COMMON NUTRITION PROBLEMS IN INDIA Dr. K.VIJAYARAGHAVAN DIRECTOR – RESEARCH,  SHARE INDIA (MEDICITI INSTITUTION) & Sr. Dy....
MOTHER AND CHILD SURVIVAL MMR  407/100,000   live births IMR*  58/1000  live births Child Mortality  19.5/1000   Children ...
NUTRITION PROBLEMS  IN INDIA WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS E...
<ul><li>WOMEN </li></ul><ul><li>•  POOR WT. GAIN  </li></ul><ul><li>DURING PREGNANCY </li></ul><ul><li>CED </li></ul><ul><...
PREVALENCE OF LBW IN S.E ASIAN COUNTRIES Vijayaraghavan
FACTORS MODIFYING PREVALENCE OF LBW <ul><li>% INSTITUTIONAL DELIVERIES </li></ul><ul><li># ANCs (Minimum: >5)   </li></ul>...
Source : Shanti Ghosh Source: Shanti Ghosh et al, 1978
Source: Leela Iyengar & Apte, S,V.,1970
Source: Leela Raman & Rajalakshmi,1974
NUTRITIONAL DISORDERS IN CHILDREN <ul><li>PROTEIN ENERGY MALNUTRITION (PEM) </li></ul><ul><li>. CLINICAL FORMS </li></ul><...
CLINCAL FORMS of PEM <ul><li>KWASHIORKOR </li></ul><ul><li>OEDEMA+ </li></ul><ul><li>IRRITABILITY+ </li></ul><ul><li>GROWT...
CLINCAL FORMS of PEM <ul><li>MARASMUS </li></ul>EXTREME WASTING “ SKIN AND BONES” MONKEY/OLD MAN FACIES Vijayaraghavan
SUB-CLINICAL FORMS OF PEM Vijayaraghavan HEIGHT FOR AGE STUNTING    WEIGHT FOR HEIGHT WASTING    WEIGHT FOR AGE UNDERNUT...
UNDERNUTRITION IN INDIA PRESCHOOL CHILDREN ADULTS (Females) Based on BMI  Vijayaraghavan Based on NCHS weight for age
VIJAY’00
DISTRIBUTION WEIGHT FOR AGE – IAP Gujarat Normal Gr. I Gr. II Gr. III Gr. IV
WEIGHT FOR AGE–  SD  CLASSIFICATION - GUJARAT
VITAMIN A  DEFICIENCY
BITOT SPOT KERATOMALACIA BILATERAL BLINDNESS   V A D Vijayaraghavan
WHO Criteria for Public Health Significance - VAD <ul><li>Minimum Prevalence (%) in children <6 yrs </li></ul><ul><li>BITO...
VITAMIN A DEFICIENCY (%) IN INDIA * 24-71 MONTHS  Vijayaraghavan 2.8 - ICMR, 2001 PREGNANT WOMEN - 0.7 NNMB PRESCHOOL CHIL...
VITAMIN A DEFICIENCY Districts(%) with X1B >0.5% Average prevalence (%) 2.1 Based on surveys in 126 Dts.  by NIN and NNMB ...
NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN Vijayaraghavan
Vijayaraghavan
ANAEMIA
Vijayaraghavan
PREVALENCE OF ANAEMIA -ADOLESCENT GIRLS
ANAEMIA IN FEMALES <ul><li>PREVALENCE OF ANAEMIA IS VERY HIGH IN BOTH THE GROUPS </li></ul><ul><li>NO CHANGE NOTICED OVER ...
IODINE DEFICIENCY DISORDERS
239 OF 282 DTs. SURVEYED – ENDEMIC 167 millions AT RISK  ? IODINE DEFICIENCY DISORDERS GOITRE+
PREVALENCE OF GOITRE IN  6-12 Yr CHILDREN - Gujarat
DIETARY INTAKES
HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS VIJAY’00
HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
NUTRIENT INTAKES AMONG INDIAN WOMEN Source: NNMB, 2000 NUTRIENTS 106 84 86 Folic Acid (  g) 29.4 28.4 32.0 Vitamin C (mg)...
NUTRIENT INTAKES  IN PREGNANT WOMEN   % RDI Source: NNMB,2000 32.9 4.9 4.9 7.3 8.5 7.3 6.1 6.1 22 Total Fat 17.1 7.3 4.9 4...
NUTRIENT INTAKES (per day) IN CHILDREN <ul><ul><ul><ul><ul><li>NNMB, 2000 </li></ul></ul></ul></ul></ul>Vijayaraghavan
DETERMINANTS OF MALNUTRITION MATERNAL MALNUTRITION START WITH A HANDICAP( LBW ) FAULTY CHILDFEEDING PRACTICES DIETARY INAD...
Factors Affecting Nutritional Status High illiteracy Unemployment/ Underemployment Large families Low purchasing power Ign...
INTERVENTIONS IN OPERATION <ul><li>DIRECT </li></ul><ul><li>CONVERGENCE OF SERVICES (RCH) </li></ul><ul><li>INTEGRATED CHI...
THANKS & NAMASKAR
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Indian Nutrition Scenario Dr. K. Vijayraghavan

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Indian Nutrition Scenario Dr. K. Vijayraghavan

  1. 1. COMMON NUTRITION PROBLEMS IN INDIA Dr. K.VIJAYARAGHAVAN DIRECTOR – RESEARCH, SHARE INDIA (MEDICITI INSTITUTION) & Sr. Dy. Director, NIN (Retd) < [email_address] >
  2. 2. 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) Vijayaraghavan *Gujarat 53
  3. 3. NUTRITION PROBLEMS IN INDIA WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY SOCIALLY DEPRIVED (SC & ST Communities) . Vijayaraghavan
  4. 4. <ul><li>WOMEN </li></ul><ul><li>• POOR WT. GAIN </li></ul><ul><li>DURING PREGNANCY </li></ul><ul><li>CED </li></ul><ul><li>MICRONUTRIENT DEFICIENCIES </li></ul><ul><li>CHILDREN </li></ul><ul><li>LOW BIRTH WEIGHT </li></ul><ul><li>GROWTH FALTERING </li></ul><ul><li>PEM </li></ul><ul><li>MICRONUTRIENT DEFICIENCIES </li></ul>NUTRITION PROBLEMS IN INDIA WHAT ARE THE COMMON PROBLEMS? <ul><li>FLUOROSIS, LATHYRISM </li></ul><ul><li>DIET RELATED CHRONIC DISEASES </li></ul><ul><li>OBESITY, CARDIOVASCULAR </li></ul><ul><li>DISEASES, DIABETES </li></ul>Vijayaraghavan
  5. 5. PREVALENCE OF LBW IN S.E ASIAN COUNTRIES Vijayaraghavan
  6. 6. FACTORS MODIFYING PREVALENCE OF LBW <ul><li>% INSTITUTIONAL DELIVERIES </li></ul><ul><li># ANCs (Minimum: >5) </li></ul><ul><li>QUALITY OF ANC </li></ul><ul><li>Includes: </li></ul><ul><li>No.of ANCs, TT, Weight, BP, Examination of Blood, Examination of Urine </li></ul>
  7. 7. Source : Shanti Ghosh Source: Shanti Ghosh et al, 1978
  8. 8. Source: Leela Iyengar & Apte, S,V.,1970
  9. 9. Source: Leela Raman & Rajalakshmi,1974
  10. 10. NUTRITIONAL DISORDERS IN CHILDREN <ul><li>PROTEIN ENERGY MALNUTRITION (PEM) </li></ul><ul><li>. CLINICAL FORMS </li></ul><ul><li> . SUBCLINICAL UNDERNUTRITION </li></ul><ul><li>MICRONUTRIENT DEFICIENCIES </li></ul>Vijayaraghavan
  11. 11. CLINCAL FORMS of PEM <ul><li>KWASHIORKOR </li></ul><ul><li>OEDEMA+ </li></ul><ul><li>IRRITABILITY+ </li></ul><ul><li>GROWTH FAILURE+ </li></ul><ul><li>DISCOLOURED HAIR+ </li></ul>Vijayaraghavan
  12. 12. CLINCAL FORMS of PEM <ul><li>MARASMUS </li></ul>EXTREME WASTING “ SKIN AND BONES” MONKEY/OLD MAN FACIES Vijayaraghavan
  13. 13. SUB-CLINICAL FORMS OF PEM Vijayaraghavan HEIGHT FOR AGE STUNTING  WEIGHT FOR HEIGHT WASTING  WEIGHT FOR AGE UNDERNUTRITION
  14. 14. UNDERNUTRITION IN INDIA PRESCHOOL CHILDREN ADULTS (Females) Based on BMI Vijayaraghavan Based on NCHS weight for age
  15. 15. VIJAY’00
  16. 16. DISTRIBUTION WEIGHT FOR AGE – IAP Gujarat Normal Gr. I Gr. II Gr. III Gr. IV
  17. 17. WEIGHT FOR AGE– SD CLASSIFICATION - GUJARAT
  18. 18. VITAMIN A DEFICIENCY
  19. 19. BITOT SPOT KERATOMALACIA BILATERAL BLINDNESS V A D Vijayaraghavan
  20. 20. WHO Criteria for Public Health Significance - VAD <ul><li>Minimum Prevalence (%) in children <6 yrs </li></ul><ul><li>BITOT SPOTS 0.5 </li></ul><ul><li>NIGHT BLINDNESS 1.0 </li></ul><ul><li>CORNEAL LESIONS 0.01 </li></ul><ul><li>CORNEAL SCARS 0.05 </li></ul><ul><li>Serum Retinol <10  g/l 5.0 </li></ul>Vijayaraghavan
  21. 21. VITAMIN A DEFICIENCY (%) IN INDIA * 24-71 MONTHS Vijayaraghavan 2.8 - ICMR, 2001 PREGNANT WOMEN - 0.7 NNMB PRESCHOOL CHILDREN 1.03 0.7 ICMR, 2001 AGE GROUP - XN* 2.1 NIN- SURVEYS SOURCE X1B
  22. 22. VITAMIN A DEFICIENCY Districts(%) with X1B >0.5% Average prevalence (%) 2.1 Based on surveys in 126 Dts. by NIN and NNMB Vijayaraghavan No VAD VAD
  23. 23. NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN Vijayaraghavan
  24. 24. Vijayaraghavan
  25. 25. ANAEMIA
  26. 26. Vijayaraghavan
  27. 27. PREVALENCE OF ANAEMIA -ADOLESCENT GIRLS
  28. 28. ANAEMIA IN FEMALES <ul><li>PREVALENCE OF ANAEMIA IS VERY HIGH IN BOTH THE GROUPS </li></ul><ul><li>NO CHANGE NOTICED OVER TIME IN THE PREVALENCE </li></ul>Pregnant Women Adolescent girls Vijayaraghavan
  29. 29. IODINE DEFICIENCY DISORDERS
  30. 30. 239 OF 282 DTs. SURVEYED – ENDEMIC 167 millions AT RISK ? IODINE DEFICIENCY DISORDERS GOITRE+
  31. 31. PREVALENCE OF GOITRE IN 6-12 Yr CHILDREN - Gujarat
  32. 32. DIETARY INTAKES
  33. 33. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS VIJAY’00
  34. 34. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS
  35. 35. NUTRIENT INTAKES AMONG INDIAN WOMEN Source: NNMB, 2000 NUTRIENTS 106 84 86 Folic Acid (  g) 29.4 28.4 32.0 Vitamin C (mg) 0.9 0.8 0.8 Riboflavin (mg) 1.1 0.9 0.9 Thiamin (mg) 1.1 142 148 Vitamin A (  g) 162 11.0 11.3 Iron (mg) 12.4 339 382 Calcium (mg) 373 21.5 24.5 Total Fat (g) 224.3 1994 1983 Energy (kcal) 56.5 47.2 49.9 Protein (g) LACTATING WOMEN PREGNANT WOMEN NPNL
  36. 36. NUTRIENT INTAKES IN PREGNANT WOMEN % RDI Source: NNMB,2000 32.9 4.9 4.9 7.3 8.5 7.3 6.1 6.1 22 Total Fat 17.1 7.3 4.9 4.9 18.3 12.2 13.4 20.7 1.2 Riboflavin Protein 2.4 9.8 40.2 36.5  100 2.4 2.4 8.5 7.3 90-100 1.2 2.4 9.8 9.8 80-90 1.2 3.7 11 23.2 70-80 0 0 17.1 8.5 60-70 7.3 9.8 11 9.8 50-60 9.8 11 2.4 3.7 40-50 22 8.5 0 1.2 30-40 53.7 52.4 0 0 <30 Iron Vitamin A % RDI Energy
  37. 37. NUTRIENT INTAKES (per day) IN CHILDREN <ul><ul><ul><ul><ul><li>NNMB, 2000 </li></ul></ul></ul></ul></ul>Vijayaraghavan
  38. 38. 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
  39. 39. 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
  40. 40. INTERVENTIONS IN OPERATION <ul><li>DIRECT </li></ul><ul><li>CONVERGENCE OF SERVICES (RCH) </li></ul><ul><li>INTEGRATED CHILD DEVELOPMENT SERVICES </li></ul><ul><li>IRON AND FOLIC ACID DISTRIBUTION </li></ul><ul><li>MASSIVE DOSE VITAMIN A PROGRAMME </li></ul><ul><li>PRIMARY HEALTH CARE PROGRAMME </li></ul><ul><li>HEALTH AND NUTRITION EDUCATION </li></ul><ul><li>INDIRECT </li></ul><ul><li>POVERTY ALLEVIATION PROGRAMMES </li></ul><ul><li>ENVIRONMENTAL SANITATION </li></ul><ul><li>PROTECTED WATER SUPPLY </li></ul><ul><li>LITERACY PROGRAMME </li></ul>
  41. 41. THANKS & NAMASKAR

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