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
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

Anorexia


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


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

Pregnant Adolescent
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
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
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

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