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.
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
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
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
16.
17. MGRS study design
year 1 year 2 year 3
Longitudinal (0-24 months)
Cross-sectional (18-71 months)
18.
19.
20.
21.
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
27.
28.
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