epidemiology undernutrition

UNDERNOURISHED CHILDREN (under weight <5 years)

Outline

Understanding Undernutrition

Burden : Global National

Various Intervention

Call for Action

It includes-under weight for one’s age.-too short for one’s age (stunted).-very thin for one’s height (wasted).-micronutrient malnutrition. ”

“ Under nutrition is defined as the outcome of insufficient food intake & repeated infectious diseases.

WHO ARE UNDER WEIGHT CHILDREN?

“The prevalence of underweight children under 5years of age is defined as the percentage of children aged 0-59 months, whose weights are less than 2 standard deviations below the median weight for age groups in the international reference population.”

- It is an internationally recognised public health indicator for monitoring nutritional status & health in populations.

- It’s a composite indicator influenced both by wasting & stunting. Hence includes both acute and chronic health condition.

- Its composite nature complicates its interpretation. Recent surveys hence include mainly Wasting & Stunting.

EPIDEMIOLOGICAL TRIAD

HOST

ENVIRONMENTAGENT

- Age & Sex

- Low birth weight

- Prev. nutritional status

- Immunization status

- Bacteria- Virus

-Parasites- Physical & Chemical

hazards

- Socioeconomic Status- Geographic area- Cultural Factors

- Degree of Urbanization- Availability of essential services

RISK FACTORS - UNDER NUTRITION

Socio economic • Lower socioeconomic status• Patriarchal society • Educational level• Cultural influence & social taboos

Biological• Low birth weight baby• Poor Infant feeding practices• Poor Maternal Health• Diseases

Miscellaneous • Natural Calamities• Adulteration of food & uneven distribution

of food• Unhygienic practices & food habits• Access & Quality of essential services

CHALLENGE OF INTER-GENERATIONAL CYCLE OF SURVIVAL, GROWTH AND DEVELOPMENT

-Early & frequent pregnancy-improper child spacing-Inadequate care during pregnancy

-Inadequate child care-Improper feeding practices-Burden of diseases & infections-Gender discrimination-Inadequate growth & Education

-Early marriage, early & frequent pregnancies with improper child spacing-Poor diet & inadequate care during pregnancy

Low birth weight

Under nourished, less aware, vulnerable

adolescent girls.

Under nourished mothers

UNDERNUTRITION

Macronutrient DeficiencyProtein energy MalnutritionKwashiorkorMarasmus

Micronutrient Deficiency “ Hidden Hunger ” IodineVitamin A & others Iron Zinc

Short term effects- Growth retardation, Appetite loss ,poor absorption.- Immune development More prone to infections.

Long term effects- Stunting- Cognitive development Attention Deficit disorder Impaired school performance Impaired memory, Social skills.

Under nutrition is particularly lethal in combination withinfectious diseases.

Leads to Vicious cycle of repeated infections, reduced immunity & deteriorating nutritional status.

Under nutrition Impaired child

development & immunity

Infection

Disease

Energy Loss

Decreased Productivity

Poverty

Impaired development of Education & Health

System

Socio-Economic + Political instability

WORLD 12.5%DEVELOPED WORLD 1.4% DEVELOPING WORLD 14.9%

LATIN AMERICA

8.3%

AFRICA22.9% ASIA

13.9%

Under nutrition causes more than half of all child death worldwide

Latin America Caribbean South america0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

8.30%

17.80%

7.70%

Latin America

Africa North Africa Sub Saharan0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

22.90%

2.70%

26.80%

Africa & it’s region

Asia Western Southern Central Eastern South Eastern

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

13.90%

10.10%

17.60%

7.40%

11.50% 10.90%

Asia & it’s region

THE SOUTH ASIAN

ENIGMA

>30% Indian babies are born with Low

birth weight compared with 16% Sub Saharan Africa.

South Asian women have lower status &

less decision making power.

Hygiene/ Sanitation

standards are below in South Asia than Sub

Saharan Africa.

THE INDIAN PROFILENFHS 4 (2015-2016) <5 under weight data is taken in terms of weight for age.

Total household 291431Total children 728532.5

Under nutrition in <5 years child 241365 (averaged as per 18 states)

33.13% of Indian children <5years is under weight.

NFHS 4 data (from 18 states)

India is 17.5% of world’s population but 39% of world’s undernourished children live here.

1 in every 3rd undernourished child lives in India .

In every 10 children 3 are under weight.

Bihar43.9%

Uttrakhand

26.6%Harya

na29.4%Madhya

Pradesh42.8%

Maharashtra

36%

West Bengal

31.5%Telangana

28.5%Karnataka

35.2%Goa23.8%

z

Andhra Pradesh

31.9%

Tamil Nadu23.8%

Andaman & Nicobar

Islands21.6%

Puducherry22%

Sikkim

14.2% Assam

29.8%Manip

ur13.8%

Tripura

24.1%

Meghalaya29%

Rural Urban Girls Boys0%

10%

20%

30%

40%

50%

60%

Rural, 50%

Urban, 38%

Girls, 49%Boys, 46%

% Prevalence under weight<5 INDIA%

Pre

vale

nce

GOVERNMENT SCHEMES TO ADDRESS UNDERNUTRITIONTARGET GROUP MAJOR SCHEMES SERVICES FROM SCHEMESPregnant and lactating mothers

• Integrated Child Developmental Scheme ICDS

• National Health Mission

• Reproductive Child Health RCH-II

• Janani Suraksha Yojana JSY

• Janani Shishu Suraksha Karyakaram

• ICDS:-Promotion of Exclusive Breastfeeding, Supplementary Nutrition, Immunization, Nutritional Education to Mothers, Preschool Education, Health Check up & Conditional maternity benefits.

• NHM:- Antenatal care , Iron supplementation , Immunization, Transportation for institutional delivery, cash benefit, post natal care, counselling for spacing of children.

Children( 0-3 years)

• Integrated Child Development Scheme

• NHM

• ICDS:- Supplementary nutrition , Growth monitoring, Health education of mother on child care, Promotion of infant & young child feeding, Home based counselling, referral & follow up of under nourished & sick children.

• NHM:- Home based new born care, immunisation, micronutrient supplementation, Deworming, Management of childhood illness & sever under nutrition, referral and cash less treatment for 1st month of life, care of Sick newborns, follow up.

Children (3-6 years)

• ICDS

• NHM

• ICDS:- Non formal pre school education, Growth monitoring, Supplementary Nutrition, Health Check up & referral, Health Education, Counselling for Care givers.

• NHM:- Immunization, Micronutrient supplementation, Deworming, Health check up, Management of illness & severe Under nutrition.

Adolescent Group( 11-18 years)

• NHM • NHM:- Immunization, Micronutrient supplementation, Health Check up.

INDIRECT SCHEMES IMPROVING UNDERNUTRITION Improving Food

Production, Quality & Quantity.

Increasing the Purchasing power of

people.

Improving the Access & Quality of essential

services.

• NFSM: National Food Security Mission.

• NMSA: National Mission for Sustainable Agriculture.

• RKVY: Rashtriya Krishi Vikas Yojana.

• MGNREGA- Mahatma Gandhi National Rural Employment Guarantee act.

• RGSEAG- Rajiv

Gandhi Scheme for empowerment of Adolescent Girls.

• Swacch Bharat Abhiyaan

• NBA: Nirmal Bharat Abhiyaan

• NRDWP: National Rural Drinking Water Programme

FOOD FORTIFICATION

To maintain nutritional quality of food

To increase the added nutrition value of food

INDIA INTEGRATED FOOD FORTIFICATION

• Fortifying Complementary food with : Iron, Iodine, Zinc, Vitamin A, Vit. B complex, Folic Acid.

• Technical & Financial Support is received from GAIN i.e. Global Alliance for Improved Nutrition.

• Example : Salt fortifying with Iodine. - Milk with Vitamin A/D. - Flour , Bread , Rice with vitamin B complex.

So, India’s primary policy response to Child Under Nutrition ?? The ICDS Program.

Are results meeting expectations ??ICDS was designed to address the Multidimensional causes of Under nutrition.But still there are repeatedly raised concerns about the mismatches.

What are the concerned areas & how to improve the nutritional status??

CONCERNED AREAS? HOW TO IMPROVE THE EFFECTIVENESS

1. Poor Target Based Approach:- Designed to address the Intergenerational cycle but focused more on older children i.e. 3-6 years.

2. Mismatch between Original intention & Actual implementation i.e. focusing more on food supplementation.

• Increase focus on Pregnant women & Young children of age 0-3 years.

• Strengthen Nutrition & health Educational activities.

• Targeting more on high risk groups.

• Improve the childcare behaviours.• Counselling Parents about proper

nutritional requirements with Demonstration Education to mothers.

3. Lack of Coordination between AWW & ANM, hampering the early detection & treatment.

4. Design is standardised.

• Improve the Coordination, home visits, outreach activities.

• Strong Monitoring & Evaluation system.

• Introduce flexibility & Decentralise responsibility according to local needs & area.

• More Funding to poorer state with high under nutrition prevalence.

• Improving the Anganwadi centre infrastructure.

WHAT MORE CAN BE DONE?

1. Inter department Synergy (ICDS+NHM+MGNREGA, Primary Education + RCH)

2. Community Participation in service delivery (Mahila mandal with AWW)

3. Improve Opportunity: Developing small & medium scale enterprises.

4. Increase Use of science & technology In Agriculture to enhance food Production and Supply.

5. All these require Political , Social & Economic efforts and Commitment.

6. More active & Strengthening Mass Media Campaign.

“ We are guilty of many errors and many faultsBut our worst crime is abandoning children,

Neglecting the foundation of life.

Many of things we can wait.The Child cannot.

Right now is the time his bones are being formed , his blood is being made

and his senses are being developed.

To him we cannot answer tomorrow.His name is today. ”

Gabriela Mistral. 1948

THANK YOU GROUP : BATTLE FOR FOODSONALI RANDHAWAAKANKSHA SHUKLA SHEFALI SHARMA UDITA JOSHIPREKSHA SINGHAMAN MAKHAIKSHUBHABRATA DAS.

ZEROHUNGERCHALLENGE

“ IN THE FIGHT AGAINST MALNUTRITION, KNOWLEDGE IS POWER ” -UNICEF