National nutritional program in india

1. By Arushi Negi
M.Sc. Nursing Ist year

2. INTRODUCTION
• Nutrition may be defined as the science of food and its
relationship to health which helps in body growth, development
and maintenance.
• The Government of India have initiated several large scale
supplementary feeding programmes, and programmes aimed at
overcoming specific deficiency diseases through various
Ministries to combat malnutrition.

3. NUTRITIONAL CELL
• It is in the Directorate General of Health Services and
provides technical advice in all matters related to the
nutrition.
• These include policy decision, programme planning,
implementation and evaluation; training content for
different levels of medical, nursing and paramedical
personnel, standards and labels for foods, proposals,
project evaluation, hospital diet etc.

4. • It is working on creating awareness through dissemination of
various types of IEC materials.
• Coordinates with State Nutrition Division which conduct diet
and nutrition surveys, imparting training of health personnel
who are involved in the programmes.
• Appraisal of several research projects on subjects such as
fluorosis, arsenic toxicity, maternal micro nutrient status, street
food management, were taken up.

6. VITAMIN A
PROPHYLAXIS
PROGRAMME

7. VITAMIN A PROPHYLAXIS PROGRAMME
• Launched by- Ministry of Health and Family Welfare
• Launched in - 1970
• Beneficiaries- all pregnant and lactating women and
children under 5 years of age
Vitamin A is an important for maintaining normal growth,
regulating cellular proliferation and differentiation,
controlling development, and maintaining visual and
reproductive functions.

8. OBJECTIVES
Prevention of
vitamin A
deficiency
Promoting
consumption of
Vitamin A rich
food
Creating
awareness about
the importance of
preventing
Vitamin A
deficiency
Treatment of
Vitamin A
deficient children
All children with
xerophthalmia are
to be treated at
health facilities.
All children having
measles, to be given 1
dose of Vitamin A
All cases of
severe
malnutrition to be
given one
additional dose of
Vitamin A.

9. DOSAGE
• Prophylactic Vitamin A as per the following dosage schedule:
• i.100000 IU at 9 months with measles immunization
• ii.200000 IU at 16-18 months, with DPT booster
• iii.200000 IU every 6 months, up to the age of 5 years.
• Thus, a total of 9 mega doses are to be given from 9 months of
age up to 5 years.
• This programme is part of blindness control program.

10. Component of the National Programme for
Control of Blindness.
• Launched in- 1976
• Goal - Reducing the prevalence of blindness to 0.3% by 2020.
• Objectives
identification
and treatment
of curable
blind
expand
research
community
awareness
Strengthening the
existing
infrastructure
facilities and
developing
human resources
Strengthening
and up-gradation
of Regional
Institutes of
Ophthalmology
(RIOs)
universal eye
care services
and quality
service
delivery;

11. Practices adopted under the programme:
1)Multipurpose District Mobile Ophthalmic Units in the District
Hospitals of States/UTs as a new initiative under the programme.
2)Distribution of free spectacles to old persons
3)Comprehensive eye-care coverage by covering diseases other
than cataract like diabetic retinopathy, glaucoma,etc.
4)Providing funds for purchase of modern ophthalmic
equipments.
5)Setting up superspecialty clinics for all major eye diseases
6)Linkage of tele-ophthalmology centres at PHC/Vision centres
with superspecialty eye hospitals

12. PROPHYLAXIS
AGAINST
NUTRITIONAL
ANEMIA

13. PROPHYLAXIS AGAINST NUTRITIONAL ANEMIA
• Prevalence of nutritional anemia in India
• 65% - infant and toddlers
• 60% - (1-6 ) years of age
• 88% - adolescent girls
• (3.3% has hemoglobin <7 gm./dl; severe anemia)
• 85% - pregnant women (9.9% having severe anemia)
• Higher in lactating women as compared to pregnancy.
• The commonest is iron deficiency anemia

14. Launched in - 1970 during the fourth Five Year Plan
• Beneficiaries - the expected and nursing mothers,acceptors of
family planning and children.
• Dosage : Adults - one tablet of iron and folic acid (100 mg
elementary iron and 0.5 mg of folic acid.)for 100 days.
• Children - (1-5 years)- one tablet of iron (20 mg elementary
iron ,60 mg of ferrous sulphate and 0.1 mg of folic acid) daily
for a period of 100 days.
• Taken by Maternal and Child Health (MCH), Division of
MoHFW,Now it is part of RCH programme.
• Iron fortification of common salt has also been developed .

15. WEEKLY IRON FOLIC ACID SUPPLEMENTATION:
• Launched by -Ministry of Health and Family Welfare
• Goal - meet the high prevalence and incidence of anaemia
amongst adolescent girls and boys.
• Long term goal is to break the intergenerational cycle of
anaemia,
• Short term benefits is of a nutritionally improved human
capital.
• Implementation - By supervised weekly ingestion of IFA
supplementation and biannual helminthic control.

16. Objectives
Reduce the
prevalence and
severity of
anaemia in
adolescent
population
Target
groups
School going
adolescent
girls and boys
in 6th to 12th
class enrolled
in
government/
Out of
school
adolescent
girls.
Intervention
Administrati
on of
supervised
Weekly Iron-
folic Acid
Screenin
g of
target
groups
Biannual
de-
worming
(Albenda
zole
400mg),
counsellin
g for
improvin
g dietary
intake
Convergence
Convergence
with key
stakeholder
programme
planning,
capacity building
of nodal service
providers
5. Current Status:
The programme
has been rolled out
in all States/UTs.
The programme
covers 11.2 crore
beneficiaries

17. IODINE
DEFICIENCY
DISORDERS
CONTROL
PROGRAMME

18. IODINE DEFICIENCY DISORDERS CONTROL
PROGRAMME
• Launched by -Government of India
• Launched in - 1962
• Objective -
i. Identification of the goitre in endemic areas
ii. Supply iodized salt in place of common salt
iii. Assess the impact of goitre control measures over time.
• A major national programme was mounted in 1986 to replace
the entire edible salt by iodide salt, in a phase - the IDD
Control manner by 1992 .
• Ban of non iodised salt under PFA act (1954).

19. SPECIAL
NUTRITION
PROGRAMME

20. SPECIAL NUTRITION PROGRAMME
• Launched in -1970
• Beneficiaries - Children below 6 years of age, pregnant and nursing
mothers .
• Aim- Improve the nutritional status of the target groups.
• Supplies -
• About 300 kcal and 10-12 grams of protein per child per day
• 500 kcal and 25 grams of protein per mother per day for 300 days.
• Transferred to the State sector in the fifth Five Year Plan as part of
the Minimum Needs
• This programme is gradually being merged into the ICDS
programme.

21. BALWADI
NUTRITION
PROGRAMME

22. BALWADI NUTRITION PROGRAMME
• Launched in -1970
• Beneficiaries- Children of 3-6 years in rural areas.
• Four national level organizations are given grants to implement the
programme :
• Central Social Welfare Board (CSWB)
• Indian Council of Child Welfare (ICCW),
• Harijan Sewak Sangh (HSS) AND Adimjati Sewak Sangh (ASS),
Kasturba Gandhi National Memorial Trust
• The food supplement provides 300 kcal and 10 grams of protein per
child per day for 270 days a year and are for their psychosocial
development.
• Balwadis are being phased out because of universalization of ICDS.

23. Integrated
Child
Development
Services (ICDS)

24. ICDS PROGRAMME
• Launched in - 1975 in pursuance of the Integrated National
Policy for Children.
• Beneficiaries - children below 6 years, and nursing and
expectant mothers from low income group.
• OBJECTIVES :
effective coordination
of policy and
implementation
proper nutrition
and
health education.
reduce the mortality
and morbidly
malnutrition
foundation for proper
psychological,
physical and social
development
improve the
nutritional
health status of
children.(0-6yrs)

25. DELIVERY OF SERVICES:
• 1. Supplementary nutrition
• The aim is to supplement nutritional intake as follows:
a. each child 6-72 months of age to get 500 cal 12-15 grams of
protein (financial norm of Rs 8 child per day);
b. Severely malnourished child 6-72 months 800 calories and 20-
25 grams protein (financial norm of Rs 12.00 per child per day);
c. Each pregnant and nursing woman to get 600 and 18-20 grams
of protein (financial norm Rs 9.50 per beneficiary per day.

26. • Supplementary nutrition is given 300 days in a year.
• Adequate funds for supplementary nutrition is provided by
the State Plan under Minimum Needs Programme .
• Children are weighed every month.
• Nutrition education and health education is given to mothers
of children suffering from 1st degree of malnutrition.
• Supplementary nutrition (therapeutic children suffering from
2nd and 3rd degree nutrition.
• Children suffering from 4th degree malnutrition
recommended hospitalization.

27. SERVICES CONT..
2.Immunization
• Immunization of children against 9 vaccine preventable diseases is being
done, while for expectant mothers immunization against tetanus is
recommended.
3.Health check-up
• antenatal care of expectant mothers
• postnatal care of nursing mother and care of newborn
• care of children under 6 years of age.
• expectant mothers are given IFA tablets along with protein supplements.
• High risk mothers and referred to appropriate institutions for special
care.

28. SERVICES CONT..
4. The health care of children under 6 years of age consists:
1. Record of weight and height of children periodical intervals;
2. Watch over milestones;
3. Immunization;
4. General check-up every 3-6 months disease, malnutrition etc.;
5.Treatment for disease like diarrhoea, dysentery respiratory tract infections
etc. which are wide prevalent;
6. Deworming;
7. Prophylaxis against vitamin A deficiency
8. Referral of serious cases to hospital provided
9. Health records of the children, antenatal and delivery card etc. are
maintained.

29. SERVICES CONT..
Non-formal pre-school education
• Children between the ages 3-6 years are imparted non-formal pre-school education in
an anganwadi in each village with about 1000 population.
• The objective is to provide opportunities to develop desirable attitude, values
behaviour pattern among children.
Schemes for adolescent girls
1. Kishori Shakti Yojana - The scheme targets adolescent girls the age group of 11 to
18 years and addresses their needs of self development, nutrition and health status,
literacy and numerical skills, vocational skills etc.
2.Nutrition Programme for Adolescent Girls- was approved in the year 2009-10, on a
pilot project basis.. Undernourished adolescent girls in the age group 11 to 19 years
(with body weight less than 30 kg in the age of group of 11 to 15 years and 35 kg in the
age group of 15 to 19 years) are covered under the scheme.
6 kg of free food grain is provided to each beneficiary per month.

30. SERVICES PROVIDED THROUGH:
• The workers at the village level who deliver the services are
called Anganwadi workers.Anganwadi workers from the local
area are given 3 months training.
• Each Anganwadi is for 1000 population in rural/urban areas and
750 population in tribal areas.
• A network of Mahila covers a Mandals has been built up in
ICDS Project areas to help Anganwadi workers in providing
health and nutrition services.
• The work of Anganwadis is supervised by Mukhyasevikas.
• Field supervision is done by the Child Development Project

31. MID-DAY
MEAL
PROGRAMME

32. MID-DAY MEAL PROGRAMME
• The mid-day meal programme (MDMP) is also known as
School Lunch Programme.
• Launched in -1961
• Beneficiaries - School children in the age group of 6-11
years.
• Objective : To attract more children for admission to
schools and retain them so that literacy improvement
occurs.
The mid-day meal programme became part of the Minimum
Needs Programme in the Fifth Five Year Plan.

33. Principles of Mid day meal :
(a)the meal should be a supplement and not a substitute to the home diet.
(b) the meal should supply at least one-third of the total energy requirement, and half of
the protein need i.e. about 300 kcal and 8-12 gms of protein per/day/student. This is
provided for 200 days in a year.
(c) the cost of the meal should be reasonably low.
(d) the meal should be such that it can be prepared easily in schools.
(e) planning nutritious menu using locally available food stuffs, food, hygiene, food
habits etc.
The important goals to be accomplished are:
a.reorientation of eating habits;
b.incorporating nutrition education into the curriculum;
c.encouraging the use of local commodities;
d.improving school attendance as we to educational performance of the pupils.

35. MID-DAY MEAL SCHEME
Also known as National Programme of Nutritional Support to Primary Education.
Launched on - 5th August 1995 and revised in 2004.
Objective -Universalization of primary education by increasing enrolment, retention
and attendance and simultaneously impacting on nutrition of students in primary
classes.
It was implemented in 2,408 blocks in the first year and covered the whole country in a
phased manner by 1997-98.
• The programme originally covered children of primary stage (classes I to V)
extended in Oct. 2002.
• The central assistance - free supply of food grain from nearest Food Corporation of
India godown at the rate of 100 g. per student per day and subsidy for transport of
food grain.
• To achieve the objective, a cooked mid-day meal with minimum 300 Calories and 8
to 12 grammes of protein content will be provided to all the children in class I to V.

36. Some suggesstions:
a)Food grains stored away from moisture, to avoid infestation.
b)Use whole wheat or broken wheat (dalia) .
c)'Single Dish Meals' using broken wheat or rice and
incorporating some amount of a pulse or soyabeans, a seasonal
vegetable/green leafy vegetable, and some amount of edible oil
will save both time and fuel.
d)Cereal pulse combination is necessary to have good quality
protein. The cereal pulse ratio could range from 3:1 to 5:1.
e)Sprouted pulses have more nutrients and should be incorporated
in single dish meals.

37. f) Leafy vegetables should be washed before cutting and should not be subjected to
washing after cutting.
g)Soaking of rice, dal, bengal gram etc. reduces cooking time.
h)Wash the grains thoroughly and soak in just sufficient amount of water required for
cooking.
i)Rice water if left after cooking should be mixed with dal if these are cooked separately
and should never be thrown away. Fermentation improves nutritive value. Preparation
of idli, dosa, dhokla etc. may be encouraged.
j)Cooking must be done with the lid on to avoid loss of nutrients. Over cooking should
be avoided.
k)Reheating of oil used for frying is harmful and should be avoided.
l)Leafy tops of carrots, radish, turnips etc. should not be thrown but utilized in preparing
mid-day meals.
m)Only 'iodized salt" should be used for cooking mid-day meals.

38. POSHAN ABHIYAN

39. POSHAN ABHIYAN (Prime Minister’s Overarching Scheme for
Holistic Nutrition)
• Launched by -Government of India
• Launche on - 8 march 2018 for a period of three years in all 36 states/UTs.
• It was earlier known as national nutrition mission.
• Goals -Improvement in nutritional status of children from 0-6 years, adolescent girls,
pregnant women and lactating mothers with fixed targets.
• It ensures convergence of various programmes i,e anganwadi services, Pradhan
Mantri Matru Vandana Yojana; Janani Suraksha Yojana; National Health Mission;
Swachh Bharat Mission of Ministry
• Month of September 2018 was celebrated as Rashtriya POSHAN Maah.
• The activities in POSHAN Maah focussed on Social Behavioural Change and
Communication (SBCC). The broad themes were: antenatal care, optimal
breastfeeding (early and exclusive), complementary feeding, anaemia, growth
monitoring, girls’ - education, diet, right age of marriage, hygiene and sanitation,
eating healthy - food fortification.

40. THE FOUR PILLARS:
1.Technology - aanganwadi app,
administrative dashboard.
2.Convergence-at national,state,
district, block, village.
3.Behavioral change
communication- campaigns, nukkad
natak, festivals,poshan maah
4.Capacity building

41. Objectives and targets are as follows :
1.Prevent and reduce stunting in children (0-6 years) by 6
percent.
2. Prevent and reduce under nutrition and underweight
prevalence in children(0-6 years) by 6 percent.
3. Reduce the prevalence of anaemia among children (6-
59 months) by 9 percent.
4. Reduce the prevalence of anaemia among girls and
women in the age group (15-49 years) by 9 percent.
5. Reduce low birth weight by 6 percent.

42. PILOT PROJECT
ON
PROGRAMME
AGAINST
MICRONUTRIENT
MALNUTRITION

43. PILOT PROJECT ON PROGRAMME AGAINST
MICRONUTRIENT MALNUTRITION
• Implemented in Assam along with four other states namely Bihar, Orissa,
West Bengal and Gujarat.
• The programme was launched in the year 1995.
• The objectives of the programme are:
• (i) To assess the magnitude of fluorosis and dental caries,
• (ii) To assess and improve iron and vitamin A status in school going
children, adolescent boys and girls, non-pregnant women, adult males
and geriatric population.
• (iii) To launch extensive information, education and communication
strategies through mass media to improve the dietary habits of the
population.
• (iv) To study zinc level in various food products and soil.

44. • The programme was implemented in 1 district of each of the 5 states.
• The following activities were undertaken:
• (i) Advocacy and sensitization meetings with people involved in policy making, with
elected members, teachers, social workers, etc.
• (ii) A baseline survey was conducted to assess the socio-economic status, food intake
pattern, estimation of HB, soil, zinc, fluorine in drinking water etc..
• (iii) Training was also organised at block level, prior to field activity surveys. Based
on the results of the survey, the IEC strategy is being developed in the local
languages.
• An expert committee has been constituted in order to scrutinize and finalise sample
IEC material on Micronutrients deficiency, diet related chronic disorders and healthy
life style for final production and printing.

45. SUMMARY:
• Through this topic we covered introduction to nutritional
programmes in india , nutritional cells, various
programmes such as vitamin a prophylaxis programme,
prophylaxis against nutritional anemia , iodine
deficiency disorders control programme , special
nutriton programme, balwadi nutritional programme,
ICDS programme, mid day meal programme , mid day
meal scheme etc

46. CONCLUSION
• The Government of India have initiated several
large scale supplementary feeding programmes,
and programmes aimed at overcoming specific
deficiency diseases through various Ministries to
combat malnutrition.

47. BIBLIOGRAPHY:
• Park . K, Parks’s textbook of preventive and social medicine,26th
edition,2021,M/S banarsidas bhanot publishers.pg -750-756.
• Gulani Krishna Kumari, Community health nursing (principles and
practices ),2nd edition reprint, 2017, Kumar publishing house,pg 734-
736,
• https://www.niti.gov.in/poshan-abhiyaan
• https://dghs.gov.in/content/1354_3_NationalProgrammeforControlofBlin
dnessVisual.aspx
• https://www.nhp.gov.in/national-vitamin-a-prophylaxis-program_pg
• https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1024&lid=3
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