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Malnutrition In Indian context

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Malnutrition In Indian context

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This presentation aims at explaining all the components of malnutrition. Such as types, causes, criteria of diagnosis, treatment & Government health initiatives to tackle the problem of malnutrition.

This presentation aims at explaining all the components of malnutrition. Such as types, causes, criteria of diagnosis, treatment & Government health initiatives to tackle the problem of malnutrition.


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Malnutrition In Indian context

  1. 1. “India against Malnutrition : Current Status and Government Initiatives” By Dr Sanket V. Nandekar JR, Dept. of Community Medicine IMS-BHU, VARANASI
  2. 2. Background and Definitions Medical component of Malnutrition World Health Assembly 2012 Global Nutrition Report 2020 Current scenario INDIA, Uttar Pradesh, Varanasi. Government Initiatives Conclusion and suggestions Outlines of the topic:
  3. 3. According to the World Health Organization (WHO), ‘Malnutrition’ refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. It can be either ‘undernutrition’ or ‘overnutrition’. Malnutrition Covers,  Underweight (low weight for age)  Micronutrient deficiencies / insufficiencies and over weight  Obesity and diet-related non-communicable diseases Malnutrition:
  4. 4. WHO Fact sheet 2021:  1.9 billion adults are overweight or obese, while 462 million are under weight.  Globally in 2020, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese.  Around 45 % of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries. At the same time, in these same countries, rates of childhood overweight and obesity are rising.
  5. 5. Types Indicator SD score  Stunting Height for Age < -2SD: stunted < -3SD: severely stunted  Underweight Weight for Age < -2 SD: underweight < -3 SD: severely underweight  Wasting Weight for Height/length < -2 SD: wasted < -3 SD: severely wasted WHO Classification
  6. 6. Grade of malnutrition Weight for age of standard(%)  Normal >80  Grade I 71-80 (mild malnutrition)  Grade II 61-70 (moderate malnutrition)  Grade III 51-60 (severe malnutrition)  Grade IV <50 (very severe malnutrition) IAP classification of malnutrition
  7. 7. Severe Acute Malnutrition: As per WHO, a child aged 6-59 month is classified as SAM if one or more of the following present:  Weight-for-length z-score (WLZ) < -3 OR  Weight-for-height z-score (WHZ) < -3 OR  Mid-upper arm circumference < 11.5 cm OR  Bipedal edema (other cause of edema like nephrotic syndrome, congenital heart disease should be excluded)
  8. 8. Anthropometry : Standing Height = Recumbent Length - 0.7
  9. 9. Measuring Recumbent Length:
  10. 10.  It is typical form of SAM  Main sign is severe wasting  Wasting often starts in Axilla & Groin (grade I)  followed by Thighs & Buttocks (grade II)  followed by Chest & Abdomen (grade III)  Lastly the Buccal pad of fat (grade IV) Marasmus :
  11. 11. No edema Child may be active No hepatomegaly May have good appetite Marasmus : Baggy pant appearance in Marasmus
  12. 12. Other findings: sugar baby appearance, hepatomegaly, anemia, moon facies. Skin changes: Indicates severe degree of malnutrition and associated with very high mortality.  Flaky paint dermatosis (pathognomic)  Crazy pavement dermatosis Hair changes: more changes at root of hair, loose luster, easily pluckable, Flag sign. Kwashiorkor : Triad of essential features of kwashiorkor:  Edema Growth retardation  Mental changes
  13. 13.  Physical and mental exhaustion,  Low weight in relation to height (wasting) and shortness for age (stunted), Diminished skin folds,  Exaggerated skeletal contours,  Loss of elasticity of skin etc General Symptoms of malnutrition :
  14. 14. WHO 10 Steps in the management of SAM: There is an intervening transitional phase of treatment for 2-3 days when dietary treatment changes from low calorie-low protein (F-75) to high calorie-high protein diet (F-100).
  15. 15. In 2012, the World Health Assembly identified: Target Topics  Maternal nutrition  Infant nutrition  Young child nutrition Six Nutrition targets to be met by 2025. Aim was to reduce: 1. Stunting by 40% in children under 5 years age 2. Prevalence of anemia by 50% among women in the age group of 19-49 years 3. Ensure 30% reduction in low birth weight 4. No increase in childhood overweight 5. Increase the rate of exclusive breastfeeding in the first six months up to at least 50% 6. Reduce and maintain childhood wasting to less than 5%.
  16. 16.  Report on Global Nutrition, produced by the Independent Expert group for the Global Nutrition Report.  The Global Nutrition Report acts as a report card on the world's nutrition globally, regionally, and country by country and on efforts to improve it.  It assesses progress in meeting Global Nutrition Targets established by the World Health Assembly .  The World Health Organization (WHO) is a Global Nutrition Report Partner. What is Global Nutrition Report?
  17. 17. India will miss targets for all four nutritional indicators for which there is data available 1. Stunting among under five children, 2. Anemia among women of reproductive age, 3. Childhood overweight 4. Exclusive breastfeeding What Global Nutrition Report 2020 says?
  18. 18. 0 10 20 30 40 50 India Uttar Pradesh Varanasi 38.4 46.3 44.7 35.5 39.7 37.4 % OF UNDER 5 CHILDRENS STUNTING NFHS 4 (%) NFHS 5 (%) 1. Aim : Reduce Stunting by 40% in under 5 Children's
  19. 19. 0 10 20 30 40 50 60 India Uttar Pradesh Varanasi 53.1 52.4 50.9 57 50.4 37.6 % OF WOMENS (AGE 15-49 YEARS) ANEMIA NFHS 4 (%) NFHS 5 (%) 2. Aim ; Reduce Anemia by 50% among all women's of Age group 15-19 Years
  20. 20. 0 5 10 15 20 25 30 India Uttar Pradesh Varanasi 21 17.9 25.3 19.3 17.3 21 % OF UNDER 5 CHILDRENS CHILDHOOD WASTING NFHS 4 (%) NFHS 5 (%) 3. Aim : Reduce and maintain Childhood Wasting to less than 5%.
  21. 21. 0 10 20 30 40 50 60 70 India Uttar Pradesh Varanasi 54.9 41.6 23.5 63.7 59.7 47.5 % OF CHILDRENS UNDER 6 MONTHS EXCLUSIVE BREASTFEEDING NFHS 4 (%) NFHS 5 (%) 4. Aim : Children under 6 months exclusively Breastfed
  22. 22. 0 0.5 1 1.5 2 2.5 3 3.5 India Uttar Pradesh Varanasi 2.1 1.5 0.9 3.4 3.1 3.1 % OF CHILDRENS UNDER 5 YEARS OVERWEIGHT NFHS 4 (%) NFHS 5 (%) 5. Aim : No increase in Childhood overweight
  23. 23. Reasons for prevalent malnutrition in India:  Monoculture agricultural practices  Changing food patterns  Poverty  Migration  Gender injustice  Lacunae at policy level
  24. 24.  Food grain production has increased over five times since Independence, still it has not sufficiently addressed the issue of malnutrition .  India has focused on increasing food production, particularly staples (wheat and rice). This led to lower production and consumption of indigenous traditional crops/grains, fruits and other vegetables, impacting food and nutrition security in the process.  This intensive monoculture agricultural practices are indirectly degrading the quality of land, water and the food derived through them. Monoculture agricultural practices:
  25. 25.  Food consumption patterns have changed substantially in India over the past few decades, which has resulted in the disappearance of many nutritious local foods, for example, millets. Changing food patterns:
  26. 26.  Though poverty alone does not lead to malnutrition, it affects the availability of adequate amounts of nutritious food for the most vulnerable populations .  Lack of sanitation and clean drinking water and dangerous hygiene practices increase vulnerability to infectious and water-borne diseases, which are direct causes of acute malnutrition. Poverty :
  27. 27. Seasonal migrations have long been a livelihood strategy for the poorest households in India, as a means to access food and money through casual labor . However, children and women are the most affected, suffering from deprivation during migrations impacting their health condition. Migration :
  28. 28.  There is a correlation between gender discrimination and poor nutrition.  Malnourished girls become malnourished adolescents who marry early and have children who become malnourished, and so the cycle continues. Gender injustice :
  29. 29.  There is a lack of real-time data that brings all these factors together to show the extent of India's malnutrition .  Lax implementation of government schemes at grassroots level.  Lack of Strong leadership & Political will. Lacunae at policy level:
  30. 30. Multi-sectoral approach :  Include providing clean drinking water to all  Reducing rates of open defecation  Improving women's status  Enhancing agricultural productivity and food security  Promoting nutrition-sensitive agriculture. What is the Solutions???
  31. 31. Many management measures have been already implemented by the Government of India to address nutritional status including,  Reducing poverty  Improving sanitation  Fortification of foods with essential nutrients  Enhancing women’s education  Improving agricultural practices etc. Management :
  32. 32. The following programs and schemes have been implemented for improving nutrition and combatting malnutrition by the Government of India.  Integrated child development scheme (ICDS)  National Food Security Act (NFSA), 2013  Mid-day Meal Scheme (MDM)  National Health Mission (NHM)  Village Health Sanitation and Nutrition Committee (VHSNC)  Food Safety and Standard Authority of India (FSSAI)  Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) or Sabla Scheme  Village Health Nutrition Day (VHND) and so on.
  33. 33. Integrated child development scheme (ICDS)  India launched ICDS in accordance with the National Policy for Children in India to fight malnutrition, ill-health, and to address gender inequality.  One of the most comprehensive schemes for child development, started by the Ministry of Women and Child Development in 1975, is funded partly by the Central government of India and partly by the UNICEF.
  34. 34.  Its aim is to provide food and primary healthcare to preschool children under 6 years of age their mothers and adolescent girls .  Anganwadi centers provide Immunizations, Health education, Health check-ups, Nutritious food, informal education and referral services under this scheme. Integrated child development scheme (ICDS)
  35. 35. Target Group Unit cost per beneficiary / day Caloric Value Children 6 months to 6 years Rs. 8.50/- 500 + Calories Pregnant & Lactating Mothers Rs. 10.00/- 600 + Calories Severely undernourished children Rs. 13.50/- 800 + Calories Provisions under ICDS :
  36. 36. March monthly progress report of ICDS Chiraigaon Block : No of 0-6 year old Children's 35754 No of Pregnant & lactating women's 6748 Reported Live Births in March 2022 315 Death in 0–6 years age group in March 2022 0 3-6 year Age group 2927 Boys 2789 Girls Total no. of Out of school girls aged 11-14 years 40
  37. 37. March monthly progress report of ICDS Chiraigaon Block : Out of 32138 children's of age group 0-5 years , Height and Weight were taken for 30889. 25158, 82% 5292, 17% 139, 1% Nutritional Status of under 5 Children’s Normal Moderate Underweight Severe Underweight 30135, 98% 681, 2% 73, 0% Nutritional Status of under 5 Children’s Normal MAM SAM
  38. 38. March monthly progress report of ICDS Chiraigaon Block :  Out of Total 30889 Children's 681 were having MAM & 73 were having SAM.  754 children's received treatment at community level on VHSND (ie Village Health Sanitation and Nutrition Day).  8 Children's were referred to PHC/CHC & 4 Children's referred to NRC.
  39. 39.  In 1995, the Central Government started the National Programme of Nutritional Support to Primary Education, popularly known as the Mid- Day Meal scheme (MDM), to improve the nutritional status and enhance enrolment and school attendance of children.  The calorific value of a mid-day meal at primary stage has been fixed at a minimum of 700 calories and 20 grams of protein by providing 150 grams of food grains (rice/wheat) per child/school day Mid-day Meal Scheme (MDM)
  40. 40. National Health Mission (NHM)  Launched in 2005, the National Health Mission covers both the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) and aims to enhance the health programmes and health service delivery, in both rural and urban areas, by improving maternal, neonatal child and adolescent health, thus preventing diseases.
  41. 41. National Food Security Act (NFSA), 2013  Launched on 10 September 2013, the National Food Security Act (2013) is an Act of the Parliament of India intended to provide subsidized food grains to approximately two-thirds of India’s 1.2 billion people.  NFSA covers up to 75% of the rural population and 50% of the urban population under Antyodaya Anna Yojana (AAY) and priority households (PHH).  AAY households, which constitute poorest of the poor are entitled to 35 kg of food grains per family per month while priority households are entitled to 5 kg per person per month.
  42. 42. National Food Security Act (NFSA), 2013  NFSA defines the joint responsibility of the Centre and State/UT Government.  While the Centre is responsible for allocation of required food grains to States/UTs, transportation of food grains up to designated depots in each State/UT and providing central assistance to States/UTs for delivery of food grains from designated Food Corp. of India (FCI) godowns to the doorstep of the Fair Price Shops (FPSs), the States/UTs are responsible for effective implementation of the Act,
  43. 43. Priority Households : National Food Security Act (NFSA), 2013
  44. 44. National Food Security Act (NFSA), 2013
  45. 45. National Food Security Act (NFSA), 2013 Antyodaya Anna Yojana (AAY)
  46. 46. Village Health Sanitation and Nutrition Committee (VHSNC)  It allows ‘panchayats’ (village councils) to contribute to the governance of health and other public services in villages.  The VHSNCs monitor the work and contribution of community health workers, such as Anganwadi Workers (AWW), Accredited Social Health Activists (ASHA), and other public staff (from government entities such as the Water and Sanitation department, Roads work, among others) in order to maintain good sanitation and healthy environments in the villages. Village Health Nutrition Day (VHND) and many more.
  47. 47.  Malnutrition is a complex and multi dimensional issue .  It is primarily caused by several factors, including poverty, inadequate food consumption, inequitable food distribution, improper maternal, infant and child feeding, and care practices, inequity and gender imbalances, poor sanitary and environmental conditions, and restricted access to quality health, education and social care services. Conclusion :
  48. 48. Strong leadership & Political will is required to Fight against Malnutrition Promotion of nutrition-sensitive agriculture at all levels. Traditional Cereals distribution should be added with Pulses to improve Protein Consumption at mass level . Strengthening implementation of government schemes at grassroots level. Need for Comprehensive real time data generation Suggestions: