CHILD NUTRITION CHALLENGES AND OPPORTUNITIES
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Transcript of CHILD NUTRITION CHALLENGES AND OPPORTUNITIES
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CHILD NUTRITION CHALLENGES AND OPPORTUNITIES
Prema Ramachandran
Director, Nutrition Foundation of India
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Major nutrition-related public health problems Chronic energy deficiency and undernutritionMicro-nutrient deficiencies Anaemia due to iron and folate deficiencyVitamin A deficiencyIodine Deficiency DisordersChronic energy excess and obesity
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Low birth weight why is it remaining unchanged Why are we unable to ensure Exclusive breast feeding for the first six months Timely appropriate & adequate complementary feedWhat is responsible for low dietary intake and high under-nutrition rates in preschool child What can we do to reduce anaemia in childrenMassive dose Vit A -Where do we go now ?Can we achieve universal access to iodised salt by 2010 What should we do to tackle over- nutrition What are the priority areas for R&D
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Low birth weight Why is it remaining unchangedWhat is its impact on IMR What happens to growth and development -are our children short , thin but fat ?What are the long term implications of low birth-weight and low growth trajectory
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Trends in Low Birth Weight196219861969-731989-93196919941988199574gMean Wt78g52g126gMean Gest ??Preterm0.7W21-16%0.8W20-15%0.3W14-10% 0
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Multicentric DataNational Neonatology Forum (1995/ 2002) Institutional Data on 37082 / 66512 Births LBW - 33% / 31.6% VLBW - 3.3% / 3.3% Preterm - 12.3% / 14.7%? Overestimates: Underprivileged and High Risk Population
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Time trends in IMRSource: RGI 2002
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IMR
Rate/1000
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19761979198219851988199119931996199719981999200020012002
IMR1291201059794807472717270686664
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Over the last three decades there is no significant change in mean birth weight or incidence of LBW However there has been a steep decline in IMRIf IUGR is major cause of LBW improvement in BW is not essential prerequisite for reduction in IMR
Chart1
278532.5
2685.7930.2
2682.529.1
Source:Safdarjung Hospital
Birth weight
% LBW
Year
Birthweight
%LBW
Time trends in birth weight
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Time trends in birth weight
196919891998
Birth weight27852685.792682.5
% LBW32.530.229.1
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Birth weight
% LBW
Year
Birthweight
%LBW
Time trends in birth weight
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Birth weight and health In India about one third of all infants weigh less than 2.5 kg at birth. Low birth weight is associated with Low growth trajectory ?Increased risk of obesity, diabetes and coronary heart disease in later life
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Child nutrition begins with maternal nutrition
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Birth weights in relation to maternal BMISource: Tenth Five Year Plan 2002
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251053.1
257341.4
265335.9
277127.7
281226.4
297214.7
Mean Birth Weight (g)
Prevalence of LBW (%)
BMI (Kg/m2)
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BMI Status of MothersMean Birth Weight (g)Prevalence of LBW (%)
< 16251053.1
16-17257341.4
17-18.5265335.9
18.5-20277127.7
20-25281226.4
> 25297214.7
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Mean Birth Weight (g)
Prevalence of LBW (%)
BMI (Kg/m2)
Figure 5.1: Birth weights in relation to maternal weights
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Improving maternal nutrition
During the Tenth Plan efforts will be made to weigh all women as early in pregnancy as possible and to monitor their weight gain This is not being done at the national level
Under the ICDS programme, food supplements are being provided to pregnant and lactating women who come to anganwadis. Coverage is between 15 and 20%Women who receive supplements are not being chosen on the basis of their nutritional status
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Tenth Plan strategy Operationalising universal antenatal care for all pregnant womenANC coverage is low ; content suboptimal Majority do not get weighed ; very few get Hb estimation done (NFHS -DLHS data).
Operationalisation of nutrition interventions for the management of under-nutrition through: targeted food supplementation and health care for those with under-nutritionAppropriate management of anaemia non existent
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Tenth Plan -Improving maternal nutrition Women who weigh < 40 kg should be identified and given food supplements consistently throughout pregnancy;given adequate antenatal care;monitored for weight gain during pregnancy and, if weight gain is sub-optimal, identify the causes and attempt remedial measures; andgiven appropriate antenatal, intrapartum and postpartum care.
Under NPAG in 51 poor districts all pregnant women were weighed those weighing
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Low birth weight 10 Plan strategy anganwadi workers to report all births in village, weigh all neonates delivered at home soon after birth and refer those weighing less than 2.2 kg to a hospital with a pediatrician.
Current status Feasibility demonstrated in small studies Anganwadis should have a 10kg tubular Salter scale for reasonably accurate weighing of neonate Need to have information about nearest hospital with a pediatricianUnfinished agenda - action will help in NNMR
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Over two decades there has been an increase in fat fold thickness of neonates in boys and girls in all birth weight categories
Chart7
3.63.23.83.5
43.44.44.2
4.53.74.94.5
4.93.75.45.1
boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Subscapular (mm)
Time trends in subscapular fat fold thickness (mm)
gestation
males
boysgirls
sachdevpurisachdevpuri
363.22.53.32
373.63.33.83.2
383.93.643.5
393.93.54.23.6
404.13.94.13.8
41443.83.9
subscapular
boysgirls
sachdevpurisachdevpuri
363.32.13.32.3
373.83.24.23.5
384.13.24.33.7
394.13.14.44.2
404.23.54.54.3
414.33.64.14.3
gestation
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triceps (mm)
Secular trends in triceps (mm)
brth wt
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Secular trends in triceps
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Secular trends in subscapular (mm)
boysgirls
sachdevpurisachdevpuri
2001-25003.43.43.53.2
2501-30003.83.84.23.7
3001-35004.34.34.63.9
3501-40005.14.24.93.9
boysgirls
sachdevpurisachdevpuri
2001-25003.63.23.83.5
2501-300043.44.44.2
3001-35004.53.74.94.5
3501-40004.93.75.45.1
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boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Triceps (mm)
Secular trends in triceps (mm)
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boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Subscapular (mm)
Secular trends in subscapular (mm)
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Over two decades there has been an increase in fat fold thickness of neonates in boys and girls in all gestational age categories
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3.22.53.32
3.63.33.83.2
3.93.643.5
3.93.54.23.6
4.13.94.13.8
443.83.9
boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
triceps (mm)
Time trends in Triceps fat fold thickness in neonates
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males
boysgirls
sachdevpurisachdevpuri
363.22.53.32
373.63.33.83.2
383.93.643.5
393.93.54.23.6
404.13.94.13.8
41443.83.9
sachdevpuri
3.32.1
3.83.2
4.13.2
4.13.1
4.23.5
4.33.6
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boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
triceps (mm)
Secular trends in triceps (mm)
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Birth weight, plasma glucose and insulin concentrations in 4-year old urban children Source: Yagnik et al, 1998
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Time Trends in nutritional status of Delhi cohortSource: Bhargava et al, 2004
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Current Status of Delhi cohort Source: Bhargava et al, 2004
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Breast feeding protection from under and over nutritionHow far have we succeeded in protection and promotion of breast feeding Emerging challenges
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Improving Infant Feeding
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Infant feeding practices -NFHS -2Source: NFHS 1998-99Breast feeding is universal in India but exclusive breast feeding upto six months and introduction of complementary feeds at six months is not common
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74.659.4
33.960.2
42.558.5
55.215
13.237
Goa65.4
65.246.5
47.241.8
17.4561.3
41.538.9
66.538.4
68.572.9
64.227.3
38.530.8
69.786.8
16.177.1
40.774.2
43.981.3
5830.1
36.338.7
53.717.5
16.387.3
48.355.4
56.917.3
48.846.3
55.233.5
Infants(0-3 months) exclusively brest fed
Timely complementary feeding of infants 6-9 mths
percent
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Infants(0-3 months) exclusively brest fedTimely complementary feeding of infants 6-9 mths
Andhra Pr.74.659.4
Ar. Pr.33.960.2
Assam42.558.5
Bihar55.215.0
Delhi13.237.0
Goa65.4
Gujarat65.246.5
Haryana47.241.8
Him. Pr.17.561.3
J & K41.538.9
Karnataka66.538.4
Kerala68.572.9
Madhya Pr.64.227.3
Maharashtra38.530.8
Manipur69.786.8
Meghalaya16.177.1
Mizoram40.774.2
Nagaland43.981.3
Orissa58.030.1
Punjab36.338.7
Rajasthan53.717.5
Sikkim16.387.3
Tamil Nadu48.355.4
Uttar Pr.56.917.3
W.Bengal48.846.3
INDIA55.233.5
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Infants(0-3 months) exclusively brest fed
Timely complementary feeding of infants 6-9 mths
percent
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Source: NFHS 1998-99Prevalence of undernutrition (Weight for age % below -2 SD)As a result there is steep increase in under nutrition between 6-23 months of age
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11.92
37.511.8
58.523.1
58.424.1
%-2SD
%-3SD
Age-groups
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StateNo. of beneficiaries as per Plg. Comm.
Pregnant Women in the BPL population 1999 (000's)BPL Population (0-4) Years 1999 (000's)Total beneficiaries (000's)Requirement of funds (in Rs. crores) as worked out by Plg.Comm.No. of beneficiaries estimated by Deptt. of WCD (000's)Requirement of funds (in Rs. crores) as per DWCDFunds allocated by the state Govt. 1997-98 (Rs. Crore)Gap as per Plg. Comm.Gap as per DWCD
Andhra Pr.285.061337.541622.6048.68250375.0940.008.6835.09
Assam285.531374.751660.2849.8192127.637.8641.9519.77
Bihar1620.576744.198364.76250.94309492.8219.13231.8173.69
Gujarat198.90842.181041.0831.23280184.03125.50-94.27-41.47
Haryana54.32259.81314.149.42100630.185.004.4225.18
Karnataka259.231239.611498.8444.97281584.4537.797.1846.66
Kerala80.19383.93464.1213.92144943.470.7513.1742.72
Madhya Pr.1039.514290.515330.02159.90301590.4541.54118.3648.91
Maharashtra561.853006.553568.41107.053569107.0743.3963.6663.68
Orissa458.822121.882580.7077.42225867.7462.3815.045.36
Punjab35.39184.48219.876.6086225.863.003.6022.86
Rajasthan295.201253.801549.0146.47208862.6410.1036.3752.54
Tamil Nadu278.491267.181545.6846.373979119.37104.00-57.6315.37
Uttar Pr.1961.557703.769665.32289.965489164.675.00284.96159.67
West Bengal493.562661.783155.3394.663446103.3821.6073.0681.78
Arunachal Pr.8.9646.3055.261.662417.232.81-1.154.42
Delhi25.33143.83169.165.072958.8520.75-15.68-11.90
Goa0.937.508.430.25962.880.50-0.252.38
Himachal Pr.12.1458.7970.932.1364319.296.64-4.5112.65
J&K12.1044.4456.541.7087226.167.33-5.6318.83
Manipur13.9586.45100.403.012898.671.871.146.80
Meghalaya24.6699.04123.693.711765.282.001.713.28
Mizoram3.2422.0025.240.761073.211.85-1.091.36
Nagaland8.4382.4090.832.722216.631.830.894.80
Sikkim4.6925.0329.720.89451.351.95-1.06-0.60
Tripura20.55139.35159.904.802678.016.95-2.151.06
A&N Islands1.499.4810.960.33310.930.55-0.220.38
Chandigarh1.026.577.590.23250.750.050.180.70
D&N Haveli1.424.786.200.19110.330.47-0.28-0.14
Daman & Diu0.210.891.100.0370.210.34-0.31-0.13
Lakshadweep0.261.211.470.0450.150.19-0.15-0.04
Pondicherry4.1126.7430.840.93591.774.16-3.23-2.39
Total8051.6535476.7643528.411305.8542685.001280.55587.28718.57693.27
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Tenth Plan- major focus on Prevention of undernutrition in infancy through promotion of exclusive breast feeding in the first six months; nutrition education for the introduction of appropriate low-cost, energy dense (home available) complementary food at 6 months ;focus on nutrition education by AWW/ ANM during each contact. Yet to be operationalised under ICDS /NRHMNeeded clear crisp messages; AWW to district doctor should all say the same things repeatedly to bring about behavioral change Use of mass media as in NRHM - will it help in bring uniformity in messages of health and ICDS workers ?
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The goals for the Tenth Plan are to enhance early initiation of breast-feeding (colostrum feeding) from the current level of 15.8 per cent (as per NFHS 2) to 50 per cent;enhance the exclusive breast-feeding rate for children up to the age of six months from the current rate of 55.2 per cent (as per NFHS 2) to 80 per cent;enhance the complementary feeding rate at six months from the current level of 33.5 percent (as per NFHS 2) to 75 per cent.Available data from DLHS and BPNI surveys indicate that these goals will not be achieved Operationalisation of this component should get major attention during 11th Plan
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Under nutrition in Preschool children Role of poverty and poor caring practices Screening , early detection and effective management can change the scenario
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Source: NNMB reportsTime Trends in Energy intake and undernutrition in children (1-3 years)Even though there is no increase in energy intake over time there has been a decline in severe undernutrition perhaps because of better access to health care
Chart1
83437
90826.6
77924.7
80722.5
72921
Energy intake
Severe Underweight(
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Source: NFHS 1998-99 Nutritional Status of children by IncomeUndernutrition rates among poor in Kerala are similar to undernutrition rates among the rich in UP. Appropriate IYCF and caring can lead to steep fall in undernutrition rates in preschoolers
Chart4
124.72.5
1683.5
18126
26.51610
29.5219.9
30.1154.9
Low
Medium
High
Fig10
Andhra Pradesh31.5
Assam43.8
Bihar54.6
Gujarat41.1
Haryana41.6
Himachal Pradesh33.3
J&K50.3
Karnataka33.6
Kerala21.1
Madhya Pradesh52.8
Maharashtra39.2
Orissa42.9
Punjab39.6
Rajasthan52.9
Tamil Nadu23.2
Uttar Pradesh58.1
West Bengal36.5
Fig10
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Figure 13: Interstate differences in birth order 3 and Above
Fig 14
LowMediumHigh
Kerala124.72.5
Tamil Nadu1683.5
Punjab18126
Orissa26.51610
Uttar Pradesh29.5219.9
Gujarat30.1154.9
Fig 14
000
000
000
000
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Low
Medium
High
Figure 14: Nutritional Status of children by Income
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Source: NFHS II
MBD00004039.xls
Chart1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Figure16: Distribution of Districts as per 1 or 2 IFA Tablets regularly - Major States (RHS 1998-99)
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Source: RCH Survey, Department of Family Welfare
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47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Fig.8-Distribution of Districts as per 1 or 2 IFA Tablets regularly - Major States
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Mean Energy Consumption- NNMB 2000The gap between RDA and the actual energy intake is greatest in preschool children and lowest in adults Poor caring practices rather than poverty appear to be the major factor for low energy intake in children
Age groupsMalesFemalesKcalsRDA% RDAKcalsRDA% RDAPre-school889135765.5897135166.4School Age1464192975.91409187675.1Adolescents2065244184.61670182391.6Adults2226242591.819231874102.6
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Over years there has been a increase in the number of households where adults are getting adequate food but children are not; this confirms that poor child feeding and caring practices rather than poverty is becoming the common cause of of undernutrition in preschool child
Chart1
31.131
25.442.9
19.17.2
24.418.9
Source:NNMB
1975-80
1996-97
Percentage
Comparison of Energy Adequate Status of Preschool Chidren and Adults
Intake
Nutrient Intake (CU/Day) By Community
Protein(g)Energy(kcal)Iron(mg)Vit.A(ug)
SC55.1212526361
ST49.8203624.3237
BC53.3209423.7291
Others56.2216925.6328
Landless A.L.51.7198923.6198
Other lab.47.9204224.7381
Ccultivators55.2220526.6362
Others54.4218723308
Status
% of 1-5 year Children with Severe Undernutrition
by Gomez Classification
State1975+1988+1996+
Kerala10.322
Tamil Nadu12.64.22.9
Karnataka14.38.36.2
Andhra pr.15.47.57.1
Maharashtra21.97.87.7
Gujarat13.81316.7
Orissa14.910.74.1
Pooled158.76.2
1975-801996-97
+ + +31.131
+ + -25.442.9
- - -19.17.2
Others24.418.9
Status
00000000
00000000
00000000
Kerala
Tamil Nadu
Karnataka
Andhra pr.
Maharashtra
Gujarat
Orissa
Pooled
percent
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Fig.4.24
1975-80
1996-97
Percentage
Comparison of Energy Adequate Status of Preschool Chidren and Adults - Distribution (%) of Households
Dietary
Intake
Adult
Male
Adult
Female
Preschool
Children
+ + +
Adequate
Adequate
Adequate
+ +
-
Adequate
Adequate
Inadequate
-
-
-
Inadequate
Inadequate
Inadequate
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Over years there has been a decline in severe under nutrition ( weight for age and height for age) but not in wasting ( weight for height). Health implications of wasting are not well documented Does low wasting rate explain the South Asian paradox ?
Chart1
77.578.618.1
68.665.119.9
63.66316.7
62.457.718.5
60.149.322.5
53.45217.5
4745.515.5
underweight(
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Energy Intake (INP) & Undernutrition among children (NFHS II)Higher dietary intake will not lead to better child nutrition unless infections are controlled
Chart1
27608.8
270020.7
261424.3
243116.5
242616.3
237516.2
234010.3
221117.6
21404.7
211520.8
211521.9
205525.5
187110.6
Kilo Calories
% Children (0-3 years) severely under weight as per NFHS-II
Kilocalories
% children
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ENERGY INTAKE
StatesKilo Calories% Children (0-3 years) severely under weight as per NFHS-II
Punjab#27608.8
Orissa*270020.7
Madhya Pradesh*261424.3
Karnataka*243116.5
West Bengal*242616.3
Gujarat*237516.2
Andhra Pradesh*234010.3
Maharashtra*221117.6
Kerala*21404.7
Rajasthan#211520.8
Uttar Pradesh*211521.9
Bihar#205525.5
Tamil Nadu*187110.6
Source: * NMB(1981-91) # Food & Nutrition Bureau (1980-86)
NFHS (1992-93)
Source: * NMB(1981-91) # Food & Nutrition Bureau (1980-86)
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Kilo Calories
Kilocalories
Figure : Average Intake of Energy * NMB(1981-91) # FNB (1980-86)
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Kilo Calories
% Children (0-3 years) severely under weight as per NFHS-II
Kilocalories
% children
Energy Intake (*NMB 1981-91 # FNB 1980-86) & Undernutrition among children (NFHS II)
Sheet3
- Source: NFHS 1998-99% of severe underweight(
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Source: NFHS 1998-99 Nutritional Status of children by Income
Chart4
124.72.5
1683.5
18126
26.51610
29.5219.9
30.1154.9
Low
Medium
High
Fig10
Andhra Pradesh31.5
Assam43.8
Bihar54.6
Gujarat41.1
Haryana41.6
Himachal Pradesh33.3
J&K50.3
Karnataka33.6
Kerala21.1
Madhya Pradesh52.8
Maharashtra39.2
Orissa42.9
Punjab39.6
Rajasthan52.9
Tamil Nadu23.2
Uttar Pradesh58.1
West Bengal36.5
Fig10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Figure 13: Interstate differences in birth order 3 and Above
Fig 14
LowMediumHigh
Kerala124.72.5
Tamil Nadu1683.5
Punjab18126
Orissa26.51610
Uttar Pradesh29.5219.9
Gujarat30.1154.9
Fig 14
000
000
000
000
000
000
Low
Medium
High
Figure 14: Nutritional Status of children by Income
Sheet3
Source: NFHS II
MBD00004039.xls
Chart1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Figure16: Distribution of Districts as per 1 or 2 IFA Tablets regularly - Major States (RHS 1998-99)
Sheet1
Source: RCH Survey, Department of Family Welfare
Sheet1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Fig.8-Distribution of Districts as per 1 or 2 IFA Tablets regularly - Major States
Sheet2
Sheet3
-
Tenth Plan Goals
Reduce prevalence of
severe undernutrition in children in 0-6 age group by 50% Mild and moderate under-nutrition from current level of 47% to 40%
Tenth Plan recommended strategies for reduction of undernutrition have not been operationalised
Available data from DLHS show that there is no major reduction in undernutrition since 1998-99.
BUTProjects in Orissa, WB ,MP has demonstrated that if the suggested strategies are followed these goals are achievable with in the existing constraints
-
Capacity building in ICDS: Tenth Plan enhancing the quality and impact of ICDS substantially through training, supervision of the ICDS personnel and improved community ownership of the programme;concentrating on the improvement of the quality of care and inter-sectoral coordination and strengthening nutrition action by the health sector;creating nutrition awareness through IEC at all levels (community, womens group, village-level workers, PRIs, programme managers and policy makers at the state and central levels); andestablishing a reliable monitoring and evaluation mechanismYet to be operationalised; should receive priority
-
Convergence of services AWW can weigh neonates in home deliveries and refer those requiring careadvise regarding exclusive breast feeding and complementary feeding identify undernourished pre-school children by weighing them at least once every three months and give food on priority to them;act as depot holder for ORS.assist in emergency referral
-
Convergence of services ANM willImmunize all infants, pregnant women and children as per schedule.Screen children especially the under nourished ones for health problems and manage/ refer those with problems. AWW willAssist ANM in organizing immunization health check ups in anganwadi;Assist ANM in administering massive dose Vitamin A
-
Micronutrient deficiencies All effort for combating anaemiaReview Vitamin A supplementation Universal access to iodised salt
-
Anaemia is a major problem right from childhood; it worsen during adolescence in girls Advent of pregnancy further aggravates anaemia
Chart1
339.2507.8
2443285
33651.49.6
severe
moderate
mild
no anaemia
Group
Percentage
Prevalence of Anaemia (%){DLHS 2003}
Sheet1
prevalence of anaemia
severemoderatemildno anaemia
preschool children3.039.250.07.8
adolescent girls24.043.028.05.0
pregnant women3.036.051.49.6
Sheet1
0000
0000
0000
severe
moderate
mild
no anaemia
Group
Percentage
Prevalence of Anaemia (%)
Sheet2
Sheet3
-
Combating anaemia Promote breastfeeding, improve complementary feeding Dietary diversification Double fortified salt Screen all children where ever possible school health, hospitals OPDs Detect and treat anaemia vigorously
- Vitamin A DeficiencyClinical Deficiency Marked ReductionBlindness: 2% (1974) to 0.04% (1985)Bitot Spots: ICMR (1969) 4.2% DWCD (1996) 0.21% NNMB: 2% (1996), 0.7% (1990 & 1997)Isolated Areas Bihar, UP (DNP-ICMR 01)Night Blindness (
-
Coverage Under Massive dose of Vitamin ACoverage can be improved -Orissa, UP But overall coverage remains low
-
Prevalence of Bitot spot has declined Is this the right time to review the massive dose vitamin A programme ?
Chart8
0.70.110.11
0.70.080.08
0.80.20.2
WHO cut - off level (0.5%) of Public Health significance
Percent
Prevalence (%) of Bitot Spots among 1-
-
Huge installed capacity for producing iodised salt This is under utilised. We supply iodised salt to other countries who attain high rates of iodised salt use
Chart1
0.210.39
0.230.63
0.340.89
0.731.61
1.484.23
2.174.5
2.274.87
2.465.79
2.846.28
2.766.53
2.856.57
2.987.5
3.77.99
4.18.73
4.0410.75
3.9711.52
4.4312.88
4.6913.92
Source:Salt Department
Production
Capacity
Million Tonnes
Progress of iodised salt production in India
Prod.&Capacity
Table X
Progress of NIDDCP at a glance as per the records of Salt Department
(in lakh tonnes)
YearNo. of Iodisation UnitsCapacityRequirementsProductionSuppliesState/UT banned
FullPartial
1983133.869.162.131.4174
198611516.0811.277.275.98106
198935348.7127.2422.7421.34176
199252965.3329.6227.1326.87226
199351965.6733.3128.2327.23245
199457275.0435.8429.4528.01254
199565782.3342.8136.9634.88272
199669987.2851.7040.9540.92272
1997784107.5052.0040.4139.07292
1998809*115.21*52.0039.7037.42292
2000926143.4846.89
*As on 31st March, 1998
Source: National Consultation on 'Benefits and Safety of Iodised Salt,
Salt Department, Government of India, Jaipur
YearProductionCapacity
19830.210.39
19840.230.63
19850.340.89
19860.731.61
19871.484.23
19882.174.50
19892.274.87
19902.465.79
19912.846.28
19922.766.53
19932.856.57
19942.987.50
19953.77.99
19964.18.73
19974.0410.75
19983.9711.52
19994.4312.88
20004.6913.92
Prod.&Capacity
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Production
Capacity
Year
Million Tonnes
Progress of iodised salt production in India
Manufact
Number of iodised salt manufacturers in the Country
YearNo. of Units
198415
198543
1986115
1987285
1988327
1989373
1990439
1991497
1992517
1993552
1994593
1995650
Manufact
0
0
0
0
0
0
0
0
0
0
0
0
Source: Evaluation of Universal Salt Iodisation in India, Salt Deptt., Min. of Industry, Govt. of India
No. of Units
Fig.11-No. of Iodized Salt Manufacturers in the Country
Price
Table XII
PDS Selling Price and Retail Price of Salt
Sl.No.Name of StatePDS Selling Price in Rs.per kgRetail Price during Dec., 2000 inRs./kg
1.Andhra PradeshN.A.3.00 loose 6.50 packed
2.Arunachal Pradesh2.602.35 loose
3.Assam2.00 powdered 3.00 packed1.99-2.07 loose 2.05-3.15 packed
4.Bihar6.50 packed
5.Goa4.00 loose 6.00 packed
6.Gujarat0.50 (Rs.1.82 subsidy comp.)
7.HaryanaN.A.
8.Himachal Pradesh7.00 packed
9.Jammu & KashmirN.A.
10.Kerala2.25 crystal salt 4.65 free flow
11.Maharashtra2.90 DPAP areas 1.65 TTDP areas
12.
13.MeghalayaN.A.3-3.50 loose 5-7 packed
14.MizoramN.A.N.A.
15.Orissa2.00
16.Rajasthan3.256.00 packed
17.SikkimN.A.
18.Tamil Nadu2.50
19.Tripura1.903-3.50 loose 5-6 packed
20.West BengalN.A.2.50 packed
21.Delhi2.50 3.50 ref. free flow6.00 packed
22.Lakshadweep2.50
23.PondicherryN.A.6.50 loose/packed
Supplies
Table XI
POPULATION, REQUIREMENT & SUPPLIES OF EDIBLE SALT - 2000
RequirementSupplies
Sl.No.Name of StateProv. Popn. as@5 kgs induring 2000
per 2001 Census000 tonnesin '000 tonnes
(Salt Comm.)
INDIA1,027,015,2475135.15221.2
1Andhra Pradesh75,727,541378.6523.6@
2Arunachal Pradesh1,091,1175.54.5
3Assam26,638,407133.2192.1
4Bihar82,878,796414.4671.0
5Jharkhand26,909,428134.5
6Goa1,343,9986.71.0
7Gujarat50,596,992253.0206.4
8Haryana21,082,989105.414.5
9Himachal Pradesh6,077,24830.44.8
10Jammu & Kashmir10,069,91750.334.0
11Karnataka52,733,958263.7115.3
12Kerala31,838,619159.2274.2@
13Madhya Pradesh60,385,118301.9336.3
14Chhatisgarh20,795,956104.0
15Maharashtra96,752,247483.8492.7@
16Manipur2,388,63411.9
17Meghalaya2,306,06911.5
18Mizoram891,0584.54.7
19Nagaland1,988,6369.910.8
20Orissa36,706,920183.5203.7
21Punjab24,289,296121.459.4
22Rajasthan56,473,122282.443.3
23Sikkim540,4932.74.7
24Tamil Nadu62,110,839310.6193.9
25Tripura3,191,16816.019.8
26Uttar Pradesh166,052,859830.3930.3
27Uttaranchal8,479,56242.4
28West Bengal80,221,171401.1654.5
29Andaman & Nicobar Islands *356,2651.80.6
30Chandigarh900,9144.527.4
31Dadra & Nagar Haveli220,4511.1
32Daman & Diu158,0590.80.1
33Delhi13,782,97668.9189.2
34Lakshadweep60,5950.3
35Pondicherry973,8294.91.4
36Defence7.0
@ Non iodised salt: 675.6
Iodised salt : 4545.6
Total 5221.2
cost
Cost of Iodisation
% Distribution of various components
Raw salt14
Crushing2
Chemical2
Labour5
Pouches&bags22
Manufacturer's margin&Wastage6
Wholesaler's margin8
Rail Tpt.23
Retailer's margin18
cost
0
0
0
0
0
0
0
0
0
Source: Salt Department
Fig.15
Packings
Packings used by Wholesalers for Distribution of Iodised Salt
Bulk69
Retail19
Bulk&Ret12
Packings
0
0
0
Fig.13
Source: Salt Department
Transport
Transportation of Iodised Salt
By Rail24.7
By Road22
By Rl.&Rd.53.4
Transport
0
0
0
Source: Salt Department
Fig.12
Storage
Storage of Iodised Salt by Manufacturers
Open Space39.7
Open Sp cvrd with polythene sheets8.2
Cvrd Godown52
Storage
0
0
0
Fig.14
Source: Salt Department
-
Many coastal , salt manufacturing states with good health indices have low iodised salt use. Prevalence of goitre in these non endemic states is relatively high
Chart1
0.6
0
1.9
3.8
12.2
4.3
0.1
9
3.9
Source: NNMB 2002
Percentage
Prevalence of goitre (children 6-12yrs)
Sheet1
Prevalence (%) of Goitre in 6-
-
There was a decline in household access to iodised salt after the ban on sale of non- iodised salt was lifted Reimposition of ban is under way
-
Tenth Plan strategy Promotion of appropriate dietary intake and lifestyles for the prevention and management of obesity and diet-related chronic diseases
Nutrition monitoring and surveillance to enable the country to track changes in the nutritional and health status of the population to ensure that:
existing opportunities for improving nutritional status are fully utilized; andemerging problems are identified early and corrected expeditiously.
-
Tenth Plan strategy Research efforts to be directed towards:
review of the recommended dietary intake of Indians;building up of epidemiological data on: relationship between birth weight, survival, growth and development in childhood and adolescence;body mass index norms of Indians and health consequences of deviation from these norms.
-
NORMAL CHILDWASTED CHILDSHORT CHILDSHORT AND WASTED CHILD
-
A NORMAL CHILDB TALL & SLIM CHILDA & B have same bodyweight. B should get more food to reach appropriate weight for his height and continue linear growth
-
A NORMAL CHILD B SHORT FAT CHILD A & B have same weight. B is short and requires more exercise to get to appropriate weight for his height .
-
BMI is the most widely used parameter for assessment of nutritional status in adults but is not used as an index to assess nutritional status in childhood and adolescence.This is perhaps because computation of BMI for age in growing children appears complicated
-
Chart3
2969812
029053
(+3)SD
Percentage
Nutritional status of public school children using BMI-for-age and weight-for-age (NFI, 2000)
BOYS
BOYS(HEIGHT FOR AGE)
AGEHIG BoysNCHS
6+121118.686.24
7+128.00123.085.37
8+132.50130.235.22
9+139.00134.936.35
10+142.70140.366.38
11+147.05145.886.44
12+154.50152.759.52
13+161.90159.767.21
14+165.40165.428.33
15+177.00172.985.02
16+172.80174.606.64
BOYS(WEIGHT FOR AGE)
AGEHIG BoysNCHS
6+2221.65
7+23.0023.42
8+29.7027.04
9+35.8029.82
10+33.8533.32
11+36.7037.12
12+44.9042.05
13+52.9547.80
14+55.6053.08
15+69.0061.38
16+61.5063.70
BOYS (BMI FOR AGE)
AGEHIG BoysNCHS
6+15.0115.37
7+15.3315.5
8+16.2715.94
9+17.9416.37
10+16.8216.9
11+17.1717.43
12+18.6918.01
13+20.0718.7
14+20.4319.39
15+21.8020.5
16+21.3020.89
BOYSMEAN SDSuprailliac (mm)Sum of 4 SFT(mm)WC (cm)HC (cm)WHRImpedence
Age (years)Sample Size (n)Age (years)Height (cm)Weight (Kg)BMI (Kg/m2)MUAC (cm)Tricep (mm)Bicep (mm)Subscapular (mm)8.205.0332.3916.0254.345.9862.755.820.87-
6+416.050.03122.116.2423.545.1915.652.3719.335.8410.004.666.543.237.653.786.903.5628.8911.1245.6914.7652.4717.260.87775.000.00
7+237.030.02126.355.3724.303.5615.191.7518.442.169.373.606.172.766.442.288.175.0733.4715.2358.632.7869.122.530.85700.0068.91
8+318.080.03133.235.2230.085.8416.852.4320.643.3210.574.376.675.408.053.6712.066.9945.0619.3462.703.2673.432.760.85702.0066.42
9+619.060.04138.436.3535.317.1618.322.9722.793.1713.524.668.033.1411.465.6511.667.0341.7122.2261.353.5771.432.880.86697.0085.78
10+6410.060.04142.536.3835.367.9617.272.9822.513.5912.375.807.263.7010.426.4111.208.0443.1623.7764.454.1075.003.620.86692.0063.83
11+3211.050.04147.516.4438.839.1817.733.5023.164.0713.135.787.684.0111.167.0614.118.8248.3426.6268.083.5380.702.970.84657.0081.22
12+3012.050.04156.009.5246.8110.1319.103.0824.493.5713.476.448.064.1212.708.6715.348.9547.9125.4869.983.6984.253.230.83599.0091.32
13+4013.060.04162.847.2153.5510.2320.103.0825.273.4513.426.597.323.6011.847.5817.458.4556.4827.2272.984.1187.683.900.83617.0066.08
14+3914.050.03165.838.3357.9511.8521.023.6726.723.2216.057.679.374.9713.617.3013.902.8.43.608.5773.452.5692.883.230.79549.0052.02
15+415.100.01177.635.0269.1310.4421.913.2428.502.0813.353.096.351.2810.002.8915.489.4251.4827.0876.054.6291.433.350.83580.00115.73
16+39
BOYSGIRLS
Age (years)Sample Size (n)Height (cm)Weight (Kg)BMI (Kg/m2)Age (years)Sample Size (n)Height (cm)Weight (Kg)BMI (Kg/m2)
6+41122.116.2423.545.1915.652.376+36120.015.8823.404.4116.202.58
7+23126.355.3724.303.5615.191.757+19125.335.6725.016.2715.792.99
8+31133.235.2230.085.8416.852.438+7130.906.7529.915.0117.392.26
9+61138.436.3535.317.1618.322.979+15138.618.3633.137.6917.122.68
10+64142.536.3835.367.9617.272.9810+52145.277.4337.668.0917.732.82
11+32147.516.4438.839.1817.733.5011+8152.964.1543.246.2418.492.74
12+30156.009.5246.8110.1319.103.0812+31154.736.7847.488.8519.752.92
13+40162.847.2153.5510.2320.103.0813+54157.575.0649.378.9419.833.13
14+39165.838.3357.9511.8521.023.6714+26158.165.5548.747.3419.482.75
15+4177.635.0269.1310.4421.913.2415+9160.975.7849.896.3519.201.71
BOYS
Age (years)Sample Size (n)Subscapular (mm)Suprailliac (mm)Sum of 4 SFT(mm)
6+417.653.788.205.0332.3916.02
7+236.442.286.903.5628.8911.12
8+318.053.678.175.0733.4715.23
9+6111.465.6512.066.9945.0619.34
10+6410.426.4111.667.0341.7122.22
11+3211.167.0611.208.0443.1623.77
12+3012.708.6714.118.8248.3426.62
13+4011.847.5815.348.9547.9125.48
14+3913.617.3017.458.4556.4827.22
15+410.002.8913.902.8.43.608.57
16+3913.628.3015.489.4251.4827.08
Age wise mean values for waist circumference, hip circumference and WHR in HIG boys (n=404)
Age (years)Sample Size (n)WC (cm)HC (cm)WHR
6+4154.345.9862.755.820.87
7+2345.6914.7652.4717.260.87
8+3158.632.7869.122.530.85
9+6162.703.2673.432.760.85
10+6461.353.5771.432.880.86
11+3264.454.1075.003.620.86
12+3068.083.5380.702.970.84
13+4069.983.6984.253.230.83
14+3972.984.1187.683.900.83
15+473.452.5692.883.230.79
16+3976.054.6291.433.350.83
6+413654.34 5.98
7+231945.69 14.76
8+31758.63 2.78
9+611562.70 3.26
10+645261.35 3.57
11+32864.45 4.10
12+303168.08 3.53
13+405469.98 3.69
14+392672.98 4.11
15+4973.45 2.56
16+392976.05 4.62
Table 6. Age wise mean values of Triceps and Biceps skinfolds in boys and girls
BOYS (n=404)GIRLS (n=286)
Age (years)Sample Size (n)Tricep (mm)Bicep (mm)Sample Size (n)Tricep (mm)Bicep (mm)
6+4110.004.666.543.233611.394.087.132.60
7+239.373.606.172.761911.314.276.381.97
8+3110.574.376.675.40714.735.779.544.45
9+6113.524.668.033.141515.325.599.204.31
10+6412.375.807.263.705215.514.919.893.67
11+3213.135.787.684.01813.503.778.183.06
12+3013.476.448.064.123115.724.989.643.54
13+4013.426.597.323.605416.336.7310.464.78
14+3916.057.679.374.972616.675.909.903.58
15+413.353.096.351.28916.132.0210.332.93
16+3914.016.418.394.332920.695.1712.554.48
MEAN SD
GIRLSSample Size (n)Age (years)Height (cm)Weight (Kg)BMI (Kg/m2)MUAC (cm)Tricep (mm)Bicep (mm)
Age (years)366.050.03120.015.8823.404.4116.202.5818.692.3011.394.087.132.60
6+197.040.04125.335.6725.016.2715.792.9918.582.8511.314.276.381.97
7+78.040.02130.906.7529.915.0117.392.2621.473.2914.735.779.544.45
8+159.080.02138.618.3633.137.6917.122.6822.183.1815.325.599.204.31
9+5210.060.04145.277.4337.668.0917.732.8222.792.7915.514.919.893.67
10+811.080.04152.964.1543.246.2418.492.7422.871.8913.503.778.183.06
11+3112.060.04154.736.7847.488.8519.752.9224.282.4815.724.989.643.54
12+5413.050.04157.575.0649.378.9419.833.1323.863.5716.336.7310.464.78
13+2614.040.02158.165.5548.747.3419.482.7524.552.3316.675.909.903.58
14+915.080.04160.975.7849.896.3519.201.7124.591.2916.132.0210.332.93
15+2916.040.03160.476.3959.1812.2422.934.1327.163.1420.695.1712.554.48
16+
Table 3: Age wise Mean BMI values for Boys and Girls
Boys (n=404)Girls (n=286)
Age (years)Sample Size (n)BMI (Kg/m2)Sample Size (n)BMI (Kg/m2)
6+4115.652.373616.202.58
7+2315.191.751915.792.99
8+3116.852.43717.392.26
9+6118.322.971517.122.68
10+6417.272.985217.732.82
11+3217.733.50818.492.74
12+3019.103.083119.752.92
13+4020.103.085419.833.13
14+3921.023.672619.482.75
15+421.913.24919.201.71
16+3921.643.242922.934.13
Table 5. Age wise Mean MUAC values for Boys and Girls
Boys (n=404)Girls (n=286)
Age (years)Sample Size (n)MUAC (cm)Sample Size (n)MUAC (cm)
6+4119.335.843618.692.30
7+2318.442.161918.582.85
8+3120.643.32721.473.29
9+6122.793.171522.183.18
10+6422.513.595222.792.79
11+3223.164.07822.871.89
12+3024.493.573124.282.48
13+4025.273.455423.863.57
14+3926.723.222624.552.33
15+428.502.08924.591.29
16+3927.593.682927.163.14
BoysGirls
6+19.3318.695.842.3
7+18.4418.582.162.85
8+20.6421.473.323.29
9+22.7922.183.173.18
10+22.5122.793.592.79
11+23.1622.874.071.89
12+24.4924.283.572.48
13+25.2723.863.453.57
14+26.7224.553.222.33
15+28.524.592.081.29
16+27.5927.163.683.14
BoysGirls
6+1011.394.664.08
7+9.3711.313.64.27
8+10.5714.734.375.77
9+13.5215.324.665.59
10+12.3715.515.84.91
11+13.1313.55.783.77
12+13.4715.726.444.98
13+13.4216.336.596.73
14+16.0516.677.675.9
15+13.3516.133.092.02
16+14.0120.696.415.17
BoysGirls
6+6.547.133.232.6
7+6.176.382.761.97
8+6.679.545.44.45
9+8.039.23.144.31
10+7.269.893.73.67
11+7.688.184.013.06
12+8.069.644.123.54
13+7.3210.463.64.78
14+9.379.94.973.58
15+6.3510.331.282.93
16+8.3912.554.334.48
Age (years)Impedence (ohms)
7+7750.00
8+70068.91
9+70266.42
10+69785.78
11+69263.83
12+65781.22
13+59991.32
14+61766.08
15+54952.02
16+580115.73
Age (years)Sample Size (n)Subscapular (mm)Suprailliac (mm)Sum of 4 SFT(mm)
6+417.653.788.205.0332.3916.02
7+236.442.286.903.5628.8911.12
8+318.053.678.175.0733.4715.23
9+6111.465.6512.066.9945.0619.34
10+6410.426.4111.667.0341.7122.22
11+3211.167.0611.208.0443.1623.77
12+3012.708.6714.118.8248.3426.62
13+4011.847.5815.348.9547.9125.48
14+3913.617.3017.458.4556.4827.22
15+410.002.8913.902.8.43.608.57
16+3913.628.3015.489.4251.4827.08
boys
Height (cm)Weight (Kg)BMI (Kg/m2)heightweightbmi
122.1123.5415.656.245.192.37
126.3524.315.195.373.561.75
133.2330.0816.855.225.842.43
138.4335.3118.326.357.162.97
142.5335.3617.276.387.962.98
147.5138.8317.736.449.183.5
156.0046.8119.109.5210.133.08
162.8453.5520.107.2110.233.08
165.8357.9521.028.3311.853.67
177.6369.1321.915.0210.443.24
girls13.52
Height (cm)Weight (Kg)BMI (Kg/m2)heightweightbmi
120.0123.4016.205.884.412.58
125.3325.0115.795.676.272.99
130.9029.9117.396.755.012.26
138.6133.1317.128.367.692.68
145.2737.6617.737.438.092.82
152.9643.2418.494.156.242.74
154.7347.4819.756.788.852.92
157.5749.3719.835.068.943.13
158.1648.7419.485.557.342.75
160.9749.8919.205.786.351.71
160.4759.1822.936.3912.244.13
BOYS
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
HEIGHT (cm)
Figure 3. Comparison of median heights of HIG boys with NCHS median
GIRLS
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
WEIGHT (Kg)
Figure 1. Comparison of median weights of HIG boys with NCHS median
Chart1
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
BMI (Kg/m2)
Figure 5. Comparison of median BMI of HIG boys with NCHS median
GRAPHS
005.845.842.32.3
002.162.162.852.85
003.323.323.293.29
003.173.173.183.18
003.593.592.792.79
004.074.071.891.89
003.573.572.482.48
003.453.453.573.57
003.223.222.332.33
002.082.081.291.29
003.683.683.143.14
Boys
Girls
Age (years)
MUAC (cm)
Age wise trend of MUAC (Mean SD) in HIG boys and girls
Prevalence 2
004.664.664.084.08
003.63.64.274.27
004.374.375.775.77
004.664.665.595.59
005.85.84.914.91
005.785.783.773.77
006.446.444.984.98
006.596.596.736.73
007.677.675.95.9
003.093.092.022.02
006.416.415.175.17
Boys
Girls
Age (years)
Triceps (mm)
Age wise trend of Triceps (Mean SD) in HIG boys and girls
Prevalence 1
003.233.232.62.6
002.762.761.971.97
005.45.44.454.45
003.143.144.314.31
003.73.73.673.67
004.014.013.063.06
004.124.123.543.54
003.63.64.784.78
004.974.973.583.58
001.281.282.932.93
004.334.334.484.48
Boys
Girls
Age (years)
Bicep (mm)
Age wise trend of Biceps (Mean SD) in HIG boys and girls
0
0
0
0
0
0
0
0
0
0
Impedence (ohms)
Age (years)
Impedance (ohms)
Figure 14. Impedence in HIG boys (n=100)
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (years)
Triceps (mm)
Figure 12. Age-wise trend of Triceps in HIG boys and girls
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (yrs)
Biceps (mm)
Figure 13. Age-wise trend of Biceps in HIG boys and girls
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (years)
MUAC (cm)
Figure 11.Age-wise trend of MUAC IN HIG boys and girls
GIRLS(HEIGHT FOR AGE)
AGEHIG GirlsNCHS
6+120117.25
7+125.1126.72
8+130.70128.18
9+136.00136.43
10+144.85141.52
11+154.00149.38
12+155.50154.32
13+158.25158.76
14+159.50160.91
15+163162.20
16+161.50162.63
GIRLS(WEIGHT FOR AGE)
AGEHIG GirlsNCHS
6+22.920.48
7+24.225.03
8+30.5025.91
9+31.4031.26
10+36.6034.74
11+42.4040.05
12+48.1043.72
13+48.2048.02
14+46.4051.42
15+50.955.06
16+55.5056.24
GIRLS(BMI FOR AGE)
AGEHIG GirlsNCHS
6+15.9514.89
7+15.5315.59
8+17.7115.77
9+16.7616.79
10+17.8617.34
11+17.8517.94
12+19.1418.35
13+19.4519.05
14+19.0219.86
15+19.4320.93
16+22.0021.26
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
HEIGHT (cm)
Figure 4. Comparison of median heights of HIG girls with NCHS median
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
WEIGHT (Kg)
Figure 2. Comparison of median weights of HIG girls with NCHS median
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
BMI (Kg/m2)
Figure 6. Comparison of median BMI of HIG girls with NCHS median
19.4419.4447.2311.112.78
10.535.2657.921.055.26
028.5757.1414.290
6.6708013.330
01.9282.6915.390
0010000
6.45093.5500
3.75.5690.7400
0088.4611.540
0088.8911.110
10.3510.3579.300
(+3SD) and above
(+2SD) and above
(-2SD)-(+2SD)
(-2SD) and below
(-3SD) and below
WEIGHT FOR AGE
BMI FOR AGE
078.0512.29.8
095.74.350
090.329.70
086.911.51.2
3.1390.636.30
6.2587.56.250
093.36.70
2.5907.50
097.4202.56
010000
2.5687.1810.260
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 9. Frequency distribution for weight for age in HIG boys
2.7877.7813.895.56
089.475.265.26
010000
093.36.670
080.7713.465.77
010000
090.326.453.23
094.443.71.85
010000
010000
086.213.4510.34
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 10. Frequency distribution for weight for age in HIG girls
1.377.9212.997.79
092.864.762.38
092.17.90
088.1610.531.32
1.786.239.482.59
59050
091.86.561.64
1.0692.565.321.06
098.4601.54
010000
1.4786.767.354.42
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 8. Frequency distribution for weight for age in HIG children (Boys+Girls)
7.7914.250.611.615.5
2.328.559.54.74.7
0076.37.813.1
07.87110.510.5
016.379.32.51.7
2.522.567.52.55
09.878.63.28.1
13.182.96.36.3
016.969.26.17.6
030.769.300
4.410.267.610.27.3
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 12. Frequency distribution of BMI for age in HIG (BOYS + GIRLS)
11.916.752.44.811.9
034.860.94.30
0080.653.2316.12
06.5668.8513.1211.48
017.1976.553.133.13
3.1328.1359.383.136.23
02063.336.6710
2.57.572.57.510
020.5256.4210.2612.8
0752500
7.6917.9558.9710.265.13
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 13. Frequency distribution of BMI for age in HIG boys
2.7811.1147.2319.4419.44
5.2621.0557.95.2610.53
014.2957.1428.570
013.338006.67
015.3982.691.920
0010000
0093.5506.45
0090.745.563.7
011.5488.4600
011.1188.8900
0079.310.3510.35
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 14. Frequency distribution of BMI for age in HIG girls
2221.65
2323.42
29.727.04
35.829.82
33.8533.32
36.737.12
44.942.05
52.9547.8
55.653.08
6961.38
61.563.7
HIG Boys
NCHS
AGE (years)
WEIGHT (Kg)
Figure 1. Comparison of median weights of HIG boys with NCHS median
22.920.48
24.225.03
30.525.91
31.431.26
36.634.74
42.440.05
48.143.72
48.248.02
46.451.42
50.955.06
55.556.24
HIG Girls
NCHS
AGE (years)
WEIGHT (Kg)
Figure 2. Comparison of median weights of HIG girls with NCHS median
121118.68
128123.08
132.5130.2325983871
139134.9335418033
142.7140.36
147.05145.88
154.5152.75
161.9159.76
165.4165.42
177172.98
172.8174.6
HIG Boys
NCHS
AGE (years)
HEIGHT (cm)
Figure 3. Comparison of median heights of HIG boys with NCHS median
120117.25
125.1126.72
130.7128.18
136136.43
144.85141.52
154149.38
155.5154.32
158.25158.76
159.5160.91
163162.2
161.5162.63
HIG Girls
NCHS
AGE (years)
HEIGHT (cm)
Figure 4. Comparison of median heights of HIG girls with NCHS median
15.0115.37
15.3315.5
16.2715.94
17.942386831316.37
16.822827412516.9
17.166520846817.43
18.69024147318.01
20.066040694618.7
20.428109783519.39
21.804767905920.5
21.320.89
HIG Boys
NCHS
AGE (years)
BMI (Kg/m2)
Figure 5. Comparison of median BMI of HIG boys with NCHS median
15.9514.89
15.5315.59
17.714585397115.77
16.760380622816.79
17.864695981517.34
17.852234685117.94
19.14332587518.35
19.445604657219.05
19.023713307119.86
19.428972413520.93
21.999166840121.26
HIG Girls
NCHS
AGE (years)
BMI (Kg/m2)
Figure 6. Comparison of median BMI of HIG girls with NCHS median
Normal
8
70
13
2
#REF!
Figure 11. Overall prevalence of overweight and obesity in HIG children using BMI-for-age
19.3318.695.845.842.32.3
18.4418.582.162.162.852.85
20.6421.473.323.323.293.29
22.7922.183.173.173.183.18
22.5122.793.593.592.792.79
23.1622.874.074.071.891.89
24.4924.283.573.572.482.48
25.2723.863.453.453.573.57
26.7224.553.223.222.332.33
28.524.592.082.081.291.29
27.5927.163.683.683.143.14
Boys
Girls
Age (years)
MUAC (cm)
Age wise trend of MUAC (Mean SD) in HIG boys and girls
1011.394.664.664.084.08
9.3711.313.63.64.274.27
10.5714.734.374.375.775.77
13.5215.324.664.665.595.59
12.3715.515.85.84.914.91
13.1313.55.785.783.773.77
13.4715.726.446.444.984.98
13.4216.336.596.596.736.73
16.0516.677.677.675.95.9
13.3516.133.093.092.022.02
14.0120.696.416.415.175.17
Boys
Girls
Age (years)
Triceps (mm)
Age wise trend of Triceps (Mean SD) in HIG boys and girls
6.547.133.233.232.62.6
6.176.382.762.761.971.97
6.679.545.45.44.454.45
8.039.23.143.144.314.31
7.269.893.73.73.673.67
7.688.184.014.013.063.06
8.069.644.124.123.543.54
7.3210.463.63.64.784.78
9.379.94.974.973.583.58
6.3510.331.281.282.932.93
8.3912.554.334.334.484.48
Boys
Girls
Age (years)
Biceps (mm)
Age wise trend of Biceps (Mean SD) in HIG boys and girls
BOYS
PREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+11.916.752.44.811.9
7+034.860.94.30
8+0080.653.2316.12
9+06.5668.8513.1211.48
10+017.1976.553.133.13
11+3.1328.1359.383.136.23
12+02063.336.6710
13+2.57.572.57.510
14+020.5256.4210.2612.8
15+0752500
16+7.6917.9558.9710.265.13
GIRLS
PREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+2.7811.1147.2319.4419.44
7+5.2621.0557.95.2610.53
8+014.2957.1428.570
9+013.338006.67
10+015.3982.691.920
11+0010000
12+0093.5506.45
13+0090.745.563.7
14+011.5488.4600
15+011.1188.8900
16+0079.310.3510.35
OVERALLPREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+7.7914.250.611.615.5
7+2.328.559.54.74.7
8+0076.37.813.1
9+07.87110.510.5
10+016.379.32.51.7
11+2.522.567.52.55
12+09.878.63.28.1
13+13.182.96.36.3
14+016.969.26.17.6
15+030.769.300
16+4.410.267.610.27.3
(+3)SD
BMI-for-age2137078
Weight-for-age018973
83
Normal7089
131
20
Boys (n=404)
Girls (n=286)
o
(+3)SD
BMI-for-age2969812
Weight-for-age029053
8 (3)
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION OF BMI FOR AGE IN PUBLIC SCHOOL BOYS
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQENCY DISTRIBUTION FOR BMI FOR AGE IN PUBLIC SCHOOL GIRLS
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR BMI FOR AGE IN PUBLIC SCHOOL CHILDREN (BOYS + GIRLS)
0
0
0
0
0
0
0
0
0
0
0
0
#REF!
Figure 11. Overall prevalence of overweight and obesity in HIG children using BMI-for-age
00000
00000
(+3)SD
Nutritional status of public school children using BMI-for-age and weight-for-age (NFI, 2004)
00000
00000
(+3)SD
Nutritional status of public school children using BMI-for-age and weight-for-age (NFI, 2000)
BOYS
PREVALENCE(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+078.0512.29.8
7+095.74.350
8+090.329.70
9+086.911.51.2
10+3.1390.636.30
11+6.2587.56.250
12+093.36.70
13+2.5907.50
14+097.4202.56
15+010000
16+2.5687.1810.260
GIRLS
PREVALENCE(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+2.7877.7813.895.56
7+089.475.265.26
8+010000
9+093.36.670
10+080.7713.465.77
11+010000
12+090.326.453.23
13+094.443.71.85
14+010000
15+010000
16+086.213.4510.34
TRICEPS(BOYS)
AGETRICEPS (mm)WHO
9+12.811.2
10+10.611.6
11+13.112.2
12+11.912.9
13+12.813.7
14+14.414.5
15+13.615.2
16+12.416
overall(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and above
6+1.377.9212.997.79
7+092.864.762.38
8+092.17.90
9+088.1610.531.32
10+1.786.239.482.59
11+59050
12+091.86.561.64
13+1.0692.565.321.06
14+098.4601.54
15+010000
16+1.4786.767.354.42
00
00
00
00
00
00
00
00
(BOYS) TRICEPS (mm)
(BOYS) WHO
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL BOYS
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL GIRLS
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL CHILDREN (BOYS + GIRLS)
-
Weight for age and BMI for ageBMI which takes into account the current height while assessing the nutritional status is a sensitive index for detection of under and over nutrition in children.It worth while to put in the additional effort to compute BMI for age to assess nutritional status in children & adolescents because it will enable early detection of both under and over nutrition and appropriate management so that these children grow into healthy adults.
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Indices to be monitoredRationale for monitoringassess progress, identify problems and take mid course correction Process indicators are to be monitored as per the NRHM/ICDS formats. In addition 100% Civil registration- reconciled at village level Births- check with No of pregnant women Deaths- assess MMR, neonatal, infant and child mortality rates Monitor- infant and child feeding practicesUnder-nutrition rates in children reconcile with the DLHS data after converting data to IAP classification