Community nutritional programmes

nutritional programmes of children, pregnant women, adolescent and elderly

1. Community nutritional programmes Dr. Harpreet Kaur 1 st Year PG student Community Medicine Guru Gobind Singh Medical College, Faridkot

2. Learning objective To know about nutritional programmes in India and basic structure of these programmes .

3. Lesson plan Introduction Nutritional programmes for pregnant and lactating mothers Nutritional programmes for children Nutritional programmes for adolescents Other nutritional programmes

4. Introduction Under-nutrition prevalent in India is- -macronutrient deficiency (Protein- energy malnutrition) -micronutrient deficiency (deficiencies in iron, iodine, vitamin A and zinc). Nutrition programs in India are directed against -general malnutrition and at specific nutritional deficiencies.

5. According to WHO, SDG Target 2.2 End all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons.

6. Nutritional programmes for pregnant and lactating mothers Programmes Ministry National nutritional Anemia Prophylaxis Programme Ministry of Health and Family welfare (MOHFW) 2. JSSK 3. ICDS programme Ministry of Social welfare (MSW) 4. Special nutrition programme 5. National Nutrition Mission Ministry of Women and Child Development 6. Pradhan Mantri Matru Vandana Yojana 7. Appilied Nutrition Programme Ministry of Rural Development

7. National nutritional Anemia Prophylaxis Programme L aunched in 1972 to prevent nutritional anemia in mothers and children. Beneficiaries - Pregnant women and nursing mothers with hemoglobin < 8gm%, - Children 1-5 years with hemoglobin < 10gm%, - Women acceptors of family planning. Currently the programme is operating as a part of RMNCH+A programme . Under the revised policy, target group has been expanded to include - Infants 6-12 months, - School children 5-10 years, - Adolescents 10-19 years of age.

8. Dosage schedule Beneficiaries Formulation doses Frequency & distribution Children 6 to 59 months 20 mg elemental iron & 100 µg folic acid Biweekly throughout the period of 6 to 60 months School children 5-9 yrs 45 mg elemental iron & 400 µg folic acid weekly throughout the period of 5-10 yrs Adolescents 10-19 yrs 100 mg elemental iron & 500 µg folic acid weekly throughout the period of 10-19 yrs Pregnant women 100 mg elemental iron & 500 µg folic acid Prophylactic: 1 tab daily, starting after the 1 st trimester Clinically anemic: 2 tab daily for 6 mts Nursing mothers Daily for 6 months Acceptors of family planning Daily for 100 days Women in reproductive age group weekly throughout the reproductive period

9. Strategies under RMNCH+A National Iron Plus Initiative: It provides a minimum service package for the management of anaemia across life stages and at different levels of health care. ASHA will be given incentives - to make home visits, - to provide at least one dose per week under direct observation and - educate the mothers about benefits of iron supplements. Use of folic acid is promoted in planned pregnancies - for the prevention of neural tube defects and other congenital abnormalities.

10. 2. Anemia Mukt Bharat To achieve the targets of World Health Assembly - 50% reduction of anemia in women of reproductive age by 2025. to reduce the prevalence amongst young children (6-59 months), adolescents and women of reproductive age groups (15-49 years) by three percent per year. This has been built upon the existing framework of NIPI.

11. Anemia Mukt Bharat initiatives

12. 12 by 12 initiative for anemia control  Launched on april 23 ,2007 at AIIMS, New Delhi. Organized by Department of Obs. & Gynae of AIIMS in collaboration with WHO, UNICEF and FOGSI. Objective- Ensuring every child at least 12 gm% hemoglobin by 12 yrs of age. Goals- To determine the prevalence of anemia in adolescence to ensure healthy parenthood. To increase awareness among adolescents regarding anemia & appropriate nutrition.

13. 3. Weekly Iron and Folic acid Supplementation (WIFS) It is a national scheme which aims to cover all children studying in classes I-XII of government, government aided and municipal schools . Main activities- Supervised administration of weekly iron and folic acid supplements. Screening of target groups for moderate or severe anemia and referral. Bi-annual deworming. Information and counselling for improving dietary intake and preventive actions for intestinal worm infestation.

14. ICDS Programme Integrated Child Development Service, 1975. There is a strong nutrition component in this programme in the form -of supplementary nutrition, vit A prophylaxis and iron and folic acid distribution. Currently it is termed as Umbrella ICDS Scheme that comprises of several subschemes . It includes- Anganwadi Services Scheme for Adolescent Girls National Nutrition Mission Pradhan Mantri Matru Vandana Yojana Child Protection Services National Creche Scheme

15. Objectives of ICDS To improve the nutritional and health status of children in the age group 0-6 years. To lay the foundations for proper physical, social and psychological development of the child. To reduce mortality ,morbidity, malnutrition and school drop-outs. To achieve effective co-ordination and implementation of policy among the various departments working for the promotion of child development. To enhance the capability of the mother and nutritional needs of the child through proper nutrition and health education.

16. Beneficiaries - pre school children below 6 yrs , adolescent girls 11-18 yrs , pregnant and lactating mothers. Anganwadi workers deliver services at village level. Mahila mandal networks have been built up in ICDS project areas to help anganwadi workers. Work of anganwadis is supervised by mukhyasevikas . Field supervision by Child Development Project Officer(CDPO).

17. The ICDS Scheme offers a package of six services- Supplementary nutrition Pre-school non-formal education Nutrition & health education Immunization Health check-up Referral services The last three services are related to health and provided by Ministry/ Department of Health and Family Welfare through NHM and health system.

18. Supplementary nutrition under ICDS Beneficiaries Calories/day Proteins(g)/day Children (6-72 months) 500 12-15 Severely underweight children (6-72 months) 800 20-25 Pregnant & nursing mothers, adolescent girls 600 18-20

19. Special nutrition Programme Started in 1970. For the nutritional benefit of children below 6 yrs , pregnant and nursing mothers. Operated in urban slums, tribal areas and backward rural areas. Supplementary food supplies 300 kcal and 10- 12 gms of protein/child/day. Beneficiary Mothers receive daily 500 kcal and 25 gms of protein. Supplement given for 300 days in a year. Main aim of this program was to improve nutritional status of target groups. This programme is gradually being merged into the ICDS programme .

20. National Nutrition Mission (POSHAN) National Nutrition Mission also named as POSHAN (PM’s Overarching Scheme for Holistic Nourishment). It was launched in March 2018 in Jhunjhunu district of Rajasthan. Goals – Prevent and reduce stunting in children (0-6 yrs ) @ 2% per annum. Prevent and reduce undernutrition in children (0-6 yrs ) @ 2% per annum. Reduce low birth weight in children (0-6 yrs ) @ 2% per annum. Reduce the prevalence of anemia among children, adolescent girls and women (15-49 yrs ) @ 3% per annum.

21. Rashtriya POSHAN Maah , September 2020 The two major activities of Rashtriya POSHAN Maah 2020 were: identification and tracking of children with severe acute malnutrition. plantation drive for promotion of kitchen gardens at the grassroots level.

22. Pradhan Mantri Matru Vandana Yojana Indira Gandhi Matritva Sahyog Yojana which was started in 2010 was renamed as Pradhan Mantri Matru Vandana Yojana in 2017. Objectives – To provide partial compensation for the wage loss in terms of cash incentives so that the woman can take adequate rest before and after delivery of the 1 st living child. The cash incentive provided would lead to improved health seeking behaviour amongst the PM & LM.

23. All eligible pregnant and lactating women receive cash incentives under in 3 installments in specific conditions. Installment Condition Amount 1 st Installment Early registration of pregnancy ₨ 1000 2 nd Installment Received at least one ANC ₨ 2000 3 rd Installment Child birth is registered Child has received first cycle of BCG,OPV, DPT and Hepatitis- B ₨ 2000

24. Nutritional programmes for children Programmes Ministry National nutritional Anemia Prophylaxis Programme Ministry of Health and Family welfare (MOHFW) 2. Vitamin A prophylaxis programme 3. ICDS programme Ministry of Social welfare (MSW) 4. Special nutrition programme 5. Balwadi nutrition programme 6. Mid-day meal programme Ministry of Education 7. Mid-day meal scheme Ministry of Human Resources Development 8. National Nutrition Mission Ministry of Women and Child Development 9 . Appilied Nutrition Programme Ministry of Rural Development

25. Vitamin A prophylaxis programme Vitamin A deficiency is one of the major causes of blindness in children below five years. The program was started in 1970 with the objective to reduce the prevalence of vitamin A deficiency disorders from 0.6% to 0.5%. Beneficiary: age group 6months - 5years Implemented by: PHC and subcenter

26. Prevention of vitamin A deficiency Promoting consumption of Vitamin A rich food Creating awareness about the importance of preventing Vitamin A deficiency Prophylactic Vitamin A as per the following dosage schedule: 100000 IU at 9 months with measles immunization 200000 IU at 16-18 months, with DPT booster 200000 IU every 6 months, up to the age of 5 years. Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years .

27. Treatment of Vitamin A deficient children Vitamin A deficiency should be treated urgently. Early stages of xeropthalmia can be reversed by administration of massive dose. 200000 IU orally on two succ essive days and repeat after 4 weeks .

28. Balwadi nutrition Programme Started in 1970. It was a healthcare and education programme launched by the Government of India to provide food supplements at Balwadis . For the benefit of children-3-6 years in rural areas. It was implemented through Balwadis , which also provide preprimary education. Voluntary organizations which receive funds are actively involved in the day-to-day management. Food supplement provides 300 Kcal and 10 g of protein per day per child. Gradually being phased out because of universalization of ICDS.

29. Mid-day meal Programme aka School Lunch Programme . Started as a national programme in 1962-63. Objectives Improve school attendance. Improve child nutrition. Principles meal should- Supplement, not substitute to home diet. Supply at least 1/3rd of total energy and ½ of protein requirement /day. low cost, easily prepared at schools. locally available food should be used and menu should be frequently changed.

30. Mid-day meal Scheme Aka National Programme of Nutritional Support to Primary Education (NP-NSPE). Launched as centrally sponsored scheme on 15th august 1995 and revised in 2004. The scheme covers children in classes I-V of - government, government aided, local body schools under Employment Guarantee Scheme (EGS) and Alternate Innovative Education (AIE) centres . In Sept. 2004, the scheme has been extended to cover children in upper primary classes, thus providing supplementary nutrition up to 14 yrs of age.

31. Objectives of mid-day meal scheme Improve the nutritional status of school children. Encouraging poor children, belonging to disadvantaged sections, to attend school more regularly. Provide nutritional support to children of primary stage in drought affected areas during summer vacation. Scheme provided- Cooked meal with 700 calories and 20 gms of protein by providing 150 gms of food grains (rice/wheat) per child/ school day.

32. Nutritional programmes for Adolescents Programmes Ministry National nutritional Anemia Prophylaxis Programme Ministry of Health and Family welfare (MOHFW) 2. ICDS programme Ministry of Social welfare (MSW) 3. Kishori Shakti Yojana Nutrition Programme for Adolescent Girls (NPAG) 5. Scheme for Adolescent Girls (SAG)

33. Kishori Shakti Yojana (KSY) This scheme is a redesign of the already existing Adolescent Girls Scheme being implemented as a component under the centrally sponsored ICDS Scheme. Objectives To improve the nutritional, health and development status of adolescent girls. Promote awareness of health, hygiene, nutrition and family care. Link them to opportunities for learning life skills. Help them gain a better understanding of their social environment and take initiatives to become productive members of the society .

34. Nutrition Programme for Adolescent Girls (NPAG) To address the problem of under-nutrition among adolescent girls. Target Group: Adolescent girls (11-19 years) Adolescent girls (11-15 years) (weight <30 Kg) Adolescent girls (15-19 years ) (weight <35 Kg)

35. NPAG-Services 6 kg of free food-grains (wheat/rice/Maize based on habitual consumption pattern of the state) /per month per beneficiary. Nutrition and Health Education to the beneficiaries and their families. This Programme is operationalised through the administrative set up of ICDS at the state, district, block and Anganwadi level.

36. Scheme for Adolescent Girls (SAG) Scheme was launched in 2010 as Rajiv Gandhi Scheme For Empowerment Of Adolescent Girls (RGSEAG)- SABLA and replaces KSY and NPAG. Objectives Enable the adolescent girls for self development & empowerment. Improve their nutrition and health status. Promote awareness about hygiene, ARSH and family & child care. Upgrade their life skills & tie up with National Skill Development Program (NSDP) for vocational skills.

37. SAG scheme includes- Nutrition component- Take home ration or hot cooked meal providing 600 calories, 18-20 g of protein per beneficiary per day for 300 days a year. Non-nutrition component- IFA supplementation Health check ups and referral Nutrition and health education

38. Nutritional programmes for Elderly Other Programmes Programmes Ministry Annapurna Scheme Ministry of Agriculture, Consumer Affairs, Food and Public distribution Programmes Ministry Iodine deficiency disorders control programme Ministry of Health and Family welfare (MOHFW) 2. National programme for prevention and control of fluorosis 3. Antyodya Anna Yojana Ministry of Agriculture, Consumer Affairs, Food and Public distribution 4. Smart Ration Card Scheme

39. Annapurna Scheme Launched in 2000-2001 by Ministry of Rural Development. Destitute senior citizens of ≥65 years of age, who are eligible for old age pension under the National Old Age Pension Scheme (NOAPS) but are not getting the pension, are covered. 10 kgs of food grains/person/month are supplied free of cost.

40. Iodine deficiency disorders control Programme National goiter control programme was launched in 1962. Renamed in 1992 to address the spectrum of disorders that are caused by iodine deficiency. Goal of the program is- to reduce the prevalence of IDD to below 10% in endemic districts of the country by 2000. Since this was achieved, the goal was modified to reduce the prevalence of IDD to below 5%.

41. Activities under the program- Surveys to assess the magnitude of IDD in districts. Supply of iodized salt in place of common salt. Resurveys 5yearly to assess impact of iodized salt & IDD. Lab monitoring of iodized salt and urinary iodine excretion. Health education and publicity. MoHFW is responsible for the overall functioning of the program. Salt Commisioner’s office under Ministry of Industry controls monitoring, production and distribution of iodized salt to the states & Uts .

42. Common salt is iodized using potassium iodate and the iodine content should not be <30 ppm at production and 15 ppm at consumption levels under the Food Safety and Standards Act. Information, education and communication regarding the importance of consumption of iodized salt in prevention of IDD is central to the program. IDD spots containing messages on consequences of iodine deficiency disorders and benefits of consuming iodized salt are being telecast through Doordarshan channels daily and IDD messages under Swasth Bharat Programme .

43. National program for prevention and control of fluorosis Fluorosis is caused by excess intake of fluorides through drinking water/food products/industrial pollutants, over a long period, resulting in major health disorders like dental fluorosis, skeletal fluorosis and nonskeletal fluorosis. These harmful effects are permanent in nature and irreversible. The desirable limit of fluoride as per Bureau of Indian Standards (BIS) is 1 ppm. To combat this problem, this program was launched in 2008-09.

44. Objectives To collect, assess and use the baseline survey data of fluorosis of Ministry of Drinking Water Supply for starting the project. Comprehensive mgt. of fluorosis in selected areas. Capacity building for prevention, diagnosis & mgt. of fluorosis cases.

45. Strategies Surveillance of fluorosis in the community including school children. Capacity building in the form of training and manpower support. Establishment of diagnostic facilities in the district/medical hospitals. Management of fluorosis cases including treatment, surgery and rehabilitation. Health education for prevention and control of fluorosis cases.

46. Antyodya Anna Yojana Launched in 25th Dec 2000. Target group – Poor families who couldn’t afford food grains even at BPL rates Service – Families are given food grains at highly subsidized rates. ex.- wheat @Rs 2/kg & rice @Rs 3/kg, 35 kg being supplied per family per month. In 2009, it was extended to include all eligible BPL, and families of HIV + ve persons in AAY list on priority.

47. Wheat will be given at Rs. 2/- per KG. The Biannual entitlement of wheat will be given at one go. The distribution will be done at the doorstep of the beneficiary directly by the department. The beneficiary can go to the consumer court, if he does not get wheat as per his entitlement. Wheat will be delivered in 30 kg standard packing. The department officials, Beneficiary, Transporter, Gram Panchayat, Nigrani Committee - all will work in coordination for disbursement of wheat. Smart Ration Card Scheme ( in Punjab)

48. Still… Where are we now ? INDIA holds 94 th Rank among 107 Countries in Global Hunger Index 2020

49. References Park K. Nutrition and Health , Park’s textbook of preventive and social medicine, 25 th ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 2019. p.716-8. Banerjee B, National Nutrition Programme , DK Taneja’s Health Policies & Programmes in India, 16 th ed. Jaypee Brothers Medical Publishers (P) Ltd; 2019.p.427-59.

50. Thank you