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Common Nutritional Problems in Sri Lanka

Common Nutritional Problems in Sri Lanka. General Health Indicators. IMR – 11.2 per 1,000 live births (Register General’s Dept.) MMR – 39.3 per 100,000 live births (FHB. 2006 ) TFR (Total fertility rate) - 2.4 per woman (DHS. 2006/7)

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Common Nutritional Problems in Sri Lanka

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  1. Common Nutritional Problems in Sri Lanka

  2. General Health Indicators IMR – 11.2 per 1,000 live births (Register General’s Dept.) MMR – 39.3 per 100,000 live births (FHB. 2006) TFR(Total fertility rate)- 2.4 perwoman(DHS. 2006/7) GFR (General fertility rate) - 79.0 per 1,000 women(DHS. 2006/7) CBR - 18.7 per 1,000 population(DHS. 2006/7)

  3. Improvement over the time a / Vital Statistics, Dept. of census & Statistics b/ Central Bank Annual Reports

  4. Nutritional Indicators LWB 16.6%(DHS. 2006/7) Average weight gain in pregnancy 8kg (FHB MIS, MRI survey report 2003) Under 5 yr children(DHS. 2006/7) Stunting 18.0% Wasting 15.0% Underweight 21.6%

  5. Nutritional Indicators Nutritional status of women (15-49 yrs) Undernourished (BMI<18.5) - 21.8% Overweight (BMI >25.0) - 24.0% (DHS. 2000) Over nutrition Adolescents 6.0% Non pregnant women 19.9% Latest data – DHS 2006/7

  6. Trends in LBW Urban 11.6% Rural 17.0% Estate 20.8% (DHS. 2000) Medical Statistician and DHS surveys 1993,2000,2006

  7. (DHS. 2000)

  8. Trends in Nutritional Status of <5 years - Underweight - Stunting - Wasting Department of Census and Statistics, DHS 1987,1993,2000, 2006/7

  9. infection malnutrition Protein Energy Malnutrition • Causes • Inadequate & faulty diets • Poverty • Socio-economic factors • Environmental factors • infections • Sanitation • personal hygiene PEM - MACRONUTRIENT DEFICIENCY Often associated with INFECTIONS Micronutrient deficiencies

  10. Eg :- Young child - Energy needs Protein needs • Staple diets Energy density • Protein content • Feeding frequency • Inadequate food availability • Poverty Inequity Lack of land • Infections Anorexia • Food intake • Absorption • Utilization • losses • Famines • Droughts, Natural disasters, War, Civil disturbances • Inappropriate weaning practices Host diet environment

  11. Malnutrition Marasmus Kwashiorkor E

  12. NON CLINICAL FORMS • WASTING - (wgt / hgt) • STUNTING - (hgt / Age) • UNDERWEIGHT - (wgt / Age) • Changes in internal organs • Gastrointestinal tract • - Mouth, Tongue, Throat • Atrophic mucosa / ulceration • Gums infected • salivary glands – atrophy • acute parotitis / oesophageal ulcers • - Mucosa of GI tract • Atrophy / Absorption • - Muscle tone in intestinal muscles • Rectal prolapse • Liver • - Fatty change • Pancreas • - Extreme wasting

  13. Kidneys • - size • - infections • Endocrine system - Pituitary gland • - Adrenal gland • - Thyroid • - Thymolymphatic system • Haemopoietic system • - Anaemia ~ Protein • ~ Iron • ~ Folic Acid • - Chronic infection • ~ suppressed BM • Muscles • - Wasting • Heart • - General Atrophy • - Cardiomegaly in Anaemic patients • Skin changes • Bone • Dental development • CNS

  14. Prevalence of Anaemia in Different groups in Sri Lanka Anaemia Status of Sri Lanka,MRI,2001

  15. Distribution of Anaemia in Pre-school children (6-59 months) by province Anaemia Status of Sri Lanka,MRI,2001

  16. Trends in the prevalence of iron deficiency anemia among under five children

  17. Iron Deficiency Amount of Iron in the body 3 – 4 gm > 50 % of it Hb Rest muscle (myoglobin) liver Hb O2 metabolic activities cells Daily requirement 14 mg / day 12 mg / day

  18. Liver RES BM Iron storage Compounds - Ferritin - Hemosiderin Iron affects :- - Cognitive development - Concentration - Attentionspan - Memory - Learning - Physical growth - Muscle function - Immunity to disease & illness - Social interaction Life cycle - New born - Infant - Preschooler - Primary schools - Adolescents - Adults - Elderly preg: lact: normal

  19. Strategy for the Control of Anaemia • Dietary diversification, Nutrition education & local food sources • EBF + Complementary feeding • 6/12 BF – 2 years • Modify diets adding local nutrient rich • Avoid Tea with meals • Enhancing / Inhibiting factors • Horticultural projects • Livestock programmes • Ensue access to varied food supply to obtain adequate diet, school garden • Nutrition Education • All institutional diets according to nutritional requirements

  20. Supplementation • Fe supplementation • Targets • Infants E BW • Preschoolers • Primary school children • Weekly supplementation • of child bearing age group • Blanket coverage to displaced & refugee camps • Fortification

  21. Vitamin A deficiency Prevalence of Vitamin A deficiency (serum retinol levels less than 20µg per dl) Among 6-71 months 1996 35.3% a 200529.3%b a/ Vit A Deficiency status of children in Sri Lanka 1995/1996. MRI. 1998 b/ MRI. 2005 (unpublished data)

  22. Vitamin A deficiency • Public Health Problems • Blindness • Duration of morbidity • Mortality • asso. with other Nutritional disorders • (infections PEM) • Causal factors~ Host • ~ Diet • ~ Environment • Host : Age younger age • (infants / preschool) • Growth • intake of milk, greens • Diet :intake of greens & fat • animal protein

  23. Environment : • Seasonal food availability • Infections , Infestations • Socio Economic • Needs :- (Functions) • Synthesis of photosensitive pigment of Retinal cells • Cell differentiation of Epithelium • Normal growth • Reproduction • Immune competance • Dry skin :- Follicular keratosis • Sweet / sebaceous gland blocked by keratin plugs • Secretions • Dry skin

  24. Storage :- • 95 % in Hepatic cells • Hepatocytes secrete “ Retinol Binding Proteins” • DIAGNOSIS :- • Clinical features Night blindness • Conjunctival xerosis • Corneal cerosis • Conj. Xerosis with ulceration • Keratomalacia • Corneal scars • Biochemical Tests • - S. Retinol level • - Relative dose response • Dietary assessments • - Hellen kellar food frequency • Conjunctival Impression Cytology • Liver biopsy / necropsy

  25. Vitamin A Policy • Recommendations & (Px & control) • Dietary modifications • 1. Ensue food security • Promote home gardening • Food & agriculture policies (multi sectoral approach) • Research to crops with micronutrients • Proper storage to nutrient losses • Food preservation • 2. Information , Education & Communication (IEC) BCC • 3. Promote BF / CF • Fortification Commercially , local production • SLS certificate for forti. Food • Supplementation • - pregnant mothers • - Regular supply of Thriposha

  26. 100,000 I u Vitamin A mega dose Regime Post Partum : 200,000 I u within 4 wks after delivery Child 0 – 59 months > 9 months > 18 months > 36 months School children grade 1, 4, 7 :- 100,000 I u Special situations ~Displaced ~Estate ~ Garment factory workers ~Prisoners ~Orphans 100,000 promote dietary modification

  27. Iodine Deficiency Disorders Total goiter rate in children aged 6-9 years 2000/2001a 20.1% 2005 b 3.8% Central 10.3% Uva 7.8% Western 7.3% a/ Case studies on successful micronutrient prorammes: The Sri Lankan experience b/ Iodine nutrition status in Sri Lanka 2005. MRI . 2006

  28. IODINE DEFICIENCY DISORDERS • Sole function of iodine - participation in the synthesis of THYROID HORMONES (T4 + T3) • THYROID HORMONES – VITAL FOR PHYSICAL & MENTAL DEVELOPMENT • Severity of mental / physical retardation depend on the severity of iodine deficiency • SPECTRUM OF IODINE DEFICIENCY • Cretin or deaf mute • Mental & physical growth retardation • Goitre • Delayed menarche • Amenorrhoea • Endemic goitre • A significant proportion of the popluation has palpable or obviously enlarged thyroids • Indicators • Goitre prevelance • Urine iodine levels • Iodine levels of salt

  29. Interventions on Food & NutritionPolicies, Strategies & Programmes • Antenatal care & supplementation • Promotion of breast feeding (BF code & Baby friendly hospitals & maternity leave) • Growth monitoring & promotion • Complementary feeding • Thriposha supplementation

  30. Interventions on Food & Nutrition Cont… 6.Vitamin A mega-dose 7. Food subsidy -“Poshana Malla”, “Kiri weeduruwa” 8. School health programmes – exercise programme, canteen policy, etc 9. School feeding programmes 10. Special food subsidy for IDPs, Plantation workers

  31. Cont… Interventions on Food & Nutrition • 11. Health & Nutrition promotion - Education programmes for pregnant & lactating women, school children • Hospital diet modification • Food fortification – salt iodization • Nutrition in emergencies

  32. Poorly coordinated Poorly targeted -Thriposha programme Inadequate rational & irregular supply-Thriposha programme Poor attention on vulnerable areas & groups –Estates Weaknesses

  33. Weaknesses Inadequate coverage of services – some estate areas Over burdened at grass root level health workers Inadequate training & poor dissemination of current knowledge to grass root level Inadequate supervision & monitoring…Quality Cont…

  34. Suggestions National inter sectoral committees (chaired by Hon PM/ Hon ministers) Establishment of NSC (chaired by SH&N) Strengthening intra & inter sectoral coordination at all level Provincial/ District nutrition committees National nutrition policy National strategic plan/ annual action plans – National, District & Divisional

  35. Suggestions Improve targeting effort (mapping out vulnerable areas & groups) Strengthening existing progrmmes – BCC, re-targeting, area specific programmes with triple A approach Due consideration gives to new initiatives -DFS, micro nutrient supplementations Encouraging dounor assisstance Increase capacity of thriposha factory & ensure regular supply Cont…

  36. Thank you…

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