1. COMMON NUTRITION PROBLEMS IN INDIA Dr. K.VIJAYARAGHAVAN DIRECTOR – RESEARCH, SHARE INDIA (MEDICITI INSTITUTION) & Sr. Dy. Director, NIN (Retd) drk.vijayaraghavan@gmail.com

2. MOTHER AND CHILD SURVIVAL MMR 407/100,000 live births IMR* 58/1000 live births Child Mortality 19.5/1000 Children Rate(1-4 years) Vijayaraghavan *Gujarat 53

3. NUTRITION PROBLEMS IN INDIA WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY SOCIALLY DEPRIVED (SC & ST Communities). Vijayaraghavan

4. WOMEN POOR WT. GAIN DURING PREGNANCY CED MICRONUTRIENT DEFICIENCIES CHILDREN LOW BIRTH WEIGHT GROWTH FALTERING PEM MICRONUTRIENT DEFICIENCIES NUTRITION PROBLEMS IN INDIA WHAT ARE THE COMMON PROBLEMS?  FLUOROSIS, LATHYRISM  DIET RELATED CHRONIC DISEASES OBESITY, CARDIOVASCULAR DISEASES, DIABETES Vijayaraghavan

5. PREVALENCE OF LBW IN S.E ASIAN COUNTRIES Vijayaraghavan

6. FACTORS MODIFYING PREVALENCE OF LBW % INSTITUTIONAL DELIVERIES # ANCs (Minimum: >5) QUALITY OF ANC Includes: No.of ANCs, TT, Weight, BP, Examination of Blood, Examination of Urine

7. Source : Shanti GhoshSource : Shanti Ghosh Source: Shanti Ghosh et al, 1978

8. Source: Leela Iyengar & Apte, S,V.,1970

9. Source: Leela Raman & Rajalakshmi,1974

10. NUTRITIONAL DISORDERS IN CHILDREN PROTEIN ENERGY MALNUTRITION (PEM). CLINICAL FORMS. SUBCLINICAL UNDERNUTRITION MICRONUTRIENT DEFICIENCIES Vijayaraghavan

11. CLINCAL FORMS of PEM KWASHIORKOR OEDEMA+ IRRITABILITY+ GROWTH FAILURE+ DISCOLOURED HAIR+ Vijayaraghavan

12. CLINCAL FORMS of PEM MARASMUS EXTREME WASTING “SKIN AND BONES” MONKEY/OLD MAN FACIES Vijayaraghavan

13. SUB-CLINICAL FORMS OF PEM UNDERNUTRITION  WEIGHT FOR AGE WASTING  WEIGHT FOR HEIGHT STUNTING HEIGHT FOR AGE Vijayaraghavan

14. UNDERNUTRITION IN INDIA PRESCHOOL CHILDREN ADULTS (Females) Based on BMI Vijayaraghavan Based on NCHS weight for age

15. VIJAY’00

16. DISTRIBUTION WEIGHT FOR AGE – IAP Gujarat Normal Gr. I Gr. II Gr. IIIGr. IV

17. WEIGHT FOR AGE– SD CLASSIFICATION - GUJARAT

18. VITAMIN A DEFICIENCY

19. BITOT SPOT KERATOMALACIA BILATERAL BLINDNESS VADVAD Vijayaraghavan

20. WHO Criteria for Public Health Significance - VAD Minimum Prevalence (%) in children <6 yrs BITOT SPOTS0.5 NIGHT BLINDNESS1.0 CORNEAL LESIONS 0.01 CORNEAL SCARS0.05 Serum Retinol <10  g/l 5.0 Vijayaraghavan

21. VITAMIN A DEFICIENCY (%) IN INDIA AGE GROUPSOURCEX1BXN* PRESCHOOL CHILDREN ICMR, 20010.71.03 NNMB0.7- NIN- SURVEYS2.1 - PREGNANT WOMEN ICMR, 2001 -2.8 * 24-71 MONTHS Vijayaraghavan

22. VITAMIN A DEFICIENCY Districts(%) with X1B >0.5% Average prevalence (%) 2.1 Based on surveys in 126 Dts. by NIN and NNMB No VADVAD Vijayaraghavan

23. NUTRITIONAL DEFICIENCY SIGNS IN PRESCHOOL CHILDREN Vijayaraghavan

25. ANAEMIA

26. Vijayaraghavan

27. PREVALENCE OF ANAEMIA - ADOLESCENT GIRLS

28. ANAEMIA IN FEMALES PREVALENCE OF ANAEMIA IS VERY HIGH IN BOTH THE GROUPS NO CHANGE NOTICED OVER TIME IN THE PREVALENCE Pregnant Women Adolescent girls Vijayaraghavan

29. IODINE DEFICIENCY DISORDERS

30. 239 OF 282 DTs. SURVEYED – ENDEMIC 167 millions AT RISK ? IODINE DEFICIENCY DISORDERS GOITRE+

31. PREVALENCE OF GOITRE IN 6-12 Yr CHILDREN - Gujarat

32. DIETARY INTAKES

33. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS VIJAY’00

34. HOUSEHOLD NUTRIENT INTAKES IN DIFFERENT AREAS

35. NUTRIENT INTAKES AMONG INDIAN WOMEN NUTRIENTSNPNLPREGNANT WOMEN LACTATIN G WOMEN Protein (g)49.947.256.5 Energy (kcal)19831994224.3 Total Fat (g)24.521.5373 Calcium (mg)38233912.4 Iron (mg)11.311.0162 Vitamin A (  g) 1481421.1 Thiamin (mg)0.9 1.1 Riboflavin (mg)0.8 0.9 Vitamin C (mg)32.028.429.4 Folic Acid (  g) 8684106 Source: NNMB, 2000

36. NUTRIENT INTAKES IN PREGNANT WOMEN % RDI % RDI EnergyProteinVitamin AIronRiboflavinTotal Fat <300052.453.71.222 30-401.208.52220.76.1 40-503.72.4119.813.46.1 50-609.8119.87.312.27.3 60-708.517.10018.38.5 70-8023.2113.71.24.97.3 80-909.8 2.41.24.9 90-1007.38.52.4 7.34.9  100 36.540.29.82.417.132.9 Source: NNMB,2000

37. NUTRIENT INTAKES (per day) IN CHILDREN NNMB, 2000 Vijayaraghavan

38. DETERMINANTS OF MALNUTRITION MATERNAL MALNUTRITION START WITH A HANDICAP(LBW) FAULTY CHILDFEEDING PRACTICES DIETARY INADEQUACY FREQUENT INFECTIONS LOW PURCHASING POWER LARGE FAMILIES HIGH FEMALE ILLITERACY TABOOS AND SUPERSTITIONS

39. Factors Affecting Nutritional Status High illiteracyUnemployment/ Underemployment Large families Low purchasing power Ignorance High dependence rate False food beliefs Inadequate intakes Low Procurement of foods Poor PDSHigh cost Low availability of foods Low productionReduced workMalnutrition of foodgrainsoutput Poor environmentMorbidity Absorption of nutrients Low Appetite Poor utilization of services poor coverage of immunization Improper health services poor infrastructure Lack of resources

40. INTERVENTIONS IN OPERATION DIRECT CONVERGENCE OF SERVICES (RCH) INTEGRATED CHILD DEVELOPMENT SERVICES IRON AND FOLIC ACID DISTRIBUTION MASSIVE DOSE VITAMIN A PROGRAMME PRIMARY HEALTH CARE PROGRAMME HEALTH AND NUTRITION EDUCATION INDIRECT POVERTY ALLEVIATION PROGRAMMES ENVIRONMENTAL SANITATION PROTECTED WATER SUPPLY LITERACY PROGRAMME