MATERNAL AND CHILD MALNUTRITION: CAUSES, NUTRITIONAL IMPLICATIONS AND INTERVENTIONS Diwa Pandey Assistant Dietician Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow

FOOD AVAILABILITY

MORTALITY RATE Source: UNICEF website

PEM: Kwashiorkor

PEM: MARASMUS

UNICEF Under 3 years Stunting46 % Wasted16 % Underweight Moderately 47 % Severely 18 % Highest: Madhya Pradesh55 % Lowest: Kerela27 % LBW 30% Anaemia Under 3 74 % Adolescent 90 % Women 50 %

MALNUTRITION UP: 2 nd 3rd

MALNUTRITION: CLASSIFICATION Type: Under nutrition/ over nutrition Cause: Endogenous/ exogenous Degree: Mild/ moderate/ severe Outcome: Reversible/ irreversible Nutrient: Single/ multiple Duration:Acute/ chronic

ANTOPOMETRY: REFERENCE Traditional reference:- Gomez, Waterlow Recent:- Stunting: Height for age Wasting: Weight for height TypeNormalMildModerateSevere Stunting (%) <70 Wasting (%) <85 Range+2 to –1 SD-1 to –2 SD-2 to –3 SD-3/more SD

GOOD NUTRITION  Promotes good health  Allows for growth and development  Protects against disease  Provides for socially essential and desirable activity  Leads to quick recovery from illness with fewer complications MALNUTRITION Impedes development MotorSensory Social Emotional Malnourished adults easy susceptibility to disease early death

ASSESSMENT OF NUTRITIONAL STATUS SL NO.Source of informationNature of informationNutritional implications 1 Socio-economical marketing distribution storage Purchasing power Distribution, storage facility Unequal distribution Within family or community 2 Food consumption pattern, cultural data Lack of knowledge, erroneous beliefs, prejudice Food choice 3 Vital, health statisticsMorbidity and mortalityExtent of risk and identification of high risk group 4AnthropomertyPhysical developmentEffect on physical dev. 5Clinical examinationDeficiency symptomsDeviation from health 6Biochemical testsNutrient- metabolite level in body tissues and fluids Impairment of biochemical function 7Additional medical historyPrevalent disease, infection, infestations Health-disease relationship WHO 1963

CAUSES OF MALNUTRITION SocialEconomical Illiteracy Poverty Poor personal hygieneUnemployment Inadequate weaning Inaccessible health and diet care Ecological Unfertile land/drought Poor sanitation Poor food distribution/famine Interaction of social, economical and ecological variables leading to malnutrition. (Underwood 1992)

FOOD AVAILABILITY Food security: World Bank (1986) Access by all people at all times to enough food for an active and healthy life. EVALUATION OF FOOD SECURITY Population levelHousehold level Individual level Food productionFood diversityDiet recall Per capita availability Diet record Import-export data Screen out potential nutritional deficiency Identify population at risk Implement appropriate intervention

BALANCED DIET Purchasing power Local availability Religious affiliations

DIETARY DIVERSITY 1)Cereals 2)Pulses 3)Roots and tubers 4)Milk 5)Sugar 6)Oils and fats 7)Fruits 8)Leafy Vegetables 9)Flesh foods and eggs  Divided into different food group depending upon their nutritional Significance  Used to cross check major nutritional deficiencies  Form a basis to implement intensive nutritional screening and appropriate intervention

MICRO-NUTRIENTS Vitamin A Iron Calcium Iodine Vitamins, minerals and trace elements: Required in minute amounts but are essential for normal metabolic processes and their inadequacy leads to various deficiency diseases.

HYGIENE AND SANITATION UNICEF (2002)TotalUrbanRural % population using improved water source % population using adequate sanitation facilities Worm infestation Loss of appetite Effect on gut mucosa Reduced nutrient intake Malnutrition Less able to procure food Loss of energy More malnutrition Increases susceptibility to infection Latham 1991

APPROPRIATE CHILD CARE PRACTICES Promotion of breast milk Timely and appropriate weaning MAXIMISING NUTRITIVE VALUE OF FOODS  Freshly consumed  Cooking and cleaning losses  Complementing foods  Natural fortification  Promote use of nutritious locally and/ or seasonally available foods

SPECIFIC INTERVENTION MEASURES  Health and nutrition surveys: especially for high risk population  Food availability and selection: priority  Use of various forms of media: individual, community or organization level  Training of field workers  Implement environmental hygiene programs