Nutrition related programmes &

PitfallsPresented By: Dr. Kunal

Guided By: Dr. Mudey

Contents• Introduction • History • Nutrition Related Programmes• Current Status• Pitfalls• Nutrition Related Health Days ( Indian)• Nutrition Related Health Days (International)• Legislations Related to Nutrition/ Food• Latest Initiatives• Recommendations • Conclusions• Acknowledgement• References

Introduction

• Nutrition:- It is a branch of science which deals

with study of dynamic process in which the consumed food is utilized for nourishment of body.

• Nutritional status of a person not only determined by quality & quantity of food intake but also by physical health.

Continued….

• Under nutrition is by far most important single cause of illness & death globally accounting for 12% of all deaths & 16 % of disability- adjusted life years lost. Low weight for age is associated more than half of all deaths in young children accounting for more than 6 million deaths per year.

• Malnutrition has multi-factorial causation that are;

Causes ofMalnutriti

on

Inadequate Food

Production

Inadequate Production Of

Protective Foods

Unsatisfactory Distribution

System

Lack of Purchasing

Power

Food Taboos & Misbeliefs

Presence Of Infections

Interfering With Digestion & Absorption

Continued….

• Ecological Factors related to malnutrition:-1. Conditioning influence2. Cultural influence 3. Socio-economic factors4. Food production5. Health & other services

Continued….

• A number of national & state programmes are in operation for control of different type of malnutrition of public health importance.

• These programmes use nutritional survey as tool.

Pregnant

Mother &

Lactating

Mothers

Infants Under five

children's

Families below

poverty line

Landless Labourers

Tribal

MOST VULNARABLE GROUP

History

• Special Nutrition Programme (SNP)• Balwadi Nutrition Program• Applied Nutrition Program (ANP)• Tamilnadu Integrated Nutrition Program• Wheat Based Supplementary Nutrition

Program

Special Nutrition Programme (SNP)

• The program was launched in the country in1970-71.

• It provided supplementary feeding of about 300 calories and 10 gms of proteins to preschool children and about 500 calories and 25gms of proteins to expectant and nursing mothers for six days a week.

• This program was operated as under Minimum Needs Program.

• Fund for nutrition component of ICDS program was shared with SNP budget.

Balwadi Nutrition Program

• This program was launched by the ministry of social welfare in 1970. This program is for the welfare of children in the age group of 3-6 years in rural areas. The children are given preschool education, diet supplementation by providing 30 k cal and 10gms of protein per day per child for 270 days a year and care for their psychosocial development.

Applied Nutrition Program

• The Applied Nutrition Program was introduced as a Pilot Scheme in Orissa in 1963 which later on extended to Tamil Nadu and Uttar Pradesh with the objectives of :-1. Promoting production of protective foods

such as vegetables and fruits.2. Ensure their consumption by pregnant and

nursing mothers and children.

Continued….

• 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.

Continued….

• Nutrition worth Rs 25 paisa/child/day and 50 paisa 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.

Tamilnadu Integrated Nutrition Program

• The Tamil Nadu Integrated Nutrition Project was started in 1980 targeting 6-36 months and children and pregnant and lactating women.

• The objectives of TINP was:1. Nutrition surveillance through regular

growth monitoring of all children in the age group 6-36 months

2. Help rehabilitate and prevent malnutrition through short term food supplementation

Continued….

3. Reduce the mortality and morbidity due to protein-energy malnutrition and specific nutrient deficiencies

4. Improve the nutritional status of pregnant and nursing women

5. Strengthen health services to provide adequate back-up support to the nutrition effort

6. Improve home child care and feeding practices through education

Continued….

7. Improve the efficiency and the impact of the above through sustained performance monitoring and evaluation

8. To reduce anaemia in pregnant and lactating women from 55% to about 20%.

9. To reduce vitamin A deficiency in the under five from about 27% to 5%

10.To reduce infant mortality by 25%.

Continued….

• TINP had four major components1. Nutrition Services2. Health Services3. Communication Services4. Monitoring & Evaluation

What Based Supplementary Nutrition Program

• Program was introduced in 1986.

• Program follows the norms of SPN or of the nutrition components of ICDS.

• Central assistance of program consist of supply of free wheat & supportive cost for other ingredients, cooking, transport, etc.

Nutrition Related Programmes

• Integrated Child Development Services(ICDS) Scheme

• Nutrition Programs For Adolescent Girls• Nutrition Advocacy and Awareness General

Programs for Food And Nutrition Board (FNB)• Follow Up Action For National Nutrition

Policy, 1993.

DIRECT

Continued….• Ministry Of Health and Family Welfare-

1. Iron and Folic Acid Supplementation of Pregnant Women.

2. Vitamin A Supplementation of Children of 9- 36 Months Age Group.

3. National Iodine Deficiency Disorder Control Program.

4. Department Of Elementary School and Literacy.

5. Midday Meal for Primary School Children.

DIRECT

Continued….

• Department of Agriculture and Cooperation 1. National Food Security Mission2. Increased Food Production3. Horticulture Interventions

• Food & public Distribution1. Targeted Public Distribution System2. Antodaya Anna Yojana3. Annapurna Scheme

INDIRECT

Continued….• Rural & Urban Development

1. Food for Work Program2. Poverty Alleviation Program3. Safe Drinking Water & sanitation Program4. National Rural Employment Guarantee Scheme

• Ministry of health1. National Rural Health Mission (NRHM)2. Integrated management of Neonatal &

Childhood Illness (IMNCI)3. Various Public Health Measures

INDIRECT

Continued….

• Department of Elementary Education & Literacy

1. Sarva Siksha Abhiyan2. Adult Literacy Program

• Department of Women & Child Development Various Women’s Support Programs

INDIRECT

INTEGRATED CHILD DEVELOPMENTSERVICES (ICDS)

• Launched on 2nd October 1975(5th 5 year plan) in

pursuance of the National Policy for children.

Continued….

• This is mainly a health intervention which adopts a holistic approach aimed at improving both the pre-natal and post-natal environment of the child.

• It is a Centrally-sponsored, State-administered scheme consisting of maternal health care in pregnancy and growth monitoring and nutritional supplements for children - services received at community centres or anganwadis.

Continued….

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

Continued….

• 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

Continued….

Beneficiaries

• Children's Below 6 years

• Pregnant & lactating Women

• Women in the age Group of 15 to 45 years

• Adolescent Girls in selected blocks

Continued….

COMPONENTS of ICDS1. supplementary nutrition, 2. immunization, 3. health check-up, 4. referral services, 5. pre-school non-formal education and 6. nutrition & health education.

ACHIEVEMENTS New ICDS

• ICDS is effective in 5659 community development blocks and major urban slums throughout the country.

• As against 227 cores beneficiaries until March 1997 there were 3.4 core beneficiaries in April 2001.

• In 2006 the scheme reached out to about 95 lakhs expectant and nursing mothers and 244.92 lakhs preschool children and562.18 lakh beneficiaries are getting supplementary nutrition.

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

Continued….

• De-worming• Prophylactic measures against anaemia,

goitre, vitamin deficiency etc• Referral to PHC/ District hospital in case of

acute need.

PROGRAMS TO PREVENT SPECIFIC DEFICIENCY STATES VITAMIN A

PROPHYLAXIS PROGRAM

• one of the components of National Programs for Control of Blindness.

• This includes administration of 200,000 I.U of vitamin A orally to all preschool children every six months the programme was launched in 1970 by the ministry of health and family welfare MCH centres in urban areas, PHC in rural areas and ICDS projects are engaged in the implementation of the program.

PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA

• The program was started by the ministry of health and family welfare during the fourth 5 year plan to prevent nutritional anaemia the program envisages distribution of iron and folic acid to young children and expectant mothers through MCH centres in urban areas PHC in rural areas and Anganwadis in project areas. The commercial production of iron fortified common salt was started in1985.

CONTROL OF IODINE DEFICIENCYDISORDER

• The production of Goitre attracts the maximum attention & hence the national programme was named as Goitre control Programme.

• The National Goitre control program was launched by the government of India in 1962 in the Goitre belt in the Himalayan region and iodized salt was supplied in Goitre endemic areas.

Continued….• Later on in 1986 this program was changed to

National Iodine Deficiency Disorders Control Program because the problem was found to be widespread and more than the problem of Goitre.

• Objectives :-1) To identify endemic areas by survey2) To ensure production & supply of iodated salt

to endemic areas3) To evaluate the effect of continuous supply of

Iodated salt in endemic areas by resurvey after 5 years.

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.

Objectives:• 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.

Continued….• To assess the magnitude of flourosis and

dental caries. • To launch extensive information, education

and communication strategies through mass media to improve the dietary habits of the population

• To study zinc level in various food products and soil.

• The program was implemented in one district of each of the five states.

Continued….

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.

• 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, serving in 84 counties with a goal of achieving.

• 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.

“ 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”.

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.

Continued….• Strengthen channels for locally produced food grains

and support local entrepreneurship.• Advocate for restoration through participation

methods.

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.

Continued….• A blend of precooked maize and soya fortified

with micro nutrients called CSB (corn- soya- blend) has been developed in India in the name of ‘Indiamix’.

Continued….

• ACTIVITIES UNDER WFP’s• Helping women to gain better access to food, education.• Involvement in community decisions.• Access to maternal and child health care to improve

child survival. • “Food for work” program in collaboration with forest

department providing food in emergencies, access to health services,

• Potable water and sanitation proper caring practices for young children.

• Education particularly girls and women

Continued….

• Supporting generation of biogas.• Protection of forest through mass awareness

and active participation.• 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 up to 20%

• Eradicate the prevalence of under nutrition 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 anaemia in high risk group to 25%.

Continued….

• 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

• 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.

Continued….

• Nutritional counselling 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.

PITFALLS

• Community participation is difficult to ensure in most areas.

• Lack of inter sectorial co-ordination.• Intersectoral coordination becomes essential in

projects, which extends over the geographical area covered by more than one primary health center.

• Determinants of low health & nutritional status are not tackled under many scheme.

• Selection & motivation of Anganwadi worker may be unsatisfactory.

Continued….• Nutrition supplementation posses many

problems. (Logistic difficulties i.e if fuel is not available, children do not get hot food)

• Coverage of expectant & nursing mothers is not satisfactory under the scheme.

• In the large number of activities, children 0-3 years, the most vulnerable age group , do not get adequate attention.

• Attendance for non-formal preschool education is not satisfactory.

Continued….

• The supply of iron folic acid tablets. Vit-A & food supplements is many times irregular & unsatisfactory.

• Anganwadi workers are agitating for an increase in honorariums, absorption into government service & permanent status.

• the location of Anganwadi may not be suitable.• With both parents working in the fields they may

have problem taking the child or bringing back from Anganwadi, which is open. Only a part of the day.

Continued….

• This overburdening with responsibilities result in decrease in quality of work & coverage.

• The training of aganwadi workers has been unsatisfactory at places, as expansion outstrip training intakes.

• The supplies are not are not regular & below standard.

• Misuse of funds.

Continued….

• Inter- departmental manipulation health services used for desirable outcome.

• Socio-economic repercussion.

Nutritional Health Related DaysORS Day July-29

National Nutrition week September - 1 to 7

World Food Day October-16

World Iodine Deficiency Day October-21

Nutritional Health Related Days (International)

Healthy Weight Week January 19-25

Women’s Healthy Weight Day January 23

America’s National Nutrition Month

March 1-31

Food Health Awareness Month April 1-30

Food Allergy Awareness Week May 11 - 17

Legislations Related to Nutrition/ Food

• Prevention of Food Adulteration Act, 1954

• Food Safety & Standards Act, 2006

Latest Initiatives

Non Governmental Initiatives

Some innovative approaches have also been tried out on a small scale by Non- Governamental Organizations like; OXFAM, DANIDA, CARE,WFP.

JEEVAN BINDI

• Strategies should be to close the gap between the resources available & families who need them by working closely with the Govt. to focus on malnutrition awareness, identification , treatment, & prevention & inserting simple but innovative technologies & practices.

• The Government of India’s National Nutrition Policy, apart

from setting nutrition goals to control and prevent malnutrition in the country, recommended that a national nutrition surveillance system should be developed.

Conclusion

• Malnutrion is a man made disease.

• Under nutrition continues to be a widespread problem in India, despite significant improvement in food production and advancement in science during the last fifty years, since Indian independence.

Continued….• Nutrition affects growth and development of a person. At

least the development of International Standards and national legislation, are essential to protect and promote national food security and public health. Civil society will have to play a more active role. The concept of food security must be recaptured and reframed in public and environment terms.

• The National and the State governments have been implementing a number of poverty alleviation programmes for the overall socioeconomic development of the community and several nutrition programmes to mitigate the sufferings of the vast multitudes of the population at risk.

Continued….

• For the purpose of deciding policies and to formulate programmes to control and prevent malnutrition, it is essential to assess What? Where? How? and Why? of the nutrition problems in the country. Monitoring of the nutritional status of population, therefore, becomes an important aspect of any nutrition programmes to assess the impact of these massive inputs and to determine the direction in which the community’s nutrition is progressing, so as to initiate appropriate corrective actions.

Acknowledgment

• Dr. Abhay Mudey • Dr. Minaxi Khapre• Dr. Pramita Mutonde• Dr. Abhishek Ingole• Dr. Manish Prasad• All the PG’s in the Dept.

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