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COMMUNITY NUTRITION PROGRAMMES
Dr. Rizwan S AAssistant Professor
Dept. of Community MedicineVMCHRI, Madurai
18.2.2016
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CNP, a boon or bane?
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Tamilian perspectives
If the Creator of the world has decreed even begging as a means of livelihood, may he too go abegging and perish
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Tamilian perspectives• Thani Oru Manithanukku
Unavu Illai Enil… Intha Jagathinai Azhithiduvom…
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Tamilian perspectives
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Learning objectives
• At the end of this class you must be able to
– Define the primary objective of CNP– List out the various CNP in India– Enlist the objectives and provisions in each CNP– Develop an opinion on the usefulness of such CNP
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Recap of goals of the NNP
• Short term interventions• Long term changes
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Introduction• Large scale supplementary
nutrition programmes
• Main aim is to improve nutritional status in targeted groups
• And overcome specific diseases to combat malnutrition
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List of CNP
1. Vitamin A prophylaxis programme 2. Prophylaxis against nutritional anaemia 3. Control of iodine deficiency disorders 4. Special nutrition programme5. Balwadi nutrition programme 6. ICDS programme 7. Mid-day meal programme 8. Mid-day meal scheme
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CNP and its ministryProgramme Ministry
Vitamin A Prophylaxis ProgrammeProphylaxis Against Nutritional anaemiaIDD Control Programme
Health and family welfare
Special Nutritional ProgrammeBalwadi Nutritional Programme
Social welfare
ICDS SchemeWomen and child development
Mid Day Meal ProgrammeMid Day Meal Scheme
Human Resource Development
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VITAMIN A PROPHYLAXIS PROGRAMME
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Vitamin A Prophylaxis Programme
• Initiated in 1970• Beneficiary: age group 6mo - 5 year• Objective: Prevent blindness due to VAD• Implemented by: PHC and subcenter• A single massive dose of Vitamin A 2 lac IU
(retinol palmitate 110mg) orally every 6 months above 1 year
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Role of Vitamin A in health
• Prevent respiratory infection• Maintain GIT epithelium integrity• Immunity• Prevent Nutritional blindness
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PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA
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Prophylaxis Against Nutritional Anaemia
• Initiated in 1970• Centrally sponsored• Over 50%pregnant woman suffer from anemia• Causes LBW and perinatal mortality, maternal
death• Objectives: Assess prevalence, Give treatment,
Give prophylaxis, Monitoring, Education
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Prophylaxis Against Nutritional Anaemia
• Beneficiaries:– Children aged 1 to 5 years– Pregnant and nursing mother– Female acceptor of terminal method of family
planning and IUDS
• Implemented by: PHC and subcenters
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Prophylaxis Against Nutritional Anaemia
• Dosage of tablets:– 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– Adolescent girls: 100 mg Fe & 0.5mg folic acid
• Children between 1 to 5 years– Screening test for anemia done at 6 mo, 1, 2 years
• Iron fortification of salt
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IODINE DEFICIENCY DISORDER CONTROL PROGRAMME
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IDD control programme
• National goiter control programme in 1962• IDD Control Programme• Replace the entire edible salt by iodide salt • Fortification of salt with iodine
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SPECIAL NUTRITIONAL PROGRAMME
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Special Nutritional Programme
• Started in 1970 in urban slums, tribal areas and backward rural areas
• Main aim is to improve nutritional status in – children <6 years– pregnant and lactating women
• Gradually being merged into ICDS
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APPLIED NUTRITIONAL PROGRAMME
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Applied Nutritional Programme
• This project was started in Orissa on 1963• Later extended to TN and UP• Objectives:– Promoting production and of protective food such
vegetables and fruits – Ensure their consumption by pregnant & lactating
women and children.• In 1973 extended to all states in INDIA
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Applied Nutritional Programme
• Major components– Nutritional Services– Health services– Communication– Monitoring and evaluation
• Later converted into ICDS
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BALWADI NUTRITION PROGRAMME
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Balwadi Nutrition Programme
• This was started in 1970 by the department of social welfare
• Beneficiary:– Preschool children 3-6 years of age
• Activities– 300 kcal and 10 g protein– Preschool education
• Phased out because universalization of ICDS
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INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME
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ICDS
• Launched on 2nd October 1975• 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• Foremost symbol of India’s commitment to her
children
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Need for ICDS
• Routine MCH services not reaching target
Population
• Nutritional component not covered by
Health services
• Need for community participation
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Objectives of ICDS
• Improve the nutritional and health status of children in the age-group 0-6 years
• Foundation for proper psychological, physical and social development of the child
• Reduce the incidence of mortality, morbidity, malnutrition and school dropout
• Co-ordination of departments to promote child development
• Nutrition and health education to the mother
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Beneficiaries of ICDS
• Pregnant women
• Nursing Mothers
• Children less than 3 years
• Children between 3-6 years
• Adolescent girls( 11-18 years)
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Functionaries of ICDS
• District Programme Officer (DPO)• Child Development Project Officer (CDPO)• Supervisor (Mukhyasevika)• Anganwadi Workers (AWW)• Anganwadi Helpers (AWH)
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Services under ICDS
• Package of services: 1. Supplementary nutrition2. Immunization3. Health check-up4. Referral services5. Pre-school non-formal education6. Nutrition & health education
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Services & beneficiaries Services Target Group
Supplementary Nutrition Children below 6 years, PLW
Immunization Children below 6 years, Pregnant Women
Health Check-up Children below 6 years, PLW
Referral Services Children below 6 years, PLW
Pre-School Education Children 3-6 years
Nutrition & Health Education
Women (15-45 years), Children 3-6 years, PLW
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COMPONENTS OF ICDS
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Supplementary Nutrition
• Supplementary feeding and growth monitoring
• Prophylaxis against vitamin A deficiency and control of nutritional anemia
• Growth Monitoring and nutrition surveillance– children <3 years of age of age are weighed once a
month– children 3-6 years of age are weighed quarterly
• Supplementary feeding for 300 days in a year
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Supplementary Nutrition per Day
Beneficiary Calorie Protein
Children (6-72 months) 500 12-15
Severely malnourished children (6-72 months)
800 20-25
Pregnant & Lactating women 600 18-20
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Immunization
• Immunization of pregnant women and children
• Protects against tetanus and reduces maternal and neonatal mortality
• Protects children from seven vaccine preventable diseases
• Provided by the health department
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Health Check-Up
• For children <6 years, antenatal care, postnatal care of nursing mothers
• Consists of weight recording, immunisation, management of malnutrition, treatment of diarrhea, de-worming, simple medicines for common illnesses
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Referral Services
• Sick or malnourished children, in need of prompt medical attention, are referred to the Primary Health Centre or its sub-centre
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Non-formal Pre-School Education
• Anganwadi – a village courtyard• Backbone of the ICDS• For 3-6 year olds • Providing a natural, joyful and stimulating
environment
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Nutrition and Health Education
• Key element of the work of the anganwadi worker
• This forms part of BCC (Behaviour Change Communication) strategy
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Role of AWW• To elicit community support • Weigh & record each child
every month• Refer cases• Organize pre-school activities• Provide supplementary
nutrition• Provide health & nutrition
education and counseling• Make home visits• Coordinate with other staff
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Role of AWH• Cook & serve food• Clean the Anganwadi premises• Cleanliness of small children• Bring small children to Anganwadi
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Norms for AWC
• For Rural/Urban Projects – 400 to 800 - 1 AWC– 800 to 1600 - 2 AWCs– 1600 to 2400 - 3 AWCs– Thereafter in multiples of 800 per AWC
• For Mini-AWC – 150 to 400 - 1 Mini AWC
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Challenges in ICDS
• Practically children 3-6 year• Pregnant & Lactating not covered• Irregular food supplies• Quality of Nutrition supplement?• Poor supervision• Lack of community ownership/ participation• Nutrition education only on papers• Children come only for food
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MID DAY MEAL PROGRAMME
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Mid Day Meal Programme - 1961
• aka School Lunch Programme• Objectives– Improve school attendance– Improve child nutrition
• Principles – Supplement, not substitute to home diet– 1/3rd of energy and ½ of protein requirement/day– low cost, easily prepared at schools– locally available food, change menu frequently
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MID-DAY MEAL SCHEME
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Mid-day meal scheme - 1995
• aka National Programme of Nutritional Support to Primary Education
• Objectives:– Universalization of primary education by
increasing enrollment (class 1 to 5) and– Improve nutritional status of children (class 1-5)– 300 kcal and 8-12 g protein
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Challenges to Mid-day meal programmes
• Good for improving nutrition of the underprivileged children
• But it requires sustainability
• Repeated incidence of food poisoning in the mid day meal causing serious threat
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Review
• Vitamin A supplement administered in Prevention of nutritional blindness in children programme contains
1. 25,000 IU/ml2. 1 lakh IU/ml3. 3 lakh IU/ml4. 5 lakh IU/ml
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Review
• Which ministry implements mid day meal scheme?
1. Ministry of social justice and empowerment2. Ministry of health and FW3. Ministry of human resource development4. Ministry of finance
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Review
• Which of these is not directly carried out by the Anganwadi worker
(a) Supplementary nutrition (b) Non-formal pre-school education (c) Immunization (d) Nutrition and Health Education
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Review
• To a child under 3 years of age, ICDS provides:
(a) 300 Kcal energy and 8-10 g protein (b) 300 Kcal energy and 16-20 g protein (c) 500 Kcal energy and 8-10 g protein (d) 500 Kcal energy and 16-20 g protein