INTRODUCTION Under nutrition is by far most important singlecause of illness and death globally accounting for 12%of all deaths and 16% of disability- adjusted life yearslost. Low weight for age is associated more than halfof all deaths in young children accounting for morethan 6 million deaths per year.
DIRECT1. Integrated Child Development Services(ICDS) Scheme2. Nutrition Programs For Adolescent Girls3. Nutrition Advocacy and Awareness General Programs for Food And Nutrition Board (FNB).4. Follow Up Action For National Nutrition Policy, 1993.5. Ministry Of Health and Family Welfare. Iron and Folic Acid Supplementation of Pregnant Women. Vitamin A Supplementation of Children of 9- 36 Months Age Group. National Iodine Deficiency Disorder Control Program. Department Of Elementary School and Literacy. Midday Meal for Primary School Children.
INDIRECTDepartment of Agriculture and Cooperation ∗ Increased Food Production ∗ Horticulture InterventionsFood And Public Distribution ∗ Targeted Public Distribution System ∗ Antodaya Anna Yojana ∗ Annapurna Scheme contd..
Rural and Urban Development ∗ Food for Work Program ∗ Safe Drinking Water and Alleviation Program ∗ National Rural Employment Guarantee Scheme ∗ Ministry of Health ∗ National Rural Health Mission ∗ Poverty Alleviation Program ∗ IMNCIDepartment Of Women And Child Development ∗ Various Women’s Welfare and Support ProgramDepartment of Education and Literacy ∗ Sarva Siksha Abhiyan ∗ Adult Literacy Program
SPECIAL NUTRITION PROGRAM The program was launched in the country in1970-71. It provided supplementary feeding ofabout 300 calories and 10 gms of proteins topreschool children and about 500 calories and25gms of proteins to expectant and nursingmothers for six days a week. This program wasoperated as under Minimum Needs Program.Fund for nutrition component of ICDS programwas shared with SNP budget.
BALWADI NUTRITION PROGRAM This program was launched by the ministry of socialwelfare in 1970. This program is for the welfare ofchildren in the age group of 3-6 years in rural areas. Thechildren are given preschool education, dietsupplementation by providing 30 k cal and 10gms ofprotein per day per child for 270 days a year and care fortheir psychosocial development.
MIDDAY MEAL PROGRAM This program was launched in 1961 by the ministry of education and was implemented throughout the country for school children in the age group of 6-11 years of age.The programs were launched to enhance the admissions and retain students in the school to improve literacy and also to improve the health status of children.Under this program the target group is provided food supplements to provide 1/3rd of the total energy requirements and half of the proteins requirement .The school lunch program opportunity in the school is used/ need to be used to educate children. contd..
Following recommendations are made in a report by Nutrition Foundations:The children in classes 1-8th could be included as beneficiaries of the program as being practiced in the state of Gujarat and Tamil Nadu.The midday meals should provide 1/3rd of the daily requirement (350-350kcal.)The meal should be hygienic quality that demands monitoring of the raw material and cooked preparation by trained personnel.In urban areas a centralized kitchen should be prepared, transported and served hygienically.Convergence of synergistic activities
THE APPLIED NUTRITION PROGRAM The Applied Nutrition Program was introduced asa Pilot Scheme in Orissa in 1963 which later onextended to Tamil Nadu and Uttar Pradesh with theobjectives of : Promoting production of protective foods such as vegetables and fruits. Ensure their consumption by pregnant and nursing mothers and children. contd..
During 1973, it was extended to all the states of the country.The nutrition education was the main focus and efforts were directed to teach rural communities through demonstration how to produce food for their consumption through their own efforts.The beneficiaries were children between 2-6 years and pregnant and lactating mothers.Nutrition worth Rs 25 paisa/child/day and 50 paise per woman per day was provided for 52 days in a year.The idea was to provide better seeds and encourage kitchen gardens, poultry farming, beehive keeping etc. but this program did not produce any effect.
TAMIL NADU INTEGRATED NUTRITION PROGRAM The Tamil Nadu Integrated Nutrition Project was started in 1980 targetting 6-36 months and children and pregnant and lactating women. The objectives of TINP was:Nutrition surveillance through regular growth monitoring of all children in the age group 6-36 months;Help rehabilitate and prevent malnutrition through short term food supplementation; contd..
Reduce the mortality and morbidity due to protein-energy malnutrition and specific nutrient deficiencies;Improve the nutritional status of pregnant and nursing women;Strengthen health services to provide adequate back-up support to the nutrition effort; Improve home child care and feeding practices through education;Improve the efficiency and the impact of the above through sustained performance monitoring and evaluation;To reduce anemia in pregnant and lactating women from 55% to about 20%.To reduce vitamin A deficiency in the under five from about 27% to 5%.To reduce infant mortality by 25%.
The project had four componentsNUTRITION SERVICES delivery formed the core of TINP I.HEALTH: The project helped to deploy and train one female multi- purpose health worker (MPHW) in a health sub centre for a population of 5000 (4-5 villages),COMMUNICATION: i) make mothers more fully aware of the nutritional needs of children; ii) bring about better intra-family food distribution: and iii) enable the community to better handle its health and nutritional needs.MONITORING AND EVALUATION :This will ensure effective implementation. A lack of such periodic evaluations may lead to the continuation of ineffective program.
INTEGRATED CHILD DEVELOPMENTSERVICES (ICDS) SCHEME ICDS was launched on 2nd October 1975(5th 5 yearplan) in pursuance of the National Policy for children.This is mainly a health intervention which adopts aholistic approach aimed at improving both the pre-natal and post-natal environment of the child. It is aCentrally-sponsored, State-administered schemeconsisting of maternal health care in pregnancy andgrowth monitoring and nutritional supplements forchildren - services received at community centres oranganwadis. contd..
Its objectives are:• To improve the nutrition and health status of children aged 0-6 years.• To lay the foundations for proper psychological, physical and social development of the child.• To reduce the incidence of mortality, morbidity, malnutrition and school drop-out.• To achieve effective coordinated policy and its implementation amongst the various departments to promote child development.• 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. contd..
Beneficiaries• children below 6 years• pregnant and lactating women• women in the age group of 15-45 years• adolescent girls in selected blocks contd..
COMPONENTS of ICDS• Supplementary Nutrition• Immunization.• Health• Referral services• Nutrition and Health Education.• Non-formal Preschool Education. contd..
SCHEME FOR ADOLESCENT GIRLS (Kishori Shakti Yojana)• A scheme for adolescent girls in ICDS was launched by the Department Of Women And Child Development, Ministry Of Human Resource Development, 1991.• Common services:• Watch over menarche• Immunization• General health check ups• Treatment for minor ailments• Deworming• Prophylactic measures against anemia, goiter, vitamin deficiency etc .• Referral to PHC/ District hospital in case of acute need.
ACHIEVEMENTS New ICDS is effective in 5659 communitydevelopment blocks and major urban slumsthroughout the country. As against 227 croresbeneficiaries until March 1997 there were 3.4 crorebeneficiaries in April 2001. In 2006 the schemereached out to about 95 lakhs expectant and nursingmothers and 244.92 lakhs preschool children and562.18 lakh beneficiaries are getting supplementarynutrition.
PROGRAMS TO PREVENT SPECIFICDEFICIENCY STATESVITAMIN A PROPHYLAXIS PROGRAMThis program is one of the components of NationalPrograms for Control of Blindness. This includesadministration of 200,000 I.U of vitamin A orally to allpreschool children every six months the programme waslaunched in 1970 by the ministry of health and familywelfare MCH centres in urban areas, PHC in rural areas andICDS projects are engaged in the implementation of theprogram.
PROPHYLAXIS AGAINST NUTRITIONALANAEMIAThe program was started by the ministry of health andfamily welfare during the fourth 5 year plan to preventnutritional anemia the program envisages distribution ofiron and folic acid to young children and expectant mothersthrough MCH centres in urban areas PHC/SC in rural areasand Anganwadis in project areas. The commercialproduction of iron fortified common salt was started in1985.
CONTROL OF IODINE DEFICIENCYDISORDER The national goiter control program was launched bythe government of India in 1962 in the Goiter belt in theHimalayan region and iodized salt was supplied in Goiterendemic areas. Later on in 1986 this program was changedto National Iodine Deficiency Disorders Control Programbecause the problem was found to be widespread and morethan the problem of Goiter.
PILOT PROJECT ON PROGRAM AGAINST MICRONUTRIENT MALNUTRITION The Pilot Project Program Against Micronutrient Malnutrition was implemented in Assam along with for other states namely Bihar, Orissa, West Bengal and Gujarat. The program was launched in the year 1995. The objectives of the programs are:• To asses the and improve iron and vitamin A status in school going children , adolescent boys and girls, non pregnant women, adult males and geriatric population.• To assess the magnitude of flourosis and dental caries. contd..
• To launch extensive information, education and communication strategies through mass media to improve the dietary habits of the population and;• To study zinc level in various food products and soil.• The program was implemented in one district of each of the five states. The following activities were undertaken.• Advocacy and sensitization meetings with people involved in policy making with elected members, teachers, social workers etc.• A baseline survey was conducted to assess the socioeconomic status, food intake pattern, estimation of Hb, soil, zinc, fluorine in drinking water etc..• Training was also organized at block level, prior to field activity surveys.
WORLD FOOD PROGRAM• World food program is the world’s largest international food aid organization, aid organization, serving in 84 counties with a goal of achieving “ a world of which every man, woman and child has access at all times to the food there can be no sustainable peace, no democracy and no development.• Founded in 1963 as the food aid arm of United nation after the Rome declaration on world food security in 1996. WFP is committed to achieve a goal of reducing half the number who are adequate access to food by 2015.
WORLD FOOD PROGRAM IN INDIA WFP goals and objectives in India:Improve nutrition and quality of life for the most vulnerable population at critical times in their lives.Make sustainable improvements in household food security for the poorest, especially for women and child and invest funds in development for long term security.Strengthen channels for locally produced food grains and support local entrepreneurship.Advocate for ecorestoration through participation methods. contd..
Beneficiaries• Poor women, particularly mothers and children at risk.• Poor forest dependent population.• WFP have included supplementary feeding and supported forestry, livestock and dairy development. A blend of precooked maize and soyafortified with micro nutrients called CSB (corn- soya- blend) has been developed in India in the name of ‘Indiamix’. contd..
NUTRITIVE VALUE OF INDIAMIXNUTRIENTS AMOUNT PER 100 GRAMProtein (g) 20Fat(g) 6Crude fibre (g) 2Carbohydrate (g) 60Energy (g) 390Calcium (g) 191Iron (g) 15Vitamin A (g) 1454
ACTIVITIES UNDER WFP’sHelping women to gain better access to food, education,and involvement in community decisions.Access to maternal and child health care improving childsurvival , “food for work” program in collaboration withforest department providing food in emergencies, accessto health services, potable water and sanitationProper caring practices for young children.Education particularly girls and women.Supporting generation of biogas.Protection of forest through mass awareness and activeparticipation.Income generating products.Creating market by local manufacturing by India Mix.Effective program implementation
NATIONAL NUTRITIONAL GOALS 11TH FIVEYEAR PLAN• Reduce the prevalence of the underweight in children under 5 years upto 20%.• Eradicate the prevalence of undernutrition in children after 5 years.• First hour breastfeeding rates to increase to 80%.• Exclusive breast feeding rates to increase to 90%.• Complementary feeding rate at six months to increase to 90%.• Reduce prevalence of anemia in high risk group to 25%.• Eliminate vitamin A deficiency in children under 5 years as a public health problem and reduce subclinical deficiency of Vitamin A in children by 50%.• Reduce prevalence of iodine deficiency disorders to less than 5%.
CURRENT STATUS AND FUTURE RECOMMENDATIONS• Supplementary food should be viewed and used only as a vehicle for providing other services under the ICDS scheme.• Supplementary foods should be cereal based, palatable and of good quality.• Fortification of foods with micronutrients: it should be mainly considered with iron and iodine.• Nutritional counseling of mothers through ICDS scheme for promotion of nutrition and health of children.• Community based rehabilitation of severely malnourished children through integrated health and nutrition interventions.
CONCLUSIONNutrition affects growth and development of a person.Atleast the development of International Standards andnational legislation, are essential to protect and promotenational food security and public health. Civil societywill have to play a more active role. The concept of foodsecurity must be recaptured and reframed in public andenvironment terms.
BIBLIOGRAPHY• Gulani K.K. (2005). Community Health Nursing. 1st Edition. Kumar Publishing House. New Delhi.Pp- 662 to 664.• Gupta M.C.,Mahajan B.K. (2003). Textbook Of Preventive And Social Medicine. Third Edition. Jaypee Brothers Medical Publishers. New Delhi. Pp-355-357.• Kishore J. (2007).National Health Programs Of India. 7th Edition Century Publication. New Delhi. Pp- 340-361.• Indian pediatrics. (2001)38.721-731.• www.springerlink.com/index/pdf retieved on 02/02/2009.