Nutrition is a major factor in bringing out the maximum potential that one is endowed both physically and mentally. Widespread malnutrition is largely a result of dietary inadequacy and unhealthy lifestyles. The great advantages of looking at malnutrition as a problem in human ecology is that it allows for variety of approaches towards its prevention.
ICDS was initiated in 1975 with the twin objectives of ensuring nutrition of preschool children through supplementary feeding and psychosocial development through early stimulation and education. The objectives also include supplementary feeding for pregnant and lactating women and nutrition education to ensure better child care and nutrition.
· The nutrition components of ICDS aims to provide the following services:
· nutrition education to mothers for improving dietary intake and dietary diversity.
· nutrition education regarding appropriate infant and young child feeding practices. growth monitoring and detection of growth faltering.
· assist in providing massive doses of vitamin A, ORS and iron tablets.
· food supplementation to preschool children between the age of six months and six years, pregnant and lactating mothers and selected adolescent girls.
The Anganwadi workers are expected to survey all families in the community and identify all pregnant, lactating women and preschool children, monitor the growth of children and provide food supplement to the three groups for 300 days in a year. ICDS guidelines specify that monthly weighing of children should be done in the crucial 0-24 months age group.
Mother and Child Protection card (MCP card) was introduced for functionaries of National Rural Health Mission (NRHM) and ICDS from 1st April 2010 to progressively replace the earlier JacchhaBacchha card. The new MCP card is increasingly viewed as a critical tool for upkeeping maternal and child health in the updated coverage of both ICDS and NRHM.
The midday meal programme (MDMP) is also known as school lunch programme. This programme has been in operation since 1961 throughout the country. In formulating midday mealsforschoolchildren, thefollowing broad principles should be kept in mind:
· The meal should be a supplement and not a substitute to the home diet.
· The meal should supply atleast one third of the total energy requirement and half of the protein need.
· cost of the meal should be reasonably low.
· meal should be such that it can be prepared easily in schools. No complicated cooking process should be involved.
· As far as possible, locally available foods should be used. This will reduce the cost of the meal.
· meal should be frequently changed to avoid monotony.
Objectives of the school feeding programme are to:
· provide food for undernourished children and to improve the nutritional status and monitor it.
· increase school enrolment and attendance of children
· reorient good eating habits.
· incorporate nutrition education into curriculum.
· improve literacy and educational performance of pupils.
· encourage the use of local commodities.
· encourage community participation in the feeding programme.
The Mid-Day Meal Programme for school children comes under the Ministry of Human Development. The Government of India pays 40 percent of the expenditure and 60 percent is borne by the States. It covers all children upto the age of 15 years.
In Tamil Nadu, the noon meal programme was launched on July 1st 1982 by the then Chief Minister M.G.Ramachandran in rural areas and then extended to the urban areas. In this programme, students from classes I to V in Corporation, Government and Government aided schools are given free mid-day meal for 200 days in a year. Under this programme, the Government of India provides 100 grams of rice, 15 gram of dhal, 1 grams of oil and 20 paise worth of vegetables per indiviual. The meal given are based on a combination of cereals, pulses and leafy vegetables. Eggs are given thrice a week. Such a diet would increase the amount of vitamins and minerals and results in weight gain and clearance of deficiency symptoms.
What do children eat today in their midday meal :
· Upto 5th standard, 100 grams of rice per child per day
· Upto 10th standard, 150 grams of rice per child per day
· Egg on all working days. Banana alternative for vegetarians.
· First and third week of month, pulav made of black Bengal gram given for protein
· Second and fourth week, green gram sundal
· Fridays, chilli fried potato for carbohydrates
· Use of double fortified salt
· Sweet pongal is served on occasions
Mid-Day meal programme has resulted in the following:
· Reduction in severe malnutrition in children.
· Increased enrolment rate at primary level.
· Reduction in drop-out rate at school level.
· Developed attentiveness in them and thereby improved their power of comprehension.
· Improved their performance in examinations.
· Decreased the incidence of various diseases and physical disorders caused by starvation or intake of less nutritious food.
· Enabled parents to attend to their routine bread earning tasks.
· The gender difference in feeding the children reduced at home.
· A favourable attitude in parents in educating the children, specifically female children.
Prevention of anaemia requires approaches that address all the potential causative factors. These include:
1. Dietary approach: The following points need to be considered for the promotion of this strategy:
· Promotion of consumption of pulses, green leafy vegetables, other vegetables which are rich in iron and folic acid and meat products rich in iron particularly for pregnant and lactating mothers and preschool children. Media can also be involved for creation of awareness.
· Creation of awareness in mothers attending antenatal clinics, immunization sessions, anganwadi centres and crèches about the prevalence of anaemia, ill effects of anaemia and that it is preventable.
· Addition of iron rich foods to the weaning foods of infants.
· Regular consumption of foods rich in vitamin C to promote iron absorption such as orange, guava, amla, etc.
· Promotion of home gardening to increase the availability of common iron rich foods such as green leafy vegetables.
· Discouraging the consumption of foods and beverages like tea and tamarind that inhibit iron absorption, immediately after food especially by the vulnerable groups like pregnant women and children.
· Promotion of iron fortified iodised salt.
2. Supplementation: Food based approachesthroughfoodfortification and dietary diversification are sustainable strategies for preventing iron deficiency and (Iodine Deficiency Disorder(IDD). As availability is low and dietary animal sources (haem -iron) are expensive, the key step towards addressing iron deficiency and IDD would be the implementation and scaling up of the IFA supplementation programme.
For preventing anaemia, low dosage iron is adequate. The National Anaemia Prophylaxis Programme (NAPP) in India, pregnant and lactating women receive 60 mg elemental iron+ 500 mcg folic acid (IFA tablet) daily for atleast 100 days during pregnancy and preschool children receive 20 mg elemental iron+ 100 mcg folic acid daily. To improve compliance, ensuring availability to all beneficiaries, follow up of pregnant women through ante natal care (ANC) for completion of therapy, counseling on common side effects, risks associated with anaemia, provision of incentives to frontline workforce, frequent evaluation to assess the programme, weekly or biweekly administration of iron and folate and inclusion of adolescent as beneficiaries are needed.
3. National Iron+ Initiative: Taking cognizance of ground realities in the operation of the programme, Ministry of Health and Family Welfare took a policy decision to develop the National Iron+ Initiative. This initiative will bring together existing programmes (IFA supplementation for pregnant and lactating women and children in the age group of 6-60 months). Thus National Iron+ Initiative will reach the following age groups for supplementation :
· Biweekly iron supplementation for preschool children of 6 months to 5 years.
· Weekly supplementation for children from 1st to 5th grade in Government and Government aided schools.
· Weekly supplementation for out of school children (5-10 years) at anganwadi centres.
· Pregnant and lactating women, daily for 100 days.
· Weekly supplementation for women in reproductive age group.
In addition to increased iron and folate intake, improvement in environmental sanitation and personal hygiene are also needed to control worm infestations and infections. Deworming done regularly would help in reducing the incidence of anaemia and improve the efficacy of iron supplements. An improvement in food intake results in improvement in haemoglobin levels
1. Nutrition education
2. Dietary modification: The most rational and sustainable long term solution to control of vitamin A deficiency is to ensure that the community includes regularly, in their daily diets, foods rich in vitamin A or its precursor.
3. Periodic supplementation or dosing of vitamin A: Currently the massive dose of vitamin A supplementation programme aims at providing the first dose of 1,00,000 IU at 9 months (at the time of measles immunization) to be followed by bi annual administration of 2,00,000 IU for children between the ages of 18 months and 59 months. The coverage under massive dose vitamin A administration has improved substantially after the initiation of biannual administration.
4. Fortification of commonly and widely consumed foods with vitamin A: Fortification or enrichment of widely consumed foods with vitamin A is another strategy toprevent and control vitamin A deficiency. Foods which are consumed daily by all sections of the community with little variation in the intake are generally utilized for the fortification. Fortified foods are integrated into the conventional food system as value added products to reach a large segment of population.