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COMMON NUTRITION PROBLEMSIN INDIA
Dr. K.VIJAYARAGHAVAN
DIRECTOR – RESEARCH,
SHARE INDIA (MEDICITI INSTITUTION)
&
Sr. Dy. Director, NIN (Retd)
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
/1000
Liv
e-b
irth
s
Source : Shanti Ghosh
Source: Shanti Ghosh et al, 1978
30.830.2
15.5
0
5
10
15
20
25
30
35
PE
R C
EN
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
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 g/l 5.0
Vijayaraghavan
VITAMIN A DEFICIENCY (%) IN INDIA
AGE GROUP SOURCE X1B XN*
PRESCHOOLCHILDREN
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
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
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
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
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 PREGNANT
WOMEN
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 (g) 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 (g) 86 84 106Source: 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