Preventing Malnutrition in Children

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Preventing Malnutrition in Children

• Dr. JP Dadhich MD,FNNF,PGD-DN
• National Coordinator,
• Breastfeeding Promotion Network of India (BPNI)
• Workshop on Nursing Management of Newborn and
  Young Children
• The Trained Nurses Association of India
• August 8, 2011

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Outline

• What is Nutrition?
• What is Malnutrition?
• Situation of Malnutrition in India
• What leads to Malnutrition?
• Why it is important to address Malnutrition?
• How Malnutrition can be prevented?

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What Is Nutrition?

• The act or process of nourishing or being
  nourished Specifically the sum of the
  processes by which an animal or plant takes in
  and utilizes food substances

4
Components of Optimal Nutrition

• Adequate and proper diet (food)
• Calories, Carbohydrates, Proteins, Fats, Minerals
  and Vitamins
• Good and loving care in a healthy environment
• Access to health care services

5
Right Food for Infants

• Begin breastfeeding within an hour
• Exclusive breastfeeding for the first six months
• Complementary feeding after six months
• Continued breastfeeding for 2 years or beyond

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• What is Malnutrition?

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Malnutrition

• Mal adjusted nutrition
• Malnutrition
• Under nutrition
• Over nutrition

double burden of malnutrition UN SCN
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Child

• Underweight
• Low weight-for-age at lt 2SD of the median value
  of the NCHS/WHO reference
• Weight for age is influenced by the height and
  weight of a child
• Therefore is a composite of stunting and wasting
• Makes interpretation of this indicator difficult
  since both weight for age and height for age
  reflect the long-term nutrition and heath
  experience of the individual or population

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Child

• Wasting
• lt 2SD of median weight for height
• Severe lt 3SD
• Usually due to acute food shortage and/or severe
  disease
• Chronic dietary deficit or disease can also lead
  to wasting
• This indicator is used extensively in emergency
  settings

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Child

• Chronic low intake leads to STUNTING
• Growth charts key indicators
• Linear growth
• lt2 SD from median value of international growth
  reference for height stunting
• lt3 SD severe stunting
• Poor diet and disease leads to shortness
• Know that nutrition, not heredity, is the cause
  because of studies of better fed children in the
  same culture and growth velocity when breastfed

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• Situation of Undernutrition in India

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Underweight Children Under Five Years of Age
(Millions)
India 57 m
South Asia Half the worlds underweight children
(World total 146 millions)
Progress for children A report card on
nutrition, UNICEF, May 2006
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Underweight U5 children ()
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Children Under 3 years Who are Underweight
(NFHS-3, 2005-2006)

• little change over seven years between NFHS 2 and
  3

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Ranking by Children U-3 who are underweight
(NFHS-3)
Rank States of Underweight
1 Madhya Pradesh 60.0
5 Gujarat 44.6
6 Uttar Pradesh 42.4
11 Haryana 39.6
21 Delhi 26.1
26 Punjab 24.9
INDIA 42.5
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Nutritional Status of Children NFHS 3
(Underweight - by new WHO Growth Standards)
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Undernutrition occurs in wealthy household also !
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• What leads to Malnutrition?

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Infant Nutritional Status

• Influenced by
• Inadequate feeding
• Frequent infections
• Inadequate food
• Health
• Care
• Defined as the behaviors and practices of
  caregivers to provide the food, health care,
  stimulation, and emotional support necessary for
  childrens health growth and development

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Why Malnutrition Sets in

• Poor feeding practices during first year like
• Delayed start of breastfeeding
• Lack of exclusive breastfeeding for first six
  months
• Increasing bottle- feeding/artificial feeding
• Delayed or early start of solid complementary
  feeding.

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Breastfeeding and Infant Nutritional Status

• Babies who breast feed usually have better
  nutritional status than those who do not
• Infant does not compete with food supply for
  family
• Breast milk is a clean food supply
• Breast milk has immunologic benefits so decreases
  disease in this way, too

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Conceptual Framework of Malnutrition
Adapted from UNICEF
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Conceptual Framework of Malnutrition
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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Conceptual Framework of Malnutrition
Household Food Security
Underlying Causes
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
25
Conceptual Framework of Malnutrition
Environ. Health, Hygiene Sanitation
Household Food Security
Underlying Causes
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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Conceptual Framework of Malnutrition
Environ. Health, Hygiene Sanitation
Household Food Security
Underlying Causes
Care of Mother and Child
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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Conceptual Framework of Malnutrition
Immediate Causes
Health
Diet
Environ. Health, Hygiene Sanitation
Household Food Security
Underlying Causes
Care of Mother and Child
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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Conceptual Framework of Malnutrition
Manifestations
Nutritional Status
Immediate Causes
Health
Diet
Environ. Health, Hygiene Sanitation
Household Food Security
Underlying Causes
Care of Mother and Child
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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Functional Consequences Mortality, Morbidity,
Lost Productivity, etc.
Consequences
Manifestations
Nutritional Status
Immediate Causes
Health
Diet
Environ. Health, Hygiene Sanitation
Household Food Security
Underlying Causes
Care of Mother and Child
Human, Economic, and Institutional Resources
Political and Ideological Structure
Root Causes
Ecological Conditions
Potential Resources
Adapted from UNICEF
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• Why it is important to prevent malnutrition?

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WHO 2009. Global health risks mortality and
burden of disease attributable to selected major
risks.
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Importance of preventing Malnutrition
Child Survival
Growth
Development
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Importance of preventing Malnutrition

• Improved schooling quantity and quality
• Cost of treating Malnutrition is 27 times
  higher than preventing it

Source ASCI, 1997
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• How Malnutrition can be prevented?

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Priority health and nutrition interventions under
2 years
Vit A
Immunizations
ORS/Diarrhoea
1 2 3 4 5 6 7 8 9 10 11 12 13
14 15 16 17 18 19 20 21 22 23 24
Complementary Feeding and Continued Breastfeeding
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Exclusive Breastfeeding
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30
Babies die here
Supplementary Food
Breastfeeding is everyone's yet no ones
responsibility
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Effect of nutrition-related interventions on
stunting in 36 countries
LSMCU 2008
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Specialized IYCF Counseling

• One to one or group counseling as a service
  delivery
• Antenatal and Postnatal
• Specialized trained additional staff at village,
  block and district level

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Growth Monitoring

• Growth Monitoring Measure weight and length
  periodically and interpret by plotting in growth
  curves
• Investigate causes of poor growth Dietary
  history evaluate for any illness.
• Counsel mother/caregivers on growth, feeding and
  caring practices

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Feeding Practices (First Year)
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Complementary feeding Indicators (NFHS 3)
Indicators for assessing IYCF practices. WHO,
UNICEF 2010
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Infant and Young Child Feeding Practices
NFHS 3
Breast fed BF3 food groups2-3 times/d
Non Breast fed Milk 4 food groups 4 times/d
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Appropriate Complementary Feeding

• Timely Additional food introduced when need for
  energy and nutrients exceeds that provided by BF
• Adequate Should provide sufficient energy,
  protein, and micronutrients
• Properly Fed Active feeding method and proper
  frequency according to age
• Safe Should be hygienically prepared, stored and
  fed

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Conclusion

• Malnutrition has a direct link with child
  survival and development
• Malnutrition can be prevented with simple
  interventions
• Optimal Infant and young child feeding is the
  cornerstone

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Thank You