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Malnutrition among children in Gujarat. Health & family Welfare Department GOG. Malnutrition. Mal adjusted nutrition Under nutrition Over nutrition. Calorie & Protein Essential fatty acids Vitamins and Minerals (Micronutrients). Diagnosis of Malnutrition. Anthropometry:
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Malnutrition among children in Gujarat Health & family Welfare Department GOG
Malnutrition Mal adjusted nutrition • Under nutrition • Over nutrition Calorie & Protein Essential fatty acids Vitamins and Minerals (Micronutrients)
Diagnosis of Malnutrition • Anthropometry: Children: Wt/Age, Ht/Age, Wt./Ht, BMI, Mid Arm Circumference, Head/chest ratio Adult: Wt/Ht, BMI, weight gain during pregnancy • Clinical signs and symptoms • Biochemical test: Hb%, Urinary iodine
Causes of Childhood Mortality Malnutrition 53% Under-nutrition contributes to 53% of all child deaths
Protein Calorie Malnutrition Normal
District wise Prevalence of Under nutrition in children (0-71 months) - DLHS 2002
Nutritional status of children (<3yrs) Gujarat(‘92-‘93)& (’98-’99)
% of women who gave exclusive Breast milk up to 4 months (DLHS,2002 & 2004)
Age specific rate of underweightchildren Brain Development
Demographic Characteristic of children in < 2 SD Wt/Age group (NFHS II)
Demographic Characteristic of children in < 2 SD Wt/Age group (NFHS II)
Profile of Mother of children in < 2 SD Wt/Age group (NFHS II)
Clinical signs of Anaemia NFHS II 75% of children Anaemic, 24% mild Anaemia Mother not aneamic-70% children anaemic Mother anaemic 75-87% children Anaemic
Clinical sins of Vitamin A deficiency 1.1% to 8.6% Night blind ness & blindness, vulnerability to infection, poor growth
Status of Vit.A prophylaxis program Biannual Supplementation rounds Next in August ‘06
Vitamin A Deficiency and Child health Improving vitamin A status of children (6 months-5 yrs.) Results in to • 23% reduction in child mortality rate • 50% reduction in child mortality rate due to acute measles • 35-50% reduction in child mortality rate due to diarrhoea
YEAR WISE REPORT OF IODINE CONTENTS SALT SAMPLE CHCKED WITH SPOT TESTING KIT 2001 TO 2004 (Till June)
Nutritional status of School childrenSchool Health-2005-06, Gujarat
Supplementation (ICDS) • Supplement not the substitute • 300 K.cal and 8-10gm. Protein • Double supplement/calorie-protein dense supplement for grade III and grade IV • Facility, time and skill for cooking • Feeding at centre for grade III and IV • Supplement for 7 months to 1 year age group • Supplement for ANC • RTE & candy
Special care of Grade III & IV Problems: Loss of appetite, high calorie protein need, Infection proneness, restriction of food, digestion Solution: Frequent feeding Calorie protein dense supplement Easily digestible food Animal/ First class protein Vitamin and Mineral supplement Treatment of infection Mother’s involvement in care of the child
MDM supplement • 300 k.cal. And 8-10gm. Protein • Supplement not substitute • Children attending school / Child’s attention in school • In built Diet education • In built equity education
Adolescent Girls Anaemia Control Programme • 2001 pilot project in Vadodara district (UNICEF) • Anaemia reduction from 74% to 53% in 17 months • Project is operationalised in all districts (UNICEF & MI) • Convergence between Health and Education department
RTE • Ready to Eat fortified with micronutrients • Operationalised in four districts (Mehsana, Patan, Panchmahal, Dahod) in 2001 • MI project • High level of micronutrient deficiency recorded in baseline study • Acceptability was high • Bulk was a limiting factor • Convergence between Health and ICDS(DWCD)
Nutri candy • Candy fortified with Vit.A, Vit.C, iron and Folic acid • Three districts vadodara, bharuch and Narmada , operationalised in 2001 • MI project • Children, Pregnant and lactating mother and Adolescent girls were beneficiaries • Convergence Health and ICDS (DWCD)
Impact Assessment Impact Children: • Improved the attendance Anganwadi • Weight gain in Grade II-IV remarkable • Improved appetite Pregnant and lactating women : • Feeling better relief from body pains and ache • Reduction in nausea, vomiting • Improved eye sight Adolescent girls • Less fatigued • Increase appetite • Regular Menstrual cycle
IMNCI Newborn 1-7d Home Based Newborn Care Immunization Diarrhea IMNCI ARI BF-CF Fever/ malaria
Mapping & Monitoring Malnutrition • ICDS special round of weighing the children with inbuilt quality check process May-June 2006 • Routine monthly assessment • Health facility assessment and support as well as regular monitoring record in health worker’s register • Inbuilt assessment through monthly reporting system
Field level Functional Convergence • Fix day ‘ Health and Nutrition Day’ Session at SC Planning and Implementation in progress • Improve quality and coverage of RCH services • Mainstreaming of Nutrition care and support • Improve quality and coverage of monitoring data • Improve Accessibility of Health and Nutrition services • Improve Maternal and Child health status
Supply Training Monitoring Integration Minimum need Community Awareness and Involvement Care and Support For Health & Nutrition workers
Control of infection D I e t E d u c a t i o n Care and Support
Gujarat progress • The second target of MDG is to reduce the proportion of people suffering from hunger by half between 1990 and 2015 • Monitoring indicator is a proportion of 0-59 months children falling below 2SD from median weight for age of the standard reference population NFHS I NFHS II Reduction in Preschool mortality rate /year should be 2.8% Reduction Observed between NFHS I and NFHS II is 3%
Nutrition care of Community • Nutrition care of vulnerable School age group Adolescent • Nutrition care of highly vulnerable Pregnant woman Breast feeding woman Preschool children Infants
Malnutrition Malnutrition Income Education
Integrated care • Maternal and Child nutrition • Adolescent and Maternal Nutrition • Nutrition and Infection control/care- sanitation, hygiene, vaccination, early detection and treatment • Nutrition and FP • Macro and Micro nutrition • Nutrition and ----------------Mental development • Family nutrition and supplementary nutrition • Nutrition supplement and Diet/ nutrition education
Where?Countries with the highest numbers of neonatal and U5 child deaths 2.5 million neonatal deaths Approx 66% of global total 6.6 million U 5 child deaths Approx 61% of global total WHO Estimates of neonatal deaths for the year 2000, forthcoming. WHO/UNICEF/UNFPA estimates of maternal mortality for the year 2000 Black, Morris, Bryce. Lancet 2003.