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Rural HealthRural HealthMukesh VatsMukesh Vats

Topics coveredTopics covered• IntroductionIntroduction• Food, nutrition and relation with healthFood, nutrition and relation with health• Nutritional status of rural IndiaNutritional status of rural India• Key issues related to nutritionKey issues related to nutrition• Macronutrients Macronutrients

– CarbohydratesCarbohydrates– ProteinsProteins– FatsFats– WaterWater

• MicronutrientsMicronutrients– VitaminsVitamins– mineralsminerals

• Nutrition related issues of rural womenNutrition related issues of rural women

Topics covered Topics covered (contd..)(contd..)

• Nutrition related issues of rural Nutrition related issues of rural childrenchildren

• Planning nutrition for rural indiaPlanning nutrition for rural india• Simple techniques to get Simple techniques to get

nutrientsnutrients• Mid day meal schemeMid day meal scheme• Nutrition and organic farmingNutrition and organic farming• Role of schools & parentsRole of schools & parents• Role of governmentRole of government• Way aheadWay ahead

INTRODUCTIONINTRODUCTION

• Nutrition is widely ignored problem when we Nutrition is widely ignored problem when we discuss the issues related to rural discuss the issues related to rural development.development.

• The nutrition directly affects the health of the The nutrition directly affects the health of the rural masses thereby has a direct role in rural masses thereby has a direct role in productivity of human resources .productivity of human resources .

• The nutrition in rural context is also The nutrition in rural context is also important from the point of view that the important from the point of view that the entire sources of nutrition come from rural entire sources of nutrition come from rural areas and the rural people are most deficient areas and the rural people are most deficient in the nutritional status.in the nutritional status.

• The rural women folk is mostly suffering The rural women folk is mostly suffering from nutritional problems and need more from nutritional problems and need more attention.attention.

Food, Nutrition and Relation with Food, Nutrition and Relation with HEALTHHEALTH

• We define food as anything that provides We define food as anything that provides nourishment to the body.nourishment to the body.

• Food is important for sustaining the life itself.Food is important for sustaining the life itself.• Food has nutritional and non nutritional Food has nutritional and non nutritional

components.components.• The various function of food are,The various function of food are,

1.1. Providing energyProviding energy2.2. Body buildingBody building3.3. Building resistanceBuilding resistance4.4. Regulating body functionsRegulating body functions

• Other than the above bio chemical functions, Other than the above bio chemical functions, the food is also performing social and the food is also performing social and psychological functions.psychological functions.

Food, Nutrition and Relation with HEALTH Food, Nutrition and Relation with HEALTH (contd..)(contd..)

• We wonder how the food can perform non We wonder how the food can perform non bio-chemical functions. Can we recollect the bio-chemical functions. Can we recollect the joy of having same food at picnic or during joy of having same food at picnic or during holi festival ! We know the satisfaction holi festival ! We know the satisfaction derived by a mother when her child likes the derived by a mother when her child likes the food prepared by her and eats it properly.food prepared by her and eats it properly.

• Nutrition is nothing but the study of food Nutrition is nothing but the study of food after consumption.after consumption.

• Our body requires the micro and macro Our body requires the micro and macro nutrients in specific quantity.nutrients in specific quantity.

• Therefore it is not only important to have all Therefore it is not only important to have all nutrients but also in correct quantity.nutrients but also in correct quantity.

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•During Vedic period the food was classified into During Vedic period the food was classified into three categories i.e. three categories i.e. rajsik, tamsikrajsik, tamsik and and satviksatvik..•The nutritional value of the food is sometimes The nutritional value of the food is sometimes linked to the market price of the food. It is linked to the market price of the food. It is incorrect to do so. The cheaper source of food incorrect to do so. The cheaper source of food could be much nutritious than the costly fast could be much nutritious than the costly fast food. The fresh guava provides better nutrient food. The fresh guava provides better nutrient than a stale apple.than a stale apple.•Rural set up in India provides better avenues Rural set up in India provides better avenues for having cheaper nutrients .for having cheaper nutrients .•Proper design of meals can offer economical Proper design of meals can offer economical solutions if local needs and traditions are taken solutions if local needs and traditions are taken into consideration.into consideration.

(contd..)(contd..)

• The concept of health not only includes the The concept of health not only includes the physical health but also the mental health physical health but also the mental health and spiritual health.and spiritual health.

• Though the nutrition takes care of the Though the nutrition takes care of the physical health and to some extent the physical health and to some extent the mental health, it can not deal with the mental health, it can not deal with the spiritual health, which, however, should not spiritual health, which, however, should not be confused with the religious practices.be confused with the religious practices.

NUTRITIONAL STATUS IN RURAL INDIANUTRITIONAL STATUS IN RURAL INDIA

• The nutritional status refers to health The nutritional status refers to health issues related to proper or improper use issues related to proper or improper use of nutrition.of nutrition.

• The nutritional status is determined by The nutritional status is determined by study of diet pattern, study of illness study of diet pattern, study of illness suffered in the past and some suffered in the past and some pathological tests.pathological tests.

• In case of studies related to populations, In case of studies related to populations, the statistical techniques are used for the statistical techniques are used for determining the nutritional status.determining the nutritional status.

• Some facts about nutritional status of Some facts about nutritional status of rural india will be discussed now.rural india will be discussed now.

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• More than 20% rural children suffer from More than 20% rural children suffer from malnutrition.malnutrition.

• About 40% children under five years are About 40% children under five years are underweight.underweight.

• Underweight among children is associated Underweight among children is associated with illiteracy of their mothers.with illiteracy of their mothers.

• Schedule tribe children have lowest Schedule tribe children have lowest nutritional status.nutritional status.

• Highest number of children with low birth Highest number of children with low birth weight are in India.weight are in India.

• About 60% children are anaemic and about About 60% children are anaemic and about 50% have access to iodized salt.50% have access to iodized salt.

Malnutrition –a common problem of rural Malnutrition –a common problem of rural IndiaIndia

Key issues related to nutrition Key issues related to nutrition

• Under nourished children can not become Under nourished children can not become healthy citizens and will add to problems for healthy citizens and will add to problems for rural India.rural India.

• Resources meant for development will have Resources meant for development will have to be diverted for providing good health.to be diverted for providing good health.

• The problem is generally not visible and not The problem is generally not visible and not covered by press etc.covered by press etc.

• Poor nutritional status of mother affects the Poor nutritional status of mother affects the children also.children also.

• The illiteracy is attributed to be the root The illiteracy is attributed to be the root cause of all the problems.cause of all the problems.

(contd..)(contd..)

• Breast feeding of new born is still not Breast feeding of new born is still not followed in some sections of society, which followed in some sections of society, which can reduce infant mortality.can reduce infant mortality.

• Colostrum provided to the infant by breast Colostrum provided to the infant by breast feeding ensures natural immunization.feeding ensures natural immunization.

• Iron deficiency and mineral deficiency is very Iron deficiency and mineral deficiency is very common among rural women and children.common among rural women and children.

• Vitamin A deficiency is affecting vision of Vitamin A deficiency is affecting vision of children in rural areas.children in rural areas.

• Iodized salt is still not so popular, resulting Iodized salt is still not so popular, resulting in Iodine deficiency whichin Iodine deficiency which causes hormone causes hormone related problems like mental retardation.related problems like mental retardation.

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• The girls of growing age requires folic The girls of growing age requires folic acid supplements along with iron acid supplements along with iron supplement.supplement.

• The nutritional status of the pregnant The nutritional status of the pregnant women and lactating mothers in rural women and lactating mothers in rural areas is cause of concern.areas is cause of concern.

Should we ignore this ???Should we ignore this ???

Macronutrients - CarbohydratesMacronutrients - Carbohydrates

• The carbohydrates are the major components The carbohydrates are the major components of food and classified as organic compounds.of food and classified as organic compounds.

• The carbohydrates are made up of three The carbohydrates are made up of three elements i.e. carbon, hydrogen and oxygen.elements i.e. carbon, hydrogen and oxygen.

• All plant based foods are sources of All plant based foods are sources of carbohydrates.carbohydrates.

• The plant based carbohydrates are further The plant based carbohydrates are further classified as available or non available.classified as available or non available.

• The human digestive system can not digest all The human digestive system can not digest all types of carbohydrates therefore some are types of carbohydrates therefore some are classified as non available i.e. fibres.classified as non available i.e. fibres.

(contd..)(contd..)

• The various sources of carbohydrates are The various sources of carbohydrates are 1.sugar (gur, cane sugar or honey) 1.sugar (gur, cane sugar or honey) 2.cereals(wheat, rice, barley, pulses, millets)2.cereals(wheat, rice, barley, pulses, millets)

3.roots(potato, tapioca)3.roots(potato, tapioca)

4.fruits(banana, mango etc.)4.fruits(banana, mango etc.)

• The above list is only indicative, almost all The above list is only indicative, almost all fruits, vegetables are sources of carbohydrates.fruits, vegetables are sources of carbohydrates.

• Carbohydrates are not temperature sensitive.Carbohydrates are not temperature sensitive.• The carbohydrates can be stored for a long The carbohydrates can be stored for a long

time without deterioration in quality.time without deterioration in quality.

Functions of carbohydratesFunctions of carbohydrates• The carbohydrates are primarily energy The carbohydrates are primarily energy

giving foods. One gram of carbohydrate giving foods. One gram of carbohydrate gives 4 calories of energy to the body.gives 4 calories of energy to the body.

• Carbohydrates are cheapest sources of Carbohydrates are cheapest sources of energy for our body.energy for our body.

• The sufficient amount of carbohydrates are The sufficient amount of carbohydrates are required for proteins to do the function of required for proteins to do the function of body building.body building.

• Similarly, insufficient carbohydrates in the Similarly, insufficient carbohydrates in the diet will result in breaking of the fats for diet will result in breaking of the fats for giving energy, which is also not good for giving energy, which is also not good for health in excessive quantities.health in excessive quantities.

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• Extra amount of carbohydrates consumed is Extra amount of carbohydrates consumed is stored in the form of glycogen but in limited stored in the form of glycogen but in limited quantities, afterwards it is stored in form of quantities, afterwards it is stored in form of fat. The extra amount of fat accumulated in fat. The extra amount of fat accumulated in the body contributes to extra weight.the body contributes to extra weight.

• The non available carbohydrates are fibres The non available carbohydrates are fibres since the enzymes present in the intestine since the enzymes present in the intestine are not able to digest the same.are not able to digest the same.

• Fibres are important for our body in many Fibres are important for our body in many ways;ways;

1.1. They absorb water and give a feeling of They absorb water and give a feeling of fullness .fullness .

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2.2. They help in the elimination of the non They help in the elimination of the non useful part of the food out of the body.useful part of the food out of the body.

3.3. The fibres save us from many disease The fibres save us from many disease like like heart problems, cancer and diabetes.heart problems, cancer and diabetes.

• The whole grains, fruits and vegetables The whole grains, fruits and vegetables are important sources of the fibres.are important sources of the fibres.

• We must avoid the refined food to get We must avoid the refined food to get good quantity of fibres.good quantity of fibres.

• Animal products generally do not Animal products generally do not contain fibres.contain fibres.

Sources of CarbohydratesSources of Carbohydrates

Proteins - macronutrientProteins - macronutrient• Proteins are also organic compounds like Proteins are also organic compounds like

carbohydrates.carbohydrates.• The proteins are made up of Carbon, The proteins are made up of Carbon,

Hydrogen, Oxygen and Nitrogen.Hydrogen, Oxygen and Nitrogen.

• There are hundreds of types of proteins but There are hundreds of types of proteins but they are made up of 22 amino acids in they are made up of 22 amino acids in different combinationsdifferent combinations..

• There are 8 amino acids which can not be There are 8 amino acids which can not be manufactured by our body.manufactured by our body.

• These amino acids are called essential amino These amino acids are called essential amino acids and should be supplied by food only.acids and should be supplied by food only.

(Contd..)(Contd..)

• The quality of proteins depend on the The quality of proteins depend on the number of amino acids present as also in number of amino acids present as also in proper proportion.proper proportion.

• Vegetarian and non vegetarian food both Vegetarian and non vegetarian food both supply us the proteins.supply us the proteins.

• The plant based proteins lack in one or two The plant based proteins lack in one or two amino acids.amino acids.

• Pulses and the grains have different types of Pulses and the grains have different types of amino acids, therefore the traditional Indian amino acids, therefore the traditional Indian foods like dosa, dalia with milk or dal with foods like dosa, dalia with milk or dal with rice or roti are good combinations for proper rice or roti are good combinations for proper absorption of proteins.absorption of proteins.

• The combination of plant and animal based The combination of plant and animal based proteins make very good combination.proteins make very good combination.

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• Soyabean, rajmah, lobia, blackgram Soyabean, rajmah, lobia, blackgram etc. are good sources of protein.etc. are good sources of protein.

• The oil seeds like groundnuts, til etc. The oil seeds like groundnuts, til etc. also contain good amount of proteins.also contain good amount of proteins.

• Milk, Paneer and Khowa are good Milk, Paneer and Khowa are good sources of animal based proteins sources of animal based proteins acceptable to vegetarians.acceptable to vegetarians.

• Meat, fish and eggs are non vegetarian Meat, fish and eggs are non vegetarian sources of proteins.sources of proteins.

Nutrition values of common food itemsNutrition values of common food items

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• While planning a balanced diet we have to While planning a balanced diet we have to consider the cost vs. availability of protein consider the cost vs. availability of protein and its acceptability to the consumers.and its acceptability to the consumers.

• The scenario of rural India is different from The scenario of rural India is different from the urban areas as there may be excess the urban areas as there may be excess production of some thing and some required production of some thing and some required source may not be available at all.source may not be available at all.

• Functions of protein are as under,Functions of protein are as under,1.First and most important function is body 1.First and most important function is body building. (requirement of proteins reduces building. (requirement of proteins reduces with the age)with the age)2.Proteins also act as carriers of essential 2.Proteins also act as carriers of essential things like hemoglobin.things like hemoglobin.

(contd..)(contd..)

• The proteins also give energy when the The proteins also give energy when the carbohydrates are not sufficient.carbohydrates are not sufficient.

• Some of the essential substances for Some of the essential substances for body like enzymes and antibiotics are body like enzymes and antibiotics are also proteins.also proteins.

• The digestion of proteins is dependent The digestion of proteins is dependent on enzymes present in gastric juices. on enzymes present in gastric juices.

• Only good quality protein( rich in all Only good quality protein( rich in all types of amino acids) is used by body types of amino acids) is used by body for the formation of tissues.for the formation of tissues.

• A balanced diet is important for proper A balanced diet is important for proper utilization of protein.utilization of protein.

Complementary proteinsComplementary proteins

Protein sourcesProtein sources

FatsFats• Fats are organic compounds made up of Fats are organic compounds made up of

carbon, hydrogen and oxygen.carbon, hydrogen and oxygen.• Fats are made of fatty acids and glycerol.Fats are made of fatty acids and glycerol.• Like amino acids there are two essential fatty Like amino acids there are two essential fatty

acids which can not be produced by body.acids which can not be produced by body.• Fats and oils are triglycerides chemically but Fats and oils are triglycerides chemically but

fats contain more saturated fatty acids and fats contain more saturated fatty acids and the oils contain less saturated fatty acids.the oils contain less saturated fatty acids.

• Main sources of fats are milk and other Main sources of fats are milk and other animal products like eggs.animal products like eggs.

• The sources of oil are oil seeds, dry fruits, The sources of oil are oil seeds, dry fruits, coconut and soyabean etc.coconut and soyabean etc.

(contd..)(contd..)

• Generally we think that fats are harmful Generally we think that fats are harmful substances and may be avoided to the extent substances and may be avoided to the extent possible. In fact the fats are essential part of possible. In fact the fats are essential part of the nutrition if taken in moderation.the nutrition if taken in moderation.

• The energy supplied by fats is highest i.e. 9 The energy supplied by fats is highest i.e. 9 cal per gram.cal per gram.

• Fats take much time in digestion and give the Fats take much time in digestion and give the feeling of satisfaction for long time.feeling of satisfaction for long time.

• The layers of fats stored under skin provide The layers of fats stored under skin provide insulation to the body.insulation to the body.

• Fats are carriers of fat soluble vitamins.Fats are carriers of fat soluble vitamins.

Sources of FatsSources of Fats

Water Water • Water is most important nutrient for all living Water is most important nutrient for all living

creatures.creatures.• The water in natural form contains various The water in natural form contains various

minerals which are required for human body.minerals which are required for human body.• The water is major content of our body and it The water is major content of our body and it

acts as a medium for all fluids.acts as a medium for all fluids.• It regulates our body temperature.It regulates our body temperature.• Water acts as solvent for most of the Water acts as solvent for most of the

nutrients for the body.nutrients for the body.• Our body receives water either directly or Our body receives water either directly or

with other foods like vegetables and fruits.with other foods like vegetables and fruits.

Micronutrients- VitaminsMicronutrients- Vitamins• Vitamins are organic compounds with Vitamins are organic compounds with

complex chemical structure.complex chemical structure.• Our body requires vitamins in very small Our body requires vitamins in very small

quantities.quantities.• The vitamins have been classified as fat The vitamins have been classified as fat

soluble or water soluble.soluble or water soluble.• Vitamin A is found only in foods of animal Vitamin A is found only in foods of animal

origin, however some vegetables with yellow origin, however some vegetables with yellow or orange colour have compounds that can or orange colour have compounds that can be converted to vitamin A by the body.be converted to vitamin A by the body.

• As the conversion of vegetable source is not As the conversion of vegetable source is not efficient, vegetarians should consume the efficient, vegetarians should consume the foods containing beta carotene in large foods containing beta carotene in large quantities.quantities.

(contd..)(contd..)

• Vitamin A is useful for maintaining normal Vitamin A is useful for maintaining normal vision.vision.

• It supports growth of the bones and protects It supports growth of the bones and protects the body from diseases and infections.the body from diseases and infections.

• Vitamin D can be manufactured by our body Vitamin D can be manufactured by our body in the presence of sunlight.in the presence of sunlight.

• Main sources of vitamin D are animal based - Main sources of vitamin D are animal based - fish oil is best source of vitamin D.fish oil is best source of vitamin D.

• It helps in building bones and helps in It helps in building bones and helps in absorption of the minerals.absorption of the minerals.

Vitamin sourcesVitamin sources

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• Vitamin E is fat soluble and is found in Vitamin E is fat soluble and is found in small quantities in all vegetarian small quantities in all vegetarian sources of food.sources of food.

• It saves the other important sources of It saves the other important sources of nutrition from destruction.nutrition from destruction.

• Vitamin K is found in some of the Vitamin K is found in some of the vegetables and also in animal foods.vegetables and also in animal foods.

• This vitamin is also manufactured in the This vitamin is also manufactured in the body.body.

• This vitamin is fat soluble and helps in This vitamin is fat soluble and helps in clotting of blood.clotting of blood.

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• Vitamin B complex refers to a group of water Vitamin B complex refers to a group of water soluble vitamins & acts like coenzymes thus soluble vitamins & acts like coenzymes thus helping enzymes to perform their role.helping enzymes to perform their role.

• Vitamin B1 is found in all types of foods Vitamin B1 is found in all types of foods except fats and sugars. Refined flour like except fats and sugars. Refined flour like Maida and polished rice contain little amount Maida and polished rice contain little amount of vitamin B complex.of vitamin B complex.

• The sprouted and fermented food are good The sprouted and fermented food are good sources of this vitamin.sources of this vitamin.

• This vitamin is very important for various This vitamin is very important for various metabolic activities of body.metabolic activities of body.

(contd..)(contd..)

• Vitamin B2 is also found in all types of food Vitamin B2 is also found in all types of food and increases with sprouting & fermentation.and increases with sprouting & fermentation.

• This vitamin also helps in metabolism of This vitamin also helps in metabolism of macro nutrients.macro nutrients.

• Folic acid is found in all types of foods.Folic acid is found in all types of foods.• This is very important for formation of blood This is very important for formation of blood

cells.cells.• Vitamin B12 is found only in non vegetarian Vitamin B12 is found only in non vegetarian

food but can be manufactured in the body.food but can be manufactured in the body.• This vitamin is important for functioning of This vitamin is important for functioning of

nervous system and bone marrow.nervous system and bone marrow.

(contd..)(contd..)

• Vitamin C is found in fresh fruits and Vitamin C is found in fresh fruits and green vegetables.green vegetables.

• Animal foods are deficient in supply of Animal foods are deficient in supply of vitamin C.vitamin C.

• It is distributed in various important It is distributed in various important organs of the body.organs of the body.

• It is helpful in healing of wounds.It is helpful in healing of wounds.• It is a known anti-oxidant and helps in It is a known anti-oxidant and helps in

absorption of iron.absorption of iron.• It protects some important substances It protects some important substances

from destruction.from destruction.

CITRUS FRUITS FOR VITAMIN CCITRUS FRUITS FOR VITAMIN C

Micro nutrients - MineralsMicro nutrients - Minerals

• Our body requires some inorganic Our body requires some inorganic compounds for proper functioning in small compounds for proper functioning in small quantities but some of these minerals are quantities but some of these minerals are required in comparatively larger quantity required in comparatively larger quantity such as calcium, phosphorus, sodium, such as calcium, phosphorus, sodium, potassium, chloride and magnesium.potassium, chloride and magnesium.

• Minerals like iron, iodine, zinc and copper are Minerals like iron, iodine, zinc and copper are required in still smaller quantities.required in still smaller quantities.

• There are some trace elements which are There are some trace elements which are required in negligible quantities.required in negligible quantities.

(contd..)(contd..)

• Calcium and phosphorus account for 75% of Calcium and phosphorus account for 75% of mineral contents of our body.mineral contents of our body.

• Calcium and Phosphorus are required for Calcium and Phosphorus are required for development of bones and teeth.development of bones and teeth.

• Calcium helps in functioning of muscles and Calcium helps in functioning of muscles and cells.cells.

• It is also required for proper functioning of It is also required for proper functioning of nerves and clotting of blood.nerves and clotting of blood.

• Phosphorus is important for metabolism and Phosphorus is important for metabolism and formation of genetic material.formation of genetic material.

MINERAL SOURCESMINERAL SOURCES

(contd..)(contd..)

• Milk and milk products are good sources of Milk and milk products are good sources of calcium.calcium.

• Some pulses and beans also contain good Some pulses and beans also contain good amount of calcium.amount of calcium.

• Sodium is present in our body in the extra Sodium is present in our body in the extra cellular fluids.cellular fluids.

• It helps in regulating alkalinity and acidity of It helps in regulating alkalinity and acidity of fluids found in body.fluids found in body.

• It also helps in functioning of nervous It also helps in functioning of nervous system and cells.system and cells.

(contd..)(contd..)

• We get maximum sodium from common salt. We get maximum sodium from common salt. However, excess consumption is bad for body.However, excess consumption is bad for body.

• Iron is required in very small amount, it helps in Iron is required in very small amount, it helps in transport of oxygen in the body and helps In transport of oxygen in the body and helps In oxidation within the cells which in turn is oxidation within the cells which in turn is responsible for release of energy for work.responsible for release of energy for work.

• It helps in functioning of the brain.It helps in functioning of the brain.• Absorption of iron is promoted by vitamin C.Absorption of iron is promoted by vitamin C.• Iodine is very important in nominal quantity Iodine is very important in nominal quantity

and is required for proper functioning of thyroid and is required for proper functioning of thyroid glands. It is found in sea food. glands. It is found in sea food.

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• Only some of the very important Only some of the very important minerals and vitamins have been minerals and vitamins have been discussed here.discussed here.

• In fact the food contains large number In fact the food contains large number of known and unknown sources of of known and unknown sources of nutrition which are very important for nutrition which are very important for our body.our body.

Nutrition related issues of rural womenNutrition related issues of rural women

• Macro indicators:Macro indicators:1.1. Life expectancy is lower than males, much Life expectancy is lower than males, much

lower than urban women and below lower than urban women and below developed nations.developed nations.

2.2. Sex ratio is declining slowly but rate is less Sex ratio is declining slowly but rate is less than the urban counterparts.than the urban counterparts.

3.3. The average height and corresponding The average height and corresponding weight is below the standards .weight is below the standards .

4.4. Anaemia is main problem of the rural Anaemia is main problem of the rural women due to deficiency of iron and folic women due to deficiency of iron and folic acid.acid.

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• The women require more quantities of The women require more quantities of iron as compared to men.iron as compared to men.

• At least 50% rural women and girls are At least 50% rural women and girls are suffering from anaemic conditions.suffering from anaemic conditions.

• This is also one of the reasons of This is also one of the reasons of maternal mortality in India.maternal mortality in India.

• The main reason of poor nutrition The main reason of poor nutrition among rural women is early marriage.among rural women is early marriage.

• The other reason is repeated child birth.The other reason is repeated child birth.

(Contd..)(Contd..)

• Gender bias is also contributing Gender bias is also contributing towards poor nutrition among rural towards poor nutrition among rural women.women.

• Illiteracy and social issues are also Illiteracy and social issues are also causing poor nutrition as the women causing poor nutrition as the women are not aware about balanced diet etc.are not aware about balanced diet etc.

• Religious beliefs and superstitions Religious beliefs and superstitions sometimes also contribute towards sometimes also contribute towards malnutrition.malnutrition.

Nutrition related issues of rural womenNutrition related issues of rural women

• Macro indicators:Macro indicators:

• The child mortality rate is double as The child mortality rate is double as compared to the urban areas and is compared to the urban areas and is strongly related to literacy rate.strongly related to literacy rate.

• Infant mortality is also more than the Infant mortality is also more than the urban areas.urban areas.

• Vitamin A deficiency is very common Vitamin A deficiency is very common among rural children.among rural children.

• The result is blindness in childhood The result is blindness in childhood itself.itself.

(contd..)(contd..)

• Iron deficiency is common in both rural Iron deficiency is common in both rural as well as urban children.as well as urban children.

• Iodine deficiency is seen and various Iodine deficiency is seen and various types of mental disorders are common types of mental disorders are common in rural children.in rural children.

• The rural children though get a cleaner The rural children though get a cleaner environment as compared to urban but environment as compared to urban but they lack in nutrition due to illiteracy they lack in nutrition due to illiteracy and poor economical status of the and poor economical status of the parents.parents.

Any solutions ???Any solutions ???• Sometimes we think that the rural nutrition Sometimes we think that the rural nutrition

issues require huge investment.issues require huge investment.• In fact, proper planning, information and In fact, proper planning, information and

education can address the issue without education can address the issue without much investment.much investment.

• The problem has to be addressed as per The problem has to be addressed as per local needs as we know that food is not only local needs as we know that food is not only related to nutrition but other social and related to nutrition but other social and personal issues are involved.personal issues are involved.

• Now we will discuss about the various Now we will discuss about the various methods to deal with problem.methods to deal with problem.

Planning nutrition for rural indiaPlanning nutrition for rural india

• A balanced diet is essential for proper A balanced diet is essential for proper nutrition.nutrition.

• The requirements of rural population are The requirements of rural population are different from the urban people.different from the urban people.

• Balanced diet for rural people should be Balanced diet for rural people should be proper to meet daily calorie requirement, proper to meet daily calorie requirement, their special needs considering more their special needs considering more exposure to contaminated water, work in the exposure to contaminated water, work in the fields & limited reach to health support fields & limited reach to health support systems.systems.

• Special diet plans have to be prepared for Special diet plans have to be prepared for mothers and young children and tribal mothers and young children and tribal groups.groups.

(contd..)(contd..)

The food groups that can be made available The food groups that can be made available in rural areas are :in rural areas are :

• Cereals and pulses for carbohydrates and Cereals and pulses for carbohydrates and proteinsproteins

• Oil seeds for fats and proteinsOil seeds for fats and proteins• Locally available vegetablesLocally available vegetables• Local fruitsLocal fruits• Milk and its productsMilk and its products• Jaggery and KhandsariJaggery and Khandsari• Locally available oilsLocally available oils• Meat products subject to acceptabilityMeat products subject to acceptability• Sea foods depending on locationSea foods depending on location

Coarse grains are good for healthCoarse grains are good for health

(contd..)(contd..)

• We have already gone through the functions We have already gone through the functions of different types of foods i.e. energy giving, of different types of foods i.e. energy giving, body building, regulating and protecting.body building, regulating and protecting.

• Depending on the requirement of the user Depending on the requirement of the user groups i.e. men, women, young girls, boys or groups i.e. men, women, young girls, boys or children, the calorie requirement is worked children, the calorie requirement is worked out.out.

• The food from energy giving group is The food from energy giving group is selected to meet the demand.selected to meet the demand.

• Depending on age, marital status and Depending on age, marital status and specific needs additional quantities can be specific needs additional quantities can be added.added.

Cheaper items of nutritionCheaper items of nutrition

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• Recommended dietary intakes for various Recommended dietary intakes for various groups are given in next slide.groups are given in next slide.

• However a professional health care person However a professional health care person must be consulted to know the specific must be consulted to know the specific requirements of some vulnerable groups.requirements of some vulnerable groups.

• Two important aspects need to be Two important aspects need to be considered, income level and social needs, considered, income level and social needs, before advising any meal plan.before advising any meal plan.

• The most important thing is to select an The most important thing is to select an affordable, tasteful and balanced diet.affordable, tasteful and balanced diet.

• Supplements are required for sick and Supplements are required for sick and persons with special needs.persons with special needs.

Simple techniques to get nutrients Simple techniques to get nutrients

• SproutingSprouting• FermentationFermentation• Food combinationsFood combinations• FortificationFortification• Washing the vegetables before cuttingWashing the vegetables before cutting• Cooking on low flamesCooking on low flames• Do not throw water after cooking riceDo not throw water after cooking rice• Cut fruits only at the time of consumptionCut fruits only at the time of consumption• Use foods that add to value of each otherUse foods that add to value of each other

Sprouted and fermented foodsSprouted and fermented foods

Mid Day meal schemeMid Day meal scheme

• With a view to enhancing enrollment, With a view to enhancing enrollment, retention & attendance and simultaneously retention & attendance and simultaneously improving nutritional levels among children, improving nutritional levels among children, the National Programme of Nutritional the National Programme of Nutritional Support to Primary Education (NP-NSPE) Support to Primary Education (NP-NSPE) was launched as a Centrally Sponsored was launched as a Centrally Sponsored Scheme on 15th August 1995 by GOI.Scheme on 15th August 1995 by GOI.

• It was further extended in 2002 to cover not It was further extended in 2002 to cover not only children in classes I-V of Government only children in classes I-V of Government but also to Government aided and Local but also to Government aided and Local Body schools. Body schools.

(contd..)(contd..)

• Central Assistance under the scheme Central Assistance under the scheme consisted of free supply of food grains @ 100 consisted of free supply of food grains @ 100 grams per child per school day and subsidy grams per child per school day and subsidy for transportation of food grains up to a for transportation of food grains up to a maximum of Rs 50/- per quintal. maximum of Rs 50/- per quintal.

• In September 2004 the scheme was revised In September 2004 the scheme was revised to provide cooked mid day meal with 300 to provide cooked mid day meal with 300 calories and 8-12 grams of protein to all calories and 8-12 grams of protein to all children studying in classes I-V in children studying in classes I-V in Government and aided schools and EGS/AIE Government and aided schools and EGS/AIE centers.centers.

(contd..)(contd..)

• In addition to free supply of food grains, the In addition to free supply of food grains, the revised scheme provided Central Assistance revised scheme provided Central Assistance for,for,

(a)(a) Cooking cost @ Re 1 per child per school Cooking cost @ Re 1 per child per school day,day,

(b)(b) Transport subsidy was raised from the Transport subsidy was raised from the earlier maximum of Rs 50 per quintal to Rs. earlier maximum of Rs 50 per quintal to Rs. 100 per quintal for special category states, 100 per quintal for special category states, and Rs 75 per quintal for other states,and Rs 75 per quintal for other states,

(c)(c) Management, monitoring and evaluation Management, monitoring and evaluation costs @ 2% of the cost of food grains, costs @ 2% of the cost of food grains, transport subsidy and cooking assistance,transport subsidy and cooking assistance,

(d)(d) Provision of mid day meal during summer Provision of mid day meal during summer vacation in drought affected areas. vacation in drought affected areas.

(contd..)(contd..)

• The scheme resulted in increased The scheme resulted in increased school attendance in rural schools.school attendance in rural schools.

• It also motivated the poor parents It also motivated the poor parents to send their wards to school.to send their wards to school.

• However the scheme is being However the scheme is being criticized on account of cutting criticized on account of cutting learning time in schools and learning time in schools and diversion of teachers’ attention for diversion of teachers’ attention for preparation of meals.preparation of meals.

Nutrition and organic farmingNutrition and organic farming

• The organically grown foods are known The organically grown foods are known to have better micronutrients than the to have better micronutrients than the conventionally grown foods.conventionally grown foods.

• The loss of organic matter in soil, The loss of organic matter in soil, poorly nourished and light soils, high poorly nourished and light soils, high amount of pesticides and chemical amount of pesticides and chemical fertilizers are main factors behind this.fertilizers are main factors behind this.

• The rural people can contribute The rural people can contribute towards better nutrition for nation and towards better nutrition for nation and themselves by gradually shifting to themselves by gradually shifting to organic farming.organic farming.

Role of schools & parentsRole of schools & parents• The schools must disseminate The schools must disseminate

information related to nutrition since they information related to nutrition since they are reliable source of information for are reliable source of information for children who try to follow the advice children who try to follow the advice given by teachers.given by teachers.

• The schools may inform the children The schools may inform the children about correct eating habits and ways of about correct eating habits and ways of getting best out of a meal.getting best out of a meal.

• The parents are duty bound to provide The parents are duty bound to provide the children with a balanced diet helpful the children with a balanced diet helpful for growth.for growth.

(contd..)(contd..)

• The balanced diet is not costly as The balanced diet is not costly as perceived by some parents. The poor perceived by some parents. The poor people may be encouraged to take people may be encouraged to take advantage of mid day meal scheme and advantage of mid day meal scheme and other Anganwadi schemes.other Anganwadi schemes.

• The parents in urban/rural areas must The parents in urban/rural areas must educate their wards about harms of fast educate their wards about harms of fast food.food.

• The parents should be made aware The parents should be made aware about misleading advertisements of about misleading advertisements of snacks and beverages.snacks and beverages.

Role of GovernmentRole of Government

• The primary role of government is to treat the The primary role of government is to treat the rural nutrition as a high priority area.rural nutrition as a high priority area.

• The mid day meal scheme is one step towards The mid day meal scheme is one step towards this objective.this objective.

• The target groups as identified by various The target groups as identified by various surveys and studies are women and children.surveys and studies are women and children.

• The coverage of Anganwadi scheme should be The coverage of Anganwadi scheme should be increased and proper monitoring mechanism increased and proper monitoring mechanism should be in place to ensure the benefits.should be in place to ensure the benefits.

• The health care infrastructure can be utilized to The health care infrastructure can be utilized to educate rural population about nutrition.educate rural population about nutrition.

Way aheadWay ahead

• The rural India is facing grave problems due to The rural India is facing grave problems due to malnutrition among women and children.malnutrition among women and children.

• There is no shortage of food grains or other There is no shortage of food grains or other agriculture/animal/marine produce to address agriculture/animal/marine produce to address this problem without any huge investment.this problem without any huge investment.

• Proper distribution, education & information are Proper distribution, education & information are the tools to solve this problem of rural India.the tools to solve this problem of rural India.

• It is duty of not only Government but also of all It is duty of not only Government but also of all people, NGOs and corporate bodies connected people, NGOs and corporate bodies connected with rural development for actively involving with rural development for actively involving themselves in finding affordable solutions.themselves in finding affordable solutions.

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