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