Success stories & innovative approach for prevention of childhood malnutrition dr harivansh chopra

Success stories & innovative
Approach for Prevention of
Childhood Malnutrition.
Dr. Harivansh Chopra
DCH., MD.
Professor &,EX.HOD
Department of Community Medicine,
LLRM Medical College, Meerut.

Whether this child will survive/ grow
normally or become malnourished?
05-10-2020 DR HARIVANSH CHOPRA 2
? ?

To which domain this child belongs ?
? ?

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”.

UNDER
WEIGHT
< 2 SDNORMAL> 2 SD

< 2 SDNORMAL
STUNTED

Nutritional Status of children
below 3 years : NFHS II
0
5
10
15
20
25
30
35
40
45
50
Stunted Underweight Wasted
46 47
16
Percentage

Nutritional Status of children
below 3 years : NFHS II
0
10
20
30
40
50
35.6
38.4
13
48.6 49.6
16.2
Percentage
Urban Rural

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

Nutritional status of under-three
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

Percentage of underweight children –
Comparison between NFHS I & II
0
10
20
30
40
50
60
Underweight Severely Underweight
52
20
47
18
Percentage
NFHS I
NFHS II

Nutritional Status of children below
3 years : NFHS III
0
5
10
15
20
25
30
35
40
45
50
38
46
19
Percentage

Nutritional Status of children below
3 years : NFHS III
0
10
20
30
40
50
31.1
36.4
16.9
40.7
49
19.8
Percentage
Urban Rural

Percentage of underweight children –
Comparison between NFHS II & III
0
10
20
30
40
50
Underweight Stunted Wasted
47 46
16
46
38
19
Percentage
NFHS II
NFHS III

UNDERWEIGHT STUNTED WASTED
47 45.5
15.5
42.5
48
19.8
35.7
38.4
21
AxisTitle
Axis Title
MALNUTRITION IN INDIA
NFHS 2 NFHS 3 NFHS 4

UNDERWEIGHT STUNTED WASTED
42.4
56.8
14.8
39.5
46.3
17.9
MALNUTRITION IN UTTAR
PRADESH
NFHS3 NFHS4

0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
INDIA UP MEERUT MACHHRA
35.70%
39.50%
35.20%
25.50%
UNDERWEIGHT
OUR EXPERIENCE : MACHHRA

0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
41.20%
46.30%
35.30%
17.50%
STUNTING

0%
5%
10%
15%
20%
25%
INDIA UTTAR PRADESH MEERUT MACHHRA
21%
17.90% 18.80%
24.50%
WASTING
INDIA UTTAR PRADESH MEERUT MACHHRA

Causes of Malnutrition
1. Inadequate Food Security.
2. Infection.
3. Low weight of adolescent girls.

4. Low Immunization coverage.
5. Maternal &Childhood Anemia
.
6. Low literacy level in female.

7. Poor sanitary conditions.
8. Low birth weight.
9. Lack of knowledge regarding
normal growth of children.

10. Poor hygiene.
11. Incorrect child rearing practices.
12. Inaccessible and Inadequate
health services.

13. Lack of Comprehensive Child
Health Care Programme.
13. Lack of political will.

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.

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.

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.No to teenage marriage

Exclusive Breast
Feeding
for 6 months

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

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
SUCCESS STORIES

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.

05-10-2020
DR HARIVANSH CHOPRA
57
Won bronze medal in malasyia in junior badminton

1.9 kg at birth
1 months

6 months2 months

10 months
6 months

IYEAR 10 MONTHS WEIGHT 11.5 KG

ANOTHER TWINS
05-10-2020
DR HARIVANSH CHOPRA
63
NOW 3 YRS BOTH WEIGHING 13KG

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

Weight gain in the first year of life
4
4
First 4 months Next 8 months
Kg.
Kg.

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

v/s
Monitor the Weight
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.

Exclusive Breast Feeding in India –
NFHS II
55
45
Exclusive Breast Feeding Not Exclusively Breast-fed

Exclusive breast feeding upto
4months
0%
10%
20%
30%
40%
50%
60%
51% 55%
45%

NFHS 3 NFHS 4
46.40%
54.90%
EXCLUSIVE BREAST FEEDING FOR 6 MONTHS
NFHS 3 NFHS 4

NFHS 3 NFHS 4
69.40%
58.40%
ANEMIA IN UNDER 5 CHILDREN
NFHS 3 NFHS 4

33.60%
38.70%
78.90%
INSTITUTIONAL DELIVERIES

42.30%
46.60%
78.90%
DELIVERIES BY SKILLED BIRTH
ATTENDANTS

INSTITUTION
AL
DELIVERIES
79%
HOME
DELIVERIES
21%
TYPE OF DELIVERY
INSTITUTIONAL DELIVERIES HOME DELIVERIES

54%46%
EXCLUSIVE BREAST FEEDING
FOR 6 MONTHS
YES
NO
43%57%
COMPLEMENTARY FEED WITHIN
6 TO 8 MONTHS
YES
NO

≤ 1 HOUR
42%> 1 HOUR
58%
BREAST FEEDING TIME AFTER DELIVERY
≤ 1 HOUR > 1 HOUR

Exclusive breastfeeding in Bihar
(0-6 months)
28
53.5
0
10
20
30
40
50
60
NFHS-3 NFHS-4

Complimentry feeding in Bihar
54.5
30.7
0
10
20
30
40
50
60
NFHS-3 NFHS-4

Immunization Coverage
0
10
20
30
40
50
60
70
80
BCG DPT 3
doses
OPV 3
doses
Measles All
Vaccines
62.2
51.7 53.6
42.2
35.5
71.6
65.1 62.8
50.7
42
Percentage
NFHS I
NFHS II

Immunization Coverage
0
10
20
30
40
50
60
70
80
BCG DPT 3
doses
OPV 3
doses
Measles All
Vaccines
71.6
55.1
62.8
50.7
42
78.2
55.3
78.2
58.8
43.5
Percentage
NFHS II
NFHS III

0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
42.00% 43.50%
62.00%
FULLY IMMUNIZED CHILD 12 - 23 MONTHS

Immunization status in Bihar
(BCG, measles, and 3 doses each of polio/DPT)
10.7 11.6
32.8
61.7
0
10
20
30
40
50
60
70
NFHS-1 NFHS-2 NFHS-3 NFHS-4

Vaccination Status of Children in
Bihar (%)
36
64.7
91.7
42.2
82.4
72.9
24.9
46.1
80.2
16.2
40.4
79.4
0
10
20
30
40
50
60
70
80
90
100
NFHS-2 NFHS-3 NFHS-4
BCG POLIO DPT MEASLES

Anemia in Children
31
62
7
Mild Moderate Severe

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

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

ANEMIA CONDITION IN
MACHHRA
22.50%77.50%
ANEMIA IN CHILDREN OF AGE 1-3
YEAR
NO ANEMIA ANEMIA

Anaemia in children in Bihar
81.1 78
63.5
0
20
40
60
80
100
NFHS-2 NFHS-3 NFHS-4

Iron Supplementation v/s
Iron Therapy – Cost
30
70
Iron Supplementation Iron Therapy

The BIGWIN Approach

Empowering Women
Poor Perpetually Pregnant female
Powerful Perceptive Problem-solving

Empowering Women
1. Mass Media
2. Government Health System
3. Mahila Mandals

Empowering Women
4. NGOs
5. Link Women
6. Anganwadi

Empowering Women
7. Health Worker
8. School Health
9. BFCI

Community medicine
? ?

Nutrition Education
1. Education is a learning process by which a
change in behaviour is brought about.
2. For providing nutrition education, one
must have sound knowledge of locally
available foods.

Nutrition Education
3. The timing of providing education is of
crucial importance.
4. All persons involved in decision making,
as well as responsible for cooking must be
sensitized.

Nutrition Education
5. The typical jargon of nutritive value in
context of calories and proteins must be
avoided.
6. Beneficiaries should be sensitized on
protective, body building, and essential
foods.

Nutrition Education
7. Vulnerable periods of life, specially
infancy, pregnancy, and lactation must be
taken into account.

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.

Principles of Nutrition Therapy
1. Mild to moderate
degree of
malnutrition can
be managed at
home.

Principles of Nutrition Therapy
2. Only severely malnourished children with
complications need to be hospitalized first.
3. The aim is to provide 1.5 – 2 gms. of
protein/ kg per day and 150 – 180
calories/kg/day.

Management of mild to moderate
degree of malnutrition
This is usually done
with the help of
protein and calorie
rich diets.

1. Besan Panjiri
1. Contents – Bengal gram flour, Wheat flour, Jaggery, Ghee (1 part each).
2. Calories: 500 calorie/100gm.
3. Protein: 9gm/100gm.
+ + +

2. Shakti aahar
1. Constituents: Roasted wheat 40gm, Roasted gram 20gm, Roasted
peanuts 10gm, Jaggery 30gm.
2. Calories: 390 calories/100gm.
3. Protein: 11.4gm/100gm.
+ + +

3. Hyderabad Mix
1. Constituents: Whole wheat 40gm, Bengal gram 16gm, Groundnuts
10gm, Jaggery 20gm.
2. Calories: 330 calories/86gm.
+ + +

Management of severely
malnourished children
1. With complications,
they should be
hospitalized.
2. Without complications,
put straightaway on
dietary management.

1. Dietary Management –
Initial Phase
1. Feeding must start gradually.
2. Initially approx. 80 Cal/kg/day and 0.7gm
protein/kg/day provided; actual body
weight rather than expected body weight
counted.

4. Sooji Kheer
1. Constituents: Toned milk 750ml, Sugar 100gm, Sooji 25gm, Oil 5gm
(aqua add 1000ml).
2. Calories: 143 calorie/100gm.
+ + +

Initial Phase
3. Small frequent feeds
given.
4. Intake gradually
increased to 100
Cal/kg/day and 1gm
protein/kg/day.

Initial Phase
5. Milk is usually the starting food; for
lactose-intolerance, other foods like rice
gruel, chicken gruel, soya rice gruel, and
cereal pulse gruel are used.

Initial Phase
6. For enriching milk,
generally coconut oil is
used.
7. Fluids should be given
with cup and spoon;
bottle-feeding best
avoided.

2. Dietary management –
Phase of High Energy Feeding
1. Caloric intake gradually
increased to 150 – 180
Cal/kg/day.
2. Child moved from
predominant milk diet to
semi solids/solid diet.
3. Protein intake increased to
1.5 – 2gm/kg/day.

Transfer to Family type diet
1. Child should be taking
nutritionally wholesome
family-type diet (cereals,
pulses, vegetables) before
discharge from hospital.

Transfer to Family type diet
2. Involves nutrition
education of parents.
3. Snacks made from
peanuts, bengal
gram, jaggery, and
oil are useful.

Nutritional Rehabilitation
1. Majority of children, after discharge from
hospital, again become victim of
Malnutrition.
2. To overcome this, Nutritional
Rehabilitation is carried out.

Ambulatory Treatment Rehabilitation in “Nutrition
Rehabilitation Centres”

Ambulatory Treatment
1. In most cases of malnutrition, education
alone is sufficient to correct situation.
2. Identify the most serious errors in diet eg.
distribution of available food in family,
inadequate use of vegetables, etc.
3. The problem may need assistance usually
as Food Supplements.

Centres (NRC)
1. Severely malnourished children, after
taking treatment from hospital, may be
transferred to NRCs.
2. The objective is to teach the mother the
various methods of preparing nutritious
and tasty foods so that the relapse of
malnutrition can be prevented.05-10-2020 DR HARIVANSH CHOPRA 121

Nutritional Rehabilitation Centres
(NRC)
Day care NRCs Residential NRCs

Day care NRCs
1. Similar to crěche or kindergarden.
2. Children spend 6 – 8 hrs daily for 6 days a
week in these centres, and take there 3
meals each day.
3. Mothers may attend centre and help
preparation of meals, or may attend
weekly meeting at centre.

Day care NRCs
4. Food stuffs and utensils
used are familiar to the
mothers, and available in
local market.
5. Adequate medical
supervision is essential at
the centres.

Residential NRCs
1. Larger staff and equipments
than day-care NRCs.
2. Children & their mothers live
in these as inpatients.
3. Serves mostly children
discharged from hospital after
treatment for severe
malnutrition.

Nutrition Supplementation
1. Approach by which both prevention and treatment
of malnutrition can be met.
2. Supplementary food supplies 500 Cal/day and 12 –
15 gm(rs 4) protein/day to children,
3. Severely malnourshied 800 cal/day and 20-25gm
Proteins/day (rs 6)
1. .

Nutrition Supplementation
Pregnant and lactating mothers
600 Cal/day and 18-20 gm
protein/day(rs 5) to mothers
for 300 days in an year

Nutritional Surveillance
1. Surveillance is
defined as “Data
Collection for
Action”.

Objectives of Nutrition
Surveillance
1. To aid long term planning in health and
development.
2. To provide input for programme
management and evaluation.
3. To give timely warning and intervention
to prevent short-term food consumption
crisis.05-10-2020 DR HARIVANSH CHOPRA 129

Triple-A approach
ASSESSMENT
of the situation
ANALYSIS
of the causes of problem
ACTION
based on the analysis
and available resources
Perceptions &
Understanding
Capabilities
Resources
Effective
Demand

Conclusion
1. Malnutrition is a preventable problem.
2. Shift in strategy is the need of the hour.
3. Infants must be made the focus of
attention in totality.
4. Application of multiple interventions like
BIGWIN will produce the desired result.

MCQs
1. Following is false about weight gain in
first year of life except:
1. Weight gain is 4 kg in 1st year.
2. Weight gain is 4 kg in 1st 4 months.
3. Weight gain is maximum during 6 – 12
months of age.
4. None of the above.
Ans. – 2.

MCQs
2. “Hyderabad Mix”, an energy dense
supplement, used for malnourished
children does not contain :
1. Bengal gram.
2. Groundnut.
3. Soyabean.
4. Jaggery.
Ans. – 3.

MCQs
3. In dietary management of malnutrition,
following is provided to children :
1. 100 Cal/kg and 1gm protein/kg.
2. 180 Cal/kg and 2 gm protein/kg.
3. 300 Calorie and 15 gm protein.
4. 500 Calorie and 25 gm protein.
Ans. – 2.

MCQs
4. NRC is :
1. Nutrition Rehabilitation Centre.
2. Nutrition Rehabilitation Council.
3. Natural Resources Council.
4. Natural Rights of Community.
Ans. – 1.

MCQs
5. Giving “timely warning” about food
consumption crisis is an objective of :
1. Disaster Management.
2. Food Census.
3. Nutrition Surveillance.
4. Food & Agriculture Research.
Ans. – 3.

Success stories & innovative approach for prevention of childhood malnutrition dr harivansh chopra

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Success stories & innovative approach for prevention of childhood malnutrition dr harivansh chopra

Similar to Success stories & innovative approach for prevention of childhood malnutrition dr harivansh chopra (20)

More from Harivansh Chopra

More from Harivansh Chopra (20)

Recently uploaded

Recently uploaded (20)