Nutritional status of children in the state of kerala
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NUTRITIONAL STATUS OF CHILDREN IN THE STATE OF KERALA. Dr. G.N.V.Brahmam Scientist – ‘F’ Division of Community Studies, National Institute of Nutrition, (I.C.M.R.) Jamai-Osmania (P.O.), Hyderabad – 500 007. HEALTH AND NUTRITION. HEALTH

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NUTRITIONAL STATUS OF CHILDREN IN THE STATE OF KERALA

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NUTRITIONAL STATUS OF CHILDREN IN THE STATE OF KERALA

Dr. G.N.V.Brahmam

Scientist – ‘F’

Division of Community Studies,

National Institute of Nutrition, (I.C.M.R.)

Jamai-Osmania (P.O.), Hyderabad – 500 007.


HEALTH AND NUTRITION

HEALTH

“… is a state of complete physical, mental, and social well being and not merely absence of disease or infirmity” - - - WHONUTRITION

“ … is a process of ingestion of food, digestion, absorption, assimilation, and utilization of various nutrients”


SIGNIFICANCE OF NUTRITION

  • Normal Growth, development and functions

  • Epidemiological data reveals strong association

    between undernutrition and morbidity &

    mortality.

  • Chronic degenerative disorders such as,

    - Coronary heart disease,

    - Hypertension,

    - Type 2 Diabetes,

    - certain types of Cancers, etc.

    are associated to diet and nutritional status

  • Undernutrition in early Childhood is associated

    with chronic degenerative disorders in later life


SIGNIFICANCE OF NUTRITION (Contd.)

  • Consumption of foods rich in dietary fiber, anti-

    oxidants is associated with reduced risk of

    certain types of cancer.

  • Obesity and overweight is also associated with

    Increased risk of developing cancer of the

    Breast, Colon, Endometrium, Gallbladder,

    Oesophagus, Pancreas, Kidney, etc.


MALNUTRITION

“ ….. a pathological state that results from ingestion of one or more nutrients, either in excess or deficient quantities over a period of time.”

Undernutrition : Due to deficient intakesOvernutrition : Due to excess intakes


HOUSEHOLD FOOD SECURITY:

Ability of the Household to access food which is culturally acceptable and adequate in terms of quality, quantity and safety for all members of the household throughout the year, in order to ensure active and healthy life


Demographic factors

Agro-climatic factors

Disasters

Socio-economic factors

DETERMINANTS OF NUTRITIONAL STATUS

  • Population

  • Family Size

  • Urbanisation

Drought/Floods

Wars

  • Food production

  • Land Ownership

  • Type of land

  • Rain fall

  • Geographic conditions

  • Agricultural techniques

  • Use of hybrid seeds

  • Use of fertilizers

  • Religion

  • Community

  • Occupation

  • Income

H H FOOD SECURITY

Availability of & participation in developmental programmes

Physiological factors

• Pregnancy

• Lactation

• Breast feeding

practices

• Infant & child

Feeding practices

FOOD INTAKE

  • PDS

  • Rural Dev. Prog.

  • Employment

  • generation prog.

Socio-cultural factors

  • Illiteracy

  • Ignorance

  • Taboos

  • Lifestyles

NUTRITIONAL STATUS

Pathological Conditions

  • Infections

    • Diarrhoeas

    • Resp. Infections

    • Malaria

    • Others

  • Infestations

    • Hook worms

    • Round worms

    • Giardiasis etc.,

Environmental factors

  • Environmental sanitation

  • Personal hygiene

  • Safe drinking water


HEALTH & ECONOMIC CONSEQUENCES OF MALNUTRITION

  • Increased Morbidities, cost of treatment

  • Underdevelopment (Physical / Mental)

  • Absenteeism, Reduced productivity, lowered

    economic development


INFECTION AND UNDERNUTRITION

….. a Vicious Cycle

INFECTION

Reduced

Food intake/ absorption

Lowered resistance/

Frequent infections

Death

UNDERNUTRITION


CAUSES OF DEATHS AMONG <5 YEAR CHILDREN IN DEVELOPING COUNTRIES

*

*

*

Malnutrition*

60%

* Approximately 70% of all childhood deaths are associated with one or more of these five conditions

*

Source: WHO 2002; Lancet-2003


Infant Mortality Rate (Per 1000 Live Births) in India and South-east Asian Countries

44 (SRS-2011)

Source :

WHO/SEARO2000

* Source:

SRS-2011

11


Under-five Mortality Rate (Per 1000 Live Births) in South-east Asian Countries & India

(55: SRS, 2011)

(2002)

(2004)

(2000)

(2003-04)

(1999-2000)

* Source: SRS, 2011


IMR & UNDER-FIVE MORTALITY RATE : URBAN Vs RURAL(Source: SRS – 2011)


Maternal Mortality Ratio (Per 100,000 Live Births) in India and South-east Asian Countries

212*

Source :

WHO/SEARO 2000

* Registrar General of

India, SRS - 2011


Prevalence (%) of Low Birth Weight in India and South-east Asian Countries

Source :

WHO/SEARO 2000

* Source: NFHS 3


PERECNT CHILDREN (12-23 MONTHS) COMPLETELY IMMUNIZED

INDIA

KERALA


INFANT & YOUNG CHILD FEEDING PRACTICES


Percent

Age (Months)

Faulty BF

Faulty Complementary feeding

* By using Harvard Reference Values

Prevalence of Underweight among 6-59 months children according to age* ( by IAP classification)


INFANT AND YOUNG CHILD FEEDING PRACTICES (NFHS 3)

India

Percent

Percent

Kerala


FOOD & NUTRIENT INTAKES


Average Daily Consumption (per CU/day) of Foodstuffs

as % of RDA : Kerala Vs Other NNMB States Pooled

RDA

Source: NNMB Survey, 2005-06 ( 8 States) NNMB


Median Intake (per CU/Day) of Various Nutrients

(as % of RDA): Kerala Vs Other NNMB States Pooled

RDA

Source: NNMB Survey, 2005-06 ( 8 States) NNMB


Average Daily intake of Foodstuffs (as % RDA) among 1-6 Year Children : Kerala

RDA

Percent of RDA

Source: NNMB Survey, 2005-06


Median Intake of Nutrients (as % RDA) by 1-6 year Children : Kerala

RDA

Percent of RDA

Source: NNMB Survey, 2005-06


Protein-Calorie inadequacy status of Children : Kerala

Calorie inadequacy

Protein inadequacy

Source: NNMB Survey, 2005-06


Source: NNMB Survey, 2005-06


Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults and Children In Kerala

Source: NNMB Survey, 2005-06


FOOD & NUTRIENT INTAKES IN KERALA

. . . TIME TRENDS


Average Intake of Foodstuffs (per CU/day) in Kerala as % of RDI by Period of Survey (NNMB)

RDA

Percent


Median Intake of Nutrients (per CU/day) in Kerala as % of RDI by Period of Survey (NNMB)

RDA

Percent


Median Intake of Nutrients (per CU/day) in Kerala as % of RDI by Period of Survey (NNMB)

RDA

Percent


ANTHROPOMETRIC INDICATORS


Prevalence (%) of Undernutrition Among 0-5 yr children According to SD Classification (<Median - 2SD)in Kerala*

Percent

(Weight for Height)

(Weight for age)

(Height for age)

Source: NNMB Survey, 2005-06

* Using WHO Child Growth Standards


Prevalence (%) of Undernutrition among <5 yr Children – By State (2006) By SD Classification

UNDERWEIGHT

STUNTING

WASTING

* Using WHO Child Growth Standards


Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD) in Kerala : By Age Group (Years)

P>0.05

Percent

Source: NNMB Survey, 2005-06 ( 8 States) NNMB

* Using WHO Child Growth Standards


Prevalence (%) of Undernutrition Among <3 yr children According to SD Classification (<Median - 2SD) in Kerala : RURAL Vs URBAN (NFHS 3)

Percent

Source: NFHS 3

* Using WHO Child Growth Standards


Prevalence (%) of Undernutrition Among 6-9 yr children According to SD Classification*

Percent

Source: NNMB Survey, 2005-06

* Using NCHS Reference Values


Prevalence (%) of Undernutrition Among Adolescent children According to BMI (Age/Sex Centile values of NHANES)

Percent

Source: NNMB Survey, 2005-06


Prevalence (%) of Overweight/Obesity among 6-15 yr urban children in Kochi City (Based on Age/Sex specific Centile values of BMI: WHO/CDC)[Overweight: BMI 85th – 95th Centile; Obese: BMI: >=95th Centile; ; Overweight+ Obese: BMI >= 85th Centile]

P<0.028

Percent

BOYS

GIRLS

P<0.005

P<0.005

Percent

Percent

Source: A.T.Cherian, Ind. Ped. 2012


Distribution (%) of Adult Men and Women According to Nutritional Status by BMI

Percent

Source: NNMB Survey, 2005-06


MICRONUTRIENT DEFICIENCIES


Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20 G/dL, Median Dietary Intake of Vit. A (as % RDA) and

Extent of Coverage for Suppl. of Massive Dose Vit. A – By State

Source:NNMB Tech. Rep. #23 - 2005


Distribution (%) of 1-5 year Children according to Vitamin ‘A’ Status : By States

Blood Vitamin A < 20 g/dL

Dietary Vitamin A Intake < 50% of RDA

P > 0.05

P > 0.05

Receipt of Massive Dose Vitamin A (1 or 2 Doses)

Source: NNMB-MND Survey, 2003 (8 States)


Prevalence (%) of Anaemia Among Different Age, Sex and Physiological Groups in Kerala

11.4

0.07

11.8

0.07

10.9

0.08

10.7

0.07

11.8

0.07

10.2

1.45

12.1

1.56

Mean ±SE

> 6 months

< 6 months

Source: NNMB-MND Survey, 2003 (8 States)


Distribution (%) of Target Beneficiaries according to receipt of IFA tablets in Kerala

Source: NNMB-MND Survey : 8 States, 2003


Percent of Households consuming salt having adequate

Amount (>=15 ppm) of Iodine in Kerala

Per cent

STATES

* By spot test

Source: NNMB-MND Survey : 8 States, 2003


Challenges:

  • Despite the positive improvements in the demographic, socio-economic and health sectors, the dietary intakes of the rural communities continues to be poor both in terms of quantity and quality.

  • Dietary intake of energy is low and that of essential micronutrients are grossly inadequate.

  • Infant and child feeding practices, especially during the first 6 months, are sub-optimal

  • Prevalence of LBW is about 16%, and about 22% of <5 year children are underweight and 30% are stunted and 15% are wasted


Challenges (contd..):

  • About 28% of the men and 21% of the women are having CED.

  • MNDs such as IDA and VAD continue to be of public health significance and coverage of target groups for IFA & Vit A distribution is low.

  • About a third of men and 40% of women are having overweight/obesity among adults known risk factors for diet related chronic degenerative diseases such as type 2 diabetes, hypertension and CHD.

  • Nearly one half of adult population are found to be having hypertension.


Possible Solutions:

  • Devise and implement appropriate IEC strategies to improve the knowledge and practices among the community, about infant and young child feeding.

  • Encourage the communities to include locally available micronutrient rich foods such as green leafy vegetables, and fruits in their regular diets through Agri. / Horti. interventions.

  • Strengthening of on-going programmes to increase the coverage of target beneficiaries for Supplementary nutrition and distribution of folifer tablets and massive dose vitamin A


Possible Solutions (Contd..):

  • Fortification of foods with vitamins / minerals in order to augment the micronutrient intakes of the individuals.

  • Improving household food and nutrition security, through socio-economic development

  • Institution of Nutrition Surveillance system and MIS for effective monitoring and interventions


SUGGESTED STRATEGIES

  • SHORT TERM

    Strengthening supplementary nutrition Programmes, in terms of quantity and type of Supplement and coverage of target population and monitoring

    Immunization, health care services

  • MEDIUM TERM

  • Micronutrient fortification of staple foods and food supplements under SNP


  • LONG TERM

    Development & implementation of State specific Nutrition Policies and Programmes,

    Strengthening Health & Nutrition education, especially regarding: - Infant & child feeding, - Nutrition during adolescence, pregnancy and Lactation,

    Dietary diversification, Bio-fortification of foods, promotion of home gardening, through Krishi Vigyan Kendra (KVK),

    Improving life-style practices

    Environmental sanitation and personal Hygiene including safe drinking water,

    Programmes for Economic development, especially at grass root level, through income generating activities, and

    Population control.


Thank you


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