Community Nuitrition.docx

INTRODUCTION Food, cloth and shelter are considered primary needs of human beings. Man cannot survive without food. Struggle between the ancient communities for the food is found in the history and development of mankind. Now the significant advances have been developed about the concepts of nutrition. Community nutrition covers all the aspects of nutrition which affects the health of the people. It emphasizes the social dimension; civilization and security.

DEFINITION  Community nutrition is the process of helping individuals and groups develop

healthy eating habits in order to promote wellness and prevent disease.  Discipline striving to improve the health, nutrition, and well-being of individuals and groups within communities.

GOAL The goal of community nutrition is to improve the health and nutritional status of people in the community by the government health sector and the community.The main aspects of community nutrition can be described under the following headings:           

Demographic structure of the community. Nutrition policy of the particular country affecting the community nutrition. Production of food grains and other food products. Availability of the food at the grass – roots level of the community. Purchasing capacity of the community. Need of special groups (pregnant,lactating mother,children and poors etc). Role of Govt ./NGOs in the community nutrition. Balanced diet/meal Planning. Nutritional education Customs and beliefs of the community about nutrition. Community nutrition programmes. Food hygiene and food laws.

MEAL PLANNING Meal planning means to plan a diet observing the principles of nutrition and keeping in view the individual’s or family’s requirement, time and financial limitations. Meal planning requires knowledge of nutrition.The nurse should know about the nutrients in diet and the individual’s requirement while planning the meal. Guidelines for Meal planning:1. Food should be in accordance with the requirements of individual or the family.

2. It is necessary to consider time saving in meal planning. 3. Variety and attraction should be considered while meal planning.Variety in meal ,increases the acceptability of food. 4. As far as possible, individual likes and dislikes and feeling of satisfaction should be considered while meal planning. 5. In meal planning diet may be divided as follows: Day’s first meal – Breakfast Second meal - Lunch Third meal - Afternoon tea Fourth meal - Supper/ dinner 6. It is advantageous to make daily and weekly meal planning. 7. Separate planning should be made for holidays,festivals and special occasions.

MERITS OF MEAL PLANNING       

Availability of meals to individual/every family members as per his requirement. Saving of time Gainful use of labour. Economy Variety in meals Freedom from unnecessary hassels. Developing the sense of meal discipline or formation of good dietary habits.

NUTRITION EDUCATION The basic objective of nutrition education is to raise the health status of the person,the family and the community.Other objectives and need of the nutrition education are as follows: 1. To avoid bad habits,prejudices,idiosyncrasies and wrong notions regarding diet. 2. To educate the individual, the family and the community about food articles and their nutritive value,balanced diet,proper cooking methods and requirement of energy. 3. To explain the technique of balanced diet,based on the availability and the income limits. 4. To inform about food substitutes,changes and modification in diet. 5. To educate about the effects of various cooking methods on the nutrients. 6. To tell about the symptoms of deficiency diseases and measures of prevention. 7. To underline the nutrional requirements of the vulnerable group. 8. To describe about the methods of storage and preservation of food.

9. To underline the importance of food hygiene. OPPORTUNITIES FOR NUTRITION EDUCATION  

During home visits. During conduction of special clinics.e.g.antenal clinic,under five clinic.

 

While conducting school health programme With patients and their attendants in outdoor and indoor clinic.

 In ladies clubs meeting,during nutrition demonstration. METHODS OF NUTRITION EDUCATION Individual nutrition education For men,individual and group education should be given to inform them regarding importance of nutrition and its objectives. Cooking demonstration is more useful in groups of mothers. The following techniques can be used to make nutrition education more effective e.g role playing,nutrition drama, puppet show, music and folk dance, posters,pictures,tape recorder, radio, journals, computer ,television, films about nutrition, kitchen gardens are also effective medium of health education.

PRINCIPLES OF NUTRITION EDUCATION It is difficult to change the dietary habits of person. Hence ,the nurse should be aware about her role and responsibilities while imparting nutrition education. 1. The following factors are important in nutrition education :  The educational level of the individual of the community.  Culture,religion,dietary habits and idiosyncrasies.  Local availability of foodstuff  Cleanliness of house and surroundings. 2. The individual should be given sufficient time to adopt new ideas and habits. 3. Any changes or suggestions regarding diet should be made according to the individual’s practices,religion and culture. 4. The individuals/patients should be made familiar with importance and objectives of nutrition education. 5. The local names should be used for the foodstuff and the education should be imparted in day- to day language. 6. The persons should be encouraged to ask question to satisfy their queries regarding nutrition. 7. Nutrition education should be combined with reproductive and child health. 8. The food articles which are not within the purchasing power of the individual or which are not consumed by him should not be advised to be included in the diet.

RESPONSIBILITIES OF NURSE IN NUTRITION EDUCATION  Assessing the health status of the individual/the family/the community.  Making an early diagnosis of nutritional diseases and deficiencies and their treatment.  Paying special attention to nutrition of the vulnerable groups and to check adulteration.

 Telling the importance of kitchen garden/village shak vaatika  Imparting applied nutrition education using modern and attractive techniques.

COMMUNITY MENTAL HEALTH DEFINITION Community mental health is a decentralized pattern of mental health,mental health care,or other services for people with mental illnesses. Community- based care is designed to supplement and decrease the need for more costly inpatient mental health care delivered in hospitals. The World Health Organization defines mental health as ³a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community´

DEVELOPMENT OF COMMUNITY MENTAL HEALTH IN INDIA Various events which influenced the development of psychiatric community hospitals in india have occurred over five phases.

PHASE I Colonial Period Prior to Indias Attaining Independence:-

 Establishment of lunatic asylums in different parts of the country PHASE II (During 1950 s) Establishment of Mental Hospitals At:     

Delhi(1966) Jamnagar(1960) Srinagar(1958) Hyderabad(1953) Amritsar(1947) Bangalore(1954)

PHASE III (During Mid 1960s) General Hospital Psychiatric Units Advantages 1. 2. 3. 4. 5. 6. 7.

Involvement of family members Greater acceptance of services Easily approachable without stigma Attracted more patient with minor problems Shorter period of hospitalization Encourage more outpatient care. Integration of mental health into the general health system.

PHASE IV(During 1970s)  

Extension of care from mental hospitals and general hospitals to the primary health centres and community. Bengaluru and chadigarh initiated pilot programs to develop and evaluate an extension of mental health services for rural underprivileged.

PHASE V (During 1990s)    

Growth of private consultant physicians Growth of private sector in psychiatric services Voluntary and nongovernmental organization taking active interest in various aspect of mental health. Substantial increase in funding and improvement in conditions of many mental hospitals.

MENTAL HEALTH SERVIES AT VARIOUS LEVELS IN INDIA Central Level :

National level hospitals Eg- NIMANS

State Level : 

State level hospitals NMHP

District Level : 

General hospital psychiatric units DMHP

Local Level :  

CHC PHC Sub –centers RESPONSIBILITY OF COMMUNITY MENTAL HEALTH NURSE

Mental health nurse jobs place individuals in a huge variety of work environments, including hospital wards, homes, outpatient departments, residential units and community drop-in centres .  Caring for patients with acute conditions - building relationships and responding to their physical and emotional needs, while delivering effective care.  Administering patients' medications and treatments - and monitoring results.  Dealing with the specific symptoms of mental illness, de-escalating stressful situations and helping patients overcome challenges.  Interacting with patients' families and other care staff - offering advice and information on patients' conditions.  Preparing and maintaining patients records, producing care plans and risk assessments.  Organizing group therapy sessions, including social and artistic events, aimed at promoting patients' mental recovery. NATIONAL NUTRITION POLICY 1993 Inspite of the significant improvement in food production and advancement in science since independence, under nutrition continues to be a widespread problem in India. In the year 1993,Govt of india announced National Nutrition Policy 1993.The strategy consists of the following: A. Direct intervention – Short – term 1. Nutrition interventions for specially vulnerable groups.

a. Expanding the Safety Net – The universal immunization programme,oral rehydration therapy and the integrated child development services have a considerable impact on child survival and extreme forms of malnutrition. b. Improving growth monitoring between age group 0 to 3 years, with closer involvement of the mothers. c. Reaching the adolescent girls through ICDS so as to make them ready for safe motherhood. d. Ensuring better coverage of expectant women in order to reduce the incidence of low birth weight babies. 2. Fortification of essential foods. 3. Popularization of low cost nutritious food. 4. Control of micro- nutrient deficiencies among vulnerable groups. B. Indirect Policy Instruments : Long – term institutional and structured changes. 1. Food security 2. Improvement of dietary pattern through production and demonstration. 3. Improving the purchasing power of the urban and rural poor and improving the public food distribution system. 4. Land reforms. 5. Health and family welfare 6. Basic health and nutrition knowledge. 7. Prevention of food adulteration 8. Nutrition surveillance. 9. Monitoring of nutrition programmes. 10. Research into various aspects of nutrition, both on the consumption side and the supply side. 11. Equal remuneration for women. 12. Communication through established media for the implementation of nutrition policy. 13. Minimum wage administration. 14. Community participation 15. Education and literacy particularly that of women. 16. Improvement of the status of women.

COMMUNITY NUTRITION PROGRAMMES The Government of India have initiated several largescale supplementary feeding programmes,and programmes aimed at overcoming specific deficiency diseases through various Ministries to combat malnutrition. OBJECTIVES  To improve overall nutritional status of vulnerable group.  To overcome specific nutritional deficiencies of mothers and children.  To help to achieve better nutrition through indirect schemes.

1. Vitamin A prophylaxis Programme One of the components of the National Programme for Control of Blindness is to administer a single massive dose of an oily preparation of vitamin A containing 200,000 IU (110 mg of retinol palmitate) orally to all pre- school children in the community every 6 months through peripheral health workers.This programme was launched by the Ministry of Health and Fanily Welfare in 1970 on the basis of technology developed at the National Institute of Nutrition at Hyderabad. An evaluation of the programme has revealed a significant reduction in vitamin A deficiency in children. 2. Prophylaxis against nutritional anaemia. In view of its public health importance,a national programme for the prevention of nutritional anaemia was launched by the Govt.of India during the fourth Five Year Plan.The Programme consists of distribution of iron and folic acid (folifar) tablets to pregnant women and young children (1- 12 years). 3. Control of iodine deficiency disorders The National Goitre Control Programme was launched by the Government of India in 1962 in the conventional goiter belt in the Himalayan region with the objective of identification of the goiter endemic areas to supply iodized salt in place of common salt and to assess the impact of goiter control measures over a period of time.

4. Special nutrition programme This programme was started in 1970 for the nutritional benefit of children below 6 years of age ,pregnant and nursing mothers and is in operation in urban slums, tribal areas and backward rural areas. The supplementary food supplies about 300 kcal and 10 – 12 grams of protein per child per day. The beneficiary mothers receive daily 500 kcal and 25 grams of protein. This supplement is provided to them for about 300 days in a year. 5. Balwadi nutrition programme This programme was started in 1970 for the benefit of children in the age group 3- 6 years in rural areas. It is under the overall charge of Department of Social Welfare. Four national level organizations including the Indian Council of Child Welfare are given grants to implement the programme. Voluntary organizations which receive the funds are actively involved in the day- to- day management.The programme is implemented through Balwadis which also provide pre- primary education to these children.The food supplement provides 300 kcal and 10 grams of protein per child per day. 6. ICDS Programme Integrated Child Development Services programme was started in 1975 in pursuance of the National Policy for Children.There is a strong nutrition components in this programme in the form supplementary nutrition,vitamin A prophylaxis and iron and folic acid distribution. The workers at the village level who deliver the services are called Anganwadi workers. 7. Mid – day meal programme The mid – day meal programme (MDMP) is also known as School Lunch Programme.This programme has been in operation since 1961 throughout the country. In formulating mid –day meals for school children, the following broad principles should be kept in mind.:a. The meal should be a supplement and not a substitute to the home diet; b. The meal should supply at least one-third of the total energy requirement, and half of the protein need; c. The cost of the meal should be reasonably low. d. The meal should be such that it can be prepared easily in schools;no complicated cooking process should be involved. e. As far as possible,locally available foods should be used;this will reduce the cost of the meal. f. The menu should be frequently changed to avoid monotony. 8. Mid- day meal scheme Mid- day meal scheme is also known as National Programme of Nutritional Support to Primary Education.It was launched as a centrally sponsored scheme on 15 August 1995 and revised in 2004.Its objective being universalization of primary education by increasing enrolment, retention and attendance and simultaneously impacting on nutrition of students in primary classes. To achieve the objectives ,a cooked mid-day meal with minimum 300 calories and 8 to 12 grammes of protein content will be provided to all the children in class I to V.

CONCLUSION The nutritional status of an individual is often the result of many interrelated factors. It is influenced by the adequency of food intake both in terms of quantity and quality and also by the physical health of the individual.The nutritional status of a community is the sum of the nutritional status of the individuals who form that community.

BIBLIOGRAPHY BOOKS 1. Bijayalakhmi Dash , “Comprehensive Textbook of Community “, Jaypee Brothers, First Edition,2017: Page no - 558 – 562. 2. Keshav Swarnkar ,”Community Health Nursing “,N.R.Brothers ,Second Edition , Page no: 279-293. 3. K .Park , “Textbook of Preventive And Social Medicine “ , M/s Banarsidas Bhanot Publishers Jabalpur, 24 th Edition,2017: 696 – 699.

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