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INTRODUCTION Health is the level of functional or, metabolic efficiency of a living being. In humans, it is the general condition of a person's mind and body, usually meaning to be free from illness, injury or pain (as in "good health" or "healthy"). The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity Although this definition has been subject to controversy, in particular as lacking operational value and because of the problem created by use of the word "complete," it remains the most enduring . Other definitions have been proposed, among which a recent definition that correlates health and personal

satisfaction. Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International

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Classification of Diseases (ICD), are commonly used to define and measure the components of health. Acording to Alma Aata declaration,1978-Health is an accepted a form of fundamental right. It has accepted a social aim on global level. Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Applications with regard to animal health are covered by

the veterinary sciences. The term "healthy" is also widely used in the context of many types of non-living organizations and their impacts for the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments. In addition to health care interventions and a person's surroundings, a number of other factors are known to influence the health status of individuals, including their background, lifestyle, and economic and social conditions; these are referred to as "determinants of health

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According to Indian Constitution Directive Principle of State Policy and Health: Article 38 of Indian Constitution impose liability on State that states will secure a social order for the promotion of welfare of the people but without public health we cannot achieve it. It means without public health welfare of people is impossible. Article 39(e) related with workers to protect their health. Article 41 imposed duty on State to public assistance basically for those who are sick and disable. Article 42 makes provision to protect the health of infant and mother by maternity benefit. In the India the Directive Principle of State Policy under the Article 47 considers it the primary duty of the state to improve public health, securing of justice, human condition of works, extension of sickness, old age,

disablement and maternity benefits and also contemplated.

Further, States duty includes prohibition of consumption of intoxicating drinking and drugs are injurious to health. Article 48A ensures that State shall Endeavour to protect and impose the pollution free environment for good health. Article 47 makes improvement of public health a primary duty of State. Hence, the court should enforce this duty against a defaulting authority on pain of penalty prescribe by law, regardless of the financial resources of such authority. Under Article 47, the State shall regard the raising of the level of nutrition and standard of living of its people and improvement of public health as among its primary duties. None of these lofty ideals can be achieved without

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controlling pollution inasmuch as our materialistic resources are limited and the claimants are many.

The Food Corporation of India being an agency of the State must conform to the letter and spirit of Article 47to improve public health it should not allow sub-standard food grains to reach the public market. The State under Article 47 has to protect poverty stricken people who are consumer of substandard food from injurious effects. Public Interest Petition for maintenance of approved

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standards for drugs in general and for the banning of import, manufacturing, sale and distribution of injurious drugs is maintainable. A healthy body is the very foundation of all human activities. That is why the adage Sariramadyam Khalu Dharma sadhanam. In a welfare State, it is the obligation of the State to ensure the creation and sustaining of conditions congenial to good health. Some other provisions relating to health fall in DPSP. The State shall in particular, direct its policy towards securing

health of workers. State organised village panchayats and gave such powers and authority for to function as units of self-government. This Directive Principle has now been translated into action through the 73rd Amendment Act 1992 whereby part IX of the constitution titled The Panchayats was inserted. The Panchayat system has significant

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implications for the health sector. There will be discussed in relation to relevant Articles 243-243A to 243O contained in Part IX. Article 41 provides right to assistance in case of sickness and disablement. It deals with The state shall within the limits of its economic capacity and development, make effective provisions for securing the right to work, to education and to public assistance in case of unemployment, Old age, sickness and disablement and in other cases of undeserved want. Their implications in relation to health

are obvious. Article 42 give the power to State for make provision for securing just and humane conditions of work and for maternity relief and for the protection of

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environment same as given by Article 48A and same obligation impose to Indian citizen by Article 51A.(g). Panchayat, Municipality and Health: Not only the State also Panchayat, Municipalities liable to improve and protect public health. Article 243G says State that the legislature of a state may endow the panchayats with necessary power and authority in relation to matters listed in the eleventh Schedule. The entries in this schedule having direct

relevance to health are as follows: 11 -Drinking 23 -Health and sanitation including hospitals, primary health centers and dispensaries.

24 -Family welfare

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25 -Women and Child development 26 -Social welfare including welfare of the handicapped and mentally retarded. Article 243-W finds place in part IXA of the constitution titled The Municipalities: Effect on Women Health of Gender Gender, equity and human rights at the core of the health response

WHO

1 May 2012 - As part of the current reform process, the World Health Organization has launched a new approach to promote and facilitate the institutional mainstreaming of gender, equity and human rights, building upon the progress that has already been made on these areas at all three levels of the Organization. The coherent approach to mainstream all three areas will be reflected in the way WHO works and what it delivers through technical cooperation, policy advice and dialogue, setting norms and standards, knowledge generation and sharing, functions. Particular efforts are geared towards enhancing WHO Country Office capacity to support countries in incorporating gender, equity and human rights within their national convening stakeholders, and other enabling

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strategic health plans, other policies and activities on the ground, and monitoring efforts. The mainstreaming process is carried out jointly by all the clusters in WHO Headquarters, Regional and Country Offices, and will be rolled out in a spirit of joint accountability. To facilitate this, a new Gender, Equity and Human Rights (GER) team has been created, bringing together previous teams on gender, equity and human rights. Strengtheningcapacityto addressharmfulhealtheffectsof gender

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Over the past five years, WHO's Gender, Women and Health Network has been piloting and developing practical capacity building materials to assist in the progressive mainstreaming of gender considerations in health sector activities. The Gender Mainstreaming Manual for Health Managers: a practical approach serves as the core capacity building manual, with a range of tools available to support

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national teams to identify and address gender and health inequities. Tools and strategies fit within the overall framework of the WHO Gender Strategy. Women health on Global level: Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences. The health of women and girls is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. For example, women and girls face increased vulnerability to HIV/AIDS. Some of the sociocultural factors that prevent women and girls to benefit from quality health services and attaining the best possible level of health include:

unequal power relationships between men and women;

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social

norms

that

decrease

education

and

paid

employment

opportunities;

an exclusive focus on womens reproductive roles; and potential or actual experience of physical, sexual and emotional violence. While poverty is an important barrier to positive health outcomes for both men and women, poverty tends to yield a higher burden on women and girls health due to, for example, feeding practices (malnutrition) and use of unsafe cooking fuels (COPD).

POOR SHOWING ON FEMALE IMR Chart 1 shows that in terms of female infant mortality rates, India is, by far, the worst performer in this group, with the slowest rate of decline. Even Bangladesh, which is much poorer and has slower national income growth, managed to bring the female IMR down faster. And

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the Indian rate is more than two-and-a-half times that of Vietnam, which has a lower per capita income. The evidence on maternal mortality is equally disturbing. India and Bangladesh both have very high rates, many multiples of those in Sri Lanka and Vietnam. But even here, the rate of reduction of this ratio has been marginally faster in Bangladesh. Of course, India is also very regionally diverse, with some states, such as Kerala, showing excellent health outcomes for women, similar to those in Vietnam. And three states have also shown much improved health indicators in the past two decades: Tamil Nadu, West Bengal and Maharashtra. But the bulk of the country still shows generally appalling levels of female IMR and MMR. One important reason for high infant and child mortality is under-nutrition, which has actually worsened in recent times, according to indicators such as calorie consumption. Rising prices of food are making this problem worse as women and girls in poor households take the brunt of food scarcity. Chart 3 shows how closely the rate of child mortality tracks the proportion of underweight children across Indian states.

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PUBLIC SPENDING, IMMUNISATION Nutrition is important, but it is not the only concern. To deliver better health outcomes, public expenditure on health service delivery is absolutely essential, and this is especially important for women and girl children. Here again, India fares badly. Public spending on health (Chart 4) is a minuscule amount in relation to GDP, and around two-third of health expenditure is out-of-pocket payment by households. This is indeed an important reason for families falling into poverty or remaining destitute, and gender biases reinforce the relative denial of health to women and girls in such conditions. Even in absolute per capita terms, public health spending in India is around half that in Vietnam, which is a country with lower per capita income. And it is just above one-third of the level in Sri Lanka. It is true that Bangladesh shows a much lower level, but then Bangladesh also has a much lower per capita income. So it is no wonder that other indicators of health service delivery also appear quite inadequate with respect to the other countries.

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Chart 6 shows that less than half of births are attended by skilled personnel, whereas in Vietnam it is near universal and it is close to that in Sri Lanka. The low proportion here suggests one important reason for the high maternal mortality ratios in India and Bangladesh. Similarly, immunisation coverage is a necessary element in ensuring child health. Full measles coverage within the first year of life is often taken as a proxy for the extent of immunisation in general, and in this case India fares worst among this set of four countries. Even Bangladesh has much higher immunisation rates. In some parts of the country, immunisation rates have barely improved. Small wonder, then, that infant mortality rates have come down more slowly in India than in these other countries.

NO URGENCY ON SANITATION Another major aspect of ensuring adequate health conditions is the provision of improved sanitation for everyone. This is one of the

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weakest aspects, along with nutrition: around 70 per cent of the population does not have access to improved toilets. Remarkably, this does not even appear as a major policy goal for the government, which does not appear to see the urgency in this matter, or the wider health effects, quite apart from the loss of dignity to citizens that comes from forced open defaecation. All of these factors are crucially determined by government policy. Despite much publicly expressed concern on all these issues, the Government of India has simply not put its money where its mouth is. Public spending as a share of GDP has not increased, and per capita spending on some essential activities such as immunisation and primary health centres has actually gone down. Instead, the government has sought to provide essential health services on the cheap, using the underpaid labour of local women working for much less than the minimum wage, not properly trained regular public employees with adequate facilities. Eleventh fifth Year Plan (20072012) The eleventh plan has the following objectives:

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1. Income & Poverty

Accelerate GDP growth from 8% to 10% and then maintain at 10% in the 12th Plan in order to double per capita income by 201617

Increase agricultural GDP growth rate to 4% per year to ensure a broader spread of benefits

Create 70 million new work opportunities. Reduce educated unemployment to below 5%. Raise real wage rate of unskilled workers by 20 percent. Reduce the headcount ratio of consumption poverty by 10 percentage points.

2. Education

Reduce dropout rates of children from elementary school from 52.2% in 200304 to 20% by 201112

Develop minimum standards of educational attainment in elementary school, and by regular testing monitor

effectiveness of education to ensure quality

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Increase literacy rate for persons of age 7 years or above to 85%

Lower gender gap in literacy to 10 percentage point Increase the percentage of each cohort going to higher education from the present 10% to 15% by the end of the plan.

3. Health

Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live births

Reduce Total Fertility Rate to 2.1 Provide clean drinking water for all by 2009 and ensure that there are no slip-backs

Reduce malnutrition among children of age group 03 to half its present level

Reduce anaemia among women and girls by 50% by the end of the plan

4. Women and Children

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Raise the sex ratio for age group 06 to 935 by 201112 and to 950 by 201617

Ensure that at least 33 percent of the direct and indirect beneficiaries of all government schemes are women and girl children

Ensure that all children enjoy a safe childhood, without any compulsion to work

5. Infrastructure

Ensure

electricity

connection

to

all

villages

and BPL households by 2009 and round-the-clock power.

Ensure all-weather road connection to all habitation with population 1000 and above (500 in hilly and tribal areas) by 2009, and ensure coverage of all significant habitation by 2015

Connect every village by telephone by November 2007 and provide broadband connectivity to all villages by 2012

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Provide homestead sites to all by 2012 and step up the pace of house construction for rural poor to cover all the poor by 201617

6. Environment

Increase forest and tree cover by 5 percentage points. Attain WHO standards of air quality in all major cities by 201112.

Treat all urban waste water by 201112 to clean river waters.

Increase energy efficiency by 20%

Target growth:8.33% Growth achieved:7.9%

The

twelve

year

plan

(2012-2017)

focuses

on

improvement of health

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Health expenditure in India In the year 2008-2009 Total health expenditure was 4.1 % of GDP. Public funds contributed only 1.1% of GDP on health and rest 3.0% of GDP health expenditure was contributed by private sector. Per capita health expenditure in 2008-09 was 1904 rupees. (Source: National Health Accounts)

10. A Renewed Commitment to Public Health 11. The Directive Principles of State Policy in the Constitution of India mandate, improvement of public health as one of the primary duties of the State. The Central and State Governments have been taking proactive steps to promote health of the people by creating a network of public health care facilities, which provide free medical services, and also proactively control the spread of diseases. The Prime Minister in his Independence Day speech (2011) stressed upon the need to provide access to improved health services to all.

12. Calling for the 12th Plan to be specially focused on health, the Prime Minister promised that unds would not be a constraint in the

important areas of education and health. Government has decided to

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increase its total health expenditure to 2.5 per cent of GDP by the end of the 12th Plan

13. Goals for Health Systems in 12th Plan Maternal Deaths The Maternal Mortality Ratio in Bihar (371 per 100,000 live births) is fourth highest in the country and above the national average of 301.

What are the Causes? The high level of MMR can be attributed to low level of institutional deliveries (23.2% compared to national figure 41%), high level of anaemia among women (63.4% compared to national figure of 51.8%), low provision of iron and folic acid tablets to ante-natal cases (8.1% compared to national figure of 20.4%), and low level of full ante-natal coverage (5.4% compared to national figure of 16.4%).

As per NFHS-3, mothers who had at least three ante-natal care visits for their last child were a mere 16.9% in comparison to the national average of 50.7%. In fact, the majority of women do not receive any

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ante-natal care whatsoever (66%). Births attended by skilled personnel were also low at 30.9% in comparison to the national average of 48.3%.

Nutrition levels of pregnant women are troubling. For only 30 percent of their last births, did mothers receive iron and folic acid supplements (IFA) and for only 10 percent of the births did mothers consume IFA for the recommended 90 days or more.

Key indicators related to family planning show the poor health status of maternal health in Bihar. Roughly 51.5% of the girls in the State get married below the age of 18 years compared to the national figure of 28%. The proportion of couples practicing any method of contraception is 34% against the national figure of 53.9%.

Some reasons for the failure of family planning include: lack of health facilities and staff to deliver services, low exposure to mass media in Bihar, low exposure of family planning messages in the community, particularly among rural and socioeconomically disadvantaged groups

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After Independence in India has taken some important steps for women welfare:(i) Mahila Samridhi Yojana: The Mahila Samridhi Yojana (MSY) was launched on 2nd October, 1993 with the objective of empowering the rural women through building thrift habit, selfreliance and confidence. The Department of Women and Child Development, the nodal agency for MSY, decided in April 1997 that now new MSY accounts should be opened form 1 April 1997 onwards but the existing account could be maintained and lastly it has closed in 1st April, 1998. (ii) Mahila Samakhya yojana:-This yojana was launched on198990 with the objective of educate the women,giving equal rights and try to empowered the women.

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(iii) Indira Mahila yojana:-This yojana was launched on 1995-96 with the objective of change the mentality of women.self dependent of women by education and communication medium. (iv) Gramin Mahila Vikash Yojana:- This yojana was launched on1996-97 with the objective of change in discrimination of women in our society, participation of decision making and awareness. (v) Reproduction and child health Plan : - this plan was launched on 1997-1998 with the objective of family welfare and maternity and child welfare. (vi) Maternal Health Programme: Its aim is decreasing mortality rate less than hundred. It has also provide maternity benefit for women. (vii) Maternity protection Scheme: According to 1995 National Social help plan. It has to provide Nutritious food under the maternity protection scheme.

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(viii) Vande Matram Yojana: This Yojana was launched on 9th February, 2004 . It main objective was decreases in maternal mortality death rate. (ix) Integrated Child Development Services:- This Service was launched on 2nd October 1975, today, ICDS Scheme represents one of the worlds largest and most unique programmes for early childhood development. ICDS is the foremost symbol of Indias commitment to her children Indias response to the challenge of providing pre-school education on one hand and breaking the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality, on the other.

1. Objectives: The Integrated Child Development Services (ICDS) Scheme was launched in 1975 with the following objectives:

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i. to improve the nutritional and health status of children in the agegroup 0-6 years; ii. to lay the foundation for proper psychological, physical and social development of the child; iii. to reduce the incidence of mortality, morbidity, malnutrition and school dropout; iv. to achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and v. to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education. 2. Services: The above objectives are sought to be achieved through a package of services comprising: i. ii. iii. supplementary nutrition, immunization, health check-up,

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iv. v. vi. referral services, pre-school non-formal education and nutrition & health education. A big issue health of women in our world which in many important issue as like Malnourishment, Anaemia, Maternal Mortality rate, Breast cancer, Infant Mortality Rate etc but I focusing on a very recent issue an Anaemia. History of Anaemia Anaemia is a condition in which RBC in blood of a person contains less haemoglobin makes blood lock pale. In India anaemia prevalent in the community is mainly due to dietary deficiency of iron, a metal element, which is a constituent of the red pigment, haemoglobin. It affects particularly Reproductive women

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 Pro-school children Adolescent girls

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Anaemia also affects seriously physical and mental capacity of School children Working males What happens to an anaemia subject? It results in decreased ability of the blood to carry oxygen to the tissues all over the body An anaemia subject may. Experience the body: Weakness Headache Loss of appetite Shortness of breath

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 Palpitation

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Nervousness Gastro intestinal disturbances Low immunity Dimnished learning ability Poor attention Increased susceptibility to infection Greater risk of death associated with pregnancy and childbirth Low birth weight (LBW) babies High infant mortality How does it affect an indindual, family and community and nation

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I. In children 1. Causes deterioration in school performance 2. Causes school absentecism and mental irritability II. Young girls 1. Lack of interest to do physical labour and intellectual work 2. Those who are already anaemia, their conditions are further aggravated on pregnancy. III. In adults Iron deficiency anaemia reduces working capacity leading to low productivity and earnings in all aspects. IV. Adverse effect on the economy of a family, community and nation Anaemia earning members earn less for which a family suffers, when such families add up to form a community, the community itself is stricken

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by poverty and when a nation has large number of such populations the nations economy is bound to be on a low profile. CAUSE AND SYMPTOMS CAUSE The main cause of anaemia in most of the affected people is the deficiency of dietary iron. That is why the anaemia is called IRON DEFICIENCY ANAEMIA (IDA). Other factors contributing to iron deficiency anaemia I. During reproductive period:

1. Repeated child births 2. Excessive menstrual loss 3. Low dietary iron making iron-nutrition inadequate for both mother and the foetus II. In adolescent girls:

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In adolescent girls rapid growth and onset of menturation take place demanding more iron. Intake of food containing low level of bioavailable iron hampere the growth and leads to anaemia. III. In infants and young children: 1. The blood volume expands rapidly: During this period the deficiency of iron in the diet hampers the development. 2. Late weaning of indants : Milk is a poor source of iron. Therefore, late weaning hampers the physical growth and mental development of an infant. The infant born of a healthy mother has adequate iron store in its body for four to six months. Therefore, weaning must start within four to six months. It is desirable to give iron containing food to infant in small quantities and gradually in increased proportion as the infant grows.

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IV. Factors related to infection and infestation: 1. Hookworm infestation causing blood loss 2. Malaria causing RBC destruction 3. Diarrhoeal diseases causing loss of nutrients 4. Other infections also increase iron demand during recovery V. Other dietary factors: 1. Presence of inhibitors of iron absorption in the food of plant origin: a. Phytate; Its presence in cereals contribute to poor absorption of iron from cereal based diets. b. Tannins : These are present in seed coat of most of legumes and spices. These interfere with absorption of iron. c. Polyphenols: In tea/coffee.

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2. Low dietary intake of vitamin c, folic acid, vitamin B12 and vitamin A 3. Low intake of animal food (Animal foods contain highly absorbable dietary iron) 4. Frequent intake of tea

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Paleness of tongue Shanti Devi (35 Years)

Paleness of inner portion of lip Archana Raut (22 Years)

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Paleness of inner portion of eyelids Mira Kumari(24 Years)

Paleness of nail bed Renu Devi (25 Years)

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An anaemic child

PURPOSE OF PROJECT First and the foremost purpose of project is to make anaemia free society. To give special attention to the diet of pregnant mothers. Also to give special care to food of the adolescent girls, preschoolers, specially under 3 yrs. Children should be given iron rich foods as they are most under able to anaemia .

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METHODOLOGY I began this particular project by asking certain questions regarding problems related to anaemia so that I could acquaint my self about their problems.

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First of all I tried to know about their social status, whether they are living in a single family or joint family. FAMILY Single family Joint family PERCENTAGE 40% 60%

I found that it was very interesting to know more about them. They were quite friendly and did not hesitate which really helped me a lot. My next approach was to know their literacy rate among them which was nearly 20%. In my next step I tried to know their social status and found that most of them belonged to the lower income group. The percentage of people belonging to lower income were as such. INCOME Rs. 1000-2000 PERCENTAGE OF PEOPLE 15%

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Rs. 2000-2500 Rs. 2500-5000 Rs. 5000-6000 25% 40% 20%

After knowing that social status, I further querried to know their problems related to their diet which was the most important factor. I found that aneamia was prevalent in all ages of both sexes. But the most vulnerable groups were. 1. Pregnant women 2. Women of reproductive ages 3. Adolescent girls 4. Young children

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Cut off figures have been laid down by the World Health Organisation (WHO) based on haemoglobin concentration to determine anaemia in different age group of both sexes. Age/ Sex group Children : 6 months 5 years Children : 6 years 14 years Adult males Adult females: Non-pregnant Blood Haemoglobin level (g/dl) <11 < 12 < 13 < 12

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Adult females : Pregnant < 11

Criteria as laid down by WHO, are as follows:Grades Mild Moderate Severe Blood Haemoglobin level (g/dl) Above 10 but less than cut off figure 7-10 Below 7

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Survey done by various researches organisation including the world health organisation (WHO) have shown that as many as 50% of preschool children are of poor communities. I selected this particular slum area of Ambedkar Nagar Mohalla in Lohanipur under Kadam Kuan police station for my project because people living there belonged to weaker section of socio-economic group and they were found to be prone to anaemic diseases. Among the anemic group were mostly pregnant and preschoolers. My main objective of this project is to create aareness among the people who are anaemic and those who are prone to anemic diseases. I want to give them information about anaemia, its cause, symptoms and how to get themselves cured. Most important is that how to prevent themselves that

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they can be anaemia free leading to a healthy life. Thus the total time taken to complete my project took 420 hours.

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Management of anaemia during Pregnancy Pregnancy One tablet of folifer daily for 100 day

Anaemia Pale tongue, Pale lips and Pale nails

Two tablets daily for 100 days

Severe Anaemia

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Very pale conjunctiva and breathlessness on exertion

Refer for investigation and treatment to nearest referral Hospital/Health centre

Pregnant woman with aneamia

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Anaemic child

Dose schedule of Iron and folic acid Beneficiary Dosage Strength Total Period Pregnant women 100 mg elemental iron in the One tablet daily for (Prophylaxix) Lactating women form of water soluble salt 100 days and 500mg. folic acid. 100 mg elemental iron in the One tablet daily for form of water soluble salt 100 days Pregnant with anaemia Children 1-5 years and 500mg. folic acid women 100 mg elemental iron in the One tablet twice

form of water soluble salt daily for 100 days. and 500mg. folic acid 20 mg. elemental iron in the One tablet daily for form of water soluble salt 100 days aftern deand 100 mg. folic acid worming necessary). . (if

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Details of question asked by me from group of people residing in Slum area of Lohanipur Ambedkar Nagar Mohalla in Lohanipur under Kadamkuan Police station. Question 1. 2. 3. 4. Answer Yes About anaemia 25% Cause of anaemia 20% Symptoms of anaemia 10% Imformation about 20% deficiency of iron during 5. pregnancy Information pregnancy Imformation to children Information of iron 17% 83% Do not Know No. 75% 80% 90% 80% -

supplements given during 6. of 26% 74%

supplementary diet given 7. about 25% 75%

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nutritions pregnancy Lastly they were advised to follow regularity of pattern in taking nuteritious diet along with supplements of iron and folic acid. Also advised them to follow good food habits as I had suggested them. ANALYSIS During my field work, I created an awareness among the target group especially pregnant women about the various govenment sponsored schemes which aimed to alleviate the condition of women particulaly pregnant women, adolescent girls and pre-school children. I also suggested then to visit local government hospitals where iron tablets vitamin tablets are provided to the needy patients by the doctors free of cost. FINDING Lastly, I should say that as a result of my efforts these women become aware about the facilities provided in local government hospitals and a marked change was seen in their eating habits and living style. I also came diet during

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to know that after my advice some of them really visited local government hospitals and finally got checked up and showed signs of improvment .

Food Fortification with Iron

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Food fortification may be one of the most effective ways of preventing iron deficiency. The vehicle should be so chosen that it is almost universally consumed. The major difficulty lies in identifying a suitable vehicle to be fortified and a form of iron that is adequately absorbed without altering the taste of appearance of the food. However, in India staple food is different from place to place. Therefore more than one staples might have to be chosen depending on which stapel is the principal item for a region. Apart from staple cereals, salt and sugar may also be considered. In India salt is considered most suitable as this dietary item is universally consumed daily, more or less, in standard quantity. A technology for fortification of salt with iron has been developed by the National Institute of Nutrition and its effectiveness in reducing anaemia was demonstrated in multicentric pilot trials. Some food producers are also fortifying breakfast cereals with iron, but such food has limited users, because of cost and most people in rural areas are not accustomed to such breakfasts. Double fortified

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salt (by iodine and iron) seems to be an affordable wayout to reach one and all.

SUGGESTION

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 To grow vegetables rich in iron, citrus fruits, rich in vitamin C and citric acid in a kitchen garden and consume liberal amounts of them daily. To create awareness among the pregnent women for regular consumption of iron, folic acid tablets. To stop open field defecation and use latrines to save from worm infection. Do not drink tea within one hour of taking main meals. Wear shoes while going out or working in the field. Use mosquito net and prevent mosquito breeding in the field.

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QUESTIONAIRES Q. What is your name? A. Meera Devi. Q. How old are you? A. 25 years. Q. What is your educational qualification? A. Illiterate. Q. What is your weight? A. 35 Kg. Q. Have you ever heard about anaemia?

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Yes No Q. Do you know about the cause of anaemia? Yes No

Q. Do you feel any weakness in your body? Yes No

Q. Have you heard about iron tablets? Yes No

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BIBLIOGRAPHY Name of the book Author of the book Year 1 Clinical Dietetics F.P. Antia & Philip Oxford And Nutrition 2 Dietetics Abraham B. Srilakshmi Press Edition New International Publishors 2011/Sixth Edition 3 A Manual of Iron Minister of Health And Deficiency Anaemia Family Welfare Government of India New Delhi - 110011 University 2002/Fourth Age

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SECTION B : PROJECT PROPOSAL (Write in clear legible land; it is preferable to give a typed version. Length should not exceed 500-600 words) SUMMARY Anaemia is a condition in which R.B.Cs in blood of a person contain less Haemoglobin (Hb) making blood look pale. Iron deficiency anaemia (IDA) is a major public health problem because of. Its high prevalence (50%-90%) or even more in certain locations) in children age, particularly pregnant women. Consequences of anaemia are: Weakness/ exhaustion Low working capacity Increase susceptibility to infections i.e., low immunity

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 Small attention span and low intelligence quotient in school children Low productivity Inpregency anaemia causes greater risk of : Maternal death Birth of low body weight new borns High infant mortality rate Causes of iron deficiency anaemia: Low dierary intake of iron Aboundance of inhibitors of iron absorption in the diets, such as, phytate, oxalate, higher phosphates, fibre, high calcium level tannin, polyphenols in the common diets.

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 Low level of facilitators of iron absorption in the diet viz., vitamin C, sulphur containing amino acides, citric acid, malic acid, vitamin A etc. Infestation of Helminths and frequent matarial attacks. Other fibrile conditions increasing iron demand in the body. Repeated child births, poor breast feeding and wearing practices, faulty cooking, and cullinary practices are also attributes for aneamia. Prophylaxis programme for the vulnerable groups Under the programme the expectant and nursing mothers and as well as women acceptors of family planning are given one tablet of iron and folic acid containing 60mg. The compositions of the tablet is changed as now the large tablet for pregnant: women contains 100mg. of elemental iron, instead of 60mg. the pregnant women are given 100 tablets covered in aluminium foil in 4 strips, each containing 25 tablets and they should start to consume the tablets after the first trimester of pregnancy. Now adolescent girls are

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also being sought to be covered in RCH programme by this prophylaxid programme. Interventions necessary for for prevention and control or iron deficiency anemia : Grow vegetables rich in iron, citrus, fruits, in Vitamin C and citric acid is a kitechen arden and consume liberal amouts of them daily Create awarness among the pregnant women for regular consumption of ironfolic acid tablets. Stop open field defecation and use latrines to same from worm infection Dont take tea within one hour of taking main meals. Wear shoes shild going out, or working in the field. Use mosquito net and prevent mosquito.

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 Use clean water to get rid of diarrhoeal diseases, which causes loss of costly metrints. Undergo deworming and take iron preparations under medical advice only. Diagnosis :To ascertain wheather an individual is suffering from anamia it is necessary that the Hb, level in his/her blood be estimated in the laboratory by a colorimetric method, knows as Cyaromet Hb method or Cyaromet Hb method or Harmons method. Recommended Dietary Allowances (RDA) of iron :Indian Council of Medical Research (ICMR) has recommended dietary allowances of iron for all age group of both sexes and also for pregnant women. The RDAs for adults are around 28 mg. per day and for a pregnant women is 38 mg. per day.

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Iron absorption is however dependent on the body iron status on Hb. Status. More anaemic persons have higher iron absorption rates and for that reason dietary absorption of iron is pregnant women is much higher (around 10%) Special Groups :Give special attention to the diet of pregnant mothers. There should be no gender bias in intrafamily distribution of food, give special care to food of the adolescent girls prescholors, espicially under 3 yrs. Children should be given iron rich foods as they are most vulnerable to anaemia.

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SECTION C: COMMENTS OF CANDIDATE ON PROJECT WORK I selected Cause and treatment of anaemia as my topic for my project work. While working on my project I met especially pregnant women and pre-school children that were anaemic. On the basis of my field work I reached to the most important conclusions that there were lack of awareness among the socioeconomic group of people belonging to weaker-section of society who are malnourished including mostly pregnant women, lactating mothers, adolescent girls and pre-school children. Therefore, Health

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comps should be arganised on every three months it areas especially where weaker section of society live. Health Card should be made of all such patients. Also on the basis of medical test, anaemia affected persons should be provided iron supplements in the form of tablet/Capsule/Syrup. On the basis of my field work I have learnt that, Health Camps are organised every three months at Primary Health Centres, rural areas and N.G.O.s are really beneficial to complete eradication of aneamia from society. Apart form iron supplements, Banana is a rich source of iron which is rather cheaper and available in pleanty. Pomegranate and grapes are also good sources of iron but they are expensive .

Date: Place: Signature of Candidate

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