NUTRITIONAL PROBLEMS IN INDIA

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NUTRITIONAL PROBLEMS IN INDIA&COMMUNITY NUTRITION PROGRAMMES : 

Mohammed Mubarak. M Ist year MSc Nursing Govt. College of Nursing. Kottayam NUTRITIONAL PROBLEMS IN INDIA&COMMUNITY NUTRITION PROGRAMMES

MAJOR HEALTH PROBLEMS IN INDIA : 

MAJOR HEALTH PROBLEMS IN INDIA COMMUNICABLE DISEASE PROBLEM POPULATION PROBLEM ENVIRONMENTAL SANITATION PROBLEM MEDICAL CARE PROBLEM NUTRITIONAL PROBLEM

CAUSE OF NUTRITIONAL PROBLEM : 

CAUSE OF NUTRITIONAL PROBLEM POOR NUTRITION UNDER NUTRITION (MALNUTRITION) OVERNUTRITION

Slide 4: 

The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition Undernutrition is found mostly in rural areas 10 percent of villages and districts accounting for 27-28 percent of all underweight children children of scheduled tribes have the poorest nutritional status and the highest wasting

DETERMINANTS OF MALNUTRITION : 

DETERMINANTS OF MALNUTRITION MATERNAL MALNUTRITION LOW BIRTH WEIGHT FAULTY CHILD FEEDING PRACTICES DIETARY INADEQUACY FREQUENT INFECTIONS LARGE FAMILIES HIGH FEMALE ILLITERACY TABOOS AND SUPERSTITIONS

FACTORS AFFECTING NUTRITIONAL STATUS : 

FACTORS AFFECTING NUTRITIONAL STATUS

HIGH RISK GROUP : 

HIGH RISK GROUP Pregnant women Lactating women Infants Preschool children Adolescent girls Elderly Socially deprived

NUTRITIONAL PROBLEMS IN INDIA : 

NUTRITIONAL PROBLEMS IN INDIA

NUTRITIONAL PROBLEMS IN INDIA : 

NUTRITIONAL PROBLEMS IN INDIA PROTEIN ENERGY MALNUTRITION LOW BIRTH WEIGHT XEROPHTHALMIA NUTRITIONAL ANEMIA IODINE DEFICIENCY DISORDERS FLUROSIS LATHYRISM OBESITY CARDIO VASCULAR DISEASES DIABETES CANCER

Slide 10: 

75 percent of preschool children suffer from iron deficiency anemia (IDA) 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD) Iodine deficiency is endemic in 85 percent of districts 11% of Indian population in India are over-nourished over 30 million people with diabetics in 1985 and by next year (2010) India is projected to have 50.8 million diabetics India is hence considered as the country with the largest population of diabetics

PROTEIN ENERGY MALNUTRITION : 

PROTEIN ENERGY MALNUTRITION PEM refers to the deficiency of energy and protein in the body. 1-2% of preschool children in India suffer from PEM.

MAIN CAUSES OF PEM : 

MAIN CAUSES OF PEM Inadequate intake of food both in quantity and quality Infections (Diarrhea, Respiratory infections, measles, intestinal worms)

Contributing factors to PEM : 

Contributing factors to PEM POOR ENVIRONMENTAL CONDITIONS, LARGE FAMILY SIZE, POOR MATERNAL HEALTH, FAILURE OF LACTATION, PREMATURE TERMINATION OF BREAST FEEDING, ADVERSE CULTURAL PRACTICES RELATED TO CHILD REARING AND WEANING, DELAYED SUPPLEMENTARY FEEDING

CLINICAL FORMS OF PEM : 

CLINICAL FORMS OF PEM MARASMUS KWASHIORKER

Marasmus : 

Marasmus common type of PEM observed among children below 1 year of age. Caused by severe deficiency of nearly all nutrients especially protein and calories conditions are characterized by extreme wasting of the muscles and a daunt expression

Marasmus : 

Marasmus Extensive tissue and muscle wasting Dry skin Loose skin folds hanging over glutei and axilla, Fat wasting small for age sparse hair that is dull brown or reddish yellow, mental retardation behavioral retardation, low body temperature (hypothermia), slow pulse and breathing rates. Absence of edema

Kwashiorker : 

Kwashiorker Kwashiorker occurs in children between 2-3 years of age Acute form of PEM due to deficiency of protein in the diet (Both in quantity and quality) Deficiency of micronutrients (Fe, Folic acid, Iodine, Selenium, and Vitamin C) Deficiency of antioxidants (albumin, Vitamin E, PUFA, Glutathione). kwashiorkor is identified as swelling of the extremities and belly, which is deceiving to their actual nutritional status

KWASHIORKER : 

KWASHIORKER Malnourished child with pedal edemas, Growth failure, Moon face, Distended abdomen, Ascitis(abnormal accumulation of fluid) Enlarged liver with fatty infiltrates, thinning of hair, Loss of teeth, Skin depigmentation Dermatitis, Irritability Anorexia

Assessment of PEM : 

Assessment of PEM Gomez Classification Weight for age = Weight of the child 100 Weight of normal child of the same age  Between 90 – 110% Normal Nutritional Status Between 75 – 89% Mild malnutrition (1st degree) Between 60 – 74% Moderate Malnutrition (2nd degree) Under 60% Severe Malnutrition (3rd degree)

Preventive Measures of PEM : 

Preventive Measures of PEM Health promotion Measures Promotion of breast feeding, low cost weaning food, nutrition education, family planning and birth spacing, Protein energy rich food,(milk, egg, fresh fruits), immunization, food fortification Early diagnosis and treatment Rehabilitation

LOW BIRTH WEIGHT : 

LOW BIRTH WEIGHT

LOW BIRTH WEIGHT : 

LOW BIRTH WEIGHT Birth weight less than 2500Gm.30% 0f babies born in India are LBW

Causative factors : 

Causative factors Maternal malnutrition and anemia. Illness and infections during pregnancy, High parity, Close birth intervals

Factors Modifying Prevalence of LBW : 

Factors Modifying Prevalence of LBW More Institutional deliveries Improving No.of ANCs (minimum: >5) Improving Quality of ANC Includes: No.ofANCs, TT, weight, BP, examination of blood, examination of urine

XEROPHTHALMIA(DRY EYE) : 

XEROPHTHALMIA(DRY EYE) Disease due to deficiency of Vitamin A Also Called Xeroma Absence of tears Xerophthalmia is most common in children aged 1-3 years Cornea and conjunctiva become horny and necrosed

Bitot’s Spots : 

Bitot’s Spots Collection of dried epithelium, micro organisms etc. forming shiny grayish white spot on the cornea A sign of Vitamin A deficiency

KERATOMALACIA : 

KERATOMALACIA Ulceration and softening of Cornea due to deficiency of vitamin A

Bilateral Blindness : 

Bilateral Blindness

Risk factors : 

Risk factors Ignorance Faulty feeding practices Infections Diarrhea Use of skimmed milk(totally devoid of vitamin a)

Prevention : 

Prevention Short term action – oral Administration of large dose of Vitamin A (retinol Palmitate) Medium term action – Food fortification with Vitamin A. Eg:Dalda,Sugar,Salt,Tea etc Long term action – Promote BF, consumption of Green Leafy Vegetables, Immunisation to infections

NUTRITIONAL ANEMIA : 

NUTRITIONAL ANEMIA A Condition in which the Hb content of blood lower than normal as a result of a deficiency of one or more essential nutrients Primarily due to lack of absorbable iron in the diet

ANAEMIA IN FEMALES IN INDIA : 

ANAEMIA IN FEMALES IN INDIA Pregnant Women Adolescent girls

Causes of Iron deficiency anemia : 

Causes of Iron deficiency anemia Inadequate intake of iron Poor bioavailability (only less than 5 percent is absorbed) Excessive loss of iron (menstruation, rapid pregnancies, hookworm infestations, other illnesses)

Effects of anemia : 

Effects of anemia Increases the risk of maternal and fetal mortality and morbidity Increase susceptibility to infection due to impaired cellular response and immune functions Reduction of work performance and productivity

Interventions : 

Interventions Iron and folic acid supplementation Nutritional anemia prophylaxis programme (daily Fe & folic acid supplementation to Pregnant Women lactating mothers & Children under 12 years) Iron fortification - Fortification of salt with iron Control of parasite and nutrition education

IODINE DEFICIENCY DISORDERS (IDD) : 

IODINE DEFICIENCY DISORDERS (IDD) IDD refers to a spectrum of disabling conditions arising from an inadequate dietary intake of iodine. IDD affects the health of humans from fetal stage to adulthood

CAUSES OF IDD : 

CAUSES OF IDD Deficient iodine Intake – Consuming foods with low Iodine content, Crops grown in iodine depleted soil Increased demand for Iodine in the body – Demand of Iodine is increased during the stage of rapid growth (Infancy, Puberty, pregnancy, lactation), Demand exceeds supply results in deficiency. Presence of Goitrogens – goiter producing substances naturally present in some foods (cabbage, cauliflower etc.) interfere with Iodine utilization

IODINE DEFICIENCY DISORDERS (IDD) : 

IODINE DEFICIENCY DISORDERS (IDD) Endemic Goiter Cretinism

Endemic Goiter : 

Endemic Goiter Also called Derbyshire Neck Enlargement of thyroid gland causing swelling in front part of the neck Due to lack of iodine in the diet Goiter belt – Himalayan region Graded from 0 – 4 Common among girls than boys

Cretinism : 

Cretinism Severe form of IDD Occurs during fetal stage Interfere with brain development causing brain damage and death Result in Growth failure, MR, Speech and hearing defects

FLUROSIS : 

FLUROSIS Occurs due to consumption of excessive amount of fluorine through drinking water Two types of flurosis Dental Flurosis Skeletal flurosis

Dental flurosis : 

Dental flurosis Seen in children 5- 7 years of age Teeth lose their shiny appearance and chalk white patches develop on them Changes are called mottling of enamel In severe cases loss of enamel gives teeth a corroded appearance Dental flurosis is confined to permanent teeth and develops only during the period of formation

Skeletal flurosis : 

Skeletal flurosis Seen in older adults Heavy fluoride deposition on skeleton Manifested as pain numbness &tingling sensation of the extremities, stiffness of neck Genu Valgum A form of skeletal deformity associated with flurosis The lower limbs appear as knock kneed due to osteoporosis.

Prevention of Flurosis : 

Prevention of Flurosis Keep the drinking water fluorine level below 1mg/lit Deflouridation of water using Nalgonda Technique (Flocculation, Sedimentation & filtration) Prevent use of fluoride toothpaste in areas of endemic flurosis Deficiency of flurine?

LATHYRISM : 

LATHYRISM Disease occur by consuming large quantities of Lathyrus sativus (Kesari dhal) Lathyrism in human is referred as Neurolathyrism The disease presents as Crippling disease of nervous system characterized by gradually developing spastic paralysis of lower limbs

LATHYRISM : 

LATHYRISM It contains a toxin called Beta oxalyl amino Alanine (BOAA) Lathyrus Kesari Dhal) is good source of protein. It is relatively cheaper.

Intervention : 

Intervention Removal of toxin Steeping method Soaking the pulse in hot water for about 2 hours and the soaked water is drained off completely Genetic Approach Development of low toxin varieties of Lathyrus Banning the crop The Prevention of food adulteration act in India has banned Lathyrus in all forms

OBESITY : 

OBESITY Most Prevalent form of malnutrition Abnormal growth of adipose tissue due to enlargement of fat cells(Hypertrophic),Increase in no. of fat cells (hyperplasic)or Combination of both

OBESITY : 

OBESITY Obesity - When the body weight is 20% more than the desirable weight. Over weight - When the body weight is between 10-20% more than the desirable weight

Factors contributing to obesity : 

Factors contributing to obesity Age Sex Genetic factors Physical Inactivity Socio economic status Eating habits Psycho social factors Alcohol The direct cause of overweight in India is lack of physical activity due to sedentary life style, loss of traditional diet, faulty diet, high stress high rate of economic growth

BMI : 

BMI BMI = Height in kilogram (Weight in Meter)2 20-25 IDEAL 26-30 OVERWEIGHT 31-40 OBESE 40+ VERY OBESE

Control of obesity : 

Control of obesity Eat food according to body’s requirement At least 3-4 hrs intervals between meals Avoid in between snacks Eat more leafy vegetables which contain high fiber Avoid intake of fatty and fried foods Regular Physical exercise

CARDIO VASCULAR DISEASES : 

CARDIO VASCULAR DISEASES Classified as one of the Food habit related Illness Change in food habits and lifestyle has increased the risk of CVD in Indian population mostly in Middle Class and upper middle class groups.

CANCER : 

CANCER 80 % of cancer due to environmental factors Dietary fat – positive correlation with Colon cancer, breast cancer Dietary fiber – Risk of colon cancer is inversely related Micro nutrients – Lack of Vitamin C & Vitamin A arise the risk of stomach cancer and lung cancer. Food additives – Saccharin, cyclamate, Coffee, aflatoxin associated with bladder cancer Alcohol – liver cancer, Rectal Cancer

COMMUNITY NUTRITION PROGRAMMES : 

COMMUNITY NUTRITION PROGRAMMES

INTEGRATED CHILD DEVELOPMENT SERVICE (ICDS) SCHEME : 

INTEGRATED CHILD DEVELOPMENT SERVICE (ICDS) SCHEME Integrated Child Development Service (ICDS) scheme was launched on 2nd October, 1975 (5th Five year Plan) in pursuance of the National Policy For Children started in 33 experimental blocks Success of the scheme led to its expansion to 2996 projects by the end of March 1994. Now the goal (Ninth Five Year Plan ) is universalization of ICDS throughout the country.

Beneficiaries : 

Beneficiaries 1. Children below 6 years2. Pregnant and lactating women3. Women in the age group of 15-44 years4. Adolescent girls in selected blocks

Objectives : 

Objectives 1. Improve the nutrition and health status of children in the age group of 0-6 years 2. Lay the foundation for proper psychological, physical and social development of the child; 3. Effective coordination and implementation of policy among the various departments 4. Enhance the capability of the mother to look after the normal health and nutrition needs through proper nutrition and health education.

The Package of services provided by ICDS : 

The Package of services provided by ICDS 1. Supplementary nutrition, Vitamin-A, Iron and Folic Acid,2. Immunization, 3. Health check-ups,4. Referral services, 5. Treatment of minor illnesses;6. Nutrition and health education to women;7. Pre-school education of children in the age group of 3-6 years, and8. Convergence of other supportive services like water supply, sanitation, etc

VITAMIN A PROPHYLAXIS PROGRAMME(1970) : 

VITAMIN A PROPHYLAXIS PROGRAMME(1970) Programme launched by Ministry of H&FW Component of National programme for control of blindness.1968,1976 Single massive dose of oily preparation of Vitamin A containing 200000 IU orally to all preschool children in the community every 6 months through peripheral health workers

PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA : 

PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA Launched by Govt.of India during 4th five year plan Distribution of iron and folic acid tablets to pregnant women and young children (1-12 years MCH centres and ICDS projects implement this programme

SCHEME FOR ADOLESCENT GIRLS (KISHORI SHAKTI YOJNA) : 

SCHEME FOR ADOLESCENT GIRLS (KISHORI SHAKTI YOJNA) A scheme for adolescent girls in ICDs was launched by the Department of Women and Child Development, Ministry of Human Resource Development in 1991. Targeted All adolescent girls in the age group of 11-18 years

SCHEME FOR ADOLESCENT GIRLS (KISHORI SHAKTI YOJNA) : 

SCHEME FOR ADOLESCENT GIRLS (KISHORI SHAKTI YOJNA) common services 1. Watch over menarche, 2. Immunization, 3. General health check-ups once in every six-months,4. Training for minor ailments, 5. De-worming, 6. Prophylactic measures against anemia, goiter, vitamin deficiency, etc., and7. Referral to PHC. District hospital in case of acute need.

IODINE DEFICIENCY DISORDER PROGRAMME : 

IODINE DEFICIENCY DISORDER PROGRAMME Launched in 1962 Focuses on Use of Iodised Salt – Replace of common salt with iodised salt, Cheapest method to control IDD Use of Iodized tablets – iodine tablets administered to school children (not widely accepted) Use of Iodized oil – 1ml Injection of Iodized oil to those suffering from IDD, Oral administration as prophylaxis in IDD severe areas Mass communication – Public awareness through mass media and public health programmes

MID-DAY MEAL PROGRAMME : 

MID-DAY MEAL PROGRAMME Also known as School launch programme Programme in operation since 1961 Objective To attract more children for admission to schools

Principles of Mid Day Meal programme : 

Principles of Mid Day Meal programme The meal should be supplement and not a substitute to home diet. The meal should supply at least one third of the total energy requirement and half of the protein needed The cost of meal should be reasonably low. The Meal should be prepared easily in schools, no complicating cooking procedures involved Locally available foods should be used The menu should be frequently changed

Mid Day Meal programme Recommendations : 

Mid Day Meal programme Recommendations Cereals 75gm/day/child Pulses 30 Oils and fats 8 Leafy vegetables 30 Non leafy vegetables 30

BALWADI NUTRITION PROGRAMME : 

BALWADI NUTRITION PROGRAMME Nutritional support to pre school children Started on 1970 Under the Department of Social welfare For children age group 3-6 years in rural areas Programme implemented through Balwadis Food supplement 300kcal and 10grams of protein per child per day

NATIONAL PROGRAMME FOR NUTRITION SUPPORT TO PRIMARY EDUCATION : 

NATIONAL PROGRAMME FOR NUTRITION SUPPORT TO PRIMARY EDUCATION This system was called provision of ‘dry rations’. Government of India will provide grains free of cost and the States will provide the costs of other ingredients, salaries and infrastructure On November 28, 2001 the Supreme Court of India gave direction that made it mandatory for the state governments to provide cooked meals instead of ‘dry rations

AKSHAYA PATRA AND PRIVATE SECTOR PARTICIPATION IN MID-DAY MEALS : 

AKSHAYA PATRA AND PRIVATE SECTOR PARTICIPATION IN MID-DAY MEALS Successfully involved private sector participation in the programme The programme is managed with an ultra modern centralized kitchen that is run through a public/private partnership. Food is delivered to schools in sealed and heat retaining containers just before the lunch break every day

EMERGENCY FEEDING PROGRAMME 2001 : 

EMERGENCY FEEDING PROGRAMME 2001 This was introduced in May, 2001 in selected states (Orissa) Emergency Feeding Programme, is a food-based intervention targeted for old, infirm and destitute persons belonging to BPL households to provide them food security in their distress conditions. Cooked food containing, rice- 200gms, Dal (pulse)- 40 gms, vegetables- 30 gms is provided in the diet of each EFP beneficiary daily by the Government.

VILLAGE GRAIN BANKS SCHEME : 

VILLAGE GRAIN BANKS SCHEME Implemented by the Ministry of Tribal Affairs to provide safeguard against starvation during the period of natural calamity or during lean season when the marginalized food insecure households do not have sufficient resources to purchase rations.

WHEAT BASED NUTRITION PROGRAMME (WBNP) : 

WHEAT BASED NUTRITION PROGRAMME (WBNP) Implemented by the Ministry of Women & Child Development providing nutritious/ energy food to children below 6 years of age and expectant /lactating women from disadvantaged sections Implemented through ICDS

SC/ST/OBC HOSTELS : 

SC/ST/OBC HOSTELS introduced in October, 1994 by Ministry of Consumer Affairs, Food & Public The residents of the hostels having 2/3rd students belonging to SC/ST/OBC  are eligible to get 15 kg food grains per resident per month.

SAMPOORNA GRAMIN ROZGAR YOJANA : 

SAMPOORNA GRAMIN ROZGAR YOJANA 50 lakh tones of food grains is to be allotted to the States/UTs free of cost by Ministry of Rural Development

NATIONAL FOOD FOR WORK PROGRAMME : 

NATIONAL FOOD FOR WORK PROGRAMME To provide supplementary wage employment and food security Implemented in tribal belts. The scheme will provide 100 days of employment at minimum wages for at least one able-bodied person from each household in the country

GRAIN BANK SCHEME : 

GRAIN BANK SCHEME Ministry of Consumer Affairs, Food & Public Distribution to establish Grain Banks in chronically food scarce areas.

PULSE MISSION : 

PULSE MISSION pulse production has been stagnant for five decades. Pulse Mission (India’s Food Security Mission) aimed at increasing pulse production. Aimed to improve pulse production by 2 million tones by2011-12

NATIONAL WATER SUPPLY AND SANITATION PROGRAMME : 

NATIONAL WATER SUPPLY AND SANITATION PROGRAMME Launched in 1954 Provide safe water supply and adequate drainage facilities for the entire urban and rural population of the country

MINIMUM NEEDS PROGRAMME : 

MINIMUM NEEDS PROGRAMME Launched on 1974 Objective To provide basic minimum needs and thereby improve the living standards of people It Includes Rural Health Rural water Supply Rural electrification Elementary education Adult education Nutrition Environmental improvement of urban slums House for landless laborers

20 POINT PROGRAMME 1975 : 

20 POINT PROGRAMME 1975 Objectives: Eradication of poverty, raising productivity, reducing inequality, improving quality of life.

Slide 84: 

National Children's Fund 1979 This Fund Provides support to the voluntary organizations that help the welfare of children. National Plan of Action for Children1990 United Nations Children's Fund National Rural Health Mission2005-2012

National Rural Health Mission2005-2012 : 

National Rural Health Mission2005-2012 Reduce the infant mortality rate (IMR) and the maternal mortality ratio (MMR) To have universal access to public health services Prevent and control both communicable and non-communicable diseases, including locally endemic diseases To have access to integrated comprehensive primary healthcare Create population stabilization, as well as gender and demographic balance Revitalize local health traditions and mainstream AYUSH Finally, to promote healthy life styles

INDIRECT PROGRAMMES : 

INDIRECT PROGRAMMES NATIONAL CANCER CONTROL PROGRAMME 1975-76 NATIONAL DIABETES CONTROL PROGRAMME POVERTY ALLEVIATION PROGRAMMES ENVIRONMENTAL SANITATION PROTECTED WATER SUPPLY PROGRAMME LITERACY PROGRAMME

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