Common nutrition problems in India

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Common nutrition problems in India

  1. 1. COMMON NUTRITION PROBLEMS IN INDIA Dr. K.VIJAYARAGHAVAN DIRECTOR – RESEARCH, SHARE INDIA (MEDICITI INSTITUTION) & Sr. Dy. Director, NIN (Retd) <drk.vijayaraghavan@gmail.com>
  2. 2. MOTHER AND CHILD SURVIVAL MMR 407/100,000 live births IMR* Child Mortality Rate(1-4 years) 58/1000 live births 19.5/1000 Children *Gujarat 53 Vijayaraghavan
  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. NUTRITION PROBLEMS IN INDIA WHAT ARE THE COMMON PROBLEMS? WOMEN CHILDREN • POOR WT. GAIN LOW BIRTH WEIGHT • GROWTH DURING PREGNANCY FALTERING • CED • PEM • MICRONUTRIENT • MICRONUTRIENT DEFICIENCIES DEFICIENCIES  FLUOROSIS, LATHYRISM  DIET RELATED CHRONIC DISEASES OBESITY, CARDIOVASCULAR DISEASES, DIABETES Vijayaraghavan
  5. 5. nm ar do ne si a Th ai la nd In B hu ta n 10 7. 2 11 16 18 20 20 Sr iL an ka 23 25 M al di ve s M ya 30 33 35 In di a N ep al PER CENT PREVALENCE OF LBW IN S.E ASIAN COUNTRIES 30 15 5 0 Vijayaraghavan
  6. 6. 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
  7. 7. INFANT MORTALITY AND BIRTH WEIGHT 1200 IMR /1000 Live-births 1000 1000 800 615 600 400 238 200 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
  8. 8. IFA SUPPLENTATION AND LBW 35 30 PER CENT 25 30.8 20 30.2 15 15.5 10 5 0 CONTROL IRON GROUPS Source: Leela Iyengar & Apte, S,V.,1970 FOLIC ACID
  9. 9. SUPPLENTATION OF IRON / FOLIC ACID AND BIRTH WEIGHT 3000 BIRTH WEIGHT (g) 2900 2800 2700 2890 2600 2500 2567 2650 2400 CONTROL IRON GROUPS Source: Leela Raman & Rajalakshmi,1974 FOLIC ACID
  10. 10. NUTRITIONAL DISORDERS IN CHILDREN • PROTEIN ENERGY MALNUTRITION (PEM) . CLINICAL FORMS . SUBCLINICAL UNDERNUTRITION • MICRONUTRIENT DEFICIENCIES Vijayaraghavan
  11. 11. CLINCAL FORMS of PEM KWASHIORKOR • • • • OEDEMA+ IRRITABILITY+ GROWTH FAILURE+ DISCOLOURED HAIR+ Vijayaraghavan
  12. 12. CLINCAL FORMS of PEM MARASMUS EXTREME WASTING “SKIN AND BONES” MONKEY/OLD MAN FACIES Vijayaraghavan
  13. 13. SUB-CLINICAL FORMS OF PEM UNDERNUTRITION WASTING STUNTING  WEIGHT FOR AGE  WEIGHT FOR HEIGHT HEIGHT FOR AGE Vijayaraghavan
  14. 14. UNDERNUTRITION IN INDIA ADULTS (Females) PRESCHOOL CHILDREN 6.2 40.6 44.3 NORMAL GRADE I 5 8.9 GRADE II 46.5 48.5 GRADE III CED Based on NCHS weight for age NORMAL OBESE Based on BMI Vijayaraghavan
  15. 15. TIME TRENDS IN ANTHROPOMETRIC PARAMETERS (<Median-2SD) NNMB 80 70 78.6 76.5 60 PER CENT 62.3 57.7 50 1975-79 1996-97 40 30 20 18.1 10 18.5 0 Height Weight Weight for Height VIJAY’00
  16. 16. DISTRIBUTION WEIGHT FOR AGE – IAP Gujarat 40 35 PER CENT 30 32.5 37.9 25 20 21 15 10 5 7.2 0 Normal Gr. I Gr. II Gr. III GRADES OF UNDERNUTRITION 1.4 Gr. IV
  17. 17. WEIGHT FOR AGE– SD CLASSIFICATION - GUJARAT 40 35 30 25 % 20 Boys Girls Pooled 15 10 5 an >M ed i an -1 -M ed i SD -1 --2 SD -2 --3 <3 SD 0
  18. 18. VITAMIN A DEFICIENCY
  19. 19. KERATOMALACIA BITOT SPOT V A D BILATERAL BLINDNESS Vijayaraghavan
  20. 20. WHO Criteria for Public Health Significance - VAD Minimum Prevalence (%) in children <6 yrs • • • • • BITOT SPOTS NIGHT BLINDNESS CORNEAL LESIONS CORNEAL SCARS Serum Retinol <10 µg/l 0.5 1.0 0.01 0.05 5.0 Vijayaraghavan
  21. 21. VITAMIN A DEFICIENCY (%) IN INDIA AGE GROUP CHILDREN PREGNANT WOMEN X1B XN* ICMR, 2001 PRESCHOO L SOURCE 0.7 1.03 NNMB 0.7 - NIN- SURVEYS 2.1 - ICMR, 2001 - 2.8 * 24-71 MONTHS Vijayaraghavan
  22. 22. VITAMIN A DEFICIENCY Districts(%) with X1B >0.5% Average prevalence (%) 2.1 No VAD 55 VAD 45 Based on surveys in 126 Dts. by NIN and NNMB Vijayaraghavan
  23. 23. NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN 6 5.7 PER CEN T 5 5.7 PEM X1B RIBO. DEF. 4 3 2 1 1.7 2.1 1.8 0.7 0.7 0.2 0.7 0 1975-79 1988-90 1996-97 PERIOD OF SURVEY Vijayaraghavan
  24. 24. 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
  25. 25. ANAEMIA
  26. 26. PREVALENCE OF ANAEMIA IN PREGNANT WOMEN 100 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
  27. 27. PREVALENCE OF ANAEMIA -ADOLESCENT GIRLS 100 98 96 94 92 % 93.9 90 99.3 92 92.2 88 91.8 86 84 91.9 87.7 87.1 82 80 MAHA. H.P. A.P. BIHAR M.P. ASSAM J&K POOLED Source: ICMR, 1999
  28. 28. ANAEMIA IN FEMALES • PREVALENCE OF ANAEMIA IS VERY HIGH IN BOTH THE GROUPS 95 90 85 • NO CHANGE NOTICED OVER TIME IN THE PREVALENCE Percent 80 75 92 84.6 70 65 60 55 50 Pregnant Women Adolescent girls Vijayaraghavan
  29. 29. IODINE DEFICIENCY DISORDERS
  30. 30. IODINE DEFICIENCY DISORDERS GOITRE+ 239 OF 282 DTs. SURVEYED – ENDEMIC 167 millions AT RISK ?
  31. 31. PREVALENCE OF GOITRE IN 6-12 Yr CHILDREN - Gujarat 16 14 12 10 Surat Valsad 8 6 4 2 0 Gr. I Gr. II Total
  32. 32. DIETARY INTAKES
  33. 33. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS 90 92 Protein (g) Rural Tribal Urban Slums 85 Energy (Kcal) 79 Calcium (mg) 87 91 131 98 118 51 48 Iron (mg) 0 20 40 60 78 80 PER CENT 100 120 140 VIJAY’00
  34. 34. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS 51 Vitamin A (µg) 46 63 Rural Tribal Thaimin (mg) 87 Riboflavin (mg) 55 Urban Slums 71 64 102 Vitamin C (mg) Folic acid (µg) 104 100 105 120 156 164 0 0 50 100 PER CENT 150 200
  35. 35. NUTRIENT INTAKES AMONG INDIAN WOMEN NUTRIENTS NPNL PREGNANT WOMEN LACTATIN 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 (µg) Thiamin (mg) 148 142 1.1 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 (µg) 86 84 106 Source: NNMB, 2000
  36. 36. 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
  37. 37. NUTRIENT INTAKES (per day) IN CHILDREN Age in Years Nutrients Mean Protien (g) 22.4 Tot fat (g) 13.5 Energy (Kcal) 867 Calcium (mg) 250 Iron (mg) 5.50 Vit A (ug) 145 Thiamin (mg) 0.44 Ribo. (mg) 0.44 Niacin (mg) 4.97 Vit C (mg) 16.5 Folic acid (mg) 45 1-3 Median 20.4 10.1 815 168 4.30 72 0.40 0.40 4.5 9.9 36.6 NNMB, 2000 4-6 Mean Median 31.4 29.40 17.6 13.90 1215 1154 300 224 8.4 6.90 205 96 0.69 0.60 0.56 0.50 7.37 6.60 24.9 17.5 65 55.1 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 Ignorance Low Procurement of foods Low production of foodgrains Poor environment Low purchasing power High dependence rate False food beliefs Inadequate intakes Poor PDS High cost Low availability of foods Reduced work Malnutrition output Morbidity Poor utilization of services Absorption of nutrients Low Appetite poor coverage of immunization Improper health services poor infrastructure Lack of resources
  40. 40. 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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