Enhancing child survival

ENHANCING CHILD
SURVIVAL
Dr. Harivansh Chopra
DCH., MD.
Professor,
Department of Community Medicine,
LLRM Medical College, Meerut.

Whether this child will survive/ grow
normally or become malnourished?
2/5/2019 2
? ?

To which domain this child belongs ?
2/5/2019 3
? ?

Dear Sir,
Greetings!!
It is pleasure hearing from you. We remember the way you
guided us to take care. Now they both are of 14 years. Their
birth weight was 1.6
And 1.7 kg respectively
Shruti's height 4 feet 11 inch and weight 47.7kg.
Kriti's height 4 feet 11 inch and weight 47 kg
Few pics are attached below.
Thanks
Regards

AT 4 MONTHS

AT 8 MONTHS

AT 2 YEARS

AT 2.5 YEARS

AT 4 YEARS

AT 6 YEARS

AT 7 YEARS

AT 8 YEARS

Name : Aarushi Sharma
DOB : 09-Nov-2003
Weight At the Time of Birth : 900 Gm
Weight as Now : 52 Kg.
Height as Now : 5‘3"
Study : Class IX in Dewan Public School Westen Road
Meerut Cantt.
Hobbies : Badminton, Swimming, Shooting, Chess,
Drawing, Dancing.
Achievement : Three years 100% Attendance Award 2012-
13, 2013-14, 2014-15 in Dewan Public School
western Road, Meerut Cantt.
WON BRONJ MEDAL IN BADMINTON IN
MALASYIA.

2/5/2019 20
Won bronze medal in malasyia in junior badminton

2/5/2019 21

1.9 kg at birth
2/5/2019 22
1 months

2/5/2019 23
6 months2 months

10 months
2/5/2019 24
6 months

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IYEAR 10 MONTHS WEIGHT 11.5 KG

ANOTHER TWINS
2/5/2019
BIRTH WT. – 1.6 AND 1.7 KG
26
NOW 3 YRS BOTH WEIGHING 13KG

DIARRHOEA
9%
PNEUMONIA
15%
INTRAPARTUM
RELATED
COMPLICATIONS
11%
MALARIA
7%
PRETERM BIRTH
COMPLICATIONS
17%
OTHERS
41%
CAUSES FOR UNDER 5 MORTALITY, WHO 2015
GLOBALLY, NEARLY HALF OF UNDER5 DEATHS ARE
ATTRIBUTABLE TO UNDERNUTRITION

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”.
2/5/2019 28

Nutritional Status of children
below 5 years : NFHS IV
0
5
10
15
20
25
30
35
40
Stunted Underweight Wasted
38.4 35.7
21
Percentage
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Nutritional Status of children
below 5 years : NFHS IV
0
10
20
30
40
50
Stunted Underweight Wasted
31 29.1
19.9
41.2
38.2
21.4
Percentage
Urban Rural
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Nutritional status of under-five
children in relation to living index
0
10
20
30
40
50
60
UNDER WT STUNTED WASTED
17.9
22.2
20.120.2
36.4
33.2
24.2
51.4
48.6
Percentage
HIGH
MEDIUM
LOW
2/5/2019 31
NFHS IV

Nutritional status of under-three
children in relation to living index
0
10
20
30
40
50
60
UNDER WT STUNTED WASTED
26.8 28.5
10.2
46.8 45.3
14.3
56.9
53.7
19.7
Percentage
HIGH
MEDIUM
LOW
NFHSII
2/5/2019 32

children in relation to age
0
10
20
30
40
50
Underweight Stunted Wasted
26.7
20.1
31.931
25.9 27.3
37.3
46.9
20.4
37.6
42.7
19.1
Percentage
< 6 months
6 - 11 months
12 - 23 months
24 - 35 months
2/5/2019 33
NFHS IV

children in relation to age
0
10
20
30
40
50
60
Underweight Stunted Wasted
11.9
15.4
9.3
37.5
30.9
13.2
58.5 57.5
21.9
58.4 56.5
13.2
Percentage
< 6 months
6 - 11 months
12 - 23 months
24 - 35 months
2/5/2019 34

Age wise prevalence of underweight in Orissa -
0
10
20
30
40
50
60
70
NFHS1 NFHS 2 NFHS 3 NFHS 4
<6months
6-11months
12-23months
24-36months
15.6%
17.8%
35.9%
29%
43.3% 42.8%
33.3%
55.6%
63.6%
66.6%
41.3%
67.7%
62.2%
64.3%
42.4%
34.7%

Percentage of underweight children –
Comparison between NFHS III & IV
0
5
10
15
20
25
30
35
40
45
Underweight Severely Underweight
42.7
15.8
35.8
11
Percentage
2/5/2019 36

Causes of Malnutrition
1. Inadequate Food Security.
2. Infection.
3. Low weight of adolescent girls.
2/5/2019 37

4. Low Immunization coverage.
5. Maternal &Childhood Anemia
.
6. Low literacy level in female.
2/5/2019 38

7. Poor sanitary conditions.
8. Low birth weight.
9. Lack of knowledge regarding
normal growth of children.
2/5/2019 39

10. Poor hygiene.
11. Incorrect child rearing practices.
12. Inaccessible and Inadequate
health services.
2/5/2019 40

13. Lack of Comprehensive Child
Health Care Programme.
13. Lack of political will.
2/5/2019 41

1. Big problem needs a Big solution.
2. If one wants to Win the battle, the effort
has to be intensive and focused.
3. So, it has to be a BIG WIN against
MALNUTRITION.
4. BIGWIN approach is to be applied.
2/5/2019 42

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.
2/5/2019 43

The BIGWIN Approach
2/5/2019 44
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.No to teenage marriage

Exclusive Breast
Feeding
for 6 months
2/5/2019 observerzparadise.com 45

Infection
Prevention/Treatment
Immunization

Growth Promotion / Monitoring

Appropriate Weaning
Practice
Safe Water HandWashing

Iron Supplementation

Nutrition education
Extra-Nutrition in
pregnancy &
lactation,
and illness in child.

No to next
pregnancy.
No to teenage
marriage

The BIGWIN Approach
2/5/2019 52

Weight gain in the first
five years of life
8
8
1st Year 2 - 5 years
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Kg.
Kg.

Weight gain in the first year of life
4
4
First 4 months Next 8 months
2/5/2019 54
Kg.
Kg.

Weight gain in the next
four years of life
2
2 2
2
2nd Year 3rd Year 4th Year 5th Year
2/5/2019 55
Kg.
Kg. Kg.
Kg.

v/s
Monitor the Weight
2/5/2019 56
F
I
R
S
T
S
E
C
O
N
D
Weight gain in 1st year of life.
Weight gain in next 4 years of life.

2/5/2019 57

2/5/2019 58

Anemia in Children
31
62
7
Mild Moderate Severe
2/5/2019 59

0
10
20
30
40
50
60
70
80
90
Any anaemia Severe anaemia
74
4
79
5
NFHS-2 NFHS-3
Anaemia among Children Age 6-35 Months
Percent
2/5/2019 60

56
58
60
62
64
66
68
70
72
74
NFHS 3 NFHS 4
73.9
63.2
ANEMIA IN UNDER 5
NFHS 3 NFHS 4

Iron Supplementation v/s
Iron Therapy – Cost
30
70
Iron Supplementation Iron Therapy
2/5/2019 62

BIG-WIN Status across 4 NFHS
NFHS 1
(under 3)
NFHS 2
(under 3)
NFHS 3
(under
5)
NFHS 4
(under 5)
Exclusive Breast
Feeding
46.0 %
(Up-to 4
months)
55 %
(Up-to 4
months)
46.4 %
(Up-to 6
months)
54.9 %
(Up-to 6
months)
Infection ARI 6.5 % 19.2 % 5.8 % 2.7 %
Diarrhoea 10.0 % 19.3 % 9.0 % 9.2 %
Growth Monitoring
(weight recordings
under ICDS)
--- --- 11.3 % 43.3 %
2/5/2019 63

NFHS 1
(under 3)
NFHS 2
(under 3)
NFHS 3
(under 5)
NFHS 4
(under 3)
Nutrition
Weight for
Age
53.4 % 47.0% 42.5 % 35.7 %
Height for
Age
52.0 % 45.5 % 48.0 % 38.4 %
Weight for
Height
17.5 % 15.5 % 19.8 % 21.0 %
Anaemia -- 74.3 % 69.4 % 58.5 %
Immunization 35.4 % 42.0 % 43.5 % 62.0 %
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BIG-WIN Status across 4 NFHS

The BIGWIN Approach
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Empowering Women
2/5/2019 66
Poor Perpetually Pregnant female
Powerful Perceptive Problem-solving

Empowering Women
1. Mass Media
2. Government Health System
3. Mahila Mandals
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Empowering Women
4. NGOs
5. Link Women
6. Anganwadi
2/5/2019 68

Empowering Women
7. Health Worker
8. School Health
9. BFCI
2/5/2019 69

Community medicine
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? ?

Action without knowledge is useless
Knowledge without action is futile

2/5/2019 72

Enhancing child survival

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