National nutrition programmes.

National Nutrition Programmes
Dr. Harivansh Chopra,
DCH, MD
Professor,
Dept. of Community Medicine,
LLRM Medical College, Meerut.
harichop@gmail.com

OBJECTIVE
• to study the various national nutritional
programmes aimed at combating
specific nutritional deficiencies as well
as to promote overall nutritional status
of the community.
29-07-2020 DR HARIVANSH CHOPRA 2

Special Nutrition Programme
1. Launched in 1970.
2. Support:
1. Originally launched as Central
programme.
2. Transferred to state sector in 5th five-year
plan as part of Minimum Needs
Programme.
3. Gradually being merged into ICDS
programme.

Beneficiaries
Children < 6 years of age Pregnant & Nursing women
Residing in:
• Urban Slums.
• Tribal Areas.
• Backward Rural Areas.

Beneficiaries of Programme
Child up to 6 years of age
300 Calories/day 10-12 grams/day

Beneficiaries of Programme
Pregnant & Nursing Women
500 Calories/day 25 grams/day

Balwadi Nutrition Programme
2. Support:
1. Overall charge –
Department of Social
Welfare.
2. Grants – four National
level organisations
including “Indian Council
of Child Welfare”.

Beneficiaries
Children in age group 3 – 6 years in rural
areas.

Organisation
Balwadi
Functions
Food Supplementation
1. 300 kcal per day,
2. 10 gms protein per day;
for 270 days an year.
Pre-primary School
Education to children.
Merged with icds in 197529-07-2020 DR HARIVANSH CHOPRA 9

Applied Nutrition Programme
1. Launched as pilot scheme in Orissa in
1963, later extended to Uttar Pradesh
and Tamil Nadu.
2. Extended to all states in 1973.

Beneficiaries
1. Children between 2-6 years of age.
2. Pregnant and Lactating mothers.

Aims
Nutritional Education: teaching
rural communities how to produce
foods for their own consumption
through their own efforts.
Promoting production of
protective foods eg.
vegetables and fruits.
Ensuring their consumption
by pregnant and nursing
mothers and children
THROUGH

Integrated Child Development
Scheme (ICDS)
1. Launch – 2nd October, 1975.
2. Ministries involved:
1. Central:
1. Department of Women and Child Development.
2. Ministry of Human Resources Development.
2. Nodal departments at state:
1. Social Welfare.
2. Rural Development.
3. Tribal Welfare.
4. Health and Family Welfare.
5. Women and Child Development.

Beneficiaries of ICDS
1. Children below 6 years.
2. Pregnant and Lactating Women.
3. Women in the age group of 15 – 45
years.
4. Adolescent girls (11-18 years) in
selected blocks.

Objectives of ICDS
1. Improve the nutrition and health status
of children in the age group of 0-6
years.
2. Lay the foundation for proper
psychological, physical and social
development of the child.

Objectives of ICDS
3.To reduce morbidity, mortality,
malnutrition and school drop out

Objectives of ICDS
4. Effective
coordination
and
implementati
on of policy
amongst
various
departments.

Objectives of ICDS
4. Enhance the
capability of the
mother to look after
the normal health
and nutrition needs
through proper
nutrition and health
education.

Organisation
ANGANWADI
Anganwadi Worker
RUN BY
1/1000 Population
Rural & Urban areas
1/700 Population
Tribal areas
Mukhya Sevika
Child Development
Project Officer
HEADED BY
HEADED BY
Helper

Organisation
ANGANWADI
Anganwadi Worker (25)
RUN BY
1/400-800 Population
Rural & Urban areas
1/300-800 Population
Tribal areas
Mukhya Sevika (4)
Child Development
Project Officer (1)
HEADED BY
HEADED BY
Helper
1MINI AWC/150- 400
Population
Rural & Urban areas
1MINI AWC/150- 300
Population
Tribal areas

Functions of Anganwadi
1. Health:
1. Immunisation.
2. Health check-
up.
3. Referral
services.
4. Treatment of
minor
illnesses.

Functions of Anganwadi
2. Nutrition:
1. Supplementary Nutrition.
2. Growth monitoring and promotion.
3. Nutrition and Health education.
3. Early Childhood care and Pre-School
Education to children of 3 – 6 years.
4. Convergence of other supportive
services.

Nutritional Services –
Supplementary Nutrition (New)
Child up to 6 years of age
Financial norm of rupees 8 per child per day

Supplementary Nutrition
Adolescent Girls

Pregnant & Nursing Mothers
600 Calories/day 18-20grams/day

Nutritional Services – Supplementary
Nutrition (new norms)
Pregnant & Nursing Mothers
Financial norm of rupees 9.5 per day

Malnourished Children
Double the daily supplement provided to other
children + Special Nutrients on medical
recommendation.

Supplementary Nutrition (new
norms)
Malnourished Children
800 calories/ day 20-25 grams/ day
Financial norm of rupees 12 per child per day

Revised nutritional and feeding
Norms
• More than 1 meal is to be provided
• morning snack e.g. banana, milk, egg,
seasonal fruit, etc.
• followed by a hot cooked meal
• Take home ration is to be provided for
• Children below 3 years
• Pregnant and lactating mothers

1. Weighing each child under 3 years of
age every month.
2. Maintenance of Growth Chart of every
child.
Growth Monitoring & Promotion

3. Children over 3 years of age assessed
with MUAC.
4. A child falling in yellow or red zone is
weighed every month.
Growth Monitoring & Promotion

5. Organisation of teaching of mothers
on health and nutrition.
Nutrition and Health Education

Schemes being run for
adolescent under ICDS
• Kishori Shakti Yojna
• Nutritional Program For Adolescent
Girls
• Rajiv Gandhi Scheme for Empowerment
of Adolescent Girls-SABLA
• Indira Gnadhi Matratva Sahyog Yojna
(IGMSY)

Mid-Day Meal Programme
1. “National Programme
of Nutritional Support
to Primary Education”
is popularly known as
“Mid-Day Meal
Scheme”.
2. Launch – 15th
August, 1995.

3. Aims at launch:
1. Improving School
Attendance.
2. Reducing school
dropouts.
3. Beneficial impact
on children’s
nutrition.
Mid-Day Meal Programme

Beneficiaries of Mid-Day Meal
1. Children of class I – V of government
schools (states like Gujrat and Tamil
Nadu include children of classes I –
VIII).
2. Programme extended to children of
government supported schools from
October, 2002.

Support
1. Central Government:
Provision of foodgrains at 3 Kgs. minimum per child
per month for 10 months (300 kcal and 8-12 gms
protein per child per day).
2. Panchayats and Nagarpalikas:
Setting up of necessary infrastructure for
preparing cooked food.

Support
3. NGOs, Women’s group, & Parent-
Teacher Council:
Preparation of cooked food.
4. Poverty Alleviation Programme:
Assistance for total charges for cooking,
supervision and kitchen.

Mid -day School Meal model menu
Foodstuffs g/day/child
Cereals and millets
Pulses
Oils and fats
Leafy vegetables
Non-leafy vegetables
75
30
8
30
30

National Nutritional Anaemia
Prophylaxis Programme
2. Aims at launch:
1. Prevent nutritional
anaemia in
mothers.
2. Prevent nutritional
anaemia in
children.

Support
1. Maternal and Child Health (MCH)
division of Ministry of Health and
Family Welfare (MoHFW).
2. Now it is a part of RCH Programme.

Iron Supplementation
Iron-Folic Acid Tablet
100 mg Elemental Iron
0.5 mg Folic Acid
X 100 days
100 mcg Folic Acid
X 100 days
Expecting and Nursing mothers.
Family Planning Acceptors.
Children 1 – 5 years.

0.5 mg Folic Acid
X 180 days
100 mcg Folic Acid
X 100 days
Expecting and Nursing mothers.
Family Planning Acceptors.
Children 1 – 5 years.

2 tab60 mg Elemental Iron
0.5 mg Folic Acid
X 100 days
250 mcg Folic Acid
X 100 days
Anaemic
pregnant
Children 6 –10 years.

TWELVE BY TWELVE INITIATIVE
Initiative launched by FOGSI in collaboration with GOI,WHO
and unicef
By 2012 every child should have 12gm% Hb by 12 years of age

National Programme for Prophylaxis
against Blindness in Children caused
due to Vitamin A Deficiency
1. Launched by Ministry
of Health and Family
Welfare in 1970 on
basis of technology
developed at
National Institute of
Nutrition, Hyderabad.

Beneficiaries
Children of age group 9 months –5
years.

Vitamin A Prophylaxis
9 months – 1 lac IU Vit. A
15 months – 2 lac IU Vit. A
2 lac IU Vit. A every 6 months
till 5 yrs of age.
1st Dose
2nd Dose
7 Doses
17 lac IU of Vit. A – Total 9 doses

Recommended Daily Intakes
1. Adults:
Retinol
(mcg)
Β-Carotene
(mcg)
Man
Woman
Pregnancy
Lactation
600
600
800
950
4800
6400
29-07-2020 DR HARIVANSH CHOPRA

Recommended Daily Intakes
2. Children and Adolescents:
Retinol
(mcg)
Β-Carotene
(mcg)
0-12 months
1-6 years
7-12 years
13-19 years
350
400
600
600
2800
3200
4800
4800

Vitamin A deficiency –
Ocular Manifestations
Night blindness
Conjunctival Xerosis
& Bitot’s Spots
Corneal Xerosis
Keratomalacia

W.H.O.CLASSIFICATION
PRIMARY SIGNS
1. XIA- Conjunctival Xerosis
2. XIB- Bitot’s Spots Conjunctival
Xerosis
3. X2 - Corneal Xerosis
4. X3A- Corneal Ulceration with
Xerosis
5. X3B- Keratomalacia29-07-2020 DR HARIVANSH CHOPRA

W.H.O.CLASSIFICATION
SECONDARY SIGNS
1. XN-Night Blindness only
2. XB-Bitot’s Spots only
3. XF-Typical Fundus changes
4. XS-Corneal scar attributable to
Xeropthalmia

Night Blindness:
1. First ocular
symptom of Vitamin
A deficiency.
2. Inability to see in
dim light.
3. It is due to
impairment in dark
adaptation.

Conjunctival Xerosis:
1. First clinical sign
of Vitamin A
deficiency
2. Conjunctiva
becomes dry and
non-wettable –
appears muddy
and wrinkled.

Bitot’s Spots:
1. Triangular, pearly-white
or yellowish, foamy
spots on bulbar
conjunctiva on either
side of cornea.
2. Frequently bilateral.
3. In older individuals,
these spots are often
inactive sequelae of
earlier disease.29-07-2020 DR HARIVANSH CHOPRA

Corneal Xerosis:
1. Cornea appears
dull, dry and non-
wettable, and
eventually
opaque.
2. Severe deficiency
leads to corneal
ulceration.

Corneal
Xerosis:
3. Corneal
ulcer may
heal with
scar –
vision
affected.

Ocular ManifestationsKeratomalacia:
1. Medical
emergency.
2. The cornea may
become soft and
burst open.
3. Eye may
collapse with
total loss of
vision.

Extra-Ocular Manifestations
Epithelium:
1. Skin – Dry and
Scaly.
2. Follicular
hyperkeratosis
on shoulders,
buttocks, and
extensor
surfaces of
extremities.29-07-2020 DR HARIVANSH CHOPRA

Diagnosis
1. Dark adaptation test.
2. Biomicroscopic examination of
conjunctiva may reveal conjunctival
xerosis.29-07-2020 DR HARIVANSH CHOPRA

Diagnosis
3. Examination of
scrapings from eye
and vagina.
4. Plasma carotene
level (it falls more
rapidly than plasma
Vit. A level).

Treatment
1. All early stages of
Xerophthalmia reversed
by 200,000 IU or 110 mg
of retinol plamitate orally
for two successive days.
2. All children with corneal
ulcers should receive Vit.
A, whether or not a
deficiency is suspected.

National Iodine Deficiency
Disorders Control Programme
Launch of National Goitre
Control Programme, 1962
OBJECTIVES:
1. Identification of Goitre
endemic areas & supply of
iodised salt in these areas.
2. To assess the impact of
goitre control measures over
a period of time.
Iodine Deficiency Disorder
Control Programme, 1986
OBJECTIVE:
1. To replace entire edible
salt by iodine salt, in phased
manner by 1992.
RENAMED

Objectives of NIDDCP
1. To conduct survey to identify
magnitude of problem in country.
2. Production and supply of iodised salt
in place of common salt.
3. To improve Health Education and
Publicity (IEC).

Objectives of NIDDCP
4. To undertake monitoring of the quality
of iodated salt assessing urinary iodine
excretion pattern and monitoring of
Iodine Deficiency Disorder.
5. To resurvey in goitre endemic regions
after five years continuous supply of
iodised salt to assess impact of control
programme.

DR HARIVANSH CHOPRA
• In India the level of iodization is fixed
under the Prevention of Food
Adulteration (PFA) Act.
AT PRODUCTION POINT AT CONSUMER LEVEL
30 PPM 15 PPM
29-07-2020 68

DR HARIVANSH CHOPRA
Iodine testing Kit
• It contains a vial with
a chemical solution.
• 1 drop of chemical
solution turns a salt
sample from light
blue to dark violet if it
contains iodine.
29-07-2020 69

Conclusion
• The various nutritional programmes are
covering the vulnerable age groups in
which the nutritional needs are more.

Conclusion
But unfortunately effective implementation
and supportive supervision is lacking due
to which still both macro and
micronutrients deficiencies are still quite
high in the community

1. Who are the beneficiaries of
bawadi nutrition program?
1. 0-3 years of age
2. 3-6 years of age
3. 0-6 years of age
4. Pregnant women
Ans . 2

Which of the following is the
aim of applied nutrition
program?
1. Promoting the production of protective
foods
2. Health education
3. Increasing the awareness about
malnutrition
4. Providing adequate calories and proteins
Ans . 1

When was ICDS launched?
1. 2nd October, 1975
2. 30th January, 1975
3. 15th august. 1975
4. 26th January, 1975
Ans . 1

Malnourished children are
provided food at a rate of
1. Rs. 8 per day
2. Rs. 5 per day
3. Rs. 4 per day
4. Rs. 3 per day
Ans . 1

How many AWW are
supervised by 1 Mukhya Sevika
1. 20
2. 25
3. 50
4. 100
Ans . 2

National nutrition programmes.

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