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					COMMON NUTRITION PROBLEMS
         IN INDIA


        Dr. K.VIJAYARAGHAVAN
       DIRECTOR – RESEARCH,
  SHARE INDIA (MEDICITI INSTITUTION)
                    &
       Sr. Dy. Director, NIN (Retd)




                              <drk.vijayaraghavan@gmail.com>
MOTHER AND CHILD SURVIVAL


MMR               407/100,000 live births
IMR*              58/1000 live births
Child Mortality   19.5/1000 Children
Rate(1-4 years)


*Gujarat 53




                                        Vijayaraghavan
NUTRITION PROBLEMS IN INDIA

     WHO IS AT RISK??

    PREGNANT WOMEN
    LACTATING WOMEN
    INFANTS    .
    PRESCHOOL CHILDREN
    ADOLESCENT GIRLS
    ELDERLY
    SOCIALLY DEPRIVED
    (SC & ST Communities)


                            Vijayaraghavan
NUTRITION PROBLEMS IN INDIA
WHAT ARE THE COMMON PROBLEMS?

     WOMEN               CHILDREN
• POOR WT. GAIN        LOW BIRTH WEIGHT
  DURING PREGNANCY   • GROWTH FALTERING
• CED                • PEM
• MICRONUTRIENT      • MICRONUTRIENT
  DEFICIENCIES         DEFICIENCIES

 FLUOROSIS, LATHYRISM
 DIET RELATED CHRONIC DISEASES
  OBESITY, CARDIOVASCULAR
  DISEASES, DIABETES
                                  Vijayaraghavan
                                                PER CENT




                                  0
                                      5
                                           10
                                                     15
                                                               20
                                                                         25
                                                                              30
                                                                                        35
                      N
                       ep
                         al
                                                                                        33
                        In
                          di
                            a
                 M                                                                 30
                  ya
                    nm
                             ar

                 M                                                       23
                  al
                       di
                         ve
                             s
                 Sr                                                 20
                      iL
                         ank
                             a
                                                               18
                   B
                       hu
                         ta
                            n
                 In                                       16
                   do
                     ne
                       si
                         a
                  Th                            11
                    ai
                      la
                        nd
                                          7.
                                            2
                                                                                             PREVALENCE OF LBW IN S.E ASIAN COUNTRIES




Vijayaraghavan
FACTORS MODIFYING PREVALENCE OF
              LBW


 • % INSTITUTIONAL DELIVERIES

 • # ANCs (Minimum: >5)

 • QUALITY OF ANC
      Includes:
      No.of ANCs, TT, Weight, BP,
      Examination of Blood,
      Examination of Urine
                                    INFANT MORTALITY AND BIRTH WEIGHT

                        1200




                        1000    1000
IMR /1000 Live-births




                         800




                         600               615



                         400



                                                    238
                         200


                                                                59
                                                                               21           18
                           0

                               <1       1-1.5    1.5-2       2-2.5          2.5-3            >3
                                                 BIRTH WEIGHT (KG)

                         S                                       Source: Shanti Ghosh et al, 1978
                           IFA SUPPLENTATION AND LBW



            35

            30

            25             30.8
                                               30.2
PER CENT




            20

            15

                                                            15.5
            10

             5

             0
                    CONTROL                IRON       FOLIC ACID

                                         GROUPS

           Source: Leela Iyengar & Apte, S,V.,1970
                          SUPPLENTATION OF IRON / FOLIC ACID
                                     AND BIRTH WEIGHT

                   3000

                   2900
BIRTH WEIGHT (g)




                   2800

                   2700
                                                           2890
                   2600
                                              2650
                   2500       2567

                   2400
                             CONTROL          IRON      FOLIC ACID

                                             GROUPS
Source: Leela Raman & Rajalakshmi,1974
 NUTRITIONAL DISORDERS IN CHILDREN




• PROTEIN ENERGY MALNUTRITION (PEM)
     . CLINICAL FORMS
     . SUBCLINICAL UNDERNUTRITION

• MICRONUTRIENT DEFICIENCIES



                               Vijayaraghavan
CLINCAL FORMS of PEM

              KWASHIORKOR

          •   OEDEMA+
          •   IRRITABILITY+
          •   GROWTH FAILURE+
          •   DISCOLOURED HAIR+




                           Vijayaraghavan
CLINCAL FORMS of PEM
              MARASMUS


           EXTREME WASTING
           “SKIN AND BONES”
           MONKEY/OLD MAN
           FACIES




                            Vijayaraghavan
    SUB-CLINICAL FORMS OF PEM



UNDERNUTRITION      WEIGHT FOR AGE



   WASTING        WEIGHT FOR HEIGHT



  STUNTING          HEIGHT FOR AGE


                                Vijayaraghavan
     UNDERNUTRITION IN INDIA



PRESCHOOL CHILDREN                                 ADULTS (Females)
             6.2
                                                     5
                    8.9
                                                                  46.5
   44.3                        40.6
                                             48.5



NORMAL    GRADE I   GRADE II     GRADE III

                                             CED         NORMAL          OBESE


 Based on NCHS weight for age                        Based on BMI



                                                                     Vijayaraghavan
                TIME TRENDS IN ANTHROPOMETRIC PARAMETERS (<Median-2SD)
                                        NNMB

           80

           70       78.6
                                    76.5
           60                                                  1975-79
                                             62.3
                             57.7                              1996-97
           50
PER CENT




           40

           30

           20
                                                        18.1    18.5
           10

            0
                    Height          Weight          Weight for Height    VIJAY’00
DISTRIBUTION WEIGHT FOR AGE – IAP
             Gujarat

           40

           35

           30              37.9
                 32.5
           25
PER CENT




           20

           15                              21

           10

           5
                                                       7.2       1.4
           0
                         Gr. I           Gr. II      Gr. III   Gr. IV
                Normal
                                 GRADES OF UNDERNUTRITION
     WEIGHT FOR AGE–
SD CLASSIFICATION - GUJARAT
    40
    35
    30
    25
  % 20
                                                      Boys
    15
                                                      Girls
    10
                                                      Pooled
     5
     0
         SD


                  SD


                           SD




                                                 an
                                       an


                                                i
                                      i


                                             ed
                                   ed
     3


                --3


                         --2
   <-




                                            >M
                                  -M
              -2


                       -1


                                -1
VITAMIN A DEFICIENCY
        BITOT SPOT        KERATOMALACIA




                      V
                      A
                      D




BILATERAL BLINDNESS




                                          Vijayaraghavan
WHO Criteria for Public Health Significance
                   - VAD

Minimum Prevalence (%) in children <6 yrs

•   BITOT SPOTS              0.5
•   NIGHT BLINDNESS          1.0
•   CORNEAL LESIONS          0.01
•   CORNEAL SCARS            0.05
•   Serum Retinol <10 g/l   5.0




                                     Vijayaraghavan
VITAMIN A DEFICIENCY (%) IN INDIA

 AGE GROUP          SOURCE       X1B   XN*

                   ICMR, 2001    0.7   1.03
 PRESCHOOL
                      NNMB       0.7      -
  CHILDREN
                  NIN- SURVEYS   2.1      -
 PREGNANT          ICMR, 2001     -     2.8
  WOMEN


 * 24-71 MONTHS



                                       Vijayaraghavan
        VITAMIN A DEFICIENCY
                                 Districts(%) with X1B >0.5%



                                     No VAD       VAD
Average prevalence (%)

            2.1
                                          55        45



  Based on surveys in 126 Dts.
  by NIN and NNMB

                                                    Vijayaraghavan
    NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN


           6


           5               5.7
                                              5.7
                                                           PEM
           4                                               X1B
PER CENT




                                                           RIBO. DEF.
           3


           2
                                                                2.1
                     1.8
           1   1.7
                                                    0.2
                                    0.7 0.7               0.7
           0
                1975-79              1988-90          1996-97

                                 PERIOD OF SURVEY
                                                                        Vijayaraghavan
DISTRIBUTION OF MICRONUTRIENT INTAKES IN
             CHILDREN - %RDI
         100



   %     50



          0
               <70    70-90   90-100   >100

  Vitam in A   86.3    3.2     1.4     9.1
  Iron         82.5    8.6     2.1     6.8
  Riboflavin   71.4   15.9     4.1     8.6

                        % RDI

                                              Vijayaraghavan
ANAEMIA
    100          PREVALENCE OF ANAEMIA IN PREGNANT WOMEN


     90


                                                                     96.8
     80

                                                             94.9
                                                                                  84.6
     70
                                                     91.4


%    60                                     87.2


                                   84.1
     50
                          82.5

                  79.4
     40


           61
     30



     20
          H.P.   M.P.    A.P.    BIHAR    MAHA.    ASSAM    RAJ.    J&K        POOLED


                                                                            Vijayaraghavan
            PREVALENCE OF ANAEMIA -
               ADOLESCENT GIRLS
    100


     98


     96


     94


     92

                                                       99.3         92
%    90                                         93.9
                                        92.2
     88                          91.9
                         91.8
     86
                  87.7
     84    87.1

     82


     80
          MAHA.   H.P.   A.P.   BIHAR   M.P.   ASSAM   J&K      POOLED

                                                         Source: ICMR, 1999
  ANAEMIA IN FEMALES
• PREVALENCE OF
  ANAEMIA IS VERY              95
  HIGH IN BOTH THE             90
  GROUPS                       85
                               80             92
                                    84.6




                     Percent
• NO CHANGE
                               75

  NOTICED OVER
                               70
                               65
  TIME IN THE                  60
  PREVALENCE                   55
                               50

                                Pregnant   Adolescent
                                 Women        girls
                                                   Vijayaraghavan
IODINE DEFICIENCY DISORDERS
IODINE DEFICIENCY DISORDERS




  GOITRE+




239 OF 282 DTs. SURVEYED –
ENDEMIC
167 millions AT RISK ?
     PREVALENCE OF GOITRE IN
     6-12 Yr CHILDREN - Gujarat

16
14
12
10
8                                 Surat
                                  Valsad
6
4
2
0
       Gr. I   Gr. II   Total
DIETARY INTAKES
  HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS


                                                90
  Protein (g)                                    92
                                           85              Rural
                                                           Tribal
                                           87              Urban Slums
Energy (Kcal)                                91
                                      79

                                                                    131
Calcium (mg)                                          98
                                                              118

                               51
    Iron (mg)                 48
                                     78


                0   20   40     60   80           100        120     140

                               PER CENT                              VIJAY’00
HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS

                        51
 Vitamin A (µg)                  63                         Rural
                       46
                                                            Tribal
                                              104           Urban Slums
  Thaimin (mg)                               100
                                        87

                                   71
Riboflavin (mg)                  64
                            55

                                             102
Vitamin C (mg)                                       120
                                               105

                                                                 156
 Folic acid (µg)                                                   164
                   0

                   0   50                100               150            200
                                      PER CENT
  NUTRIENT INTAKES AMONG INDIAN WOMEN

     NUTRIENTS        NPNL   PREGNANT   LACTATIN
                              WOMEN     G WOMEN
      Protein (g)     49.9     47.2       56.5
    Energy (kcal)     1983     1994      224.3
     Total Fat (g)    24.5     21.5       373
    Calcium (mg)      382      339        12.4
       Iron (mg)      11.3     11.0       162
    Vitamin A (g)    148      142        1.1
    Thiamin (mg)      0.9       0.9       1.1
   Riboflavin (mg)    0.8       0.8       0.9
   Vitamin C (mg)     32.0     28.4       29.4
    Folic Acid (g)    86       84        106
Source: NNMB, 2000
             NUTRIENT INTAKES IN PREGNANT WOMEN
                             % RDI

  % RDI      Energy     Protein   Vitamin A   Iron   Riboflavin   Total Fat

    <30             0     0         52.4      53.7      1.2          22
   30-40        1.2       0         8.5       22       20.7         6.1
   40-50        3.7      2.4         11       9.8      13.4         6.1
   50-60        9.8       11        9.8       7.3      12.2         7.3
   60-70        8.5      17.1        0         0       18.3         8.5
   70-80       23.2       11        3.7       1.2       4.9         7.3
   80-90        9.8      9.8        2.4       1.2       4.9         4.9
  90-100        7.3      8.5        2.4       2.4       7.3         4.9
   100        36.5      40.2       9.8       2.4      17.1         32.9

Source: NNMB,2000
    NUTRIENT INTAKES (per day) IN CHILDREN
                          Age in Years
Nutrients              1-3            4-6
               Mean     Median   Mean Median
Protien (g)     22.4      20.4   31.4    29.40
Tot fat (g)     13.5      10.1   17.6    13.90
Energy (Kcal)   867        815   1215     1154
Calcium (mg)    250        168    300      224
Iron (mg)       5.50      4.30    8.4     6.90
Vit A (ug)      145        72     205      96
Thiamin (mg)    0.44      0.40   0.69     0.60
Ribo. (mg)      0.44      0.40   0.56     0.50
Niacin (mg)     4.97       4.5   7.37     6.60
Vit C (mg)      16.5       9.9   24.9     17.5
Folic acid (mg) 45        36.6     65     55.1
            NNMB, 2000                       Vijayaraghavan
DETERMINANTS OF MALNUTRITION

 MATERNAL MALNUTRITION
 START WITH A HANDICAP(LBW)
 FAULTY CHILDFEEDING PRACTICES
 DIETARY INADEQUACY
 FREQUENT INFECTIONS
 LOW PURCHASING POWER
 LARGE FAMILIES
 HIGH FEMALE ILLITERACY
 TABOOS AND SUPERSTITIONS
        Factors Affecting Nutritional Status
High illiteracy                                     Unemployment/
                                                    Underemployment
                           Large families
                                                   Low purchasing power
         Ignorance                  High dependence rate
                           False food beliefs      Inadequate intakes
Low Procurement
of foods             Poor PDS                        High cost
                          Low availability of foods
Low production            Reduced work              Malnutrition
of foodgrains             output

Poor environment           Morbidity        Absorption of nutrients
                                                            Low Appetite
Poor utilization of services                poor coverage of immunization
                                                     Improper health services
                                            poor infrastructure
                                  Lack of resources
  INTERVENTIONS IN OPERATION

DIRECT
•CONVERGENCE OF SERVICES (RCH)
•INTEGRATED CHILD DEVELOPMENT SERVICES
•IRON AND FOLIC ACID DISTRIBUTION
•MASSIVE DOSE VITAMIN A PROGRAMME
•PRIMARY HEALTH CARE PROGRAMME
•HEALTH AND NUTRITION EDUCATION
INDIRECT
•POVERTY ALLEVIATION PROGRAMMES
•ENVIRONMENTAL SANITATION
•PROTECTED WATER SUPPLY
•LITERACY PROGRAMME

				
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