Nutritional Problems in Nepal
First year 2020-24
Practical
Community Medicine Department
Dr. Bharati Shakya
Nutritional Problems in Nepal
• Protein Energy Malnutrition (PEM)
• Vitamin A Deficiency
• Nutritional/ Iron deficiency Anaemia
• Iodine Deficiency Disorders
• Low birth weight
MACRONUTRIENT
DEFICIENCY
Protein Energy Malnutrition (PEM)
Clinical criteria to differentiate the two types of malnutrition
MARASMUS KWASHIOKOR
1. Gross wasting of muscular 1. Hidden by oedema and fat
tissue
2. Gross wasting of 2. Fat often retained but not firm
subcutaneous tissue 3. Oedema present in lower legs,
3. No detectable edema face and forearm
4. Hair changes -seldom 4.Sparse,silky,easily pulled out
hair
5. No skin changes 5.Diffuse pigmentation present
6. Child is usually quiet and 6. Child is irritable and Apathetic
apathetic
7. Appetite is good
8. No hepatic enlargement 7. Loss of appetite
8. Hepatic enlargement present
a) Kwashiorkor is a severe form of undernutrition, which
develops in individuals on diets with a low
protein/energy ratio. The main symptoms of
Kwashiorkor are oedema, wasting, liver enlargement,
hypoalbuminaemia, steatosis and the possible
depigmentation of skin and hair.
b) Marasmus is the other form of malnutrition, which is
caused by inadequate intake of both protein and
energy. The main symptoms of marasmus are severe
wasting, with little or no oedema, minimal
subcutaneous fat and non- normal serum albumin
levels.
Prevention
-Breast feeding should be promoted and low cost
weaning foods should be recommended.
-Child’s diet must contain protein and energy rich
food ( milk, egg, meat, ghee, etc)
- All children should be immunized completely
- Fortified food should be consumed
- “Road to Health” card should be maintained
- Early diagnosis and treatment of infections &
diarrhoea must be done
WHO definitions
c) Stunting- Children whose height-for-age Z-
score is below minus two standard
deviations(-2SD) from the WHO Child Growth
Standards median of the reference
population. It is an indicator of past growth
failure.
d) Wasting - Children whose weight-for-height Z-
score is below two standard deviations(-2SD)
from the WHO Child Growth Standards
median of the reference population. It often
indicates recent and severe weight loss.
e) Underweight-Children whose weight-for age z
score is below minus two standard deviations
(-2 SD) from the median of the reference
population are classified as underweight. It is
an indicator to assess changes in the
magnitude of malnutrition over time.
Nepal Demographic & Health Survey
(NDHS) 2022 found that
• 25% of children under age 5 are stunted,
• 19% are underweight , and
• 8% are wasted.
• One percent of children under 5 are
overweight.
MICRONUTRIENT DEFICIENCY
f) Vitamin A deficiency disorders
• Xerophthalmia (dry eye) comprises all the
ocular manifestations of vitamin A deficiency
comprising of
- nightblindness
- conjunctival xerosis
- bitot’s spot
- corneal xerosis
- keratomalacia
Preventive meaures
• Increase the consumption of vit. A rich foods such
as Animal foods (retinol) - Liver, eggs, butter,
cheese, whole milk, fish, meat, fish liver oils.
• Plant foods(carotenes) - Green leafy vegetables
e.g. Spinach, amaranth;yellow fruits and vegetables
eg. Papaya, mango, pumpkin;Roots e.g. Carrot
• Fortified foods- Vanaspati, margarine, milk
• Prophylaxis of young children with vit. A.
g) Iodine deficiency disorders (IDD)
Most important consequences of the spectrum of IDD
are:
• Goiter
• Mental retardation
• Hypothyroidism
• Delayed motor milestones
• Endemic Cretinism
• Intrauterine death, spontaneous abortions
• Increased morbidity and mortality of infants and
neonates
Prevention
Create awareness about the consequences of
iodine deficiency disorder, specially for high risk
groups (infants, pregnant and lactating women)
Advise the people to use iodized salt for
household consumption on daily basis.
Educate the public to eat iodine rich food items
like sea fish and cod liver oil, and
Avoid goitrogenic foods such as cabbage,
cauliflower.
h) Iron deficiency anemia
Salient features
• Extreme fatigue
• Pale skin
• Weakness
• Headache
• Dizziness or lightheadedness
• Brittle nails
In severe cases
• Shortness of breath
• Chest pain
• Frequent infections
• Fast heartbeat
• Unusual cravings for non-nutritive substances, such as ice, dirt or starch-
PICA
• Poor appetite, especially in infants and children with iron deficiency
Prevention & Control measures
• Iron and Folic acid supplementation to pregnant
women, lactating mothers and children
• Iron rich foods should be consumed eg, liver,
meat,fish,green leafy vegetables,cereals,
legumes,nuts,etc
• Iron fortified foods should be consumed
• Nutrition education on food diversification &
healthy eating practices should be given and
deworming should be done periodically.
i) Rickets
• Age- children between the age of 6 months
and 2 years.
There is reduced calcification of growing
bone.
• C/F- growth failure, bone deformity,
muscular hypotonia, tetany and convulsions
Prevention
• Educating parents to expose their children
regularly to early morning sunshine
• Consumption of vit. D rich foods such as fish,
fish liver oils, egg yolk, butter, cheese.
• Vit D fortified foods should be consumed.
• Prophylaxis of young children with vit. D.
THANK YOU
