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Prevention of Childhood Malnutrition. Dr. Harivansh Chopra DCH, MD Professor Department of Community Medicine, LLRM Medical College, Meerut. harichop@gmail.com. Objectives. To study the magnitude of Protein Energy Malnutrition and causes associated with it.
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Prevention of Childhood Malnutrition Dr. Harivansh Chopra DCH, MD Professor Department of Community Medicine, LLRM Medical College, Meerut. harichop@gmail.com observerzparadise.com
Objectives • To study the magnitude of Protein Energy Malnutrition and causes associated with it. • To study methods of prevention, treatment, and rehabilitation of PEM. observerzparadise.com
Whether this child will grow normally or become malnourished? ? ? observerzparadise.com
Protein Energy Malnutrition Defined as “chronic pathological condition which arises due to absolute or relative lack of protein and energy in the diet over an extended period of time and is commonly associated with infection albeit infestation in young children”. observerzparadise.com
Nutritional Status of children below 3 years : NFHS II observerzparadise.com
Nutritional Status of children below 3 years : NFHS II observerzparadise.com
Nutritional status of under-three children in relation to living index NFHSII observerzparadise.com
Nutritional status of under-three children in relation to age observerzparadise.com
Percentage of underweight children –Comparison between NFHS I & II observerzparadise.com
Nutritional Status of children below 3 years : NFHS III observerzparadise.com
Nutritional Status of children below 3 years : NFHS III observerzparadise.com
Percentage of underweight children –Comparison between NFHS II & III observerzparadise.com
Distribution of 1-5 years children (Gomez classification) NNMB observerzparadise.com
Causes of Malnutrition • Inadequate Food Security. • Infection. • Low weight of adolescent girls. observerzparadise.com
Causes of Malnutrition • Low Immunization coverage. • Maternal Anemia. • Low literacy level in female. observerzparadise.com
Causes of Malnutrition • Poor sanitary conditions. • Low birth weight. • Lack of knowledge regarding normal growth of children. observerzparadise.com
Causes of Malnutrition • Poor hygiene. • Incorrect child rearing practices. • Inaccessible and Inadequate health services. observerzparadise.com
Causes of Malnutrition • Lack of Comprehensive Child Health Care Programme. • Lack of political will. observerzparadise.com
MALNUTRITION IS A BIG PROBLEM • Big problem needs a Big solution. • If one wants to Win the battle, the effort has to be intensive and focused. • So, it has to be a BIG WIN against MALNUTRITION. • BIGWIN approach is to be applied. observerzparadise.com
Shift Strategy A shift in strategy is the need of the hour. Infants must be made the focus of attention for mothers as – • NEITHER a mother would like to deliver a low-birth weight baby; • NOR any mother would like to have a malnourished child. observerzparadise.com
The BIGWIN Approach Exclusive Breast Feeding for 6 months. Infection Prevention/Treatment and Immunization. Growth Promotion / Monitoring. Appropriate Weaning Practice. Safe Water Iron Supplementation. Nutrition education & Extra-Nutrition in pregnancy & lactation, and illness in child. No to next pregnancy. observerzparadise.com
Weight gain in the first five years of life Kg. Kg. observerzparadise.com
Weight gain in the first year of life Kg. Kg. observerzparadise.com
Weight gain in the next four years of life Kg. Kg. Kg. Kg. observerzparadise.com
v/s Monitor the Weight F I R S T Weight gain in 1st year of life. S E C O N D Weight gain in next 4 years of life. observerzparadise.com
Exclusive Breast Feeding in India – NFHS II observerzparadise.com
Immunization Coverage observerzparadise.com
Immunization Coverage observerzparadise.com
Anemia in Children observerzparadise.com
Anaemia among Children Age 6-35 Months Percent observerzparadise.com
Iron Supplementation v/sIron Therapy – Cost observerzparadise.com
Empowering Women Poor Perpetually Pregnant female Powerful Perceptive Problem-solving observerzparadise.com
Empowering Women • Mass Media • Government Health System • Mahila Mandals observerzparadise.com
Empowering Women • NGOs • Link Women • Anganwadi observerzparadise.com
Empowering Women • Health Worker • School Health • BFCI observerzparadise.com
Nutrition Education • Education is a learning process by which a change in behaviour is brought about. • For providing nutrition education, one must have sound knowledge of locally available foods. observerzparadise.com
Nutrition Education • The timing of providing education is of crucial importance. • All persons involved in decision making, as well as responsible for cooking must be sensitized. observerzparadise.com
Nutrition Education • The typical jargon of nutritive value in context of calories and proteins must be avoided. • Beneficiaries should be sensitized on protective, body building, and essential foods. observerzparadise.com
Nutrition Education • Vulnerable periods of life, specially infancy, pregnancy, and lactation must be taken into account. observerzparadise.com
Nutrition Therapy If one is not able to prevent the occurrence of malnutrition, one has to go for treatment of malnutrition. Although prevention is still better than cure. observerzparadise.com
Principles of Nutrition Therapy • Mild to moderate degree of malnutrition can be managed at home. observerzparadise.com
Principles of Nutrition Therapy • Only severely malnourished children with complications need to be hospitalized first. • The aim is to provide 1.5 – 2 gms. of protein/ kg per day and 150 – 180 calories/kg/day. observerzparadise.com
Management of mild to moderate degree of malnutrition This is usually done with the help of protein and calorie rich diets. observerzparadise.com
+ + + 1. Besan Panjiri • Contents – Bengal gram flour, Wheat flour, Jaggery, Ghee (1 part each). • Calories: 500 calorie/100gm. • Protein: 9gm/100gm. observerzparadise.com
+ + + 2. Shakti aahar • Constituents: Roasted wheat 40gm, Roasted gram 20gm, Roasted peanuts 10gm, Jaggery 30gm. • Calories: 390 calories/100gm. • Protein: 11.4gm/100gm. observerzparadise.com
+ + + 3. Hyderabad Mix • Constituents: Whole wheat 40gm, Bengal gram 16gm, Groundnuts 10gm, Jaggery 20gm. • Calories: 330 calories/86gm. • Protein: 11.3gm/86gm. observerzparadise.com
Management of severely malnourished children • With complications, they should be hospitalized. • Without complications, put straightaway on dietary management. observerzparadise.com
1. Dietary Management – Initial Phase • Feeding must start gradually. • Initially approx. 80 Cal/kg/day and 0.7gm protein/kg/day provided; actual body weight rather than expected body weight counted. observerzparadise.com
+ + + 4. Sooji Kheer • Constituents:Toned milk 750ml, Sugar 100gm, Sooji 25gm, Oil 5gm (aqua add 1000ml). • Calories: 143 calorie/100gm. • Protein: 2.8gm/100gm. observerzparadise.com