common nutritional problems in sri lanka
DESCRIPTION
Common Nutritional Problems in Sri Lanka. General Health Indicators. IMR – 11.2 per 1,000 live births (Register General’s Dept.) MMR – 39.3 per 100,000 live births (FHB. 2006 ) TFR (Total fertility rate) - 2.4 per woman (DHS. 2006/7) - PowerPoint PPT PresentationTRANSCRIPT
General Health Indicators
• IMR – 11.2 per 1,000 live births (Register General’s Dept.)
• MMR – 39.3 per 100,000 live births (FHB. 2006)
• TFR (Total fertility rate) - 2.4 per woman (DHS. 2006/7)
• GFR (General fertility rate) - 79.0 per 1,000 women (DHS. 2006/7)
• CBR - 18.7 per 1,000 population (DHS. 2006/7)
Improvement over the time
1945 2000
CBR/1000 Population a 36.6 17.6
CDR/1000 Population a 21.9 5.6
MMR/1,000 Live Births a 165.2 2.0
IMR/1,000 Live Births a 140.0 13.6
Life Expectancy at Birth (Yrs) b
Male
Female
43.9
41.6
72.0
76.0
Literacy Rate b Male
Female
70.1
57.8
92.5
90.1
a / Vital Statistics, Dept. of census & Statistics
b/ Central Bank Annual Reports
Nutritional Indicators
• LWB 16.6% (DHS. 2006/7)
• Average weight gain in pregnancy 8kg
(FHB MIS, MRI survey report 2003)
• Under 5 yr children (DHS. 2006/7)
– Stunting 18.0%– Wasting 15.0%– Underweight 21.6%
Nutritional Indicators
• Nutritional status of women
(15-49 yrs)– Undernourished (BMI<18.5) -
21.8%– Overweight (BMI >25.0) -
24.0% (DHS. 2000)
• Over nutrition– Adolescents 6.0%– Non pregnant women 19.9%
Thinness
Normal Over weigh
t
Obese
Urban 15.2 % 49.1 % 26.3 % 9.3 %
Rural 25.3 % 55.7 % 16.1 % 3.0 %
Estate 40.4 % 56.1 % 2.6 % 0.9 %
Latest data – DHS 2006/7
Trends in LBW
23
20.519.9
17.9 17.8
16.416.7
16.1
17.1 16.9 17.117.6
16.6
15
16
17
18
19
20
21
22
23
24
25
1988 1994 1995 1996 1998 1999 2000 2001 2002 2003 2004 2005 2006
LBW percent
Medical Statistician and DHS surveys 1993,2000,2006
Urban 11.6%
Rural 17.0%
Estate 20.8% (DHS. 2000)
(DHS. 2000)
57.3
54.3
43
38.1 37.7
30.729.4
49.9
44.6
36.2
27.5
23.8
16.1
13.513.9 13.9
11.612.9
15.5
12.814
22.821.6
18.4 18
15.5 15
10
15
20
25
30
35
40
45
50
55
60
1975-76 1977-78 1980-82 1987 1993 1995-96 2000 2006-07
year
perc
entag
e belo
w -2S
DTrends in Nutritional Status of <5 years
- Underweight
- Stunting
- Wasting
Department of Census and Statistics, DHS 1987,1993,2000, 2006/7
Protein Energy Malnutrition
Causes
Inadequate & faulty diets
Poverty
Socio-economic factors
Environmental factors
infections
PEM - MACRONUTRIENT DEFICIENCY
Often associated with
INFECTIONS
Micronutrient deficiencies
Sanitation
personal hygiene
infection
malnutrition
Host diet environment
Eg :-
Young child - Energy needs
Protein needs
Staple diets Energy density
Protein content
Feeding frequency
Inadequate food availability
Poverty Inequity Lack of land
Infections Anorexia
Food intake
Absorption
Utilization
losses
Famines
Droughts, Natural disasters, War, Civil disturbances
Inappropriate weaning practices
Malnutrition
Marasmus Kwashiorkor
Marasmic Kwashiorkor
Emaciated Bilat pitting oedema
Legs trunk moon face
Fat & muscle Fat & muscle
Prominance of Scapulae Spina & Ribs
Skin lesion & Atrophy, erythema, desquamation
Old man’s appearance
(Thin flaccid skin)Pale
Normal hairHair changes (yellow, red, sparse, bald patches)
Frequent infections
with signsFrequent infections
imbalance
Asso. with dehydration
Dehydration
Alert & irritableLethargic, miserable irritable
E
NON CLINICAL FORMS WASTING - (wgt / hgt)
STUNTING - (hgt / Age)
UNDERWEIGHT - (wgt / Age)
Changes in internal organs Gastrointestinal tract
- Mouth, Tongue, Throat
Atrophic mucosa / ulceration
Gums infected
salivary glands – atrophy
acute parotitis / oesophageal ulcers
- Mucosa of GI tract
Atrophy / Absorption
- Muscle tone in intestinal muscles
Rectal prolapse
Liver
- Fatty change
Pancreas
- Extreme wasting
Kidneys
- size
- infections
Endocrine system - Pituitary gland
- Adrenal gland
- Thyroid
- Thymolymphatic system
Haemopoietic system
- Anaemia ~ Protein
~ Iron
~ Folic Acid
- Chronic infection
~ suppressed BM
Muscles
- Wasting
Heart
- General Atrophy
- Cardiomegaly in Anaemic patients
Skin changes
Bone
Dental development
CNS
29.9
20.9 22.3
31.6 30.3
0
5
10
15
20
25
30
35
Percen
tage (%
)
Pre schoolchildren
School children Adolescent Non pregnantwomen
Pregnant women
Anaemia Status of Sri Lanka,MRI,2001
Prevalence of Anaemia in Different groups
in Sri Lanka
27.3
30.6 31.2
25
32.8
40.1
28
0
5
10
15
20
25
30
35
40
45
Perc
entag
e
Wes
tern
Sout
hern
Cent
ral
Saba
raga
muw
a Uva
North
Cen
tral
Way
amba
Distribution of Anaemia in Pre-school
children (6-59 months)
by province
Anaemia Status of Sri Lanka,MRI,2001
Trends in the prevalence of iron
deficiency anemia among
under five children
70
45
29.9
0
10
20
30
40
50
60
70
80
1973 1996 2001
Anemia
Iron Deficiency
Amount of Iron in the body
3 – 4 gm
> 50 % of it Hb
Rest muscle (myoglobin)
liver
Hb O2 metabolic activities
cells
Daily requirement
14 mg / day
12 mg / day
Haem Non haemAbsorption 40 %
Fish, meat, dry fish
(Enhancing factors
Vit C,sour things)
10 – 15 %
Cereals, pulses, vegetables, fruits, eggs, dairy
(Inhibiting factors
Tannin, caffain)
Iron storage
Compounds - Ferritin
- Hemosiderin
Iron affects :-- Cognitive development
- Concentration
- Attentionspan
- Memory
- Learning
- Physical growth
- Muscle function
- Immunity to disease & illness
- Social interaction
Life cycle
- New born
- Infant
- Preschooler
- Primary schools
- Adolescents
- Adults
- Elderly
Liver
RES
BM
preg:
lact:
normal
Strategy for the Control of Anaemia
Dietary diversification, Nutrition education & local
food sources
EBF + Complementary feeding
6/12 BF – 2 years
Modify diets adding local nutrient rich
Avoid Tea with meals
Enhancing / Inhibiting factors
Horticultural projects
Livestock programmes
Ensue access to varied food supply to
obtain adequate diet, school garden
Nutrition Education
All institutional diets according to
nutritional requirements
Supplementation
Fe supplementation
Targets
Infants E BW
Preschoolers
Primary school children
Weekly supplementation
of child bearing age group
Blanket coverage to displaced & refugee camps
Fortification
Vitamin A deficiency
• Prevalence of Vitamin A deficiency (serum retinol levels less than 20µg per dl)
Among 6-71 months
1996 35.3% a
2005 29.3% b
a/ Vit A Deficiency status of children in Sri Lanka 1995/1996. MRI. 1998
b/ MRI. 2005 (unpublished data)
Vitamin A deficiency
Public Health Problems
▲ Blindness
▲ Duration of morbidity
▲ Mortality
asso. with other Nutritional disorders
(infections PEM)
Causal factors ~ Host
~ Diet
~ Environment
Host : Age younger age
(infants / preschool)
Growth
intake of milk, greens
Diet : intake of greens & fat
animal protein
Environment :
Seasonal food availability
Infections , Infestations
Socio Economic
Needs :- (Functions)
o Synthesis of photosensitive pigment of Retinal cells
o Cell differentiation of Epithelium
o Normal growth
o Reproduction
o Immune competance
Dry skin :-Follicular keratosis
Sweet / sebaceous gland blocked by keratin plugs
Secretions
Dry skin
Storage :-
95 % in Hepatic cells
Hepatocytes secrete “ Retinol Binding Proteins”
DIAGNOSIS :-
Clinical features Night blindness
Conjunctival xerosis
Corneal cerosis
Conj. Xerosis with ulceration
Keratomalacia
Corneal scars
Biochemical Tests
- S. Retinol level
- Relative dose response
Dietary assessments
- Hellen kellar food frequency
Conjunctival Impression Cytology
Liver biopsy / necropsy
Vitamin A Policy
Recommendations & (Px & control)
Dietary modifications
1. Ensue food security
● Promote home gardening
● Food & agriculture policies
(multi sectoral approach)
● Research to crops with micronutrients
● Proper storage to nutrient losses
● Food preservation
2. Information , Education & Communication (IEC) BCC
3. Promote BF / CF
Fortification Commercially , local production
SLS certificate for forti. Food
Supplementation
- pregnant mothers
- Regular supply of Thriposha
Vitamin A mega dose Regime
Post Partum :
200,000 I u within 4 wks after delivery
Child 0 – 59 months
> 9 months
> 18 months
> 36 months
School children
grade 1, 4, 7 :- 100,000 I u
Special situations ~ Displaced
~ Estate
~ Garment factory workers
~ Prisoners
~ Orphans
100,000
promote dietary modification
100,000 I u
Iodine Deficiency Disorders
• Total goiter rate in children aged 6-9 years
2000/2001a 20.1%2005b 3.8%
Central 10.3%
Uva 7.8%
Western 7.3%
a/ Case studies on successful micronutrient prorammes: The Sri Lankan experienceb/ Iodine nutrition status in Sri Lanka 2005. MRI . 2006
IODINE DEFICIENCY DISORDERS
Sole function of iodine - participation in the synthesis of
THYROID HORMONES (T4 + T3)
THYROID HORMONES – VITAL FOR PHYSICAL
& MENTAL
DEVELOPMENT
Severity of mental / physical retardation depend
on the severity of iodine deficiency
SPECTRUM OF IODINE DEFICIENCY• Cretin or deaf mute
• Mental & physical growth retardation
• Goitre
• Delayed menarche
• Amenorrhoea
Endemic goitre
• A significant proportion of the popluation has
palpable or obviously enlarged thyroids
Indicators• Goitre prevelance
• Urine iodine levels
• Iodine levels of salt
Interventions on Food & NutritionPolicies, Strategies &
Programmes
1. Antenatal care & supplementation
2. Promotion of breast feeding (BF code & Baby friendly hospitals & maternity leave)
3. Growth monitoring & promotion
4. Complementary feeding
5. Thriposha supplementation
Interventions on Food & Nutrition
6. Vitamin A mega-dose
7. Food subsidy -“Poshana Malla”, “Kiri weeduruwa”
8. School health programmes – exercise programme, canteen policy, etc
9. School feeding programmes
10. Special food subsidy for IDPs, Plantation workers
Cont…
11. Health & Nutrition promotion - Education programmes for pregnant & lactating women, school children
12. Hospital diet modification
13. Food fortification – salt iodization
14. Nutrition in emergencies
Interventions on Food & Nutrition
Cont…
• Poorly coordinated
• Poorly targeted - Thriposha programme
• Inadequate rational & irregular supply- Thriposha programme
• Poor attention on vulnerable areas & groups – Estates
Weaknesses
Weaknesses
• Inadequate coverage of services – some estate areas
• Over burdened at grass root level health workers
• Inadequate training & poor dissemination of current knowledge to grass root level
• Inadequate supervision & monitoring…Quality
Cont…
Suggestions
• National inter sectoral committees (chaired by Hon PM/ Hon ministers)
• Establishment of NSC (chaired by SH&N)
• Strengthening intra & inter sectoral coordination at all level
• Provincial/ District nutrition committees
• National nutrition policy
• National strategic plan/ annual action plans – National, District & Divisional
Suggestions
• Improve targeting effort (mapping out vulnerable areas & groups)
• Strengthening existing progrmmes – BCC, re-targeting, area specific programmes with triple A approach
• Due consideration gives to new initiatives -DFS, micro nutrient supplementations
• Encouraging dounor assisstance
• Increase capacity of thriposha factory & ensure regular supply
Cont…