NUTRITIONAL PROBLEMS IN INDIA

&
COMMUNITY NUTRITION PROGRAMMES

Mohammed Mubarak. M
Ist year MSc Nursing
Govt. College of Nursing. Kottayam
MAJOR HEALTH PROBLEMS IN
INDIA
COMMUNICABLE DISEASE PROBLEM
POPULATION PROBLEM
ENVIRONMENTAL SANITATION PROBLEM
MEDICAL CARE PROBLEM
NUTRITIONAL PROBLEM
CAUSE OF NUTRITIONAL
PROBLEM
POOR NUTRITION

UNDER NUTRITION (MALNUTRITION)

OVERNUTRITION
The World Bank estimates that India is ranked 2nd
in the world of the number of children suffering
from malnutrition
Undernutrition is found mostly in rural areas
10 percent of villages and districts accounting for
27-28 percent of all underweight children
children of scheduled tribes have the poorest
nutritional status and the highest wasting
DETERMINANTS OF MALNUTRITION

MATERNAL MALNUTRITION
LOW BIRTH WEIGHT
FAULTY CHILD FEEDING PRACTICES
DIETARY INADEQUACY
FREQUENT INFECTIONS
LARGE FAMILIES
HIGH FEMALE ILLITERACY
TABOOS AND SUPERSTITIONS
FACTORS AFFECTING NUTRITIONAL STATUS
HIGH RISK GROUP
Pregnant women
Lactating women
Infants
Preschool children
Adolescent girls
Elderly
Socially deprived
NUTRITIONAL PROBLEMS IN
INDIA
 NUTRITIONAL PROBLEMS IN INDIA
PROTEIN ENERGY
MALNUTRITION
LOW BIRTH WEIGHT
XEROPHTHALMIA
NUTRITIONAL ANEMIA
IODINE DEFICIENCY DISORDERS
FLUROSIS
LATHYRISM
OBESITY
CARDIO VASCULAR DISEASES
DIABETES
75 percent of preschool children suffer from
iron deficiency anemia (IDA)
57 percent of preschool children have sub-clinical
Vitamin A deficiency (VAD)
Iodine deficiency is endemic in 85 percent of districts
11% of Indian population in India are over-nourished
over 30 million people with diabetics in 1985 and by
next year (2010) India is projected to have 50.8 million
diabetics
India is hence considered as the country with the
largest population of diabetics
PROTEIN ENERGY MALNUTRITION

PEM refers to the deficiency of energy and protein in

the body.
1-2% of preschool children in India suffer from PEM.
MAIN CAUSES OF PEM

Inadequate intake of food both in quantity and quality

Infections (Diarrhea, Respiratory infections, measles,
intestinal worms)
Contributing factors to PEM

POOR ENVIRONMENTAL CONDITIONS,

LARGE FAMILY SIZE,
 POOR MATERNAL HEALTH,
FAILURE OF LACTATION,
 PREMATURE TERMINATION OF BREAST
FEEDING,
ADVERSE CULTURAL PRACTICES RELATED TO
CHILD REARING AND WEANING,
DELAYED SUPPLEMENTARY FEEDING
CLINICAL FORMS OF PEM

MARASMUS
KWASHIORKER
Marasmus
common type of PEM observed among children below
1 year of age.
 Caused by severe deficiency of nearly all nutrients
especially protein and calories
conditions are characterized by extreme wasting of the
muscles and a daunt expression
Marasmus
Extensive tissue and muscle
wasting
Dry skin
Loose skin folds hanging over
glutei and axilla,
Fat wasting
small for age
sparse hair that is dull brown or
reddish yellow,
mental retardation
behavioral retardation,
low body temperature (
hypothermia),
 slow pulse and breathing rates.
Absence of edema
 Kwashiorker
Kwashiorker occurs in children between 2-3 years of age
Acute form of PEM due to deficiency of protein in the
diet (Both in quantity and quality)
Deficiency of micronutrients (Fe, Folic acid, Iodine,
Selenium, and Vitamin C)
Deficiency of antioxidants (albumin, Vitamin E, PUFA,
Glutathione).
kwashiorkor is identified as swelling of the extremities
and belly, which is deceiving to their actual nutritional
status
KWASHIORKER
Malnourished child with
pedal edemas,
Growth failure,
Moon face,
Distended abdomen,
Ascitis(abnormal
accumulation of fluid)
Enlarged liver with fatty
infiltrates, thinning of
hair,
Loss of teeth,
Skin depigmentation
Dermatitis,
Irritability
Assessment of PEM
Gomez Classification

Weight for age = Weight of the child

100
 Weight of normal child of the same
age
Between 90 – 110% Normal Nutritional Status
Between 75 – 89% Mild malnutrition (1st degree)
Between 60 – 74% Moderate Malnutrition (2nd
degree)
Under 60% Severe Malnutrition (3rd degree)
Preventive Measures of PEM

Health promotion Measures

Promotion of breast feeding, low cost weaning food,
nutrition education, family planning and birth spacing,
Protein energy rich food,(milk, egg, fresh fruits),
immunization, food fortification
Early diagnosis and treatment
Rehabilitation
LOW BIRTH WEIGHT
 LOW BIRTH WEIGHT

Birth weight less than 2500Gm.30% 0f babies born in

India are LBW

35
30
25
PER CENT

20
15
10
5 Series2
0 45
Causative factors
Maternal malnutrition and anemia.
Illness and infections during pregnancy,
High parity,
Close birth intervals
Factors Modifying Prevalence of LBW
More Institutional deliveries
 Improving No.of ANCs (minimum: >5)
Improving Quality of ANC
Includes: No.ofANCs, TT, weight, BP, examination of
blood, examination of urine
 XEROPHTHALMIA(DRY EYE)

Disease due to
deficiency of Vitamin
A
Also Called Xeroma
Absence of tears
Xerophthalmia is most
common in children
aged 1-3 years
Cornea and conjunctiva
become horny and
necrosed
 Bitot’s Spots
•Collection of
dried epithelium,
micro organisms
etc. forming shiny
grayish white spot
on the cornea
•A sign of Vitamin
A deficiency
KERATOMALACIA
Ulceration
and softening
of Cornea due
to deficiency
of vitamin A
Bilateral Blindness
Risk factors

Ignorance
 Faulty feeding practices
 Infections
Diarrhea
Use of skimmed milk(totally devoid of vitamin a)
Prevention

Short term action – oral Administration of large dose

of Vitamin A (retinol Palmitate)
Medium term action – Food fortification with
Vitamin A. Eg:Dalda,Sugar,Salt,Tea etc
Long term action – Promote BF, consumption of
Green Leafy Vegetables, Immunisation to infections
NUTRITIONAL ANEMIA
A Condition in which the Hb content of blood lower
than normal as a result of a deficiency of one or more
essential nutrients
Primarily due to lack of absorbable iron in the diet
ANAEMIA IN FEMALES IN INDIA

95
90
85
80
Percent

75
70
65
92
60 84.6

55
Pregnant Adolescent
50
Women girls
Causes of Iron deficiency anemia

Inadequate intake of iron

Poor bioavailability (only less than 5 percent is
absorbed)
Excessive loss of iron (menstruation, rapid
pregnancies, hookworm infestations, other illnesses)
Effects of anemia

Increases the risk of maternal and fetal mortality and

morbidity
Increase susceptibility to infection due to impaired
cellular response and immune functions
Reduction of work performance and productivity
Interventions

Iron and folic acid supplementation

Nutritional anemia prophylaxis programme (daily Fe
& folic acid supplementation to Pregnant Women
lactating mothers & Children under 12 years)
Iron fortification - Fortification of salt with iron
Control of parasite and nutrition education
IODINE DEFICIENCY DISORDERS (IDD)

IDD refers to a spectrum of disabling conditions

arising from an inadequate dietary intake of iodine.

IDD affects the health of humans from fetal stage to

adulthood
 CAUSES OF IDD
Deficient iodine Intake – Consuming foods with low
Iodine content, Crops grown in iodine depleted soil

Increased demand for Iodine in the body – Demand of

Iodine is increased during the stage of rapid growth
(Infancy, Puberty, pregnancy, lactation), Demand
exceeds supply results in deficiency.

Presence of Goitrogens – goiter producing substances

naturally present in some foods (cabbage, cauliflower
etc.) interfere with Iodine utilization
IODINE DEFICIENCY DISORDERS (IDD)

Endemic Goiter
Cretinism
Endemic Goiter

•Also called
Derbyshire Neck
•Enlargement of
thyroid gland causing
swelling in front part
of the neck
•Due to lack of iodine
in the diet
•Goiter belt –
Himalayan region
•Graded from 0 – 4
•Common among girls
than boys
Cretinism
Severe form of IDD
Occurs during fetal stage
Interfere with brain development causing brain
damage and death
Result in Growth failure, MR, Speech and hearing
defects
FLUROSIS

Occurs due to consumption of excessive amount of

fluorine through drinking water
Two types of flurosis
Dental Flurosis
Skeletal flurosis
 Dental flurosis
Seen in children 5- 7 years of age
Teeth lose their shiny appearance
and chalk white patches develop
on them
Changes are called mottling of
enamel
In severe cases loss of enamel
gives teeth a corroded appearance
Dental flurosis is confined to
permanent teeth and develops
only during the period of
formation
Skeletal flurosis
 Seen in older adults
 Heavy fluoride
deposition on
skeleton
 Manifested as pain
numbness
&tingling sensation
of the extremities,
stiffness of neck
Genu Valgum
 A form of skeletal
deformity
associated with
flurosis
 The lower limbs
appear as knock
kneed due to
osteoporosis.
Prevention of Flurosis

Keep the drinking water fluorine level below 1mg/lit

Deflouridation of water using Nalgonda Technique
(Flocculation, Sedimentation & filtration)
Prevent use of fluoride toothpaste in areas of endemic
flurosis
Deficiency of flurine?
 LATHYRISM

Disease occur by consuming

large quantities of Lathyrus
sativus (Kesari dhal)
Lathyrism in human is referred as
Neurolathyrism
The disease presents as Crippling
disease of nervous system
characterized by gradually
developing spastic paralysis of
lower limbs
LATHYRISM

It contains a toxin called Beta oxalyl amino Alanine

(BOAA)
Lathyrus Kesari Dhal) is good source of protein.
It is relatively cheaper.
Intervention
Removal of toxin
Steeping method
 Soaking the pulse in hot water for about 2 hours and the soaked water
is drained off completely
 Genetic Approach
 Development of low toxin varieties of Lathyrus

Banning the crop

 The Prevention of food adulteration act in India has banned Lathyrus
in all forms
OBESITY
Most Prevalent form of malnutrition
Abnormal growth of adipose tissue due to enlargement
of fat cells(Hypertrophic),Increase in no. of fat cells
(hyperplasic)or Combination of both
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
 Factors contributing to obesity
 Age
 Sex
 Genetic factors
 Physical Inactivity
 Socio economic status
 Eating habits
 Psycho social factors
 Alcohol
The direct cause of
overweight in India is
 lack of physical activity due
to sedentary life style,
 loss of traditional diet,
 faulty diet,
 high stress
 high rate of economic growth
BMI
BMI = Height in kilogram
(Weight in Meter)2
20-25 IDEAL
26-30 OVERWEIGHT
31-40 OBESE
40+ VERY OBESE
 Control of obesity
Eat food according to body’s requirement
At least 3-4 hrs intervals between meals
Avoid in between snacks
Eat more leafy vegetables which contain high fiber
Avoid intake of fatty and fried foods
Regular Physical exercise
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.
 CANCER
80 % of cancer due to environmental factors
Dietary fat – positive correlation with Colon cancer, breast
cancer
Dietary fiber – Risk of colon cancer is inversely related
Micro nutrients – Lack of Vitamin C & Vitamin A arise
the risk of stomach cancer and lung cancer.
Food additives – Saccharin, cyclamate, Coffee, aflatoxin
associated with bladder cancer
Alcohol – liver cancer, Rectal Cancer
COMMUNITY NUTRITION PROGRAMMES
 INTEGRATED CHILD DEVELOPMENT
SERVICE (ICDS) SCHEME
Integrated Child Development Service (ICDS) scheme
was launched on 2nd October, 1975 (5th Five year Plan)
in pursuance of the National Policy
For Children started in 33 experimental blocks
Success of the scheme led to its expansion to 2996
projects by the end of March 1994.
 Now the goal (Ninth Five Year Plan ) is universalization
of ICDS throughout the country.
Beneficiaries

1. Children below 6 years

2. Pregnant and lactating women
3. Women in the age group of 15-44 years
4. Adolescent girls in selected blocks
 Objectives
1. Improve the nutrition and health status of children in
the age group of 0-6 years
2. Lay the foundation for proper psychological, physical
and social development of the child;
3. Effective coordination and implementation of policy
among the various departments
4. Enhance the capability of the mother to look after the
normal health and nutrition needs through proper nutrition
and health education.
 The Package of services provided by
ICDS
1. Supplementary nutrition, Vitamin-A, Iron and Folic
Acid,
2. Immunization,
3. Health check-ups,
4. Referral services,
5. Treatment of minor illnesses;
6. Nutrition and health education to women;
7. Pre-school education of children in the age group of 3-6
years, and
8. Convergence of other supportive services like water
supply, sanitation, etc
VITAMIN A PROPHYLAXIS
PROGRAMME(1970)
Programme launched by Ministry of H&FW
Component of National programme for control of
blindness.1968,1976
Single massive dose of oily preparation of Vitamin A
containing 200000 IU orally to all preschool children
in the community every 6 months through peripheral
health workers
PROPHYLAXIS AGAINST
NUTRITIONAL ANAEMIA
Launched by Govt.of India during 4th five year plan
Distribution of iron and folic acid tablets to pregnant
women and young children (1-12 years
MCH centres and ICDS projects implement this
programme
SCHEME FOR ADOLESCENT GIRLS
(KISHORI SHAKTI YOJNA)
A scheme for adolescent girls in ICDs was launched
by the Department of Women and Child Development,
Ministry of Human Resource Development in 1991.
Targeted All adolescent girls in the age group of 11-18
years
 SCHEME FOR ADOLESCENT GIRLS
(KISHORI SHAKTI YOJNA)
common services
1. Watch over menarche,
2. Immunization,
3. General health check-ups once in every six-months,
4. Training for minor ailments,
5. De-worming,
6. Prophylactic measures against anemia, goiter, vitamin
deficiency, etc., and
7. Referral to PHC. District hospital in case of acute need.
IODINE DEFICIENCY DISORDER PROGRAMME

Launched in 1962
Focuses on
Use of Iodised Salt – Replace of common salt with iodised
salt, Cheapest method to control IDD
Use of Iodized tablets – iodine tablets administered to
school children (not widely accepted)
Use of Iodized oil – 1ml Injection of Iodized oil to those
suffering from IDD, Oral administration as prophylaxis in
IDD severe areas
Mass communication – Public awareness through mass
media and public health programmes
MID-DAY MEAL PROGRAMME

Also known as School launch programme

Programme in operation since 1961
Objective
To attract more children for admission to schools
 Principles of Mid Day Meal
programme
The meal should be supplement and not a substitute to
home diet.
The meal should supply at least one third of the total
energy requirement and half of the protein needed
The cost of meal should be reasonably low.
The Meal should be prepared easily in schools, no
complicating cooking procedures involved
Locally available foods should be used
The menu should be frequently changed
Mid Day Meal programme
Recommendations
Cereals 75gm/day/child
Pulses 30
Oils and fats 8
Leafy vegetables 30
Non leafy vegetables 30
 BALWADI NUTRITION PROGRAMME
Nutritional support to pre school children
Started on 1970 Under the Department of Social welfare
For children age group 3-6 years in rural areas
Programme implemented through Balwadis
Food supplement
300kcal and 10grams of protein per child per day
 NATIONAL PROGRAMME FOR NUTRITION
SUPPORT TO PRIMARY EDUCATION
This system was called provision of ‘dry rations’.
Government of India will provide grains free of cost and
the States will provide the costs of other ingredients,
salaries and infrastructure
On November 28, 2001 the Supreme Court of India gave
direction that made it mandatory for the state governments
to provide cooked meals instead of ‘dry rations
 AKSHAYA PATRA AND PRIVATE SECTOR
PARTICIPATION IN MID-DAY MEALS
Successfully involved private sector participation in the
programme
The programme is managed with an ultra modern
centralized kitchen that is run through a public/private
partnership.
Food is delivered to schools in sealed and heat retaining
containers just before the lunch break every day
 EMERGENCY FEEDING
PROGRAMME 2001
This was introduced in May, 2001 in selected states
(Orissa)
Emergency Feeding Programme, is a food-based
intervention targeted for old, infirm and destitute persons
belonging to BPL households to provide them food
security in their distress conditions.
Cooked food containing, rice- 200gms, Dal (pulse)- 40
gms, vegetables- 30 gms is provided in the diet of each
EFP beneficiary daily by the Government.
VILLAGE GRAIN BANKS SCHEME
Implemented by the Ministry of Tribal Affairs
to provide safeguard against starvation during the
period of natural calamity or during lean season when
the marginalized food insecure households do not have
sufficient resources to purchase rations.
WHEAT BASED NUTRITION
PROGRAMME (WBNP)
Implemented by the Ministry of Women & Child
Development
providing nutritious/ energy food to children below 6
years of age and expectant /lactating women from
disadvantaged sections
Implemented through ICDS
SC/ST/OBC HOSTELS
introduced in October, 1994 by Ministry of Consumer
Affairs, Food & Public
The residents of the hostels having 2/3rd students
belonging to SC/ST/OBC are eligible to get 15 kg
food grains per resident per month.
SAMPOORNA GRAMIN ROZGAR YOJANA

50 lakh tones of food grains is to be allotted to the

States/UTs free of cost by Ministry of Rural
Development
 NATIONAL FOOD FOR WORK PROGRAMME

To provide supplementary wage employment and food

security
Implemented in tribal belts.
The scheme will provide 100 days of employment at
minimum wages for at least one able-bodied person from
each household in the country
GRAIN BANK SCHEME

Ministry of Consumer Affairs, Food & Public

Distribution
to establish Grain Banks in chronically food scarce
areas.
PULSE MISSION

pulse production has been stagnant for five decades.

Pulse Mission (India’s Food Security Mission) aimed

at increasing pulse production.
 Aimed to improve pulse production by 2 million tones by2011-12
NATIONAL WATER SUPPLY AND
SANITATION PROGRAMME
Launched in 1954

Provide safe water supply and adequate drainage

facilities for the entire urban and rural population of
the country
 MINIMUM NEEDS PROGRAMME
 Launched on 1974
Objective
To provide basic minimum needs and thereby improve the living
standards of people
 It Includes
 Rural Health
 Rural water Supply
 Rural electrification
 Elementary education
 Adult education
 Nutrition
 Environmental improvement of urban slums
 House for landless laborers
20 POINT PROGRAMME 1975

Objectives:
Eradication of poverty,
 raising productivity,
 reducing inequality,
 improving quality of life.
National Children's Fund 1979
This Fund Provides support to the voluntary
organizations that help the welfare of children.
National Plan of Action for Children1990
United Nations Children's Fund
National Rural Health Mission2005-2012
National Rural Health Mission2005-2012

Reduce the infant mortality rate (IMR) and the maternal

mortality ratio (MMR)
To have universal access to public health services
Prevent and control both communicable and non-
communicable diseases, including locally endemic diseases
To have access to integrated comprehensive primary
healthcare
Create population stabilization, as well as gender and
demographic balance
Revitalize local health traditions and mainstream AYUSH
Finally, to promote healthy life styles
INDIRECT PROGRAMMES

 NATIONAL CANCER CONTROL PROGRAMME 1975-76

 NATIONAL DIABETES CONTROL PROGRAMME

 POVERTY ALLEVIATION PROGRAMMES

 ENVIRONMENTAL SANITATION

 PROTECTED WATER SUPPLY PROGRAMME

 LITERACY PROGRAMME