Communitiy nutrition programme

BY:- FIROZ QURESHIDEPT. PSYCHIATRIC NURSING

COMMUNITY NUTRITION

Community Nutrition Discipline that strives to improve the health, nutrition, and well being of individuals and groups with in communities -any program whose target is the community, whether funded through public/ private funds.

Areas of Community Nutrition

1. People: individuals who benefit from programs and services; health of the people in the community2. Policy: course of action chosen by public officials to address

a problem. Policies direct laws, regulations and programs3. Programs: Instruments used by CN to seek behavior changes

that improve nutrition status and health- wide ranging- target specific status

DEFINITION OF NUTRITION:

Combination of dynamic process by which the consumed food is utilized for nourishment and structural and functional efficiency of every cell of the body.

(American heritage dictionary )

The science or study that deals with food and nourishment, especially in humans.

(biology)

National Nutrition Monitoring Bureau (NNMB)

Recognizing the need for good quality data for monitoring nutritional status, ICMR in 1972 established the National Nutrition Monitoring Bureau in the National Institute of Nutrition (NIN), Hyderabad. Since 1973, surveys carried out by the NNMB have been a major source of data on diet and nutritional status of the Indian population.

NNMB units were established in ten States- Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Gujarat, West Bengal, Maharashtra, Uttar Pradesh and Madhya Pradesh & Orissa.

The objectives of NNMB : 1) To collect data on dietary intake and

nutritional status of the population in the states of India on a continuous basis.

2) To monitor the ongoing national nutrition programmes and to recommend mid course corrections to improve their effectiveness.

The Central Reference Laboratory located at National Institute of Nutrition is responsible for preparation of the survey protocol, sampling, and training of the field staff, quality control, data analysis and report writing.

MAJOR NUTRITIONAL PROBLEMS IN INDIA:

1. PROTEIN ENERGY MALNUTRITION 2. LOW BIRTH WEIGHT 3. XEROPHTHALMIA(DRY EYE)4. NUTRITIONAL ANEMIA5. IODINE DEFICIENCY DISORDERS6. CANCER LATHYRISM 7. OBESITY8. CARDIO VASCULAR DISEASES9. FLUROSIS

NATIONAL NUTRITION GOALS : Reduce the prevalence of underweight in children under

5 years to 20%. Eradicate the prevalence of severe under nutrition in

children under five years. First hour breastfeeding rates to increase to 80%. Exclusive breastfeeding rates to increase to 90%. Complementary feeding rate at six months to increase

to 90%. Reduce prevalence of anaemia in high risk groups

(infants, pre-school children, adolescent girls, pregnant and lactating women) to 25%.

Eliminate vitamin A deficiency in children under 5 years as a public health problem and reduce sub-clinical deficiency of vitamin A in children by 50%.

Reduce prevalence of Iodine Deficiency Disorders to less than 5%.

HISTORY OF NUTRITIONAL PROGRAMMES IN INDIA:

SPECIAL NUTRITION PROGRAMME FOR PRE-SCHOOL CHILDREN AND EXPECTANT AND NURSING MOTHERS.1970-71

BALWADI NUTRITION PROGRAM(1970 ) APPLIED NUTRITION PROGRAMME(1963) NATIONAL GOITER CONTROL PROGRAMME (NGCP)1986 NATIONAL WATER SUPPLY AND SANITATION PROGRAMME

(1954) MINIMUM NEEDS PROGRAMME(1974) 20 POINT PROGRAMME 1975 NATIONAL DIARRHOEAL DISEASES CONTROL

PROGRAMME(1981) TAMIL NADU INTEGRATED NUTRITION PROGRAMME ( 1980 ) WHEAT BASED SUPPLEMENTARY NUTRITION PROGRAMME

(1986)

PRESENT NUTRITIONAL PROGRAMMES: 1. INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME ,1975 2. VILLAGE GRAIN BANK SCHEME(2004)-Ministry of Tribal Affairs 3. WHEAT BASED NUTRITION PROGRAMME (WBNP)-ministry of Women

&Child Development4. EMERGENCY FEEDING PROGRAMME(2001)5. ANNAPURNA SCHEME(2000-01)-Ministry of Rural Development 6. SCHEME FOR SUPPLY OF FOODGRAINS TO WELFARE INSTITUTIONS

(2002-03)7. RAJIV GANDHI SCHEME FOR EMPOWERMENT OF ADOLESCENT GIRLS

(RGSEAG) – SABLA(2010)- ministry of Women &Child Development8. SC/ST/OBC HOSTELS -1994- ministry of consumer affairs 9. NATIONAL FOOD SECURITY MISSION'- 2007-08- Ministry of Agriculture10. AKSHAYA PATRA AND PRIVATE SECTOR PARTICIPATION IN MID-DAY

MEALS, 200111. NATIONAL PROGRAMME FOR NUTRITION SUPPORT TO PRIMARY

EDUCATION : 2001

Cont...12. NATIONAL FOOD FOR WORK PROGRAMME : 2004

13. THE SAMPOORNA GRAMEEN ROZGAR YOJANA-200114. NATIONAL RURAL HEALTH MISSION-2005-2012 15. MID DAY MEAL PROGRAMME(1961)16. MID-DAY MEAL SCHEME (1995)17. NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS

PROGRAMME(1970) :18. NATIONAL PROGRAMME FOR CONTROL OF

BLINDNESS(1970) 19. VITAMIN A PROPHYLAXIS PROGRAMME(1970)20. IODINE DEFICIENCY DISORDER CONTROL

PROGRAMME(1992)21. WORLD FOOD PROGRAMME IN INDIA 22. NATIONAL FOOD SECURITY BILL, 2011

INTEGRATED CHILD DEVELOPMENT SERVICE (ICDS) SCHEME: Integrated Child Development Service (ICDS) scheme

was launched on 2nd October, 1975 (5th Five year Plan) .

The primary responsibility for the implementation of the programme is with the Department of Women and Child Development, Ministry of Human Resources Development at the Centre and the nodal departments at the state.

Beneficiaries 1. Children below 6 years

2. Pregnant and lactating women3. Women in the age group of 15-44 years4. Adolescent girls in selected blocks

Objectives1. Improve the nutrition and health status of children in the age

group of 0-6 years;2. Lay the foundation for proper psychological, physical and social

development of the child;3. Effective coordination and implementation of policy among the

various departments; and4. Enhance the capability of the mother to look after the normal

health and nutrition needs through proper nutrition and health education.

The Package of services provided by ICDs 1. Supplementary nutrition, Vit-A, Iron and Folic Acid,

2. Immunization, 3. Health check-ups,4. Referral services, 5. Treatment of minor illnesses;6. Nutrition and health education to women;7. Pre-school education of children in the age group of 3-6 years8. Convergence of other supportive services like water supply, sanitation, etc.

Scheme for Adolescent Girls (Kishori Shakti Yojna)

IN health sector girls are the crucial groups need special attention. On one side they need appropriate nutrition, education, health education, training for adulthood, training for acquiring skills as the base for earning an independent livelihood, training for motherhood, etc. A scheme for adolescent girls in ICDs was launched by the Department of Women and Child Development, Ministry of Human Resource Development in 1991.

Common Services: All adolescent girls in the age group of 11-18 years (70%)

received the following 1. Watch over menarche, 

2. Immunization, 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.7. Referal to PHC.District hospital in case of acute need.

MID-DAY MEAL PROGRAMME 

Tamil Nadu was the first to initiate a massive noon meal programme to children. Mid-Day Meal (MDM) Scheme was launched in primary schools during 1962-63.

Mid-Day Meal improves three areas: 1. School attendance, 2. Reduced dropouts, 3. A beneficial impact on children’s

nutrition.

Cont...

The programme covers around 21.1 million children in class I to V standard by 1989-90.

Food grains at the rate of 3 Kg. minimum per child are provided per month (300 k cal and 8-12 grams of protein per day) free of cost. In rural areas, Panchayats and Nagarpalikas are involved or setting up of necessary infrastructure for preparing cooked food. The total charges for cooking, supervision and kitchen are eligible for assistance under Poverty Alleviation Programme. In several states, supplementary feeding was assisted by food supplies from Cooperation for American Relief Everywhere (CARE) and World Food Programme (WFP).

SPECIAL NUTRITION PROGRAMME (SNP)  The programme was launched in the country

in 1970-71. It provides supplementary feeding of about 300 calories and 10 grams of protein to preschool children and about 500 calories and 25 grams of protein to expected and nursing mothers for six days a week. This programme was operated under Minimum Need Programme. The programme was taken up in rural areas inhibited predominantly by lower socio-economic groups in tribal and urban slums. Fund for nutrition component of ICDs programme is taken from the SNP budget.

BALWADI NUTRITION PROGRAMME

Fund for the supplementary feeding of Balwadi Nutrition programme is given by the Central Government which was launched in 1970-71 through voluntary organisations.

It provides 300 calories and 10 grams of protein per child (3-5 years) per day for 270 days a year.

WHEAT BASED SUPPLEMENTARY NUTRITION PROGRAMME 

  A centrally sponsored programme was

introduced in 1986 but now transferred to the State Sector. This programme follows the norms of SNP or of the nutrition component of the ICDs.

Central Assistance for the programme consist of supply of free wheat and supportive costs for other ingredients, cooking, transport etc.

APPLIED NUTRITION PROGRAMME The Applied Nutrition Programme (ANP) was introduced in Orissa

in 1963 which later on extended to Tamil Nadu and Uttar Pradesh with the objectives of:

a) promoting production of protective food such as vegetables and fruits

b) ensure their consumption by pregnant and nursing mothers and children.

During 1973, it was extended to all the state of the country. The nutritional Education was the main focus and efforts were directed to teach rural communities through demonstration how to produce food for their consumption through their own efforts.

The beneficiaries are children between 2-6 years and pregnant and lactating mothers. Nutrition worth of 25 paisa per child per day and 50 paisa per woman per day are provided for 52 days in a year.

The idea is to provide better seeds and encourage kitchen gardens & poultry farming. The community kitchens and school gardens could not function properly due to lack of suitable land, irrigation facilities, and low financial investment.

TAMIL NADU INTEGRATED NUTRITION PROGRAMME 

The Tamil Nadu Integrated Nutrition Project was started in 1980 targeting at 6-36 month old children, and pregnant and lactating women.

TIMP aimed for: To reduced malnutrition upto 50% among children under 4

years of age; To reduce infant mortality by 25%; To reduce Vit-A deficiency in the under 5 year from about

27% to 5%; and To reduce ammonia in pregnant and nursing women from

about 55% to about 20%. This project has four major components:  1. Nutrition services,

2. Health services, 3. Communication, and4. Monitoring and evaluation.

Cont... TINP-II was designed to cover in a phased manner.

316 of the total 385 rural blocks in Tamil Nadu. The Goals of the programme were:

1. To increase the proportion of children classified as “nutritionally normal” by 50% in new and 35% in TINP-II areas

2. To reduce the infant mortality to 55% per 1000 live births

3. To 50% reduction in incidence of low birth weight.

The projects are assisted by World Bank and with the goal of universalization of ICDs all the TINP blocks will be converted to ICDs blocks.

NATIONAL NUTRITION ANEMIA PROPHYLAXIS PROGRAMME

 Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3% has haemoglobin < 7 gm./dl; severe anemia) and 85% pregnant women (9.9% having severe anemia. The commonest is iron deficiency anemia.

The programme was launched in 1970 to prevent nutritional anemia in mothers and children. Under this programme, the expected and nursing mothers as well as acceptors of family planning are given one tablet of iron and folic acid containing 100 mg elementary iron and children in the age group of 1-5 years are given one tablet of iron containing 20 mg elementary iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days. This programme is being taken up by Maternal and Child Health (MCH) Division of Ministry of Health and Family Welfare. Now it is part of RCH programme.

  WORLD FOOD PROGRAMME (WFP)  World Food programme is the world’s largest

international food aid organisation, serving in 84 countries working with the goal of achieving “A world in which every man, woman and child has access at all times to the food needed for an active and healthy life. Without food, there can be no sustainable peace, no democracy and no development”. Founded in 1963 as the food aid arm of the United Nation. After the Rome Declaration on World Food Security in 1996, WFP is committed to achieve the goal of halving the number who are without adequate access to food by 2015.

NATIONAL NUTRITIONAL POLICY(1993):

Short term interventions Nutrition Intervention for specially vulnerable groups fortification of Essential Foods Popular is action of Low Cost Nutritious Food Control of Micro-Nutrient Deficient amongst vulnerable Gro.

Long term interventions Food Security Improvement of Dietary pattern through Production and Demonstration Health & Family Welfare Basic Health and Nutrition Knowledge Prevention of Food adulteration.

NATIONAL FOOD SECURITY BILL, 2011 :

  Right To Access Of Food Security

Entitlements of Pregnant and Lactating Women Entitlements of children at the age group of 0 – 6yrs Midday meal to Children Prevention and Treatment of Child Malnutrition.

Entitlement of Destitute persons Entitlement of Homeless Persons Emergency and Disaster Affected Persons Right of persons living in starvation Constitution of National Food Commission

CURRENT NUTRITIONAL STATUS IN INDIA by UNICEF

In India 20 per cent of children under five years of age suffer from wasting due to acute undernutrition.

• India has the highest number of low birth weight babies per year at an estimated 7.4 million.

• Only 25 per cent of newborns were put to the breast within one hour of birth. 

• Less than half of children (46 per cent) under six months of age are exclusively breastfed. 

• Only 20 per cent children age 6-23 months are fed appropriately according to all three recommended practices for infant and young child feeding.

• 70 per cent children age 6- 59 months are anaemic. Children of mothers who are severely anaemic are seven times as likely to be severely anaemic as children of mothers who are not anaemic.

• Only half (51 per cent) of households use adequately iodized salt. 

• Only one third (33 per cent) Indian children receive any service from an anganwadi centre; less than 25per cent receive supplementary foods through ICDS; and only 18 per cent have their weights measured in an AWC. (Source NFHS 3, 2005-2006)

Cont...

Nutritional Issues in India   Undernutrition jeopardizes children’s survival, health,

growth and development. Optimal infant and young child feeding entails the

initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of the child’s life. Early initiation of breastfeeding contributes to reducing neonatal mortality. 

It ensures early skin-to-skin contact, which is important in preventing hypothermia and establishing the bond between the mother and her child.

Anaemia in young children is a serious concern, because it can result in increased morbidity from infectious diseases and impaired cognitive performance, behavioural and motor development, coordination, language development, and school achievement.

Cont... Vitamin and mineral deficiencies are highly

prevalent throughout the developing world.  Iodized salt consumed as table salt and/or as

food-grade salt (used in food processing) improves brain development; prevents motor and hearing deficits. Zinc given as part of Oral Rehydration Therapy for the treatments for diarrhoea reduces duration and severity of diarrhoea.

Hand washing with soap by caregivers’ and children prior to food preparation and eating, serving foods immediately after preparation.

Significant disparity in nutritional status also exists in terms of mothers’ education and literacy.

NUTRITIONAL REHABILITATION

The nutrition rehabilitation centre is a hut like structure with a vegetable & fruits garden around it.

In this centre children are treated for PEM & their mothers educated in the right methods of childcare, feeding, gardening & nutrition.

A pediatrician, a nurse, a pharmacist, a health instructor, ward boys, helpers & gardener staff present in nutrition rehabilitation centre.

The mother stays either full time in the centre or during the day, returning home for the night.

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