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Dr. Bela Shah, ICMRDr. R. C. Sharma
Desert Medicine Research Centre
JODHPUR dmrcDesert Medicine Research Centre
Continuous & Integrated Drought Management
Health Component
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Network of ICMR Institutes
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IGNP
India
Rajasthan
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DMRCCurrent Programmes
Dengue RF/RHD registry
Malaria Diabetes
Tuberculosis Hypertension
Nutrition Musculoskeletal disorders
Emphasis on: Focused research of relevance to
Public HealthdmrcDesert Medicine Research Centre
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28 villages from Luni Panchayat Samiti, Jodhpur tehsil
Covered 1193 women- 384 Pregnant women 400 Lactating women 409 NPNL women (Control)
Micronutrient deficiency disorders,Nutritional Status & morbidity in pregnant & lactating women
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Iron Deficiency: Hemoglobin levels
Iodine deficiency disorder: UIE levels (WET digestion method) Iodine content of salt sample (standard iodometric titration method)
Nutritional deficiency signs & Morbidities Dietary pattern (24 hour recall method)
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Iron Deficiency Disorder
P & L2007
N=753
Control
2006-07N=391
NIN 2003
N=2983
NFHS II 1998
ICMR 2001
N=6633
IDAP: <11 g/dlL&C:<12g/dl
81.0 71.6 76.3 51.8 84.9
Sev. IDA (<7 g/dl)
14.0 4.1 4.3 - 13.1
(Figures are in percent)
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Iodine Deficiency Disorder
P & L2006-07N=753
Control2006-07N=391
NIN 2003
N=2983
NFHS II 1998
ICMR 2001N=66
33
IDD 47.3 41.9 - - -
Iodized salt intake
16.7 22.4 30.7 46.3 55.5
Figures are in percent
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Major Nutritional Deficiency Signs
Pregnant Controls n=384 n=409 VAD-Night blindness 8.8 % 0.9 % Thyroid enlargement 3.1 % 0.5 %
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Percent of RDA
Cereals consumption 79Fats & Oils 80Pulses & legumes 56Leafy Vegetables 9.5Milk & Milk foods Adequate
n=148
Dietary IntakePregnant & lactating women
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• Protein (20%) & Calories 40 %• Iron (36%) & Folic Acid 57 %
• IFA tablets consumption–43 %• Consumption of Iodized salt- 19.1 %
Dietary Deficiencies
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Nutrition MonitoringJodhpur District
• 30 villages from six Tehsils• Covering 600 households
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Nutritional deficiency signs
Anthropometric measurements Ht, Wt, MUAC & FFT
Dietary intake-24 hour recall method
Nutritional morbidities
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Major Nutritional Deficiency Signs n=3540
Dental caries- 31.2 %Dental Fluorosis- 25.2 %Hair Discolouration- 6.0 %Gums spongy/bleeding- 2.6 %
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Nutritional Morbidities n=3540
ARI - 5.4 %Fever - 4.5 %Diarrhea - 1.1 %N.A.D. - 88.7 %
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Nutritional Status
Preschool children1-5 (n=553) Grades Normal Mild Moderate Severe
Under Nutrition 18.6 27.3 15.9 38.2(Wt for age)
Stunting 28.4 14.8 56.2 (Ht for age)
Adults Obesity Normal CED I CED II CED III
n=1148(BMI) 7.8 57.2 18.7 9.1 7.2
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Dietary Deficiencies (n=1565)
• Diet grossly deficient in GLV - 91.0 % Fats - 55.0 % Pulses & legumes - 59.5 % Other Vegetables - 35.0 %
Cereals - 20 % of RDA
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Sub-Clinical Vitamin-A Deficiency
among children of Rajasthan
A UNICEF sponsored multi centric and cross sectional study
Covering seven districts of Rajasthan from seven different agro-climatic zones
Sample Size: 3000 children (6-71
months) from Rural and Urban areas
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Nutrition
Research focus:
- Nutrition atlas for Desert - Monitoring of Nutritional Deficiencies
and associated morbidities
- Development of Nutritional intervention package considering Socio-behavioural & cultural aspects
dmrcDesert Medicine Research Centre
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Projects Proposed
Fortification of wheat & millet flour with iron along with double fortification in salt & their impact on nutrition status of preschool children DBT-NIN networking
Development of nutrition package for Micronutrient deficiencies & its impact assessment on pregnant & lactating women
Impact assessment of consumption of three electrolyte products on mineral profile & general health profile of Jawans in desert areas of Rajasthan DFRL,Mysore
Estimation of Zinc def. in school children
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Expertise
Medical anthropologists Clinicians Social scientists Trained Technicians
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Infra structure
Anthropometric equipments for Anthropometry
Dietary cups, balances etc for Dietary intake
Colorimeter, spectrophotometer & HPLC for
biochemical analysis of MDDs (Iron, Iodine, Vitamin A)
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Suggested Monitoring
Crude Mortality-Secondary & Primary
Acute Malnutrition } Anthropometry
Chronic Malnutrition }
Food Access /Availability } Dietary
Dietary Diversity } Intake
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Target Group
Pregnant Women Preschool children
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Monitoring Parameters
Nutritional status:Anthropometry Dietary Intake Nutritional deficiency signs Biochemical tests
Outcome of pregnancy: AbortionsStill BirthUnder weight new born
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Impact of Under-Nutrition
Under weight children Anemic mothers Marasmic babies Vitamin A deficiency blindness Vitamin B deficiencies Vitamin C deficiencies
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Monitoring Parameters
AnthropometryAcute Malnutrition: Weight / Height(Wasting) Weight / AgeChronic Malnutrition: Height / Age(Stunting)
Dietary Intake 24 hour recall method: Food Access Food Availability Food Diversity
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Nutritional Deficiency Signs
1. Protein-energy malnutrition
Popn. Group Clinical Symptoms / Signs Children Always present
Marasmus Wasting
Kwashiorkar OedemaMarasmic Wasting + OedemaKwashiorkar
Adults Wasting & weakness
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Nutritional Deficiency Signs
2. Anemia - Pallor (palms, Tongue, conjunctiva)
3. Vitamin A deficiency
(XN) Night blindness (X1A) Xerosis of conjunctiva (X1B) Bitot spot (X2) Xerosis of cornea (X3A) Xerosis of cornea + ulcer (X3B) Keratomalacia (XS) Corneal scar + history of VAD
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Nutritional Deficiency Signs
4. Vitamin B complex deficiency 1. Riboflavin (B2) & Pyridoxine (B6) deficiency
Angular stomatitisChelosis Glossitis
2. Thiamin deficiency (B1)
Beriberi*3. Nicotinic acid deficiency (B2)
Pellagra*
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Nutritional Deficiency Signs
5. Vitamin C deficiency - Scurvy
6. Fluoride- Dental Caries Dental Fluorisis
7. Iodine deficiency disorders - Goiter Cretinism
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DMRC proposes to participate and share responsibility in efforts towards
1.Development of socioeconomic drought monitoring indicators and
2. Impact assessment of mitigating measures on five parameters Crude Mortality, Acute Malnutrition, Chronic Malnutrition, Food Access /Availability,
Dietary Diversity
Response
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dmrcDesert Medicine Research Centre