FEEDING PROGRAMME FOR VULNERABLE GROUPS

ISABELLA THOBURN COLLEGE

Department of Nutrition

Name-Deepshikha Patel
Roll no.-190381270006
M.sc(SEM.3)
INTRODUCTION

In an effort to ensure proper nutrition to the children and women of the weaker
sections of the society in both the urban and rural areas, the Governments at both
the Centre and the State levels, have taken up special feeding programmes. These
are,at present,considered an important way of improving the nutritional standards
of the country. Thus, money has been specially allotted to these programmes in
various Five Year Plans of the country by both Central and State Governments.

OBJECTIVES OF THE FEEDING PROGRAMMES -

The main objective of the feeding programmes is to improve the nutritional status of
the community. Malnutrition is a major problem facing the country. Undernutrition
classified as one state of malnutrition refers to inadequacy of food intake by sections
of the population. Undernutrition is seen mostly in economically backward people
residing in rural, tribal and urban slums. The dietary surveys conducted by the
National Nutrition Monitoring Bureau (NNMB) reveal that 50 per cent of the
households surveyed in different states consume food which is inadequate to meet
their requirements of either energy or protein or both. Malnutrition may be
prevalent even among other groups due to lack of nutrition knowledge. Thus, the
objectives of the feeding programmes are:
1) To supplement the diets of weaker sections of the community to combat
undernutrition.
2) 2) To educate the community for combating and preventing malnutrition.

FEEDING PROGRAMME:-

Integrated Child Development scheme(ICDS):

The Integrated Child Development Service (ICDS) Scheme providing for

supplementary nutrition, immunization and pre-school education to the children is a
popular flagship programme of the government. Launched in 1975, it is one of the
world’s largest programmes providing for an integrated package of services for the
holistic development of the child. ICDS is a centrally sponsored scheme implemented
by state governments and union territories. The scheme is universal covering all the
districts of the country.
The Scheme has been renamed as Anganwadi Services.

Objectives
 To improve the nutritional and health status of children in the age-group 0-6
years;
 To lay the foundation for proper psychological, physical and social
development of the child;
 To reduce the incidence of mortality, morbidity, malnutrition and school
dropout.
  To achieve effective co-ordination of policy and implementation amongst the
various departments to promote child development; and
 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.

Beneficiaries:

 Children in the age group of 0-6 years

 Pregnant women and
 Lactating mothers

Services under ICDS

The ICDS Scheme offers a package of six services:

.Supplementary Nutrition
.Pre-school non-formal education
.Nutrition & health education
.Immunization
.Health check-up and
.Referral services
Three of the six services viz. immunization, health check-up and referral services are
related to health and are provided through National Health Mission and Public
Health Infrastructure. The services are offered at Anganwadi Centres through
Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHS) at grassroots level.

The delivery of services to the beneficiaries is as follows:

Services Target Group Service provided by
(i) Supplementary Children below 6 Anganwadi Worker and
Nutrition years, Anganwadi Helper
Pregnant & (Ministry of Women and Child
Lactating Mothers Development (MWCD))
(P&LM)  
(ii) Immunization* Children below 6 ANM /MO
years, Health system, Ministry of Health
Pregnant & and Family Welfare (MoHFW)
Lactating Mothers
(P&LM)
iii) Health Check-up* Children below 6 ANM/MO/AWW
years, (Health system, MHFW)
Pregnant &  
Lactating Mothers
(P&LM)
(iv) Referral Services Children below 6 AWW/ANM/MO
years, (Health system, MoHFW)
 Pregnant &
Lactating Mothers
(P&LM)
v) Pre-School Children 3-6 years AWW
Education (MWCD)
(vi) Nutrition & Women (15-45 AWW/ANM/MO
Health Education years) (Health system, MoHFW &
MWCD)

Vitamin A Prophylaxis Programme:-

The programme was launched in 1970 with the objective of reducing the disease and
preventing blindness due to Vitamin A deficiency. It was initially started in 7 states
with severe problems. Later it was extended to the entire country.

Under the programme, children aged 6 months to 6 years were to be administered a

mega dose of vitamin A at 6 monthly intervals. To prioritize Vitamin A
administration, the programme was revised to give 5 mega doses at 6 months intervals
to children 9 months to 3 years of age. In view of adequate supplies of Vitamin A, the
target group has been revised to cover children 9 months- 5 years, since 2007.

Objectives: to decrease the prevalence of Vitamin A deficiency from current 0.6%

to less than 0.5%.

Strategy:

.Health and nutrition education to encourage colostrum feeding, exclusive breast

feeding for the first six months, introduction of complementary feeding thereafter
and adequate intake of Vitamin A rich foods.

.Early detection and proper treatment of infections

.Prophylactic Vitamin A as per the following dosage schedule:

-100000 IU at 9 months with measles immunisation

-200000 IU at 16-18 months, with DPT booster
-200000 IU every 6 moths, 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.

Sick Children:

.All children with xerophthalmia are to be treated at health facilities.

.All children having measles, to be given 1 dose of Vitamin A if they have not
received it in the previous month.

.All cases of severe malnutrition to be given one additional dose of Vitamin A.

Special Nutrition Programme (SNP):-

The Special Nutrition Programme (SNP) was launched in 1970-71 by the Ministry of
Social Welfare, Government of India. It was initially launched as a Central
Programme but was transferred to the state sector during the fifth five year plan.
During the sixth and seventh five year plans, steps were taken to convert the SNP
centres on the pattern of ICDS scheme by strengthening them with health and other
inputs. At present 22.87 million beneficiaries are covered by the scheme. It is
planned to increase the number of beneficiaries upto 30.92 million by the end of
1991-92.

(Source : Annual Plan 1990-91, Planning Commision, Government of India, 1992) 

Objectives : The objectives of the programme is to improve the, nutritional of

preschool children, pregnant and lactating mothers of poor socio-economic groups
in urban slums, tribal areas and drought prone rural areas. 

Beneficiaries : The programme caters to : 

Preschool children 
Pregnant and lactating mothers. 

The beneficiaries are selected on the basis of their socio-economic groups. The
pregnant mother in the last trimester and lactating mothers during the first four
months are given priority. The malnourished children are also given priority. 

Activities : The activities of the programme include: 

_to provide supplementary nutrition. 
_to provide health care services including supply of Vitamin A solution and iron and
folic acid tablets.

The supplementary nutrition is provided to children in 6-72 months, to provide 300

calories and log protein per child per day. The severely malnourished children are
provided 600 calories and 20g protein/day. Iron and folic acid tablets and Vitamin A
solution are also provided. 

The pregnant and lactating mothers receive supplementary nutrition containing 600
calories and 20g protein per day. Iron and folic acid tablets are also provided. The
cost of supplementary nutrition is same as in the ICDS scheme. 
Organisation : The programme is implemented through a network of balwadis,
which are located at the village/community level. The balwadi worker and the helper
is most peripheral functionaries implementing the scheme.

Balwadi Nutrition Programme (BNP):-

The Balwadi Nutrition Programme (BNP) was started in 1970-71. It is operated

through Balwadis and day-care centres which are being run by the five national
voluntary organisations. There are about five thousand Balwadis implementing the
programme. It is a non-expanding and non-plan activity of the government of India.
At present about 2.29 lakh beneficiaries are being covered under the scheme. 
(Source : Indian Paediatrics 1992, 29: 1601-1613) 

Objectives : The programme aims to supply about one-third of'the calorie and half
of the protein requirements of the pre-school child as measure to improve
nutritional and health status. 

Beneficiaries : Beneficiaries are pre-school children between the age of 3 to 5

years. Priority is given to children belonging to low income group. 

Activities : The supplementary nutrition consisting 300 calories and 10 g of protein

per child per day is given for 770 days a year. Apart from nutritional
supplementation, the activities for social and emotional development are
undertaken at balwadis. 

Organisation : The Balwadi worker is the most peripheral worker implementing

the programme at the village/community level. 

NATIONAL NUTRITION ANEMIA PROPHYLAXIS PROGRAMME:-

 Available studies on prevalence of nutritional anemia in India show that

65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3%
has hemoglobin <7 gm./dl; severe anemia) and 85% pregnant women
(9.9% having severe anemia. The prevalence of anemia was marginally
higher in lactating women as compared to pregnancy. The commonest is
iron deficiency anemia.

 The programme was launched in 1970 to prevent nutritional anemia in

mothers and children. Under this programme, the expected and nursing
mothers as well as acceptors of family planning are given one tablet of iron
and folic acid containing 60 mg elementary iron which was raised to 100
mg elementary iron, however folic acid content remained same (0.5 mg of
folic acid) and children in the age group of 1-5 years are given one tablet of
iron containing 20 mg elementary iron (60 mg of ferrous sulphate and 0.1
mg of folic acid) daily for a period of 100 days. This programme is being
 taken up by Maternal and Child Health (MCH), Division of Ministry of
Health and Family Welfare. Now it is part of RCH programme.

 National programmes to control and prevent anemia have not been

successful. Experiences from other countries in controlling moderately-
severe anemia guide to adopt long term measures i.e. fortification of food
items like milk, cereal, sugar, salt with iron. Nutrition education to improve
dietary intakes in family for receiving needed macro/micro nutrients as
protein, iron and vitamins like folic acid, B, B,C, etc. for hemoglobin
synthesis is important. Nutritional Anemia Control Programme should be
comprehensive and incorporate nutrition education through school health
and ICDs infrastructure to promote regular intake of iron/ folic acid-rich
foods, to promote intake of food which helps in absorption of iron and folic
acid and adequate intake of food.

Mid-Day Meal Scheme:-

Mid-day meal (MDM) is a wholesome freshly-cooked lunch served to children in

government and government-aided schools in India. On 28 November 2001, the
Supreme Court of India passed a mandate stating, "We direct the State
Governments/Union Territories to implement the Mid Day Meal Scheme by
providing every child in every Government and Government assisted Primary School
with a prepared midday meal."
MID-DAY MEAL SCHEME AIMS TO:
 avoid classroom hunger
 increase school enrolment
 increase school attendance
 improve socialisation among castes
 address malnutrition
 empower women through employment

IMPLEMENTATION OF THE MIDDAY MEAL SCHEME:

The Akshaya Patra Foundation, which was successfully implementing its own school
lunch programme in Karnataka since 2000, was called in to give testimonies for
verifying the efficacy of the scheme; following which the mandate to implement Mid
Day Meal Scheme was passed.
In order to successfully carry out this mandate, each State Government started its
own Mid-Day Meal Programme with Akshara Dasoha being initiated by the
Government of Karnataka.
One of the major challenges faced by the Government was the successful
implementation of the scheme. As per the NP-NSPE, 2006 Guidelines (Midday Meal
Scheme Guidelines), wherever possible, the Government would mobilise community
support and promote public-private partnership for the programme. Not-for-profits,
such as Akshaya Patra, are therefore encouraged to set up operations and act as the
implementing arm of the Government.
The Karnataka Human Development Report, 2005 states, ‘The recognition of the role
of voluntary agencies in partnering with Government initiatives by the Centre may
have had some influence in the initiatives taken by the Government of Karnataka to
bring several NGOs into major Government sponsored programmes.’ As the report
states, the Government of Karnataka was the first to take the step of involving NGOs
in development programmes. Additionally, the report states that this ‘involvement
of the NGOs in multilateral/bilateral programmes, raises the level of co-operation to
another level. The NGOs become not only implementers; they also find a place in
designing and managing programmes together with Government at all levels.’
This pioneering move by the Government of Karnataka to make NGOs the
implementing arm of the Government has been one of the major reasons for its
success in reaching the programme's goals. The achievements of these private-public
partnerships have even influenced the Central Government. By setting up and
encouraging private-public partnerships, the Government is successfully leveraging
the skills and resources of the private sector for the greater good. India's Midday
Meal Scheme is one of the largest school lunch programmes in the world benefiting
9.78-crore children in 11.40-lakh schools (as per 2016-17 data).

MID DAY MEAL MENU

At Akshaya Patra, the menu is designed and implemented after taking into
consideration various factors, including regional palate, taste, and flavours. Menu
diversity is achieved by using a wide variety of seasonal vegetables and locally
available ingredients. We have adopted a cyclic approach with preference to local
palate. For example, serve Sukhdi in Gujarat, Dalma in Odisha, and Bisibelebath in
Karnataka.
 
menu planning incorporates a range of flavours with a variety of spices, condiments,
vegetables, and staple groups. To sustain the interest of our beneficiaries, an
additional menu item is provided.

As an example, menu for Bengaluru:-

 NATIONAL GOITRE CONTROL PROGRAMME:-

Iodine is an essential micronutrient required daily at 100-150 micrograms for normal

human growth and development.  Deficiency of iodine can cause physical and
mental retardation, cretinism, abortions, stillbirth, deaf mutism, squint & various
types of goiter. As per the surveys conducted by the Directorate General of Health
Services, Indian Council of Medical Research, Health Institutions and the State Health
Directorates, it has been found that out of 414 districts surveyed in all the 29 States
and 7 UTs, 337 districts are endemic i.e where the prevalence of Iodine Deficiency
Disorders (IDDs) is more than 5% (Annexure-I).

 Control Programme:

Realizing the magnitude of the problem, the Government of India launched a 100
per cent centrally assisted National Goitre Control Programme (NGCP) in 1962.   In
August, 1992 the National Goitre Control Programme (NGCP) was renamed as
National Iodine Deficiency Disorders Control Programme (NIDDCP) with a view of
wide spectrum of Iodine Deficiency Disorders like mental and physical retardation,
deaf mutisim, cretinism, still births, abortions etc.. The programme is being
implemented in all the States/UTs for entire population.

Goal :

  1. To bring the prevalence of IDD to below 5% in the country

 2. To ensure 100% consumption of adequately iodated salt (15ppm) at the

household level.

 Objectives:

1. Surveys to assess the magnitude of Iodine Deficiency Disorders in the

districts.

2.  Supply of iodated salt in place of common salt.

3.  Resurveys to assess iodine deficiency disorders and the impact of

iodated salt after every 5 years in the districts.

4.  Laboratory monitoring of iodated salt and urinary iodine excretion.

5.   Health Education and Publicity.   

    
     

Policy :

On the recommendations of Central Council of Health in 1984, the Government took

a policy decision to Iodate the entire edible salt in the country by
1992.  The   programme started in April, 1986 in a phased manner.  To date, the
annual production of iodated salt in our country is 65 lakh metric tones per annum.

Applied Nutrition Programme (ANP):-

The ANP was first implemented in Orissa and Andhra Pradesh in 1962. By 1973, the
whole country was covered by the scheme. This programme till date is the best
conceived nutrition programme but it could not achieve the desired results due to
management failure. The programme was initiated as a centrally sponsored scheme
but now is implemented by the stats. Due to shift in thrust in the recent years, the
ANP is at present a non-expandable, low priority programme as compared to other
nutrition programmes implemented by the states. 

Objectives : The objectives of the programme are: 

_to make people conscious of their nutritional needs, 

_to increase production of nutritious foods and its consumption, and 
_to provide supplementary nutrition to vulnerable groups through local production
of food.
The programme aimed at the approach of "self reliance" to be developed at the
community and individual level. 
Beneficiaries : The programme reaches out to : 
Children between 3-6 years 
Pregnant and lactating mothers. 

Activities : ANP envisaged production of nutritious bod by people themselves and

to be consumed by them to improve their own nutritional status. Poultry farming,
horticulture, beehieve keeping, kitchen gardening and nutrition education were
main activities in the programme. 

The supplementary nutrition was provided to children and women beneficiaries. 

Organisation : The programme is implemented under the supervision of block

development officer. The Balsevikas with the help of a helper undertake the
programme activities at the village/community level. 

Wheat-Based Supplementary Nutrition Programme (WNP):-

The wheat-based supplementary nutrition programme is a centrally sponsored

scheme started in 1986. This scheme was initiated to enlarge the scope of existing
nutrition programme by covering additional beneficiaries. The children and
antenanta and mother, primarily in tribal areas, urban slums and backward areas.
Initially, this scheme was meant to cover additional beneficiaries who could not be
covered by IDCS projects. But from 1990, only the beneficiaries of the central
sectorICDS projects are provided supplementary nutrition under this scheme. At
present 16 states and 3 union territories are implementing this scheme, with a target
of thirty lakh beneficiaries.

Objectives :  The programme aims to enlarge the scope of existing nutrition

programme by covering additional beneficiaries i.e. pre-school children and nursing
and expectant mothers through wheat-based supplementary nutrition. 

Beneficiaries : Children of pre-school age, nursing and expectant mothers in

disadvantaged areas with high IMR or high concentration of scheduled castes,
particularly in urban slums and backward rural and tribal areas. 

Activities : Under this scheme supplementary nutrition is provided to the pre-

school children and pregnant and expectant mothers. The scheme consists of 2
components, viz. Centrally funded component and state funded component. 

i) Centrally funded component : Under the centrally sponsored WNP, the

supplementary food containing 300 calories and 10 grams protein is given to
children and 500 calories and 20 grams of protein to expectant and nursing mothers.
Assistance at a cost norm of 75 paise per beneficiary per day for 25 days in a month
is provided. Out of 75 paise, the GO1 contributes 50 paise and the balance 25 paise
is borne by the concerned state governments themselves. 

ii) State funded component : Under this component, the wheat was initially
provided to the state governments at a subsidy of Rs. 700 per m.t., to provide "
supplementary nutrition to the beneficiaries covered by the state government
nutrition programmes. From 1989, no subsidy is given to the state governments. The
states are, however, now provided wheat at the public distribution system (PDS)
rate. 

CONCLUSION:-

1. Undernutrition, as assessed by anthropometric criteria, predisposes infants and

children to diarrhea and to its duration and severity.

2.Sociocultural determinants of feeding practices must be incorporated in the design

of interventions targeted at improving nutritional status and risk of enteric disease.

3.Exclusive breastfeeding for as long as practical and as long as an infant's normal

growth is maintained minimizes a child's risk of enteric disease.
4.Maternal nutritional status appears to affect milk volume; its impact on milk
quality is more variable and less understood.

5.The continuation of breastfeeding after the introduction of

complementary/supplementary foods provides partial protection to the infant
against enteric disease.

6.Enteric pathogens are transmitted by the fecal-oral route, and foods ingested by
children are major vehicles of this transmission.

7. Utensils used for food preparation, storage, and feeding are common sources of
bacterial contamination. Weaning foods given to young children are common routes
of transmission for some bacterial enteropathogens. Furthermore, initial fecal
contamination of foods, poor hygiene practices in food preparation, and poor food
storage practices contribute to food contamination.

8.Unacceptably low nutrient densities often limit the appropriateness of traditional

weaning or supplementary foods.

9.Specific hygienic behaviors related to feeding practices, eg., handwashing, reduce

the incidence of diarrhea in people in developing countries, and additional
interventions to reduce food contamination should be evaluated.

10.Multiple rather than single approaches (eg., adjustment of pH, high solute
concentrations, and reduced water content) are more reliable for the inhibition of
bacterial growth in foods.

11.Evaluations of food processing options must consider food preferences,

availability of raw ingredients, capital and labor requirements cost, local child
feeding practices, and the sociocultural acceptance of foods produced.

JOURNAL ARTICLE:-

Impact of a School Milk Programme on the Nutritional Status of School

Children-
From the start of the school milk feeding programme in February 1985 to
October 1986, a total of 2, 766 children aged six to nine years from 12 primary
schools in Ulu Selangor were followed-up for about two years. The children's weight
and height were monitored at the beginning, in the middle and at the end of the
study.
The study shows that there is a reduction in the prevalence of protein-energy
malnutrition in terms of underweight (15.3% to 8.6%), stunting (16.3% to 8.3%) and
wasting (2.6% to 1.7%) from the start of the school feeding programme to two years
later. Associated with this there was an improvement in the attendance rate of the
children during the same period. As there was no major developmental change in
Ulu Selangor during that period, it is likely that the reduction in the prevalence of
protein-energy malnutrition and the improvement of the attendance rate among the
children are due to the impact of the school milk feeding programme.

The Effect Of School Feeding Programme On Primary School

Attendance In Rural Areas Of Lagos State, Nigeria-

This study was carried out to determine the effect of School Feeding Programme
(SFP) on primary school children attendance in Epe Local government Area (LGA) of
Lagos.. A multi-stage sampling technique was used to collect information from 220
school pupils in the state. The result of the regression analysis showed that
punctuality; absenteeism; child’s gender; child’s age; child’s birth order; household
size; years of education of the household head and SFP were significant variables
which affect attendance of children in school. The t-test revealed that the school-
feeding programme [SFP] succeeded in increasing parent’s income. The result of the
test of structural difference in the two samples taken using the chow test revealed
that SFP improves attendance of children in school and that there was significant
difference in attendance of children in class with and without SFP. It was
recommended that government should extend the School Feeding Programme to all
the states and all primary school classes in Nigeria so as to increase attendance of
school age children and improve enrolment of children in schools. The economic
implications of this are that it helps to increase parents’ income, thereby alleviating
extreme poverty and hunger among pupils and parents.

RELATIONSHIP BETWEEN SCHOOL FEEDING PROGRAMMES AND THE

PUPILS’ SCHOOL ATTENTANCE IN PUBLIC PRIMARY SCHOOLS-

Education can be achieved successfully if hunger is controlled. This can be done if

SFPs are introduced and implemented in schools. School Feeding Programme was
initiated in Kenya in 1979 with provision of milk packets to the pupils and it was fully
implemented in 1980 by the government of Kenya with collaboration with World
Food Programme (WFP). The objective of this study was to assess the relationship
between SFPs and the pupils’ effectiveness in learning in public primary schools in
Kitui County. The study intended to assess attendance as an indicators of
effectiveness in learning. The study used Classical Liberal Theory of Equal
Opportunity and Maslow’s Theory of Human motivation. The researcher used Survey
Research Design. The target population was 374 primary schools under feeding
Programme in Kitui County. The sample size was 112 schools which are 30% of the
target population. These schools were sampled randomly. The researcher also
randomly sampled five percent (19) class seven teachers to get a total of 131
respondents. The research instruments used by the researcher were the
questionnaires for head teachers and the interviews for class seven teachers’
representatives. To test validity of the research instruments, the researcher did
piloting in two schools (10%) of the sample target, 19 class seven teachers. The
researcher also discussed the instruments with her supervisors and was advised
accordingly. Reliability of the research instruments was calculated using test-retest
method. Quantitatively collected data was analyzed using descriptive statistics and
Pearson r with the help of SPSS software while qualitatively collected data was
analyzed using Focus by Question Analyses Strategy. Analyzed results were
presented using tables, graphs and pie-charts. The findings of the study may help the
administrators and policy makers in laying their strategies successfully. Results show
that there was a significant relationship between school feeding program and the
pupils’ school attendance. Findings from the interviews further confirmed that there
was unwavering agreement among class seven teachers’ representatives that school
feeding program was positively associated with pupils’ school attendance. The study
concludes that SFP has significant influence on effectiveness in learning in relation to
attendance among primary school pupils, hence the hypothesis that there is no
significant relationship between school feeding Programme and the pupils’
attendance was therefore, rejected. The study recommends that the county
government should liaise with parents and guardians of primary school pupils so as
to expand SFPs to retain pupils at school. These findings will be beneficial to the
Ministry of Education and the school administrators while laying their strategies.

REFERENCE:-

- www.researchgate.net
- icds.gov.in
- www.nzdl.org
- Mdm.nic.in
- nutrition-health-education.blogspot.com