1. Dr. Rupesh Kumar Agarwal
DNB Pediatrics club activity
J.L.N. HOSPITAL AND RESEARCH CENTRE
6 December 2012 JLNH&RC
2. Community Nutritional
Programmes
Large scale supplementary programmes
Main aim is to improve nutritional status
in targeted groups
To overcome specific diseases through
various ministries to combat malnutrition
6 December 2012 JLNH&RC
3. Programmes
Ministry
Vitamin A Prophylaxis Programme Health and family
Prophylaxis Against Nutritional anaemia. welfare
IDDs Control Programme.
Special Nutritional Programme
Balwadi Nutritional Programme Social welfare
ICDS Programme
Mid Day Meal Programme Education
Mid Day Meal Scheme Human Resource
Development
6 December 2012 JLNH&RC
4. Wheat based nutrition program
(human resource development)
Nutrition program for adolescent girls
(human resource development)
Annapurna scheme
(human rural development)
Applied nutrition program
National food for work program
6 December 2012 JLNH&RC
5. Vitamin A Prophylaxis
Programme
Initiated in 1970
Age group 1-5 year
Priority to VAD geographical area
OBJECTIVE
Prevent blindness due to VAD
ORGANIGATION
PHC and subcenter
6 December 2012 JLNH&RC
6. ROLE OF VIT A IN
HEALTH
Prevent respi infection
maintain git and gut epithelium integrity
Immune function
Prevent Nutritional blindness
6 December 2012 JLNH&RC
7. Vitamin A Prophylaxis
Programme
Beneficiary group
preschool children(6 months to 5 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
6 December 2012 JLNH&RC
8. Prophylaxis Against Nutritional
Anaemia
Pregnant woman <11 gm/dl
nonpregnant woman <12gm/dl
Initiated in 1970
Centrally sponsored
Over 50%pregnant woman suffer from
anemia
20% of maternal death
Causes LBW and perinatal mortality
6 December 2012 JLNH&RC
9. OBJECTIVE
Assess prevalence
Give antianemic treatment
Give prophylaxis
Monitoring
Education
6 December 2012 JLNH&RC
10. BENEFICIARIES
Children age group 1to 5
Pregnant and nursing mother
Female acceptor of terminal method of
family planning and IUDS
ORGANIGATION
PHC and subcenters
6 December 2012 JLNH&RC
11. Iron and folic acid to
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
Iron fortification in salt
Children between 1 to 5 years.
Screening test for aneamia done at 6 months,1 and 2
years of age.
6 December 2012 JLNH&RC
12. Iodine Deficency Disorder
Control Programme
National goiter control programme in 1962
IDD Control Programme
Replace the entire edible salt by iodide salt
Double fortification of salt iodine and iron (40ppm and
1000ppm)
6 December 2012 JLNH&RC
13. Special Nutritional
Programme in urban slums,
This was started in 1970 is in operation
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
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
6 December 2012 JLNH&RC
14. 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.
1973 it is extended to all states in INDIA
Mainly through nutritional education
Nutrition worth 25 paisa for children and 50
paisa for pregnant and lactating women for 52
days in a year
6 December 2012 JLNH&RC
15. Major components
Nutritional Services
Health services
Communication
Monitoring and evaluation
Later it is converted as ICDS
6 December 2012 JLNH&RC
16. Balwadi Nutrition Programme
This was started in 1970 under the department of
social welfare
Beneficiary group
preschool children 3-6years of age
300kcal and 10gm protein
Also provided with pre school education
Balawadis are being phased out because
universalization of ICDS
6 December 2012 JLNH&RC
18. ICDS
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.
6 December 2012 JLNH&RC
19. Purpose for Initiation
Routine MCH services not reaching target
Population
Nutritional component not covered by
Health services
Need for community participation
6 December 2012 JLNH&RC
20. Objectives:
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.
6 December 2012 JLNH&RC
21. Services:
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.
6 December 2012 JLNH&RC
22. Beneficiaries of ICDS
Children < 6 years Adolescent Girls
Pregnant Woman Lactating women
Women in Reproductive
age group (15-44)
6 December 2012 JLNH&RC
23. Services and beneficiaries
Services Target Group Service Provided by
Supplementary Children below 6 years: Anganwadi Worker and
Nutrition Anganwadi Helper
Pregnant & Lactating Mother (P&LM)
Immunization* Children below 6 years: ANM/MO
Pregnant Women
Health Check-up* Children below 6 years: ANM/MO/AWW
Pregnant & Lactating Mother (P&LM)
Referral Services Children below 6 years: AWW/ANM/MO
Pregnant & Lactating Mother (P&LM)
Pre-School Education Children 3-6 years AWW
Nutrition & Health Women (15-45 years), Children 3-6 AWW/ANM/MO
Education years
Pregnant & Lactating Mother (P&LM)
6 December 2012 JLNH&RC
24. Supplementary Nutrition
This includes supplementary feeding and growth
monitoring; and prophylaxis against vitamin A
deficiency and control of nutritional anaemia.
Growth Monitoring and nutrition surveillance are
two important activities that are undertaken.
Children <3 years of age 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.
6 December 2012 JLNH&RC
25. Immunization:
Immunization of
pregnant women and
infants protects children
from six vaccine
preventable diseases-
poliomyelitis, diphtheria,
pertusis, tetanus, tuberc
ulosis and measles.
Immunization of
pregnant women
against tetanus also
reduces maternal and
neonatal mortality
6 December 2012 JLNH&RC
26. Health Check-ups
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.
6 December 2012 JLNH&RC
27. Referral Services:
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
6 December 2012 JLNH&RC
28. Non-formal Pre-School Education
(PSE)
anganwadi – a village
courtyard
PSE is considered the
backbone of the ICDS
programme.
Its for the three-to six
years old children and
is directed towards
providing and
ensuring a
natural, joyful and
stimulating
environment
6 December 2012 JLNH&RC
29. Nutrition and Health
Education
It is a key element of
the work of the
anganwadi worker.
This forms part of
BCC (Behaviour
Change
Communication)
strategy
6 December 2012 JLNH&RC
30. THE ICDS TEAM:
The ICDS team comprises
Anganwadi Workers,
Anganwadi Helpers,
Supervisors,
Child Development Project Officers
(CDPOs) and
District Programme Officers (DPOs).
6 December 2012 JLNH&RC
31. Role of AWW
To elicit community support
Participation in running the program
Weigh & record each child every month
Refer cases
Organize non-formal pre-school activities
Provide supplementary nutrition
Provide health & nutrition education and
counseling
6 December 2012 JLNH&RC
32. Role of AWW
Make home visits
Assist PHC staff
Guide ASHA
Assist in implementation of Kishori
Shakti Yojana (KSY)
6 December 2012 JLNH&RC
33. Role of AW Helper
Cook & serve food
Clean the Anganwadi premises
Cleanliness of small children
Bring small children to Anganwadi
6 December 2012 JLNH&RC
34. Role of ASHA
Awareness generation
Counsel women
Community mobilization
Work with VHSC
Escort/accompany pregnant women &
children requiring treatment
Provide primary medical care
6 December 2012 JLNH&RC
35. Role of ANM
Hold weekly / fortnightly meeting with ASHA
Participate & guide in organizing the Health
Days at AWC
Utilize ASHA in motivating the pregnant
women and married couples
Guide ASHA in motivating pregnant women
for full ANC
Educate ASHA on danger signs of pregnancy
and labor
6 December 2012 JLNH&RC
36. Role of Health Department
Health Check-ups
Handling Referral
Immunization
Nutrition & Health Education
Monitoring of Health components
6 December 2012 JLNH&RC
37. Anganwadi Centre
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
6 December 2012 JLNH&RC
38. 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.
6 December 2012 JLNH&RC
39. Supplementary Nutrition per Day
Beneficiary Pre-revised Revised
w.e.f. Feb.
2009
Calories Protein Calorie Protein
(KCal) (G) s (KCal) (Gm)
Children (6-72 300 8-10 500 12-15
months)
Severely 600 20 800 20-25
malnourished
children (6-72
months)
Pregnant & Lactating 500 15-20 600 18-20
6 December 2012 JLNH&RC
40. Revised financial norms for food
supplement
Category Pre- Revised w.e.f
revised June 2010
Children (6-72 Rs. 2.00 Rs.4.84
months)
Severely Rs. 2.70 Rs.5.82
malnourished children
(6-72 months)
Pregnant & Lactating Rs. 2.30 Rs.6.00
6 December 2012 JLNH&RC
41. International Partners
United Nations International Children’
Emergency Fund (UNICEF)
Cooperative for Assistance and Relief
Everywhere (CARE)
World Food Programme (WFP)
6 December 2012 JLNH&RC
42. Major Initiatives
Revision in Population norms
Universalization and 3rd phase of expansion
of the Scheme of ICDS
Increment in Budgetary allocation for ICDS
Scheme
Introduction of cost sharing between Centre
& States
Revision in financial norms of supplementary
nutrition
6 December 2012 JLNH&RC
43. Monitoring System
Central level
State level
Block level
Village level (Anganwadi level)
6 December 2012 JLNH&RC
44. Failures
Practically children 3-6 Yrs and
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
6 December 2012 JLNH&RC
45. Mid Day Meal Programme
Major Objective:
improve the School attendance
reduce school drop outs
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
6 December 2012 JLNH&RC
46. Mid-day meal scheme
National programme of nutritional support to
primary education
Objective
Universalization of primary education by increasing
enrollment (class 1 to 5) and
Improve nutritional status of children.
350 to 500 kcal and 8-12gm protein
6 December 2012 JLNH&RC
47. Drawbacks
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.
6 December 2012 JLNH&RC
48. Keep visiting
dnbpaediatrics.blogspot.in
6 December 2012 JLNH&RC