The document discusses malnutrition in India based on various surveys. It summarizes the results of the 2005-06 NFHS and 2011 HUNGaMA surveys which found that 20% of Indian children are wasted, 48% are stunted, and 43% are underweight. The HUNGaMA survey of over 100,000 children across 9 states found underweight in 42% and stunting in 59% of children under 5. Maternal education also impacts child nutrition, with 45% of children of illiterate mothers being underweight compared to 27% of children of literate mothers. The document then outlines methods of nutritional assessment, growth charts, national nutritional programs like ICDS, and services provided.

1. Nutritional Assessment

2. Outline
Determinants
Methods of Assessment
Surveillance of Growth&
Development
Growth Charts
Uses of Growth Charts
Growth &
Development

3. According to the 2005-06 National Family Health
Survey(NFHS-3),
 20 % - Wasted (acutely malnourished)
 48 % - Stunted (chronically malnourished).
 43 % - Under weight.

4.  The HUNGaMAsurvey conducted across 112 rural districts of India in
2011
 Provides reliable estimates of child nutrition covering nearly 20% of
Indian children.
109,093 under 5 children ; 3360 villages ; 9 states;
 October 2010-February 2011

5.  U 5 malnutrition:
 underweight – 42%
 stunted-59%
 Child malnutrition starts very early in life (24 months):
 underweight – 42%
 stunted- 58%
 Mothers’ education level determines children’s nutrition
 underweight – 45%( Illiterate), 27%(literate)
 stunted- 63%( Illiterate), 43%(literate)
• 92 % mothers had never heard the word
“malnutrition”
HUNGaMA SURVEY RESULTS

6. Determinants
• Genetic
• Nutrition
• Age
• Sex
• Physical surroundings
• Psychological factors
• Infections & Parasitoses
• Economic factors

7. Methods of Assessment
Mean or Median values
Percentiles
Age independent indices
(wt for ht/ length)
Longitudinal Assessment/
Cross sectional study

8. Surveillance of Growth &
Development
The commonly used methods are :
1. Weight for Age
2. Height for Age
3. Weight for height
Behavioural development
1. Motor development
2. Personal - social development
3. Adaptive development
4. Language development

9. Motor Development Assessment

10. Other anthropometric Measurements
• Head circumference
• Chest circumference
• Crown-heel length

11. Mid upper arm circumference

12. Classification of Nutritional Status Based on
Anthropometric Parameters
Weight of child
Weight for age(%) = X 100
Weight of 'normal child' of same age
Malnutrition grade Weight/Age (%) of
normal
Normal >90%
Grade I (Mild) 75- 89%
Grade II
(Moderate)
60- 74%
Grade III (Severe) < 60%
Malnutrition grade Weight/Age (%) of
normal
Normal > 80%
I Grade 70-80%
II Grade 60- 70%
III Grade 50- 60%
IV Grade < 50%
Gomez Classification (IAP) Classification

13. • From 1977 NCHS growth references were used.
• Based on 1 longitudinal and 3 cross sectional studies.
• Done in American population.
• Most of the children were artificially fed.
• Inaccurate estimates of overweight and undernutrition.
Need for international growth standards

14. • 1993 WHO working group on infant growth done a
comprehensive review of NCHS references.
• NCHS references differs from the growth pattern of healthy
breastfed infants.
• Decided to develop new growth standards.
• Reference population should be representative for entire
world.
Development of New Growth References

15. Based on
• Optimal nutrition
Optimal growth
• Optimal environment
• Optimal health care
Multicentre Growth Reference Study

17. MGRS study design
year 1 year 2 year 3
Longitudinal (0-24 months)
Cross-sectional (18-71 months)

22. 0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
WHO MED BOYS WHO MED GIRLS WHO 2SD BOYS WHO 2SD GIRLS WHO 3SD BOYS WHO 3SD GIRLS
B
G
B
B
G
G
Graph shows how Boys and Girls grow differently

23. • Prescriptive approach
• International sample
• Breast fed infants as normal
• Reference data for assessing obesity and underweight
• Velocity reference
• Linking between physical growth and motor development
Merits of MGRS

24. 0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Weight
(in
kg)
Age in Months
80%of Median 70%of Median 60%of Median 50%of Median
I
II
III
IV
Mild
Moderate
Severe
V.Severe
Normal

25. • MGRS grading is based on SD values.
Nutrition is graded as
• Normal
• Moderately underweight- Below -2SD to -3SD
• Severely underweight- Below -3SD
MGRS standards and IAP classification-contd

26. • Adopted new standards in FEB 2009 under NRHM and ICDS.
• Mother and Child Protection card and growth chart were
developed.
• Card contains all the vital details.
• Chart is easily understood by peripheral health worker and
mother.
• Kept by the mother.
Growth chart now used in India

29. • Growth monitoring.
• Diagnostic tool.
• Planning and policy making.
• Educational tool.
• Tool for action.
• Evaluation.
• Tool for teaching.
Uses of Growth Chart

30. NATIONAL NUTRITIONAL PROGRAMMES
1. INTEGRATED CHILD DEVELOPMENT SERVICE(ICDS)
• Launched on 2nd October 1975
• Network consists of 5659 projects in rural and urban slums.
Goal : Universalization of ICDS through out country.
Responsibility:
• Central Level: Min of HRD, Dept. of Women & Child Development
• State level: Dept. of Social Welfare
Dept. of Tribal Welfare
Dept. of Rural Development
Dept. of Health & Family Welfare
Dept. of woman & Child Welfare

31. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd---)
Beneficiaries
• Children below 6 years
• Pregnant and lactating women
• Women in the age group 15-45 years
• Adolescent girls in selected blocks

32. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd---)
Objectives
• To Improve nutritional and health status of children in 0-6 years age
group
• To lay foundation for proper psychological development of the
children
• To reduce incidence of Mortality, Morbidity. Malnutrition and school
drop out.
• Intersectoral co-ordination to promote child development
• Proper nutrition and health education of mother

33. ICDS (Contd--)
Organization of ICDS:
CDPO
Assistant CDPO
Mukhya Sevika
Anganwadi worker (AWW)
NATIONAL NUTRITIONAL PROGRAMMES

34. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd--)
Anganwadi : Covers 1000 population
Mini Anganwadi:
Covers 150 -500 Population – Rural Area
Covers 150-300 Population – Tribal Area
Covers 500 -1500 Population – Urban Area
AWW – paid Rs. 1500/Per month,
Insured for Rs.50,000/-, premium 280/-
Helper – Paid Rs.700/ Per month,

35. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd--)
Services at Anganwadi:
• Health - Immunization
- Health Checkup
- Referral services
- Treatment of Minor illnesses
• Nutrition – Supplementary Nutrition
- Growth Monitoring and Promotion
- Nutrition and Health Education

36. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd--)
Services at Anganwadi (contd--)
• Education – Preschool education to children of 3 to 6 years
• Convergence – of other supportive services such as :
- Drinking water
- Environmental Sanitation
- Women’s empowerment programme
- Non-formal education and adult literacy

37. NATIONAL NUTRITIONAL PROGRAMMES
ICDS (Contd--)
Nutrition (Revised -2009 by Govt. of India)
Category Age Amount
per
person
Protein Calories
Children 6-72 months 4.00 12-15gm 500
Severely
underweight
child
6-72 months 6.00 20-25gm 800
Pregnant
women &
Nursing
Mothers
Reproductive
age group
5.00 18-20gm 600

38. THANK YOU