The poverty rate in India is impacting the economy and Malnutrition (Undernutrition) is a consequence of poverty. There are various ways to combat malnutrition including SAM management strategies along with various ongoing nutrition improvement programs focusing on maternal and child health.

1. UNDERNUTRITION
AKANSHA BHATNAGAR

2. UNDERNUTRITION
• According to UNICEF, “Under-nutrition is defined as the outcome of insufficient
food intake and repeated infectious diseases. It includes being underweight for one’s
age, too short for one’s age (stunted), dangerously thin for one’s height (wasted) and
deficient in vitamins and minerals (micronutrient malnutrition)”
• The global prevalence of stunting among under five is 48% (moderate and severe)
and wasting is 20% (moderate and severe) and with an underweight prevalence of
43% (moderate and severe), it is the highest in the world.

3. CONSEQUENCES
TYPE APPEARANCE CAUSE
Acute
malnutrition
Wasting or
thinness
Acute inadequate nutrition leading to rapid weight
loss or failure to gain weight normally.
Chronic
malnutrition
Stunting or
shortness Inadequate nutrition over long period of time leading
to failure of linear growth.
Acute and
chronic
malnutrition
Underweight A combination measure, therefore, it could occur as a
result of wasting, stunting, or both.

4. AETIOLOGY OF MALNUTRITION
• Age (dietary changes, insufficient intake according to requirement, likes and dislikes)
• Birth interval (Frequent childbirth: early weaning of earlier child and due to maternal low
body stores LBW child)
• Socio-cultural factors affecting feeding practices (delay in the initiation of breast feeding,
lack of colostrum and inappropriate complementary feeding)
• Gender (the gender inequality of male preference over female )
• Mother’s literacy status (Increasing literacy status of a mother have a positive effect in
reducing undernutrition)
• Poverty and income (inadequate dietary intake, large family, infection, unhygienic
environment and illiteracy).
• Health care services (less healthcare facilities and low quality services)
• Maternal nutrition (undernourished mother gives birth to a low birth weight baby )
• Infection (inadequate dietary intake, the immune response gets weaker and increases
susceptibility to infections).

6. CHRONIC ENERGY DEFICIENCY
•Chronic Energy Deficiency (CED) refers to an
intake of energy less than the requirement, for a
period of several months or years. It leads to protein
energy malnutrition.
• Slow growth is an adaptation to CED and therefore
children becomes stunted.
• If the energy intake is too low to meet the
requirements of stunted children than wasting
occurs.

7. PROTEIN ENERGY MALNUTRITION
According to World Health Organization, protein energy malnutrition
(PEM) refers to “an imbalance between the supply of protein and
energy and the body's demand for them to ensure optimal growth and
function”.

8. TYPES OF PEM
•Kwashiorkor
•Marasmus
•Marasmic- kwashiorkor

9. MANAGEMENT OF PEM
 World Health Organization (WHO) 10-step scheme
• HYPOTHERMIA
• HYPOGLYCEMIA
• DEHYDRATION
• MICRONUTRIRNTS INFECTIONS
• ELECTROLYTES
• STARTER NUTRITION
• TISSUE BUILDING NUTRITION
• STIMULATION
• PREVENTION OF RELAPSE
 Modification of the standard oral rehydration solution
 Give broad-spectrum antibiotic
 Diarrhea prevention

10. ACUTE MALNUTRITION
Acute malnutrition is caused by a decrease in food consumption and/or illness resulting
in sudden weight loss or oedema. There are two types of acute malnutrition:
• Moderate acute malnutrition (MAM):
is defined by a weight-for-height indicator between -3 and -2 z-scores (standard
deviations) of the international standard or by a mid-upper arm circumference
(MUAC) between 11.5 cm and 12.5 cm, less severe wasting.
• Severe acute malnutrition(SAM):
is defined by very low weight-for-height indicator below -3 z-score (standard
deviation) of international standard or by a mid-upper arm circumference (MUAC)
below 11.5 cm, severe wasting with edema.

11. MANAGEMENT OF SAM
Long term management involve:
• Dismantling unequal power structures.
• Improving equitable access to health services and nutritious foods.
• Promoting breastfeeding and optimal infant and young child feeding practices.
• Improving water and sanitation.
• Planning for cyclic food shortages and emergencies.
Short term management:
• Routine medicine
• Nutrition health and counseling
• Ready-to-use therapeutic food (RUTF) – it is a high-energy, micronutrient enhanced
paste used to treat children under age 5 who are affected by severe acute
malnutrition.
• Treat and prevent dehydration

12. PREVENTION OF MALNUTRITION
• Breastfeeding promotion
• Complementary feeding
• Nutritional education
• Food fortification including multiple micronutrient
supplementations
• Conditional cash transfer (CCT)
• De-worming children
• Growth monitoring

13. IMPORTANT PROGRAMMES TO
COMBAT MALNUTRITION
• Integrated Child Development Service Programme (ICDS): This is a
unique programme under which a package of integrated services consisting
of supplementary nutrition, immunization, health check up, referal and
education service are provided to the most vulnerable groups even within
children and women
• Special Nutrition Programme (SNP): Main activity under this programme
is to provide supplementary feeding to the beneficiaries (children <6 yrs and
nursing mothers) for 300 days in a year.
• Creches for Children of Working and Ailing Women: The scheme,
implemented since 1975, has been designed to free the working, and in some
cases ailing mothers, from the task of looking after their children while they
are on work or are sick. The services available to the children include
sleeping and daycare facilities, supplementary nutrition, immunization,
medicines, entertainment and checkups at weekly intervals.

14. • Wheat Based Supplementary Nutrition Programme: The scheme was started
with the twin objective of providing supplementary nutrition to children and
popularising wheat intake. The wheat is supplied to the State Governments by the
Food Corporation of India at the same subsidized rates as for the public distribution
system.
• World Food Programme Project: The major part of WFP's assistance to India
supports projects in forestry, irrigation and supplementary nutrition. WFP's food
assistance to India is focused on poverty alleviation, directly targeting the most
vulnerable section of the society
• CARE Assisted Nutrition Programmes: CARE-India extends food aid so that
supplementary nutrition can be provided to pre-school children of age less than six
years and expectant/nursing mothers.
• Tamil Nadu Integrated Nutrition Project: The project seeks to provide enhanced
inputs in the areas of health, communications, training, project management,
operations, research, monitoring and evaluation.
• UNICEF Assistance for Women and Children: UNICEF's assistance covers a
wide spectrum and is available in the sectors of health, education, nutrition, water
and sanitation, rural development urban basic services etc.

15. THANK YOU