1. The problems of malnutrition in Armenia
Luiza Gharibyan, PhD
Associate professor
Yerevan State Medical University, Department of Hygiene and Ecology,
Armenia
Luiza Khachic Gharibyan graduated from Yerevan State Medical Institute, faculty Hygiene and Sanitary. Dissertation PhD in “Experimental Argument of Methodology for prediction of combined action concerning Atmosphere pollution”.
Her first Supercourse lecture has a title “Armenian Health Profile”(../ns0041.index.htm)
Both lectures were prepared during scholarship in University of Pittsburgh, School of Public Health ( U.S.A.) in 2002 according JFDP program. (

2. The transition to the new social-economic conditions creates deep changes in living standards in Republic and that’s why the most part of population is appeared under the threshold of poorness, which reflects on the health index level.

3. The situation is threatening for the social health
The situation is threatening for the social health. One of the most important indexes of social health is children’s physical development. In literature there is a lot of information about the decrease of anthropometrics indexes during the wars and economic crashes.

4. In poor countries the number of short and thin children (according to the standards) is bigger, because of malnutrition.
Over 200 million children in developing countries under the age of five are malnourished.

5. Malnutrition contributes to more than half of the nearly 12 million under-five deaths in developing countries each year. Malnourished children often suffer the loss of precious mental capacities. They fall ill more often. If they survive, they may grow up with lasting mental or physical disabilities.

6. Using data from 53 developing countries, researchers from Cornell University have concluded that over half of those 13 million child deaths each year are associated with malnutrition.

7. Further, they show that more than three quarters of all these malnutrition-assisted deaths are linked not to severe malnutrition but to mild and moderate forms.

8. The major nutrition problems in the world are: 1
The major nutrition problems in the world are: 1.Protein–energy malnutrition (PEM) Iodine deficiency disorders (IDD) 3.Iron deficiency 4.Vitamin A deficiency or hypovitaminosis A(VAD) 5. Nutrition-related chronic diseases

11. In the public imagination, the home of the malnourished child is sub-Saharan Africa. But the league tables clearly show that the worst-affected region is not Africa but South Asia.
In the public imagination, the home of the malnourished child is sub-Saharan Africa. But the league tables clearly show that the worst-affected region is not Africa but South Asia. Just over 30% of Africa's children are underweight, but the corresponding figure for South Asia is over 50%. And in Bangladesh and India, the proportion of children malnourished is very significantly higher than in even the poorest countries of the sub-Sahara.
Measured by absolute numbers, it is to be expected that problems of poverty will be concentrated in South Asia, simply because of the sheer size of its populations (India alone has 50% more people than 47 countries of sub-Saharan Africa put together). But when the proportion affected is also far higher, as is the case with child malnutrition, then the centre of gravity of the problem shifts still further. That is why half of the world's malnourished children are to be found in just three countries - Bangladesh, India, and Pakistan.

12. Just over 30% of Africa's children are underweight, but the corresponding figure for South Asia is over 50%. And in Bangladesh and India, the proportion of children malnutrished is very significantly higher than in even the poorest countries of the sub-Sahara.

13. Measured by absolute numbers, it is to be expected that problems of poverty will be concentrated in South Asia, simply because of the sheer size of its populations (India alone has 50% more people than 47 countries of sub-Saharan Africa put together).

14. But when the proportion affected is also far higher, as is the case with child malnutrition, then the centre of gravity of the problem shifts still further.
That is why half of the world's malnourished children are to be found in just three countries - Bangladesh, India, and Pakistan.

15. Over 8 million of the 13 million under-five deaths in the world each year can be put down to diarrhea, pneumonia and malaria.
In sub-Saharan Africa, the proportion is about one sixth (some of which can be put down to malaria). These variations alone go some of the way towards explaining the different rates of child malnutrition in the two regions. But why should low birth weight be so much more common in South Asia? Low birth weight indicates that the infant was malnourished in the womb and/or that the mother was malnourished during her own infancy, childhood, adolescence, and pregnancy. The proportion of babies born with low birth weight therefore reflects the condition of women, and particularly their health and nutrition, not only during pregnancy but over the whole of their childhood and young lives. During the pregnancy itself, the average woman should gain about 10 kilos in weight. What evidence there is suggests that most women in Africa probably come close to that figure, whereas most women in South Asia probably gain little more than 5 kilos.2
And it is when we close in on this subject that we find the first really significant clues to the South Asian enigma. Approximately one third of all babies in India are born with low birth weight. In Bangladesh, the proportion is one half.

16. Malnutrition around the world

17. Birth weight is an obvious place to begin the search
Birth weight is an obvious place to begin the search. In all countries and cultures, low birth weight is the best single predictor of malnutrition.
Does this mean that girls and women in South Asia are less well regarded and less well cared for than in sub-Saharan Africa? The answer must be yes. And it is a conclusion which draws reinforcement from the fact that only in Asia do we find a ratio of female life expectancy to male life expectancy that is significantly below the worldwide norms.
The incidence of low birth weight is one clear marker of this process. Another is the level of anaemia. About 40% of women in sub-Saharan Africa suffer from iron deficiency anaemia, as opposed to approximately 60% of women in South Asia, a proportion that rises to 75% in pregnancy (and a staggering 83% in India).
In short, the poor care that is afforded to girls and women by their husbands and by elders is the first major reason for levels of child malnutrition that are markedly higher in South Asia than anywhere else in the world

18. Birth weights below 2,500 grams have been found to be very closely associated with poor growth not just in infancy but throughout childhood.
In sub-Saharan Africa, the proportion is about one sixth (some of which can be put down to malaria). These variations alone go some of the way towards explaining the different rates of child malnutrition in the two regions. But why should low birth weight be so much more common in South Asia? Low birth weight indicates that the infant was malnourished in the womb and/or that the mother was malnourished during her own infancy, childhood, adolescence, and pregnancy. The proportion of babies born with low birth weight therefore reflects the condition of women, and particularly their health and nutrition, not only during pregnancy but over the whole of their childhood and young lives. During the pregnancy itself, the average woman should gain about 10 kilos in weight. What evidence there is suggests that most women in Africa probably come close to that figure, whereas most women in South Asia probably gain little more than 5 kilos.2
And it is when we close in on this subject that we find the first really significant clues to the South Asian enigma. Approximately one third of all babies in India are born with low birth weight. In Bangladesh, the proportion is one half.

19. The purpose of this work is to find out the health deviation of children in Armenia, because of malnutrition malnutrition and organize corresponding social-medical help.

20. We assessed children in Yerevan in 4 secondary schools (No. 32, No. 38
We assessed children in Yerevan in 4 secondary schools (No. 32, No. 38. No. 19, No. 8) of children’s anthropometrics indexes (about 4000 children) and data of 2000 newborns. We found each child’s family social economic status, parents’ health condition and possible harmful factors possible negative influence on a child.

21. Obtained data’s analysis shows that the physical development indexes are lower than the standards, in the families where the malnutrition is organized badly or it’s connected with the low standards of living. We want to present you the following dates obtained in 2 different regions in Yerevan about seven-year-olds schoolchildren height and weight.

22. We compared the schoolchildren of No. 38 (Shengavit region), No
We compared the schoolchildren of No. 38 (Shengavit region), No. 8 (Central region) in period Shengavit region children’s height and weight was higher than now. Analyze dates show, that first form boys’ average height decreased 2.64cm (dignity index t=3.6), girls’ is 2.21cm (dignity index t=3.07).

23. Yerevan deferent regions’ seven-years-old children’s height and weight in 80s. Low height boys’ number increased in 7.8% and girls’ - in 10.9%.

24. Besides it there is a decrease in number of children with good physical development correspondingly mothers’ with high education in 15.23%, mothers’ with secondary education in 7.16%.

25. The boys’ body mass decreased in 1. 22cm (t=3. 2)
The boys’ body mass decreased in 1.22cm (t=3.2). In the same school among 140 examined children’s hemoglobin average level is m= , which is certainly lower than the norms.

26. Despite the No. 38 school children’s indexes, No
Despite the No. 38 school children’s indexes, No. 8 Pushkin school first form schoolchildren’s physical development indexes average level is higher. It’s known, that the people attend this school are from well-provided families. The parents mostly have high education and have jobs.

27. So the presented material first gives us right to speak about children’s malnutrition. In Armenia during the last 10 years many families’ rations contains mostly cheap hydrocarbon origin food. While protein containing food such as meat, dairy, egg is necessary for the drawing body of young children.

28. Thus 79gr protein from which 47gr must have animal origin, fats – 79gr (16gr animal origin), hydrocarbon – 315gr, calcium – 1100mg, phosphor – 1650mg, iron – 18mg, vitamin B1 – 1.4mg, vitamin B2 – 1.6mg, vitamin C – 60mg, vitamin A – 0.7mg is one day food physiological standard and the food total calorie is 2300kcal.

29. So it is necessary 47gr animal origin protein for the normal growth of body. It’s necessary to mention, that 1 egg contains 6.25gr complete protein, 100gr meat contains 16-20gr proteins and 100ml milk contains 3.3ml. Schoolchild’s breakfast must contain 1/3-1/4 of the ration.

30. The most part of the families, which have been studied by us, are in bad financial condition and the expenses of each family per day is less than 1 USD.

31. The main part of ration in these families contains hydrocarbon – potato, pasta, bread and the usage of food providing protein (egg, meat, dairy) is very low.

32. Bronchitis in Yerevan (primary morbidity of children)1988-1998

33. The number of newborn with low weight per %
One of the most important indicator of social health is children’s physical development.
In literature there is a lot of information about the decrease of anthropometrics data during the wars and economic crisis.
One of the goal of this work was also to find out the health deviation of children because of malnutrition.
This paper illuminates that during the war and economic depression in Armenia parameters of children’s growth and development from socially vulnerable groups are lower than average figure. For assessment of degree of insufficiency of nutrition on the population level (as WHO experts recommend) we took into account simultaneously
1.Death rate of children 4years old and younger
2.Mass of body during birth
3.Growth (height) of children till 7years old.
4.Age at beginning of menstruation(4) .
The selection of the contingent for anthropometrics research took place with a special questionnaire. We found out each child family social economic status, health condition of parents and possible harmful factors which could have influence on a child’s health. We used anthropometrics, laboratory methods of research.

34. The number of sick newborn per % in Charentsavan (R.Armenia)
The information of children’s mortality and data of mass of body during birth were gathered from official statistics. By data’s showed that physical development indexes are lower than standards in the poor families (with per/day expenses $1 U.S. and less for each person).Now average level of purchasing power is lower for population of Armenia then 10 days ago.
The prevalence of short boys increased in 7.8% and girl’s in 10.9%.The number of children with good physical development decreased. Adequate food is certainly very important for normal growth of a young children and fetus.
Among the vulnerable group the average body mass of newborns with low weight(2,5 kg and lower) have increased .Meanwhile the number of newborns with good physical growth has decreased .The incidence of low birth weigh is clear marker of this process
Among the cases of mortality the death rate of children 4 years old and younger has increased, of which perhaps can be assumed to be associated with malnutrition

35.  Our experts have found also that menarche beginning later among the girls from socially vulnerable groups .Now, when the
children in Armenia need medical service assistance, the pediatric care in schools and ambulatory health control are brought down to the minimal level .Recorded data of worsening of this children’s health issues has
revealed that immediate help should be extended to children to save their normal physical growth.
It is hoped that policy recommendations born out of this analysis will be given consideration when institutional frameworks are developed and when policy decision
making occurs to improve the medical and social aid of children in Armenia .

36. CONCLUSION
Within the transition period to the new social relations, and correspondingly to the new public health care system the efforts are to be done in public health management sphere.

37. First of all, we must revise the worn out approaches in order to put the health care activities in correspondence with the new realities. Meanwhile we must give due attention to the existing experience in this sphere in the countries with the developed health care system.