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  2. 2. Malnutritionis defined as a pathological state resulting from relative or absolute deficiency of one or more essential nutrients. It is primary when there is deficiency of food available or secondary when food is available but the body cannot assimilate it for one or another reason. (Or) Malnutrition is a medical condition caused by an improper or insufficient diet. Malnutrition is technically a category of diseases that includes 1)under nutrition , 2)obesity and overweight, 3)micronutrient deficiency among others . However, it is frequently used to mean under nutrition from either inadequate calories or inadequate specific dietary components for whatever reason. Forms of malnutrition 1. protein-calorie malnutrition (PCM) • Kwashiorkor, marasmus, and mixed marasmus-kwashiorkor. 2. micronutrient malnutrition • particularly vitamin A deficiency (VAD), iron deficiency anemia (IDA), and iodine deficiency disorders (IDD) Effects • Digestive system: Decreased production of HCL, and frequent diarrhea that could be fatal. • Cardiovascular system: Reduced heart size, reduced amount of blood pumped, bradycardia, and heart failure. • Respiratory system: Slow breathing, reduced lung capacity, and, ultimately, respiratory failure. • Reproductive system: Reduced size of ovaries and testes, loss of libido, cessation of menstruation • Nervous system: Apathy and irritability, mental retardation in children sometimes, mental dysfunction in older people. • Muscles: Reduced muscle mass and strength and reduced ability to exercise or work. • Blood: Anaemia • Metabolism: Hypothermia, fluid accumulation in arms, legs, and abdomen, and disappearance of subcutaneous fat. • Skin and hair: As in slide 8 • Immune system: Impaired ability to fight infections and repair wounds • Malnutrition affects HIV transmission by increasing the risk of transmission from mother to child and also increasing replication of the virus. 2
  3. 3. Causes Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. Clinical malnutrition, such as in cachexia, is a major burden also in developed countries. Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if the area lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education. • Dietary practices • Diseases and infections • Poverty and food prices • Agricultural productivity • Future threats 1) Weight for age is the best screening tool. >Weight for age below 2 Standard Deviation from median is taken as Malnutrition. >It is used for mass screening of children to detect under nutrition. 2) Weight for Height below the 5th Centile classifies the child as Wasted ( Acute Malnutrition). 3)Height for age below the 5th centile classifies the child as Stunted (Chronic Malnutrition) Anthropometric Indices in Malnutrition Classification Weight as % of the standard Normal >90 Grade 1 (mild under nutrition) 75-89 Grade 2 (moderate under nutrition) 60-74 Grade 3 ( severe under nutrition) <60 Weight for height Height for age Nutriti onal status ≥ 80% ≥ 90% Normal <80% ≥ 90% Wasted ≥ 80% < 90 % Stunte d <80% < 90% Wasted and stunted3
  4. 4. Malnutrition in the world The United Nations Food and Agriculture Organization estimates that nearly 870 million people, or one in eight people in the world, were suffering from chronic undernourishment in 2010-2012. Almost all the hungry people, 852 million, live in developing countries, representing 15 percent of the population of developing counties. There are 16 million people undernourished in developed countries (FAO 2012). 4
  5. 5. Malnutrition in India • India is one of the fastest growing countries in terms of population and economics, sitting at a population of 1,139.96 million (2009) and growing at 10–14% annually (from 2001–2007).India's Gross Domestic Product growth was 9.0% from 2007 to 2008; since Independence in 1947, its economic status has been classified as a low-income country with majority of the population at or below the poverty line. The combination of people living in poverty and the recent economic growth of India has led to the co-emergence of two types of malnutrition: under nutrition and over nutrition. • Despite India's 50% increase in GDP since 1991,more than one third of the world's malnourished children live in India. Among these, half of them under 3 are underweight and a third of wealthiest children are over nutrient. • The World Bank estimates that India is ranked 1st in the world of the number of children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.[The UN estimates that 2.1 million Indian children die before reaching the age of 5 every year – four every minute – mostly from preventable illnesses such as diarrhea, typhoid, malaria, measles and pneumonia • West Bengal • Rajasthan • Uttar Pradesh • Gujarat • Madhya Pradesh Programs to address the causes of malnutrition in India :- Midday meal scheme in Indian schools Integrated child development scheme National Plan of Action for Children National Children's Fund United Nations Children's Fund National Rural Health Mission Top 5 states in India effecting from Malnutrition 5
  6. 6. To over come this my solution MOTHER TERESA SUSTAINABLE PLAN AGAINST MALNUTRITION (MTSPAM) GOLE:  Make every one to know about malnutrition, its cause’s, its effect’s and prevention methods.  Looking over all plan’s (as given in 4 slid) .  Reduce malnutrition to levels below public health significance etc. OBJECTIVES: with help of present plans  Improve knowledge and practice of key health and nutrition concepts and behaviors – Infant and young child feeding (breastfeeding and complementary feeding) – Consumption of vegetables and eggs – Sanitary and hygienic practices (hand washing, tooth brushing, use of sanitary toilet facilities)  To improve food intake in participating households.  To prevent stunting among children 6 menthes to 2 years old.  To reduce the prevalence of underweight-for-age among children 0-8 years old. Target Peoples All uneducated and ruler families 6
  7. 7. IMPLEMENTATION OF PLAN Recruit 10 people for each district to monitor whether the plans are implementing as per requirements.  This group of people should be qualified as they can make their own strategies to react as per situation.  The minimum powers should be delegated to them to interfere in the undertaken plans. This 10 people should have contacts with district level hospital, PDS system , Sarpanch, schools, judiciary, police station etc. This group should report their progress periodically to the appropriate government. They should have extra benefits apart from salary (ex: refund of travelling expenses for on duty) .  Implement existing plans in a appropriate manner. Sources of funds :--- black money can be used for the same . The nutritional food should be supplied by the government without neglecting the poor people . FINANCIAL REQUIREMENT 3. 1.4 billion is required for one year. 2. 610 * 10 = 6100 Members Each employee will get Rs. 20000/- per month. 1. Present districts are 610 app. 10 members for each district 7
  8. 8. How The MTSPAM Work Recruit the employers for MTSPAM under the human resource of Indian as per recruitment rules. First step:- These 10 have to visit every village under there district to create awareness program about the Malnutrition with help of village Sarpanch in the village premises. These awareness program must be conducted in the presence of Sarpanch, Dean of District Hospital ,S I. In the program they must explain about malnutrition, Its causes, Its effects and also Few preventing methods .Second step:- In the same program they have to explain about the present and existing government plans against malnutrition Its goals, about its financial budget using by the govt. ,its benefits to common citizen and about rules of plans. 8
  9. 9. Final and Main step:- They have to explain about the MTSPAM ,that they will act as “an intercede between common peoples and government” , about their powers and contacts with hospital ,PDS system, rural panchayat , police station, to get information about pregnancy ladies and also new born babies. Their should be a flow of information from intermediateries continuously about providing facility’s like food grains ,medicine's etc to citizen’s and also from citizen whether they are getting it or not. Every citizen will have a right to get whatever the government planning to give them like food items, medical facilities, education facilities and the financial facilities etc. If any injustice happens to them (citizen) regarding malnutrition plans then they have right to inform MTSPAM member’s for quick solution. 9
  10. 10. PRESENT PLAN’S MTSPAM Hospital, Sarpanch, Schools, PDS system Judiciary, Police Station Etc. Malnourish ed Mother Low Birth Weight Stunted Child Malnourish ed Girl No Colostrum/ Exclusive Breastfeeding for 6 Months Inadequate Food and Health Care Delayed, Inadequate Complementary Food after 6 Months Frequent Infections and Prolonged diarrhoea Poverty Lack of awareness Infections Inadequate Food and Health care Low BMI Poor Diet Gender Discrimination Early marriage and pregnancy Inadequate Foetal Nutrition Low Weight Gain during Pregnancy Gender Discrimination Multiple Pregnancies Inadequate Catch Up and Growth act as “an intercede between common peoples and government” 10
  11. 11. Criteria To Measure The Impact Of The Solution Measurement of birth and death rate. Conducting survey Complaint rate BMI of villager’s Sudden inspection to village’s Appropriate Monitoring Mechanisms Monthly reports must be submitted to human resource. Appropriate government may take a sudden inspection. Challenges and Mitigation Factors The ruling and opposition political parties should give a positive consent about the plan and give rights to interfere with the existing plans. Economical and financial supports must be provided. The railway and the state transport authorities should give free passes to go any where on the duty for MTSPAM members. The low level government employees should say yes to give any information to them. Merits Reduces malnutrition. Increases efficiency of work by the government server. Increase GDP in future. Low budget plan with the help of govt. employees. Provides extra 6000+ employment Create trust on government. 11
  12. 12. Appendix References  Few basic information we took Wikipedia.  Most of the matter form UNICEF web site .  A report of National Situationer on HUNGER AND MALNUTRITION IN INDIA: STATUS,CAUSES AND CURES (2012) by MHRD.  Copy of Levels & Trends in Child Malnutrition by UNICEF-WHO-The World Bank.  Statistics and numbers from WHO and UNICEF Joint Global Nutrition Database, 2011  Ppt on National Perspective on Micronutrient Deficiencies and Their Impact on Health and Productivity by ICCIDD and AIIMS.  PPT on Economics of Malnutrition by Veena S Rao.  Images from Google images. 12