Dr. Bela Shah, ICMR Dr. R. C. Sharma Desert Medicine Research Centre JODHPUR dmrc Desert Medicine Research Centre Continuous & Integrated Drought Management Health Component

Network of ICMR Institutes

IGNP India Rajasthan

DMRC Current Programmes DengueRF/RHD registry MalariaDiabetes TuberculosisHypertension Nutrition Musculoskeletal disorders Emphasis on: Focused research of relevance to Public Health dmrc Desert Medicine Research Centre

28 villages from Luni Panchayat Samiti, Jodhpur tehsil Covered 1193 women- 384 Pregnant women 400 Lactating women 409 NPNL women (Control) Micronutrient deficiency disorders, Nutritional Status & morbidity in pregnant & lactating women

Iron Deficiency: Hemoglobin levels Iodine deficiency disorder: UIE levels (WET digestion method) Iodine content of salt sample (standard iodometric titration method) Nutritional deficiency signs & Morbidities Dietary pattern (24 hour recall method)

Iron Deficiency Disorder P & L 2007 N=753 Control N=391 NIN 2003 N=2983 NFHS II 1998 ICMR 2001 N=6633 IDA P: <11 g/dl L&C:<12g/dl Sev. IDA (<7 g/dl) (Figures are in percent)

Iodine Deficiency Disorder P & L N=753 Control N=391 NIN 2003 N=2983 NFHS II 1998 ICMR 2001 N=663 3 IDD Iodized salt intake Figures are in percent

Major Nutritional Deficiency Signs Pregnant Controls n=384 n=409 VAD-Night blindness 8.8 % 0.9 % Thyroid enlargement 3.1 % 0.5 %

Percent of RDA Cereals consumption 79 Fats & Oils 80 Pulses & legumes 56 Leafy Vegetables 9.5 Milk & Milk foods Adequate n=148 Dietary Intake Pregnant & lactating women

Protein (20%) & Calories 40 % Iron (36%) & Folic Acid 57 % IFA tablets consumption–43 % Consumption of Iodized salt % Dietary Deficiencies

Nutrition Monitoring Jodhpur District 30 villages from six Tehsils Covering 600 households

Nutritional deficiency signs Anthropometric measurements Ht, Wt, MUAC & FFT Dietary intake-24 hour recall method Nutritional morbidities

Major Nutritional Deficiency Signs n=3540 Dental caries % Dental Fluorosis % Hair Discolouration- 6.0 % Gums spongy/bleeding- 2.6 %

Nutritional Morbidities n=3540 ARI % Fever % Diarrhea % N.A.D %

Nutritional Status Preschool children 1-5 (n=553) Grades Normal Mild Moderate Severe Under Nutrition (Wt for age) Stunting (Ht for age) Adults Obesity Normal CED I CED II CED III n=1148(BMI)

Dietary Deficiencies (n=1565) Diet grossly deficient in GLV % Fats % Pulses & legumes % Other Vegetables % Cereals - 20 % of RDA

Sub-Clinical Vitamin-A Deficiency among children of Rajasthan A UNICEF sponsored multi centric and cross sectional study Covering seven districts of Rajasthan from seven different agro-climatic zones Sample Size: 3000 children (6-71 months) from Rural and Urban areas

Nutrition Research focus: - Nutrition atlas for Desert - Monitoring of Nutritional Deficiencies and associated morbidities - Development of Nutritional intervention package considering Socio-behavioural & cultural aspects dmrc Desert Medicine Research Centre

Projects Proposed Fortification of wheat & millet flour with iron along with double fortification in salt & their impact on nutrition status of preschool children DBT-NIN networking Development of nutrition package for Micronutrient deficiencies & its impact assessment on pregnant & lactating women Impact assessment of consumption of three electrolyte products on mineral profile & general health profile of Jawans in desert areas of Rajasthan DFRL,Mysore Estimation of Zinc def. in school children

Expertise Medical anthropologists Clinicians Social scientists Trained Technicians

Infra structure Anthropometric equipments for Anthropometry Dietary cups, balances etc for Dietary intake Colorimeter, spectrophotometer & HPLC for biochemical analysis of MDDs (Iron, Iodine, Vitamin A)

Suggested Monitoring Crude Mortality- Secondary & Primary Acute Malnutrition } Anthropometry Chronic Malnutrition } Food Access /Availability } Dietary Dietary Diversity } Intake

Target Group  Pregnant Women  Preschool children

Monitoring Parameters Nutritional status:  Anthropometry  Dietary Intake  Nutritional deficiency signs  Biochemical tests Outcome of pregnancy:  Abortions  Still Birth  Under weight new born

Impact of Under-Nutrition  Under weight children  Anemic mothers  Marasmic babies  Vitamin A deficiency blindness  Vitamin B deficiencies  Vitamin C deficiencies

Monitoring Parameters Anthropometry Acute Malnutrition: Weight / Height (Wasting) Weight / Age Chronic Malnutrition: Height / Age (Stunting) Dietary Intake 24 hour recall method: Food Access Food Availability Food Diversity

Nutritional Deficiency Signs 1.Protein-energy malnutrition Popn. Group Clinical Symptoms / Signs Children Always present Marasmus Wasting Kwashiorkar Oedema Marasmic Wasting + Oedema Kwashiorkar Adults Wasting & weakness

Nutritional Deficiency Signs 2. Anemia - Pallor (palms, Tongue, conjunctiva) 3. Vitamin A deficiency (XN) Night blindness (X1A) Xerosis of conjunctiva (X1B) Bitot spot (X2) Xerosis of cornea (X3A) Xerosis of cornea + ulcer (X3B) Keratomalacia (XS) Corneal scar + history of VAD

Nutritional Deficiency Signs 4. Vitamin B complex deficiency 1. Riboflavin (B2) & Pyridoxine (B6) deficiency Angular stomatitis Chelosis Glossitis 2. Thiamin deficiency (B1) Beriberi * 3. Nicotinic acid deficiency (B2) Pellagra *

Nutritional Deficiency Signs 5. Vitamin C deficiency - Scurvy 6.Fluoride- Dental Caries Dental Fluorisis 7. Iodine deficiency disorders - Goiter Cretinism

DMRC proposes to participate and share responsibility in efforts towards 1.Development of socioeconomic drought monitoring indicators and 2. Impact assessment of mitigating measures on five parameters Crude Mortality, Acute Malnutrition, Chronic Malnutrition, Food Access /Availability, Dietary Diversity Response

dmrc Desert Medicine Research Centre