Community Nutrition Programmes in Preventing Malnutrition

Park's Textbook of Preventive and Social Medicine

1. Vitamin A Prophylaxis Programme

• Launched in 1970 by the Ministry of Health and Family Welfare, based on technology developed at the National Institute of Nutrition (NIN), Hyderabad.
• Evaluation has revealed a significant reduction in vitamin A deficiency in children.

2. Prophylaxis Against Nutritional Anaemia

• Distribution of iron and folic acid (folifar) tablets to:
  • Pregnant women
  • Young children (1-12 years)
• Implementation through: MCH Centres (urban), Primary Health Centres (rural), and ICDS projects.
• Technology for control of anaemia through iron fortification of common salt was also developed at NIN, Hyderabad.

1. Prophylactic iron and folic acid supplementation
2. Deworming
3. Intensified year-round behaviour change communication (BCC) campaign ("solid body, smart mind") focusing on:
   • Improving compliance to IFA supplementation and deworming
   • Appropriate infant and young child feeding (IYCF) practices
   • Increase in iron-rich food intake through diet diversity, fortified foods
   • Ensuring delayed cord clamping (by 3 minutes) after delivery
4. Testing and treatment of anaemia using digital/point-of-care methods (special focus on pregnant women and school-going adolescents)
5. Mandatory provision of IFA-fortified foods in government-funded public health programmes
6. Intensifying awareness, screening and treatment of non-nutritional causes of anaemia in endemic pockets (malaria, haemoglobinopathies, fluorosis)

3. Control of Iodine Deficiency Disorders (IDD)

• The National Goitre Control Programme was launched in 1962 in the Himalayan goitre belt.
• Objective: Identify goitre endemic areas, supply iodized salt in place of common salt, and assess impact.
• Surveys showed the problem was more widespread: ~145 million people living in known goitre endemic areas.
• A major national programme - the IDD Control Programme - was mounted in 1986 with the objective to replace all edible salt with iodized salt in a phased manner by 1992.

4. Special Nutrition Programme

• Started in 1970 for children below 6 years of age, pregnant and nursing mothers.
• Operates in urban slums, tribal areas and backward rural areas.
• Supplementary food provides:
  • Children: 300 kcal and 10-12 g protein/day
  • Beneficiary mothers: 500 kcal and 25 g protein/day
• Supplement provided for about 300 days per year.
• Originally a Central programme, transferred to State sector in the Fifth Five Year Plan as part of the Minimum Needs Programme.
• Gradually being merged into the ICDS programme.

5. Balwadi Nutrition Programme

• Started in 1970 for children in the age group of 3-6 years in rural areas.
• Under the overall charge of the Department of Social Welfare.
• Four national level organizations including the Indian Council of Child Welfare receive grants for implementation.
• Implemented through Balwadis which also provide pre-primary education.
• Food supplement provides 300 kcal and 10 g protein per child per day.
• Being phased out because of universalization of ICDS.

6. ICDS Programme (Integrated Child Development Services)

• Started in 1975 in pursuance of the National Policy for Children.
• Strong nutrition component including:
  • Supplementary nutrition
  • Vitamin A prophylaxis
  • Iron and folic acid distribution
• Beneficiaries:
  • Pre-school children below 6 years
  • Adolescent girls 11-18 years
  • Pregnant and lactating mothers
• Village-level workers delivering services: Anganwadi workers
  • Each Anganwadi unit covers 400-800 population
  • Mini Anganwadi centres cover 150-400
• A network of Mahila Mandals supports Anganwadi workers in providing health and nutrition services.
• Supervision: Mukhyasevikas (field) and Child Development Project Officer (CDPO).

7. Mid-day Meal Programme (MDMP)

• Also known as the School Lunch Programme; in operation since 1961.
• Major objective: Attract more children for school admission and retain them to improve literacy.

• (a) The meal should supplement, not substitute, home diet
• (b) Should supply at least one-third of total energy requirement and half of protein need
• (c) Cost should be reasonably low
• (d) Should be easy to prepare in schools
• (e) Locally available foods should be used
• (f) Menu should be frequently changed to avoid monotony

• NIN, Hyderabad recommends a minimum of 250 feeding days per year to have the desired impact.
• Goals beyond feeding: Reorientation of eating habits, incorporating nutrition education in curriculum, encouraging use of local commodities, improving school attendance and educational performance.

• Cook with lid on to avoid nutrient loss
• Avoid overcooking
• Avoid reheating oil used for frying
• Use leafy tops of vegetables in meals
• Use only iodized salt for cooking

8. Monitoring and Evaluation of Nutrition Programmes

• It is considered unethical to launch a major nutritional programme without a built-in provision for monitoring, evaluation and feedback.
• Since health and nutrition of the young child is indivisible from the health and nutrition of the family as a whole, improvement of the family diet as a whole is the key to improving the child's diet in poor families.
• Long-term solution: As an eminent nutrition scientist noted, "In the long run, we can hope to improve the nutritional status of our children only through improvement in the economic conditions of the community... Organized State-sponsored feeding programmes cannot be the permanent answer to the problem."