COMMON NUTRITION PROBLEMSIN INDIA

Soumya Ranjan ParidaBasic B.Sc. Nursing 4th year

Sum Nursing College

MOTHER AND CHILD SURVIVAL

MMR 407/100,000 live births

IMR* 58/1000 live birthsChild Mortality 19.5/1000 ChildrenRate(1-4 years)

Vijayaraghavan

*Gujarat 53

NUTRITION PROBLEMS IN INDIA

WHO IS AT RISK??

PREGNANT WOMENLACTATING WOMENINFANTSPRESCHOOL CHILDRENADOLESCENT GIRLSELDERLYSOCIALLY DEPRIVED(SC & ST Communities)

.

Vijayaraghavan

WOMEN• POOR WT. GAIN DURING

PREGNANCY• CED• MICRONUTRIENT

DEFICIENCIES

CHILDRENLOW BIRTH WEIGHT• GROWTH

FALTERING• PEM• MICRONUTRIENT

DEFICIENCIES

NUTRITION PROBLEMS IN INDIA

WHAT ARE THE COMMON PROBLEMS?

FLUOROSIS, LATHYRISM DIET RELATED CHRONIC DISEASES OBESITY, CARDIOVASCULAR DISEASES, DIABETES

Vijayaraghavan

PREVALENCE OF LBW IN S.E ASIAN COUNTRIES

33

30

23

2018

16

11

7.2

0

5

10

15

20

25

30

35

PE

R C

EN

T

Nepal

India

Mya

nmar

Mal

dives

SriLan

ka

Bhutan

Indones

ia

Thaila

nd

Vijayaraghavan

FACTORS MODIFYING PREVALENCE OF LBW

• % INSTITUTIONAL DELIVERIES

• # ANCs (Minimum: >5)

• QUALITY OF ANC

Includes: No.of ANCs, TT, Weight, BP,

Examination of Blood, Examination of Urine

INFANT MORTALITY AND BIRTH WEIGHT

1000

615

238

59 21 180

200

400

600

800

1000

1200

<1 1-1.5 1.5-2 2-2.5 2.5-3 >3

BIRTH WEIGHT (KG)

IMR

/100

0 L

ive-

bir

ths

Source : Shanti Ghosh

Source: Shanti Ghosh et al, 1978

30.830.2

15.5

0

5

10

15

20

25

30

35

PER

CEN

T

CONTROL IRON FOLIC ACID

GROUPS

IFA SUPPLENTATION AND LBW

Source: Leela Iyengar & Apte, S,V.,1970

SUPPLENTATION OF IRON / FOLIC ACID AND BIRTH WEIGHT

2890

26502567

2400

2500

2600

2700

2800

2900

3000

CONTROL IRON FOLIC ACID

GROUPS

BIR

TH

WE

IGH

T (

g)

Source: Leela Raman & Rajalakshmi,1974

NUTRITIONAL DISORDERS IN CHILDREN

• PROTEIN ENERGY MALNUTRITION (PEM) . CLINICAL FORMS

. SUBCLINICAL UNDERNUTRITION

• MICRONUTRIENT DEFICIENCIES

Vijayaraghavan

CLINCAL FORMS of PEMCLINCAL FORMS of PEM

KWASHIORKOR

• OEDEMA+

• IRRITABILITY+

• GROWTH FAILURE+

• DISCOLOURED HAIR+

Vijayaraghavan

CLINCAL FORMS of PEMCLINCAL FORMS of PEM

MARASMUS

EXTREME WASTING

“SKIN AND BONES”

MONKEY/OLD MAN FACIES

Vijayaraghavan

SUB-CLINICAL FORMS OF PEM

UNDERNUTRITION WEIGHT FOR AGE

WASTING WEIGHT FOR HEIGHT

STUNTING HEIGHT FOR AGE

Vijayaraghavan

UNDERNUTRITION IN INDIA

PRESCHOOL CHILDREN ADULTS (Females)

48.546.5

5

CED NORMAL OBESE

40.6

8.9

44.3

6.2

NORMAL GRADE I GRADE II GRADE III

Based on BMI

Vijayaraghavan

Based on NCHS weight for age

78.6

57.7

76.5

62.3

18.1 18.5

0

10

20

30

40

50

60

70

80

PER

CEN

T

Height Weight Weight for Height

TIME TRENDS IN ANTHROPOMETRIC PARAMETERS (<Median-2SD)NNMB

1975-79

1996-97

VIJAY’00

DISTRIBUTION WEIGHT FOR AGE – IAPGujarat

32.537.9

21

7.2 1.40

5

10

15

20

25

30

35

40

PE

R C

EN

T

GRADES OF UNDERNUTRITION

Normal Gr. I Gr. II Gr. III Gr. IV

WEIGHT FOR AGE– SD CLASSIFICATION - GUJARAT

0

5

10

15

20

25

30

35

40

%

<- 3

SD

- 2--3

SD

- 1--2

SD

-1- M

edia

n

>Med

ian

Boys

Girls

Pooled

VITAMIN A DEFICIENCY

BITOT SPOT KERATOMALACIA

BILATERAL BLINDNESS

V

A

D

Vijayaraghavan

WHO Criteria for Public Health Significance- VAD

Minimum Prevalence (%) in children <6 yrs

• BITOT SPOTS 0.5• NIGHT BLINDNESS 1.0• CORNEAL LESIONS 0.01• CORNEAL SCARS 0.05• Serum Retinol <10 µg/l 5.0

Vijayaraghavan

VITAMIN A DEFICIENCY (%) IN INDIA

AGE GROUP SOURCE X1B XN*

PRESCHOOL

CHILDREN

ICMR, 2001 0.7 1.03

NNMB 0.7 -NIN- SURVEYS 2.1 -

PREGNANT WOMEN

ICMR, 2001 - 2.8

* 24-71 MONTHS

Vijayaraghavan

VITAMIN A DEFICIENCY

Districts(%) with X1B >0.5%

Average prevalence (%)

2.155 45

Based on surveys in 126 Dts. by NIN and NNMB

No VAD VAD

Vijayaraghavan

1.71.8

5.7

0.7 0.7

5.7

0.20.7

2.1

0

1

2

3

4

5

6

PE

R C

EN

T

1975-79 1988-90 1996-97

PERIOD OF SURVEY

PEM

X1B

RIBO. DEF.

NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN

Vijayaraghavan

0

50

100

%

% RDI

DISTRIBUTION OF MICRONUTRIENT INTAKES IN CHILDREN - %RDI

Vitamin A 86.3 3.2 1.4 9.1

Iron 82.5 8.6 2.1 6.8

Riboflavin 71.4 15.9 4.1 8.6

<70 70-90 90-100 >100

Vijayaraghavan

ANAEMIA

61

79.4

82.5

84.1

87.2

91.4

94.9

96.8

84.6

20

30

40

50

60

70

80

90

100

%

H.P. M.P. A.P. BIHAR MAHA. ASSAM RAJ. J&K POOLED

PREVALENCE OF ANAEMIA IN PREGNANT WOMEN

Vijayaraghavan

87.1

87.7

91.891.9

92.2

93.999.3 92

80

82

84

86

88

90

92

94

96

98

100

%

MAHA. H.P. A.P. BIHAR M.P. ASSAM J&K POOLED

Source: ICMR, 1999

PREVALENCE OF ANAEMIA -ADOLESCENT GIRLS

ANAEMIA IN FEMALES• PREVALENCE OF

ANAEMIA IS VERY HIGH IN BOTH THE GROUPS

• NO CHANGE NOTICED OVER TIME IN THE PREVALENCE

84.6

92

50

55

60

65

70

75

80

85

90

95

Pe

rce

nt

Pregnant Women

Adolescent girls

Vijayaraghavan

IODINE DEFICIENCY DISORDERS

239 OF 282 DTs. SURVEYED –ENDEMIC167 millions AT RISK ?

IODINE DEFICIENCY DISORDERS

GOITRE+

PREVALENCE OF GOITRE IN 6-12 Yr CHILDREN - Gujarat

0

2

4

6

8

10

12

14

16

Gr. I Gr. II Total

Surat

Valsad

DIETARY INTAKES

HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS

78

118

79

85

48

98

91

92

51

131

87

90

0 20 40 60 80 100 120 140

Iron (mg)

Calcium (mg)

Energy (Kcal)

Protein (g)

PER CENT

RuralTribalUrban Slums

VIJAY’00

0

105

55

87

46

164

120

64

100

63

156

102

71

104

51

0 50 100 150 200

Folic acid (µg)

Vitamin C (mg)

Riboflavin (mg)

Thaimin (mg)

Vitamin A (µg)

PER CENT

Rural

Tribal

Urban Slums

HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS

NUTRIENT INTAKES AMONG INDIAN WOMEN

NUTRIENTS NPNL PREGNANTWOMEN

LACTATING WOMEN

Protein (g) 49.9 47.2 56.5

Energy (kcal) 1983 1994 224.3

Total Fat (g) 24.5 21.5 373

Calcium (mg) 382 339 12.4

Iron (mg) 11.3 11.0 162

Vitamin A (µg) 148 142 1.1

Thiamin (mg) 0.9 0.9 1.1

Riboflavin (mg) 0.8 0.8 0.9

Vitamin C (mg) 32.0 28.4 29.4

Folic Acid (µg) 86 84 106

Source: NNMB, 2000

NUTRIENT INTAKES IN PREGNANT WOMEN % RDI

% RDI Energy Protein Vitamin A Iron Riboflavin Total Fat

<30 0 0 52.4 53.7 1.2 22

30-40 1.2 0 8.5 22 20.7 6.1

40-50 3.7 2.4 11 9.8 13.4 6.1

50-60 9.8 11 9.8 7.3 12.2 7.3

60-70 8.5 17.1 0 0 18.3 8.5

70-80 23.2 11 3.7 1.2 4.9 7.3

80-90 9.8 9.8 2.4 1.2 4.9 4.9

90-100 7.3 8.5 2.4 2.4 7.3 4.9

≥100 36.5 40.2 9.8 2.4 17.1 32.9

Source: NNMB,2000

NUTRIENT INTAKES (per day) IN CHILDREN

Age in Years 1-3 4-6 Nutrients

Mean Median Mean Median Protien (g) 22.4 20.4 31.4 29.40 Tot fat (g) 13.5 10.1 17.6 13.90 Energy (Kcal) 867 815 1215 1154 Calcium (mg) 250 168 300 224 Iron (mg) 5.50 4.30 8.4 6.90 Vit A (ug) 145 72 205 96 Thiamin (mg) 0.44 0.40 0.69 0.60 Ribo. (mg) 0.44 0.40 0.56 0.50 Niacin (mg) 4.97 4.5 7.37 6.60 Vit C (mg) 16.5 9.9 24.9 17.5 Folic acid (mg) 45 36.6 65 55.1

NNMB, 2000 Vijayaraghavan

DETERMINANTS OF MALNUTRITION

MATERNAL MALNUTRITIONSTART WITH A HANDICAP(LBW)FAULTY CHILDFEEDING PRACTICESDIETARY INADEQUACYFREQUENT INFECTIONSLOW PURCHASING POWERLARGE FAMILIESHIGH FEMALE ILLITERACYTABOOS AND SUPERSTITIONS

Factors Affecting Nutritional Status

High illiteracy Unemployment/Underemployment

Large familiesLow purchasing power

Ignorance High dependence rateFalse food beliefs Inadequate intakes

Low Procurement of foods Poor PDS High cost

Low availability of foodsLow production Reduced work Malnutritionof foodgrains output

Poor environment Morbidity Absorption of nutrients Low Appetite

Poor utilization of services poor coverage of immunizationImproper health services

poor infrastructure Lack of resources

INTERVENTIONS IN OPERATION

DIRECT•CONVERGENCE OF SERVICES (RCH)•INTEGRATED CHILD DEVELOPMENT SERVICES•IRON AND FOLIC ACID DISTRIBUTION•MASSIVE DOSE VITAMIN A PROGRAMME•PRIMARY HEALTH CARE PROGRAMME•HEALTH AND NUTRITION EDUCATION

INDIRECT•POVERTY ALLEVIATION PROGRAMMES•ENVIRONMENTAL SANITATION•PROTECTED WATER SUPPLY•LITERACY PROGRAMME