UNIT 23 MAJOR NUTRITION
PROGRAMMES - I : NUTRIENT
DEFICIENCY CONTROL
PROGRAMMES
I
Structure
23.1 Introduction
23.2 National Prophylaxis Programme for Prevention of Nutritional Blindness
23.3 National Nutritional Anaemia Control Programme
23.4 Iodine Prophylaxis Programme
23.5 Let Us S u m U p
23.6 Glossary
23.7 Answers to Check Your Progress Exercises
/
23.1 INTRODUCTION
--
You know that one suffers from the symptoms of a particular vitamin or mineral
deficiency disorqler, if one does not consume diet adequate in that nutrient for quite
sometime. One obvious way to prevent such disorder is to consume F e t rich in
vitamins and minerals. However, poor people canno! afford these foods as they are
too expensive. It is not possible for the Government to make these foods available
to poor and needy on regular basis.
As gn alternative method, ~ o v e r n m e n of
t Ihdia runs organized prophylaxis
(preventive)' programmes. Under this scheme, the commercially prepared vitamins
and minerals are supplied to vulnerable sections of our population through organized
programmes. These programmes are known as nutrient deficiency control
programmes or prophylaxis programmes and are of pature of stopgap arrangement.
These are expected to be phaseq out as and when the purchasing power of people
improves and they start consuming balanced diets.
In this particular unit, you will study about the three nutrient deficiency control
programmes - the National Prophylaxis Programme for Prevention of Nutritional
I Blindness, the National Nutritional Anaemia Control Programme and the Iodine
Prophylaxis Programme. You will find information regarding the objectives, target
beneficiaries of the programmes and the distribution strategy.
Objectives
I After going through this unit, you will be able to
e explain the. basis of nutrient deficiency control programmes
e describe the objectives, target group and method of distribution of benefits of
three nutrient deficiency control programmes i.e.
- National Prophylaxis Programme for Prevention of Nutritional Blindness
I - National Nutritional Anaem~aC,ontrol Programme
k - Iodine Prophylaxis Programme
23.2 NATIONAL PROPHYLAXIS PROGRAMME FOR
I- PREVENI'ION OF NUTRITIONAL BLINDNESS
Can you recall some of the symptoms which appear due to deficiency of vitamin A
(Unit 17, Block 5J? Vitamin A deficiency leads to complaints of night blindness and
other eye signs like conjunctival dryness (xerosis) and bitot spots. These signs are not
dangerous because they can be cured by giving vitamin A. Rut the severe forms of
vitamin A deficiency specially among children of preschool age (1 to 5 years) result
in kcratomalacia --,a condition where. the cornea (black portion of the eye) gets
completely
- destroyed. This condition is irreversible (incurable) and when occurs,
i
, makes the child blind. The socio-economic implications of blindness or blind children
are tragic for the family as well as for the society. Therefore, a preventive programme
. of distribution of massive doses of vitamin A is being undertaken in the country. The
basis of this programme is the fact that the human liver can store vitamin A consumed
in excess of daily requirement. The stored vitamin A is released as and when the
body-needs it. n! other words the liver acts a s a 'saving bank', in which the body
saves (stores) its surplus vitamin A and withdraws it when the intake falls short of
the requirement. Making use of this knowledge, the National Institute of Nutrit~on
gave 2000 preschool children large doses of vitamin A , two times a year. The do\e
called as the massive or mega (big) dose, was calculated to give the child adequak
vitamin A every day for sin months. An examination of these children at the end of
a year showed most 'encouiaging results. These'were :
- None of the children were nightblind
- None developed conjuctival xerosis or bitot spots
- None developed nutritional blindness.
Thus the National Prophylaxis Programme for prevention of Nutritional Blindness
was born.
Let us now study about the details of the programme. We shall discuss this
programmes as well as other nutrition programmes in the block under three main
headings - objectives, target groups and distribution strategy. You should get
familiar with these terms.
Objectives : Refer to the specific aims to be achieved through the prograinme. '
Target group : Nutrition programmes cater to only vulnerable sections of the
community. Each programme targets at some particular vulnerable sections of the
community i.e. target group.
Distribution Strategy : Refer to the method of distribution of benefits of the
programme.
Let us learn about the objectives, target group and the method of distribution benefits
of National prophylaxis programme for prevention of nutritional blindness.
Objectives :The programme aims at preventing blindness due to vitamin A deficiency
in childern (between 6 months to 5 years) by supplying mega (high) dose ef vitamin A.
Target group :All children of 6 months to 5 years are eligible (particularly those living
in rural, tribal and urban slum areas).
Dose and distribution strategy : A liquid preparation of vitamin A in oil providing
200,000 IU (in 2 ml) is given to every child between the ages of 1 and 5 years. Vitamin
A solution is kept away from direct sunlight and a bottle once opened is utilized
within 6-8 weeks. A child must receive a total of 9 oral doses of vitamin A by fifth
birthday. An irlfant between the age of 6-11 months is given a dose of 100,000 ZU.The
contact with an infant during. administration of measles vaccine between the age of
9-12 months is considered practical time for administering the vitamin A supplement
of 100,000 IU to infants.
The mother child immunization card is used to record and monitor the administration
..
of vitamia, A ' * '-I children under two years. Similarly growth monitoring cards or
register, wzed for monitoring growth of children under the ICDS Programme are used
for recording and monitoring administration of vitamin A solution till the age of five
years.
Distribution of vitamin A is carried out by the Auxiliary Nurse Midwife (ANM) -
a functionary belonging to Health Department in Ministry of Health and Family
Welfare. There is an ANM for a population of 3000-5000 people in a state. Her main
task is family weifarc. She also educates people about healthy living and helps in
distributing the benefits of nutrition programmes. Actual feeding (administration) of
the dose is conducted at the 'door-step' of the beneficiary, once in six months. It i:
recommended that the health worker, as soon as she receives the stock of vitamin A,
shpuld cover all the eligible children of her area within as short a period as possible
(on cash basis) by home (domicilliary) visits (administration at the clinics or at one
place is not recommended). Wherever Integrated Child bevelopment Services
(ICDS) is functioning, anganwadi workers should be involved in the diktribution and
administration of vitamin. You will learn more about anganwadi workers and
. Integrated Child Development ~ e r v i & sin Unit 24.
,Check Your Progress Exercise 1 -
Majcr Nutrition Programmes 1:
Nulrienl Deficiency
1) Fill in the blanks Control Programmes
a) Massive dose of vitamin A provided under national prophylaxis programme
for prevention of nutritional blindness is ..............................................
IU per child.
b) Children in the age ..................................to ....................................
years are prone to vitamin A deficiency.
c) The vitamin A dose is given to ........................................ children l'iving
in rural and tribal areas or urban slums.
d) The dose of vitamin A is given to children .........................................in
six months.
2 What is the basis of National Prophylaxis Programme for Prevention of
Nutritional Blindness?
.... ..........................................................................................
...........................................................................................................
~ ~ -- --
----
~-
. ~ A
-. - -- -
- --
.- .-, -.- . -
-
A
,, ---+
23.3 THE NATIONAL ANAEMIA CONTROL
PROGRAMME
Anaemia is anpthermajor nutritional proble~naffecting the health of the people in
the country. It 'is particularly serious among the women of child bearing age
(especially during pregnancy and lactation) and young children.
I
Surveys done by varibus research organizations including the World Health
Organization (WHO) have shown that in our country as many as 50% of preschool
children of poor corqmunities are anaemic. In case of women, particularly during
pregnancy, as many as 70% or even more of them are likely to be anaemic
(haemoglobin level less than 10 g per 100 ml). The anaemia among women tends to
.increase with increasing number of pregnancies. You know that anaemia has certain
, harmful consequences. It-reduces the capacity for doing work and hen$e thk sffects
the work output. Anaemic mothers often give birth to low birth weight babies (babies
born with birth weight less than 2500 g or (2.5 kg). It can even lead to death nf the
mother.
, In view of these serious consequences of nutritional anaemias, the Governwcnt
initiated the National Nutritional Anaemia Control Programme.
Objectives : The programme aims at significantly decreasing the prevalence and
incidence of anaemia*inwomen in reproductive age group especially pregnant and. .
lactating women and preschool children. The programme focuses on the following : .
- Promotion of regular consumption of foods rich in iron.
- Provision of iron and folate supplements in the form of tablets to the "high risk"
groups.
r - Identification and treatment of severely anaemic cases.
Target group : The beneficiaries of the programme are :
a) Pregnant women
b) Lactating mothers
c) Family planning acceptors (women who accept family planning measures like
intrauterine devices (IUD) and tubectomy)
d) Children of-both sexes between ages 1 to 5 years.
Distribution Straitegy : Supply of iron-folic aqid tablets to the target population
constitutes the main input. Two types of tablets being distributed are : (1) bigtahlets,
each containing 68 mg of iron (ferrous sulphate) and 500 pg of folic acid (for women).
One big tablet per day for 100 days should be given to pregnant woman after first
trimester. The contact during the administration of tetanus toxoid should be utilized
for distribution of tablets to pregnantwoman after the first trimester of pregnancy.
Similarly lactating woman and IUD- acceptor$ should receive ?ne tablet per day for
, 100 days. Mothers often accompany their infants on immunization sessions. They call
. be handed over tablets during this time (2) small tablets, each containing 20 mg of
iron and 100 pg of folic acid (for children) daily for 100 days every year. Register
wed for growth monitoring of children can be used to record the intake of tablets also. .
For young children who cannot swallow tablets, iron and folk add (in the same dose,
as in a small tablet) are given in 2 ml of syntpy liquid.
The health functionaries like Auxiliary Nurse Midwife (ANM) is responsible for
distribution of tabletsfliquid. Of late, the services of Anganwadi Worker (AWW) of
Integrated Development Services (ICDS) are also being used to distribute the
--
Iron-folate tablets. --
Check Your Progress Exercise 2
1) State whether the following statements are true or false. Correct the false
statements. I
a) Women of child bearing age and children are the target beneficiaries of the .
National Anaemia Control Programmes.
b) Nutritional anaemia can be only due to iron and folic aciddeficiency.
.....................................................................................................
c) Anaemia can even lead to death of women during child birth.
\
d) Sixty milligram of iron is given to women during pregnancy as a prophylactic
measure.
e) Dosage of iron and folic acid in National Nutritional Anaemia Control
Programme is same for women and children.
-
23.4. NATIONAL IDD CONTROL PROGRAMMF, '-
Goitre, as you know, is a condition in which the thyroid gland (located in front
portion of the neck) is enlarged. This condition is caused due to the deficiency of
iodine. In fact, iodine deficiency leads not only to goitre but also to a number of other
disabilities like p'a.+:;r'd m d mental retardathn, hearing and speech defects
(deaf-ml:::,.,,, itlMng children and spontaneous abortions and-still birth among
women (refer to Unit 18, Block 5).
A; you have read in Unit 18, Block 5, the problem of iodine aeficiency is endemic
in certain areas of the country. The surveys conducted indicated that the problem of
goitre is present in a broad sub-Himalayan belt of mountain slopes of our country.,
It stretches from Kashmir in the north-west to the Naga Hills in the East and includes
parts of the states of Himachal Pradesh, Funjab, Haryana, Uttar Pradesh, Bihar,
West Rengal, Sibim, Assam, Mizoram, Meghalaya, Tripura, Manipur, Nagaland
and Arunachal Pradesh. In addition, pockets of endemic goitre have been recently
detected in the states of Gujarat, Mahgrashtra, Andhra Pradesh and including Kerala
and Delhi.
It is estimated that a populatibn of nearly 140 million, live in endemic areas and out
of this. nearly 40 million are said to suffer from obvious manifestations of IDD
(Iodine Deficiency Disorders).
PROGRAMMES - I : NUTRIENT
DEFICIENCY CONTROL
PROGRAMMES
I
Structure
23.1 Introduction
23.2 National Prophylaxis Programme for Prevention of Nutritional Blindness
23.3 National Nutritional Anaemia Control Programme
23.4 Iodine Prophylaxis Programme
23.5 Let Us S u m U p
23.6 Glossary
23.7 Answers to Check Your Progress Exercises
/
23.1 INTRODUCTION
--
You know that one suffers from the symptoms of a particular vitamin or mineral
deficiency disorqler, if one does not consume diet adequate in that nutrient for quite
sometime. One obvious way to prevent such disorder is to consume F e t rich in
vitamins and minerals. However, poor people canno! afford these foods as they are
too expensive. It is not possible for the Government to make these foods available
to poor and needy on regular basis.
As gn alternative method, ~ o v e r n m e n of
t Ihdia runs organized prophylaxis
(preventive)' programmes. Under this scheme, the commercially prepared vitamins
and minerals are supplied to vulnerable sections of our population through organized
programmes. These programmes are known as nutrient deficiency control
programmes or prophylaxis programmes and are of pature of stopgap arrangement.
These are expected to be phaseq out as and when the purchasing power of people
improves and they start consuming balanced diets.
In this particular unit, you will study about the three nutrient deficiency control
programmes - the National Prophylaxis Programme for Prevention of Nutritional
I Blindness, the National Nutritional Anaemia Control Programme and the Iodine
Prophylaxis Programme. You will find information regarding the objectives, target
beneficiaries of the programmes and the distribution strategy.
Objectives
I After going through this unit, you will be able to
e explain the. basis of nutrient deficiency control programmes
e describe the objectives, target group and method of distribution of benefits of
three nutrient deficiency control programmes i.e.
- National Prophylaxis Programme for Prevention of Nutritional Blindness
I - National Nutritional Anaem~aC,ontrol Programme
k - Iodine Prophylaxis Programme
23.2 NATIONAL PROPHYLAXIS PROGRAMME FOR
I- PREVENI'ION OF NUTRITIONAL BLINDNESS
Can you recall some of the symptoms which appear due to deficiency of vitamin A
(Unit 17, Block 5J? Vitamin A deficiency leads to complaints of night blindness and
other eye signs like conjunctival dryness (xerosis) and bitot spots. These signs are not
dangerous because they can be cured by giving vitamin A. Rut the severe forms of
vitamin A deficiency specially among children of preschool age (1 to 5 years) result
in kcratomalacia --,a condition where. the cornea (black portion of the eye) gets
completely
- destroyed. This condition is irreversible (incurable) and when occurs,
i
, makes the child blind. The socio-economic implications of blindness or blind children
are tragic for the family as well as for the society. Therefore, a preventive programme
. of distribution of massive doses of vitamin A is being undertaken in the country. The
basis of this programme is the fact that the human liver can store vitamin A consumed
in excess of daily requirement. The stored vitamin A is released as and when the
body-needs it. n! other words the liver acts a s a 'saving bank', in which the body
saves (stores) its surplus vitamin A and withdraws it when the intake falls short of
the requirement. Making use of this knowledge, the National Institute of Nutrit~on
gave 2000 preschool children large doses of vitamin A , two times a year. The do\e
called as the massive or mega (big) dose, was calculated to give the child adequak
vitamin A every day for sin months. An examination of these children at the end of
a year showed most 'encouiaging results. These'were :
- None of the children were nightblind
- None developed conjuctival xerosis or bitot spots
- None developed nutritional blindness.
Thus the National Prophylaxis Programme for prevention of Nutritional Blindness
was born.
Let us now study about the details of the programme. We shall discuss this
programmes as well as other nutrition programmes in the block under three main
headings - objectives, target groups and distribution strategy. You should get
familiar with these terms.
Objectives : Refer to the specific aims to be achieved through the prograinme. '
Target group : Nutrition programmes cater to only vulnerable sections of the
community. Each programme targets at some particular vulnerable sections of the
community i.e. target group.
Distribution Strategy : Refer to the method of distribution of benefits of the
programme.
Let us learn about the objectives, target group and the method of distribution benefits
of National prophylaxis programme for prevention of nutritional blindness.
Objectives :The programme aims at preventing blindness due to vitamin A deficiency
in childern (between 6 months to 5 years) by supplying mega (high) dose ef vitamin A.
Target group :All children of 6 months to 5 years are eligible (particularly those living
in rural, tribal and urban slum areas).
Dose and distribution strategy : A liquid preparation of vitamin A in oil providing
200,000 IU (in 2 ml) is given to every child between the ages of 1 and 5 years. Vitamin
A solution is kept away from direct sunlight and a bottle once opened is utilized
within 6-8 weeks. A child must receive a total of 9 oral doses of vitamin A by fifth
birthday. An irlfant between the age of 6-11 months is given a dose of 100,000 ZU.The
contact with an infant during. administration of measles vaccine between the age of
9-12 months is considered practical time for administering the vitamin A supplement
of 100,000 IU to infants.
The mother child immunization card is used to record and monitor the administration
..
of vitamia, A ' * '-I children under two years. Similarly growth monitoring cards or
register, wzed for monitoring growth of children under the ICDS Programme are used
for recording and monitoring administration of vitamin A solution till the age of five
years.
Distribution of vitamin A is carried out by the Auxiliary Nurse Midwife (ANM) -
a functionary belonging to Health Department in Ministry of Health and Family
Welfare. There is an ANM for a population of 3000-5000 people in a state. Her main
task is family weifarc. She also educates people about healthy living and helps in
distributing the benefits of nutrition programmes. Actual feeding (administration) of
the dose is conducted at the 'door-step' of the beneficiary, once in six months. It i:
recommended that the health worker, as soon as she receives the stock of vitamin A,
shpuld cover all the eligible children of her area within as short a period as possible
(on cash basis) by home (domicilliary) visits (administration at the clinics or at one
place is not recommended). Wherever Integrated Child bevelopment Services
(ICDS) is functioning, anganwadi workers should be involved in the diktribution and
administration of vitamin. You will learn more about anganwadi workers and
. Integrated Child Development ~ e r v i & sin Unit 24.
,Check Your Progress Exercise 1 -
Majcr Nutrition Programmes 1:
Nulrienl Deficiency
1) Fill in the blanks Control Programmes
a) Massive dose of vitamin A provided under national prophylaxis programme
for prevention of nutritional blindness is ..............................................
IU per child.
b) Children in the age ..................................to ....................................
years are prone to vitamin A deficiency.
c) The vitamin A dose is given to ........................................ children l'iving
in rural and tribal areas or urban slums.
d) The dose of vitamin A is given to children .........................................in
six months.
2 What is the basis of National Prophylaxis Programme for Prevention of
Nutritional Blindness?
.... ..........................................................................................
...........................................................................................................
~ ~ -- --
----
~-
. ~ A
-. - -- -
- --
.- .-, -.- . -
-
A
,, ---+
23.3 THE NATIONAL ANAEMIA CONTROL
PROGRAMME
Anaemia is anpthermajor nutritional proble~naffecting the health of the people in
the country. It 'is particularly serious among the women of child bearing age
(especially during pregnancy and lactation) and young children.
I
Surveys done by varibus research organizations including the World Health
Organization (WHO) have shown that in our country as many as 50% of preschool
children of poor corqmunities are anaemic. In case of women, particularly during
pregnancy, as many as 70% or even more of them are likely to be anaemic
(haemoglobin level less than 10 g per 100 ml). The anaemia among women tends to
.increase with increasing number of pregnancies. You know that anaemia has certain
, harmful consequences. It-reduces the capacity for doing work and hen$e thk sffects
the work output. Anaemic mothers often give birth to low birth weight babies (babies
born with birth weight less than 2500 g or (2.5 kg). It can even lead to death nf the
mother.
, In view of these serious consequences of nutritional anaemias, the Governwcnt
initiated the National Nutritional Anaemia Control Programme.
Objectives : The programme aims at significantly decreasing the prevalence and
incidence of anaemia*inwomen in reproductive age group especially pregnant and. .
lactating women and preschool children. The programme focuses on the following : .
- Promotion of regular consumption of foods rich in iron.
- Provision of iron and folate supplements in the form of tablets to the "high risk"
groups.
r - Identification and treatment of severely anaemic cases.
Target group : The beneficiaries of the programme are :
a) Pregnant women
b) Lactating mothers
c) Family planning acceptors (women who accept family planning measures like
intrauterine devices (IUD) and tubectomy)
d) Children of-both sexes between ages 1 to 5 years.
Distribution Straitegy : Supply of iron-folic aqid tablets to the target population
constitutes the main input. Two types of tablets being distributed are : (1) bigtahlets,
each containing 68 mg of iron (ferrous sulphate) and 500 pg of folic acid (for women).
One big tablet per day for 100 days should be given to pregnant woman after first
trimester. The contact during the administration of tetanus toxoid should be utilized
for distribution of tablets to pregnantwoman after the first trimester of pregnancy.
Similarly lactating woman and IUD- acceptor$ should receive ?ne tablet per day for
, 100 days. Mothers often accompany their infants on immunization sessions. They call
. be handed over tablets during this time (2) small tablets, each containing 20 mg of
iron and 100 pg of folic acid (for children) daily for 100 days every year. Register
wed for growth monitoring of children can be used to record the intake of tablets also. .
For young children who cannot swallow tablets, iron and folk add (in the same dose,
as in a small tablet) are given in 2 ml of syntpy liquid.
The health functionaries like Auxiliary Nurse Midwife (ANM) is responsible for
distribution of tabletsfliquid. Of late, the services of Anganwadi Worker (AWW) of
Integrated Development Services (ICDS) are also being used to distribute the
--
Iron-folate tablets. --
Check Your Progress Exercise 2
1) State whether the following statements are true or false. Correct the false
statements. I
a) Women of child bearing age and children are the target beneficiaries of the .
National Anaemia Control Programmes.
b) Nutritional anaemia can be only due to iron and folic aciddeficiency.
.....................................................................................................
c) Anaemia can even lead to death of women during child birth.
\
d) Sixty milligram of iron is given to women during pregnancy as a prophylactic
measure.
e) Dosage of iron and folic acid in National Nutritional Anaemia Control
Programme is same for women and children.
-
23.4. NATIONAL IDD CONTROL PROGRAMMF, '-
Goitre, as you know, is a condition in which the thyroid gland (located in front
portion of the neck) is enlarged. This condition is caused due to the deficiency of
iodine. In fact, iodine deficiency leads not only to goitre but also to a number of other
disabilities like p'a.+:;r'd m d mental retardathn, hearing and speech defects
(deaf-ml:::,.,,, itlMng children and spontaneous abortions and-still birth among
women (refer to Unit 18, Block 5).
A; you have read in Unit 18, Block 5, the problem of iodine aeficiency is endemic
in certain areas of the country. The surveys conducted indicated that the problem of
goitre is present in a broad sub-Himalayan belt of mountain slopes of our country.,
It stretches from Kashmir in the north-west to the Naga Hills in the East and includes
parts of the states of Himachal Pradesh, Funjab, Haryana, Uttar Pradesh, Bihar,
West Rengal, Sibim, Assam, Mizoram, Meghalaya, Tripura, Manipur, Nagaland
and Arunachal Pradesh. In addition, pockets of endemic goitre have been recently
detected in the states of Gujarat, Mahgrashtra, Andhra Pradesh and including Kerala
and Delhi.
It is estimated that a populatibn of nearly 140 million, live in endemic areas and out
of this. nearly 40 million are said to suffer from obvious manifestations of IDD
(Iodine Deficiency Disorders).
