Community Nutritional Programmes

Dr. Rupesh Kumar Agarwal
DNB Pediatrics club activity
J.L.N. HOSPITAL AND RESEARCH CENTRE

6 December 2012 JLNH&RC

Community Nutritional
Programmes
 Large scale supplementary programmes

 Main aim is to improve nutritional status
in targeted groups

 To overcome specific diseases through
various ministries to combat malnutrition


Programmes
Ministry
Vitamin A Prophylaxis Programme Health and family
Prophylaxis Against Nutritional anaemia. welfare
IDDs Control Programme.

Special Nutritional Programme
Balwadi Nutritional Programme Social welfare
ICDS Programme

Mid Day Meal Programme Education
Mid Day Meal Scheme Human Resource
Development

 Wheat based nutrition program
(human resource development)
 Nutrition program for adolescent girls
(human resource development)
 Annapurna scheme
(human rural development)
 Applied nutrition program
 National food for work program


Vitamin A Prophylaxis
Programme
 Initiated in 1970
 Age group 1-5 year
 Priority to VAD geographical area
 OBJECTIVE
Prevent blindness due to VAD
 ORGANIGATION
PHC and subcenter


ROLE OF VIT A IN
HEALTH
 Prevent respi infection
 maintain git and gut epithelium integrity
 Immune function
 Prevent Nutritional blindness


Vitamin A Prophylaxis
Programme
 Beneficiary group
preschool children(6 months to 5 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


Prophylaxis Against Nutritional
Anaemia
 Pregnant woman <11 gm/dl
nonpregnant woman <12gm/dl
 Initiated in 1970
 Centrally sponsored
 Over 50%pregnant woman suffer from
anemia
 20% of maternal death
 Causes LBW and perinatal mortality


OBJECTIVE
 Assess prevalence
 Give antianemic treatment
 Give prophylaxis
 Monitoring
 Education


BENEFICIARIES
 Children age group 1to 5
 Pregnant and nursing mother
 Female acceptor of terminal method of
family planning and IUDS
 ORGANIGATION
 PHC and subcenters


Iron and folic acid to
 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

 Adolescent girls : 100 mg Fe & 0.5mg folic acid

 Iron fortification in salt
 Children between 1 to 5 years.
 Screening test for aneamia done at 6 months,1 and 2
years of age.


Iodine Deficency Disorder
Control Programme
 National goiter control programme in 1962

 IDD Control Programme
Replace the entire edible salt by iodide salt

Double fortification of salt iodine and iron (40ppm and
1000ppm)


Special Nutritional

Programme in urban slums,
This was started in 1970 is in operation
tribal areas and backward rural areas.

 It was launched under minimum need programme
 Main aim is to improve nutritional status in targeted group.

children below 6 years
pregnant and lactating women

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

Applied Nutritional
Programme
 This project was started in Orissa on 1963
 Later extended to TN and UP
 Objectives:
 Promoting production and of protective food
such Vegetables and fruits
 Ensure their consumption by pregnant &
lactating women and children.
 1973 it is extended to all states in INDIA
 Mainly through nutritional education
 Nutrition worth 25 paisa for children and 50
paisa for pregnant and lactating women for 52
days in a year


Major components
 Nutritional Services
 Health services
 Communication
 Monitoring and evaluation

Later it is converted as ICDS


Balwadi Nutrition Programme
 This was started in 1970 under the department of
social welfare
preschool children 3-6years of age
300kcal and 10gm protein

Also provided with pre school education
Balawadis are being phased out because
universalization of ICDS


ICDS
 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.

Purpose for Initiation

 Routine MCH services not reaching target
Population
 Nutritional component not covered by
Health services
 Need for community participation


Objectives:
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.


Services:
 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.


Beneficiaries of ICDS
Children < 6 years Adolescent Girls

Pregnant Woman Lactating women

Women in Reproductive
age group (15-44)

Services and beneficiaries
Services Target Group Service Provided by
Supplementary Children below 6 years: Anganwadi Worker and
Nutrition Anganwadi Helper
Pregnant & Lactating Mother (P&LM)

Immunization* Children below 6 years: ANM/MO

Pregnant Women

Health Check-up* Children below 6 years: ANM/MO/AWW


Referral Services Children below 6 years: AWW/ANM/MO


Pre-School Education Children 3-6 years AWW

Nutrition & Health Women (15-45 years), Children 3-6 AWW/ANM/MO
Education years


Supplementary Nutrition
 This includes supplementary feeding and growth
monitoring; and prophylaxis against vitamin A
deficiency and control of nutritional anaemia.
 Growth Monitoring and nutrition surveillance are
two important activities that are undertaken.
 Children <3 years of age 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.


Immunization:
 Immunization of
pregnant women and
infants protects children
from six vaccine
preventable diseases-
poliomyelitis, diphtheria,

pertusis, tetanus, tuberc
ulosis and measles.
 Immunization of
pregnant women
against tetanus also
reduces maternal and
neonatal mortality


Health Check-ups
 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.


Referral Services:
 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


Non-formal Pre-School Education
(PSE)
 anganwadi – a village
courtyard
 PSE is considered the
backbone of the ICDS
programme.
 Its for the three-to six
years old children and
is directed towards
providing and
ensuring a
natural, joyful and
stimulating
environment

Nutrition and Health
Education
 It is a key element of
the work of the
anganwadi worker.

 This forms part of
BCC (Behaviour
Change
Communication)
strategy


THE ICDS TEAM:
The ICDS team comprises
 Anganwadi Workers,
 Anganwadi Helpers,
 Supervisors,
 Child Development Project Officers
(CDPOs) and
 District Programme Officers (DPOs).


Role of AWW
 To elicit community support
 Participation in running the program
 Weigh & record each child every month
 Refer cases
 Organize non-formal pre-school activities
 Provide supplementary nutrition
 Provide health & nutrition education and
counseling


Role of AWW

 Make home visits

 Assist PHC staff

 Guide ASHA

 Assist in implementation of Kishori
Shakti Yojana (KSY)


Role of AW Helper

 Cook & serve food

 Clean the Anganwadi premises

 Cleanliness of small children

 Bring small children to Anganwadi


Role of ASHA
 Awareness generation
 Counsel women
 Community mobilization
 Work with VHSC
 Escort/accompany pregnant women &
children requiring treatment
 Provide primary medical care


Role of ANM
 Hold weekly / fortnightly meeting with ASHA
 Participate & guide in organizing the Health
Days at AWC
 Utilize ASHA in motivating the pregnant
women and married couples
 Guide ASHA in motivating pregnant women
for full ANC
 Educate ASHA on danger signs of pregnancy
and labor


Role of Health Department
 Health Check-ups
 Handling Referral
 Immunization
 Nutrition & Health Education
 Monitoring of Health components


Anganwadi Centre
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


 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.


Supplementary Nutrition per Day
Beneficiary Pre-revised Revised
w.e.f. Feb.
2009
Calories Protein Calorie Protein
(KCal) (G) s (KCal) (Gm)
Children (6-72 300 8-10 500 12-15
months)
Severely 600 20 800 20-25
malnourished
children (6-72
months)
Pregnant & Lactating 500 15-20 600 18-20

Revised financial norms for food
supplement
Category Pre- Revised w.e.f
revised June 2010

Children (6-72 Rs. 2.00 Rs.4.84
months)
Severely Rs. 2.70 Rs.5.82
malnourished children
(6-72 months)
Pregnant & Lactating Rs. 2.30 Rs.6.00


International Partners

 United Nations International Children’
Emergency Fund (UNICEF)
 Cooperative for Assistance and Relief
Everywhere (CARE)
 World Food Programme (WFP)


Major Initiatives
 Revision in Population norms
 Universalization and 3rd phase of expansion
of the Scheme of ICDS
 Increment in Budgetary allocation for ICDS
Scheme
 Introduction of cost sharing between Centre
& States
 Revision in financial norms of supplementary
nutrition


Monitoring System

 Central level
 State level
 Block level
 Village level (Anganwadi level)


Failures
 Practically children 3-6 Yrs and
Pregnant & Lactating not covered
 Irregular food supplies
 Quality of Nutrition supplement?
 Poor supervision
 Lack of community ownership/ participation
 Nutrition education only on papers
 Children come only for food


Mid Day Meal Programme
 Major Objective:
improve the School attendance
reduce school drop outs
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


Mid-day meal scheme
 National programme of nutritional support to
primary education
 Objective
Universalization of primary education by increasing
enrollment (class 1 to 5) and
Improve nutritional status of children.
350 to 500 kcal and 8-12gm protein


Drawbacks

 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.


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