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TRENDS IN THE NUTRITIONAL STATUS OF RURAL COMMUNITIES IN INDIA
- AN OVERVIEW
1
Dr. G.N.V. Brahmam, M.B.,B.S., D.P.H., Scientist – ‘F’ (Retd.), N.I.N., ICMR
Phone: (R) 040 –2720 7341 Mobile: 098490 52748
E-mail: gnvbrahmam@yahoo.com
2
DETERMINANTS OF NUTRITIONAL STATUS
• Food production • Land Ownership • Type of land • Rain fall • Geographic conditions • Agricultural techniques • Use of hybrid seeds • Use of fertilizers • Dairy/poultry/Fisheries • Animal husbandry
• Population • Family Size • Urbanisation
• Religion • Community • Occupation • Income
Drought/Floods Wars
• Illiteracy • Ignorance • Taboos • Life Styles
• PDS • Rural Dev. Prog. • Employment generation prog.
• Infections • Diarrhoeas • Resp. Infections • Malaria • Others
• Infestations • Hook worms • Round worms • Giardiasis etc.,
• Environmental sanitation • Personal hygiene • Safe drinking water
H H FOOD SECURITY
FOOD INTAKE
NUTRITIONAL STATUS
Agro-climatic factors Demographic factors Socio-economic factors
Disasters
Availability of & participation in developmental programmes
Socio-cultural factors
Environmental factors
Pathological Conditions
Physiological factors
• Pregnancy • Lactation • Breast feeding practices • Infant & child Feeding practices
• Availability/Access to Health care facility/services • Health seeking behaviour
Health Care
NUTRITIONALLY VULNERABLE GROUPS
• Infants and Young Children (<5 years)
• Adolescent Girls
• Pregnant & Lactating Women
• Elderly
• Socio-economically deprived Groups
- Schedule Castes
- Schedule Tribes
- Communities in Urban Slum and Chronically drought prone rural areas
3
States Pooled 4
- Certain Vital Statistics
5
Pneumonia17%
Neonatal42%
HIV/AIDS4%
Others19%
Tetanus1%
Malaria7% Measles
1%
Diarrhoea9%
CAUSES OF DEATHS AMONG <5 YEAR CHILDREN IN DEVELOPING COUNTRIES
Source: UNICEF, 2010
Malnutrition* 60%
* *
*
*
* Approximately 70% of all childhood deaths are associated with one or more of these five conditions
*
*
6
Source: SRS, India - 2010
Source : WHO/SEARO 2000
Infant Mortality Rate (Per 1000 Live Births) in India and South-east Asian Countries
47 (SRS-2010)
South-east Asian Countries
India (NNMB States)
7
(2002) (2004) (2000) (2003-04) (1999-2000)
Under-five Mortality Rate (Per 1000 Live Births) in South-east Asian Countries & India
(59: SRS, 2010)
* Source: SRS, 2010
Source: SRS, India - 2010
South-east Asian Countries Source : World Development
Report 2007
India (NNMB States)
8
Maternal Mortality Ratio (Per 100,000 Live Births) in India and South-east Asian Countries 212*
Source : WHO/SEARO 2000
Registrar General of India, (2007-09, SRS-2011 )
India (NNMB States)
South-east Asian Countries
9
Prevalence of Low Birth Weight
Source : WHO/SEARO 2000
3330
25 2523
13
8
10
10
20
30
40Pe
r cen
t
India Bangladesh Nepal Myanmar Bhutan Maldives Indnesia DPR Korea
South-east Asian Countries
India (NNMB States)
2523 23 22 22
2119 19 19
17
22
0
10
20
30
Perc
ent
UPM.P.
W.BM.R.
GUJORI
KAR A.PKER T.N
INDIA
* Source: NFHS3, 2005-06
PERCENT CHILDREN (12-23 MONTHS) COMPLETELY IMMUNIZED
43.553.5
61.0 65.2
0
20
40
60
80
100
. NFHS-3 (2005-06)
DLHS (2007)
CES (2009)
RSOC (2013-14)
11
Prevalence (%) of Low Birth weight (<2.5 kg) : RSOC 2013-14
18.6 18.3 18.7
0
5
10
15
20
25
Total Urban Rural
21.619.6
0
5
10
15
20
25
SC ST
15.5
21.8
0
5
10
15
20
25
Richest Poorest
* (21.5) * (19.3) * (23.3) * (NFHS-3 : 2005-06)
States Pooled 12
- Infant and Young Child Feeding Practices
13
Infant and Young Child Feeding Practices in India
25
47 46
72
5350
36
20
0
20
40
60
80
100
Early Initiation of BF (<1 hour)
Exclusive BFupto 6 months
Compl.Feeding
among 6- 9monthsChildren
AdequateFrequency
AdequateDiversity
NFHS 3 (2006)
RSOC (2013-14)
Perc
ent
States Pooled 14
Prevalence of Underweight among 6-59 months children according to age* ( by SD classification) using WHO Child Growth Standards
2630
3943 42
47
20
40
60
80
<6 6-11 12-23 24-35 36-47 48-59
NNMB StatesPooled
Age (Months)
Percent
Faulty BF Faulty Complementary feeding
Food & Nutrient Intakes
15
Average Intake of Foods & Nutrients among Rural Households: Per CU/Day as % Recommended (ICMR-2010)
65
60
28
32
35
18
41
100
0 20 40 60 80 100 120
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals
Mean intakes as % RDI, (Dietary Guidelines for Indians, 2011)
Source: NNMB, Tech Rep 26, 2012 59
73
87
57
100
20
73
55
77
62
0 25 50 75 100 125
Total Folate
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein
RDI
RDA
Median Intakes as % RDA for Indians (ICMR – 2010)
Average Daily Foods & Nutrients Intake among 1-6 Yr Children : By Age Group (As % RDI : Balanced Diets – 2011)
6567
3624
1317
3742
2326
2014
6750
174218
0 50 100 150 200 250
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals
1-3 yrs4-6 yrs
Source: NNMB, Tech Rep 26, 2012
607223
38 6069
6750 100
1001519 52
5541
33 6977
122139
0 25 50 75 100 125 150
Total Folate
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein
1-3 yrs4-6 YRS
Mean intakes as % RDI, (Dietary Guidelines for Indians, 2011)
RDI
RDA
Median Intakes as % RDA for Indians (ICMR – 2010)
0
20
40
60
80
100
% R
DI
Percent Distribution of 1-6 yr Children According to Daily Median Intake of
Micronutrients
Riboflavin 52 14 34Vitamin A 81 7 13Iron 46 18 36Total Folate 35 18 47
<50% RDA 50-70% RDA >=70% RDA
Source: NNMB, Tech Rep 26, 2012
Average intake of Food stuffs (as % of RDI) Among Adolescent Girls: By Age Group
2119
17
4316
2639
4542
10598
120
0 20 40 60 80 100 120 140
Other Veg.
Green Leafy Veg.
Pulses
Cereals
10-12 yrs13-15 yrs16-17 yrs
% RDA
Source: NNMB Tech. Rep. #26 - 2012
RDA
4840
3337
3031
136
122222
16
0 20 40 60 80 100 120 140
Sugar & Jaggery
Fats & Oils
Milk & M.P
Fruits 10-12 yrs13-15 yrs16-17 yrs
% RDA
RDA
Median intake of Nutrients (as % of RDA) Among Adolescent Girls: By Age Group
1715
1442
373434
3129
6565
6676
7787
0 20 40 60 80 100 120
Vit. A
Iron
Calcium
Energy
Proteins
10-12 yrs13-15 yrs16-17 yrs
% RDA
Source: NNMB Tech. Rep. #26 - 2012
RDA
1715
1463
6053
8681
79
5843
42110
8390
0 20 40 60 80 100 120
D. Folate
Vit. C
Niacin
Riboflavin
Thiamin
10-12 yrs13-15 yrs16-17 yrs
% RDA
RDA
Proportion (%) of Adolescent Girls with intake of Nutrients in amounts <70% of RDA – By Age Group
32
42 42
73
60 58
89 88 86 8681
77
90 88 87
0
20
40
60
80
100
Proteins Energy Calcium Iron Vit. A
10-12 yrs
13-15 yrs
16-17 yrs
Source: NNMB Tech. Rep. #26 - 2012
%
37 39
26
82 84
72
40 3734
6458
6355
73
67
0
20
40
60
80
100
Thiamin Riboflavin Niacin Vit. C D. Folate
10-12 yrs13-15 yrs16-17 yrs
%
Distribution (%) of Adult Men & Women according to Physical Activity
26.8
58.9
44.5
73.2
41
55
0.50.1
0.5
0
10
20
30
40
50
60
70
80
%
SEDENTARY MODERATE HEAVY
MENWOMENPooled
Median intake of Nutrients (as % of RDA) Among ADULT MEN : By Physical Activity Level
2122
84
76
56
62
7480
8982
0 20 40 60 80 100 120
Vit. A
Iron
Calcium
Energy
Proteins
Sedentary
Moderate
% RDA
RDA
% RDA
RDA
5953
60
75
96
109
5464
109110
0 20 40 60 80 100 120
D. Folate
Vit. C
Niacin
Riboflavin
Thiamin
Sedentary
Moderate
Median intake of Nutrients (as % of RDA) Among ADULT WOMEN : By Physical Activity Level
1920
56
55
4955
8088
8580
0 20 40 60 80 100 120
Vit. A
Iron
Calcium
Energy
Proteins
Sedentary
Moderate
% RDA
RDA
% RDA
RDA
5953
60
75
96109
5464
109110
0 20 40 60 80 100 120
D. Folate
Vit. C
Niacin
Riboflavin
Thiamin
Sedentary
Moderate
Proportion (%) of Adult Women with intake of Nutrients in amounts <70% of RDA – By Physiological Status
38
71
54
27
39 40
63
83
9285
90
58
85 8790
0
20
40
60
80
100
Proteins Energy Calcium Iron Vit. A
NPNL
Preg.
Lact.
Source: NNMB Tech. Rep. #26 - 2012
%
22
2924
57
7378
17
2924
46
6774
68
88
59
0
20
40
60
80
100
Thiamin Riboflavin Niacin Vit. C D. Folate
NPNLPreg.Lact.
%
States Pooled 26
Distribution (%) of Sedentary Adult Men & Women with Protein Calorie Inadequacy
29
4419
19
35
39
27
36
0 50 100
ProteinInadequacy
CalorieInadequacy
Men
Women
Preg. Women
Lact. Women
Percent Source: NNMB, Tech Rep 26, 2012
Food & Nutrient Intakes -- Time Trends
27
Average Household Intake of foodstuffs (g/per CU/day): Time trends – States* Pooled
STATES Period of Survey RDI
(Dietary Guidelines:
2011) 1975-79 1988-90 1996-97 2011-12
Cereals & Millets 505 469 450 368 375
Pulses & Legumes 34 32 27 33 75
Green Leafy Veg. 8 9 15 16 100
Other Veg. 54 49 47 48 200
Roots & Tubers 56 41 44 50 200
Milk & Milk Prod. 116 92 86 95 300
Fats & Oils 14 13 12 16 25
Sugar & Jaggery 23 29 21 14 20
28 Source: NNMB, Tech Rep 26, 2012
*KER, TN, KAR, AP, MR, GUJ, ORI (7 States)
Median Household Intake of Nutrients (per CU/day): Time trends – States* Pooled
STATES Period of Survey RDA
(2011) 1975-79 1988-90 1996-97 2011-12
Proteins (g) 61.5 58.4 53.7 49.0 60
Energy (Kcal) 2349 2283 2108 1852 2320
Calcium (mg) 606 565 521 433 600
Iron (mg) 17.2 15.5 14.2 13.4 25
Vitamin A (µg) 246 282 300 296 600
Thiamin (mg) 1.46 1.33 1.20 1.20 1.20
Riboflavin (mg) 0.81 0.87 0.90 0.80 1.40
Niacin (mg) 14.7 14.2 12.7 13.7 16
Vitamin C (mg) 39 37 40 46 40
Dietary Folate (µg) - - 153 127 200
29 Source: NNMB, Tech Rep 26, 2012 *KER, TN, KAR, AP, MR, GUJ, ORI (7 States)
30
NUTRITIONAL STATUS - Anthropometry
States Pooled
31
Prevalence (%) of Undernutrition Among 0-5 yr Children According to SD Classification (<Median - 2SD) : By Age Group & Gender
38
48
42 4146
43
22 22 22
0
20
40
60
Underweight Stunting Wasting
<3 yrs3-5 yrsPooled
Using WHO Child Growth Standards
Source: NNMB, Tech Rep 26, 2012
42 4144 42
23 22
0
20
40
60
Underweight Stunting Wasting
BoysGirls
States Pooled
32
3937
35
23
31
4552
4254
41
0 20 40 60 80
PooledMP
GUJORI
KARWBAPMRTN
KER
Per cent
49
454343
41
1921
4251
48
0 20 40 60 80
PooledGUJORIMPAP
KARWBMR
KeralaT.N.
Per cent
35
2824
22
181615
18
29
23
0 20 40 60 80
PooledMP
GUJT.NUP
KARORI
KERAPMR
Per cent
Prevalence (%) of Undernutrition among <5 yr Children – By State *
UNDERWEIGHT STUNTING
WASTING
* Using WHO Child Growth Standards
Source: NNMB, Tech Rep 26, 2012
States Pooled 33
Distribution (%) of Adolescent Boys & Girls according to Age/sex specific BMI
31
36
23
68
62
75
1 2 2
0
20
40
60
80
Undernourished (<Median-2SD)
Normal (Median-2SD toMedian+1SD)
OverWeight/Obesity
(>=Median+1SD)
5-9 yrs
10-13 yrs
14-17 yrs
Perc
ent
Source: NNMB, Tech Rep 26, 2012
Perc
ent
Girls
37
47
41
62
51
57
1 2 2
0
20
40
60
80
Undernourished (<Median-2SD)
Normal (Median-2SD toMedian+1SD)
OverWeight/Obesity
(>=Median+1SD)
5-9 yrs
10-13 yrs
14-17 yrs
Boys
Distribution (%) of Adult Men & Women According to Body Mass Index (BMI Grades - Asian Cut-off Levels): By Physical Activity
32
3935
4043
41
29
18 24
0
20
40
60
CED Normal Over Weight
Sedentary
Moderate/Heavy
Pooled
Perc
ent
Source: NNMB Tech. Rep. #26 - 2012 BMI: < 18.5 18.5 – 23.0 ≥ 23.0
Adult Women
2936 34
4147 45
29
17 21
0
20
40
60
CED Normal Over Weight
Sedentary
Moderate/Heavy
Pooled
BMI: < 18.5 18.5 – 23.0 ≥ 23.0
Adult Men X2 : p (<0.001)
X2 : p (<0.001)
Perc
ent
States Pooled 35
NUTRITIONAL STATUS - Time Trends
States Pooled 36
Distribution (%) of <5 Children by Undernutrition and Period of Survey (Using WHO / MGRS Values)
43 40 42
5145 43
2023 22
0
20
40
60
80
Underweight Stunting Wasting
NFHS2 (2001)
NFHS3 (2006)
NNMB (2011-12)
Perc
ent
UNDERNUTRITION (< Median - 2SD)
States Pooled 37
Distribution (%) of Adult Men & Women according to BMI Grades by Period of Survey
59
46
3239
5156
24
12
0
20
40
60
80
CED Normal Over Weight
1975-79
1996-97
2011-12
Perc
ent
BMI : <18.5 18.5 – 25.0 >=25.0
Adult Women
Adult Men
5248
33
4447
51
37
16
0
20
40
60
80
CED Normal Over Weight
1975-79
1996-97
2011-12
BMI : <18.5 18.5 – 25.0 >=25.0
Perc
ent
Micronutrient Deficiency Disorders of Public Health significance:
-- Iron Deficiency Anaemia (IDA)
-- Vitamin ‘A’ Deficiency (VAD) and
-- Iodine Deficiency Disorders (IDD)
-- Vitamin D Deficiency
38
Iron Deficiency Anaemia (IDA)
39
32.5 31.4 30.325.7 22.3 24.8
45.2
23.7
47 47.2
24.7
43.3 41.9
45.8
41.7
20.5 20.7
45.5
31.4 30.5
8.4
0.62.83.04.11.81.12.1
1-5 yr Boys & Girls
12-14 YrGirls.
15-17 Yr.Girls
Preg.Women
Lact.Women
NPNL.Women
Men
Normal Mild Moderate Severe
10.2 0.03
11.2 0.03
11.0 0.03
9.9 0.03
10.6 0.03
Mean ±SE
Prevalence (%) of Anaemia by Age, Gender & Physiological Groups
(≥ 6 months) (≤ 6 months)
10.7 1.99
12.6 2.09
Source: MND-NNMB, Tech Rep 22, 2003
STRATEGIES FOR CONTROL & PREVENTION OF IDA/VAD
Short Term Strategies:
IDA:
Distribution of ‘FOLIFER’ (Iron & Folic Acid Tabs.) to Vulnerable groups viz.,
-- Pregnant Women -- Lactating Women (< 6 months) -- FP Acceptors -- 1 to 5 Year Children
@ 1 Tab. Adult/Child per day for100 days
41
Particulars Per cent
Pregnant (2053)
Lactating (2213)
Children (2178)
Received IFA tablets 62.2 12.3 3.8
No. of tablets received 10 – 29 2.3 1.5 0.4 30 – 59 17.1 5.6 1.2 60 – 89 12.8 1.4 0.3
≥ 90 29.9 3.8 1.8
Distribution (%) of Beneficiaries according to Receipt of IFA tablets
Source: NNMB-MND Survey : 8 States, 2003
Figures in ( ) indicate numbers
42
Vitamin A Deficiency (VAD)
43
States Pooled: NNMB-2003: 0.8
NNMB-2012: (0.2) < 0.5 %
0.5 %
Kerala 0 (0)
Tamil Nadu 0.5 (0)
Karnataka
0.7 (0.5) *
Andhra Pradesh 1.2 (0.2)
Maharashtra 1.3 (0)
Madhya Pradesh 1.4 (0)
Orissa 0.3 (0) West
Bengal 0.6 (0.3)
Trends in the Prevalence (%) of Bitot spots Among Rural Preschool children: NNMB-2003 & (2012)
WHO cut-off level of 0.5% prevalence denotes Public Health significance
Source:
NNMB - MND Surveys in Rural India: 2003 & NNMB RegularSurvey-2012
44
Gujarat (0)
Uttar
Pradesh(0.5)*
STRATEGIES FOR CONTROL & PREVENTION OF IDA/VAD
Short Term Strategies (Contd..):
VAD: Distribution of ‘Massive Dose Vitamin A to 9-60 months children, once in 6 months:
-- First dose of 100 thousand IU at 9 months along with Measles Immunization
-- Second dose 200 thousand IU at 18 months along with DPT/Polio Booster
-- 3rd dose onwards 200 thousand IU every 6 months
45
Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20 G/dL, Median Dietary Intake of Vit. A (as % RDA) and
Extent of Coverage for Suppl. of Massive Dose Vit. A – By State
STATES Blood
Vitamin A < 20 g/dL
Dietary Intake of Vitamin A < 50% of RDA
Receipt of Massive Dose Vitamin A
1 or 2 Doses
No. of Doses
One Two
Kerala 79.4 91.8 38.5 28.4 10.1 Tamil Nadu 48.8 81.9 50.6 20.2 30.4 Karnataka 52.1 90.4 56.6 42.1 14.5 AP 61.5 92.9 49.3 14.2 35.1 Maharashtra 54.7 88.8 52.1 29.4 22.7 MP 88.0 87.4 52.3 19.1 33.2 Orissa 57.7 77.5 80.0 38.8 41.2 West Bengal 61.2 80.6 50.6 46.8 3.8 Pooled 61.8 86.3 55.4 30.3 25.1
Source: NNMB - MND Surveys in Rural India: 2003 46
Distribution (%) of 1- 5 Yr. Children according to Coverage for Receipt of Massive Dose Vit. A during the year 2011-12: By State
STATES Receipt of Massive Dose Vitamin A
Received No. of Doses
One Two Kerala 81.1 49.3 31.8 Tamil Nadu 66.0 30.2 35.8 Karnataka 94.4 40.6 53.8 Andhra Pradesh 90.6 36.2 54.4 Maharashtra 94.4 38.6 55.8 Gujarat 91.9 35.2 56.7 Madhya Pradesh 95.6 45.1 50.5 Orissa 93.1 39.5 53.6 West Bengal 89.8 32.5 57.3 Uttar Pradesh 57.8 26.7 31.1 Pooled 85.0 36.5 48.5
47 Source: NNMB, Tech Rep 26, 2012
Iodine Deficiency Disorders (IDD)
48
Pooled: 3.9
< 5 %
> 5 % Kerala
0.6
Tamil Nadu 0
Karnataka 1.9
Andhra Pradesh 3.8
Maharashtra 12.2
Madhya Pradesh 4.3
Orissa 0.1
West Bengal 9.0
Prevalence (%) of IDD among 6 – 11 Year Children
Source: MND-NNMB, Tech Rep 22, 2003
Pooled: 3.9
< 5 %
> 5 % Kerala
0.6
Tamil Nadu 0
Karnataka 1.9
Andhra Pradesh 3.8
Maharashtra 12.2
Madhya Pradesh 4.3
Orissa 0.1
West Bengal 9.0
Pooled: 3.9
< 5 %
> 5 % Kerala
0.6
Tamil Nadu 0
Karnataka 1.9
Andhra Pradesh 3.8
Maharashtra 12.2
Madhya Pradesh 4.3
Orissa 0.1
West Bengal 9.0
49
Dist- ricts
Northern North-Eastern Eastern Central Southern
PREV. Current PREV. Current PREV. Current PREV. Current PREV. Current
1 41.6 10.4 65.8 5.4 35.2 22.9 44.0 3.4 54.0 12.4
2 41.2 9.6 40.2 4.6 33.2 23.1 36.6 14.5 64.4 11.5
3 27.4 8.5 26.5 8.4 64.3 40.1 40.9 14.5 28.0 9.3
4 44.7 17.2 68.6 4.8 20.9 21.9 35.0 8.2 32.9 9.5
5 45.7 14.4 68.6 5.2 37.8 26.7 55.6 10.2 32.1 7.7
6 30.0 6.9 50.2 8.6 37.8 23.7 41.8 16.2 41.1 7.2
7 52.3 20.6 25.9 5.0 21.6 21.8 22.0 9.2 21.0 12.8
8 24.5 19.3 25.9 6.5 30.3 39.6 13.7 9.9 44.4 11.2
Prevalence of Total Goitre (%) in Select Districts (8Dist. /Region) of Different Regions of the Country
50
89
64 64 6357 51
36
63
83
6671
0
10
20
30
40
50
60
70
80
90
100
KER AP ORI MP TN WB KAR MP - Urban Rural Pooled
Percent of HHs consuming adequately Iodised (≥15 ppm) Salt
Coverage Evaluation Survey: UNICEF - MoH&FW (GoI) 2009
Per
cen
t
INDIA 51 STATES
Vitamin - D Deficiency
52
53
Studies Cut off point Prevalence %
Delhi, Madhava Rao, Goswami, Adults-2006
< 20 ng/ml 94.3%
Seema Puri et al Adolescent girls < 20 ng/ml 90.8%
Pregnancy, Term NIN study, 2008 < 20 ng/ml 51.8%
Cord blood, NIN, 2008 < 20 ng/ml 91%
Alok sachan et al pregnancy < 10 ng/ml 42.5%
Harinarayan et al Tirupati, children < 20 ng/ml 75%
Prevalence of VDD - Indian studies
62
7582 77
44
7062
72
0
10
20
30
40
50
60
70
80
90
urban Rural
Men
Women
Boys
Girls
Prevalence of VDD in Tirupati, South India
Harinarayan et al, IJMR,2008
Prevalence of vitamin D deficiency (< 50 nmol/l) among Urban adult women (>=30 yrs) by income Category
( ICMR task force study- Hyderabad arm: 2008)
67.0
45.0
4.0
0
10
20
30
40
50
60
70
80%
HIG MIG LIG
56
Overweight, Obesity, Hypertension & Diabetes Mellitus
57
14
2121
3035
17
25
1412
2010
0 10 20 30 40 50 60 70 80 90 100
PooledM.PU.P
W.B.Orissa
Guj.Karnat.
Mahara.A.P.T.N.
Kerala
Per cent
514040
505252
6066
45
5557
0 20 40 60 80 100
PooledM.RGUJKARM.P.A.P.T.N
W.BORIU.P
KER
Per cent
145
8
9
141516
2323
14
9
0 10 20 30 40 50 60 70 80 90 100
PooledU.PW.BM.PORIMR
KARGUJA.PT.N
KER
Per cent
2214
17
17
2122
2426
3030
21
17
20
0 20 40 60 80 100
PooledM.PU.P.A.P
T.N.KARGUJORIT.NORIM.RW.BKER
Per cent
Prevalence (%) of Obesity according to BMI/WHR/WC and HTN among ADULT MEN – By State
BMI (23.0) WHR (0.90)
WC (90 cm)
Source: NNMB, Tech Rep 26, 2012
HTN (SBP>= 140 and/or DBP >=/90 mm Hg)
58
19
2021
3647
19
24
1614
2312
0 10 20 30 40 50 60 70 80 90 100
PooledM.PORIU.P
W.BGUJM.R
KARA.PT.N
KER
Per cent
644446
62
6570
7388
65
72
53
0 20 40 60 80 100
PooledM.RGUJKARA.PU.PORIW.BM.PTN
KER
Per cent
2310
16
18
1919
2430
54
18
17
0 10 20 30 40 50 60 70 80 90 100
PooledORI
GUJM.R
KARA.P
W.BU.PM.PT.N.
Kerala
Per cent
221517
17
2025
282829
20
17
0 10 20 30 40 50 60 70 80 90 100
PooledU.PM.PA.P
GUJKART.NM.RKERORIW.B
Per cent
Prevalence (%) of Obesity according to BMI/WHR/WC and HTN among ADULT WOMEN – By State
BMI (23.0) WHR (0.80)
WC (80 cm) HTN (SBP>= 140 and/or DBP >=/90 mm Hg)
Source: NNMB, Tech Rep 26, 2012
Prevalence (%) of Hypertension (JNC-VII) Among Rural Adult Men & Women : By Physical Activity Level
3239
3540
4341
2918
24
0
20
40
60
80
Normal Pre HTN HTN
SedentaryModerate/HeavyPooled
Perc
ent
Source: NNMB Tech. Rep. #26 - 2012
WOMEN
2936
3441
47 45
29
17 21
0
20
40
60
80
Normal Pre HTN HTN
SedentaryModerate/HeavyPooled MEN
Perc
ent
X2 : p (<0.001)
X2 : p (<0.001)
60
5.1
7.57.8
13.016.4
6.4
11.1
4.73.6
8.23.3
0 5 10 15 20
PooledW.BU.PORIM.PM.RA.P
KARGUJT.N
KER
Per cent
6.82.2
3.2
4.4
5.36.4
8.211.6
14.0
4.7
3.4
0 5 10 15 20
PooledU.P
W.BORIA.PM.PM.R
KARGUJ
TNKER
Per cent
Prevalence (%) of Diabetes Mellitus – By State (Fasting Blood Glucose >= 126mg/dL)
ADULT WOMEN
Source: NNMB, Tech Rep 26, 2012
ADULT MEN
Prevalence (%) of Diabetes Mellitus Among Rural Adult Men & Women : By Physical Activity Level
93 95 94
7 5 6
0
20
40
60
80
100
Normal Diabetes M.
SedentaryModeratePooled
Perc
ent
Source: NNMB Tech. Rep. #26 - 2012
WOMEN
89 94 92
116 8
0
20
40
60
80
100
Normal Diabetes M.
SedentaryModeratePooled MEN
Perc
ent X2 : p (<0.001)
X2 : p (<0.001)
Strategies for Control & Prevention
62
63
SHORT TERM Strengthening supplementary feeding Programmes (eg. ICDS), in terms of :
- Quantity and quality of Supplement - Regularity - Coverage of target population and monitoring
National Programme for Control & Prevention of IDA: - Distribution of IFA Tablets to target population,
National Programme for prevention of Nutritional Blindness: - Massive dose Vitamin A Supplementation,
Long Term Strategies Health & Nutrition Education Dietary Diversification – B. C. Commn. Development of Kitchen Gardens Agro-biodiversity, Bio-fortification, GM Foods Environmental Sanitation & Personal Hygiene Provision of Safe Drinking water Immunization Prompt treatment of Infections Income generating activities Improvement in HH food Security Promotion of Healthy Life style Practices . . . Population Control 64
Medium Term Strategies
Fortification of Foods with micronutrients - Milk (Vit. A & Vit. D) - Salt (Iodine, Iron) - Cooking oils (Vit. A & Vit. D) - Wheat Flour (Iron, Vit. A, Folic Acid) - Rice (Iron, Ultra Rice [PATH]) - Supplementary foods under ICDS/MDM - Ready to eat convenience foods
65
Advantages & Disadvantages of Various Strategies STRATEGY ADVANTAGES LIMITATIONS
Short Term (Nutrient Supplemen-tation)
Immediate Benefit
Very Effective, if properly implemented.
Expensive, Needs Manpower, Inadequate/Irregular Supplies, Inadequate/Irregular Coverage, Non-compliance, Not Sustainable.
Long Term (Nutrition Education/ Dietary Diversification)
Desirable, Sustainable, No cost involved.
Difficult to achieve, Time consuming.
Medium Term (Food Fortification)
Easy, Cost effective, Good compliance, Sustainable, Easy to Regulate.
Risk due to several foods being fortified
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67
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