BHARTI

MPH

CONTENTS INTRODUCTION DEFINITION OF PEM TYPES OF MALNUTRITION INCIDENCE OF PEM CAUSES OF PEM NUTRITIONAL DEFICIENCY DISEASES CLASSIFICATION OF PEM EFFECTS OF MALNUTRITION CHILD MALNUTRITION IN INDIA

INTRODUCTION Protein energy malnutrition (PEM) – Major

health and nutrition problem in India . Occurs particularly in weaklings and

children in the first years of life. Not only an important cause of childhood

morbidity and mortality , but leads to permanent impairment of physical and mental growth.

DEFINITION OF PEM Bad nutrition As a state in which a prolonged lack of one or

more nutrients retards physical development or causes the appearance of specific clinical conditions such as anaemia,goitre etc.

As ‘a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients.’

TYPES OF MALNUTRITION Undernutrition -insufficient food is eaten Overnutrition -consumption of excessive

quantity of food . Imbalance -disproportion among essential

nutrients . Specific deficiency -relative or absolute

lack of nutrients.

World Health Report 2003.

DIFFERENCE BETWEEN OVER AND UNDER NUTRITION

Overnutrition is encountered much more frequently than under nutrition .

The health hazards from over nutrition are a high incidence of obesity, diabetes, hypertension, cardiovascular and renal diseases.

PERCENTAGE OF CHILDREN AFFECTED BY MALNUTRITION

COUNTRY STUNTING ,1980-90 (AGES 24-59 MONTHS)

WASTING,1980-90

(AGES12-23 MONTHS)

INDIA 65 27

CHINA 41 8

NEPAL 69 14

BANGLADESH 65 14

SRI LANKA 27 13

PAKISTAN 50 9

INCIDENCE OF PEM

India is one of the countries with highest proportion of malnourished children in the world along with Bangladesh, Nepal .

IN INDIA – Preschool age children – 1-2% Great majority of PEM are the

‘intermediates’ ones -80%(i.e. the mild and moderate cases which

frequently go unrecognized)

CAUSES OF PEM An inadequate intake of food both in

quantity and quality. Infections notably diarrhea, respiratory

infections , measles and intestinal worms-1. Increase requirements of calories, protein

and other nutrients.2. While decrease their absorption and

utilization.

Conceptual Framework for the Causes of Malnutrition in Society

NUTRITIONAL DEFICIENCY DISEASES

1. Kwashiorkor, 2. Marasmus3. Xerophthalmia,4. Nutritional anaemias and 5. Endemic goiter. (Iceberg’ of malnutrition: a much larger

population are affected by hidden malnutrition which is not easy to diagnose. )

CLASSIFICATION OF PEM

Classified according to severity, course and the relative contributions of energy or protein deficit

WEIGHT FOR AGE CLASSIFICATIONS HEIGHT FOR AGE CLASSIFICATIONS WEIGHT FOR HEIGHT CLASSIFICATION

CONT-(1) Weight for age classifications- Gomez’z Weight of more than 90 percent of expected for

that age (50th centile) as normal. Weights for age between 76-90% grade- l Weights for age between 61-75% grade -ll Less than or equal to 60 % are classified as

grade -III malnutrition respectively .

(2) Height for age classification : Children with less than 80% height of

expected for age as dwarf. Those with a height of between 80 to

93 % are classified as short and more than 93 % of height is seen in

normal children.

(3) Weight for height classification -acute or chronic based on anthropometry.

In acute malnutrition weight is primarily affected .

A proportionate reduction in weight and height points towards a chronic courses

A greater and disproportionate reduction in height indicates acute on chronic PEM.

EFFECTS OF MALNUTRITION

It is of two type :(1) Direct and

(2) Indirect

Direct- the occurrence of frank and subclinical nutrition deficiency diseases such as

Kwashiorkor Marasmus Vitamin and mineral deficiency diseases etc.

Indirect- High morbidity and mortality among young children,

Retarded physical and mental growth and development ,

Lowered vitality of the people leading to lowered productivity and reduced life expectancy .

The high rate of maternal mortality , Stillbirth and slow birth –weight are all associated

with malnutrition.

CHILD MALNUTRITION IN INDIA

World’s malnourished children-40% Low birth weight infants -35%

(developing world) Every year children die in India-2.5 million

(accounting for one in five deaths in the world)

CONT-1. More than half of all preschoolers, and 75 %

suffer from iron deficiency anemia.2. Maternal mortality in India is one of the highest

in the world, with 540 deaths per 100,000 live births .

3. 83 % of women in India suffer from iron – deficiency anemia, compared with 40% in Sub –Saharan Africa.

4. Acc to GHI India ranked 117th out of 119 countries on child malnutrition.

NUTRITIONAL STATUS In 1997 – about 170 million children under

five years of age i.e. 30% of the world’s children are malnourished .

It is recognized that 56%of the deaths in under five children , in developing countries are attributed to malnutrition .

In India 47%of all children below 3 years of age are undernourished.

ACCELERATING PROGRESS IN REDUCING CHILD MALNUTRITION IN INDIA

Integrated child development services (ICDS)

Public Distribution System (PDS) The Mid –Day Meals Program Community public works programs The National Old age Pension program Annapurna program

STRATEGIC CHOICES FOR IMPROVED CHILD NUTRITION

SHORT-TERM STRATEGY:

1. Nutrition and health programs and policies

2. Effectively address the main nutrition problems.

3. Combined efforts with action.

4. Strong monitoring and evaluation.

5. Research can identify gaps .

5. Additional research.6.Focused on states, districts,& communities 7. Increase attention to girls and women

health. LONG TERM STRATEGY :1. Policymakers should work on economic

growth & poverty reduction policy.2. Strong partnership b/w National agencies.

Prime Minister Manmohan Singh stated, “The problem of malnutrition is a matter of national shame.... I appeal to the nation to resolve and work hard to eradicate malnutrition in five years.” This concept note focuses on international research and policy experiences in reducing child malnutrition and outlines how to move forward in close cooperation with the country’s policymakers and its nutrition community

REFERENCES Park k .Park’s text book of preventive and social medicine

17th edn. Jabalpur:banarsidas bhanot publishers;2003.p 435 Ghai op ,Gupta p Essential preventive medicine,1st edn.

Jangpura , Delhi: Vikas publishing house pvt Ltd; 1999.p.142 National Family Health Survey II, Key Findings, International

Institute of Population Sciences. Mumbai, India: IIPS Press; l998. Vol 99. p. 17-8.      

Gopujkar PV, Chaudhari SN, Ramaswami MA, Gore MS, Goplan C. Infant Feeding Practices with special reference to the use of Commercial Infant Foods. Nutrition Foundation of India, Scientific Report No.4. New Delhi: Ratna Offset; 1984. p. 115.