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Malnutrition, Causes,Framework, vicious cycle,Preventive measures,Policy and strategies of Government of Nepal.
1. BY : Dhirendra Nath
National Open College
Sanepa lalitpur
Malnutrition
2. Malnutrition
Malnutrition has been defined as "a pathological state
resulting from a relative or absolute deficiency or
excess of one or more essential nutrients".
It comprises four forms –under-nutrition, over-
nutrition, imbalance and the specific deficiency.
3. PEM
as a major health and nutrition problem in Nepal
(weaklings and children in the first years of life)
also to permanent impairment of physical and
possibly, of mental growth of those who survive.
its clinical forms - kwashiorkor and marasmus
two different clinical pictures at opposite poles of a single
continuum.
4. PEM is primarily due to
(a) an inadequate intake of food (food gap) both in
quantity and quality, and
(b) infections, notably diarrhoea, respiratory tract
infections, measles and intestinal worms
increase requirements for calories, protein and other
nutrients,
decreasing their absorption and utilization.
It is a vicious circle - infection contributing to
malnutrition and malnutrition contributing to
infection, both acting synergistically
6. Other contributory factors in the web of causation, viz.
poor environmental conditions,
large family size,
poor maternal health,
failure of lactation,
premature termination of breast feeding, and
adverse cultural practices relating to child rearing and
weaning such as
the use of over-diluted cow's milk and
discarding cooking water from cereals and
delayed supplementary feeding
7. Impact of malnutrition
High Morbidity and mortality
survival
Academic performance of children
Socio-economic
National Devlopment
Drug action
Health and Devlopment
13. Causes of Malnutrition and Death
Manifestations
Immediate Causes
Underlying Causes
Basic Causes
Malnutrition and Death
Inadequate
Dietary Intake
Disease
Insufficient
Household
Food Security
Inadequate
Maternal and
Child Care
Insufficient Health
Services & Unhealthy
Environment
Formal and Non-
Formal Institutions
Potential
Resources
UNICEF
Framework
14. Preventive measures
There is no simple solution to the problem of
PEM.
Many types of actions are necessary.
The following is adapted from the 8th FAO/WHO
Expert Committee on Nutrition for the prevention
of PEM in the community
15. Early detection of PEM
The first indicator of PEM is under-weight for age
The most practical method to detect this, is to
maintain growth charts
These charts indicate at a glance whether the child is
gaining or losing weight.
16. (a) Health promotion
1. Measures directed to pregnant and lactating women
(education, distribution of supplements)
2. Promotion of breast feeding.
3. Development of low cost weaning foods : the child
should be made to eat more food at frequent intervals
4. Measures to improve family diet
17. Cont……
5. Nutrition education - Promotion of correct feeding
practices.
6. Home economics
7. Family planning and spacing of births
8. Family environment
18. (b) Specific protection
1. The child's diet must contain protein and energy-
rich foods. Milk, eggs, fresh fruits should be given if
possible.
2. Immunization
3. Food fortification
19. Early diagnosis and treatment
1. Periodic surveillance
2. Early diagnosis of any lag in growth
3. Early diagnosis and treatment of diarrhoea
4. Development of programmes for early rehydration
of children with diarrhoea.
5. Development of supplementary feeding
programmes during epidemics.
6. De-worming of heavily infested children
21. Policy:
To reduce PEM in under 5 years and reproductive
aged women
Strategies:
Protect, promote and support optimal feeding
practice for infants and young children (capacity
building on IYCF)
Increase coverage of GM
BCC for changing dietary practices
Strengthen Nutrition Rehabilitation Homes
Community Based Management of Acute
Malnutrition
Improve maternal nutrition and low birth weight of
baby through improved maternal nutrition practices
22. IDD
IDDs are spectrum of the disorders that occur
due to deficiency of iodine & associated
hypothyroidism, commencing from intrauterine life
& extending through infancy, childhood,
adolescent to adult life with serious implications
23. Prevention and Control
Strengthen the implementation of Iodized Salt
Act, 2055 for regulation and monitoring of Iodized
salt trade to ensure that all edible salt is iodized
Increase the accessibility and market share of
iodized packet salt with ‘two‐child’ logo
24. Create awareness about the importance of use
of iodized salt for the control of IDD through
social marketing campaign
Celebrate month of February as an iodine month
25. Government action on IDD:
Universal Iodization of Salt, 50 ppm at the point of
production to 30 ppm at retail and 15 ppm at
household level
Distribution of iodized salt in remote area at
subsidized rates
Monitoring of the iodized salt at the entry point and in
the market
Iodized salt warehouse construction in various part of
the country
Increase accessibility of 2- child logo iodized salt
Social marketing of 2-child logo iodized salt
BCC for use of iodized salt
26. Iron Deficiency Anemia
It is a condition that results a lowering of
hemoglobin levels below which is considered to
be normal for a specific demographic group
It occurs at all stages of the lifecycle but is more
prevalent in women especially pregnant women
and young children
This is frequently worsened by infectious
diseases i.e. malaria, TB, hookworm infestations
27. Cause of IDA
Some underlying causes
Inadequate BF
Incorrect or incomplete complementary feeding
Low level of family education
Poor intra family distribution of food at H/H level
Poor cooking/processing, storage, preservation at
H/H level
Food fad(trend) and faulty food habits
28. Cause of IDA
Poor health and agricultural services
Lack of institutional capacity/trained manpower
Low production of iron rich foods
Lack of H/H gardening
Insufficient marketing infrastructures
Poorly developed commercial food processing
industry
29. Prevention and Control
Health Promotion
Adequate nutrition, household gardening
Nutrition education to improve dietary habits
Health education specially to pregnant mothers
about hazards of anemia and their prevention
Periodical deforming specially among children and
at least once during second trimester of pregnancy
30. Prevention and Control
Specific Protection
Food fortification with iron
Salt, sugar, wheat flour & other foods for fortifications
Supplementation with iron and other nutrients:
Early Diagnosis and Prompt Treatment
ED:
By history of headache, giddiness, fatigue, loss of appetite
etc
By clinical signs
By lab investigations
31. Prevention and Control
Disability Limitation
It can be done by giving intensive treatment in
hospital by blood transfusion
If severe anemia is associated with cardiac
failure(high output failure), packed cell transfusion is
given under the umbrella of digoxin, lasix &
potassium salts
Rehabilitation
If treatment is given correctly & completely, the
person will not become handicapped
32. Objective
To reduce the prevalence of anemia among women and
children.
Target:
To reduce the prevalence of iron deficiency anemia to
less than 40% by the year 2017.
33. Control of Anemia
Increase coverage and compliance of iron/folic
supplementation for pregnant and breast feeding
women
Reduce the burden of parasitic infestations
(Helminthes, Malaria and Kala‐azar)
Identify and implement food fortification to
increase the dietary iron intake focusing on
commercial as well as small‐scale community
based fortification initiatives
34. Control of Anemia
Promote dietary diversification to improve the
quality of food consumed with an emphasis on
bio‐available iron
Promote maternal care practices and services to
improve health and nutritional status of mother
and babies
35. Control of Anemia
Identify and implement the effective modalities to
address iron deficiency in adolescents and
non‐pregnant women of reproductive age
Advocate for equity among genders in access
and control over household foods
36. Vitamin A Deficiency
When there is deficiency of Vitamin A in the body,
several complications results in the body which is
called as VAD
37. Causes of VAD
Some Immediate Causes
Low intake of Vit A rich foods
High incidence (of measles, diarrhea, ARI)
Interference with the absorption of Vit A in the small
intestine(obs jaundice, giardiasis, ascariasis)
Conversion of caretenoids to vitamin A in liver(in
certain diseases like chronic pancreatitis)
Interference in transport(in liver disease)
38. VAD Control
Objective
To virtually eliminate Vitamin A
deficiency disorder and sustain the
elimination
Target
To virtually eliminate Vitamin A
deficiency disorder by the year 2017
39. VAD Control
The Nepal vitamin A supplementation (VAS)
programme for young children is held up as a
global success story
It was started in 1993 in 8 districts following a
meeting in Kathmandu that considered three
major research projects in Nepal in the late
1980s which all concluded that periodic
dosing of children 6‐60 months with high dose
vitamin A resulted in significant reductions in
child mortality
40. By the end of 1997 the programme was
implemented in 32 districts and by 2002 it had
expanded to all 75 districts
FCHVs distribute the capsules to young children
twice a year through a ‘campaign‐style’ activity
41. Government action on VAD:
Bi-annually mass supplementation of Vitamin A to under
five children, 100000 IU for 6-12 months and 200000 IU
for 12-60 months children
Vitamin A supplementation to postpartum mothers, 200000
IU within 6 weeks of delivery
Treatment of clinical cases (eye problems, malnutrition,
measles, chronic diarrhea etc.)
BCC for changing dietary practices
Promote vitamin A fortification
Nutrition education
Support for home gardening to increase production of
Vitamin A rich fruits and vegetables
Training on improved methods for production, preparation
and preservation of Vitamin A rich foods
42. Recommendation
Proper monitoring of activities.
Implementation plan should be prepared properly.
Staff should be increased for education program .
Train FCHV about BCC.
Proper monitoring and evaluation of BFHI program.
43. Cont….
Lack access of iron and folic acid fortified food in
community level ,increase access and
awareness.