National nutritional programme (NNP)

Detail description of National nutritional programme

1. NATIONAL NUTRITIONAL
PROGRAMME FOR CHILDREN
Ms. SaheliC
Lecturer
IACN

2. INTRODUCTION
•Malnutrition is the most important single cause of
illness & death.
•globally accounting for 12% of all deaths & 16% of
disability.
•The problem of Malnutrition in India has been
recognized since the inception of five year plans and
a number of nutritional programs have been
introduced for combating it.
•These programs help in bringing down the morbidity
and mortality due to malnutrition.

3. NAME OFPROGRAM MINISTRY DATE OFLAUNCH
Mid day mealprogramme Ministry ofeducation 1961
Iodine deficiencyprogramme Health and Familywelfare1962
Applied nutritionalprogram Ministry of ruraldevelopment1963
National programme for VitA
deficiency
Health and Familywelfare1970
National nutritionalanemia
controlprogram
Health and Familywelfare1970
Special nutritionprogram Health and Socialwelfare 1970
Balwadi nutritionprogram Socialwelfare 1970
ICDS Socialwelfare 1975

4. 1. Mid-day Meal Scheme-1961
•The mid-day meal scheme is the popular name for
school meal programme in India.
•It involves provision of lunch; free of cost to school
children on all working days.
•106 million children, 8 lakhschools in 576 district
was included.
•One of the pioneers of the scheme is the Madras
corporation that started providing cooked meals to
children in corporation schools in the Madras city in
1923.

5. •The programme was introduced in a large scale in
1962 in TN.
•Major thrust came in 1982 when it had decided to
universalize the scheme for all children in
government schools in primary classes in TN.
•Later the programme was expanded to cover all
children up to class 12.

6. •In September 2004 the scheme was revised to provide cooked
mid day meal with 300 calories and 8-12 grams of protein to all
children studying in classes I-V in Government and aided schools
and EGS/ AIE centres.
•In addition to free supply of food grains, the revised scheme
provided Central Assistance for-
Cooking cost @ Rs 1 per child per school day.
Transport subsidy was raised from the earlier maximum of Rs
50 per quintal to Rs. 100 per quintal for special category states,
and Rs 75 per quintal for other states.

7. Management, monitoring and evaluation costs @ 2 %
of the cost of food grains, transport subsidy and
cooking assistance.
Provision of mid day meal during summer vacation in
drought affected areas.

8. •In July 2006 the scheme was further revised to provide
assistance for cooking cost at the rate of
a.Rs. 1.80 per child/ school day for states in the North
Eastern Region, provided the NER states contribute Rs.
0.20 per child/ school day.
b.Rs. 1.50 per child/ school day for other States and UTs,
contribute Rs 0.50 per child / School day.
•In October 2007, the scheme has been further revised to
cover children in upper primary (classes VI to VIII) initially
in 3479 Educationally Backwards Blocks (EBBs).

9. •Around 1.7 crore upper primary children are expected
to be included by this expansion of the scheme
•The programme will be extended to all areas across
the country from 2008-2009.
•The calorific value of a mid day meal at upper primary
stage has been fixed at a minimum of 700 calories and
20 grams of protein by providing 150 grams of food
grains (rice/ wheat) per child/school day.

10. OBJECTIVES OF THE PROGRAMME
1. To improve the nutritional status of children
2. protecting children from classroom hunger,
3. increasing school enrolment and attendance,
4. improved socialization among children belonging to all castes,
5. The scheme has a long history especially in Tamil Nadu and
Gujarat.
6. Has been expanded to all parts of India after a landmark
direction by the Supreme Court of India on November 28, 2001.
7. The success of this scheme is illustrated by the tremendous
increase in the school participation and completion rates in
TAMILNADU.

11. PRINCIPLES
•The meal should be a supplement and not a substitute
to the home diet.
•The meal should supply at least one third of the total
energy requirement and half of the protein need
•The cost of the meal should be reasonably low
•The meal should be such that it can be prepared easily
in schools, no complicated cooking process should be
involved
•As far as possible, locally available foods should be
used, this will reduce the cost of the meal.
•The menu should be frequently changed to avoid
monotony.

12. MODEL MENU
Foodstuffs
•Cereals and millets
•Pulses
•Oils and fats
•Leafy vegetables
•Non –leafy vegetables
g/day/child
75
30
8
30
30

14. 2.THE APPLIED NUTRITION
PROGRAMME

15. •One of the earliest nutritional programmes, by
Ministry of Rural Development.
•This project was started in Orissa on 1963.
Later extended to Tamilnadu and UP.
•In 1973 extended to all states in INDIA.

16. OBJECTIVES
1.To make people conscious of their nutritional needs.
2.To increase production of nutritious foods and its
consumption andto provide supplementary nutrition to
vulnerable groups through local production of food.
3.The programme aimed at the approach of "self
reliance“ to be developed at the community and
individual level.

17. BENEFICIARIES
•children between 2-6 years
•pregnant and lactating mothers.

18. SERVICES
•Nutritional education, Nutrition worth 25 Paisefor
children and 50 Paisefor pregnant and lactating women
for 52 days in a year.
•Organization : The programme is implemented under
the supervision of block development officer.
•The Bal sevikaswith the help of a helper undertake the
programme activities at the village/community level.

19. 3. NATIONAL IODINE
DEFICIENCY DISORDER
CONTROL PROGRAMME
(NIDDCP)

20. INTRODUCTION
•Iodine is required for the synthesis of the thyroid
hormones, thyroxine(T4) and triiodothyronine(T3) and
essential for the normal growth and development and
well being of all humans.
•It is a micronutrient and normally required around 100-
150 microgram for normal growth and development.

21. Deficiencyofiodinemaycausefollowingdisorders:
Goiter
Subnormalintelligence.
Neuromuscularweakness.
Endemiccretinism
Stillbirth.
Hypothyroidism.
Defectinvision,hearing,andspeech.
Spasticity.
Intrauterinedeath.
Mentalretardation.

22. AIM /OBJECTIVES
•Initialsurveytoidentifymagnitudeoftheprobleminthecountry.
•To reduce the prevalence ifIDDpresents.
•Production and supply of iodized salt to the endemic regions.
•Health education and publicity.
•To undertake monitoring of the quality of the iodized salt, assessing
urinary iodine excretion pattern and monitoring of the iodie
deficiency disorder.

23. •Re-survey in goiterendemic regions after 5 years continuous
supply of iodized salt to assess the impact of the control
programme. The result of re survey in some areas has revealed
that the prevalence of goiterhas not been controlled as desired.
•In 1992, the National Goitercontrol programme (NGCP) was
renamed as National Iodine deficiency Disorder control
programme (NIDDCP).

24. To assess the impact of control measure after fiveyears.
To conduct IEC campaign for promoting community
participation in the implementation of theprogramme.

25. BURDEN OF THE DISEASE
•Iodinedeficiencyhasbeenidentifiedallovertheworld.Itissignificant
healthproblemsin130countriesandaffects740millionpeople.
•OnethirdoftheworldpopulationisexposedtotheriskofIDD.
•ItisestimatedthatinIndiaalone,morethan6.1crorepeopleare
sufferingfromendemicgoiterand88lakhpeoplearemental/motor
handicaps.
•Anationallevelsurveyhasbeencarriedoutin25statesand5union
territoriesinthecountryandfoundthatoutof282districtssurveyed,
In241districtsitisamajorpublichealthproblemwherethe
prevalencerateismorethan10%.

26. •It is estimated that more than 71 million persons are
suffering from goiterand other iodine deficiency
disorders like mental retardation, deaf mutism, squint,
and neuromotordefects.

27. PROGRAMME:
Followingthesuccessfultrialofiodizedsaltin
Kangaravalley,HimachalPradeshin1962,
Indiahaslaunched100%centrallysponsored
theNationalGoiterControlProgramme.

28. COMPONENTS OF IDDC
PROGRAMME
1.Iodizationofsalt andoil
2.Monitoring andsurveillance
3.Manpowertraining
4.Masscommunication

29. IODIZEDSALT
Mosteconomical,convenientandeffectivemeans
of mass prophylaxis forIDD.
Under PFA act level of iodization is 30 ppmat
manufacturerleveland15 ppmatconsumer
level.
Addition of 30 mg of iodineperKg usually inthe
form of potassiumiodate.
Potassiumiodateismorestableinwarm,dampand
tropicalclimate.

30. IODIZED OIL(INJECTION)
IM iodized oil ( poppy seed oil, sunfloweroil)
1ml of IM injection will provide protectionfor 4years
More expansive than iodizedsalt
Less practicable as it is very difficult toreach each
and every one to giveinjection.
Iodized oil (oral) or sodium iodated tabletsalso tried
More costly than IMinjection

31. Iodine monitoring and surveillance-
components
Iodine excretiondetermination
Determination of iodine content in soil andfood
Determination of iodine in salt at factory level,
wholesale and retail level and community or
consumerlevel.

32. # Manpowertraining:
Training of health worker in all approachesof
IDDcontrol
Training on publiceducation
# Masscommunication:
Mass communication through postersradio,
television, news papers and othermeans

33. POLICY
•On the recommendations of Central Council of Health in 1984, the
Government in 1992 took policy decision with the goal of ‘Universal
Iodization of Salt’ and started the salt department in the Ministry of
industry.
•Realizing the importance of iodine deficiency in relation to Human Resource
Development, NIDDCP has been included in 20 point programme of Prime
Minister.
•The Central notification restricting the sale of non-iodated salt with effect
from May 1998 has since been lifted with effect from November 2000.
•The notification issued by 29 states/UTs covering their entire territory and
partially by 2 states restricting the sale of non-iodated salt in their respective
states is still continuing.

34. 4. INTEGRATED CHILD
DEVELOPMENT
SERVICES(ICDS)-1975

35. INTRODUCTION
•ICDSisthecountry’smostcomprehensiveandmulti
dimensionalprogramme.
•ItisacentrallysponsoredschemeoftheMinistryof
WomenandChildDevelopment.
•ICDSprogrammewaslaunchedon2
nd
October,1975-
the106
th
birthanniversaryofMahatmaGandhi-the
FatheroftheNation.

36. •ICDS is the most unique programme for early
childhood care and development
encompassing integrated services for
development of children below 6 years,
expectant and nursing mothers and
adolescent girls living in the most backward,
rural, urban and tribal areas.

37. To improve the nutritional and health status of pre-
school children in the age-group of 0-6years.
Toimprovethephysical,mentaland social
development of thechild.
To reduce the incidence of mortality,
morbidity, malnutrition and schooldrop-out.
Toenhancethecapabilityofthemothertolookafter
thenormalhealthandnutritionalneedsofthechild
throughpropernutritionandhealtheducation.
OBJECTIVES

38. TargatedBeneficiaries
TheSchemetargetsthemostvulnerablegroups
ofpopulation-
includechildrenupto6yearsofage,
pregnantwomenandnursingmothersbelongingtopoorest
ofthepoorfamiliesandlivinginbackwardruralareas,
tribalareasandurbanslums.
Theidentificationofbeneficiariesisdonethrough
surveyingthecommunityandidentifyingthe
familieslivingbelowthepovertyline.

39. 1)Children less than 3 years:
Supplementary nutrition.
Growth monitoring.
Immunization.
Health check up
Referral services.
2) Children between 3-6 years:
Non formal preschool education.
Supplementary nutrition.
Growth monitoring.
Immunization.
Health check up.
Referral services.

40. 3) Expectant and nursing mothers:
•Health check up.
•Tetanus toxoidimmunization to pregnant women.
•Supplementary nutrition.
•Nutrition and health education.
4) Other woman 15-45 years:
•Nutrition and health education.
•IFA supplementation and de worming intervention.
•Non formal education.
•Home based skill training and vocational training.
•Supplementary nutrition;

41. 5) Adolescent girls between 11-18 years:
•Nutrition and health education.
•IFA supplementation and de-worming intervention.
•Non formal education.
•Home based skill training and vocational training.
•Supplementary nutrition.

50. Package ofServices
1)SupplementaryNutrition
2)Immunization
3)HealthCheck-up
4)Treatment & ReferralServices
5)Non-formal Pre-schoolEducation
6)Nutrition & HealthEducation

51. 1. Supplementarynutrition
Allchildrenbelow6yearsofage
Adolescentgirls
expectantmothersbelongingtoschedulecasteand
tribeswho’smonthlyincomelessthan300andland
lessagriculturist
Givenfor300days(lunch)
Growthmonitoring.
Nutritionandhealtheducation.

52. 2.IMMUNIZATION
•Anganwadiarrangeswithhealthworkerfemaleservingher
areatogiveimmunizationtoherwardsandpregnant
mothers.
3.HEALTH
•Healthcheckup.
•Immunization.
•Identificationandtreatmentofcommonchildhood
illnessesandminorailments.
•Referralservices.

53. 4. TREATMENT AND REFERRAL SERVICES
With help of female health worker get all needy children
treated for minor illness like diarrhoea, ARI, minor cuts,
fever etc.
All other cases and severe mulnutritionrefers to medical
officer of PHC.

54. Recipients Calories Grams
of
Protein
Children up to6
Years
300 8-10
AdolescentGirls500 20-25
Pregnant and
nursingmothers
500 20-25
Malnourished
Children
Double the dailysupplement
provided to the other
children(600 and/or special
nutrients on medical
recommendation

55. 5. Non formalpre school education
Childrenbetween3-6yearsareimportedpre-elementary
educationwithoutformalhoursofteaching;without
syllabusandtest.
Earlycareandstimulationofchildrenunder3years.
Teachingismixedwithplay.
Locallymadecharts,pictures,diagrams,toysandplay
equipmentsareused
Preschooleducationtochildreninthe3-6yearsagegroup.

56. 6)Nutrition and health education
•Nutritionandhealtheducationisakeyelementofthe
workoftheAnganwadiworker.ThisformspartofBCC
(Behaviourchangecommunication)strategy.
•Thishasthelongtermgoalofcapacitybuildingof
women;especiallyintheagegroupof15-45yearsso
thattheycanlookaftertheirownhealth,nutrition
anddevelopmentneedsaswellasthatoftheir
childrenandfamilies.

57. The impact of the programme
Evidentfrom the remarkable improvements made in
child survival and developmentindicators-
1.Decrease in Prevalence of Malnutrition among Pre-school
Children
2.Improved immunization Coverage in ICDSAreas
3.Decrease in IMR in ICDSAreas
4.Improvement in School Enrolment and Reduction in School
Dropout Rate in ICDS Areas,1992.