The ICDS and the nutrition mission focused on a 1000 days window approach, about improving ANC and child care till 2 years much before the child comes to the Anganwadis. This has given dividends!
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issuesShyam Ashtekar
The Anganwadi has a supplementary feeding program for last 3 decades, with several problems of provision, services, quality etc. We need a review of this component and change is necessary. The system has done some efforts with local help in many districts.
Declining Malnutrition in Maharashtra-6-The Tribal IssuesShyam Ashtekar
Moderate malnutrition (>30%) still lingers in 15-20 tribal blocks, including some severe grade MN calling for rehab effort. The tribal Malnutrition is a complex web--poverty, culture, migration, terrain, services, lack of awareness, supply gaps etc. We need a roadmap, a practical and pragmatic agenda.
Declining Child Malnutrition in Maharashtra-5 The Rehab effortsShyam Ashtekar
There is about 4-5 % severe acute malnutrition-SAM-in tribal parts of Maharashtra. Rehab is necessary. Rehab efforts are available from village Anganwadi level to the block level CTC and the district hospital NRC.
Child Malnutrition Decline in Maharashtra-1 An OverviewShyam Ashtekar
Malnutrition dropped-esp UW and stunting- in U2 children in Maharashtra as per CNSM surveys 2012. It is only a beginning. But there are challenges ahead, including cultural,socio-economic, women-health, nutrition and child care.
Declining Child Malnutrition in Maharashtra-3 The Anganwadi ImprovementsShyam Ashtekar
The Anganwadi Center (AWC) are the main system of service delivery for child care-nutrition, health, pre-primary ed etc. Over 1 lakh AWCs dot the spread of Maharashtra. The ICDS has made substantial improvements in the AWCs , attracting parents and children. This was a joint effort of the dept and the community. There is a Change indeed.
To study the knowledge, beliefs and practices of mothers, in relation to initiation, duration and type of breastfeeding, introduction and type of complementary food and other infant feeding practices.
Misuse of food given by government by workers.
Government is spending a huge amount for welfare of childre,but if see the position of anganwadi’s in some villages , it is evident that this money is eaten away by people in between.
School is present but teachers visit only for 3 to 4 days in a month in some villagers.
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issuesShyam Ashtekar
The Anganwadi has a supplementary feeding program for last 3 decades, with several problems of provision, services, quality etc. We need a review of this component and change is necessary. The system has done some efforts with local help in many districts.
Declining Malnutrition in Maharashtra-6-The Tribal IssuesShyam Ashtekar
Moderate malnutrition (>30%) still lingers in 15-20 tribal blocks, including some severe grade MN calling for rehab effort. The tribal Malnutrition is a complex web--poverty, culture, migration, terrain, services, lack of awareness, supply gaps etc. We need a roadmap, a practical and pragmatic agenda.
Declining Child Malnutrition in Maharashtra-5 The Rehab effortsShyam Ashtekar
There is about 4-5 % severe acute malnutrition-SAM-in tribal parts of Maharashtra. Rehab is necessary. Rehab efforts are available from village Anganwadi level to the block level CTC and the district hospital NRC.
Child Malnutrition Decline in Maharashtra-1 An OverviewShyam Ashtekar
Malnutrition dropped-esp UW and stunting- in U2 children in Maharashtra as per CNSM surveys 2012. It is only a beginning. But there are challenges ahead, including cultural,socio-economic, women-health, nutrition and child care.
Declining Child Malnutrition in Maharashtra-3 The Anganwadi ImprovementsShyam Ashtekar
The Anganwadi Center (AWC) are the main system of service delivery for child care-nutrition, health, pre-primary ed etc. Over 1 lakh AWCs dot the spread of Maharashtra. The ICDS has made substantial improvements in the AWCs , attracting parents and children. This was a joint effort of the dept and the community. There is a Change indeed.
To study the knowledge, beliefs and practices of mothers, in relation to initiation, duration and type of breastfeeding, introduction and type of complementary food and other infant feeding practices.
Misuse of food given by government by workers.
Government is spending a huge amount for welfare of childre,but if see the position of anganwadi’s in some villages , it is evident that this money is eaten away by people in between.
School is present but teachers visit only for 3 to 4 days in a month in some villagers.
Severe Acute Malnutrition- Low but Hurting Indian Children?_Crimson Publisherscrimsonpublisherscojrr
The childhood undernutrition is an important public health and development challenge in developing countries including India. Despite multiple National Nutrition Programs implemented over last 50 years and supplementary feeding activity as a nutrition improving activity in Integrated Child Development Scheme since 1975, it is matter of concern that we still run nutrition rehabilitation centers for hospitalizing and managing Severe Acute Malnutrition (SAM) cases coming from poor-socio-economic families even in 2021. COVID-19 pandemic since early 2020 has further exacerbated the situation with shrinking food diversity and low intake combined with episodes of missing supplementary feeding at times. Over a million Anganwadi centres have identified nearly a million ‘severely acute malnourished’ children from six months to six years across the country as of November 2020. The recently published results of Phase I of the National Family Health Survey-5 have reported an increase in the incidence of SAM over the last 10 years. Nutrition Rehabilitation Centres (NRCs) launched in 2014 as National Plan of Action for Children were meant to treat SAM cases at health facilities. However, there are studies that suggest that NRCs have not been highly effective. In many NRCs, SAM cases are being discharged early because either the caregivers could not stay for a requisite duration, or the centre could not keep the baby for requisite period, due to lack of oversight.
critical evaluation ICDS( integrated child development services)Shameem Ganayee
Integrated Child Development Services (ICDS) is an Indian government programme that offers a wide range of services to children under the age of 6 years, such as food, early education, primary healthcare, immunization, health control, and referral.
Success stories & innovative approach for prevention of childhood malnutr...Harivansh Chopra
in this presentation i have shown few success stories of low birth weight children attaining normal weight by the end of first year by implementing an innovative BIGWIN APPROACH. Bigwin is an acronym for the best practices described aptly in this presentation.if we can shift the strategy to prevent malnutrition in children from under six to under one than we can overcome malnutrition in five years time provided if we are able to reach every pregnant women and newborn child.
Severe Acute Malnutrition- Low but Hurting Indian Children?_Crimson Publisherscrimsonpublisherscojrr
The childhood undernutrition is an important public health and development challenge in developing countries including India. Despite multiple National Nutrition Programs implemented over last 50 years and supplementary feeding activity as a nutrition improving activity in Integrated Child Development Scheme since 1975, it is matter of concern that we still run nutrition rehabilitation centers for hospitalizing and managing Severe Acute Malnutrition (SAM) cases coming from poor-socio-economic families even in 2021. COVID-19 pandemic since early 2020 has further exacerbated the situation with shrinking food diversity and low intake combined with episodes of missing supplementary feeding at times. Over a million Anganwadi centres have identified nearly a million ‘severely acute malnourished’ children from six months to six years across the country as of November 2020. The recently published results of Phase I of the National Family Health Survey-5 have reported an increase in the incidence of SAM over the last 10 years. Nutrition Rehabilitation Centres (NRCs) launched in 2014 as National Plan of Action for Children were meant to treat SAM cases at health facilities. However, there are studies that suggest that NRCs have not been highly effective. In many NRCs, SAM cases are being discharged early because either the caregivers could not stay for a requisite duration, or the centre could not keep the baby for requisite period, due to lack of oversight.
critical evaluation ICDS( integrated child development services)Shameem Ganayee
Integrated Child Development Services (ICDS) is an Indian government programme that offers a wide range of services to children under the age of 6 years, such as food, early education, primary healthcare, immunization, health control, and referral.
Success stories & innovative approach for prevention of childhood malnutr...Harivansh Chopra
in this presentation i have shown few success stories of low birth weight children attaining normal weight by the end of first year by implementing an innovative BIGWIN APPROACH. Bigwin is an acronym for the best practices described aptly in this presentation.if we can shift the strategy to prevent malnutrition in children from under six to under one than we can overcome malnutrition in five years time provided if we are able to reach every pregnant women and newborn child.
This Powerpoint shows about Child Malnutrition in Ethiopia that includes introduction, cause & effect and conclusion. For instance, some children get malnutrition which can lead to many diseases. And finally how to slove this problem.
Growth prospects of children after discharge from malnutrition treatment cent...POSHAN
This presentation was made by Dr. Jyoti Sharma (Public Health Foundation of India) in the session on ‘Implementation research on delivery of preventive and curative interventions during early childhood’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Addressing severe-acute malnutrition in Rajasthan using community-based strat...POSHAN
This presentation was made by Dr. Deepti Gulati (GAIN) in the session on ‘Implementation research on delivery of preventive and curative interventions during early childhood’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey
IPH, Open, Conference, Belfast, Northern, Ireland, Dublin, Titanic, October, 2014, Health Public
It enables the Public health officer to apply basic knowledge of the principles of nutrition and its relation to the body, to health and diseases in the promotion of health, in assessing nutritional states of communities and to identify specific nutritional deficiencies and to undertake appropriate intervention measures.
Community-based management of severe acute malnutrition in India: New evidenc...POSHAN
This presentation was made by Dr. Alan Pereira (Medicins Sans Frontiers) in the session on ‘Implementation research on delivery of preventive and curative interventions during early childhood’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Galactosemia is a rare, hereditary disorder of carbohydrate metabolism that affects the body's ability to convert galactose (a sugar contained in milk, including human mother's milk) to glucose (a different type of sugar).
0. day 1 final presentation 6.8.18 niti aayogPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
This PPT has all the necessary information about 'National Rural Health Mission'. It is useful for students of Medical field learning 'Preventive & Social Medicine' as well as anyone who is interested in knowing about it.
Copyright Disclaimer - Use of these PowerPoint Presentation for any commercial purpose is strictly prohibited. The presentations uploaded on this profile are protected under Copyright Act,1957.
Nutritional deficiencies are very common in india as well as in other developing countries.both macro and micro nutrients are not eaten in adequate quantities in india due to poverty and ignorance. A number of national program are there to combat these deficiencies.But unfortunately effective implementation is lacking due to which nutritional deficiency is not being overcome in our country. Now due to covid -19 these are bound to increase
Proposal Development on Organizing Health Promotion Education Communication T...Mohammad Aslam Shaiekh
Proposal Development on Organizing Health Promotion Education Communication Training Program on Maternal Infant and Young Child Nutrition Practices in Pumdi, Pokhara Municipality 22.
This is a modern STP plant at Nashik Maharashtra. This introductory presentation is meant for medical and other students, organised by PSM/ComMed depts.
This is a proposal for pluralistic primary care for India, describing the need, rationale, structure, framework, modality and legalities. My old book 'Health and Healing' a 700 page publication from Orient Longman detailed this program, which needs updating.
Chikitsa -Revamping The Health Sector of Maharashtra 2015Shyam Ashtekar
This is a systematic review of Maharashtra's ( A state in India) Health Sector, and a program for revamping this sector, with a 10 point agenda. The book is in Marathi, and this is an English Summary. I have dealt with public and private health sectors, as well as the global context of health system management.
This is an idea I tested in 2010 in some vilages with help of NGOs. It is workable, but we need a more serious trial and analysis. I am proposing that village & community based health centers is a key to many of our health system problems. This will provide a wide network of services at the base of the health care pyramid, generate local employment and spread health information in the last mile. I am appealing for help. Pl call me on 09422271544 or email on shyamashtekar@yahoo.com
Health care terrain of a district nashik 2011Shyam Ashtekar
This is my study of the health care sector of a district in Maharashtra-(Nashik) in 2011. How do we go from here to Universal Health care? I invite comments
Health care- Bihar & UP 2012-Dr Shyam AshtekarShyam Ashtekar
This is my brief pictorial personal account on rural health care in Bihar (5 districts) & UP (one district) done in Oct 2012-the ground situation and challenges.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Declining Child malnutrition in Maharashtra India 2-The Effort
1. CHILD MALNUTRITION IN
MAHARASHTRA (INDIA)
AUGUST 2013- JANUARY 2014
Malnutrition in Maharashtra Review
Maharashtra-A
2014
SITUATION, EFFORTS, DECLINE AND CHALLENGES
A REVIEW
FOR THE STATE NUTRITION MISSION
POWERPOINT 2 /6
THE EFFORTS
Dr Shyam Ashtekar,
MD (Community Med)
shyamashtekar@yahoo.com
1
2. THE EFFORTS TO REDUCE MALNUTRITION
IN MAHARASHTRA
The Important 1000 days window
3. THE IMPORTANT 1000 DAYS’ WINDOW
7 to 12
months, 145
Only Breast
feeding, 180
Malnutrition in Maharashtra Review
Maharashtra-A
2014
2nd Year 365
Pregnancy
300
3
4. IMPROVING
THE AWC
improve it’s attendance.. And then extend the
services to the U2 group also.
This calls for improvement of building, equipment and
services. This was the effort.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
First of all AWC (Anganwadi center) must retain and
4
6. DASHAPADI OR THE TEN IMPORTANT RULES.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
6
7. TEN RULES FOR
PREVENTING
MALNUTRITION
Institutional
birth and
Breastfeeding
Complete
Immunization
6 m Exclusive
Breastfeeding
Growth
monitoringwt/ht/muac
Focus on 6m-3y
child-nutrition
edn of the
mother
Malnutrition in Maharashtra Review
Maharashtra-A
2014
Vit A doses
Compliment
ary feeding
at 6m, 6m
Birthday
Hand-wash,
Micronutrie
nts Sachet
water safety,
Sanitation
De-worming,
Illness
treatment,
immunization
7
8. HEALTH AND NUTRITION OF
ADOLESCENT GIRLS
Malnutrition in Maharashtra Review
Maharashtra-A
2014
Health of adolescent girls is crucial for
prevention of future child malnutrition, ALSO
her own well being is no less important.
Includes health and nutrition education,
growth promotion and personality
development.
a weekly tablet of iron folic acid is given to
girls outside school from the AWC
At least 3 girls get THR for home use – the
utility is not known.
8
9. ANTE NATAL CARE
Early diagnosis of pregnancy, at least 3 medical check ups and
IFA provision for 90 days.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
treatment contacts.
Take Home ration provision every month. to improve meals at home.
Detecting and action for smaller abdominal size foot-edema or hyper
tension, proteins in urine etc. These pregnancies lead to smaller
babies.
Need to protect and promote health of mother and baby
But only 75% pregnant women got the 3 essential visits.
9
10. INSTITUTIONAL
CHILDBIRTH
There is an effort to ensure institutional delivery for all cases.
102 ambulance is available in every district.
All care medicines for mother and children are free.
Mothers also get some incentives for attending institutional
delivery.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
We have JSY program under NRHM for this.
Some districts registered 90% institutional delivery rate.
ASHA activists help this program.
10
11. THE EFFORT TO IMPROVE BIRTH
WEIGHT
Low Birth Weight was and is a major issue.
districts.
These babies tend to remain underweight.
A limited but possible solution is to improve ANC
Malnutrition in Maharashtra Review
Maharashtra-A
2014
20%-50% babies have low birth weight in various
care. (But the LBW is a long term issue)
11
12. PROMOTING NEONATAL
CARE UNITS-JSSK
PROGRAM
illnesses call for neonatal care units.
The ambulance ensures door to door service
NICUs have been started in each districts by Health
dept..with all free care
Follow up services are available
Malnutrition in Maharashtra Review
Maharashtra-A
2014
Low Birth Weight , prematurity and other neonatal
12
13. EARLY BREAST FEEDING
Need to start breast feeding within the 1st hour of birth.
Mothers need to learn a proper technique of breast feeding
Need counseling for dispelling wrong concepts about breast feeding.
There are special rooms for breast feeding mothers in all hospitals.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
ASHA & AWC workers offer counseling for this from early stage.
However despite all this only 60% babies get timely initiation of breast
feeding.
13
14. EXCLUSIVE BREAST FEEDING
TILL 6 MONTHS.
harmful.
But many families give water, honey, gripe water, extra
milk, baby food etc in the state of Maharashtra.
This causes infections and triggers malnutrition.
Malnutrition in Maharashtra Review
Maharashtra-A
2014
No need to give any other feed till 6 months-actually
The CNSM survey reports only 58% of exclusive breast
feeding.
14
15. HIRKANI KAXA FOR
PROMOTING BREAST
FEEDING .
feeding in all public hospitals and 250 bus
stands
This helped both breast-feeding mothers
and send the right message to community
Malnutrition in Maharashtra Review
Maharashtra-A
2014
Promoted separate rooms for breast
15
16. BETTER MANAGEMENT OF HOME FEEDING
Malnutrition in Maharashtra Review
Maharashtra-A
2014
More than improving the SNP (supplementary
Nutrition Program) in the AWC, It was
necessary to
Early and Exclusive Breast feeding AND
Improve home feeding from 6 months to 6
years.
16
17. SEMI SOLID FEEDS AFTER 6
MONTHS.
It is time to give semi solid substances like porridge.
The CNSM (Comprehensive Nutrition Survey of
Maharashtra 2012 by IIPS) reports this at 63% --too low.
Many children get liquids, milk etc. as supplements; this
triggers malnutrition.
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After 6 months breast feeding is not enough for the baby.
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18. FREQUENT, PROPER FEEDS & FOOD VARIETY.
The baby should get at least 6-8 feeds every day besides breast
feeding. (6 months to 2 years age group.)
The CNSM survey reports low compliance on this (10-34%).
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The feed should include energy dense & proteins , iron and vitamins.
Nutrition will not improve unless home feeding improves considerably.
The AWC tried to promote this factor through mother education
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19. HYGIENE AND
SANITATION
with open defecation.
This causes infections and triggers malnutrition.
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Use of toilets must improve. But countless villages continue
AWC is promoting a hand-wash before feeding the baby and
encourage children to do the same.
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20. MICRO NUTRIENTS
Our meals lack iron, Zinc, Calcium, vitamins.
To ensure this a sachet of Micro Nutrients is
These Micro Nutrients reduce illnesses and
promote growth.
However the change of taste has made Micro
Nutrients less popular in some districts.
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added in the daily meals in the AWC
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21. TAKE HOME RATION (THR)
Younger babies can not attend and sit in the AWC.
3 packets of 1 KG THR are provided for children.
At home it is expected that some portion of THR is mixed in hot water
or cooked and the child given a feed.
But there are complaints about the quality of THR and hence it is
discarded or fed to cattle or chicken.
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THR is meant for this younger group.
Other families cook the entire packet and serve it to the entire family.
Therefore THR utilization is unsatisfactory.
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22. SOME WAYS OF USING THR
In some districts THR is used to prepare popular food
Frying in oil or ghee makes it more energy dense.
Some families have liked this option. But many families
have no time for these niceties.
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items like laddus and sweets.
That perpetuates the question mark on THR
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23. CRÈCHE
Crèches have been started in some Tribal blocks.
Space is rented ensuring that it has a toilet.
2 women assistants work on monthly honorarium of Rs. 1600/- each
About 10-15 children are served with 4 meals a day in the crèche.
The meals are made from THR and some other food-stuff
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Crèche operates from 9 to 5 in the day time.
The AWC Sevika checks Height and weight.
The RBSK medical team attends the crèche once in 4 to 6 months.
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24. CRÈCHE
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Crèche is a valuable social facility.
A Crèche ensures a safe baby–sitting with trained workers.
This frees the mother for work and leisure.
The Crèche service is free.
But non tribal areas do not have this facility.
We need a larger movement and system management for
Crèches everywhere.
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25. RBSK (RASHTRIYA BAL
SWASTHYA KARYAKRAM)
Each block has a RBSK mobile team since 2013.
Has a rented vehicle.
RBSK offers checkup from infants to
adolescence.
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RBSK has 2 doctors, a nurse & pharmacist
RBSK offers treatment/referral for childhood
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illnesses
26. RBSK..
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But the work load implies that it is at least
4-6 months before the next visit.
The RBSK generates lot of useful data but
this must be put online for better
research.
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27. IMMUNIZATION
AWC has monthly immunization day.
against 6 infections.
Hence immunization is important for prevention of
malnutrition.
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Complete immunization protection of the child
Measles was especially linked to malnutrition
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29. THE USUAL METHOD OF MALNUTRITION DETECTION.
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30. SCREENING FOR MALNUTRITION
Every U 6 Child’s weight is recorded in the AWC every
The weight is plotted on growth charts against the age
in months. This helps in grading of nutrition.
About 8-10% children are malnourished in the state.
Severely underweight child is rare in non tribal areas.
Height is measured every three months to check
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month.
wasting with wt-height table
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31. MALNUTRITION- SUW, SAM, MAM, MUAC ETC.
THE LINE LISTING OF MALNOURISHED CHILDREN IN A PHC AREA
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32. IF THE CHILD IS ALREADY MALNOURISHED..
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We must ensure timely
diagnosis and timely
treatment.
The AWC and RBSK do this by
screening every baby
Children with MN are
referred for rehab.
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33. SCREENING OF MALNUTRITION
the 3 methods
Severe wasting ( weight for height )
MUAC less than 11.5 cm.
Foot edema
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Severe Malnutrition is decided by one of
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34. NUTRITION REHABILITATION
If the Child is severely malnourished it is
this we have rehab centers at the village or the
health center or the block or District hospital.
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necessary to start the management early. For
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35. BETTER MONITORING- GEOGRAPHIC INFO SYSTEM
RJMCHN has now has a GIS
system for the entire state.
This GIS is available on
www//:mhnss.ind.in
Basically it has all the 1206
boxes of the monthly
progress Report-MP
The AW sevika can get it
done in 30 Rs provision and
within 30 min.
She can upload the AWC
abstract info (5-7 KB file)on
the site thru the Sangram
software at village level.
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This can help to
Generate MIS from AWC to
state level and update
within 48 hrs
Generate info for action on
every level.
It can generate both
process and outcome
indicators
We can generate about
1500 reports from this data
It also provides camera sites
for physical verification at
each AWC
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38. BEST WISHES
Dr Shyam Ashtekar (MD, Community Medicine)
21 Cherry Hills Society, Anandwalli,
Nashik 422013
shyamashtekar@yahoo.com
Cell +919422271544
Website:
arogyavidya.org,
bharatswasthya.net
A study of Anganwadis and campaign against malnutrition
in Maharashtra for and with support of
Rajmata Jijau Mission,
August to Dec 2013
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