Malnutrition among children in Gujarat

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Malnutrition among children in Gujarat

• Health family Welfare Department
• GOG

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Malnutrition

• Mal adjusted nutrition
• Under nutrition
• Over nutrition

Calorie Protein Essential fatty
acids Vitamins and Minerals (Micronutrients)
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Diagnosis of Malnutrition

• Anthropometry
• Children Wt/Age, Ht/Age, Wt./Ht, BMI,
• Mid Arm Circumference,
• Head/chest ratio
• Adult Wt/Ht, BMI,
• weight gain during pregnancy
• Clinical signs and symptoms
• Biochemical test Hb, Urinary iodine

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Malnutrition Monitoring Indicators
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Infant mortality rate
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Causes of Childhood Mortality
Malnutrition 53
Under-nutrition contributes to 53 of all child
deaths
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Protein Calorie Malnutrition
Normal
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District wise Prevalence of Under nutrition in
children (0-71 months) - DLHS 2002
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Nutritional status of children (lt3yrs)
Gujarat(92-93) (98-99)
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Low birth weight babies
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of women who gave exclusive Breast milk up to 4
months (DLHS,2002 2004)
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Age specific rate of underweight children
Brain Development
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Demographic Characteristic of children in lt 2
SD Wt/Age group (NFHS II)
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Demographic Characteristic of children in lt 2
SD Wt/Age group (NFHS II)
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Profile of Mother of children in lt 2 SD Wt/Age
group (NFHS II)
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Maternal Nutritional profile and Child Nutrition
(NFHS II)
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Clinical signs of Anaemia
NFHS II 75 of children Anaemic, 24 mild
Anaemia Mother not aneamic-70 children
anaemic Mother anaemic 75-87 children Anaemic
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Clinical sins of Vitamin A deficiency
1.1 to 8.6
Night blind ness blindness, vulnerability to
infection, poor growth
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Status of Vit.A prophylaxis program
Biannual Supplementation rounds Next in August 06
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Vitamin A as a public health problem in Gujarat
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Vitamin A Deficiency and Child health

• 23 reduction in child mortality rate
• 50 reduction in child mortality rate due to
  acute measles
• 35-50 reduction in child mortality rate due to
  diarrhoea

Improving vitamin A status of children (6
months-5 yrs.) Results in to
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Clinical signs of Iodine deficiency disorders
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YEAR WISE REPORT OF IODINE CONTENTS SALT SAMPLE
CHCKED WITH SPOT TESTING KIT 2001 TO 2004 (Till
June)
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Nutritional status of School childrenSchool
Health-2005-06, Gujarat
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National Nutrition programs
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Supplementation (ICDS)

• Supplement not the substitute
• 300 K.cal and 8-10gm. Protein
• Double supplement/calorie-protein dense
• supplement for grade III and grade IV
• Facility, time and skill for cooking
• Feeding at centre for grade III and IV
• Supplement for 7 months to 1 year age group
• Supplement for ANC
• RTE candy

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Special care of Grade III IV

• Problems Loss of appetite, high calorie
• protein need, Infection proneness,
• restriction of food, digestion
• Solution Frequent feeding
• Calorie protein dense supplement
• Easily digestible food
• Animal/ First class protein
• Vitamin and Mineral supplement
• Treatment of infection
• Mothers involvement in care of
  the child

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MDM supplement

• 300 k.cal. And 8-10gm. Protein
• Supplement not substitute
• Children attending school / Childs attention in
  school
• In built Diet education
• In built equity education

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GUJARAT INITIATIVES
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Adolescent Girls Anaemia Control Programme

• 2001 pilot project in Vadodara district (UNICEF)
• Anaemia reduction from 74 to 53 in 17 months
• Project is operationalised in all districts
  (UNICEF MI)
• Convergence between Health and Education
  department

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RTE

• Ready to Eat fortified with micronutrients
• Operationalised in four districts (Mehsana,
  Patan, Panchmahal, Dahod) in 2001
• MI project
• High level of micronutrient deficiency recorded
  in baseline study
• Acceptability was high
• Bulk was a limiting factor
• Convergence between Health and ICDS(DWCD)

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RTE Impact assessment Panchmahal istrict
(2002-2003)
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Nutri candy

• Candy fortified with Vit.A, Vit.C, iron and Folic
  acid
• Three districts vadodara, bharuch and Narmada ,
  operationalised in 2001
• MI project
• Children, Pregnant and lactating mother and
  Adolescent girls were beneficiaries
• Convergence Health and ICDS (DWCD)

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Impact Assessment

• Impact Children
• Improved the attendance Anganwadi
• Weight gain in Grade II-IV remarkable
• Improved appetite
• Pregnant and lactating women
• Feeling better relief from body pains and ache
• Reduction in nausea, vomiting
• Improved eye sight
• Adolescent girls
• Less fatigued
• Increase appetite
• Regular Menstrual cycle

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IMNCI
Newborn 1-7d Home Based Newborn Care
Immunization
Diarrhea
IMNCI
ARI
BF-CF
Fever/ malaria
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Mapping Monitoring Malnutrition

• ICDS special round of weighing the children
  with inbuilt quality check process May-June 2006
• Routine monthly assessment
• Health facility assessment and support as well as
  regular monitoring record in health workers
  register
• Inbuilt assessment through monthly reporting
  system

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Field level Functional Convergence

• Fix day Health and Nutrition Day Session at
  SC
• Planning and Implementation in progress
• Improve quality and coverage of RCH services
• Mainstreaming of Nutrition care and support
• Improve quality and coverage of monitoring data
• Improve Accessibility of Health and Nutrition
  services
• Improve Maternal and Child health status

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Minimum need
Community Awareness and Involvement
Care and Support For Health Nutrition workers
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Control of infection
D I e t E d u c a t i o n
Care and Support
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Gujarat progress

• The second target of MDG is to reduce the
  proportion of people suffering from hunger by
  half between 1990 and 2015
• Monitoring indicator is a proportion of 0-59
  months children falling below 2SD from median
  weight for age of the standard reference
  population

NFHS I
NFHS II
Reduction in Preschool mortality rate /year
should be 2.8 Reduction Observed between NFHS I
and NFHS II is 3
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THANK YOU
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Determinants of malnutrition
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• Nutrition care of Community
• Nutrition care of vulnerable
• School age group
• Adolescent
• Nutrition care of highly vulnerable
• Pregnant woman
• Breast feeding woman
• Preschool children
• Infants

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Breast feeding Weaning
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Malnutrition

• Malnutrition

Income
Education
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Integrated care

• Maternal and Child nutrition
• Adolescent and Maternal Nutrition
• Nutrition and Infection control/care- sanitation,
  hygiene, vaccination, early detection and
  treatment
• Nutrition and FP
• Macro and Micro nutrition
• Nutrition and ----------------Mental development
• Family nutrition and supplementary nutrition
• Nutrition supplement and Diet/ nutrition
  education

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Where?Countries with the highest numbers of
neonatal and U5 child deaths
2.5 million neonatal deaths Approx 66 of
global total
6.6 million U 5 child deaths Approx 61 of
global total
WHO Estimates of neonatal deaths for the year
2000, forthcoming. WHO/UNICEF/UNFPA estimates of
maternal mortality for the year 2000 Black,
Morris, Bryce. Lancet 2003.
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Infant Mortality Rates (India), Decline over the
Years
IMR by Sex
India State-wise NMR
Female gt Male 9
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of BCG Coverage Fully Immunization- DLHS
Survey, 2002 2004
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Malnutrition and Health
Physical Health
Mental health
Social Health

• Growth
• retardation
• Infections
• Disability
• Death

• Mental
• retardation
• Low IQ

Isolation Increased societal responsibility Due
to Illness, disability Weakness Mental
retardation Low IQ Poverty
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What are the causes of death?
Source WHR 2005
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Pregnancy Low Basel weight Poor Weight gain
Anaemia , Vit. A def.
Adolescent Second peak of growth Micronutrient
deficiency
New born 20 LBW BF problem Faulty
weaning Infections
LIFE CYCLE PROBLEM
Infant Poor growth, dev. micronutrient
def. Faulty weaning Infections
Pre adolescent Growth MN Increase
activity Selective food
Pre schooler Poor growth dev. Faulty Child
feeding Infections
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Vulnerability to malnutrition

• Growth Intra uterine, Infancy, Preschool,
• Adolescent
• Infections Worm infestation, Measles, Malaria,
• Diarrhoea, Tuberculosis, HIV
• Diet In adequate diet, Faulty diet,
• Un hygienic diet
• Increased need Physiology, climate,
• occupation, sports exercise
• Socio economically at risk group Poor,
• Illiterate, Ignorant, girl child,
  unwanted
• child ,women, disaster victim
  

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Infection- malnutrition cycle
Infection

• Loss of appetite
• Increased calorie
• and protein need
• Restriction of food
• Loss of nutrients

• Low phagocytosis
• Low immunoglobulin
• formation
• Low T cell count
• vulnerable mucosa

Malnutrition
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Malnutrition and FP

• Number
• More children to share the food
• More time and energy of mother for care and
  support
• Spacing
• Less spacing is almost equal to twin baby care
• Maternal nutrition and health do not get recoup
  and subsequent episodes adversely affect maternal
  as well as child nutrition and health

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Lessons learnt
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Lessons learnt- Micro nutrients
SUPPLEMENT
EDUCATE
ACCESS
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Food Supplementation Nutrient supplementation
Food intervention Control Approach
Food Fortification
Food Subsidy (PDA)
IEC and Counselling