
300300 8-108-10
Adolescent GirlsAdolescent Girls 500500 20-2520-25
Pregnant andPregnant and
nursing mothersnursing mothers
500500 20-2520-25
MalnourishedMalnourished
ChildrenChildren
Double the daily supplementDouble the daily supplement
provided to the otherprovided to the other
children(600 and/or specialchildren(600 and/or special
nutrients on medicalnutrients on medical
recommendationrecommendation

11. Non formal educationNon formal education
 Children between 3-6 years are importedChildren between 3-6 years are imported
pre- elementary education without formalpre- elementary education without formal
hours of teaching without syllabus and testhours of teaching without syllabus and test
 Teaching is mixed with play. Locally madeTeaching is mixed with play. Locally made
charts, pictures, diagrams, toys and playcharts, pictures, diagrams, toys and play
equipments are usedequipments are used

12. ImmunizationImmunization
 Anganwadi arranges with health worker femaleAnganwadi arranges with health worker female
serving her area to give immunization to herserving her area to give immunization to her
wards and pregnant motherswards and pregnant mothers
Treatment & Referral servicesTreatment & Referral services
 With help of HWF get all needy children treatedWith help of HWF get all needy children treated
for minor illness like diarrhea, ARI, minor cuts,for minor illness like diarrhea, ARI, minor cuts,
fever etcfever etc
 All other cases and sever malnutrition refers toAll other cases and sever malnutrition refers to
medical officer of PHCmedical officer of PHC
Growth monitoringGrowth monitoring
 Checks the weight of all preschool childrenChecks the weight of all preschool children
every month and records in growth chartevery month and records in growth chart

14. The impact of the programmeThe impact of the programme
 Evident from the remarkable improvementsEvident from the remarkable improvements
made in child survival and developmentmade in child survival and development
indicatorsindicators
1.1. Decrease in Prevalence of Malnutrition amongDecrease in Prevalence of Malnutrition among
Pre-school ChildrenPre-school Children
2.2. Improved immunization Coverage in ICDSImproved immunization Coverage in ICDS
AreasAreas
3.3. Decrease in IMR in ICDS AreasDecrease in IMR in ICDS Areas
4.4. Improvement in School Enrolment andImprovement in School Enrolment and
Reduction in School Dropout Rate in ICDSReduction in School Dropout Rate in ICDS
Areas, 1992.Areas, 1992.

15. Mid-day Meal Scheme-1962Mid-day Meal Scheme-1962
TheThe mid-day meal schememid-day meal scheme is theis the
popular name for school meal programme inpopular name for school meal programme in
IndiaIndia..
It involves provision of lunch free of cost toIt involves provision of lunch free of cost to
school-children on all working days.school-children on all working days.
106 million children, 8 lakh schools in 576106 million children, 8 lakh schools in 576
districtdistrict

16. objectives of the programme are:objectives of the programme are:
 To improve the nutritional status of childrenTo improve the nutritional status of children
 protecting children from classroom hunger,protecting children from classroom hunger,
 increasing school enrolment and attendance,increasing school enrolment and attendance,
 improved socialization among children belongingimproved socialization among children belonging
to allto all castescastes,,
 The scheme has a long history especially inThe scheme has a long history especially in
Tamil NaduTamil Nadu andand GujaratGujarat,,
 Has been expanded to all parts of India after aHas been expanded to all parts of India after a
landmark direction by thelandmark direction by the
Supreme Court of IndiaSupreme Court of India onon November 28November 28,, 20012001..
 The success of this scheme is illustrated by theThe success of this scheme is illustrated by the
tremendous increase in the school participationtremendous increase in the school participation
and completion rates in TAMIL NADU..and completion rates in TAMIL NADU..

17.  One of the pioneers of the scheme is theOne of the pioneers of the scheme is the
MadrasMadras corporation that started providingcorporation that started providing
cooked meals to children in corporationcooked meals to children in corporation
schools in the Madras city inschools in the Madras city in 19231923..
 The programme was introduced in a largeThe programme was introduced in a large
scale in 1962 in TNscale in 1962 in TN
 Major thrust came inMajor thrust came in 19821982 decided todecided to
universalize the scheme for all children inuniversalize the scheme for all children in
government schools in primary classes ingovernment schools in primary classes in
TN. Later the programme was expandedTN. Later the programme was expanded
to cover all children up to class 12.to cover all children up to class 12.

18. PrinciplesPrinciples
 The meal should be a supplement and not a substitute toThe meal should be a supplement and not a substitute to
the home dietthe home diet
 The meal should supply at least one third of the totalThe meal should supply at least one third of the total
energy requirement and half of the protein needenergy requirement and half of the protein need
 The cost of the meal should be reasonably lowThe cost of the meal should be reasonably low
 The meal should be such that it can be prepared easilyThe meal should be such that it can be prepared easily
in schools, no complicated cooking process should bein schools, no complicated cooking process should be
involvedinvolved
 as far as possible, locally available foods should beas far as possible, locally available foods should be
used, this will reduce the cost of the mealused, this will reduce the cost of the meal
 The menu should be frequently changed to avoidThe menu should be frequently changed to avoid
monotonymonotony

19. Model menuModel menu
FoodstuffsFoodstuffs g/day/childg/day/child
Cereals and milletsCereals and millets 7575
PulsesPulses 3030
Oils and fatsOils and fats 88
Leafy vegetablesLeafy vegetables 3030
Non – leafy vegetablesNon – leafy vegetables 3030

20. Special nutrition programmeSpecial nutrition programme
 Programme was started in 1970Programme was started in 1970
BeneficiariesBeneficiaries
 Children below 6 years of ageChildren below 6 years of age
 Pregnant and nursing mothersPregnant and nursing mothers
 In urban slums, tribal areas and backwardIn urban slums, tribal areas and backward
rural areasrural areas

21.  Supplementary food supplies about 300Supplementary food supplies about 300
kcal and 10-12 grams of protein per childkcal and 10-12 grams of protein per child
per dayper day
 Mothers receive daily 500 kcal and 25Mothers receive daily 500 kcal and 25
grams of proteingrams of protein
 Supplement is provided for 300 days inSupplement is provided for 300 days in
yearyear
 It is gradually being merged with ICDSIt is gradually being merged with ICDS
programmeprogramme

22. Balwadi nutrition programmeBalwadi nutrition programme
 Started in 1970Started in 1970
 6000 Balwadi centre -across the country6000 Balwadi centre -across the country
 For children under the age group of 3-6For children under the age group of 3-6
yearsyears
 Provide pre-primary education to childrenProvide pre-primary education to children
 Food supplement provides 300 kcal andFood supplement provides 300 kcal and
10 grams of protein per child per day for10 grams of protein per child per day for
270 days270 days

23. Tamilnadu integrated nutritionTamilnadu integrated nutrition
programmeprogramme
 Was started in the year 1981Was started in the year 1981
 Beneficiaries are children < 6 years,Beneficiaries are children < 6 years,
pregnant and lactating motherspregnant and lactating mothers
 Merged with ICDS programmeMerged with ICDS programme

24. Prophylaxis against nutritionalProphylaxis against nutritional
anaemiaanaemia
19701970

25. prevalence of nutritional anemia inprevalence of nutritional anemia in
IndiaIndia
 65% infant and toddlers65% infant and toddlers
 60% 1-6 years of age,60% 1-6 years of age,
 88% adolescent girls (3.3% has88% adolescent girls (3.3% has
hemoglobin <7 gm./dl; severe anemia)hemoglobin <7 gm./dl; severe anemia)
 85% pregnant women (9.9% having85% pregnant women (9.9% having
severe anemia.severe anemia.
 The prevalence of anemia was marginallyThe prevalence of anemia was marginally
higher in lactating women as compared tohigher in lactating women as compared to
pregnancy.pregnancy.
 The commonest is iron deficiencyThe commonest is iron deficiency
anemia.anemia.

27.  The programme was launched in 1970The programme was launched in 1970
 1992 became part of CSSM programme1992 became part of CSSM programme
 1997 became part of RCH programme1997 became part of RCH programme
 All pregnant mothers get 1 tablet of IFA per dayAll pregnant mothers get 1 tablet of IFA per day
for 100 daysfor 100 days
 All anaemic mothers get 2 tablets of IFA per dayAll anaemic mothers get 2 tablets of IFA per day
for 100 daysfor 100 days
 All anaemic child get 1 tablet of IFA per day forAll anaemic child get 1 tablet of IFA per day for
100 days100 days
 All acceptors of family planning (IUD) are givenAll acceptors of family planning (IUD) are given
one tablet of IFA for 100 daysone tablet of IFA for 100 days
 All adolescent girls were given 1 tablet of IFAAll adolescent girls were given 1 tablet of IFA
per weekper week

28. DoseDose
 60 mg of elementary iron &0.5 mg of folic60 mg of elementary iron &0.5 mg of folic
acid and which was raised to 100 mgacid and which was raised to 100 mg
elementary iron from 1992 however folicelementary iron from 1992 however folic
acid content remained sameacid content remained same
 Children in the age group of 1-5 years areChildren in the age group of 1-5 years are
given one tablet of iron containing 20 mggiven one tablet of iron containing 20 mg
elementary iron (60 mg of ferrous sulphateelementary iron (60 mg of ferrous sulphate
and 0.1 mg of folic acid) daily for a periodand 0.1 mg of folic acid) daily for a period
of 100 days.of 100 days.

30. Vitamin-A prophylaxisVitamin-A prophylaxis
programmeprogramme
19701970

31.  VAD is the most common cause ofVAD is the most common cause of
preventable blindness in children(1-3yrs)preventable blindness in children(1-3yrs)
 20-40 million children worldwide-20-40 million children worldwide-
estimated to have at least mildestimated to have at least mild vitamin Avitamin A
deficiency (VAD)deficiency (VAD), half reside in India., half reside in India.
 VAD causes an estimated 60,000 childrenVAD causes an estimated 60,000 children
in India to go blind each year.in India to go blind each year.

32.  Prevalence rates vary greatly among thePrevalence rates vary greatly among the
states and range from less than 1% to 6%.states and range from less than 1% to 6%.
 Prevalence of Xerophthalmia 0.6% as perPrevalence of Xerophthalmia 0.6% as per
GBD 2000 estimatesGBD 2000 estimates
 VAD in India remains a significant publicVAD in India remains a significant public
health problem.health problem.

33.  The National Vitamin A prophylaxisThe National Vitamin A prophylaxis
programme was started in 1971programme was started in 1971
 Became part of RCH programme fromBecame part of RCH programme from
19971997
GoalGoal
 To make vitamin –A deficiency no more aTo make vitamin –A deficiency no more a
public health problempublic health problem
 To reduce Bitot’s spot to less than 0.5%To reduce Bitot’s spot to less than 0.5%
 To bring down the prevalence of nightTo bring down the prevalence of night
blindness to less than 1%blindness to less than 1%

34. Short term measuresShort term measures
 children between 1-5 years were given oralchildren between 1-5 years were given oral
doses of 200,000 IU vitamin A every six months.doses of 200,000 IU vitamin A every six months.
 Currently, vitamin A is given only to children lessCurrently, vitamin A is given only to children less
than three years old who are at greatest risk.than three years old who are at greatest risk.
 The administration of the first two doses is linkedThe administration of the first two doses is linked
with routine immunization to improve thewith routine immunization to improve the
coverage. A dose of 100,000 IU is given alongcoverage. A dose of 100,000 IU is given along
with measles vaccine at nine months of age andwith measles vaccine at nine months of age and
200,000 IU with DPT booster at fifteen months200,000 IU with DPT booster at fifteen months

36. Medium term measureMedium term measure
Fortification of foodFortification of food
 Vanaspati is with vitamin A and D to the extentVanaspati is with vitamin A and D to the extent
of 2500 IU of vit-A and 175 IU of vit-D perof 2500 IU of vit-A and 175 IU of vit-D per
100grams100grams
 Fortified milk Currently, 62 dairies are fortifyingFortified milk Currently, 62 dairies are fortifying
milk with 200 IU/100 ml with future plans formilk with 200 IU/100 ml with future plans for
expansion.expansion.
 Other food considered for fortification includeOther food considered for fortification include
sugar, salt, tea, margarine, dried skimmed milksugar, salt, tea, margarine, dried skimmed milk
etcetc

37. Long term measuresLong term measures
 Dietary improvement is, undoubtedly, the mostDietary improvement is, undoubtedly, the most
logical and sustainable strategy to prevent VAD.logical and sustainable strategy to prevent VAD.
 Nutrition education -A change in dietary habitsNutrition education -A change in dietary habits
and increased access to vitamin A-rich foodsand increased access to vitamin A-rich foods
through education.through education.
 Immunization against infectious diseasesImmunization against infectious diseases
 Prompt treatment of Diarrhoeal diseasesPrompt treatment of Diarrhoeal diseases
 Better feeding practices of infants and childrenBetter feeding practices of infants and children

38. National Iodine Deficiency DisorderNational Iodine Deficiency Disorder
Control programme (NIDDCP)Control programme (NIDDCP)
19921992

39.  National goitre control programme was launchedNational goitre control programme was launched
in 1962in 1962
 GOI adopted policy of universal salt iodizationGOI adopted policy of universal salt iodization
(USI) 1984(USI) 1984
 Amended 1988- level of iodization of salt atAmended 1988- level of iodization of salt at
manufacture level at 30ppm and consumer levelmanufacture level at 30ppm and consumer level
15ppm15ppm
 1990 sale and manufacture of non iodized salt1990 sale and manufacture of non iodized salt
was bannedwas banned
 Referred as NIDDC programme in 1992 with anReferred as NIDDC programme in 1992 with an
am to bring down the incidence of IDD belowam to bring down the incidence of IDD below
10% by 200010% by 2000

40. Components of IDDC programmeComponents of IDDC programme
 Iodization of salt and oilIodization of salt and oil
 Monitoring and surveillanceMonitoring and surveillance
 Manpower trainingManpower training
 Mass communicationMass communication

41. Iodized saltIodized salt
 Most economical, convenient and effectiveMost economical, convenient and effective
means of mass prophylaxis for IDDmeans of mass prophylaxis for IDD
 Under PFA act level of iodization is 30ppmUnder PFA act level of iodization is 30ppm
at manufacturer level and 15ppm atat manufacturer level and 15ppm at
consumer levelconsumer level
 Addition of 30 mg of iodine per Kg usuallyAddition of 30 mg of iodine per Kg usually
in the form of potassium iodatein the form of potassium iodate
 Potassium iodate is more stable in warm,Potassium iodate is more stable in warm,
damp and tropical climatedamp and tropical climate

42. Iodized oil (injection)Iodized oil (injection)
 IM iodized oil ( poppy seed oil, safflowerIM iodized oil ( poppy seed oil, safflower
oil)oil)
 1ml of IM injection will provide protection1ml of IM injection will provide protection
for 4 yearsfor 4 years
 More expansive than iodized saltMore expansive than iodized salt
 Less practicable as it is very difficult toLess practicable as it is very difficult to
reach each and every one to give injectionreach each and every one to give injection
Iodized oil (oral) or sodium iodate tabletsIodized oil (oral) or sodium iodate tablets
also triedalso tried
 More costly than IM injectionMore costly than IM injection

43. Iodine monitoring and surveillance-Iodine monitoring and surveillance-
componentscomponents
 Iodine excretion determinationIodine excretion determination
 Determination of iodine content in soil andDetermination of iodine content in soil and
foodfood
 Determination of iodine in salt at factoryDetermination of iodine in salt at factory
level, wholesale and retail level andlevel, wholesale and retail level and
community or consumer level.community or consumer level.

44. Manpower trainingManpower training
 Training of health worker in all approachesTraining of health worker in all approaches
of IDD controlof IDD control
 Training on public educationTraining on public education
Mass communicationMass communication
 Mass communication through postersMass communication through posters
radio, television, news papers and otherradio, television, news papers and other
meansmeans