Date post: | 18-Dec-2014 |
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Supplementary nutrition in India
Dr. Babu lal MeenaMD Pediatrics
Objectives
• To know about nutritional programmes in India
• Basic structure of these programmes
• Benefits of these programmes
• Hurdles in implementation
Poverty
Undernutritionrelated disease
Retardation ofGrowth and
development
Poor strength of adults
Impaired productivity
Low earningcapacity
OutcomeUnder-Nutrition
ImmediateCauses
InadequateDietary Intake Disease
UnderlyingHealth /NutritionCauses
Inadequate Care for Mothers and Children
InsufficientAccess 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
Supplementar
y feeding
Therapeu
tic
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/Population
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
Populationpreviously
Populationcurrently
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
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
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
DisadvantageDisadvantage
• 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
Thank you