National nutritional program in india

national nutritional programs in India

1. NATIONAL NUTRITIONAL PROGRAMMES By Arushi Negi M.Sc. Nursing Ist year

2. INTRODUCTION Nutrition may be defined as the science of food and its relationship to health which helps in body growth, development and maintenance. The Government of India have initiated several large scale supplementary feeding programmes, and programmes aimed at overcoming specific deficiency diseases through various Ministries to combat malnutrition.

3. NUTRITIONAL CELL It is in the Directorate General of Health Services and provides technical advice in all matters related to the nutrition. These include policy decision, programme planning, implementation and evaluation; training content for different levels of medical, nursing and paramedical personnel, standards and labels for foods, proposals, project evaluation, hospital diet etc.

4. It is working on creating awareness through dissemination of various types of IEC materials. Coordinates with State Nutrition Division which conduct diet and nutrition surveys, imparting training of health personnel who are involved in the programmes. Appraisal of several research projects on subjects such as fluorosis, arsenic toxicity, maternal micro nutrient status, street food management, were taken up.

5. VITAMIN A PROPHYLAXIS PROGRAMME

6. VITAMIN A PROPHYLAXIS PROGRAMME Launched by- Ministry of Health and Family Welfare Launched in - 1970 Beneficiaries- all pregnant and lactating women and children under 5 years of age Vitamin A is an important for maintaining normal growth, regulating cellular proliferation and differentiation, controlling development, and maintaining visual and reproductive functions.

7. OBJECTIVES

8. DOSAGE Prophylactic Vitamin A as per the following dosage schedule: i.100000 IU at 9 months with measles immunization ii.200000 IU at 16-18 months, with DPT booster iii.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. This programme is part of blindness control program.

9. Component of the National Programme for Control of Blindness. Launched in- 1976 Goal - Reducing the prevalence of blindness to 0.3% by 2020.   Objectives identification and treatment of curable blind expand research community awareness Strengthening the existing infrastructure facilities and developing human resources Strengthening and up-gradation of Regional Institutes of Ophthalmology (RIOs) universal eye care services and quality service delivery;

10. Practices adopted under the programme: 1)Multipurpose District Mobile Ophthalmic Units in the District Hospitals of States/UTs as a new initiative under the programme. 2)Distribution of free spectacles to old persons 3)Comprehensive eye-care coverage by covering diseases other than cataract like diabetic retinopathy, glaucoma,etc. 4)Providing funds for purchase of modern ophthalmic equipments. 5)Setting up superspecialty clinics for all major eye diseases 6)Linkage of tele-ophthalmology centres at PHC/Vision centres with superspecialty eye hospitals 7)Development of eye banks and eye donation centres

11. PROPHYLAXIS AGAINST NUTRITIONAL ANEMIA

12. PROPHYLAXIS AGAINST NUTRITIONAL ANEMIA Prevalence of nutritional anemia in India 65% - infant and toddlers 60% - (1-6 ) years of age 88% - adolescent girls (3.3% has hemoglobin <7 gm./dl; severe anemia) 85% - pregnant women (9.9% having severe anemia) Higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia

13. Launched in - 1970 during the fourth Five Year Plan Beneficiaries - the expected and nursing mothers,acceptors of family planning and children. Dosage : Adults - one tablet of iron and folic acid (100 mg elementary iron and 0.5 mg of folic acid.)for 100 days. Children - ( 1-5 years)- one tablet of iron (20 mg elementary iron ,60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. Taken by Maternal and Child Health (MCH), Division of MoHFW,Now it is part of RCH programme. Iron fortification of common salt has also been developed . 

14. WEEKLY IRON FOLIC ACID SUPPLEMENTATION: Launched by - Ministry of Health and Family Welfare Goal - meet the high prevalence and incidence of anaemia amongst adolescent girls and boys. L ong term goal is to break the intergenerational cycle of anaemia, Short term benefits is of a nutritionally improved human capital. Implementation - By supervised weekly ingestion of IFA supplementation and biannual helminthic control.

15. Objectives

16. IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME

17. IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME Launched by - Government of India Launched in - 1 962 Objective - Identification of the goitre in endemic areas Supply iodized salt in place of common salt Assess the impact of goitre control measures over time. A major national programme was mounted in 1986 to replace the entire edible salt by iodide salt, in a phase - the IDD Control manner by 1992 . Ban of non iodised salt under PFA act (1954).

18. SPECIAL NUTRITION PROGRAMME

19. SPECIAL NUTRITION PROGRAMME Launched in - 1970 Beneficiaries - Children below 6 years of age, pregnant and nursing mothers . Aim- Improve the nutritional status of the target groups. Supplies - About 300 kcal and 10-12 grams of protein per child per day 500 kcal and 25 grams of protein per mother per day for 300 days. Transferred to the State sector in the fifth Five Year Plan as part of the Minimum Needs This programme is gradually being merged into the ICDS programme.

20. BALWADI NUTRITION PROGRAMME

21. BALWADI NUTRITION PROGRAMME Launched in - 1970 Beneficiaries- Children of 3-6 years in rural areas. Four national level organizations are given grants to implement the programme : Central Social Welfare Board (CSWB) Indian Council of Child Welfare (ICCW), Harijan Sewak Sangh (HSS) AND Adimjati Sewak Sangh (ASS), Kasturba Gandhi National Memorial Trust  The food supplement provides 300 kcal and 10 grams of protein per child per day for 270 days a year and are for their psychosocial development.  Balwadis are being phased out because of universalization of ICDS.

22. Integrated Child Development Services (ICDS)

23. ICDS PROGRAMME Launched in - 1975 in pursuance of the Integrated National Policy for Children. Beneficiaries - children below 6 years, and nursing and expectant mothers from low income group. OBJECTIVES : effective coordination of policy and implementation proper nutrition and health education. reduce the mortality and morbidly malnutrition foundation for proper psychological, physical and social development improve the nutritional health status of children.(0-6yrs)

24. DELIVERY OF SERVICES: 1. Supplementary nutrition The aim is to supplement nutritional intake as follows: a. each child 6-72 months of age to get 500 cal 12-15 grams of protein (financial norm of Rs 8 child per day); b. Severely malnourished child 6-72 months 800 calories and 20-25 grams protein (financial norm of Rs 12.00 per child per day); c. Each pregnant and nursing woman to get 600 and 18-20 grams of protein (financial norm Rs 9.50 per beneficiary per day.

25. Supplementary nutrition is given 300 days in a year. Adequate funds for supplementary nutrition is provided by the State Plan under Minimum Needs Programme . Children are weighed every month. Nutrition education and health education is given to mothers of children suffering from 1st degree of malnutrition. Supplementary nutrition (therapeutic children suffering from 2nd and 3rd degree nutrition. Children suffering from 4th degree malnutrition recommended hospitalization.

26. SERVICES CONT.. 2.Immunization Immunization of children against 9 vaccine preventable diseases is being done, while for expectant mothers immunization against tetanus is recommended. 3.Health check-up antenatal care of expectant mothers postnatal care of nursing mother and care of newborn care of children under 6 years of age. expectant mothers are given IFA tablets along with protein supplements. High risk mothers and referred to appropriate institutions for special care.

27. SERVICES CONT.. 4. The health care of children under 6 years of age consists: 1. Record of weight and height of children periodical intervals; 2. Watch over milestones; 3. Immunization; 4. General check-up every 3-6 months disease, malnutrition etc.; 5.Treatment for disease like diarrhoea, dysentery respiratory tract infections etc. which are wide prevalent; 6. Deworming; 7. Prophylaxis against vitamin A deficiency 8. Referral of serious cases to hospital provided 9. Health records of the children, antenatal and delivery card etc. are maintained.

28. SERVICES CONT.. Non-formal pre-school education Children between the ages 3-6 years are imparted non-formal pre-school education in an anganwadi in each village with about 1000 population. The objective is to provide opportunities to develop desirable attitude, values behaviour pattern among children. Schemes for adolescent girls 1. Kishori Shakti Yojana - The scheme targets adolescent girls the age group of 11 to 18 years and addresses their needs of self development, nutrition and health status, literacy and numerical skills, vocational skills etc. 2. Nutrition Programme for Adolescent Girls- was approved in the year 2009-10, on a pilot project basis.. Undernourished adolescent girls in the age group 11 to 19 years (with body weight less than 30 kg in the age of group of 11 to 15 years and 35 kg in the age group of 15 to 19 years) are covered under the scheme. 6 kg of free food grain is provided to each beneficiary per month.

29. SERVICES PROVIDED THROUGH: The workers at the village level who deliver the services are called Anganwadi workers.Anganwadi workers from the local area are given 3 months training. Each Anganwadi is for 1000 population in rural/urban areas and 750 population in tribal areas. A network of Mahila covers a Mandals has been built up in ICDS Project areas to help Anganwadi workers in providing health and nutrition services. The work of Anganwadis is supervised by Mukhyasevikas. Field supervision is done by the Child Development Project Officer (CDPO).

30. MID-DAY MEAL PROGRAMME

31. MID-DAY MEAL PROGRAMME The mid-day meal programme (MDMP) is also known as School Lunch Programme. Launched in - 1961 Beneficiaries - School children in the age group of 6-11 years. Objective : To attract more children for admission to schools and retain them so that literacy improvement occurs. The mid-day meal programme became part of the Minimum Needs Programme in the Fifth Five Year Plan.

32. Principles of Mid day meal : (a)the meal should be a supplement and not a substitute to the home diet. (b) the meal should supply at least one-third of the total energy requirement, and half of the protein need i.e. about 300 kcal and 8-12 gms of protein per/day/student. This is provided for 200 days in a year. (c) the cost of the meal should be reasonably low. (d) the meal should be such that it can be prepared easily in schools. (e) planning nutritious menu using locally available food stuffs, food, hygiene, food habits etc. The important goals to be accomplished are: a.reorientation of eating habits; b.incorporating nutrition education into the curriculum; c.encouraging the use of local commodities; d.improving school attendance as we to educational performance of the pupils. 

33. MID-DAY MEAL SCHEME Also known as National Programme of Nutritional Support to Primary Education. Launched on - 5th August 1995 and revised in 2004. Objective - Universalization of primary education by increasing enrolment, retention and attendance and simultaneously impacting on nutrition of students in primary classes. It was implemented in 2,408 blocks in the first year and covered the whole country in a phased manner by 1997-98. The programme originally covered children of primary stage (classes I to V) extended in Oct. 2002. The central assistance - free supply of food grain from nearest Food Corporation of India godown at the rate of 100 g. per student per day and subsidy for transport of food grain. To achieve the objective, a cooked mid-day meal with minimum 300 Calories and 8 to 12 grammes of protein content will be provided to all the children in class I to V.

34. Some suggesstions: a)Food grains stored away from moisture, to avoid infestation. b)Use whole wheat or broken wheat (dalia) . c)'Single Dish Meals' using broken wheat or rice and incorporating some amount of a pulse or soyabeans, a seasonal vegetable/green leafy vegetable, and some amount of edible oil will save both time and fuel. d)Cereal pulse combination is necessary to have good quality protein. The cereal pulse ratio could range from 3:1 to 5:1. e)Sprouted pulses have more nutrients and should be incorporated in single dish meals.

35. f) Leafy vegetables should be washed before cutting and should not be subjected to washing after cutting. g)Soaking of rice, dal, bengal gram etc. reduces cooking time. h)Wash the grains thoroughly and soak in just sufficient amount of water required for cooking. i)Rice water if left after cooking should be mixed with dal if these are cooked separately and should never be thrown away. Fermentation improves nutritive value. Preparation of idli, dosa, dhokla etc. may be encouraged. j)Cooking must be done with the lid on to avoid loss of nutrients. Over cooking should be avoided. k)Reheating of oil used for frying is harmful and should be avoided. l)Leafy tops of carrots, radish, turnips etc. should not be thrown but utilized in preparing mid-day meals. m)Only 'iodized salt" should be used for cooking mid-day meals.

36. POSHAN ABHIYAN

37. POSHAN ABHIYAN (Prime Minister’s Overarching Scheme for Holistic Nutrition) Launched by - Government of India Launche on - 8 march 2018 for a period of three years in all 36 states/UTs. It was earlier known as national nutrition mission. Goals - Improvement in nutritional status of children from 0-6 years, adolescent girls, pregnant women and lactating mothers with fixed targets. It ensures convergence of various programmes i,e anganwadi services, Pradhan Mantri Matru Vandana Yojana; Janani Suraksha Yojana; National Health Mission; Swachh Bharat Mission of Ministry Month of September 2018 was celebrated as Rashtriya POSHAN Maah. The activities in POSHAN Maah focussed on Social Behavioural Change and Communication (SBCC). The broad themes were: antenatal care, optimal breastfeeding (early and exclusive), complementary feeding, anaemia, growth monitoring, girls’ - education, diet, right age of marriage, hygiene and sanitation, eating healthy - food fortification.

38. THE FOUR PILLARS:

39. Objectives and targets are as follows : 1.Prevent and reduce stunting in children (0-6 years) by 6 percent. 2. Prevent and reduce under nutrition and underweight prevalence in children(0-6 years) by 6 percent. 3. Reduce the prevalence of anaemia among children (6-59 months) by 9 percent. 4. Reduce the prevalence of anaemia among girls and women in the age group (15-49 years) by 9 percent. 5. Reduce low birth weight by 6 percent.

40. PILOT PROJECT ON PROGRAMME AGAINST MICRONUTRIENT MALNUTRITION

41. PILOT PROJECT ON PROGRAMME AGAINST MICRONUTRIENT MALNUTRITION Implemented in Assam along with four other states namely Bihar, Orissa, West Bengal and Gujarat. The programme was launched in the year 1995. The objectives of the programme are: (i) To assess the magnitude of fluorosis and dental caries, (ii) To assess and improve iron and vitamin A status in school going children, adolescent boys and girls, non-pregnant women, adult males and geriatric population. (iii) To launch extensive information, education and communication strategies through mass media to improve the dietary habits of the population. (iv) To study zinc level in various food products and soil. 

42. The programme was implemented in 1 district of each of the 5 states.  The following activities were undertaken: (i) Advocacy and sensitization meetings with people involved in policy making, with elected members, teachers, social workers, etc. (ii) A baseline survey was conducted to assess the socio-economic status, food intake pattern, estimation of HB, soil, zinc, fluorine in drinking water etc.. (iii) Training was also organised at block level, prior to field activity surveys. Based on the results of the survey, the IEC strategy is being developed in the local languages. An expert committee has been constituted in order to scrutinize and finalise sample IEC material on Micronutrients deficiency, diet related chronic disorders and healthy life style for final production and printing.

43. SUMMARY: Through this topic we covered introduction to nutritional programmes in india , nutritional cells, various programmes such as vitamin a prophylaxis programme, prophylaxis against nutritional anemia , iodine deficiency disorders control programme , special nutriton programme, balwadi nutritional programme, ICDS programme, mid day meal programme , mid day meal scheme etc

44. CONCLUSION The Government of India have initiated several large scale supplementary feeding programmes, and programmes aimed at overcoming specific deficiency diseases through various Ministries to combat malnutrition.

45. BIBLIOGRAPHY: Park . K, Parks’s textbook of preventive and social medicine,26th edition,2021,M/S banarsidas bhanot publishers.pg -750-756. Gulani Krishna Kumari, Community health nursing (principles and practices ),2nd edition reprint, 2017, Kumar publishing house,pg 734-736, https://www.niti.gov.in/poshan-abhiyaan https://dghs.gov.in/content/1354_3_NationalProgrammeforControlofBlindnessVisual.aspx https://www.nhp.gov.in/national-vitamin-a-prophylaxis-program_pg https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1024&lid=388