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Malnutrition among children in Gujarat

Malnutrition among children in Gujarat. Health & family Welfare Department GOG. Malnutrition. Mal adjusted nutrition Under nutrition Over nutrition. Calorie & Protein Essential fatty acids Vitamins and Minerals (Micronutrients). Diagnosis of Malnutrition. Anthropometry:

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Malnutrition among children in Gujarat

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  1. Malnutrition among children in Gujarat Health & family Welfare Department GOG

  2. Malnutrition Mal adjusted nutrition • Under nutrition • Over nutrition Calorie & Protein Essential fatty acids Vitamins and Minerals (Micronutrients)

  3. Diagnosis of Malnutrition • Anthropometry: Children: Wt/Age, Ht/Age, Wt./Ht, BMI, Mid Arm Circumference, Head/chest ratio Adult: Wt/Ht, BMI, weight gain during pregnancy • Clinical signs and symptoms • Biochemical test: Hb%, Urinary iodine

  4. Malnutrition Monitoring Indicators

  5. Infant mortality rate

  6. Causes of Childhood Mortality Malnutrition 53% Under-nutrition contributes to 53% of all child deaths

  7. Protein Calorie Malnutrition Normal

  8. District wise Prevalence of Under nutrition in children (0-71 months) - DLHS 2002

  9. Nutritional status of children (<3yrs) Gujarat(‘92-‘93)& (’98-’99)

  10. Low birth weight babies

  11. % of women who gave exclusive Breast milk up to 4 months (DLHS,2002 & 2004)

  12. Age specific rate of underweightchildren Brain Development

  13. Demographic Characteristic of children in < 2 SD Wt/Age group (NFHS II)

  14. Demographic Characteristic of children in < 2 SD Wt/Age group (NFHS II)

  15. Profile of Mother of children in < 2 SD Wt/Age group (NFHS II)

  16. Maternal Nutritional profile and Child Nutrition (NFHS II)

  17. Clinical signs of Anaemia NFHS II 75% of children Anaemic, 24% mild Anaemia Mother not aneamic-70% children anaemic Mother anaemic 75-87% children Anaemic

  18. Clinical sins of Vitamin A deficiency 1.1% to 8.6% Night blind ness & blindness, vulnerability to infection, poor growth

  19. Status of Vit.A prophylaxis program Biannual Supplementation rounds Next in August ‘06

  20. Vitamin A as a public health problem in Gujarat

  21. Vitamin A Deficiency and Child health Improving vitamin A status of children (6 months-5 yrs.) Results in to • 23% reduction in child mortality rate • 50% reduction in child mortality rate due to acute measles • 35-50% reduction in child mortality rate due to diarrhoea

  22. Clinical signs of Iodine deficiency disorders

  23. YEAR WISE REPORT OF IODINE CONTENTS SALT SAMPLE CHCKED WITH SPOT TESTING KIT 2001 TO 2004 (Till June)

  24. Nutritional status of School childrenSchool Health-2005-06, Gujarat

  25. National Nutrition programs

  26. Supplementation (ICDS) • Supplement not the substitute • 300 K.cal and 8-10gm. Protein • Double supplement/calorie-protein dense supplement for grade III and grade IV • Facility, time and skill for cooking • Feeding at centre for grade III and IV • Supplement for 7 months to 1 year age group • Supplement for ANC • RTE & candy

  27. Special care of Grade III & IV Problems: Loss of appetite, high calorie protein need, Infection proneness, restriction of food, digestion Solution: Frequent feeding Calorie protein dense supplement Easily digestible food Animal/ First class protein Vitamin and Mineral supplement Treatment of infection Mother’s involvement in care of the child

  28. MDM supplement • 300 k.cal. And 8-10gm. Protein • Supplement not substitute • Children attending school / Child’s attention in school • In built Diet education • In built equity education

  29. GUJARAT INITIATIVES

  30. Adolescent Girls Anaemia Control Programme • 2001 pilot project in Vadodara district (UNICEF) • Anaemia reduction from 74% to 53% in 17 months • Project is operationalised in all districts (UNICEF & MI) • Convergence between Health and Education department

  31. RTE • Ready to Eat fortified with micronutrients • Operationalised in four districts (Mehsana, Patan, Panchmahal, Dahod) in 2001 • MI project • High level of micronutrient deficiency recorded in baseline study • Acceptability was high • Bulk was a limiting factor • Convergence between Health and ICDS(DWCD)

  32. RTE Impact assessment Panchmahal istrict (2002-2003)

  33. Nutri candy • Candy fortified with Vit.A, Vit.C, iron and Folic acid • Three districts vadodara, bharuch and Narmada , operationalised in 2001 • MI project • Children, Pregnant and lactating mother and Adolescent girls were beneficiaries • Convergence Health and ICDS (DWCD)

  34. Impact Assessment Impact Children: • Improved the attendance Anganwadi • Weight gain in Grade II-IV remarkable • Improved appetite Pregnant and lactating women : • Feeling better relief from body pains and ache • Reduction in nausea, vomiting • Improved eye sight Adolescent girls • Less fatigued • Increase appetite • Regular Menstrual cycle

  35. IMNCI Newborn 1-7d Home Based Newborn Care Immunization Diarrhea IMNCI ARI BF-CF Fever/ malaria

  36. Mapping & Monitoring Malnutrition • ICDS special round of weighing the children with inbuilt quality check process May-June 2006 • Routine monthly assessment • Health facility assessment and support as well as regular monitoring record in health worker’s register • Inbuilt assessment through monthly reporting system

  37. Field level Functional Convergence • Fix day ‘ Health and Nutrition Day’ Session at SC Planning and Implementation in progress • Improve quality and coverage of RCH services • Mainstreaming of Nutrition care and support • Improve quality and coverage of monitoring data • Improve Accessibility of Health and Nutrition services • Improve Maternal and Child health status

  38. Supply Training Monitoring Integration Minimum need Community Awareness and Involvement Care and Support For Health & Nutrition workers

  39. Control of infection D I e t E d u c a t i o n Care and Support

  40. Gujarat progress • The second target of MDG is to reduce the proportion of people suffering from hunger by half between 1990 and 2015 • Monitoring indicator is a proportion of 0-59 months children falling below 2SD from median weight for age of the standard reference population NFHS I NFHS II Reduction in Preschool mortality rate /year should be 2.8% Reduction Observed between NFHS I and NFHS II is 3%

  41. THANK YOU

  42. Determinants of malnutrition

  43. Nutrition care of Community • Nutrition care of vulnerable School age group Adolescent • Nutrition care of highly vulnerable Pregnant woman Breast feeding woman Preschool children Infants

  44. Breast feeding & Weaning

  45. Malnutrition Malnutrition Income Education

  46. Integrated care • Maternal and Child nutrition • Adolescent and Maternal Nutrition • Nutrition and Infection control/care- sanitation, hygiene, vaccination, early detection and treatment • Nutrition and FP • Macro and Micro nutrition • Nutrition and ----------------Mental development • Family nutrition and supplementary nutrition • Nutrition supplement and Diet/ nutrition education

  47. Where?Countries with the highest numbers of neonatal and U5 child deaths 2.5 million neonatal deaths Approx 66% of global total 6.6 million U 5 child deaths Approx 61% of global total WHO Estimates of neonatal deaths for the year 2000, forthcoming. WHO/UNICEF/UNFPA estimates of maternal mortality for the year 2000 Black, Morris, Bryce. Lancet 2003.

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