UBLIC EALTH APPENINGS JSPH Jodhpur School Public Health

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JSPHPUBLIC HEALTH HAPPENINGS

Regd. Office : 131, II Polo Ground, Paota 342006 - Jodhpur (Rajasthan) India Email :- [email protected], 88751-71400 (M)

Issue 19 – September 2018National Nutrition Month 2018

Special Edi�on:

It gives me great pleasure to learn t h a t i s J S P Hpublishing a special issue of JSPH Newsle�er focused on “Na�onal Nutri�on Week”. JSPH in collabora�on with NSI Jodhpur Chapter has been co r g a n i z i n g a n u m b e r o f ac�vi�es on Nutri�on for Public Health Professionals. Na�onal N u t r i � o n w e e k ( 1 - 7 September), ini�ated in 1982, is an annual event of immense significance.

Every year September is being celebrated as the Na�onal Nutri�on Month to mark the c o u n t r y ' s fi g h t a g a i n s t malnutri�on. The Ministry of women and child development a c c o r d i n g t o a n o ffi c i a l statement has directed to o rga n i ze p ro g ra m m e s to spread awareness on the issues related to malnutri�on like stun�ng, under-nutri�on, anemia and low birth weight in c h i l d r e n a n d f o c u s o n adolescent girls, pregnant women and lacta�ng mothers,.

Under the , it Poshan Abhiyanwas also decided that through the use of technology, a t a r g e t e d a p p r o a c h a n d convergence would be used to reduce the level of stun�ng, under-nutri�on and anemia in children.

The Ministry of women and c h i l d d e v e l o p m e n t h a s developed a caller tune and ringtone to popularize and create a connect with the goal of . I 'Sahi Poshan Desh Roshan'am happy to express that NSI members, faculty and students o f J S P H a r e j o i n t l y implemen�ng the Na�onal program through var ious ac�vi�es reported in JSPH Newsle�ers and to NSI HQ. Hyderabad. Around a dozen ac�vi�es during the year have been planned by NSI Jodhpur Chapter JSPH. and

From the desk of:

Prof. (Dr.) Ram Gopal Convener, NSI Jodhpur Chapter

Expert Talk - Prof. (Dr.) Ram Gopal

Vitamin D is one of the major h e a l t h c o n c e r n s g l o b a l l y i rrespec�ve of geographical loca�on, gender or ethnicity. A growing body of evidence suggests that prevalence of vitamin D deficiency among south Asian popula�on is quite high inspite of abundance of sunshine available. Vitamin D is understood to have poten�al mechanis�c role in energy metabolism and hence linked to poten�al risk of cardio metabolic risk factors. Presence of at least three out of five from the fac�on of such risk factors such as central obesity, raised blood pressure, raised triglyceride, lower h i g h - d e n s i t y l i p o p r o t e i n cholesterol and raised fas�ng g lucose i s character i sed as “ M e t a b o l i c s y n d r o m e ” o r commonly called as MetS (Alber�, 2009).

Various lifestyle factors among Indian popula�on such as a) high intake of sugar and refined carbohydrate rich foods b) lack of physical inac�vity c) vitamin D deficiency and d) environmental factors such as high levels of smoking/pollu�on predispose

Indian popula�on at risk for these cardio metabolic

disorders (Keefe et al., 2016). A recent cross-sec�onal study a m o n g A s i a n I n d i a n i n S a n Francisco Bay area suggest that fi�y two percent of par�cipants either deficient or with low vitamin D levels also met minimum criteria to metabolic syndrome (Chiang et al 2018). Instead, achieving high serum vitamin D status has been well associated with greater postprandial glucose oxida�on and improved insul in sens i�v i ty (Pathak et al., 2017) and hence r e d u c i n g t h e r i s k o f cardiometabol ic r isk factors (Parker et al., 2017).

On the posi�ve side, these all above-men�oned risk factors are modifiable and achievable with persistence and con�nuous effort. It is the responsibility of us as health care professionals to spread t h e a w a r e n e s s r e g a r d i n g importance of op�mising healthy lifestyle through either educa�on or interven�on to achieve ul�mate goal, that is, “Health for All”.

National Nutrition MonthExpert Talk - Dr. Kaveri Pathak

From the desk of:

Kaveri Pathak(Accredited Practising Dietitian)

www.jsph.in

India is one of the world's fastest growing economies and our government is running one of the largest an�-malnutri�on programs. Despite this, the nutri�onal status of our children doesn't paint a beau�ful picture. While sharing his message focussing “Na�onal Nutr�on Week - India” for readers of JSPH Newsle�er, Dr Rajan Sankar (Program Director – Nutri�on at TATA Trusts ) shared that “Malnutri�on is such a cri�cal i s s u e t h a t i t s m u l � - d i m e n s i o n a l repercussions extend beyond chi ld mortality rates to impact a na�on’s overall economic health. Evidence shows that the right nutri�on in the first thousand days of a child’s life — from concep�on to the age of two years — can save more than 1 million l ives each year, reduce the r isk of developing diseases such as diabetes, and increase a country’s GDP by as much as 11 percent year over year. It was the pervasive and alarming consequences of India’s malnutri�on burden that led Tata Trusts C h a i r m a n S i r R ata n Tata to m a ke malnutri�on a priority area.”Spread over 17 states and 172 districts in India, Tata Trusts are focussed on seven strategic work areas: health; water; educa�on; urban poverty allevia�on; rural uplifment; energy; and arts, crafs & culture. Programs supported by the Trusts reach out to millions of households through an efcient network of more than 450 partner organiza�ons.

Mr Ratan N Tata, Chairman of the Tata Trusts, has made nutri�on a priority for our organiza�on. India has enjoyed strong economic growth in recent �mes, and has produced many great intellectual, scien�fic a n d t e c h n i c a l a c h i e v e m e n t s . Malnourishment s�ll exists on a wide scale, affec�ng woman and children in par�cular. It is too early to report concrete results, but we are forging important partnerships in the fight against malnutri�on and the early signs of progress are promising.

Tata Trusts work with several state governments, and also works with a number of community-based organisa�ons, with local NGOs, and with the academia. Companies that are interested in focussing its CSR work on nutri�on, I will strongly recommend that they iden�fy a good civil society partner or an NGO to work with the communi�es to increase to the community par�cipa�on in this wide range of public-funded programmes. Once thing that we find is that there is a lot of policies and programmes in our country; they are not implemented very well and the one way to improve that is to increase the community ownership of these programmes, and by increasing community demand, I am confident this will result in an improved programme delivery by the public systems. I wish Team JSPH all my best wishes for all their future endeavours.

2PUBLIC HEALTH HAPPENINGS

Dr Rajan Sankar

(Program Director – Nutri�on at TATA Trusts )

Dr.Rajan Sankar is a Physician and a specialist in internal medicine. Dr. Sankar was the Head of Thyroid Research Centre and department of endocrinology in the Defence Research and Development Organiza�on and re�red from the Army Medical Corps in the rank of Colonel a�er 24 years of service. He has been ac�vely involved with Iodine Deficiency Disorders elimina�on ac�vi�es in India and in South Asia region. In recogni�on of his contribu�on in this field, he was awarded the Sir Sriram Memorial Award by the Na�onal Academy of Medical Sciences of India in 1997 and the Sivanthi Adityan Gold Medal by the Associa�on of Physician of India in the year 1990. He has published over 100 scien�fic publica�ons in na�onal and interna�onal journals.

Experts’ Talk - National Nutrition Week

*Parts of artwork / news content have been borrowed from internet with due thanks to the owner of the content /photograph/art.

Na�onal Nutri�on week is celebrated each year th

from 1 st September to 7 Sep. The theme for this

year “Ensuring Focused interven�ons on

addressing under nutri�on during the first 1000

days of the child : Be�er child Health”

To encourage and reinforce the importance of

this theme, The Modi Government has

announced it to celebrate it for the en�re month.

The first 1000 days is en�re period of pregnancy nd

to child's 2 birthday and it is the most crucial

part for child's life both in terms of cogni�ve &

physical development. The op�mum nutri�on for

both mother and child during this period can have

a strong posi�ve impact on the child's growth and

development and reduce disease risk as well

protect mother's health so that she could deliver

a healthy baby. Undernutri�on can have a

detrimental effect on the child during pregnancy

as it could lead to problems like Intra Uterine

Growth Retarda�on (IUGR), Low Birth Weight

(LBW) leading to further complica�ons.

1000 days is also called window of opportunity.

The impact of inadequate nutri�on during this

golden period is devasta�ng and irreversible,

which effects both physical , sensory & cogni�ve

development. Therefore it becomes paramount

to focus more during this period with both

nutri�on specific & sensi�ve interven�ons for the

child to have a healthier tomorrow.

In some countries a healthy diet will drama�cally

reduce child malnutri�on ,infec�ons and in turn,

child mortality while in others ge�ng early

nutri�on right will help to prevent a child's life -

long risk of developing non communicable

diseases like obesity , diabetes, cardiac diseases

and some cancers,

therefore it becomes very important that focus

should be to provide, educate ,supplement ,

support pregnant and lacta�ng women to be

able to provide best nutri�on to the child. A child

receives in the first two years of life are vitally

important influences in determining good health

both now and into the future. These first 1000

days of life set us up for good health across our

lives. It becomes important in fulfilling growth

poten�al with right quality of nutrients, focussing

more on the impact of early life nutri�on,

Encourage exclusive Breast feeding for first six

months, Colostrum being the first immunisa�on

of every child which a child would relish for years

and the best part is it comes with tender love and

emo�ons of mother to her child thereby

developing into a strong bonding between

mother and her child and breas�eeding also

provides protec�on from diarrhoea and

pneumonia, these being few for the leading

causes of under five mortality specially in south

east Asia region.

Therefore special efforts to address the

nutri�onal needs of both mother and child during

the first 1000 days is required. The best possible

way is by promo�ng and suppor�ng exclusive

breas�eeding for six months for con�nued

breast-feeding along with complimentary un�l

age 2 or beyond to have op�mum nutri�on.

“Ensuring focused interven�ons on addressing under nutri�on during the first 1000 days of the child : Be�er child Health”


From the desk of: Rashmi Rathore

Nutri�onist and Associate Professor - JSPH


Worrying Nutri�onal Sta�s�cs: Although in a decade from 2005 to 2015) there has been an overall reduc�on in the infant mortality rate and under-five mortality rate in India s�ll it is housing about 50 percent of undernourished children of the world ( Joint study by Assocham and EY). The report found that towards the end of 2015, 40% of the Indian children were undernourished.Conversely, urban India is faced with the challenge of overnutri�on. India is ranked as the third most obese na�on in the world a�er the US and China and also the diabetes capital of the world, with about 69.2 million people living with it as per the 2015 data by World Health Organisa�on Tra d i � o n a l m et h o d s fo r q u a n� f y i n g malnutri�on in children involve the physical handling of subjects, can be �me-consuming and are suscep�ble to inaccuracy because they require enumerators to interpret the value. An innova�ve ar�¬cial intelligence (AI) based approach to augment the management informa�on system under implementa�on AI programs have been developed and applied to prac�ces as diagnosis processes, treatment protocol development, drug development, personalized medicine, pa�ent monitoring and care. Medical ins�tu�ons such as The Mayo Clinic, Memorial Sloan Ke�ering Cancer Center, Massachuse�s General Hospital, and Na�onal

Health Service have developed AI algorithms for their departments. Large technology companies such as IBM and Google and startups such as Welltok and Ayasdi, have also developed AI algorithms for healthcare.AI, Malnutri�on, and India: Government has also taken ini�a�ve NITI Aayog is working on early diagnosis and detec�on of Diabe�c Re�nopathy and Cardiac Risk based on the AI models. Such ini�a�ves would in the long run help pa�ents on proac�ve medica�on in early stages rather than reac�ve health care in advanced stages – bringing down health care costs and be�er chances of recovery.An innova�ve ar�¬cial intelligence (AI) based approach to augment the management informa�on system under implementa�on. was used in a state of Karnataka, India, CSTEP has developed an applica�on supported by State government and UNICEF. The analyses yielded from this ini�a�ve is helping to iden�fy lagging districts, Anganwadi centers or even individual children. The interven�ons could include increasing supplies to par�cular Anganwadis, dispatching health professionals to monitor the health and nutri�on of children, and iden�fying special educa�onal needs of children. The system will be designed to provide powerful visualiza�ons for decis ion-makers and state-of-the-art algorithms for �mely interven�ons. Known AI techniques/algorithms will be used for the la�er.

Artificial Intelligence to Tackle Malnourishment - Bhawna Sati



The most effec�ve tool based on AI is

developed by Kenya based Kimetrica an

applica�on called Methods for Extremely

Rapid Observa�on of Nutri�onal Status

(MERON) It could allow for a non-invasive,

�me efficient, and tamper-proof approach to

assessing the malnutri�on status of an

individual by using a facial recogni�on and

p r o c e s s i n g a l g o r i t h m .

MERON has been trained on a database of

photos to be able to recognize the facial

features, like the roundness of cheeks, that

correspond to malnutri�on. All it needs is a

facial photo and it can instantly categorize

t h e i m a g e a s n o r m a l , m o d e ra t e l y

malnourished or severely malnourished.

Ini�al trials suggest the AI has a 78 percent

accuracy rate in detec�ng normal weight

individuals; Kimetrica has completed the

trails with photos of malnourished children.

MERON could offer the following benefits:

I t o ff e r s t h e f o l l o w i n g b e n e fi t s :

1. An increase in the accuracy of data

collected with regards to malnutri�on status;

2. A reduc�on in resources related to the

training of enumerators;

3. Use of inconspicuous measurement tools;

4. Use of less invasive (in some cultures)

measurement techniques.

These benefits could, in turn, result in a

number of important outcomes for the

diagnosis and treatment of malnutri�on in

children under five.

These include

1. More appropriate distribu�on of funding

and scarce resources based on accurate

measurements;

2. Savings in resources (resources used for

training of enumerators in taking accurate

w e i g h t fo r h e i g h t m e a s u r e m e n t s ;

transporta�on of bulky equipment and

opportunity c o s t f o r c o m m u n i � e s

par�cipa�ng in surveys);

3. Easier data collec�on in hard to access high

risk/conflict areas and in areas where

physical handling of children is culturally not

acceptable.

This technology has drawn lots of hopes to

t a c k l e t h e l o n g - t e r m p r o b l e m s o f

malnourishment and the target of achieving

aim of the Na�onal Nutri�on Mission, to

bring down stun�ng of children in the age

bracket of 0-6 years from 38.4% in 2018 to

25% by 2022.

From the desk of:

Bhawna Sati Nutri�onist and

Head of Department - JSPH



The Na�onal Nutri�on Week was observed

throughout the country from 1st to 7th September.

The theme of the Na�onal Nutri�on Week for 2017

"Op�mal Infant & Young Child Feeding Prac�ces:

Be�er Child Health". The basic objec�ve of this

annual event is to intensify awareness genera�on

on the importance of nutri�on for health which has

an impact on development, produc�vity, economic

growth and ul�mately Na�onal development.

The Food and Nutri�on Board of Ministry of Women

& Child Development, through its 43 Community

Food and Nutri�on Extension Units (CFNEUs)

located in 30 States/UTs, coordinated with

co n c e r n e d D e p a r t m e nt o f t h e S tate / U T

Governments, Na�onal Ins�tu�ons, NGOs and

organized State/UT Level Workshops, Orienta�on

Training of Fields Func�onaries, Awareness

Genera�on Camps, Community mee�ngs during

the week on the specified theme.

Large numbers of State, district and village level

ac�vi�es were organized during this week. One day

workshops were held to sensi�ze and for capacity

building of State/Districts Level officers on

importance of nutri�on for be�er health. There

were lecture cum demonstra�on on low cost

nutri�ous recipes for grassroots level func�onaries

like school teachers, anganwadi workers and

helpers, village women and mahila sami�s. Mini

exhibi�on on nutri�on displaying low cost

nutri�ous diets for different age groups were also

be organized at grassroots level. Awareness

genera�on on weight management and its

importance through Body Mass Index were held for

adolescent boys and girls. Besides there were large

number of ac�vi�es like quiz compe��on on

nutri�on and compe��on on prepara�on of

nutri�ous recipes. Awareness programmes were

held at village level through puppet shows, skits,

dance & dramma, films, slide shows, AV Spots,

nutri�on rallies etc.

Nutri�on is an issue of survival, health and

development for current and succeeding

genera�ons. Child born underweight have impaired

immune func�on and increased risk of diseases

such as diabetes and heart diseases in their later

life. Malnourished children tend to have lower IQ

and impaired cogni�ve ability, thus affec�ng their

school performance and then produc�vity in their

later life. It has to be realized that the nutri�onal

health and all age groups represent say Na�onal

Economic Asset.

As, improving the nutri�onal status of the

popula�on is impera�ve for Na�onal Development.

Under nutri�on in young children con�nues to be a

major public health problem in India. The NFHS4

has not shown an encouraging improvement in the

nutri�onal status, especially among women and

children. As per NFHS-4 the level of underweight

has decreased by 6.8% and is stun�ng by 9.6%. Level

of anaemia has decreased by 11% as compared to

NNHS-3 figures.

Malnutri�on is not to be viewed merely as an

offshoot of poverty having adverse effects on health

and development of individuals but as a na�onal

problem that results in loss of produc�vity and

economic backwardness. Time has come to create a

moment so as to improve nutri�on at the individual

level. Thus, series of convergent and well

coordinated ac�ons in different sectors are required

to be undertaken in the mission mode approach to

address this big network problem of malnutri�on



P O S H A N A b h i y a a n i s a m u l � -ministerial convergence mission of government of India with the vision to ensure a�ainment of malnutri�on free India by 2022. The objec�ve of POSHAN Abhiyaan is to reduce stun�ng in iden�fied Districts of India with the highest malnutri�on burden by improving u�l iza�on of key Anganwadi Services and improving the quality of Anganwadi Services delivery. I t s a i m s t o e n s u r e h o l i s � c development and adequate nutri�on for pregnant women, mothers and children.The Ministry of Women and Child D e v e l o p m e n t ( M W C D ) i s implemen�ng POSHAN Abhiyaan in 315 Districts in first year, 235 Districts in second year and remaining districts will be covered in the third year.There are a number of schemes directly/indirectly affec�ng the nutri�onal status of children (0-6 year's age) and pregnant women and lacta�ng mothers. In spite of these, level of malnutri�on and related problems in the country is high. There is no dearth of schemes but lack of crea�ng synergy and linking the schemes with each other to achieve common goal. POSHAN Abhiyaan t h r o u g h r o b u s t c o n v e r g e n c e mechanism and other components

would strive to create the synergy.The POSHAN Abhiyaan, as an apex body, will monitor, supervise, fix targets and guide the nutri�on related interven�ons across the Ministries. The proposa l cons i st s o f m a p p i n g o f v a r i o u s S c h e m e s contribu�ng towards addressing malnutri�on, introducing a very robust convergence mechanism, ICT based Rea l T ime Moni tor ing system, incen�vizing States/UTs for mee�ng the targets,incen�vizing Anganwadi Workers (AWWs) for using IT based tools elimina�ng registers used by AWWs introducing measurement of height of children at the Anganwadi Centres (AWCs), Social Audits, Se�ng-up Nutri�on Resource Centres, involving masses through Jan Andolan for their par�cipa�on on nutri�on through various ac�vi�es, among others.

MAJOR IMPACTThe programme through the targets will strive to reduce the level of stun�ng, under-nutri�on, anaemia and low birth weight babies. It will c re ate sy n e rg y, e n s u re b e �e r monitoring, issue alerts for �mely ac�on, and encourage States/UTs to perform, guide and supervise the line Ministries and States/UTs to achieve the targeted goals.


POSHAN Abhiyaan aims to ensure holistic development and

adequate nutrition for pregnant women, mothers and children

Source: www.india.gov.in/spotlight/poshan-abhiyaan


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UBLIC EALTH APPENINGS JSPH Jodhpur School Public Health