trends in the nutritional status of rural communities … · 2016. 1. 18. · source: nnmb, tech...

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: [email protected]

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*


Registrar General of India, (2007-09, SRS-2011 )

India (NNMB States)


9

Prevalence of Low Birth Weight


3330

25 2523

13

8

10

10

20

30

40Pe

r cen

t

India Bangladesh Nepal Myanmar Bhutan Maldives Indnesia DPR Korea


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


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


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


%

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.


%

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


42 4144 42

23 22

0

20

40

60


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


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


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


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


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


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


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)


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)


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


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


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


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

66

trends in the nutritional status of rural communities … · 2016. 1. 18. · source: nnmb, tech...

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