Common nutrition problems in India

1. COMMON NUTRITION PROBLEMS
IN INDIA
Dr. K.VIJAYARAGHAVAN
DIRECTOR – RESEARCH,
SHARE INDIA (MEDICITI INSTITUTION)
&
Sr. Dy. Director, NIN (Retd)
<[email protected]>

2. MOTHER AND CHILD
SURVIVAL

MMR 407/100,000 live births
IMR* 58/1000 live births
Child Mortality 19.5/1000 Children
Rate(1-4 years)
Vijayaraghavan
*Gujarat 53

3. NUTRITION PROBLEMS IN
INDIA
WHO IS AT RISK??
PREGNANT WOMEN
LACTATING WOMEN
INFANTS
PRESCHOOL CHILDREN
ADOLESCENT GIRLS
ELDERLY
SOCIALLY DEPRIVED
(SC & ST Communities)
.
Vijayaraghavan

4. WOMEN
• POOR WT. GAIN
DURING
PREGNANCY
•CED
•MICRONUTRIENT
DEFICIENCIES
CHILDREN
LOW 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

5. PREVALENCE OF LBW IN S.E ASIAN COUNTRIES
3
3
3
0
2
3
2
0
1
8
1
6
1
1
7
. 2
0
5
10
15
20
25
30
35
P
E
R

C
E
N
T
N
e
p
a
l
I n
d
i a
M
y
a
n
m
a
r
M
a
l d
i v
e
s
S
r i L
a
n
k
a
B
h
u
t a
n
I n
d
o
n
e
s
i a
T
h
a
i l a
n
d
Vijayaraghavan

6. 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

7. INFANT MORTALITY AND BIRTH WEIGHT
1000
615
238
59
21
18
0
200
400
600
800
1000
1200
<1 1-1.5 1.5-2 2-2.5 2.5-3 >3
BIRTH WEIGHT (KG)
I
M
R

/
1
0
0
0

L
i
v
e
-
b
i
r
t
h
s
S
o
u
r
c
e

:

S
h
a
n
t
i

G
h
o
s
h
Source: Shanti Ghosh et al, 1978

8. 30.8
30.2
15.5
0
5
10
15
20
25
30
35
P
E
R

C
E
N
T
CONTROL IRON FOLIC ACID
GROUPS
IFA SUPPLENTATION AND LBW
Source: Leela Iyengar & Apte, S,V.,1970

9. SUPPLENTATION OF IRON / FOLIC ACID
AND BIRTH WEIGHT
2890
2650
2567
2400
2500
2600
2700
2800
2900
3000
CONTROL IRON FOLIC ACID
GROUPS
B
I
R
T
H

W
E
I
G
H
T

(
g
)
Source: Leela Raman & Rajalakshmi,1974

10. NUTRITIONAL DISORDERS IN CHILDREN
•PROTEIN ENERGY MALNUTRITION (PEM)
. CLINICAL FORMS
. SUBCLINICAL UNDERNUTRITION
•MICRONUTRIENT DEFICIENCIES
Vijayaraghavan

11. CLINCAL FORMS of PEMCLINCAL FORMS of PEM
KWASHIORKOR
•OEDEMA+
•IRRITABILITY+
•GROWTH FAILURE+
•DISCOLOURED HAIR+
Vijayaraghavan

12. CLINCAL FORMS of PEMCLINCAL FORMS of PEM
MARASMUS
EXTREME WASTING
“SKIN AND BONES”
MONKEY/OLD MAN
FACIES
Vijayaraghavan

13. SUB-CLINICAL FORMS OF PEM
UNDERNUTRITION
 WEIGHT FOR AGE
WASTING
 WEIGHT FOR
HEIGHT
STUNTING
HEIGHT FOR AGE
Vijayaraghavan

14. UNDERNUTRITION IN INDIA
PRESCHOOL CHILDREN ADULTS (Females)
48.5
46.5
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

15. 78.6
57.7
76.5
62.3
18.118.5
0
10
20
30
40
50
60
70
80
P
E
R

C
E
N
T
Height Weight Weight for Height
TIME TRENDS IN ANTHROPOMETRIC PARAMETERS (<Median-2SD)
NNMB
1975-79
1996-97
VIJAY’00

16. DISTRIBUTION WEIGHT FOR AGE – IAP
Gujarat
32.5
37.9
21
7.2 1.4
0
5
10
15
20
25
30
35
40
P
E
R

C
E
N
T
GRADES OF UNDERNUTRITION
Normal Gr. I
Gr. II
Gr. III Gr. IV

17. WEIGHT FOR AGE–
SD CLASSIFICATION - GUJARAT
0
5
10
15
20
25
30
35
40
%
<
- 3
S
D
- 2
- - 3
S
D
- 1
- - 2
S
D
- 1
- M
e
d
i a
n
>
M
e
d
i a
n
Boys
Girls
Pooled

18. VITAMIN A DEFICIENCY

19. BITOT SPOT KERATOMALACIA
BILATERAL BLINDNESS
V
A
D
Vijayaraghavan

20. 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 mg/l 5.0
Vijayaraghavan

21. VITAMIN A DEFICIENCY (%) IN
INDIA
AGE GROUP SOURCE X1B XN*
PRESCHOO
L
CHILDREN
ICMR, 2001 0.7 1.03
NNMB 0.7 -
NIN- SURVEYS 2.1 -
PREGNANT
WOMEN
ICMR, 2001 - 2.8
* 24-71 MONTHS
Vijayaraghavan

22. VITAMIN A DEFICIENCY
Districts(%) with X1B >0.5%
Average prevalence (%)
2.1
55
45
Based on surveys in 126 Dts.
by NIN and NNMB
No VAD VAD
Vijayaraghavan

23. 1.7
1.8
5.7
0.70.7
5.7
0.2
0.7
2.1
0
1
2
3
4
5
6
P
E
R

C
E
N
T
1975-79 1988-90 1996-97
PERIOD OF SURVEY
PEM
X1B
RIBO. DEF.
NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN
Vijayaraghavan

24. 0
50
100
%
% RDI
DISTRIBUTION OF MICRONUTRIENT INTAKES IN
CHILDREN - %RDI
Vitamin A86.3 3.2 1.4 9.1
Iron 82.5 8.6 2.1 6.8
Riboflavin71.4 15.9 4.1 8.6
<70 70-9090-100>100
Vijayaraghavan

25. ANAEMIA

26. 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

27. 87.1
87.7
91.8
91.9
92.2
93.9
99.3
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

28. 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
P
e
r
c
e
n
t
Pregnant
Women
Adolescent
girls
Vijayaraghavan

29. IODINE DEFICIENCY DISORDERS

30. 239 OF 282 DTs. SURVEYED –
ENDEMIC
167 millions AT RISK ?
IODINE DEFICIENCY DISORDERS
GOITRE+

31. 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

32. DIETARY INTAKES

33. 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
Rural
Tribal
Urban Slums
VIJAY’00

34. 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

35. NUTRIENT INTAKES AMONG INDIAN WOMEN
NUTRIENTS NPNL PREGNANT
WOMEN
LACTATIN
G 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 (mg) 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 (mg) 86 84 106
Source: NNMB, 2000

36. NUTRIENT INTAKES IN PREGNANT WOMEN
% RDI
% RDI EnergyProteinVitamin A Iron RiboflavinTotal 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
³100 36.5 40.2 9.8 2.4 17.1 32.9
Source: NNMB,2000

37. 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

38. DETERMINANTS OF MALNUTRITION
MATERNAL MALNUTRITION
START WITH A HANDICAP( LBW)
FAULTY CHILDFEEDING PRACTICES
DIETARY INADEQUACY
FREQUENT INFECTIONS
LOW PURCHASING POWER
LARGE FAMILIES
HIGH FEMALE ILLITERACY
TABOOS AND SUPERSTITIONS

39. Factors Affecting Nutritional Status
High illiteracy Unemployment/
Underemployment
Large families
Low purchasing power
Ignorance High dependence rate
False food beliefs Inadequate intakes
Low Procurement
of foods Poor PDS High cost
Low availability of foods
Low production Reduced work Malnutrition
of foodgrains output
Poor environment Morbidity Absorption of nutrients
Low Appetite
Poor utilization of services poor coverage of immunization
Improper health services
poor infrastructure
Lack of resources

40. 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