Pub l i c H e a l t h Nut r i t i o na l P rob l e m a f f ec t i ng Ind i an p opul a t i on .

S t ep by S t ep proc e dure f or c ondu c t i ng n ut r i t i ona l gu i danc e

K. Shivashankar,

2nd year P.G. Dept. of Public Health Dentistry

Saveetha dental college

INTRODUCTION

COMMUNICABLE DISEASE PROBLEM

POPULATION PROBLEM

ENVIRONMENTAL SANITATION PROBLEM

MEDICAL CARE PROBLEM

NUTRITIONAL PROBLEM

NUTRITIONAL PROBLEMS• UNDER NUTRITION (MALNUTRITION)

• OVERNUTRITION

FACTORS CONTRIBUTING TO NUTRITIONAL PROBLEMS

a) Socio-economic factors

b) Food considerations

c) Aspects of health d) Demographic issues

C O N C E P T U A L F R A M E W O R K F O R T H E C A U S E S O F M A L N U T R I T I O N I N S O C I E T Y

INDICATORS OF NUTRITIONAL HEALTH

Three standard indices of physical growth that describe the nutritional status of childrenHeight-for-age (stunting)

Weight-for-height (wasting)

Weight-for-age (underweight)

Two indicators of nutritional status are presented for adultsHeight

Body mass index (BMI).

NUTRITIONAL PROBLEMS IN INDIA

Low birth weightProtein Energy MalnutritionXerophthalmiaKeratomalcia Nutritional anaemiaLathyrism Endemic goiter (Iodine deficiency disorders) Endemic fluorosisObesity and overweightCardio Vascular Diseases

LOW BIRTH WEIGHT About 28 % of babies born

in India are LBW as compared to 4 percent in some developed countries.

Every year children die in India-2.5 million

Maternal mortality in India is one of the highest in the world, with 540 deaths per 100,000 live births .

CAUSES OF LOW BIRTH WEIGHT

Maternal malnutrition and nutritional anaemia.

Hard physical labour and illness (infections) during pregnancy.

Short maternal stature, very young age pregnancy.

Smoking.

P R O T E I N E N E R G Y M A L N U T R I T I O N

CLASSIFICATION OF PEM

WEIGHT FOR AGE CLASSIFICATIONS

HEIGHT FOR AGE CLASSIFICATION

WEIGHT FOR HEIGHT CLASSIFICATION

VITAMIN A DEFICIENCY

Xeropthalmia

Keratomalcia

 NUTRITIONAL ANEMIA

WHO standard – Hb level estimation

Adult male – 13 gm%

Adult Female non pregnant- 12gm%

Pregnant woman- 11gm%

Children < 6 years- 11gm%

Children 6-14 years- 12gm%

 NUTRITIONAL ANEMIA

TREATMENTDose: Each Tab contains 80 mg of elemental iron ( 200mgFe sulphate ) and 0.5mg of Folic acidDuration: 2-3 months Hb returns to normal. Follow up: estimate Hb after 3 months Refer to Hospital if Hb<10gm%

Children: If anemia , supplement 20mg of elemental iron ( 100mg Fe Sulphate)

Iron Fortification: simple addition of ferric orthophosphate or ferrous sulphate with sodium bisulphate to fortify salt with iron.

Io d i ne d e f i c i e nc y d i s or d er s ( I DD) :

ENDEMIC FLUOROSIS

ENDEMIC FLUOROSIS

LATHYRISM

OBESITY

Obesity - When the body weight is 20% more than the desirable weight.

Over weight - When the body weight is between 10-20% more than the desirable weight

CARDIO VASCULAR DISEASES

Classified as one of the Food habit related Illness

Change in food habits and lifestyle has increased the risk of CVD in Indian population mostly in Middle Class and upper middle class groups.

PREVENTIO N O F M ALNUTRI TIO N

•ACTION AT FAMILY LEVEL

Nutrition education on

a)Selection of right kind of local foods

b)Planning of nutritionally adequate diets c)Promotion of breast feeding and adequate infant & child feeding.

•ACTION AT COMMUNITY LEVEL:

•People's participation is essential.

•Empowerment and participation of women are particularly important

A C T I O N AT N AT I O N A L L E V E L

Rural development

Increase agricultural production, distribution and storage

Stabilization of population

Nutrition related health services

ACTION AT THE INTERNATIONAL LEVEL

World Food Program ,1963 providing enough safe food to those in need •In September 2000, the United Nations Millennium Declaration was endorsed by 190 countries and was translated into eight Millennium Development Goals (MDGs) to be achieved by 2015.

G UIDELINES F O R CO UNS ELI NG

a) Gather information

Interviewing- Purpose of an interview is to obtain information and to give help. Basic goal in interviewing is to understand

The problem

The factor that contribute to it

The personality of the patient

Patient selection

Diet history

Diet diary

b) Evaluation and interpretation

Adequacy of intake of food

The amount and type of food

G UIDELINES F O R CO UNS ELI NG

c)Develop and implement plan of action

d)Seek active participation of family

e)Follow-up the progress and assessment made

f)Computer diet analysis:

NUTRITIONAL ASSESSMENT

Clinical examination

Anthropometry

Bio chemical evaluation

Functional assessment

Assessment of dietary intake

Vital health statistics

Ecological studies

COMMUNITY NUTRITION PROGRAMMES

INTEGRATED CHILD DEVELOPMENT SERVICE (ICDS) SCHEME 

VITAMIN A PROPHYLAXIS PROGRAMME(1970)

PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA

SCHEME FOR ADOLESCENT GIRLS (KISHORI SHAKTI YOJNA)

IODINE DEFICIENCY DISORDER PROGRAMME (1962)

MID-DAY MEAL PROGRAMME (1961)

COMMUNITY NUTRITION PROGRAMMES

BALWADI NUTRITION PROGRAMME

NATIONAL PROGRAMME FOR NUTRITION SUPPORT TO PRIMARY EDUCATION

AKSHAYA PATRA AND PRIVATE SECTOR PARTICIPATION IN MID-DAY MEALS

EMERGENCY FEEDING PROGRAMME 2001

VILLAGE GRAIN BANKS SCHEME

WHEAT BASED NUTRITION PROGRAMME (WBNP)

COMMUNITY NUTRITION PROGRAMMES

SC/ST/OBC HOSTELS

SAMPOORNA GRAMIN ROZGAR YOJANA

NATIONAL FOOD FOR WORK PROGRAMME

GRAIN BANK SCHEME

PULSE MISSION

National Rural Health Mission 2005-2012

CONCLUSION