Chapter 12 = National Nutritional Programmes and Role of Nurse ate Governments may also consider the S ing similar bodies, i.e. state coordi- and others. Many national health and nutrition aa eaniiien ie nutrition councils. surveys renortes that there have been steady natetassuch bodies at district level, but slow decrement have been found in and aswell as malnutrition, nutrient deficiency, mortality and morbidity. These as follows (Fig. 9), i pigh Tip ! of the National Nutritional Policy ere pasites that nutrition Is the backbone of une ep evlopiient. s country’ that malnutrition can be tackled at various plate ugh multispectral approach, As the series of activities in different sectors stifles oe loa, distribution, education, empow- je 008 Pre men and nutritional Surveillance, erence and indirect interventions were identi- goth i jed- | . Programmes Aimed to Improve the Nutritional status Applied Nutrition Programme NALNUTRITIONAL PROGRAMMES (10 ment of India has initiated several ve in nutrition on a national scale to mmsvrevent major nutritional problens | of PI ol OF National Nutritional Programmes weit owssotyoaenes | [come [ Applied Nutrition earn 8 Prophylaxis. Integrated Child Development |__ Programme gramme Services Scheme spec Nuiton ‘Anemia Mukt Bharat Suprlementary Nutiton | Seeaa perton bicrdore Comme tee yen Supplementation Weekly Iron Folic ‘Acid | | i Fig. 9: Classification of National Nutrition ProgrammesAPPLIED NUTRITION AND DIETETICS eggs, fish, milk, vegetables and fruitsand by means of health education to promote their consumption by mothers and children. The Applied Nutrition Programme is one of the longest single programmes assisted by UNICEF in many countries. In India it now covers 1,375 community development blocks and serves 1.7 million women and children. Special Nutrition Programme (SNP) Special Nutrition Programme was launched in the country in 1970-71. It provides supplementary feeding to the extent of about 300 calories and 10 grams of proteins to pre-school children and about 500 calories and 20 gram. 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. The nutrition component of the ICDS programme is funded by States and Union Territories from the SNP budget. At presents about 21.5 million beneficiaries are covered under this programme. Balwadi Nutrition Programme Balwadi Nutrition Programme (BNP) is being implemented since 1970-71 through five national level voluntary organizations. 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. Mid-day Meal Scheme In 1956, the erst while Madras state launched the mid-day meal programme of providing free meal to the elementary school children with a view to Enrolling poor children who generally remain outside the school due to poverty. © Giving one meal to the children attending the school. ‘The National Programme of Nutrition 4 provide primary education has been launched o 15" August 1995. The programme provides fro, lunches on working dafs for children in primary and upper primary classes in government ang government aided schools. Objectives | To improve nutritional status of the schoo) children. To attract children to enroll themselves into school. To encourageregular attendance by providing supplementary nutrition. inciples of Mid-day Meal Scheme ‘The meal should be supplemented and not substitute of the home diet. It should supply at least one ‘third of total energy and half of protein needs. 3 © Cost should be low and easy to prepare in schools © Locally available food should be used. © The menu should be changed frequently, In the year 2001, MDMS became a cooked mid. day meal scheme in which prepared mid-day meal was provided to primary school children with 300 calories of energy and 8-12 grams of protein per day for minimum 200 days. @ wooerann taxeaway © In drought affected areas, the mid-day meal is distributed in summer vacations also. Food grains (wheat and rice) are supplied free of cost @ 100 gram per child per school day. Cooked/processed hot meal is being served with a minimum content of 300 calories and 8-12 grams of protein each day of school for a minimum of 200 days.of food stuff distributed in daity Amon ideday meal program is depicted i, ander eal nie ‘Amount of Food Stuffin Daily Meal 3 BLE EE Ene) Cereals and millets 75 Pulses 30 ils and fats 8 Leafy vegetables 30 Non-leafy vegetables 30 he year 2004, scheme was revised where dation to free supply of food grains, revised a jand central asian for the following, hem Cooking cost at Rs 1 per child per scj Transport Rs 75/ quintal provision of mid-day meal durin vocations in draught affected area: hool day 8 summer Ss. 2006, scheme was further revised ag Cooking cost at Rs 1.80 per child per school day Nuwitional norms were revised for 450 is calories and 12 grams of. Protein 2007, scheme was further revised as Cover children of upper (class VI to VIII) "National programme of school” with 700 calories protein, Primary classes mid-day meal in and 20 grams of April 2008, scheme was further revised and pported under Sarva § hiksha Abhiyan, le of Nurse ‘The nurse acts as nutrition munity with the help of nu tool. Inschool health the nutritional Counselor in com- trition assessment Programme, thenurse assesses tatus of school children, ) Chapter 12 * National Nutritional Programmes and Role of Nurse Programmes Ai As a nurse advocate, she should convey the information Telated to nutrition to the teachers, parents and children. AS a planner, she should plan the weekly menu for the school children, She should supervise the cooking of mid-day meal. To assess and refer th '€ cases of severe- malnutrition, Plan and organize the hi Programmes on nutri and their parents, ealth education ition for school children * To maintain the school health Tecords, med at Specific Deficiency Diseases Vitamin A Prophylaxis Programme Vitamin A Prophy in 1970 by the Welfare. I Severe problems, later it Country. Under this Progra months to 6 years were to be dose of Vitamin A at 6 mont months intervals, vylaxis Programme was launched Ministry of Health and Family it was started with Seven states with was extended to the imme, children aged 6 e administered a mega thly intervals, Objective To reduce diseas es and preventin, due to Vitamin g blindness A deficiency, '€ Commonness of Vitamin A deficiency from current 0.6% to< 0.5%. Children between 3 years. In 2007, it it has been children 9 month: Tevised to cover S to 5 years, Programme Strategy The programme focuses on two methods (Fig. 10).APPLIED NUTRITION AND DIETETICS Treatment of Vitamin A” deficiency deficiency, Fig. 10: Programme Strategy for Vitamin A Prophylaxis Prevention Strategy has Long Term and Short Term Intervention Programme © Long term intervention To provide health and nutrition educa- tion, to encourage colostrum feeding and exclusive breastfeeding for the first six months. The introduction of complementary feeding thereafter and adequate intake of Vitamin A rich foods. © Short term intervention Massive doses of Vitamin A must be administered at periodic intervals to preschool children. Prophylactic Vitamin A as per the following dosage schedule: 100000 IU at 9 months with measles immunization. 200000 IU at 16-18 months, with DPT booster. 200000 IU every 6 months, up to the age ~ of Syears. Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years. Treatment of Vitamin A deficiency All those children are suffering from xerophthalmia are to be treated at health facilities, given 1 dose of Vitamin A if they have not received it in the previous month. © Single oral dose of 200000 IU immediately after diagnosis. ¢ Follow up dose of 200000 IU, 1 to 4 weeks after. Age wise Vitamin Adoses is depicted in Table 4 TABLE 4: Age Wise Vitamin A Doses Age Pee ‘9 months 100000 1u 15 months 200000 1u every 6 months, up to the age of S years * 200000 1U 3 doses are to be given from 9 months of * Total 9 meg age up to 5 years: Role of Nurse ‘The nurse should identify the under 5 chi. dren under the age of 5 of that area. ‘She should prepare a plan of action for them, She can act as nutrition counselor in com. munity with the help of nutrition assessment tool. Ensure the supply of Vitamin A solution, Administer the Vitamin A solution to age group (9 months to 5 years). Supervise and monitor in the field. Promote exclusive breast feeding for new- borns in mothers. Ensure adequate intake of sources of Vitamin Ain children Health education to community regarding the Vitamin A rich food and importance of breast-feeding. © Regular monitoring of services to watch the progress of programme. © Submission of report to authorities or con- cerned medical personnel time to time, National Nutritional Anemia Prophylaxis Programme This programme was launches by Ministry of Health and Family Welfare for the prevention of nutritional anemia in ‘mothers and children in 1970. Currently, the National Nutritional Anemia Prophylaxis Programme is operated as part oftive child health (RCH) programme duct 4 rel ee revised policy. ef jor OC Tget_group has been expanded to phe tar phe ude g-12 months, -school sien 6-10 infants jd -adolescents 11-18 years of age, nd a years 2 ye cally found to be anemic. nica a active ' ject" the prevalence and incidence of decrenwn men of reproductive age, pregnant/ emia i vothers and preschool children, ati et Group . oe aiciaried Of the programiie are: en ey ‘en of reproductive age, pregnant and ‘Wom lactating meters ears ool children 1-5 year | Women who take family planning measure Mehas IUD and tubectomy su agramme Strategy main strategies of the programmeare as low: enessfor the Intake of Iron Rich Foods: patscenr gtivanid dilareat ret 5 years of te cena ond lactating mothers should i Jeouraged to take iron and folic acid rich io such asgreen leafy vegetables, sprouted ulses and animal food on regular basis, The Jniamin C enbarices-the absorption of Iron. Regular consumption of amla, guava,orange and green mango must be encouraged. Promotion of Intake of Iron and Folic Acid Supplements to High Risk Group: All Pregnant women anemic or non-anemic, Preschool children and adolescent gi irls must be given iron and folic acid supplements on priority basi Recommended Doses * Forinfants and children, having 20 mg elemental iron and 100 mes folic acid per ml, should be made available, Dosage for various age grou * Children 6-59 months: 20 mg elemental iron + 100 ug folic acid for 100 days if the child is clinically found to be anemic. aliquid formulation PS is as follows, 100 days, The programme also aimed to include health and nutrition education to improve dietary intakes and e, and folic acid rich fo, ods as well as food items that help iton absorption, overall, Age wise daily doses ofiron is depicted in Table 5.APPLIED NUTRITION AND DIETETICS. TABLE S: Age Wise Daily Doses of Iron Infants and Children 20mg family planning; Programme Implementation © At PHC level. it is the responsibility of the health workers to distribute the iron and folic acid tablets Anemia Mukt Bharat National Nutritional Anemia Prophylaxis Programme (NNAPP) was started in 1970 as and evolved in 2018 as Anemia Mukt Bharat. The reduction of anemia is one of the important objectives of the POSHAN Abhiyaan launched in March 2018. Anemia Mukt Bharat strategy has been designed to reduce prevalence of anemia by 3 percentage points per year among children, adolescents and women in the reproductive age group(15-49 years), between the year 2018 and 2022. al High Tip The prevalence of anemia across all ages has been more than 50% amongst the vulnerable groups in India and in the last 10 years, the percentage point reduction of anemia prevalence has been extremely low in most age groups. 6x6x6 Strategy 6x6x6 strategy of Anemia Mukt Bharat 6x6 is depicted in Table 6. 100 mgs per mi 2 Children 6-59 months 20 mg 100 mg folic 100 Children 6-10 years 30mg 0.250 mg 100 4a Adolescents and Adults 100 mg 0.500 mg, 100 S. Pregnant women prophylactically - 1 tablet of 100mg 0.500 mg, 100, 6. Pregnant women —Anemic 2tablet of 100mg ——-0.500 mg 100 7. Lactating mothers and acceptors of 100mg 0.500 me 100 Fig. 11: Logo of Anemia Mukt Bharat institutional mechanisms Fig. 12: 6x6x6 Strategyrat 6x6 Approach pvemia Mukt Bh: c t ¢ ous Interventions | E 5 Z acaty oe ths) * Prophylactic iron and folic acid ‘mon (6-59 SE eee ‘© Intra-ministerial ‘coordination, ” ‘supplementation * National Anemia Mukt Bharat else? (5-9 veRrs) ils © Deworming unit aqtereZent boys and Bi Intensified year round behavior ® National Centre of Excellence and oer iafane change communication (BCC) Advance Research on Anemia 0 of reprodu and delayed cord clamping after Control (NCEAR) wera years) (0-6 months) delivery. * Convergence with other ering women ( © Testing and treatment of anemia ministries tate ant women of pregnant women and school Strengthening supply chain and ee Boing adolescents logistics. * Mandatory provision of ron and» anemia Mukt Bharat dashboard folic acid fortified food in govt. and digital portal:one stop shop funded health Programmes on anemia. © Intensifying awareness, screening, and treatment of Non-nutritional causes of anemia in endemic Pockets, with special focus on malaria, ® - Setting up programme Management un; tion Plan Roles Units for tine testing and treating of adolescent oma eastatnationalandstatlone : ; as and boys in government and govern. Denominator and HMIS based quarterly . t aided schools (through RBSK) and Progress reports and awards. en in . i See oromen (ANC clinics), Dedicated AMB dashboard and portal (www, eS cord clamping, anemiamuktbharat info), yet . cae from 100 mg to 60 mg elemental iron Strengthening programmes to address non. in prophylactic dose of elemental iton for eden LaSes Of anemia with special vomen and adolescents. The IFA tablets wit aoe sen cinkage with malatia, uoroen and " coal haemoglobinopathies, be suf . e i * Mandating use of fortified food in public aasblishmentofnationalceneotexellenc veil eee a and advanced research on anemia control : at ia Insti fal tes special focus on use of double fo rtified salt - All India Institute of Medical Sciences iodine and tron. : (AIMS), New Dethi, P 4 ° State institute: Useafinvasive digital methods othemoglabin Nes of excellence and advanced ‘ t Tesearch on anemia contro! . estimation and point of care treatment. ‘ . . ing intravenous iron sucroseyterie ° ating a Jan Andere through intensive - tri sche Using inte 4 - Communication and newly developed com. se for , Boas : : carboxy maltose oF management 9 munication material and communication ac. moderate/ severe anemia, tivities, Special focus on newly-wed women aged 20-24 years. Covering private schools in addition to sovernment/government aided schools, Targes of Anemia Mukt Bharat Targets of Anemia Mukt Bharat 2022 is depicted in Fig. 11,Bharat 6x6 Approach months) Chapter 12 * National Nutritional Programmes and Role of Nurse ECE Prophylactic iron and folic acid © Intra-ministerial coordination mo (59 supplementation National Anemia Mukt Bharat at aren (5-9 VO ‘and girls Deworming i unit 4 escent DOYS Intensified year round behavior National Centre of Excellence and iy yea) Fe iclive o8e change communication (BCC) ‘Advance Research on Anemia (ude enof repro and delayed cord clamping after Control (NCEAR) be) years) (0-6 months) delivery : © Convergence with other erating women * Testing and treatment of anemia ministries wip gnant wore of pregnant women and school Strengthening supply chain and i going adolescents logistics, * Mandatory provision of iron and © Anemia Mukt Bharat dashboard folic acid fortified food in govt and digital portal:One stop shop funded health programmes on anemia, * Intensifying. awareness, screening and treatment of non-nutritional causes of anemia in endemic Pockets, with special focus on malaria, e jon Plan tine testing and treating of adolescent Ei andl boys 48" govecruneneadta govern- ae aided schools (through RBSK) and pregnant women (ANC clinics), pelayed cord clamping. switch from 100 mg to 60 mg elemental iron in prophylactic dose of elemental iton for women and adolescents. The IFA tablets will be sugar coated. Mandating use of fortified food in public health programmes, Special focus on use of double fortified salt - jodine and iron. r Use ofinvasive digital methods ofhemoglobin estimation and point of care treatment, Using intra-venous iron carboxy maltose for moderate/ severe anemia. Special focus on newly-wed women 20-24 years, Covering private schools in addition to government/government aided schools, sucrose/ferric management ~ of aged atnational and stat Denominator and HMIS b; Progress reports and awards, Dedicated AMB dashboard and anemiamuktbharat info), elevels, ased_ quarterly Portal (www, New Delhi. State institutes of excellence and advanced Tesearch on anemia control, Creating a Jan Andolan through intensive communication and newly developed com. munication material and communication ac. tivities. Targes of Anemia Mukt Bharat Targets of Anemia Mukt Bharat 2022 is depicted in Fig. 11. dgJON AND DIETETICS APPLIED NUTRIT! CHILDREN 6-69 MONTHS, er Oa) Cy Pers ADOLESCENT, BOYS 15-19. YEARS Pee nli iy Auer) ADOLESCENT GIRLS 15-19 yg, eae eae Prt mere) WOMEN OF REPRODUCTIVE AGE ir Pn ayes Nae ANMAU oN) LACTATING WOMEN Cees EG) © Assessment of vulnerable group. Identify the antenatal, postnatal mothers and under five children of that particular area for further care. © Deworming in the areas of heavy manifesta- tion. ‘ © Provide the adequate supply of Iron and folic acid to the needy persons. Monitoring of cases effectively. Refer the severe anemic cases to concerned health care facilities, * Plan and organize the health education programme for general public with emphasis oniron rich foods. * Advocate the role of Vitamin C in enhance- ment of iron absorption. Se bye Targets of Anemia Mukt Bharat. * Maintain the accurate records of cases ang their progress. Timely and regular follow up of cases, © Tomaintain the school health records, National lodine Deficiency Disorders Control Programme Jodine is an essential micronutrient with an average daily at 100-150 micrograms for normal human growth and development. al High Tip It is estimated that more than 71 million persons are suffering from goiter and other iodine deficiency disorders. Government of India launched a 100 per cent centrally assisted- National Goitre ControlGCP) in 1962. In August 1992, named as National lodine Control Programme (NID- Jiew of wide spectrum of iodine ith ‘yeorders like mental and physical scene Dee lantiaen! cretinism, stillbirths, ardations orion mofthe Programme t mize commonness of IDD 2 5% and ; Oe consumption of adequately iodized ai pm) atthe domestic level, It pjectives of the Programme ives of the programme are depicted in pjectiv g. 14. check the ps Deficiency Disorders in the district & supply of iodized salt To conduct the survey to assess the impact of iodized salt after every 5 years, Laboratory monitoring of iodized salt and urinary iodine excretion Awareness programmes for health education and publicity aT Fig. 12: Objectives of NIDDCP arget Group ‘The programme covers the entire population, especially women in. child bearing age and young children. nplementation strategy Jodine is an essential micronutrient required daily at 100-150 micrograms - for normal human growth and development. Deficiency of todine can cause physical and mental retardation, abortions, cretinism, stillbirth, deaf-mutism, squint & various types of goiter. It has been found th: Iodine Deficiency Dis. fat the occurrence of than 5%, orders (IDDs) is more ‘The programme is being implemented in all the States/UTs for entire population. Goiter Rate (TGR) in the entire country is reduced significanth Production of iodized salt also increased to 65.00 lakh MT. \ ‘The consumption of adequately iodized salt at household level has been increased from. 51.1% (as per NFHS It report 2005-06) to 71.1% (as per CES Teport, 2009). Role of Nurse Assessment of children wit deficiency disorders, Tdentify the children from school and community with signs and symptoms of iodine deficiency. : Provide the adequate supply of iodized salt to the needy people. th goiter andiodine Monitoring of cases effectively, Refer the cases to concerned health care facilities. Plan and organize the health education Programme for general public with emphasis on iodine rich foods. Creating the awareness among general public Tegarding high risk groups(infants pregnant and lactating women) iodized salt for them. Educate the public about the importance of proper storage of iodized salt. Advocate the household consumption of iodized salt, and importance of Maintain the accurate records of cases and their progress.APPLIED NUTRITION AND DIETETICS © Timely and regular follow up of eas © bvaluation of IDD programme periodically through community survey, Others Nutritional Disorders Integrated Child Development Services Scheme Integrated Child Development Service (ICDS) Scheme was launched on October 2nd, 1975. Itwas brought for providing supplementary nutrition, immunization and pre-school education to the children. It is one of the world’s largest programmes to provide an integrated package of services for the entire development of a child. It is a centrally funded scheme executed’ by state governments and union territories. Objectives of ICDS Objectives of ICDS are as follows (Fig. 15). Improve the nutrition ‘and health status of children in the age group of 0-6 years Lay the foundation for proper psychological, physical and social development of the child a —— Effective coordination I and implementation of policy ‘among the various departments; Enhance the capability ‘of the mother to look after the normal health and nutrition needs through proper nutrition and health education Fig. 15: Objectives of ICDS Beneficiaries of ICDS ¢ Children below 6 years ¢ Pregnant and lactating women Women In the age group of 15-44 yearg Adolescent gitls in sclected blocks a, Add on Services of ICDS «Convergence of other supportive services lige water supply, sanitation, etc. Pre-school education of children inthe age grou, of 3-6 years. : Nutrition and health education to women, Treatment of minor illnesses. Referral services, health check-ups and immunization. «Supplementary nutri acid Se ee Programme Implementation viz. n, Vitamin-A, fron and fog e he three services immunization health checkup and referral services. arg related to health and are provided throu, National Health Mission and Public Heal, Infrastricture in Anganwari Centers throug, Anganwari Workers (AWWs) and Angenwari Helpers (AWHS) at a basic level. Role of Nurse in ICDS Assessment of beneficiaries and their ero). ment in Anganwaris. Identify the children from school ang community, adolescent girls and pregnant and lactating mothers. 5 © Ensure that the adequate supply of mitrition is being provided by the anganwaris. © Plan and organize the health education progrmme for beneficiaries. © Creating the awareness among general public regarding high risk groups(infants, pregnant and lactating women). © Supervise the health assessment and educa- tion programme for children. ¢ Supervise the accurate records of immuniza- tion, enrolled preschool children in angan- ° waris.he compliance of daily menu dis- the neck in Anganwaris, aye a ntary Nutrition Programme jee! tary Nutritional Programme sure trovides hot meals along with take- (SNP) PRY ‘ ete number of rations and meals ee pends on their malnutrition receive Jevels. ovided for 300 days at the rate of Rs 8 ae pe children and Rs 9.50 for pregnant yer day se Prdlactatingmothers. an" orely malnourished children are allocated sae per day. Adolescent Girls (11-14 years M cofschool) are allocated Rs 9.59 por day. phere is a provision of one Anganwari Centre i for a population of 400-809, jshori Shakti Yojana ‘The scheme for adolescent girls was put into operation with effect from 1st November 1991 a now renamed as Kishori Shakti Yojna in the year 2010. ® IMPORTANT TAKEAWAY ne target group of this scheme was adolescent girls he the age group of 11-18 year | The broad objective of the scheme was to advance the nutritional, health and develop- ment status of adolescent girls, support increasing knowledge of health, hygiene, nutrition and family care and to integrate them with opportunities for learning life skills, going back to school, helping girls grow to understand their society and become prolific members of the society. » Common services « , Watch over menarche «Immunizations General health chee! six- months, ‘cups once in every. ‘Training for minor ailments Deworming Prophylactic measures against anemia, Bolter, vitamin deficiency, etc, : Referral to primary health center/distriet hospital in case of acute need, Birls and boys. ° WIFS is evidence based Programmatic *sponse to the prevailing anemia situation ronsst adolescent girls and boys through Supervised weekly ingestion of IFA supple. mentation and biannual helminthes control, Objective of WIFS © To reduce the prevalence and severity of anemiaiin adolescent population (10-19 years), © To ensure administration of TFA tablet once Per week and Albendazole twice a year for de-worming, To inform adolescent boys and girls of the correct dietary practices for increasing iron intake. To disseminate information on preventing worm infestation among adolescences and encourage adoption of correct hygiene practices, including use of footwear to prevent worm infestation. Target groups of WIFS © School going adolescent girls and boys in 6th to 12th class enrolled in government/ government aided/municipal schools. © Outof school adolescent girls.APPLIED NUTRITION AND DI! Diss © = Administra © Screening of ¢ Biannual Al High Tip JETETICS interventions of WIFS ition of supervised weekly Iron- folie acid supplements of 100 mB iron and 500 ug folic acid for 52 weeks in a year, on @ fixed day preferably Monday’ get groups for moderate/ anaemia and referring these cases to health facility. (administration of | of worm severe an appropriat deworming Albendazole 400 mg) for contro infestation. i ‘emination of information on nutrition and counseling for improving dietary intake and for taking actions for prevention of m infestation. intestinal wor! Current Status of WIFS «The programme has been rolled out in all states/UTS. < The programme covers 11.2 core beneficiaries including 8.4 crore in-school and 2.8 crore out of school beneficiaries. Role of Nurse in WIFS ups. adolescent girls class enrolled aided/ ‘Assessment of vulnerable gro Identify the school going and boys in 6th to 12th in government/government municipal schools from community. ‘Also identify the out of school adolescent . girls. Deworming in the areas of heavy manifesta- tion. Provide the adequate supply of iron and folic acid to the needy people Monitoring of cases effectively. Refer the severe’anemic cases health care facilities. Plan and organize the health education programme for general public with emphasis on Iron rich foods Advocate therole ofvitamin Cin enhancement of|ron absorption. to concerned Maintain the accurate record their progress, § OF casey Timely and regular follow up of, “ Also maintain the school health reer Tecordy Malnutrition is wi Nutritional ‘iotione eae in India etary practices, limited st Sa) tions, large families, decreased no” ine tm andereppton Pe ; ition problems in Indi classified in four broad grou; He energy malnutrition, Tice ie. Protein, ciency disorders, chronic dise: men aes eating disorders eee Protein energy malnutrition i; to describe clinical Siotien q miu deficiency of protein and ene ne from occurs in preschool children and. i the main cause of it. en Kwashiorkor is a debilitatin, threatening condition caused oy feet m protein in the diet ye ltk of The main causes of LBW ai small for gestational age ofan Pith oe The factors may lead to LBW are you multiples pregnancies, poor riitlion” ioe disease or hypertension, drug addic ie best insufficient potential care. . neu These are silent diseases of vitami mineral deficiencies affecting people ra ages and genders. Important micronut is a are Iodine, Iron, Zink, calcium, sel oe fluorine and all vitamins. oe Iron deficiency Anemia is caused insufficient dietary intake and absorp iron, or iron loss due to bleeding. 7 The Iron rich foods are meat, eggs, leafy green vegetables and iron fortified foods. India is one of the major endemic iodine deficiency disease countries. 1 other Mostly thea ig