Dr. Bela Shah, ICMRDr. R. C. Sharma

Desert Medicine Research Centre

JODHPUR dmrcDesert Medicine Research Centre

Continuous & Integrated Drought Management

Health Component

Network of ICMR Institutes

IGNP

India

Rajasthan

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

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

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)

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)

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

Major Nutritional Deficiency Signs

Pregnant Controls n=384 n=409 VAD-Night blindness 8.8 % 0.9 % Thyroid enlargement 3.1 % 0.5 %

Percent of RDA

Cereals consumption 79Fats & Oils 80Pulses & legumes 56Leafy Vegetables 9.5Milk & Milk foods Adequate

n=148

Dietary IntakePregnant & lactating women

• Protein (20%) & Calories 40 %• Iron (36%) & Folic Acid 57 %

• IFA tablets consumption–43 %• Consumption of Iodized salt- 19.1 %

Dietary Deficiencies

Nutrition MonitoringJodhpur District

• 30 villages from six Tehsils• Covering 600 households

Nutritional deficiency signs

Anthropometric measurements Ht, Wt, MUAC & FFT

Dietary intake-24 hour recall method

Nutritional morbidities

Major Nutritional Deficiency Signs n=3540

Dental caries- 31.2 %Dental Fluorosis- 25.2 %Hair Discolouration- 6.0 %Gums spongy/bleeding- 2.6 %

Nutritional Morbidities n=3540

ARI - 5.4 %Fever - 4.5 %Diarrhea - 1.1 %N.A.D. - 88.7 %

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

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

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

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

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

Expertise

Medical anthropologists Clinicians Social scientists Trained Technicians

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)

Suggested Monitoring

Crude Mortality-Secondary & Primary

Acute Malnutrition } Anthropometry

Chronic Malnutrition }

Food Access /Availability } Dietary

Dietary Diversity } Intake

Target Group

Pregnant Women Preschool children

Monitoring Parameters

Nutritional status:Anthropometry Dietary Intake Nutritional deficiency signs Biochemical tests

Outcome of pregnancy: AbortionsStill BirthUnder weight new born

Impact of Under-Nutrition

Under weight children Anemic mothers Marasmic babies Vitamin A deficiency blindness Vitamin B deficiencies Vitamin C deficiencies

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

Nutritional Deficiency Signs

1. Protein-energy malnutrition

Popn. Group Clinical Symptoms / Signs Children Always present

Marasmus Wasting

Kwashiorkar OedemaMarasmic Wasting + OedemaKwashiorkar

Adults Wasting & weakness

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

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*

Nutritional Deficiency Signs

5. Vitamin C deficiency - Scurvy

6. Fluoride- Dental Caries Dental Fluorisis

7. Iodine deficiency disorders - Goiter Cretinism

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

dmrcDesert Medicine Research Centre