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. Involvement of family members

2. Greater acceptance of services
3. Easily approachable without stigma
4. Attracted more patient with minor problems
5. Shorter period of hospitalization
6. Encourage more outpatient care.
7. 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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