Horace Mann - Visionary Education Reformer
Horace Mann, a pioneer in education reform, dedicated his life to improving public schools. Born in 1796, Mann's personal experiences shaped his vision for education and led to the establishment of common schools in Massachusetts. He believed in the importance of education for a democratic society and advocated for free, non-sectarian, and inclusive schooling.
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COMMUNITY NUTRITION PROGRAMME Under-nutrition most important single cause of illness and death globally. 12% of all deaths and 16% DALY (disability- adjusted life years) lost. Even mild to moderate under-nutrition in the womb reduces cognitive development. Number of people suffering from food insecurity and hunger is growing-even though food production doubled in last 40 years
18% of world population- hungry. In S.E. Asia 1out of 4 persons-hungry. In Sub-Saharan Africa 1 out of 3 persons- hungry. 1/3rdpreschool children stunted. 16% babies born are LBW.
CAUSES OF MALNUTRITION- Strongly linked with poverty. Environment safe water or sanitation. Indoor air pollution- wood or animal dung used for cooking and heating along with poor ventilation.
GOI initiated several large scale supplementary feeding programmes. Programmes aiming at overcoming specific deficiency diseases through various ministries to combat malnutrition.
NUTRITION PROGRAMMES IN INDIA PROGRAMME MINISTRY 1.Vitamin A prophylaxis programme Ministry of Health & Family Welfare 2. Prophylaxis against anemia Ministry of Health & Family Welfare 3. IDD control programme Ministry of Health & Family Welfare 4. Special nutrition programme Ministry of Social Welfare 5.Balwadi nutrition programme Ministry of Social Welfare 6. ICDS programme Ministry of Social Welfare 7. Mid-day meal programme Ministry of Education 8. Mid-day meal scheme Ministry of Human Resources Development
NUTRITIONAL PROGRAM IN INDIA MINISTRY OF RURAL DEVELOPMENT Applied nutrition programme MINISTRY OF SOCIAL WELFARE Integrated Child Development Services Scheme Balwadi Nutrition Programme Special Nutrition Programme MINISTRY OF HEALTH AND FAMILY WELFARE National Nutrition Anemia Prophylaxis Programme National Prophylaxis Programme For Prevention of blindness due to Deficiency of Vitamin A National Iodine Deficiency Disorder Control Programme MINISTRY OF EDUCATION Mid Day Meal Programme
VITAMIN AND MINERAL DEFICIENCY 1. Iodine deficiency-lowered intellectual capacity-10-15% 2. Iron deficiency in 6-24 months-impairing mental development, 40-60% of developing world children. 3. Severe iron deficiency anemia-deaths of 50,000 young pregnant women/year in pregnancy and childbirth. 4. Iron deficiency in adults-losses of 2% GDP.
5. Vitamin A deficiency-compromising immune systems-40% of developing world s under-fives-1 million deaths of young children/year. 6. Iodine deficiency in pregnancy-20 million mentally impaired babies/year. 7. Folate deficiency-200,000 severe birth defects/year and associated 1 in every 10 adults deaths from heart disease. 8. Half children with Vitamin Mineral Deficiency- immeasurable burden on individuals, health services, education systems.
SOLUTION 1. Fortification 2. Supplementation 3. Education 4. Disease control
PILOT PROJECT AGAINST MICRONUTRIENT MALNUTRITION OBJECTIVES 1. Assess magnitude of fluorosis and dental carries, iron and vitamin A deficiency. 2. Assess and improve vitamin A status in school going children, adolescent boys and girls, non-pregnant women, adult male and geriatrics. 3. Launch IEC 4. Zinc level in food products and soil 5. Coordinate with similar programme.
NUTRITIONAL REHABITILATION CENTER Unit in District Health Facility, children with severe acute malnutrition (SAM) enrolled, admission and provided medical and nutritional therapeutic care, curative care- timely, adequate and appropriate feeding Gujarat Govt. Mission Balam Sukham in 2012. Mobile Nutritional Rehabilitation Center (NRC)
1.Vitamin A prophylaxis programme Under the National Program for Prophylaxis against Blindness in Children caused due to Vitamin A deficiency. Every child given a dose of 1,00,000 I.U. of vitamin A at age of 9 months than at 16 months and every 6thmonthly up to age of 5 years through peripheral health worker. Program was launched by MOH&FW in 1970 on the basis oh technology developed by National Institute of nutrition, Hyderabad.
Evaluation of program revealed a reduction in vitamin A deficiency in children.
2. PROPHYLAXIS AGAINST ANEMIA Programme was launched by GOI in 1970, during 4thfive year plan to prevent nutritional anemia in mothers and children. The expected and nursing mothers as well as acceptors of F.P.- one tablet of IFA 60 mg elementary iron raised to 100 mg elemental iron and 0.5 mg of folic acid and children in age group 1-5 years one tablet of IFA containing 20 mg elemental iron and 0.1 mg folic acid daily for a period of 100 days.
IRON DEFICIENCY- THREE STAGE 1-Decrease storage of iron without any detectable abnormalities. 2-An intermediate stage- latent iron deficiency i.e. iron stores are exhausted, but anemia does not occur yet recognized by serum ferritin levels. Percentage of saturation of transferrin falls from normal value of 30% to 15% 3- decrease in concentration of circulating hemoglobin.
HEMOGLOBIN LEVEL MILD 10.0-10.9 gm/dl MODERATE 8.0-9.9 gm/dl SEVERE - < than 8 gm/dl Anemic children(6-35 months) in 1998-99 : 74% 2005-06 : 79% Increase in both rural as well as urban. Higher in rural than urban area.
Anemic children (6-35 months) Kerala - 56% Himachal Pradesh 59% Uttar Pradesh - 85% Bihar - 88% Rural-urban difference widens from 4% in 1998 to 8% in 2005-06
Infants and toddlers - 65% 1-6 years of age - 60% Adolescents girls Pregnant women - 88% (3.3% hemoglobin < 7gm/dl) - 85% (9.9 % severe anemia)
PREVALENCE OF IRON DEFICIENCY ANEMIA IN INDIA Iron deficiency anemia Children (6-35 months) 6-11 months 12-23 months 24-35 months <6months-6 yrs (<11g/dl) 5-11 yrs Adolescent girls(<12g/dl) Mild anemia Moderate anemia severe anemia Adolescent girls in Urban slum of Delhi Pregnant and Lactating women (<11g/dl) Percentage 79 (NFHS-3) 71.7-80 77.7-78 72 70 73 52-88 34 15.7 1.8 46.6 58 (NFHS-3) 81.7 (ICMR)
RECOMMENDATIONS (GOI 2007) Infants 6-12 months included. Children between 6-60 months given 20 mg elemental iron and 100 microgram folic acid/ day. National IMNCI guidelines to be followed For 6-60 months children 20mg elemental iron and 100 microgram folic acid/ml Dispersible tablet prefer over liquid formulations
Recommendations for pregnant and lactating women 1 tablet/day for 100 days of 100 mg elemental iron and 500 microgram folic acid. School children 6-10 years old 30 mg elemental iron and 250 microgram folic acid and adolescents 11-18 years old given same dose as adult included in NNAPP. Multiple channels and strategies Double fortified salt/sprinklers/ultra-rice and other micronutrient candidates or fortified candidates.
Programme by Maternal and Child Health (MCH) Division of MOH&FW. Now part of RCH Nutrition education to improves dietary intake.
STATEGIES Use traditional food processing techniques to increase bioavailability of iron. Dietary behavior through nutrition education. Consume iron-fortified processed complementary foods. Supplement infants and young children. Combinations of above strategies.
12-by-12 INITIATIVE FOR ANEMIA CONTROL Launched at AIIMS on April 24,2007 with a view to ensure that every child should have hemoglobin 12gm by age of 12 By jointly MOH&FW, GOI, WHO, FOGSI (The Federation of Obstetrics and Gynecology Societies of India) and UNICEF along with other partners. Controlling adolescent anemia is an effective and sustainable nation building exercise.
All partners agencies work in their areas like adoption of few schools and creating public awareness by giving advise on dietary pattern. Workshops in rural and slum areas. Children 10-14 years screened and if hemoglobin <12 gm., iron supplements given. In adopted schools, in Iron Day-students educated about issue and dietary pattern corrected.
12 by 12 focuses on increasing iron intake of children, controlling worm infestations and other infections and improving overall nutrition by changing dietary pattern to make iron more bio-available.
3. IDD CONTROL PROGRAMME Programme launched by GOI in 1962 National Goiter Control Program (NGCP) in conventional goiter belt in Himalayan region with objective of identification of goiter endemic areas to supply iodized salt in place of common salt and to assess impact of goiter control measures over a period of time. In 1992 renamed as National Iodine Deficiency Control Program (NIDDCP) IDD affects all ages, both sexes and different SE Status
Iodine deficiency during pregnancy Decreased availability of iodine to foetus Decreased synthesis of thyroxine Prevents normal development of foetal brain and body Neonatal Chemical Hypothyroidism (NCH)
LIFE STAGE EFFECT Fetus Abortion Stillbirths Congenital Anomalies Increased Perinatal Mortality Increased Infant Mortality Neurological Cretinism Mental deficiency, Deaf, Mutism Dwarfism mental deficiency Psychomotor defects Neonate Neonatal goiter Neonatal hypothyroidism Child and adolescent Goiter Juvenile Hypothyroidism Impaired mental function Retarded physical function Retarded physical development Adult Goiter with its complication Hypothyroidism Impaired mental function
NATIONAL IODINE DEFICIENCY CONTROL PROGRAM (NIDDCP)- GOAL- Reduce prevalence of IDD < 10% in entire country by 2012 A.D.
OBJECTIVES 1. Surveys to assess magnitude of IDD 2. Supply of iodized salt 3. Resurvey after every 5 years to assess the extent of IDD and impact of iodized salt. 4. Laboratory monitoring of iodated salt and urinary iodine excretion. 5. Health education & Publicity.
POLICY- Consumption of iodized salt best and simplest way to control IDD. On recommendation of Central Council of Health 1984, GOI decide to iodate the entire edible salt in the country by 1992. Program commenced in phrased manner in April 1986. GOI banned sale of non-iodized salt from 17th May,2006 under Prevention of Food Adulteration Act 1954.
NODAL MINISTRY- MOH&HW. STANDARD FOR IODATED SALT- At production and consumption levels at least 30 and 15 ppm respectively.
4. SPECIAL NUTRITION PROGRAMME Stared in 1970 for children below 6 years , pregnant & nursing mothers and in urban slums, tribal areas and backward rural areas. Supplementary food supply 300 kcal and 10-12 gr. Protein/children/day and for mothers 500 kcal and 25 gm. Protein/mother/day for 300 days/year. Originally launched as central program and transferred to state in Vth five year program part of minimum needs program.
MAIN AIM OF PROGRAM- improve nutritional status of target group. Merged into ICDS programme.
5.BALWADI NUTRITION PROGRAMME Stared in 1970 for children aged 3-6 years in rural areas by ministry of Social Welfare. Funds given to voluntary organizations. Through BALWADIS which also provide pre- primary education to these children. Provide 300 kcal and 10 gm. Protein/child/day. Phased out in ICDS.
6. ICDS PROGRAMME Launched on Oct. 2nd 1975 (5th five year plan) in pursuance of National Policy for children in 33 experimental blocks. Network consists of 5659 projects in rural and urban pockets. Goal is universalization throughout the country. Through Women and Child Development, Ministry of Human Resources development and nodal Department of State-Social Welfare, Rural Development, Tribal Welfare, Health and Family Welfare or Woman & Child Development.
BENICIERIES- Children below 6 years. Pregnant and lactating women. Women in age group of 15-45 years. Adolescents girls in selected blocks.
OBJECTIVES of ICDS- To improve nutritional and health status of preschool children in age group 0-6 years. To lay the foundation of proper psychological development of the child. To reduce the incidence of mortality, morbidity, malnutrition and school dropout.
To achieve effective coordination of policy and implementation amongst various departments to promote child development. To enhance capacity of mother to look after the normal health and nutritional needs of the child through nutrition and health education.
ORGANIZATION THE ANGANWADI- Located within village or slum area. Focal point for delivery of services at community levels to children below 6 years, pregnant women, lactating mother and adolescent girls. Meeting ground for women, mothers and other social health workers for discussion, awareness program, joint action for child development and women empowerment.
Run by anganwari worker (AWW) supported by helper. Each anganwari covers 1000 population in rural and urban area. Mini-Anganwari covers remote and low populated hamlets/villages in tribal blocks. Cover 150-500 population in rural area, 500- 1500 population in urban area and 150-300 population in tribal area
Free nutritional food (2009) Rs. 4/child/day, 500 kcal, protein 12-15 gm. Rs, 6/child/day for severely malnourished, 800 kcal, protein 20-25 gm. Rs. 5 /pregnant/lactating mothers/day, 500kcal, protein 18-20 gm.
SERVICES HEALTH- Immunization Health checkup Referral services Treatment of minor illness. NUTRITION- Supplementary Nutrition Growth monitoring and promotion Nutrition and health education
Early childhood care and Pre-School Education to children of 3-6 years CONVERGENCE- Of other supportive services-safe drinking water, environmental sanitation, women s empowerment programs, non-formal education and adult literacy.
CALORIES AND PROTEIN GIVEN IN ICDS Recipients Calories Grams of protein Rs. 500 12-15 4 1. Child up to 6-72 months 500 20-25 4 2. Adolescent girls 600 18-20 5 3. Pregnant and lactating Mothers 800 20-25 6 Malnourished children
ANGANWARI WORKER- Part time trained voluntary worker. Receives honorarium of Rs. 3000/month. Assisted by helper paid honorarium of 1500/month Maintain growth chart of every child and weigh each child every month. Children above 3 years assessed by UMAC . If child s UMAC < than 13.5 than weigh every month.
Non-formal education for children of 3-6 years. Educate mother on health and nutrition. Coordinate with PHC staff for health check-up. Immunization and referral of suffering child. Treatment of minor illness. Maintain all files and records of services provided and growth of the children and submit report monthly to MUKHYA SEVIKA. Supplementary nutrition feeding for children (0-6 years) and expectant and lactating mothers. Sample survey to find out total beneficiaries.
