The document discusses the dual burden of malnutrition in India. It begins by defining nutrition and malnutrition. It then describes the forms of malnutrition, including undernutrition which results in stunting, wasting, and low birth weight. The two main forms of undernutrition are protein-energy malnutrition and micronutrient deficiencies. The document also discusses overnutrition. It provides data on the prevalence of malnutrition in India, including high rates of stunting, wasting, and anemia among children. It notes that malnutrition is a major contributor to child deaths in India and discusses some of the causes, including poverty, lack of sanitation, and cultural factors. The document concludes by calling for recognition of nutrition as a basic human right.

2. the dual burden of malnutrition
in India
ZubiyaShaikh
Roll no. 50
Department of Composite Home Science
S.V.T College of Home Science
Year 2015-2016

3. the dual burden of
malnutrition in India

4. What is nutrition ?
 It is the science that interprets the interaction
of nutrients and other substances in food in relation to
maintenance, growth, reproduction, health and disease
of an organism. It includes food intake, absorption,
assimilation, biosynthesis, catabolism and excretion.

5. Getting to know malnutrition..
• A term used to refer to any condition in which the body does
not receive enough nutrients for proper function. Malnutrition
may range from mild to severe and life-threatening.
• People are malnourished if their diet does not provide
adequate calories and protein for growth and maintenance or
they are unable to fully utilize the food they eat .
• At times malnutrition can be so severe that the damage it
does to the body is permanent even though you survive.

6. Forms of Malnutrition
• Malnutrition is a broad term commonly used as an alternative
to undernutrition but technically it also refers to overnutrition.
 Under nutrition –
• Being below the optimum nutrient level for a healthy growth,
development and living is called undernourishment.

7. Under-nutrition results in:
Stunting
• Stunted growth, also known as stunting and nutritional stunting, is
a reduced growth rate inhuman development.
• Stunted children may never regain the height lost as a result of
stunting, and most children will never gain the corresponding body
weight.
• Measured by height for age.

9. Wasting
• Wasting, also known as wasting syndrome, refers to the process
which causes muscle and fat tissue to "waste" away.
• Measured by Weight-for-height (WFH).

10. Low Birth Weight
• Low birth weight (LBW) is defined as a birth weight of a
liveborn infant of less than 2,500 g (5 pounds 8 ounces)
regardless of gestational age.
• Their chance of survival is poor; they have less ability to
resist diseases, therefore, suffer from frequent infection,
inability to cope up thus they are Severely Malnourished.

12. • Reduced ability to perform normal tasks / physical
performance – for example, not being able to walk as far
or as fast as usual .
• Altered mood – malnutrition can be associated with
lethargy and depression.
• Recurring illness : Recurrent or chronic infections
• Weak immune system
• Low immune function
• Weight loss
• Tiredness, loss of energy
• Poor concentration

13. The Two forms of Under nutrition
• Protein-Energy Malnutrition (PEM)
• Protein Energy Malnutrition (PEM) is a malnutrition
resulting from the deficiency of protein and/or energy in
diet.

14. PEM iceberg

15. Kwashiorkor
• It is found in children who have a diet that is usually
insufficient in energy and protein and often in other
nutrients.
• Kwashiorkor is often associated with, or even
precipitated by, infectious diseases

16. Signs of kwashiorkar
• Oedema
• Stunting
• Wasting
• Fatty infiltration
• of the liver.
• Mental changes
• Hair changes.
• Skin changes.
• Anaemia.
• Diarrhoea.
• Moonface.

17. Nutritional marasmus
• In marasmus the main deficiency is one of food in general, and
therefore also of energy.
• Nutritional marasmus is in fact a form of starvation, and the possible
underlying causes are numerous. For whatever reason, the child
does not get adequate supplies of breastmilk or of any alternative
food.

18. Signs of marasmus

19. Nutritional Deficiency Diseases
• It is caused by relative / absolute lack of individual nutrient.
• Nutrient deficiencies alter bodily functions and processes at the most
basic cellular level.
• These processes include water balance, enzyme function, nerve
signaling, digestion, and metabolism.
• Nutrient deficiencies can also lead to other diseases

21.  THE HINDU MAY 2015

22. Over nutrition
• Overnutrition is a form of malnutrition in which the intake of nutrients
is oversupplied. The amount of nutrients exceeds the amount required
for normal growth, development, and metabolism.
• Overnutrition can develop into obesity, which increases the risk of
serious health conditions, including cardiovascular disease,
hypertension, cancer, and type-2 diabetes.
• By 2020, an estimated two-thirds of the global burden of disease will be
caused by chronic non-communicable diseases, most of which are
associated with diet.

24. The prevalence of wasting in South Asia is so severe, at just under 15 per cent, that it is
approaching the level of a critical public health problem
Indicating out of every five children in India
one is wasted

25. Undernutrition contributes to nearly half of all deaths in children under 5 and is widespread in Asia and
Africa
;
Percentage of children under 5 who are stunted, 2008-2015
*Data are the most recent available estimate between 2008 and 2015

27. GLOBAL UNDER-FIVE MORTALITY RATE ,
UNICEF Oct 2015

28. Malnutrition is India's silent emergency
Nearly half of India's children- approximately 60 million - are underweight, 48% have
stunted growth (too short for their age), 20% are wasted (too thin for their height,
indicating acute malnutrition), 75% are anaemic, and 57% are deficient in Vitamin A.
Describing malnutrition as India's silent emergency, the World Bank report says
that the rate of malnutrition cases among children in India is almost five times
more than in China, and twice than in Sub-Saharan Africa.

29. • THE TIMES OF INDIA MARCH 2014
• 75% of Indians suffer vitamin
deficiency: THE TIMES OF INDIA
OCTOBER 2015

31. Food security and Hunger
• Food security is often defined as access by all people at all times to
sufficient food required for a healthy and active life
• India is a food surplus nation but according to The 2015 Global Hunger
Index (GHI) Report ranked India 20th amongst leading countries with a
serious hunger situation. It has more than 190 million food-insecure
people, the most in the world

33. sanitation
• In India ,more than 122 million households have no toilets, and 33% lack
access to latrines, over 50% of the population (638 million) defecate in
the open.
• Although 211 million people gained access to improved sanitation from
1990–2008, only 31% use the facilities provided.
• Only 11% of Indian rural families dispose of stools safely whereas 80% of
the population leave their stools in the open or throw them in the
garbage. Open air defecation leads to the spread of disease and
malnutrition through parasitic and bacterial infections.

35. Poverty
• It suggests economic causes of malnutrition

36. • Breastfeeding
• Social and cultural factors
• Natural calamities & the landless.

37. Treatment for Malnutrition – Under Nutrition
 Hospitalization
 Diet
 Rehydration.
 Treatment of hypothermia
 Recover

38. Case study : NRC at nandurbar

39. • The district has six blocks all of which are tribal viz.
Dhadgaon, Akkalkuwa, Taloda, Shahada, Navapur and
Nandurbar. There are a total of 931 villages and four
towns. Of the total villages, 492 have a population of
less than 500, out of these 131 are difficult to access.
Pucca roads connect about 32% of the villages

40. Nandurbar at a glance……
Total Population (Census 2011) 1,602,902
Non Tribal Population 36 %
Tribal Population 64 %
Below Poverty Line (BPL) Population (%) 75.43 %
SC / ST Population (%) 68.69 %
Blocks 6
Gram Panchayat 501
Villages 939
Padas (Hamlets) 1465
No. Of PHCs 58
No. of RH / Cottage / SDH 15
Sub centres 290

41. • Till 23.12.2011…….. NO special treatment
Facility for Children with Malnutrition (SAM) in
District Hospital Nandurbar

42. Nutritional Rehabilitation Center , Nandurbar
District Hospital
Challenges at Beginning
• Administrative support – Financial / Manpower shortage
(SN/Dietician) / Logistics (Equipments and Supplies)
• Very Low Patient flow.. (BOR) – No linkages
• Stay of mothers in NRC – 2-3 days
• High rates of Defaulter.
• Language barrier.
• Low attendance for follow up camp

43. Admissions procedure
• Triage the patients in waiting area
• Give all severely malnourished ~10% sugar-water to
drink (assistant)
• Do anthropometry (assistant)
• Do appetite test (assistant)
• Check IMCI signs (nurse)
• Decide with the mother Out- or In- patient care (nurse)
• Register the patient
• Fill out the multi-chart
• Explain to the caretaker the procedures of the
program/ centre (nurse)
• Take only essential history and examination in order to
start of treatment (surveillance data - nurse)
• Start routine treatment (nurse)

44. ANTHROPOMETRIC MEASUREMENTS

45. 45
Body weight Poor Moderate Good
kg Gram of SF( Special Feed)
3 – 3.9 < 15 15 – 20 >20
4 – 5.9 < 20 20 – 25 >25
6 – 6.9 < 20 20 – 30 >30
7 – 7.9 < 25 25 – 35 >35
8 – 8.9 < 30 30 – 40 >40
9 – 9.9 < 30 30 – 45 >45
10 – 11.9 < 35 35 – 50 >50
12 – 14.9 < 40 40 – 60 >60
APPETITE TEST -To pass the appetite test the intake of a test meal has to be at least
in the moderate range.

46. Preparation of Special Food (SF)
Sr.
No.
Ingredients Amount
1 Groundnut 1 kg
2 Whole Milk Powder 1200 g
3 Sugar 1120 g
4 Coconut Oil 600 g
Method :
•Roast the groundnuts and take off the peel
•Finely grind the groundnuts and sugar together to a powder like consistency
•Sieve the powder to remove any lumps
•Add milk powder and oil to it and mix well
1 Spoon (15 ml) = 12 gm of TF

48. During the Stay at NRC :
 Medical Check up by Paediatrician (Daily)

49. Proper Cleanliness in NRCs
Cleanliness of mother & child
Cleanliness of Staff
Cleanliness of Kitchen
Cleanliness of Ward

50. Cook preparing glasses for
feed….

51. Mothers taught Hand washing
before feeding the child….

52. Feeding in NRC

53. Mother feeding the child

54. Mother feeding the child

55. Wheat & Green Gram
Sprouted Dried Roasted Floured
In 3:1 Proportion
55
What is amylase flour????

56. Sr.
No
Ingredient Amount
(gms)
Calories
(Kcal)
Proteins
(gms)
1. Milk 25 33.3 1.8
2. Sugar 5 20.0 00
3. Amylase flour (Wheat) 20 68 2.56
4. Amylase flour (Green gram) 10 34.8 2.45
5. Groundnut 10 56.8 2.52
6. Oil 20 180 00
7. Gingelly Seed (Til) 5 28.15 0.92
8. Spices and condiments for
taste
Total 95 421.05 10.25
56
Recipe of Upma
Cost of recipe is Rs. 4.25

58. Amylase flour based recipes
prepared by Mother at home

59. Health Education Counselling
session to Mothers

60. Play Therapy for Emotional and
Sensory stimulation to children

61. Stimulation and play
therapy

62. Event celebration: (Anniversary
/ Makar sankranti / Birthday etc)

63. Counseling of Parents in Local
language by UNICEF resource
person…

64. Bathing of children in Phase II
with Hot water

65. On Admission 4 Weeks Later
ON ADMISSION - 4 WEEKS LATER

66. Counseling with breastfeeding support
Adm date 12.05.12
Adm wt 1.825kg
II- 3.7.12- wt 3.375

67. INNOVATIONS
 ACTIVITIES TO MAINTAIN FOLLOW UP-
Follow up camps at Taluka place (Rural Hospital)
 Activities to increase referral- Training Session
on Introduction to NRC for ASHA Workers
 Gift to children who visit NRC timely for follow up

68. Follow up camp:

69. Sensitization of ASHA Workers
about NRC

70. Sensitization of ASHA Workers
about NRC

71. Visited by Collector Nandurbar

72. Other Visits…
 Dr Pandge (Dy Director
RJHN Mission)
 Dr Karnataki (State Maternal
Health Consultant)

73. Conclusion
• NUTRITION AS AN UNALIENABLE RIGHT
• We cannot, we must not, accept the present condition of the great
majority of the world’s population as something to be dealt with
band-aids
• The major reason for formulating this document is to realize that
international justice demands that we recognize the rights and
needs of all people of this world we inhabit- and that we work jointly,
towards a common goal of betterment of human condition

74. References
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Causes, Consequences, and Solutions
• The double burden of malnutrition Case studies from six developing
countries. FAO FOOD AND NUTRITION PAPER. 84
• Indian Dietetic Association National Conference: Severe Acute Malnutrition
2011
• Monika Blössner Mercedes de Onis (2005) Malnutrition quantifying the
health impact at national and local levels. (WHO)
• Umezawa M, Kogishi K, Tojo H, (February 1999). "High-linoleate and high-
alpha-linolenate diets affect learning ability and natural behavior in SAMR1
mice". J. Nutr. 129
• UNICEF-WHO-World Bank Group : Joint child malnutrition estimates . Key
findings of the 2015 edition
• www.who.int/

75. • en.wikipedia.org
• www.wfp.org/countries/india World food Programme
• www.nlm.nih.gov
• Michael C. Latham . Rome, 1997, Human nutrition in the developing world ,
Food and agricultural organization of United States Document.
• Spears, D. (2013). How much international variation in child height can
sanitation explain? - Policy research working paper. The World Bank,
Sustainable Development Network, Water and Sanitation Program
• Intensive Care Nursery House Staff Manual
• Chopra M, Galbraith S, Darnton-Hill I: A global response to a global
problem: the epidemic of overnutrition. Bulletin of the World Health
Organization 2002, 80:952-958.

76. • “Nutrition In Global Health.” Global Health Education Consortium, 29 June 2011.
Web. 15 May 2012.1
• Parks, Naomi. "What Is Overnutrition and Undernutrition?" Livestrong.
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of under- and overnutrition in India. J Epidemiol Community Health 2007;61:802–9.
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Physical Activity and Health. 2004.
• "2015 Global Hunger Index Report" (PDF). International Food Policy Research
Institute (IFPRI).
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• February 2012.
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20.

78. THANK YOU…
Awaiting a better future…