Table 4A.

Table showing strategies to combat dietary calcium deficiency governmental and digital in rural and urban region.

S.NO	Program	TARGET POPULATION	FEATURES	IMPACT	LIMITATIONS	REMEDIAL MEASURES
1	Indian Social Security Net Program (SSNP)
	a) Integrated Child Development program (ICDS)	Community level 0–6 years age	Food supplement at community level	Reduced school dropouts	Did not help achieving nutrition sufficiency 1) The food became the only source of food rather than a supplement. 2) The nutrition composition did not give much weightage to dietary calcium. 3) Children did not attend at very early age of 0–3years, before malnutrition sets in (111, 112)	Instant or precooked fortified products for infants and children can be given: complementary food supplements, micronutrient powders(can be used as home fortificants or point-of-use fortificants) and fortified blended foods. Cookies, biscuits, compressed bars and chikkies are other type of fortified complimentary foods that can be used.
	b) National Guidelines for Calcium Supplementation during Pregnancy and Lactation	Pregnant women from 1st trimester till 6 months post-partum	500 mg elemental calcium and 250 IU Vitamin D3 twice a day	Increase in awareness of nutrition during and after pregnancy	Calcium and Vitamin D dose advocated is far less than the guidelines for treatment deficiency for population at risk (113–115).	1) Upgrade vitamin D and calcium dose. 2) Continue supplements till 2 years postpartum 3) Compliment feeding with multiple fortifications of essential micronutrients
	c) Mid–Day–Meals Scheme (MDM)	1) Primary stage (class 1–5). 2) Upper primary stage (class 6–8)	Nutrition norm: 1) primary stage - 450 calories. 2) upper primary stage-700 calories	Increase in school going children with 25 crore children studying in 15 lakh schools	1) In year 2018–2019, there was 25% gap in coverage (116). 2) Bridges the food gap, but not the nutrition gap. 3) Little emphasis on calcium and vitamin D	1) Educate parent and children. 2) Supplement fortified milk(with calcium and vitamin D) at the beginning and end of school session–preferably in tetra packs–to prevent adulteration, dilution and pilferage. 3) Inclusion of cheese and paneer in MDM. 4) Supply of fortified flour (with calcium and vitamin D) instead of grains used for preparing MDM. 5) Encourage schools to grow vegetables rich in calcium in kitchen garden for MDM. 6) Increase in adoption of MDM by charitable institutions and CSR if required. 7) Distribution of snacks with high calcium content to children as mid-morning and evening snack for all age groups (117, 118). 8) Snacks made of Gingelly(Sesame) seeds rich in calcium. 9) poster and verbal education at PDS centers
	d) Targeted public distribution system	1) Below Poverty Line(BPL)(to the poorest families), 2) Anatyodaya Anna Yojana (AAY)(poorest 20% BPL), and, 3) Above poverty line(APL)(low income not among the poorest
	1)Targeted fortification	1) Lower socio economic strata 2) Those on Public Distribution System(PDS) 3) MDM/ICDS				1) Involve ISKON, Akshaya Patra, 2) fortified ready to eat snacks
	2) Mass fortification	Discussed in our previous review (109).
	3) Market driven fortification	Growing children, pregnant and lactating mothers, health conscious population, Subjects recovering from chronic illness,				Fortification of milk, flour, salt oil etc.
2.	Food fortification			It can deliver significant proportion of RDA for a number of micro nutrients without necessitating a change in dietary pattern of the population on a continuous basis and without calling for individual compliance	Cannot correct all or either of severity of micro nutrient deficiency, locality or poverty limiting the access of the FF	This problem is overcome by the PDS which caters to 80 crore population (vide supra).
	a) Home fortification (HF)	At Household level	Encourages self-reliance, distributes cost effectively and widely, allows freedom of individual choice to utilize the additives		1) No guarantee the target population would participate, 2) The supply of additives has to be replenished to sustain HF, 3) Uncomfortable feel of adding a substance to their food without knowing what it is and 4) The barrier of using additives to regular cooked foods.	Overcome by educational programs (119).
	b) Commercial and industrial fortification (IF)	reaches large populations through PDS or retail stores	Can be made available at low costs with high quantity of production		The producer may drastically increase the price or some may unknowingly perceive the addition as unethical practice.	Overcome by legislation (119).
	c) Biofortification (BF) (genetically modified)	can benefit large population	Well suited for daily diet of low income population using large staple foods.	it requires minimal intervention, is highly sustainable once it is introduced,	Improper knowledge may impact the mono cultures and reduce the bioavailability	Overcome by educational programs