Community Nutrition ProgrammesCommunity Nutrition Programmes

Community Nutrition ProgrammesCommunity Nutrition Programmes(Objectives)(Objectives)

To improve overall nutritional status To improve overall nutritional status vulnerable groupvulnerable group

To overcome specific nutritional To overcome specific nutritional deficiencies among mothers and deficiencies among mothers and children children

To help to achieve better nutrition To help to achieve better nutrition through indirect schemes through indirect schemes

Programme Programme Ministry Ministry •Vitamin-A prophylaxis Vitamin-A prophylaxis programmeprogramme

MHFWMHFW

•Prophylaxis against Prophylaxis against nutritional anaemianutritional anaemia

MHFWMHFW

•Iodine deficiency disorder Iodine deficiency disorder control programmecontrol programme

MHFWMHFW

•Special nutrition Special nutrition programme programme

MSWMSW

•Balwadi nutrition Balwadi nutrition programmeprogramme

MSWMSW

•ICDS programmeICDS programme MSWMSW•Midday meal programmeMidday meal programme MEME

Integrated ChildIntegrated Child Development Development Services(ICDS) -1975Services(ICDS) -1975

objectives objectives To improve the nutritional and health To improve the nutritional and health

status of pre-school children in the age-status of pre-school children in the age-group of 0-6 yearsgroup of 0-6 years

To improve the physical, mental and To improve the physical, mental and social development of the childsocial development of the child

To reduce the incidence of mortality, To reduce the incidence of mortality, morbidity, malnutrition and school drop-morbidity, malnutrition and school drop-out; out;

To enhance the capability of the mother to To enhance the capability of the mother to look after the normal health and look after the normal health and nutritional needs of the child through nutritional needs of the child through proper nutrition and health educationproper nutrition and health education

Administrative set upAdministrative set up

At state level -state ICDS programme officer At state level -state ICDS programme officer who report to DPHwho report to DPH

District level ICDS programme officerDistrict level ICDS programme officer Block level(100 Villages) – Child Block level(100 Villages) – Child

Development Project Officer Development Project Officer For every 20-25 ICDS center 1 supervisor For every 20-25 ICDS center 1 supervisor

(mukhya sevika)(mukhya sevika) At ICDS centre – Anganwadi worker (every At ICDS centre – Anganwadi worker (every

1000 pop)1000 pop) In tribal areas 1 Anganwadi for 700 pop In tribal areas 1 Anganwadi for 700 pop

Targeted BeneficiariesTargeted Beneficiaries The Scheme targets the most vulnerable The Scheme targets the most vulnerable

groups of population groups of population include children upto 6 years of age, include children upto 6 years of age, pregnant women and nursing mothers pregnant women and nursing mothers

belonging to poorest of the poor families belonging to poorest of the poor families and living in backward rural areas, tribal and living in backward rural areas, tribal areas and urban slums. areas and urban slums.

The identification of beneficiaries is done The identification of beneficiaries is done through surveying the community and through surveying the community and identifying the families living below the identifying the families living below the poverty line.poverty line.

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

Supplementary nutritionSupplementary nutrition

All children below 6 years of age All children below 6 years of age Adolescent girls Adolescent girls expectant mothers belonging to expectant mothers belonging to

schedule caste and tribes who’s schedule caste and tribes who’s monthly income less than 300 and monthly income less than 300 and land less agriculturistland less agriculturist

Given for 300 days ( lunch)Given for 300 days ( lunch)

Recipients Recipients CaloriesCalories Grams Grams of of ProteiProteinn

Children upto 6 Children upto 6 Years Years

300 300 8-108-10

Adolescent Girls Adolescent Girls 500 500 20-2520-25

Pregnant and Pregnant and nursing mothers nursing mothers

500 500 20-2520-25

Malnourished Malnourished Children Children

Double the daily Double the daily supplement provided to supplement provided to the other children(600 the other children(600 and/or special nutrients and/or special nutrients on medical on medical recommendation recommendation

Non formal educationNon formal education

Children between 3-6 years are Children between 3-6 years are imported pre- elementary education imported pre- elementary education without formal hours of teaching without formal hours of teaching without syllabus and testwithout syllabus and test

Teaching is mixed with play. Locally Teaching is mixed with play. Locally made charts, pictures, diagrams, made charts, pictures, diagrams, toys and play equipments are used toys and play equipments are used

ImmunizationImmunization Anganwadi arranges with health worker Anganwadi arranges with health worker

female serving her area to give female serving her area to give immunization to her wards and pregnant immunization to her wards and pregnant mothersmothers

Treatment & Referral servicesTreatment & Referral services With help of HWF get all needy children With help of HWF get all needy children

treated for minor illness like diarrhea, ARI, treated for minor illness like diarrhea, ARI, minor cuts, fever etcminor cuts, fever etc

All other cases and sever malnutrition All other cases and sever malnutrition refers to medical officer of PHC refers to medical officer of PHC

Growth monitoringGrowth monitoring Checks the weight of all preschool children Checks the weight of all preschool children

every month and records in growth chartevery month and records in growth chart

The impact of the programmeThe impact of the programme Evident from the remarkable Evident from the remarkable

improvements made in child survival and improvements made in child survival and development indicatorsdevelopment indicators

1.1. Decrease in Prevalence of Malnutrition Decrease in Prevalence of Malnutrition among Pre-school Childrenamong Pre-school Children

2.2. Improved immunization Coverage in Improved immunization Coverage in ICDS AreasICDS Areas

3.3. Decrease in IMR in ICDS AreasDecrease in IMR in ICDS Areas4.4. Improvement in School Enrolment and Improvement in School Enrolment and

Reduction in School Dropout Rate in ICDS Reduction in School Dropout Rate in ICDS Areas, 1992.Areas, 1992.

Mid-day Meal Scheme-1962Mid-day Meal Scheme-1962The The mid-day meal schememid-day meal scheme is the is the popular name for school meal popular name for school meal programme in programme in India. .

It involves provision of lunch free of It involves provision of lunch free of cost to school-children on all working cost to school-children on all working days.days.106 million children, 8 lakh schools in 106 million children, 8 lakh schools in 576 district 576 district

objectives of the programme are:objectives of the programme are: To improve the nutritional status of children To 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 improved socialization among children

belonging to all belonging to all castescastes, , The scheme has a long history especially in The scheme has a long history especially in

Tamil NaduTamil Nadu and and GujaratGujarat, , Has been expanded to all parts of India after Has been expanded to all parts of India after

a landmark direction by the a landmark direction by the Supreme Court of IndiaSupreme Court of India on on November 28November 28, , 20012001. .

The success of this scheme is illustrated by The success of this scheme is illustrated by the tremendous increase in the school the tremendous increase in the school participation and completion rates in TAMIL participation and completion rates in TAMIL NADU..NADU..

One of the pioneers of the scheme is One of the pioneers of the scheme is the the MadrasMadras corporation that started corporation that started providing cooked meals to children in providing cooked meals to children in corporation schools in the Madras city corporation schools in the Madras city in in 19231923. .

The programme was introduced in a The programme was introduced in a large scale in 1962 in TN large scale in 1962 in TN

Major thrust came in Major thrust came in 19821982 decided to decided to universalize the scheme for all universalize the scheme for all children in government schools in children in government schools in primary classes in TN. Later the primary classes in TN. Later the programme was expanded to cover all programme was expanded to cover all children up to class 12. children up to class 12.

Principles Principles The meal should be a supplement and not a The meal should be a supplement and not a

substitute to the home dietsubstitute to the home diet The meal should supply at least one third of the The meal should supply at least one third of the

total energy requirement and half of the protein total energy requirement and half of the protein needneed

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 The meal should be such that it can be prepared

easily in schools, no complicated cooking process easily in schools, no complicated cooking process should be involvedshould be involved

as far as possible, locally available foods should be as 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 avoid The menu should be frequently changed to avoid monotony monotony

Model menuModel menu

Foodstuffs Foodstuffs g/day/childg/day/child

Cereals and milletsCereals and millets 7575

Pulses Pulses 3030

Oils and fatsOils and fats 88

Leafy vegetablesLeafy vegetables 3030

Non – leafy Non – leafy vegetablesvegetables

3030

Special nutrition programmeSpecial nutrition programme

Programme was started in 1970Programme was started in 1970

Beneficiaries Beneficiaries Children below 6 years of ageChildren below 6 years of age Pregnant and nursing mothers Pregnant and nursing mothers In urban slums, tribal areas and In urban slums, tribal areas and

backward rural areasbackward rural areas

Supplementary food supplies about Supplementary food supplies about 300 kcal and 10-12 grams of protein 300 kcal and 10-12 grams of protein per child per dayper child per day

Mothers receive daily 500 kcal and Mothers receive daily 500 kcal and 25 grams of protein 25 grams of protein

Supplement is provided for 300 days Supplement is provided for 300 days in yearin year

It is gradually being merged with It is gradually being merged with ICDS programmeICDS programme

Balwadi nutrition programmeBalwadi nutrition programme

Started in 1970 Started in 1970 6000 Balwadi centre -across the country6000 Balwadi centre -across the country For children under the age group of 3-6 For children under the age group of 3-6

yearsyears Provide pre-primary education to Provide pre-primary education to

children children Food supplement provides 300 kcal and Food supplement provides 300 kcal and

10 grams of protein per child per day 10 grams of protein per child per day for 270 days for 270 days

Tamilnadu integrated nutrition Tamilnadu 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 mothers pregnant and lactating mothers Merged with ICDS programme Merged with ICDS programme

Prophylaxis against nutritional Prophylaxis against nutritional anaemiaanaemia

1970 1970

prevalence of nutritional anemia in prevalence 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% has 88% adolescent girls (3.3% has

hemoglobin <7 gm./dl; severe anemia)hemoglobin <7 gm./dl; severe anemia) 85% pregnant women (9.9% having 85% pregnant women (9.9% having

severe anemia. severe anemia. The prevalence of anemia was The prevalence of anemia was

marginally higher in lactating women marginally higher in lactating women as compared to pregnancy.as compared to pregnancy.

The commonest is iron deficiency The commonest is iron deficiency anemia. anemia.

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 All pregnant mothers get 1 tablet of IFA

per day for 100 daysper day for 100 days All anaemic mothers get 2 tablets of IFA All anaemic mothers get 2 tablets of IFA

per day for 100 daysper day for 100 days All anaemic child get 1 tablet of IFA per All anaemic child get 1 tablet of IFA per

day for 100 days day for 100 days All acceptors of family planning (IUD) are All acceptors of family planning (IUD) are

given one tablet of IFA for 100 days given one tablet of IFA for 100 days All adolescent girls were given 1 tablet of All adolescent girls were given 1 tablet of

IFA per week IFA per week

DoseDose

60 mg of elementary iron &0.5 mg of 60 mg of elementary iron &0.5 mg of folic acid and which was raised to 100 folic acid and which was raised to 100 mg elementary iron from 1992 mg elementary iron from 1992 however folic acid content remained however folic acid content remained samesame

Children in the age group of 1-5 years Children in the age group of 1-5 years are given one tablet of iron containing are given one tablet of iron containing 20 mg elementary iron (60 mg of 20 mg elementary iron (60 mg of ferrous sulphate and 0.1 mg of folic ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. acid) daily for a period of 100 days.

Vitamin-A prophylaxis Vitamin-A prophylaxis programmeprogramme

19701970

VAD is the most common cause of VAD is the most common cause of preventable blindness in children(1-preventable blindness in children(1-3yrs) 3yrs)

20-40 million children worldwide- 20-40 million children worldwide- estimated to have at least mild estimated to have at least mild vitamin A deficiency (VAD)vitamin A deficiency (VAD), half , half reside in India. reside in India.

VAD causes an estimated 60,000 VAD causes an estimated 60,000 children in India to go blind each children in India to go blind each year. year.

Prevalence rates vary greatly among Prevalence rates vary greatly among the states and range from less than the states and range from less than 1% to 6%.1% to 6%.

Prevalence of Xerophthalmia 0.6% Prevalence of Xerophthalmia 0.6% as per as per GBD 2000 estimatesGBD 2000 estimates

VAD in India remains a significant VAD in India remains a significant public health problem. public health problem.

The National Vitamin A prophylaxis The National Vitamin A prophylaxis programme was started in 1971programme was started in 1971

Became part of RCH programme Became part of RCH programme from 1997from 1997

Goal Goal To make vitamin –A deficiency no To make vitamin –A deficiency no

more a public health problem more a public health problem To reduce Bitot’s spot to less than To reduce Bitot’s spot to less than

0.5%0.5% To bring down the prevalence of To bring down the prevalence of

night blindness to less than 1%night blindness to less than 1%

Short term measuresShort term measures children between 1-5 years were given children between 1-5 years were given

oral doses of 200,000 IU vitamin A every oral doses of 200,000 IU vitamin A every six months.six months.

Currently, vitamin A is given only to Currently, vitamin A is given only to children less than three years old who are children less than three years old who are at greatest risk.at greatest risk.

The administration of the first two doses is The administration of the first two doses is linked with routine immunization to linked with routine immunization to improve the coverage. A dose of 100,000 improve the coverage. A dose of 100,000 IU is given along with measles vaccine at IU is given along with measles vaccine at nine months of age and 200,000 IU with nine months of age and 200,000 IU with DPT booster at fifteen monthsDPT booster at fifteen months

Medium term measureMedium term measure

Fortification of foodFortification of food Vanaspati is with vitamin A and D to the Vanaspati is with vitamin A and D to the

extent of 2500 IU of vit-A and 175 IU of vit-extent of 2500 IU of vit-A and 175 IU of vit-D per 100gramsD per 100grams

Fortified milk Currently, 62 dairies are Fortified milk Currently, 62 dairies are fortifying milk with 200 IU/100 ml with fortifying milk with 200 IU/100 ml with future plans for expansion. future plans for expansion.

Other food considered for fortification Other food considered for fortification include sugar, salt, tea, margarine, dried include sugar, salt, tea, margarine, dried skimmed milk etc skimmed milk etc

Long term measuresLong term measures

Dietary improvement is, undoubtedly, the Dietary improvement is, undoubtedly, the most logical and sustainable strategy to most logical and sustainable strategy to prevent VAD.prevent VAD.

Nutrition education -A change in dietary Nutrition education -A change in dietary habits and increased access to vitamin A-habits and increased access to vitamin A-rich foods through education. rich foods through education.

Immunization against infectious diseasesImmunization against infectious diseases Prompt treatment of Diarrhoeal diseases Prompt treatment of Diarrhoeal diseases Better feeding practices of infants and Better feeding practices of infants and

children children

National Iodine Deficiency Disorder National Iodine Deficiency Disorder Control programme (NIDDCP) Control programme (NIDDCP)

19921992

National goitre control programme was National goitre control programme was launched in 1962launched in 1962

GOI adopted policy of universal salt GOI adopted policy of universal salt iodization (USI) 1984iodization (USI) 1984

Amended 1988- level of iodization of salt Amended 1988- level of iodization of salt at manufacture level at 30ppm and at manufacture level at 30ppm and consumer level 15ppmconsumer level 15ppm

1990 sale and manufacture of non iodized 1990 sale and manufacture of non iodized salt was banned salt was banned

Referred as NIDDC programme in 1992 Referred as NIDDC programme in 1992 with an am to bring down the incidence of with an am to bring down the incidence of IDD below 10% by 2000IDD below 10% by 2000

Components of IDDC programmeComponents of IDDC programme

Iodization of salt and oilIodization of salt and oil Monitoring and surveillance Monitoring and surveillance Manpower training Manpower training Mass communication Mass communication

Iodized saltIodized salt

Most economical, convenient and Most economical, convenient and effective means of mass prophylaxis effective means of mass prophylaxis for IDDfor IDD

Under PFA act level of iodization is Under PFA act level of iodization is 30ppm at manufacturer level and 30ppm at manufacturer level and 15ppm at consumer level 15ppm at consumer level

Addition of 30 mg of iodine per Kg Addition of 30 mg of iodine per Kg usually in the form of potassium usually in the form of potassium iodateiodate

Potassium iodate is more stable in Potassium iodate is more stable in warm, damp and tropical climate warm, damp and tropical climate

Iodized oil (injection)Iodized oil (injection) IM iodized oil ( poppy seed oil, IM iodized oil ( poppy seed oil,

safflower oil) safflower oil) 1ml of IM injection will provide 1ml of IM injection will provide

protection for 4 yearsprotection for 4 years More expansive than iodized saltMore expansive than iodized salt Less practicable as it is very difficult Less practicable as it is very difficult

to reach each and every one to give to reach each and every one to give injectioninjection

Iodized oil (oral) or sodium iodate Iodized oil (oral) or sodium iodate tablets also triedtablets also tried

More costly than IM injection More costly than IM injection

Iodine monitoring and surveillance-Iodine monitoring and surveillance-componentscomponents

Iodine excretion determination Iodine excretion determination Determination of iodine content in Determination of iodine content in

soil and foodsoil and food Determination of iodine in salt at Determination of iodine in salt at

factory level, wholesale and retail factory level, wholesale and retail level and community or consumer level and community or consumer level.level.

Manpower trainingManpower training Training of health worker in all Training of health worker in all

approaches of IDD controlapproaches of IDD control Training on public education Training on public education

Mass communicationMass communication Mass communication through posters Mass communication through posters

radio, television, news papers and radio, television, news papers and other meansother means