PEM LBW PROTEIN ENERGY MALNUTRITION LOW BIRTH WEIGHT PUBLIC HEALTH NUTRITION

1. Nutritional Problem of Public
Health Importance: LBW & PEM
Dr. Anuj Singh
Asst. Professor
Community Medicine Dept.
UIMS, Prayagraj

2. Public Health Nutrition:
is concerned with promotion of good health
through prevention of nutrition–related
illnesses / problems in the population.
is large scale, organized and multidisciplinary
approaches to solve nutritional problems.
The mission of public health nutrition is to
maintain optimal nutritional status of the
population.

3. Birth Weight
• First weight of the new born
after birth
 Importance?

5. Low birth weight

6. Low birth weight
• WHO def:
Weight at birth less than 2500 g (5.5 lb)
• Low birth weight continues to be a significant
public health problem globally and is
associated with a range of both short term-
and long term consequences

7. Complication of LBW

9. Radiant warmer

10. Phototherapy

11. Oxygen therapy

13. Kangaroo Mother Care (KMC)
A special method of caring low birth weight
(<2500gm) babies. As the name suggests Kangaroo
Mother Care consists of keeping the baby in close
skin-to-skin contact with his/her mother as
practiced by female kangaroo animal for their babies.

14. Benefits KMC-
• Keeping the baby warm
• Promoting and sustaining breastfeeding
• Decreasing risk of infection
• Promoting bonding between baby and mother

15. Two essential components of KMC
1. Skin to skin contact: Early, continuous and prolonged
skin-to-skin contact between the mother and the
baby is the basic feature of KMC. The infant is placed
on her mother’s chest between the breasts.
2. Exclusive breast feeding : The baby on KMC is
breastfed exclusively. Skin-to-skin contact promotes
breast milk production and enables the small baby to
learn sucking quickly. Intimate physical contact
during KMC strengthens the emotional bonding
between the mother and the baby.

17. Protein - Energy Malnutrition
(PEM)
WHO def:
“An imbalance between the supply of protein
and energy and the body's demand for them
to ensure optimal growth and function”

18. PEM is primarily due to:
I. Inadequate intake food: both in quality and
quantity
II. Infections: such as diarrhoea, measles,
respiratory infection, intestinal worm.
(Theses infection increase the requirements
calorie, protein and other nutrient while
decreasing their absorption and utilization)

19. Infection and malnutrition acts
synergistically

20. Other contributory factors of malnutrition-
1. Large family size
2. Poor maternal health
3. Lactation failure
4. Premature termination of breast feeding
5. Adverse cultural practices related to child
rearing and weaning e.g.
 Over diluted cow’s milk
 Delayed supplementary feeding
 Discarding cooking water from cereals

21. Interrelated connection of nutritional
status from generation to generation

22. Measurement of Under nutrition
• Weight-for- Age (WFA)
• Height-for-Age (HFA)
• Weight-for-Height (WFH)

23. Type of Undernutrition-
a) Stunting:
Low height for age
Indicator of chronic malnutrition
b) Wasting:
Low weight-for-height
Indicator of acute malnutrition
c) Underweight:
Low weight for age
Combination of both (Stunting, wasting)

24. Classification of PEM
1 GOMEZ CLASSIFICATION
2 WATERLOW CLASSIFICATION
3 IAP CLASSIFICATION
4 WHO CLASSIFICATION

29. PEM-Types

31. Marasmus:
• Marasmus is characterized by sever form of
wasting
• There is marked wasting of muscles & fat as these
tissue are consumed to make energy
• Acute starvation or acute illness over borderline
nutritional status precipitates this condition
• Severe marasmus is typical form of SAM

32. Marasmus:
• The main sign ‘Severe wasting’
• Monkey facies - wrinkled or aged
appearance due to loss of buccal pad
of fat
• Baggy pant appearance- loose skin
over the buttock
• Affected children may appear to be
alert in spite of their condition
• No edema

33. Kwashiorkar:
• Usually affects children 1-4 years age
• The main sign is pitting edema starting from
legs-feet and spreading all over in advanced
cases
• Because of edema children may look healthy

34. Kwashiorkar:
• ‘Fat sugar baby appearance’
• Show no sign of hunger & it is difficult to
feed them
• Edema: mild to moderate
• Skin Changes: pigmentation,
dyspigmentation, desquamation (buttock,
perenium, thigh). Petechiae, skin may peel
off resembling burn.
• Hair: Easily pluckable
Flag sign
• Multisystem involvement

35. Kwashorkar
• Flag sign
• Skin lesion

36. Marasmic-Kwashiorkar
• Mixed form of undernutrition
• Manifest as edema occurring in children who may
not have other sign of Kwashorkar and have varied
manifestations of Marasmus.

38. Severe Acute Malnutrition (SAM)
• defined as severe wasting:
- Weight for height/length <-3SD and or
- MUAC <11.5 cm for children 6-59 months and or
- Presence of bilateral edema
• Children with SAM have 9 time higher risk of
death

39. Complication of SAM
• Hypoglycemia
• Hypothermia
• Infection (Viral, bacterial, fungal)
• Electrolyte imbalance
• Dehydration ,shock
• Heart failure

40. 10 steps of PEM management:

41. •PEM Prevention

42. Early detection of PEM-
 Weight for age:
Growth Chart
 Arm circumference:
Shakirs tape (1-5 years)

43. Growth Chart

45. Shakirs tape

46. Shakirs tape
>13.5 Satisfactory nutrition status
12.5-
13.5
Mild moderate malnutrition
<12.5 Severe malnutrition

47. Preventive measures:
a) Health promotion
b) Specific protection
c) Early diagnosis & treatment
d) Rehabilitation

48. 1. Education and dietary supplementation to
pregnant & lactating mothers
2. Breast feeding promotion
3. Low cost weaning food
4. Improve family diet
5. Nutritional education
6. Family planning & spacing
A) Health promotion:

49. B) Specific protection
1. Child diet must contain protein and energy
reach foods. (Milk, eggs, ,fruits)
2. Immunization
3. Food fortification

50. c) Early diagnosis & treatment
1. Periodic surveillance
2. Early diagnosis of any lag in growth
3. Early diagnosis & treatment of infection
4. Development of programmes for early
rehydration of children with diarrhoea
5. Development of supplementry feeding
programmes during epidemics
6. Deworming

51. d) Rehabilitation
1. Nutritional rehabilitation services
2. Hospital treatment
3. Follow up care

52. • Food supplementation programmes have a
very important role to play to combat
malnutrition.
• The aim of these supplementary feeding
programmes is to improve the nutritional
status of vulnerable groups through
distribution of food supplements.
Supplementary feeding programmes

53. Following supplementary feeding programmes :
1. National Programme of Nutritional Support
to Primary Education (Mid Day Meal
Programme)
2. Special Nutrition Programme
3. Pradhan Mantri's Gramodaya Yojana
(PMGY)
4. Balwadi Feeding Programme
5. Composite Nutrition Programme, and
6. Applied nutrition programme