This document summarizes India's national nutrition programs and the state of undernutrition in the country. It discusses programs like the Integrated Child Development Services scheme and mid-day meal program that provide supplementary nutrition to children, pregnant/nursing women. Despite these programs, 46% of children under-3 are underweight and 38% are stunted. It highlights issues like lack of monitoring and hygiene in mid-day meal kitchens that have led to poisoning incidents. Overall, the national nutrition programs aim to address undernutrition but face challenges in proper implementation and monitoring.

1. Supplementary nutrition in India
Dr. Babu lal Meena
MD Pediatrics

2. Objectives
• To know about nutritional programmes in India
• Basic structure of these programmes
• Benefits of these programmes
• Hurdles in implementation

3. Poverty
Undernutrition
related disease
Retardation of
Growth and
development
Poor strength of
adults
Impaired
productivity
Low earning
capacity

4. Outcome
Under-Nutrition
Immediate
Causes
Inadequate
Dietary Intake Disease
Underlying
Health /
Nutrition
Causes
Inadequate
Care for Mothers
and Children
Insufficient
Access to Food
Lack of health services
&
unhealthy environment

5. Current Nutrition Status
• 26% of the population is still below poverty line
• Wide gap in food production and consumption
• 46% children below 3 years are underweight, 38 % are
stunted, 19% are wasted
• 2.2 million suffer from cretinism
• 7 million children per year affected by Nutritional blindness

6. Food
security/General
Distribution
Supplementary
feeding
Therapeutic
feeding
Early Intervention Late Intervention
Cost-Benefit Not Cost-effective

7. National Nutrition Programme
• Integrated child development service scheme
• Mid day meal programme
• National prophylaxis programme for control of Vitamin A
deficiency
• National prophylaxis programme for control of nutritional
anemia
• National control of Iodine deficiency disorders

8. ICDS
• Integrated Child Development Service (ICDS) scheme
• Central departments
– Department of Women and Child development, Ministry of Human
Resources Development
• Nodal departments
– Social welfare, Rural development, Tribal welfare, Health & family
welfare or Women and child development

9. ICDS
• Beneficiaries
1. Children below 6 years
2. Pregnant and lactating women
3. Women in the age group of 15-45 years
4. Adolescent girls in selected blocks

10. ICDS
• Objectives
– Proper physical and psychological development of child
– Improve nutritional and health status of children 0-6 years
– Reduce incidence of mortality, morbidity, malnutrition and school
drop-out
– Enhance the capability of the mother and family to look after the
health, nutritional and developmental needs of the child
– Achieve effective coordination of policy and implementation among
various department to promote child development

11. Norms of anganwadi
Type AWC/Populat
ion
Mini AWC
Urban 800-1000 Nil
Rural 500-1500 150-500
Tribal 300-1500 150-300
Urban 400-800 Nil
Rural 400-600 150-400
Tribal 300-800 150-300
Population
previously
Population
currently

12. Target group and service provider
Services Target group Services provided by
Nutrition and
Supplementary nutrition
Children < 6 years, pregnant
and lactating women
AWW, AWH
Immunization
(6 disease)
Children < 6 years, pregnant
and lactating women
ANM, MO
Health check up Children < 6 years, pregnant
and lactating women
ANM, AWW, MO
Referral Children < 6 years, pregnant
and lactating women
ANM, MO, AWW
Pre school education 3-6 years AWW
Nutrition and health
examination
15-45 years ANM, MO, AWW

13. Supplementary Nutrition Norms
Beneficiaries Pre revised Revised
Calorie Protein Calorie Protein
Below 6 years 300 8-10 500 12-15
Severely malnourished
children
600 20 800 20-25
Pregnant women and
nursing mothers
500 15-20 600 18-20

14. Financial norms
Pre revised rates Revised rates
Children (6-72 months) Rs. 2 Rs. 4
Severely malnourished
child (6-72 months)
Rs. 2.7 Rs. 6
Pregnant women and
nursing mothers
Rs. 2.3 Rs. 5

15. Achievements
• 244 lac pre-school children, 95 lac nursing mothers and 562
lac beneficiaries are getting supplementary nutrition
• Better immunization coverage
• Increased institutional delivery

16. Mid-Day
Meals in
India

17. MDM programme
• Mid day meal programme
• Since 1923 in Madras Tamilnadu 1982
• Formally launched on Aug 1995 in India
• November 2001 Supreme court made obligatory for the Govt.
to provide cooked meals to children in Govt. school
• By Oct-2002 it also included Govt. supported schools

18. MDM programme
• Objectives
– Increase school attendance
– Reduce school dropout
– Beneficial impact on children’s nutrition and health

20. Norms in MDM programme
Beneficiaries Calorie
(k/cal/day)
Protein
(gm/kg/day)
Money
Up to 8th class 350-500 (1/3
RDA)
12-15 (1/2 RDA) Rs. 2.5

21. Achievements of MDM scheme
• Better nutrition to children
• More school enrollment
• Decreased school dropout
• Socialization and Educational benefits
• Better nutritional status
• Decreased economic burden to families

22. Enrolment, Attendance and Retention
• Enrolment: Big gains,
especially for girls and
children of other
disadvantaged groups (SCs
and STs).
•Attendance and rentention: Limited evidence on
improvement but measurement issues make it
difficult to capture these effects.

23. Nutrition: Quantity
• Prescribed food quantity
– 300 grams of grain & 8-12 grams of protein
– Increased to 450 grams of grain and 12-15 grams of
protein in the 2006 Guidelines

24. Nutrition: Quality
• Depends on:
– Menu (plain boiled rice)
– Cooking practices
– Hygiene conditions (kitchens, drinking water)

25. Socialization and Health benefits
• Socialization
(Eating together)
• Overcoming caste
discrimination
(Denial of food to Scheduled
caste children, Segregated
seating, separate food/utensils
for children of different castes)
• Inculcating hygienic
habits
(Washing hands and utensils
before and after eating, eating
together)

26. Educational benefits
• Impact on learning:
– Eliminates classroom hunger - children able to
concentrate better as many children would come to
school on an empty stomach
– Makes school environment more fun

27. Accidents
• Many small no of poisoning cases
• Largest is in Bihar
– Killed 23 children
– Organophosphorous poisoning
– Occurred due to unmonitored food supply
– It could be prevented by good monitoring

29. What not done
• Surveillance of supplied raw material
• Good storage facilities not available
• Hygiene maintenance not done
• Sample survey of food served to children
• Action despite of repeated poisoning cases

30. A survey done by an institute
• Small cooking area
• Less no of staff
• Lack of good light and ventilation
• Lack of exhaust fan
• Lack of wash basin and soap, hot water
• Lack of staff changing facility
• Gloves not used

31. A survey done by an institute cont.
• Hand swab showing
– Coagulase negative staph, Staph aureus, E. Coli
– Enterococcus, acinetobacter
• Food showing
– Bacilus cereus
– Enterococcus, coliforms

32. Advantage
• Better nutrition to child
• Improved health of child and
women
• Decreased family burden
• Good school attendance
• Reduced school drop out
Disadvantage
Disadvantage
• Recurrent incidence of poisoning
• No national system of nutrition
monitoring and surveillance

33. Food security bill
• Food security act – 2013
• 1.25 lakh crore, Central Govt. funded
• Largest in the world
• 2/3 rd population will receive 5 kg/month food grain at 1-3
rupee/kg from ration shop
• Under process in parliament

34. What could be done
• Targeted surveillance to find out prevalence of
undernourished children
• Surveillance of mid day meal kitchens and storage system
• Proper monitoring of mid day meal
• To maintain hygiene of food