1. Nutrition-Malnutrition Presented By: Khan Tawhid Parvez

2. Nutrition is the foundation of Health Health is the backbone of a nation

3. Magnitude of Malnutrition Micronutrient related - More than 80% < 2 year children have nutritional anaemia -About 40% population have ID -More than 2.5% PLW have VAD -Zinc deficiency disorders are becoming more pronounced

4. Magnitude of Malnutrition Macronutrient related -More than 40% <2 children are LWA -About 40% children are stunted -More than 40% WCBA have low BMI -Colostrums rejection is > 50% -IYCF practices are unacceptable -mean pregnancy weight gain is <5kg..Continued…

5. Magnitude of Malnutrition Economic loss -Direct yearly loss due to micro and macronutrient deficiency is >US$2.2 billion -Indirect loss (health expenses due to malnutrition) is huge.

6. Malnutrition There will be about 3,000 deaths globally, mostly women, infants and children, during this presentation session! Globally, one in three people are malnourished

7. 7 Causes of under-five deaths in relation to malnutrition in Bangladesh More than one third of this mortality is attributable to Undernutrition

8. Causes of Deaths among U-5 Children in Developing Countries Ref: World Health organization. The global burden of disease: 2004 update. Geneva, World Health organization, 2008

9. Nutrition Itis the process in which food is consumed, digest and absorb and use them for health and growth. In other words, nutrition can be defined as food or nourishment needed to keep an organism growing, healthy and viable. (Traditional) This definition is no longer being used.

10. Definition of mal/nutrition Nutrition or malnutrition is the physical impression of the interactions among the determinants of malnutrition.

11. Definition of mal/nutrition Although ‘primarily’ it is the physical impression, but other indicators can also be used to determine the nutritional status. Clinical Bio-chemical Dietary Anthropometric – Stunting, wasting, underweight Ultrasonography - Thyroid Radio Immuno-assay - Iodine

12. Determinants of Malnutrition (cont) There are basically 03 determinants of malnutrition: Lack of Foods Lack of Caring Practices and Lack of Health Services ( including environmental and personal hygiene )

13. Determinants of Malnutrition (cont) Lack of Foods Causes: lack of land lack of technology lack of transport season cooking process lack of communication lack of affordability lack of availability natural and man made calamity food culture etc.

14. Determinants of Malnutrition (cont) Lack of Caring Practices Causes:lack of care during pre, natal and post natal period no / lack of breastfeeding (BF) no / lack of use of PHC / ESD lack of familial support lack of knowledge on various issues related to pregnancy, child birth and child care vaccination importance of food and rest etc.

15. Determinants of Malnutrition (cont) Lack of Health Services Causes:no hospital (if yes, then) no doctor (if yes, then) no nurses (if yes, then) no paramedics (if yes, then) no medicine no / lack of communication lack of confidence remote etc.

16. Determinants of Malnutrition (cont) All these three determinants are interdependent They remain in a ‘chain like fashion’ or ‘three separate rings connected together’. If any one of the determinants is lacking (‘-’), then it will have a trickle down effect on the other two determinants of nutrition Then the overall outcome would be ‘-’ which means malnutrition.

17. Conceptual frame work of Malnutrition

18. Human, Economic, and Institutional Resources Nutritional Status HealthDiet Household Food Security Potential Resources Ecological Conditions Care of Mother and Child Environ. Health, Hygiene & Sanitation Political and Ideological Structure Root Causes Manifestations Immediate Causes Underlying Causes Functional Consequences: Mortality, Morbidity, Lost Productivity, etc. Consequences Adapted from UNICEF Unicef nutrition strategy

19. Thank You

20. Components of Optimal Nutrition Adequate and proper diet (food) –Calories, Carbohydrates, Proteins, Fats, Minerals and Vitamins Good and loving care in a healthy environment Access to health care services

21. What are the Roles of Nutrition in Public Health? Nutrition during antenatal & postnatal period, children, elder population To treat infectious and chronic diseases through dietary modification Conducting nutrition assessments and research Promote food security and ensure food supply Nutrition intervention and community nutrition program For implementing Government nutrition policy Nutrition during antenatal & postnatal period, children, elder population To treat infectious and chronic diseases through dietary modification Conducting nutrition assessments and research Promote food security and ensure food supply Nutrition intervention and community nutrition program For implementing Government nutrition policy Improving Populatio n Health 21