1. Presenter: Dr. Preetham M

2. Major health problems in India
1. Communicable diseases
2. Population
3. Environmental sanitation
4. Medical care
5. Nutritional

3. 1. Nutritional anemia
2. Iodine deficiency
disorders
3. obesity

4. 4. Protein energy
malnutrition
5. Low birth weight
6. Xerophthalmia(dry
eye)
7. Cancer
8. Lathyrism
9. Flurosis

5. Cause of Nutritional problem
 POOR NUTRITION
• UNDER NUTRITION (MALNUTRITION)
• OVERNUTRITION

7.  In the last five decades, the mortality rate has come
down by 50 percent and the fertility rate by 40 percent
but the reduction in under nutrition is only 20 percent.
 Around half of the pre-school children still suffer from
under-nutrition.
 Micronutrient deficiencies are widespread;
 More than half the women and children are anaemic;
 Reduction in Vitamin-A deficiency and iodine
deficiency disorders (IDD) is sub-optimal.

8. The World Bank estimates that India is ranked 2nd in
the world of the number of children suffering from
malnutrition
 Under nutrition is found mostly in rural areas
 Under privileged section of the society like urban
slums, rural, and tribal are worst affected by
malnutrition particularly pregnant and lactating
women and children are at a higher risk

9.  Nutrition is a critical part of health and development.
Better nutrition is related to
 improved infant, child and maternal health,
 stronger immune systems,
 safer pregnancy and childbirth,
 lower risk of non-communicable diseases (such as
diabetes and cardiovascular disease), and
 longevity.

10.  Healthy children learn better. People with
adequate nutrition are more productive and
can create opportunities to gradually break the
cycles of poverty and hunger.
 Malnutrition, in every form, presents
significant threats to human health.

11.  About 165 million children globally are
stunted, according to 2011 figures, resulting
from not enough food, A vitamin- and
mineral-poor diet, inadequate child care and
disease.
 As growth slows down, brain development
lags and stunted children learn poorly.

12.  Wasting and bilateral oedema are severe forms
of malnutrition - resulting from acute food
shortages and compounded by illness.
 Rising food prices, food scarcity in areas of
conflict, and natural disasters diminish
household access to appropriate and adequate
food, all of which can lead to wasting.

13.  Essential vitamins
and minerals in the
diet are vital to boost
immunity and healthy
development.
 Maternal
undernutrition.

14.  Nutritional problems in adolescents start
during childhood and continue into adult life.
Anaemia is a key nutritional problem in
adolescent girls.
 Preventing early pregnancies and assuring
adequate intakes of essential nutrients for
developing girls can reduce maternal and child
deaths later, and stop cycles of malnutrition
from one generation to the next.

15.  They are the large scale supplementary
programmes
 Main aim is to improve nutritional status in
targeted groups
 To overcome specific diseases through
various ministries to combat malnutrition

17.  Ministry of Health and Family Welfare
 Ministry of Social Welfare
 Ministry of Education and Culture
 Department of Food in the Ministry of Food
and Agriculture
 Ministry of Rural Reconstruction

18.  Special nutrition programme for pre-school
children and expectant and nursing
mothers.1970-71
 Balwadi nutrition program(1970)
 Applied nutrition programme(1963)

19.  National goiter control programme
(ngcp)1986
 National water supply and sanitation
programme (1954)
 Minimum needs programme(1974)

20.  20 point programme 1975
 National diarrhoeal diseases control
programme(1981)

21.  Tamil nadu integrated nutrition programme
(1980)
 Wheat based supplementary nutrition
programme (1986)

23.  Mid Day Meal Scheme Human Resource
Development
 Vitamin A Prophylaxis Programme
 Prophylaxis Against Nutritional anaemia.
 IDDs Control Programme.
Health and family
welfare
 Special Nutritional Programme
 Balwadi Nutritional Programme
 ICDS Programme
Social welfare
Mid Day Meal Programme Education

24.  Adequate availability of foodstuffs by:
1. Ensuring production of cereals, pulses and
seasonal vegetables.
2. Making them available throughout the year.
3. More cost-effective and efficient targeting of
the PDS.
4. Improving people's purchasing power through
appropriate programmes including food for
work schemes.

25.  Prevention of under-nutrition through
nutrition education aimed at:
1. Ensuring appropriate infant feeding practices
2. Promoting appropriate intra-family
distribution of food based on requirements;
3. Dietary diversification to meet the nutritional
needs of the family.

26.  Operationalising universal screening of all
pregnant women, infants, preschool and school
children for under-nutrition and nutritional
intervention

27.  Research efforts will be directed towards:
 Review of the recommended dietary intake of
Indians;
 Building up of epidemiological data on:
▪ Relationship between birth weight, survival, growth
and development in childhood and adolescence;
 Body mass index norms of Indians and health
consequences of deviation from these norms.

30.  Initiated in 1970
 Age group 6 months-6 year
 Priority to Vitamin A deficient geographical
area
 OBJECTIVE
Prevent blindness due to Vitamin A
Deficiency
 ORGANIGATION
PHC and subcenter

31.  Beneficiary group
 preschool children(6 months to 6 years)
 A single massive dose of oily preparation of
Vitamin A 200,000 IU (retinol palmitate
110mg) orally every 6 months for every
preschool child above 1 year
half the amount in < than 1 year children

32. 31 August 2013 JLNH&RC

33.  Pregnant woman <11 gm/dl
non pregnant woman <12gm/dl
 Initiated in 1970
 Centrally sponsored
 Over 85%pregnant woman suffer from
anemia (health and family welfare
official site)
 Causes LBW and perinatal mortality

34. OBJECTIVE
1. Assess prevalence
2. Give anti anemic treatment
3. Give prophylaxis
4. Monitoring
5. Education

35. BENEFICIARIES
 Children age group 1 to 10,
 Pregnant and nursing mother,
 Acceptors of family planning,
 Adolescent girls.
 ORGANIGATION
 PHC and sub centers

36.  Pregnant women : 100 mg Fe & 0.5mg folic acid
 Children 6 to 60 months : 20mg Fe & 0.1 mg folic acid
Should be given 100 days
 6 to 10 years of age : 30 mg iron and 0.25 mg folic acid
 Adolescent girls : 100 mg Fe & 0.5mg folic acid
 Iron fortification in salt
 Screening test for aneamia done at 6 months,1 and 2
years of age.

37.  Developed by National Institute of Nutrition,
Hyderabad
 Addition of ferric ortho phoshapte or ferrous sulphate
with sodium bisulphate was enough to fortify salt
with iron.
 When consumed for 12-18 months –
reduce prevalence of anaemia.
 Commercial production since 1985.

39. Effect on people : HUMANS Health &
Socioeconomic impact
Effect on animals : LIVESTOCK Clinical & Reproductive
disorders,
decreased productivity
Low Availability
of iodine : PLANTS Iodine poor feeds &
fodders
Soil Erosion : WATER, SOILEnvironmental iodine
deficiency
Iodine Deficiency – A Disease of The Soil

40. Brain Cell Growth
Iodine Deficiency Iodine Sufficiency
Iodine Deficiency is the single most
common cause of preventable mental retardation

41. JLNH&RC
Iodine Deficiency = Goitre =
Visible Swelling
No Pain = Not a cause of
Mortality = Cosmetic problem
Cretinism rare
IDD – The Hourglass
Historic
View
Current
View
Mental & Physical growth
Loss of Energy-hypothyroidism
Learning Disability, Poor Motivation
Child Development and Child Survival
Human Resource Development

42.  National goiter control
programme was started in 1962
 Renamed it on 1992 as
National iodine deficiency
disorder control programme
 Replace the entire edible salt
by iodide salt
Double fortification of salt
iodine and iron (35ppm
and 1000ppm)

43. 1. Surveys to assess the magnitude of the Iodine
Deficiency Disorders
2. Supply of Iodated salt in place of common
salt.
3. Re-survey after every 5 years to assess the
extent of Iodine Deficiency Disorders and the
impact of iodated salt.
4. Laboratory Monitoring of Iodated Salt and
Urinary Iodine Excretion
5. Health Education & Publicity

44.  This project was started in Orissa on 1963
 Later extended to TN and UP.
 Objectives:
 Promoting production of Vegetables and fruits
 Ensure their consumption by pregnant & lactating
women and children.
 In1973 it was extended to all states of INDIA
 The idea is to provide better seeds and encourage
kitchen gardens, poultry farming, beehive
keeping, etc.,

45.  Nutritional Services
 Health services
 Communication
 Monitoring and evaluation
It is being merged into ICDS

46.  This was started in 1970 is in operation in urban
slums, tribal areas and backward rural areas.
 It was launched under minimum need programme
 Main aim is to improve nutritional status in
targeted group.
 Beneficiary group
children below 6 years
pregnant and lactating women

47. Child : 300kcal and 10-12gm protein
pregnant :500kcal and 25 gm protein
Total of 300 days in a year
This programme is gradually being merged into
ICDS

48. The Department of Social Welfare has a scheme to
provide the nutritional services for children in the
age-group 3-5 years provided through Balwadies.

49.  A place where, the children in the age group of
2 ½ to 5 years receive pre- primary education.
 The balwadi teachers are usually local women.
 Besides the education and recreational
activities there are other regular programmes
such as monthly meetings of the parents in
which the parents are educated about
childcare, health and nutrition etc.

50.  There are regular medical health checks up.
 Other cultural programmes which the balwadi
children celebrate are Independence
Day, Children’s Day, Teachers’ Day,etc.
Also, every year a Sports Day is held and in some
areas children are taken out on annual picnics.
 Once the children reach the age of 5, they can be
admitted to schools.

51.  This programme was started in December
1970.
 It gives the provision of supplementary
nutrition of 300 calories and 10 grams of
protein during 270 days in the age group of 3-
5 years in a year for children attending
Balwadis.
 This program is being phased out due to
universalisation of ICDS.

53.  Launched on 2nd October 1975.
 ICDS Scheme represents one of the world’s
largest and most unique programmes for early
childhood development.
 India’s response to the challenge of
 Providing pre-school education on one hand and
 Breaking the vicious cycle of malnutrition, morbidity,
reduced learning capacity and mortality, on the other.
 ICDS is the foremost symbol of India’s
commitment to her children.

54. 1. Routine MCH services not reaching target Population
2. Nutritional component not covered by Health services
3. Need for community participation

55. 1. To improve the nutritional and health status of children in the age-
group 0-6 years;
2. To lay the foundation for proper psychological, physical and
social development of the child;
3. to reduce the incidence of mortality, morbidity, malnutrition and
school dropout;
4. To achieve effective co-ordination of policy and implementation
amongst the various departments to promote child development;
and
5. 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.

56. Children < 6 years
31 August 2013
Pregnant Woman Lactating women
Adolescent Girls
Women in Reproductive
age group (15-44)
Children below 6 years

57.  The above objectives are sought to be
achieved through a package of services
comprising:
1. Supplementary nutrition,
2. Immunization
3. Health check-up
4. Referral services
5. Pre-school non-formal education and
6. Nutrition & health education.

58. Services Target Group Service Provided by
Supplementary
Nutrition
Children below 6 years:
Pregnant & Lactating Mother (P&LM)
Anganwadi Worker and
Anganwadi Helper
Immunization* Children below 6 years:
Pregnant Women
ANM/MO
Health Check-up* Children below 6 years:
Pregnant & Lactating Mother (P&LM)
ANM/MO/AWW
Referral Services Children below 6 years:
Pregnant & Lactating Mother (P&LM)
AWW/ANM/MO
Pre-School Education Children 3-6 years AWW
Nutrition & Health
Education
Women (15-45 years), Children 3-6
years
Pregnant & Lactating Mother (P&LM)
AWW/ANM/MO

59.  This includes supplementary feeding and growth
monitoring;
 Growth Monitoring and nutrition surveillance are
two important activities that are undertaken.
 Children <3 years of age are weighed once a month
 children 3-6 years of age are weighed quarterly
 They avail of supplementary feeding support for
300 days in a year.

60.  Immunization of pregnant women
and infants protects children from
six vaccine preventable diseases-
poliomyelitis, diphtheria, pertusis,
tetanus, tuberculosis and measles.
 Immunization of pregnant women
against tetanus also reduces
maternal and neonatal mortality

61.  This includes health care of children less than six
years of age, antenatal care of expectant mothers
and postnatal care of nursing mothers.
 Recording of weight, immunization, management of
malnutrition, treatment of diarrhoea, de-worming
and distribution of simple medicines etc.

62.  During health check-ups and growth
monitoring, sick or malnourished children, in
need of prompt medical attention, are referred
to the Primary Health Centre or its sub-centre

63.  Anganwadi – a village
courtyard. Its for the three-to
six years old children and is
directed towards providing and
ensuring a natural, joyful and
stimulating environment
 PSE is considered the
backbone of the ICDS
programme.

64.  It is a key element of
the work of the
Anganwadi worker.
 This forms part of
BCC (Behaviour
Change
Communication)
strategy

65.  There was a gap in between women and child age
group which was not covered by any health and
social welfare programme whereas girls in this
crucial groups need special attention.
 Their needs:
 appropriate nutrition,
 education,
 health education,
 training for adulthood,
 training for motherhood, etc.

66.  This scheme for adolescent girls in ICDS was
launched by the Department of Women and
Child Development, Ministry of Human
Resource Development in 1991.

67.  Beneficiary : All adolescent girls in the age group of
11-18 years (70%) received the following
 Common services:
1. Watch over menarche,
2. Immunisation,
3. General health check-ups once in every six-months,
4. Training for minor ailments,
5. Deworming,
6. Prophylactic measures against anemia, goiter,
vitamin deficiency, etc. and
7. Referral to PHC. District hospital in case of acute
need.

68.  Child Development Project Officers (CDPOs)
 District Program Officers (DPOs)
 Anganwadi Workers
 Anganwadi Helpers
 Auxiliary Nurse Midwife (ANM)
 Accredited Social Health Activist (ASHA)

69. 1. Monitor growth of children,
2. Provide non formal pre-school education,
3. Provide supplementary nutrition
4. Give health and nutrition education
5. Referral for sick children
6. Elicit community participation
7. Provide health service in collaboration with
ANM/ASHA
8. Implement adolescent girls’ scheme

70. 1. To cook and serve the food to children
2. To clean the Anganwadi premises daily and
fetching water.
3. Cleanliness of small children.
4. To bring small children from the village to
the Anganwadi.

71. 1. Awareness generation
2. Counsel women
3. Community mobilization
4. Escort/accompany pregnant women & children
requiring treatment
5. Provide primary medical care

72. 1. Hold weekly / fortnightly meeting with ASHA
2. Participate & guide in organizing the Health Days
at AWC
3. Utilize ASHA in motivating the pregnant women
and married couples
4. Guide ASHA in motivating pregnant women for
full ANC
5. Educate ASHA on danger signs of pregnancy and
labor

73.  Health Check-ups
 Handling Referral
 Immunization
 Nutrition & Health Education
 Monitoring of Health components

74. Population Norms:
 For Rural/Urban Projects
400-800 - 1 AWC
800-1600 - 2 AWCs
1600-2400 - 3 AWCs
Thereafter in multiples of 800 1 AWC
 For Mini-AWC
150-400 -1 Mini AWC

75.  For Tribal /Riverine/Desert, Hilly and other difficult
areas/ Projects
300-800 - 1 AWC
 For Mini- AWC
150-300 1 Mini AWC
 At present there are 5659 ICDS projects.

76. Beneficiary Pre-revised Revised
w.e.f. Feb.
2009
Calories
(KCal)
Protein
(G)
Calorie
s (KCal)
Protein
(Gm)
Children (6-72
months)
300 8-10 500 12-15
Severely
malnourished
children (6-72
months)
600 20 800 20-25
Pregnant & Lactating 500 15-20 600 18-20

77. Category Pre-
revised
Revised w.e.f
June 2010
Children (6-72
months)
Rs. 2.00 Rs.4.84
Severely
malnourished children
(6-72 months)
Rs. 2.70 Rs.5.82
Pregnant & Lactating Rs. 2.30 Rs.6.00

78.  United Nations International Children’ Emergency Fund
(UNICEF)
 Cooperative for Assistance and Relief Everywhere (CARE)
 World Food Programme (WFP)

80.  Major Objective:
1. Improve the School attendance
2. Reduce school drop outs
3. Beneficial impact on Childs nutrition
 Principles
1. Supplement, not substitute to home diet
2. 1/3 total energy requirement/day and
½ total protein requirement /day
3. Reasonably low cost
4. Easily prepared at schools
5. As for as possible locally available food
6. Change menu frequently

82.  Also called as National programme of nutritional
support to primary education
 Hot and hygienic cooked meal is provided to all the
children studying in classes 1 to 10 in the
Government and aided Primary and high Schools all
over the State.

83. JLNH&RC
Cont..
• Objectives:
1. To ensure enrollment of all children of school going age.
2. To enhance retention rate.
3. To facilitate academic excellence.
4. To improve child health and increase nutrition level (350
to 500 kcal and 8-12gm protein)
5. To bring social equity

84. 31 August 2013 JLNH&RC

85.  Programme is good as for as improving nutrition
of the underprivileged children
 But it requires sustainability for this requires
political will, community participation,
monitoring and evaluation
 Repeated incidence of food poisoning in the mid
day meal causing serious threat to existence of
this programme.