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Supplementary nutritional programmes in india

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DrBabu Meena
DrBabu Meena

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.

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Supplementary nutrition in India Dr. Babu lal Meena MD Pediatrics
Objectives • To know about nutritional programmes in India • Basic structure of these programmes • Benefits of these programmes • Hurdles in implementation
Poverty Undernutrition related disease Retardation of Growth and development Poor strength of adults Impaired productivity Low earning capacity
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
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
Food security/General Distribution Supplementary feeding Therapeutic feeding Early Intervention Late Intervention Cost-Benefit Not Cost-effective
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
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
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
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
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
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
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
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
Achievements • 244 lac pre-school children, 95 lac nursing mothers and 562 lac beneficiaries are getting supplementary nutrition • Better immunization coverage • Increased institutional delivery
Mid-Day Meals in India
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
MDM programme • Objectives – Increase school attendance – Reduce school dropout – Beneficial impact on children’s nutrition and health
Supplementary nutritional programmes in india
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
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
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.
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
Nutrition: Quality • Depends on: – Menu (plain boiled rice) – Cooking practices – Hygiene conditions (kitchens, drinking water)
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)
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
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
Supplementary nutritional programmes in india
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
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
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
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
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
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
Supplementary nutritional programmes in india

More Related Content

Supplementary nutritional programmes in india

  • 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
  • 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
  • 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