1. TOPIC : PEM (SIGN AND SYMPTOMS,
TREATMENT)
Subject: Community Nutrition
E- CLASS ASSIGNMENT
Shubham Gupta
10 sem
Groups-50
2. PROTEIN ENERGY MALNUTRITION
• Protein Energy Malnutrition (PEM) is the deficiency of macronutrients or
energy and protein in the diet.
• It is a nutritional disorder, which affects all the segments of population like
children, women and adult males particularly from the backward and
downtrodden communities.
Clinical forms
o Kwashiorkor
o Marasmus
o Marasmic kwashiorkor
Sub-clinical forms
Underweight
Wasting
Stunting
Different Types of PEM
3. KWASHIORKOR
• Kwashiorkor is an African word, meaning a "disease of the displaced
child", who is deprived of adequate nutrition.
• Mostly in children between the ages of 1 and 3 years, when they are
completely weaned (taken off the breast).
• The three essential manifestations or signs of kwashiorkor are:
1. Oedema (swelling of feet)
2. Growth failure, and
3. Mental changes.
4. CLINICAL SIGNS OF KWASHIORKOR IN DETAIL
Oedema: accumulation of fluid in the tissues.
• Usually begins with a slight swelling in feet gradually spreading up the legs. Later, hands
and face may also have oedema.
Poor growth: Growth retardation is the earliest manifestation.
• The child will be lighter and shorter than its normal peers of same age and weigh about
80% or less of their normal peers.
• Sometimes, in cases of gross swelling, the body weight may be relatively higher. The
child will also be wasted (thinner). The child's arms and legs will appear thin as a result
of wasting.
Mental changes: kwashiorkor child has no interest in the surrounding.
• The child will also be irritable and prefers to stay at one place and in one position.
5. OTHER SIGNS WHICH MAY BE PRESENT ARE
Hair changes: In kwashiorkor, the hair loses its healthy sheen and becomes silkier and
thinner. It takes coppery red colour (referred to as 'discoloured hairy).
• You could easily pluck small tufts of hair without causing any pain (referred to as easy
pluck ability) just by passing your hands through the hair.
Skin changes: In many cases, dermatosis (changes in skin) is seen.
• Such changes are common in areas of friction.
Moon face: The cheeks may seem swollen with fluid or fatty tissue and often be
slightly sagging.
Micronutrient deficiencies: Almost all the children manifest anaemia (due to iron
deficiency) of some degree.
• Eye signs of vitamin A' deficiency are also common.
• Manifestations of vitamin B complex deficiency are also noted in many cases.
6.
7. MARASMUS
• Marasmus is common in children below the age of 2 years.
• The marasmic children are so weak that they may not have even
energy to cry, which most often is barely audible.
• The child is extremely wasted with very little subcutaneous fat
with the skin hanging loosely particularly over the buttocks.
• Oedema is absent and there are no skin and hair changes.
• However, frequent diarrhoeal episodes leading to dehydration and
micronutrient deficiencies of vitamin A, iron and B-complex are
common.
8. • Signs and Symptoms of Marasmus
• Extreme muscle wasting - "skin and
bones"
• Loose and hanging skin folds
• Old man's or monkey faces
• Absolute weakness
9. MARASMIC KWASHIORKOR
• Sometimes, in areas where PEM is common, malnourished children exhibit the
features of both kwashiorkor and marasmus. Such changes could occur during the
transition from one form of severe PEM to another.
• These children will have extreme wasting of different degrees (representing
marasmus) and also oedema (a sign of kwashiorkor).
• They may also man
• Signs and symptoms of Marasmic Kwashiorkor
• Extreme muscle wasting - "skin and bones"
• Loose and hanging skin folds
• Old man's or monkey's face
• Absolute weakness
• Oedema
10. BIOCHEMICAL SIGNS SPECIFIC TO PEM
Biochemical Changes Marasmus Kwashiorkor
Serum albumin Normal or slightly decreased low
Urinary urea per g of
the creatinine
Normal or decreased low
Urinary Hydroxyproline Index low low
Serum free amino acid ratio Normal Elevated
Anaemia May be observed Common iron and folate
deficiency may be associated
Pancreatic secretions Reduced enzymatic activity Reduced enzymatic activity
11. TREATMENT
Diet
• Treatment of cases of kwashiorkor or marasmus involves mainly providing appropriate
nutrition support. The child should receive a diet that provides adequate amounts of
energy and protein. Both of these are required in larger quantities than normal.
The child should be given the following concentrations:
• Energy : 170 - 200 kcal per kg of body weight
• Protein : 3 - 4 g/kg of body weight
Vitamin and mineral supplements
• All cases of severe PEM require multivitamin preparation to meet the increased
demands during recovery.
• Iron (60 mg) and folic acid (100 mg) may be given daily to correct anaemia.
12. Oral rehydration
• Since diarrhoea is very common in severe PEM, correction of dehydration is the first step
in the treatment.
• Home made (salt-sugar mixture) or commercial oral rehydration solution (ORS) can be
administered to correct dehydration.
• Intravenous fluids are required only in severe dehydration.
Control of infections and infestations
• Appropriate antibiotics should be started immediately since infections are the immediate
cause of death in many children.
• Children with intestinal infestations Like giardiasis and ascariasis should be treated.
"prevention is better than cure". So it becomes extremely
important that we make sincere efforts to prevent and control PEM
13. SUPPLEMENTARY FEEDING PROGRAMMES
• 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.
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
14. MID DAY MEAL PROGRAMME
• The National Programme of Nutritional Support to Primary Education commonly
known as Mid Day Meals Scheme was launched in August, 1995
• The mid day meal programme is one of the most important ongoing feeding
programmes
• organized by the Department of Education not only to improve nutritional status of
school children but also to attract poor children to school.
Objectives
• The programme is intended to give a boost to universalization of primary education
by increasing enrolment, retention and attendance and simultaneously impacting
upon nutritional status of students in primary classes.
15. SPECIAL NUTRITION PROGRAMME
• The Special Nutrition Programme was launched by the Central Social Welfare Board
(CSWD) in 1970-71.
• The aim of the programme was to provide supplementary nutrition to children,
pregnant women and nursing mothers belonging to the weaker sections of the
society.
• The main component of the programme was food supplementation.
• The supplement consisted of 300 Kcal and 10 g protein for children and 500 Kcal
and 25 g protein for Pregnant- lactating women. Feeding of the beneficiaries was
undertaken for 300 days a year.
• In addition to supplementary feeding, the scheme also included periodic health
check ups for the beneficiaries.
16. PRADHAN MANTRI'S GRAMODAYA YOJANA (PMGY)
• In order to achieve the objective of sustainable human development at the village
level, a new initiative in the form of Pradhan Mantri's Gramodaya Yojana (PMGY) has
been introduced in the Annual Plan 2000-01.
• Schemes related to health, nutrition, education, drinking water, housing and rural
roads are undertaken within this programme
• The PMGY has two components: Prograrmmes for rural connectivity with 50 percent
allocation, and other programmes of primary health, primary education, rural
shelter, rural drinking water and nutrition with the remaining 50 percent allocation.
17. BALWADI FEEDING PROGRAMME
• Like the Special Nutrition Programme , the Balwadi Feeding Programme was also
launched in 1970-71.
• Although the Special Nutrition Programme is no longer in operation, the Balwadi
Feeding Programme remains one of the ongoing programmes -implemented
through the voluntary organizations.
• The beneficiaries of the programme include preschool children attending the
Balwadi. The services provided under the programme are supplementary feeding,
regular health check-ups, immunization, habit formation and socialization through
games and recreation.
• The nutrition programme also has an educative value as it brings together several
children of the same age and is expected to inculcate good habits and help children
develop taste for different types of foods.
18. COMPOSITE NUTRITION PROGRAMME
• The Composite Nutrition Programme was a feeding programme launched by the
Department of Community Development, with the main objective of providing
nutrition education to the masses.
• The core of the programme was nutrition education and its particular application
through demonstration feeding.
• The programme had five components:
1. Nutrition education through mahila mandals
2. Encouragement of economic activities of mahila mandals ,
3. Strengthening 'the supervisory machinery for women's programme
4. Training of associate women workers, and
5. Demonstration feeding
19. APPLIED NUTRITION PROGRAMME
• The Applied Nutrition Programme was one of the first national nutrition programmes
launched in 1963 through the Community Development Department,
• Aimed at improving the nutrition of lactating and pregnant women and children.
• The programme was developed 'to educate rural people about how they can increase and
improve their food supply through their own efforts'.
The main objectives of the programme were:
1. To encourage production of body-building foods (such as eggs, fish, milk etc.) and
protective foods (such as vegetables, fruits), and
2. To provide nutrition education, so as to promote consumption of the body-building
protective foods by mothers and children.
