BIOCHEMISTRY AND HUMAN NUTRITION

Module 4. Human nutrition

Lesson 32
PLANNING AND NUTRITIONAL POLICIES

32.1 Introduction

• Widespread poverty resulting in chronic and persistent hunger is the single biggest scourge of the developing world today.
• Under nutrition is a condition resulting from inadequate intake of food or more essential nutrient(s) resulting in deterioration of physical growth and health.
• The inadequacy is relative to the food and nutrients needed to maintain good health, provide for growth and allow a choice of physical activity levels, including work levels that are socially necessary.
• This condition of under-nutrition, therefore, reduces work capacity and productivity amongst adults and enhances morality and morbidity amongst children.
• Such reduced productivity translates into reduced earning capacity, leading to further poverty, and the vicious cycle goes on.
• The nutritional status of a population is therefore critical to the development and well being of a nation.

32.2 Need for a Nutrition Policy

• The need for a National Nutrition Policy is implicit in both the paramountcy of nutrition in development as well as in the complexity of the problem.
• The general problem of under-nutrition should be seen as a part of a larger set process that produces and consumes agricultural commodities on farms, transforms them into food in the marketing sector and sells the food to customers to satisfy nutritional, aesthetic and social needs.
• From being a deficit nation, depending on food imports in the sixties, to having become surplus in food grains in the eighties is a saga of concerted agricultural research, extension work and development, resulting in a dramatic productivity increase.
• Yet, from all accounts, endemic malnutrition and ill health resulting from malnutrition continue to stalk the country. It is this stark reality that underscores the need for a nutrition policy. Increased food production does not by itself necessarily ensure nutrition for all.

32.3 Nutrition Problems of India

The major nutrition problems of India can be classified as follows:-

• Under-nutrition resulting in:

(a) Protein Energy Malnutrition (PEM);
(b) Iron deficiency;
(c) Iodine deficiency;
(d) Vit, “A” deficiency;
(e) Low Birth Weight Children;

• Seasonal dimensions of Nutrition;

1. Natural calamities and the landless;
2. Market Distortion and Disinformation;
3. Urbanization;
4. Special Nutritional Problems of Hill people, Industrial Workers, Migrant Workers, and other special categories;
5. Problems of Overnutrition, overweight and obesity for a small section of urban population;

For India and much of the Third World nutrition status is characterized by varying degrees of undernutrition for women and children

• Protein Energy Malnutrition is the most widespread form of malnutrition among pre-school children of our country. A majority of them suffer from varying grades of malnutrition.
• Nutritional anaemia among the pre-school children and expectant and nursing mothers is one of the major preventable health problems in India. It has been estimated in various studies particularly those conducted by NIN that roughly 56 percent pre-school children and almost 50 percent of the expectant mothers in the third trimester of pregnancy suffer from iron deficiency, which is basically due to inadequate or poor absorption of iron from a predominantly cereal-based diet.
• In India, nearly 40 million persons are estimated to be suffering from goiter and 145 million are living in the known goiter endemic regions ranges from 1.5 per cent in Assam (Cachar Distt.) to 68.6% in Mizoram. It is estimated that iodine deficiency also accounts for 90,000 still births and neo-natal deaths every year.
• Nutritional blindness which affects over seven million children in India per year results mainly from the deficiency of vitamin A, coupled with protein energy malnutrition. In its several form, it often results in loss of vision and it has been estimated that around 60,000 children become blind every year.
• The prevalence of low birth weight children is still unacceptably high for India. The nutritional status of infants is closely related to the material nutritional status during pregnancy and infancy. In India 30% of all the infants born are low birth weight babies (Weight less than 2500 gms.)
• There are serious seasonal dimensions of the nutrition question. In large parts of India, the rainy months are the worst months for the rural, landless poor. This is when cultivation, deweeding, ploughing and other works demand maximum energy from them, while food stocks at home dwindle and market prices rise.
• These are again the months when water-borne diseases are so frequent. This condition goes on aggravating till late October or even November. This same group of rural landless poor is most vulnerable to droughts, floods and famines. As has been established in famine periods, worst affected groups are the landless agricultural labourers, artisans, craftsmen and non-agricultural labourers in that order.
• Under-nutrition in urban areas is a major area of concern. Studies by NNMB have actually shown that the nutritional status of urban slum dwellers in India is almost as bad as that of rural poor. The deleterious effects of rural urban movements on nutrition in much of the third world, is quite well known. The children of urban slum dwellers and of the urban informal sector are nutritionally the most fragile of all groups.
• Uncertainity of income and the absence of informal nutritional support system within society, so common to rural areas of India place many of these families on the very edge of survival.

32.4 Nutrition Policy Instruments

Nutrition is a multi-sectoral issue and needs to be tackled at various levels. Nutrition affects development as much as development affects nutrition. It is, therefore, important to tackle the problem of nutrition both through direct nutrition intervention for specially vulnerable groups as well as through various development policy instruments which will create conditions for improved nutrition.

• Direct Intervention

Nutrition Intervention for especially vulnerable groups:

Expanding the Safety Net The Universal Immunization Programme, oral Rehydration Therapy and the Integrated Child Development Services (ICDS) have had a considerable impact on child survival

• Reaching the Adolescent Girls
• Awarness among mothers regarding nutritional status of babies
• Ensuring better coverage of expectant women
• Fortification of Essential Foods
• Popularization of Low Cost Nutrition Food
• Control of Micro-Nutrient Deficiencies amongst vulnerable Groups

• Indirect Policy Instruments

• Food Security
• Improvement of Dietary pattern through Production and Demonstration
• Improving the purchasing power: Poverty alleviation programmes, like the Integrated Rurat Development Programme (IRDP) and employment generation schemes like Jawahar Rozgar Yojana, Nehru Rozgar Yojana and DWCRA are to be re-oriented and restricted to make a forceful dent on the purchasing power of the lowest economic segments of the population. In all poverty alleviation programmes nutritional objectives shall be incorporated explicitly and the nutritional benefits of income generation shall be taken for granted.
• Public Distribution System
• Land Reforms
• Basic Health and Nutrition Knowledge
• Prevention of Food Adulteration
• Nutrition Surveillance: Nutrition surveillance is another weak area requiring immediate attention. The NNMB/NIN of ICMR needs to be strengthened so that periodical monitoring of the nutrition status of children, adolescent girls and pregnant and lactating mothers below the poverty line values place through representative samples and results are transmitted to all agencies concerned
• Monitoring of Nutrition Programmes: Monitoring of Nutrition Programmes (viz ICDS), and of Nutrition Education and Demonstration by the Food and Nutrition Board, through all its 67 centres 7 field units, should be continued.
• Communication: Communication through established media is one of the most important strategies to be adopted for the effective implementation of the Nutrition Policy.
• Minimum Wage Administration

32.4 Intervention Programmes to Combat Malnutrition

32.4.1 Integrated child development services (ICDS)

Integrated Child Development Services (ICDS) was launched in 1975. This programme is implemented by the Nodal Department i.e. the Department of Women and Child Development has been expended to 2765 projects up to December 1992. The package of services provided to the beneficiaries of the programme are supplementary nutrition, Immunization, Health check-up, Referral services, Non-formal pre-school education and nutrition and health Education. Supplementary nutrition is one of the major components of the programmes. The beneficiaries of the programme are children below 6 years, pregnant and lactating mothers and women in the age group 15-44 years. This programme supplements the health, nutrition and family welfare activities with appropriate cooperation and coordination between functionaries of the Health Department and nodal department.

32.4.2 Special nutrition programme

The special Nutrition Programme (SNP) was launched in the country in 1970-71. It provides supplementary feeding to the extent of about 300 calories and 10 gm of proteins to pre-school children and about 500 calories and 20 gm of protein to expectant and nursing mothers for 300 days a year. At present SNP is operated as a part of the Minimum Needs Programme in the various states.

32.4.3 Balwadi nutrition programme

The Balwadi Nutrition Programme (BNP) is being implemented SINCE 1970-71 through five national level voluntary organisations. The Central grant is given for supplementary feeding of children. It consists of 300 calories and 10 gm of protein per child per day for 270 days a year.

32.4.4 Wheat based supplementary nutrition programme

A centrally sponsored scheme called Wheat-based Supplementary Nutrition Programme (WNP) was introduced in 1986. This programme follows the norms of SNP or of the nutrition component of the ICDs. Central assistance for the programme consists of supply of free wheat and supportive costs for other ingredients, cooking, transport etc. At present around 3 million children and expectant and nursing mothers are covered under this programme.

32.4.5 Mid day meal programme

In 1956 the erstwhile Madras State launched a Prophylaxis programme of providing free meal to the elementary school children with a view to (a) enrolling poor children who generally remain outside the school due to poverty; and (b) to attract children to enroll themselves into school and to encourage regular attendance by providing supplementary nutrition.

32.4.5 Nutritional anaemia prophylaxis programme

Taking cognizance of this problem, the Government of India launched a Prophylaxis programme in 1970 to prevent nutritional anemia in mothers and children. Under the Programme, the expectant and nursing mothers as well as women acceptors of family planning are given one tablet of iron and folic acid containing 60 mg elemental iron (9180 mg of ferrous sulphate) and 0.5 mg of folic acid and children in the age group 1-5 years are given one tablet of iron containing 20 mg elemental iron (60 mg of ferrous sulphate and 0.1 mg folic acid) daily for a period of 100 days. This programme covered children and pregnant women with haemoglobin level less than 8 gm per cent and 10 gm per cent respectively.

32.4.6 Prophylaxis programme against blindness due to vitamin a deficiency

The programme was initiated by the Government in 1970. Under this programme children in age group 1-5 years are given an oral dose of 0.2 million I.U. of Vitamin A in oil every 6 months. During 1980, the Department of Food introduced a scheme of Fortification of Milk with Vitamin A to prevent nutritional blindness. At present there are 42 dairies in the country implementing this scheme.

32.4.7 Goitre control programme

A National Goitre Control Programme was initiated by the Government of India in 1962 to identify goitre endemic regions and to assess the impact of goitre control measure. The availability and production of iodized salt, strengthening of administrative machinery controlling the entry of non-iodized salt in the endemic regions have been recommended as measures to improve the implementation of the programme.

32.4.8 National diarrhoeal diseases control programme

The programme was launched in 1981 to reduce the mortality in children below five years due to diarrheal diseases through introduction of Oral Rehydration Therapy (ORT). The high priority accorded to the Programme is part of the package of services rendered under the MCH programme which was initiated during 1980-85 has now been strengthened extensively. The Anganwadi Centers of the ICDS Scheme have served as nucleus for the propagation of Oral Rehydration Therapy (ORT) which has been found to be an effective measure of preventing dehydration caused by diarrhea.

32.5 Function of the Food and Nutrition Board

The Food and Nutrition Board as reconstituted on 26 July 1990, advises Government, coordinates and reviews the activities. In regards to food and nutrition extension/education; development, production and popularization of nutritious. Foods and Beverages; measures required to combat deficiency diseases; and conservation and efficient utilization as well as argumentation of food resources by way of food preservation and processing.