Programmes

Nutrition

Gujarat is home to more than 60 million people and often called India’s growth engine. Undoubtedly, it is better positioned compared to many other states in terms of economy, infrastructure, industrialization and governance. However, it is still waging a battle against under nutrition, which remains high and staggering, according to large-scale community-based surveys, such as NFHS-3, 2005-06, NNMB (2007-08).

High prevalence of under-nutrition and nutritional deficiencies in women and children, especially among children (< 3 years of age), is a matter of concern for the state. Poor feeding leading to Protein Energy malnutrition (PEM) and faulty caring practices as reflected by the health and nutrition indicators (NFHS3), appear to be the underlying cause of under-nutrition. A mismatch between the availability of food and good nutrition hence underlies as a major cause of malnutrition in Gujarat. The major group vulnerable to malnutrition are women of child bearing age (15 – 44 years) especially those who are pregnant or nursing; and young children (up to 59 months of age).

Government of Gujarat (GoG) has implemented several measures new initiatives during last few years to overcome the problem of malnutrition. However, a need has been felt to mitigate the problem of malnutrition through an integrated inter-sectorial holistic approach covering various interventions across various sectors and departments. In order to improve the current status of nutrition, it was felt that the preventive and curative strategy needs to be very carefully evolved keeping in view various stages of desirable interventions namely adolescence, 9 months of pregnancy to first two years of age (critical 1000 days) and for children up to 6 years.

Programmes under SNC

Mamta Abhiyan

Since early 2007, this joint four-pronged health and nutrition service delivery strategy is operational. It includes the following components:

  • Mamta Divas (Village Health and Nutrition Day): This is a monthly fixed day fixed site joint nutrition and health delivery strategy implemented in each village. Along with routine immunization, services such as micronutrient supplementation (IFA, Calcium, Vitamin A and iodine through free 1.5 kg of iodized salt for all pregnant and lactating mothers), Hemoglobin test for the pregnant woman at the time of registration and also in the 6th and the 8th month, counseling are provided by health and Anganwadi workers. Additionally growth monitoring for children under-three ever quarter is carried out by health/ICDS supervisors
  • Mamta Mulakat (Post Natal Care Home Visit)
  • Mamta Sandarbh (Referral and Services)
  • Mamta Nondh (Record and Reports)

National Iron Plus Initiative (NIPI)

Anemia, a manifestation of undernutrition and poor dietary intake of iron is a serious public health problem among pregnant women, infants, young children and adolescents. NFHS III data reflects a higher prevalence of anemia (among children and women in reproductive age) in our country.

Taking cognizance of ground realities discussed above, the Ministry of Health and Family Welfare (GOI) took a policy decision to develop the National Iron+ initiative. This initiative will bring together existing programmes (IFA supplementation for pregnant and lactating women and children in the age group of 6- 60 months) and introduce new age groups. Thus National Iron+ Initiative will reach the following age groups for supplementation or preventive programming through a Life Cycle Approach:

SNC Organogram
  • Bi- weekly iron supplementation for pre-school children 6 months to 5 years.
  • Weekly supplementation for children from 1st to 5th grade in Govt & Govt Aided schools
  • Weekly supplementation for out of school children (5-10 years) at Anganwadi Centers
  • Weekly supplementation for adolescents (10-19 years)
  • Pregnant and lactating women
  • Weekly supplementation for women in reproductive age

An anemia supplementation program across the life cycle is proposed in which beneficiaries will receive iron and folic acid supplementation irrespective of their iron/hb status. The age specific interventions are based on WHO recommendations, synthesis of global evidence on IFA supplementation and the recommendation of national experts.

Facility Based Management of Severe Acute Malnourished Children

Children with Severe Acute Malnutrition (SAM) are at higher risk of mortality and morbidity due to common childhood illnesses as they have reduced immunity and in some cases deranged metabolic system .Severely Acute Malnourished children contributes significantly to deaths in children under the age of five years. In order to tackle this problem, facility based management of Severe Acute Malnourished (SAM) children has been started in CMTCs and NRCs across the state.

  • The Child Malnutrition Treatment Center as "Bal Sewa Kendra" at PHC/CHC/ Sub District level for malnourished children needing some medical care. Under this program malnourished children with some medical needs are enrolled residentially in the CHC/ Sub District level hospital for 21 working days were they are provided 6-8 times supervised diet + micronutrient supplementation and medicines. During this period mother's of malnourished children are also provided wage loss compensation for the period they stay in the facility
  • Nutrition Rehabilitation Center as "Bal Sanjeevani Kendra" at District Hospital/ Medical College for malnourished children with significant medical care. Under this program malnourished children with significant medical needs are enrolled residentially in the District level hospital or Medical College for 21-25 working days were they are provided 6-8 times supervised diet + micronutrient supplementation and medicines. During this period mother's of malnourished children are also provided wage loss compensation for the period they stay in the facility.

National Programme for Prevention and Control of Fluorosis (NPPCF)

Fluorosis, a public health problem, is caused by excess intake of fluorides through drinking water/food products/ industrial pollutants, over a long period. It results in major health disorders like dental Fluorosis, skeletal Fluorosis and non-skeletal Fluorosis besides inducing ageing. Based on excess level of fluoride content in number of districts, the States/UT’s have been classified as mild, moderate and severe endemic States/UT’s of Fluorosis. A total of 100 districts from 17 States have been identified as affected and Gujarat is one of them.

Goal

To prevent and control Fluorosis in the country

Activities
  • Community diagnosis of Fluorosis village/block/cluster wise
  • Facility mapping from prevention, health promotion, diagnostic facilities, reconstructive surgery and rehabilitation point of view- village/block/district wise
  • Gap analysis in facilities and organizations of physical and financial support for bridging the gaps, as per strategies
  • Diagnosis of individual cases and providing its management
  • Public health intervention on the basis of community diagnosis
  • Behavior chance using IEC

In Gujarat NPPCF is running in three districts, Jamnagar, Sabarkantha and Vadodara. Staff engaged includes –district consultant, laboratory technician and field investigator.

Vitamin A Supplementation (VAS)

Vitamin A is an important micronutrient for maintaining normal growth, regulating cellular proliferation and differentiation, controlling development, and maintaining visual and reproductive functions. Diet surveys have shown that the intake of Vitamin A is significantly lower than the recommended daily allowance in young children, adolescent girls and pregnant women. Vitamin A supplementation program for children 9 months to 5 years is done through biannual round. First dose is given along with measles at 9 months of age regularly during the Mamta Day. Doses 2 to 9 are supplemented biannually upto 5 years of age in the months of February and August.

National Iodine Deficiency Disorder Control Programme (NIDDCP)

In India, to combat Iodine deficiency disorders, National Goiter Control Programme (NGCP) was launched in 1962 which was later renamed as The National Iodine Deficiency Control Programme (NIDDCP). In Gujarat State, the IDD control program was first introduced in Bharuch District in 1982 followed by Valsad and some talukas of Vadodara districts in 1988. In 1994, the entire State was covered under NIDDCP.

Major roles of IDD cell
  • Establishment of IDD monitoring laboratories
  • Health education and publicity
  • Salt testing in the community using STK (Spot Testing Kit)
  • IDD surveys

Gujarat has a fulltime functional State IDD cell which is a part of the State Nutrition Cell. Gujarat’s IDD cell consists of one Technical Officer, one Statistical Assistant, two Laboratory Technicians and one clerk.


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