-
CHILD NUTRITION CHALLENGES AND OPPORTUNITIES
Prema Ramachandran
Director, Nutrition Foundation of India
-
Major nutrition-related public health problems Chronic energy
deficiency and undernutritionMicro-nutrient deficiencies Anaemia
due to iron and folate deficiencyVitamin A deficiencyIodine
Deficiency DisordersChronic energy excess and obesity
-
Low birth weight why is it remaining unchanged Why are we unable
to ensure Exclusive breast feeding for the first six months Timely
appropriate & adequate complementary feedWhat is responsible
for low dietary intake and high under-nutrition rates in preschool
child What can we do to reduce anaemia in childrenMassive dose Vit
A -Where do we go now ?Can we achieve universal access to iodised
salt by 2010 What should we do to tackle over- nutrition What are
the priority areas for R&D
-
Low birth weight Why is it remaining unchangedWhat is its impact
on IMR What happens to growth and development -are our children
short , thin but fat ?What are the long term implications of low
birth-weight and low growth trajectory
-
Trends in Low Birth
Weight196219861969-731989-93196919941988199574gMean
Wt78g52g126gMean Gest ??Preterm0.7W21-16%0.8W20-15%0.3W14-10% 0
-
Multicentric DataNational Neonatology Forum (1995/ 2002)
Institutional Data on 37082 / 66512 Births LBW - 33% / 31.6% VLBW -
3.3% / 3.3% Preterm - 12.3% / 14.7%? Overestimates: Underprivileged
and High Risk Population
-
Time trends in IMRSource: RGI 2002
Chart2
129
120
105
97
94
80
74
72
71
72
70
68
66
64
IMR
Rate/1000
Sheet1
19761979198219851988199119931996199719981999200020012002
IMR1291201059794807472717270686664
Sheet1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
IMR
Sheet2
Sheet3
-
Over the last three decades there is no significant change in
mean birth weight or incidence of LBW However there has been a
steep decline in IMRIf IUGR is major cause of LBW improvement in BW
is not essential prerequisite for reduction in IMR
Chart1
278532.5
2685.7930.2
2682.529.1
Source:Safdarjung Hospital
Birth weight
% LBW
Year
Birthweight
%LBW
Time trends in birth weight
Sheet1
Time trends in birth weight
196919891998
Birth weight27852685.792682.5
% LBW32.530.229.1
Sheet1
00
00
00
&A
Page &P
Birth weight
% LBW
Year
Birthweight
%LBW
Time trends in birth weight
Sheet2
Sheet3
-
Birth weight and health In India about one third of all infants
weigh less than 2.5 kg at birth. Low birth weight is associated
with Low growth trajectory ?Increased risk of obesity, diabetes and
coronary heart disease in later life
-
Child nutrition begins with maternal nutrition
-
Birth weights in relation to maternal BMISource: Tenth Five Year
Plan 2002
Chart1
251053.1
257341.4
265335.9
277127.7
281226.4
297214.7
Mean Birth Weight (g)
Prevalence of LBW (%)
BMI (Kg/m2)
Sheet1
BMI Status of MothersMean Birth Weight (g)Prevalence of LBW
(%)
< 16251053.1
16-17257341.4
17-18.5265335.9
18.5-20277127.7
20-25281226.4
> 25297214.7
Sheet1
00
00
00
00
00
00
&A
Page &P
Mean Birth Weight (g)
Prevalence of LBW (%)
BMI (Kg/m2)
Figure 5.1: Birth weights in relation to maternal weights
Sheet2
Sheet3
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Improving maternal nutrition
During the Tenth Plan efforts will be made to weigh all women as
early in pregnancy as possible and to monitor their weight gain
This is not being done at the national level
Under the ICDS programme, food supplements are being provided to
pregnant and lactating women who come to anganwadis. Coverage is
between 15 and 20%Women who receive supplements are not being
chosen on the basis of their nutritional status
-
Tenth Plan strategy Operationalising universal antenatal care
for all pregnant womenANC coverage is low ; content suboptimal
Majority do not get weighed ; very few get Hb estimation done (NFHS
-DLHS data).
Operationalisation of nutrition interventions for the management
of under-nutrition through: targeted food supplementation and
health care for those with under-nutritionAppropriate management of
anaemia non existent
-
Tenth Plan -Improving maternal nutrition Women who weigh < 40
kg should be identified and given food supplements consistently
throughout pregnancy;given adequate antenatal care;monitored for
weight gain during pregnancy and, if weight gain is sub-optimal,
identify the causes and attempt remedial measures; andgiven
appropriate antenatal, intrapartum and postpartum care.
Under NPAG in 51 poor districts all pregnant women were weighed
those weighing
-
Low birth weight 10 Plan strategy anganwadi workers to report
all births in village, weigh all neonates delivered at home soon
after birth and refer those weighing less than 2.2 kg to a hospital
with a pediatrician.
Current status Feasibility demonstrated in small studies
Anganwadis should have a 10kg tubular Salter scale for reasonably
accurate weighing of neonate Need to have information about nearest
hospital with a pediatricianUnfinished agenda - action will help in
NNMR
-
Over two decades there has been an increase in fat fold
thickness of neonates in boys and girls in all birth weight
categories
Chart7
3.63.23.83.5
43.44.44.2
4.53.74.94.5
4.93.75.45.1
boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Subscapular (mm)
Time trends in subscapular fat fold thickness (mm)
gestation
males
boysgirls
sachdevpurisachdevpuri
363.22.53.32
373.63.33.83.2
383.93.643.5
393.93.54.23.6
404.13.94.13.8
41443.83.9
subscapular
boysgirls
sachdevpurisachdevpuri
363.32.13.32.3
373.83.24.23.5
384.13.24.33.7
394.13.14.44.2
404.23.54.54.3
414.33.64.14.3
gestation
0000
0000
0000
0000
0000
0000
boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
triceps (mm)
Secular trends in triceps (mm)
brth wt
000000
000000
000000
000000
36
37
38
39
40
41
Triceps (mm)
Secular trends in triceps
Sheet3
0000
0000
0000
0000
0000
0000
boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
subscapular(mm)
Secular trends in subscapular (mm)
000000
000000
000000
000000
36
37
38
39
40
41
Subscapular (mm)
Secular trends in subscapular (mm)
boysgirls
sachdevpurisachdevpuri
2001-25003.43.43.53.2
2501-30003.83.84.23.7
3001-35004.34.34.63.9
3501-40005.14.24.93.9
boysgirls
sachdevpurisachdevpuri
2001-25003.63.23.83.5
2501-300043.44.44.2
3001-35004.53.74.94.5
3501-40004.93.75.45.1
0000
0000
0000
0000
boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Triceps (mm)
Secular trends in triceps (mm)
0000
0000
0000
0000
boys sachdev
boys puri
girls sachdev
girls puri
Birth weight (g)
Subscapular (mm)
Secular trends in subscapular (mm)
-
Over two decades there has been an increase in fat fold
thickness of neonates in boys and girls in all gestational age
categories
Chart2
3.22.53.32
3.63.33.83.2
3.93.643.5
3.93.54.23.6
4.13.94.13.8
443.83.9
boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
triceps (mm)
Time trends in Triceps fat fold thickness in neonates
Sheet1
males
boysgirls
sachdevpurisachdevpuri
363.22.53.32
373.63.33.83.2
383.93.643.5
393.93.54.23.6
404.13.94.13.8
41443.83.9
sachdevpuri
3.32.1
3.83.2
4.13.2
4.13.1
4.23.5
4.33.6
Sheet1
0000
0000
0000
0000
0000
0000
boys sachdev
boys puri
girls sachdev
girls puri
Gestation (wks)
triceps (mm)
Secular trends in triceps (mm)
Sheet2
Sheet3
-
Birth weight, plasma glucose and insulin concentrations in
4-year old urban children Source: Yagnik et al, 1998
-
Time Trends in nutritional status of Delhi cohortSource:
Bhargava et al, 2004
-
Current Status of Delhi cohort Source: Bhargava et al, 2004
-
Breast feeding protection from under and over nutritionHow far
have we succeeded in protection and promotion of breast feeding
Emerging challenges
-
Improving Infant Feeding
-
Infant feeding practices -NFHS -2Source: NFHS 1998-99Breast
feeding is universal in India but exclusive breast feeding upto six
months and introduction of complementary feeds at six months is not
common
Chart2
74.659.4
33.960.2
42.558.5
55.215
13.237
Goa65.4
65.246.5
47.241.8
17.4561.3
41.538.9
66.538.4
68.572.9
64.227.3
38.530.8
69.786.8
16.177.1
40.774.2
43.981.3
5830.1
36.338.7
53.717.5
16.387.3
48.355.4
56.917.3
48.846.3
55.233.5
Infants(0-3 months) exclusively brest fed
Timely complementary feeding of infants 6-9 mths
percent
Sheet1
Infants(0-3 months) exclusively brest fedTimely complementary
feeding of infants 6-9 mths
Andhra Pr.74.659.4
Ar. Pr.33.960.2
Assam42.558.5
Bihar55.215.0
Delhi13.237.0
Goa65.4
Gujarat65.246.5
Haryana47.241.8
Him. Pr.17.561.3
J & K41.538.9
Karnataka66.538.4
Kerala68.572.9
Madhya Pr.64.227.3
Maharashtra38.530.8
Manipur69.786.8
Meghalaya16.177.1
Mizoram40.774.2
Nagaland43.981.3
Orissa58.030.1
Punjab36.338.7
Rajasthan53.717.5
Sikkim16.387.3
Tamil Nadu48.355.4
Uttar Pr.56.917.3
W.Bengal48.846.3
INDIA55.233.5
Sheet1
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Infants(0-3 months) exclusively brest fed
Timely complementary feeding of infants 6-9 mths
percent
Sheet2
Sheet3
-
Source: NFHS 1998-99Prevalence of undernutrition (Weight for age
% below -2 SD)As a result there is steep increase in under
nutrition between 6-23 months of age
Chart1
11.92
37.511.8
58.523.1
58.424.1
%-2SD
%-3SD
Age-groups
Sheet1
StateNo. of beneficiaries as per Plg. Comm.
Pregnant Women in the BPL population 1999 (000's)BPL Population
(0-4) Years 1999 (000's)Total beneficiaries (000's)Requirement of
funds (in Rs. crores) as worked out by Plg.Comm.No. of
beneficiaries estimated by Deptt. of WCD (000's)Requirement of
funds (in Rs. crores) as per DWCDFunds allocated by the state Govt.
1997-98 (Rs. Crore)Gap as per Plg. Comm.Gap as per DWCD
Andhra Pr.285.061337.541622.6048.68250375.0940.008.6835.09
Assam285.531374.751660.2849.8192127.637.8641.9519.77
Bihar1620.576744.198364.76250.94309492.8219.13231.8173.69
Gujarat198.90842.181041.0831.23280184.03125.50-94.27-41.47
Haryana54.32259.81314.149.42100630.185.004.4225.18
Karnataka259.231239.611498.8444.97281584.4537.797.1846.66
Kerala80.19383.93464.1213.92144943.470.7513.1742.72
Madhya
Pr.1039.514290.515330.02159.90301590.4541.54118.3648.91
Maharashtra561.853006.553568.41107.053569107.0743.3963.6663.68
Orissa458.822121.882580.7077.42225867.7462.3815.045.36
Punjab35.39184.48219.876.6086225.863.003.6022.86
Rajasthan295.201253.801549.0146.47208862.6410.1036.3752.54
Tamil
Nadu278.491267.181545.6846.373979119.37104.00-57.6315.37
Uttar
Pr.1961.557703.769665.32289.965489164.675.00284.96159.67
West
Bengal493.562661.783155.3394.663446103.3821.6073.0681.78
Arunachal Pr.8.9646.3055.261.662417.232.81-1.154.42
Delhi25.33143.83169.165.072958.8520.75-15.68-11.90
Goa0.937.508.430.25962.880.50-0.252.38
Himachal Pr.12.1458.7970.932.1364319.296.64-4.5112.65
J&K12.1044.4456.541.7087226.167.33-5.6318.83
Manipur13.9586.45100.403.012898.671.871.146.80
Meghalaya24.6699.04123.693.711765.282.001.713.28
Mizoram3.2422.0025.240.761073.211.85-1.091.36
Nagaland8.4382.4090.832.722216.631.830.894.80
Sikkim4.6925.0329.720.89451.351.95-1.06-0.60
Tripura20.55139.35159.904.802678.016.95-2.151.06
A&N Islands1.499.4810.960.33310.930.55-0.220.38
Chandigarh1.026.577.590.23250.750.050.180.70
D&N Haveli1.424.786.200.19110.330.47-0.28-0.14
Daman & Diu0.210.891.100.0370.210.34-0.31-0.13
Lakshadweep0.261.211.470.0450.150.19-0.15-0.04
Pondicherry4.1126.7430.840.93591.774.16-3.23-2.39
Total8051.6535476.7643528.411305.8542685.001280.55587.28718.57693.27
Sheet2
-
Tenth Plan- major focus on Prevention of undernutrition in
infancy through promotion of exclusive breast feeding in the first
six months; nutrition education for the introduction of appropriate
low-cost, energy dense (home available) complementary food at 6
months ;focus on nutrition education by AWW/ ANM during each
contact. Yet to be operationalised under ICDS /NRHMNeeded clear
crisp messages; AWW to district doctor should all say the same
things repeatedly to bring about behavioral change Use of mass
media as in NRHM - will it help in bring uniformity in messages of
health and ICDS workers ?
-
The goals for the Tenth Plan are to enhance early initiation of
breast-feeding (colostrum feeding) from the current level of 15.8
per cent (as per NFHS 2) to 50 per cent;enhance the exclusive
breast-feeding rate for children up to the age of six months from
the current rate of 55.2 per cent (as per NFHS 2) to 80 per
cent;enhance the complementary feeding rate at six months from the
current level of 33.5 percent (as per NFHS 2) to 75 per
cent.Available data from DLHS and BPNI surveys indicate that these
goals will not be achieved Operationalisation of this component
should get major attention during 11th Plan
-
Under nutrition in Preschool children Role of poverty and poor
caring practices Screening , early detection and effective
management can change the scenario
-
Source: NNMB reportsTime Trends in Energy intake and
undernutrition in children (1-3 years)Even though there is no
increase in energy intake over time there has been a decline in
severe undernutrition perhaps because of better access to health
care
Chart1
83437
90826.6
77924.7
80722.5
72921
Energy intake
Severe Underweight(
-
Source: NFHS 1998-99 Nutritional Status of children by
IncomeUndernutrition rates among poor in Kerala are similar to
undernutrition rates among the rich in UP. Appropriate IYCF and
caring can lead to steep fall in undernutrition rates in
preschoolers
Chart4
124.72.5
1683.5
18126
26.51610
29.5219.9
30.1154.9
Low
Medium
High
Fig10
Andhra Pradesh31.5
Assam43.8
Bihar54.6
Gujarat41.1
Haryana41.6
Himachal Pradesh33.3
J&K50.3
Karnataka33.6
Kerala21.1
Madhya Pradesh52.8
Maharashtra39.2
Orissa42.9
Punjab39.6
Rajasthan52.9
Tamil Nadu23.2
Uttar Pradesh58.1
West Bengal36.5
Fig10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Figure 13: Interstate differences in birth order 3 and Above
Fig 14
LowMediumHigh
Kerala124.72.5
Tamil Nadu1683.5
Punjab18126
Orissa26.51610
Uttar Pradesh29.5219.9
Gujarat30.1154.9
Fig 14
000
000
000
000
000
000
Low
Medium
High
Figure 14: Nutritional Status of children by Income
Sheet3
Source: NFHS II
MBD00004039.xls
Chart1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Figure16: Distribution of Districts as per 1 or 2 IFA Tablets
regularly - Major States (RHS 1998-99)
Sheet1
Source: RCH Survey, Department of Family Welfare
Sheet1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Fig.8-Distribution of Districts as per 1 or 2 IFA Tablets
regularly - Major States
Sheet2
Sheet3
-
Mean Energy Consumption- NNMB 2000The gap between RDA and the
actual energy intake is greatest in preschool children and lowest
in adults Poor caring practices rather than poverty appear to be
the major factor for low energy intake in children
Age groupsMalesFemalesKcalsRDA% RDAKcalsRDA%
RDAPre-school889135765.5897135166.4School
Age1464192975.91409187675.1Adolescents2065244184.61670182391.6Adults2226242591.819231874102.6
-
Over years there has been a increase in the number of households
where adults are getting adequate food but children are not; this
confirms that poor child feeding and caring practices rather than
poverty is becoming the common cause of of undernutrition in
preschool child
Chart1
31.131
25.442.9
19.17.2
24.418.9
Source:NNMB
1975-80
1996-97
Percentage
Comparison of Energy Adequate Status of Preschool Chidren and
Adults
Intake
Nutrient Intake (CU/Day) By Community
Protein(g)Energy(kcal)Iron(mg)Vit.A(ug)
SC55.1212526361
ST49.8203624.3237
BC53.3209423.7291
Others56.2216925.6328
Landless A.L.51.7198923.6198
Other lab.47.9204224.7381
Ccultivators55.2220526.6362
Others54.4218723308
Status
% of 1-5 year Children with Severe Undernutrition
by Gomez Classification
State1975+1988+1996+
Kerala10.322
Tamil Nadu12.64.22.9
Karnataka14.38.36.2
Andhra pr.15.47.57.1
Maharashtra21.97.87.7
Gujarat13.81316.7
Orissa14.910.74.1
Pooled158.76.2
1975-801996-97
+ + +31.131
+ + -25.442.9
- - -19.17.2
Others24.418.9
Status
00000000
00000000
00000000
Kerala
Tamil Nadu
Karnataka
Andhra pr.
Maharashtra
Gujarat
Orissa
Pooled
percent
Sheet3
00
00
00
00
Fig.4.24
1975-80
1996-97
Percentage
Comparison of Energy Adequate Status of Preschool Chidren and
Adults - Distribution (%) of Households
Dietary
Intake
Adult
Male
Adult
Female
Preschool
Children
+ + +
Adequate
Adequate
Adequate
+ +
-
Adequate
Adequate
Inadequate
-
-
-
Inadequate
Inadequate
Inadequate
-
Over years there has been a decline in severe under nutrition (
weight for age and height for age) but not in wasting ( weight for
height). Health implications of wasting are not well documented
Does low wasting rate explain the South Asian paradox ?
Chart1
77.578.618.1
68.665.119.9
63.66316.7
62.457.718.5
60.149.322.5
53.45217.5
4745.515.5
underweight(
-
Energy Intake (INP) & Undernutrition among children (NFHS
II)Higher dietary intake will not lead to better child nutrition
unless infections are controlled
Chart1
27608.8
270020.7
261424.3
243116.5
242616.3
237516.2
234010.3
221117.6
21404.7
211520.8
211521.9
205525.5
187110.6
Kilo Calories
% Children (0-3 years) severely under weight as per NFHS-II
Kilocalories
% children
Sheet1
ENERGY INTAKE
StatesKilo Calories% Children (0-3 years) severely under weight
as per NFHS-II
Punjab#27608.8
Orissa*270020.7
Madhya Pradesh*261424.3
Karnataka*243116.5
West Bengal*242616.3
Gujarat*237516.2
Andhra Pradesh*234010.3
Maharashtra*221117.6
Kerala*21404.7
Rajasthan#211520.8
Uttar Pradesh*211521.9
Bihar#205525.5
Tamil Nadu*187110.6
Source: * NMB(1981-91) # Food & Nutrition Bureau
(1980-86)
NFHS (1992-93)
Source: * NMB(1981-91) # Food & Nutrition Bureau
(1980-86)
Sheet1
0
0
0
0
0
0
0
0
0
0
0
0
0
Kilo Calories
Kilocalories
Figure : Average Intake of Energy * NMB(1981-91) # FNB
(1980-86)
Sheet2
00
00
00
00
00
00
00
00
00
00
00
00
00
&A
Page &P
Kilo Calories
% Children (0-3 years) severely under weight as per NFHS-II
Kilocalories
% children
Energy Intake (*NMB 1981-91 # FNB 1980-86) & Undernutrition
among children (NFHS II)
Sheet3
- Source: NFHS 1998-99% of severe underweight(
-
Source: NFHS 1998-99 Nutritional Status of children by
Income
Chart4
124.72.5
1683.5
18126
26.51610
29.5219.9
30.1154.9
Low
Medium
High
Fig10
Andhra Pradesh31.5
Assam43.8
Bihar54.6
Gujarat41.1
Haryana41.6
Himachal Pradesh33.3
J&K50.3
Karnataka33.6
Kerala21.1
Madhya Pradesh52.8
Maharashtra39.2
Orissa42.9
Punjab39.6
Rajasthan52.9
Tamil Nadu23.2
Uttar Pradesh58.1
West Bengal36.5
Fig10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Figure 13: Interstate differences in birth order 3 and Above
Fig 14
LowMediumHigh
Kerala124.72.5
Tamil Nadu1683.5
Punjab18126
Orissa26.51610
Uttar Pradesh29.5219.9
Gujarat30.1154.9
Fig 14
000
000
000
000
000
000
Low
Medium
High
Figure 14: Nutritional Status of children by Income
Sheet3
Source: NFHS II
MBD00004039.xls
Chart1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Figure16: Distribution of Districts as per 1 or 2 IFA Tablets
regularly - Major States (RHS 1998-99)
Sheet1
Source: RCH Survey, Department of Family Welfare
Sheet1
47.826086956521.739130434813.04347826098.69565217398.6956521739
13.043478260947.826086956517.39130434788.695652173913.0434782609
06.97674418616.279069767437.209302325639.5348837209
36.842105263221.052631578910.526315789531.57894736840
5.882352941241.176470588217.647058823517.647058823517.6470588235
502516.66666666678.33333333330
4020151015
85.71428571437.14285714297.142857142900
11.111111111142.222222222222.22222222226.666666666717.7777777778
46.66666666673.3333333333202010
26.666666666750106.66666666676.6666666667
5.882352941217.647058823529.411764705941.17647058825.8823529412
3.3333333333013.33333333335033.3333333333
43.47826086964.34782608730.434782608717.39130434784.347826087
02.941176470633.823529411820.588235294142.6470588235
5.263157894742.105263157921.052631578915.789473684215.7894736842
TOP 20%
20-40%
40-60%
60-80%
80-100%
Fig.8-Distribution of Districts as per 1 or 2 IFA Tablets
regularly - Major States
Sheet2
Sheet3
-
Tenth Plan Goals
Reduce prevalence of
severe undernutrition in children in 0-6 age group by 50% Mild
and moderate under-nutrition from current level of 47% to 40%
Tenth Plan recommended strategies for reduction of
undernutrition have not been operationalised
Available data from DLHS show that there is no major reduction
in undernutrition since 1998-99.
BUTProjects in Orissa, WB ,MP has demonstrated that if the
suggested strategies are followed these goals are achievable with
in the existing constraints
-
Capacity building in ICDS: Tenth Plan enhancing the quality and
impact of ICDS substantially through training, supervision of the
ICDS personnel and improved community ownership of the
programme;concentrating on the improvement of the quality of care
and inter-sectoral coordination and strengthening nutrition action
by the health sector;creating nutrition awareness through IEC at
all levels (community, womens group, village-level workers, PRIs,
programme managers and policy makers at the state and central
levels); andestablishing a reliable monitoring and evaluation
mechanismYet to be operationalised; should receive priority
-
Convergence of services AWW can weigh neonates in home
deliveries and refer those requiring careadvise regarding exclusive
breast feeding and complementary feeding identify undernourished
pre-school children by weighing them at least once every three
months and give food on priority to them;act as depot holder for
ORS.assist in emergency referral
-
Convergence of services ANM willImmunize all infants, pregnant
women and children as per schedule.Screen children especially the
under nourished ones for health problems and manage/ refer those
with problems. AWW willAssist ANM in organizing immunization health
check ups in anganwadi;Assist ANM in administering massive dose
Vitamin A
-
Micronutrient deficiencies All effort for combating
anaemiaReview Vitamin A supplementation Universal access to iodised
salt
-
Anaemia is a major problem right from childhood; it worsen
during adolescence in girls Advent of pregnancy further aggravates
anaemia
Chart1
339.2507.8
2443285
33651.49.6
severe
moderate
mild
no anaemia
Group
Percentage
Prevalence of Anaemia (%){DLHS 2003}
Sheet1
prevalence of anaemia
severemoderatemildno anaemia
preschool children3.039.250.07.8
adolescent girls24.043.028.05.0
pregnant women3.036.051.49.6
Sheet1
0000
0000
0000
severe
moderate
mild
no anaemia
Group
Percentage
Prevalence of Anaemia (%)
Sheet2
Sheet3
-
Combating anaemia Promote breastfeeding, improve complementary
feeding Dietary diversification Double fortified salt Screen all
children where ever possible school health, hospitals OPDs Detect
and treat anaemia vigorously
- Vitamin A DeficiencyClinical Deficiency Marked
ReductionBlindness: 2% (1974) to 0.04% (1985)Bitot Spots: ICMR
(1969) 4.2% DWCD (1996) 0.21% NNMB: 2% (1996), 0.7% (1990 &
1997)Isolated Areas Bihar, UP (DNP-ICMR 01)Night Blindness (
-
Coverage Under Massive dose of Vitamin ACoverage can be improved
-Orissa, UP But overall coverage remains low
-
Prevalence of Bitot spot has declined Is this the right time to
review the massive dose vitamin A programme ?
Chart8
0.70.110.11
0.70.080.08
0.80.20.2
WHO cut - off level (0.5%) of Public Health significance
Percent
Prevalence (%) of Bitot Spots among 1-
-
Huge installed capacity for producing iodised salt This is under
utilised. We supply iodised salt to other countries who attain high
rates of iodised salt use
Chart1
0.210.39
0.230.63
0.340.89
0.731.61
1.484.23
2.174.5
2.274.87
2.465.79
2.846.28
2.766.53
2.856.57
2.987.5
3.77.99
4.18.73
4.0410.75
3.9711.52
4.4312.88
4.6913.92
Source:Salt Department
Production
Capacity
Million Tonnes
Progress of iodised salt production in India
Prod.&Capacity
Table X
Progress of NIDDCP at a glance as per the records of Salt
Department
(in lakh tonnes)
YearNo. of Iodisation
UnitsCapacityRequirementsProductionSuppliesState/UT banned
FullPartial
1983133.869.162.131.4174
198611516.0811.277.275.98106
198935348.7127.2422.7421.34176
199252965.3329.6227.1326.87226
199351965.6733.3128.2327.23245
199457275.0435.8429.4528.01254
199565782.3342.8136.9634.88272
199669987.2851.7040.9540.92272
1997784107.5052.0040.4139.07292
1998809*115.21*52.0039.7037.42292
2000926143.4846.89
*As on 31st March, 1998
Source: National Consultation on 'Benefits and Safety of Iodised
Salt,
Salt Department, Government of India, Jaipur
YearProductionCapacity
19830.210.39
19840.230.63
19850.340.89
19860.731.61
19871.484.23
19882.174.50
19892.274.87
19902.465.79
19912.846.28
19922.766.53
19932.856.57
19942.987.50
19953.77.99
19964.18.73
19974.0410.75
19983.9711.52
19994.4312.88
20004.6913.92
Prod.&Capacity
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Production
Capacity
Year
Million Tonnes
Progress of iodised salt production in India
Manufact
Number of iodised salt manufacturers in the Country
YearNo. of Units
198415
198543
1986115
1987285
1988327
1989373
1990439
1991497
1992517
1993552
1994593
1995650
Manufact
0
0
0
0
0
0
0
0
0
0
0
0
Source: Evaluation of Universal Salt Iodisation in India, Salt
Deptt., Min. of Industry, Govt. of India
No. of Units
Fig.11-No. of Iodized Salt Manufacturers in the Country
Price
Table XII
PDS Selling Price and Retail Price of Salt
Sl.No.Name of StatePDS Selling Price in Rs.per kgRetail Price
during Dec., 2000 inRs./kg
1.Andhra PradeshN.A.3.00 loose 6.50 packed
2.Arunachal Pradesh2.602.35 loose
3.Assam2.00 powdered 3.00 packed1.99-2.07 loose 2.05-3.15
packed
4.Bihar6.50 packed
5.Goa4.00 loose 6.00 packed
6.Gujarat0.50 (Rs.1.82 subsidy comp.)
7.HaryanaN.A.
8.Himachal Pradesh7.00 packed
9.Jammu & KashmirN.A.
10.Kerala2.25 crystal salt 4.65 free flow
11.Maharashtra2.90 DPAP areas 1.65 TTDP areas
12.
13.MeghalayaN.A.3-3.50 loose 5-7 packed
14.MizoramN.A.N.A.
15.Orissa2.00
16.Rajasthan3.256.00 packed
17.SikkimN.A.
18.Tamil Nadu2.50
19.Tripura1.903-3.50 loose 5-6 packed
20.West BengalN.A.2.50 packed
21.Delhi2.50 3.50 ref. free flow6.00 packed
22.Lakshadweep2.50
23.PondicherryN.A.6.50 loose/packed
Supplies
Table XI
POPULATION, REQUIREMENT & SUPPLIES OF EDIBLE SALT - 2000
RequirementSupplies
Sl.No.Name of StateProv. Popn. as@5 kgs induring 2000
per 2001 Census000 tonnesin '000 tonnes
(Salt Comm.)
INDIA1,027,015,2475135.15221.2
1Andhra Pradesh75,727,541378.6523.6@
2Arunachal Pradesh1,091,1175.54.5
3Assam26,638,407133.2192.1
4Bihar82,878,796414.4671.0
5Jharkhand26,909,428134.5
6Goa1,343,9986.71.0
7Gujarat50,596,992253.0206.4
8Haryana21,082,989105.414.5
9Himachal Pradesh6,077,24830.44.8
10Jammu & Kashmir10,069,91750.334.0
11Karnataka52,733,958263.7115.3
12Kerala31,838,619159.2274.2@
13Madhya Pradesh60,385,118301.9336.3
14Chhatisgarh20,795,956104.0
15Maharashtra96,752,247483.8492.7@
16Manipur2,388,63411.9
17Meghalaya2,306,06911.5
18Mizoram891,0584.54.7
19Nagaland1,988,6369.910.8
20Orissa36,706,920183.5203.7
21Punjab24,289,296121.459.4
22Rajasthan56,473,122282.443.3
23Sikkim540,4932.74.7
24Tamil Nadu62,110,839310.6193.9
25Tripura3,191,16816.019.8
26Uttar Pradesh166,052,859830.3930.3
27Uttaranchal8,479,56242.4
28West Bengal80,221,171401.1654.5
29Andaman & Nicobar Islands *356,2651.80.6
30Chandigarh900,9144.527.4
31Dadra & Nagar Haveli220,4511.1
32Daman & Diu158,0590.80.1
33Delhi13,782,97668.9189.2
34Lakshadweep60,5950.3
35Pondicherry973,8294.91.4
36Defence7.0
@ Non iodised salt: 675.6
Iodised salt : 4545.6
Total 5221.2
cost
Cost of Iodisation
% Distribution of various components
Raw salt14
Crushing2
Chemical2
Labour5
Pouches&bags22
Manufacturer's margin&Wastage6
Wholesaler's margin8
Rail Tpt.23
Retailer's margin18
cost
0
0
0
0
0
0
0
0
0
Source: Salt Department
Fig.15
Packings
Packings used by Wholesalers for Distribution of Iodised
Salt
Bulk69
Retail19
Bulk&Ret12
Packings
0
0
0
Fig.13
Source: Salt Department
Transport
Transportation of Iodised Salt
By Rail24.7
By Road22
By Rl.&Rd.53.4
Transport
0
0
0
Source: Salt Department
Fig.12
Storage
Storage of Iodised Salt by Manufacturers
Open Space39.7
Open Sp cvrd with polythene sheets8.2
Cvrd Godown52
Storage
0
0
0
Fig.14
Source: Salt Department
-
Many coastal , salt manufacturing states with good health
indices have low iodised salt use. Prevalence of goitre in these
non endemic states is relatively high
Chart1
0.6
0
1.9
3.8
12.2
4.3
0.1
9
3.9
Source: NNMB 2002
Percentage
Prevalence of goitre (children 6-12yrs)
Sheet1
Prevalence (%) of Goitre in 6-
-
There was a decline in household access to iodised salt after
the ban on sale of non- iodised salt was lifted Reimposition of ban
is under way
-
Tenth Plan strategy Promotion of appropriate dietary intake and
lifestyles for the prevention and management of obesity and
diet-related chronic diseases
Nutrition monitoring and surveillance to enable the country to
track changes in the nutritional and health status of the
population to ensure that:
existing opportunities for improving nutritional status are
fully utilized; andemerging problems are identified early and
corrected expeditiously.
-
Tenth Plan strategy Research efforts to be directed towards:
review of the recommended dietary intake of Indians;building up
of epidemiological data on: relationship between birth weight,
survival, growth and development in childhood and adolescence;body
mass index norms of Indians and health consequences of deviation
from these norms.
-
NORMAL CHILDWASTED CHILDSHORT CHILDSHORT AND WASTED CHILD
-
A NORMAL CHILDB TALL & SLIM CHILDA & B have same
bodyweight. B should get more food to reach appropriate weight for
his height and continue linear growth
-
A NORMAL CHILD B SHORT FAT CHILD A & B have same weight. B
is short and requires more exercise to get to appropriate weight
for his height .
-
BMI is the most widely used parameter for assessment of
nutritional status in adults but is not used as an index to assess
nutritional status in childhood and adolescence.This is perhaps
because computation of BMI for age in growing children appears
complicated
-
Chart3
2969812
029053
(+3)SD
Percentage
Nutritional status of public school children using BMI-for-age
and weight-for-age (NFI, 2000)
BOYS
BOYS(HEIGHT FOR AGE)
AGEHIG BoysNCHS
6+121118.686.24
7+128.00123.085.37
8+132.50130.235.22
9+139.00134.936.35
10+142.70140.366.38
11+147.05145.886.44
12+154.50152.759.52
13+161.90159.767.21
14+165.40165.428.33
15+177.00172.985.02
16+172.80174.606.64
BOYS(WEIGHT FOR AGE)
AGEHIG BoysNCHS
6+2221.65
7+23.0023.42
8+29.7027.04
9+35.8029.82
10+33.8533.32
11+36.7037.12
12+44.9042.05
13+52.9547.80
14+55.6053.08
15+69.0061.38
16+61.5063.70
BOYS (BMI FOR AGE)
AGEHIG BoysNCHS
6+15.0115.37
7+15.3315.5
8+16.2715.94
9+17.9416.37
10+16.8216.9
11+17.1717.43
12+18.6918.01
13+20.0718.7
14+20.4319.39
15+21.8020.5
16+21.3020.89
BOYSMEAN SDSuprailliac (mm)Sum of 4 SFT(mm)WC (cm)HC
(cm)WHRImpedence
Age (years)Sample Size (n)Age (years)Height (cm)Weight (Kg)BMI
(Kg/m2)MUAC (cm)Tricep (mm)Bicep (mm)Subscapular
(mm)8.205.0332.3916.0254.345.9862.755.820.87-
6+416.050.03122.116.2423.545.1915.652.3719.335.8410.004.666.543.237.653.786.903.5628.8911.1245.6914.7652.4717.260.87775.000.00
7+237.030.02126.355.3724.303.5615.191.7518.442.169.373.606.172.766.442.288.175.0733.4715.2358.632.7869.122.530.85700.0068.91
8+318.080.03133.235.2230.085.8416.852.4320.643.3210.574.376.675.408.053.6712.066.9945.0619.3462.703.2673.432.760.85702.0066.42
9+619.060.04138.436.3535.317.1618.322.9722.793.1713.524.668.033.1411.465.6511.667.0341.7122.2261.353.5771.432.880.86697.0085.78
10+6410.060.04142.536.3835.367.9617.272.9822.513.5912.375.807.263.7010.426.4111.208.0443.1623.7764.454.1075.003.620.86692.0063.83
11+3211.050.04147.516.4438.839.1817.733.5023.164.0713.135.787.684.0111.167.0614.118.8248.3426.6268.083.5380.702.970.84657.0081.22
12+3012.050.04156.009.5246.8110.1319.103.0824.493.5713.476.448.064.1212.708.6715.348.9547.9125.4869.983.6984.253.230.83599.0091.32
13+4013.060.04162.847.2153.5510.2320.103.0825.273.4513.426.597.323.6011.847.5817.458.4556.4827.2272.984.1187.683.900.83617.0066.08
14+3914.050.03165.838.3357.9511.8521.023.6726.723.2216.057.679.374.9713.617.3013.902.8.43.608.5773.452.5692.883.230.79549.0052.02
15+415.100.01177.635.0269.1310.4421.913.2428.502.0813.353.096.351.2810.002.8915.489.4251.4827.0876.054.6291.433.350.83580.00115.73
16+39
BOYSGIRLS
Age (years)Sample Size (n)Height (cm)Weight (Kg)BMI (Kg/m2)Age
(years)Sample Size (n)Height (cm)Weight (Kg)BMI (Kg/m2)
6+41122.116.2423.545.1915.652.376+36120.015.8823.404.4116.202.58
7+23126.355.3724.303.5615.191.757+19125.335.6725.016.2715.792.99
8+31133.235.2230.085.8416.852.438+7130.906.7529.915.0117.392.26
9+61138.436.3535.317.1618.322.979+15138.618.3633.137.6917.122.68
10+64142.536.3835.367.9617.272.9810+52145.277.4337.668.0917.732.82
11+32147.516.4438.839.1817.733.5011+8152.964.1543.246.2418.492.74
12+30156.009.5246.8110.1319.103.0812+31154.736.7847.488.8519.752.92
13+40162.847.2153.5510.2320.103.0813+54157.575.0649.378.9419.833.13
14+39165.838.3357.9511.8521.023.6714+26158.165.5548.747.3419.482.75
15+4177.635.0269.1310.4421.913.2415+9160.975.7849.896.3519.201.71
BOYS
Age (years)Sample Size (n)Subscapular (mm)Suprailliac (mm)Sum of
4 SFT(mm)
6+417.653.788.205.0332.3916.02
7+236.442.286.903.5628.8911.12
8+318.053.678.175.0733.4715.23
9+6111.465.6512.066.9945.0619.34
10+6410.426.4111.667.0341.7122.22
11+3211.167.0611.208.0443.1623.77
12+3012.708.6714.118.8248.3426.62
13+4011.847.5815.348.9547.9125.48
14+3913.617.3017.458.4556.4827.22
15+410.002.8913.902.8.43.608.57
16+3913.628.3015.489.4251.4827.08
Age wise mean values for waist circumference, hip circumference
and WHR in HIG boys (n=404)
Age (years)Sample Size (n)WC (cm)HC (cm)WHR
6+4154.345.9862.755.820.87
7+2345.6914.7652.4717.260.87
8+3158.632.7869.122.530.85
9+6162.703.2673.432.760.85
10+6461.353.5771.432.880.86
11+3264.454.1075.003.620.86
12+3068.083.5380.702.970.84
13+4069.983.6984.253.230.83
14+3972.984.1187.683.900.83
15+473.452.5692.883.230.79
16+3976.054.6291.433.350.83
6+413654.34 5.98
7+231945.69 14.76
8+31758.63 2.78
9+611562.70 3.26
10+645261.35 3.57
11+32864.45 4.10
12+303168.08 3.53
13+405469.98 3.69
14+392672.98 4.11
15+4973.45 2.56
16+392976.05 4.62
Table 6. Age wise mean values of Triceps and Biceps skinfolds in
boys and girls
BOYS (n=404)GIRLS (n=286)
Age (years)Sample Size (n)Tricep (mm)Bicep (mm)Sample Size
(n)Tricep (mm)Bicep (mm)
6+4110.004.666.543.233611.394.087.132.60
7+239.373.606.172.761911.314.276.381.97
8+3110.574.376.675.40714.735.779.544.45
9+6113.524.668.033.141515.325.599.204.31
10+6412.375.807.263.705215.514.919.893.67
11+3213.135.787.684.01813.503.778.183.06
12+3013.476.448.064.123115.724.989.643.54
13+4013.426.597.323.605416.336.7310.464.78
14+3916.057.679.374.972616.675.909.903.58
15+413.353.096.351.28916.132.0210.332.93
16+3914.016.418.394.332920.695.1712.554.48
MEAN SD
GIRLSSample Size (n)Age (years)Height (cm)Weight (Kg)BMI
(Kg/m2)MUAC (cm)Tricep (mm)Bicep (mm)
Age
(years)366.050.03120.015.8823.404.4116.202.5818.692.3011.394.087.132.60
6+197.040.04125.335.6725.016.2715.792.9918.582.8511.314.276.381.97
7+78.040.02130.906.7529.915.0117.392.2621.473.2914.735.779.544.45
8+159.080.02138.618.3633.137.6917.122.6822.183.1815.325.599.204.31
9+5210.060.04145.277.4337.668.0917.732.8222.792.7915.514.919.893.67
10+811.080.04152.964.1543.246.2418.492.7422.871.8913.503.778.183.06
11+3112.060.04154.736.7847.488.8519.752.9224.282.4815.724.989.643.54
12+5413.050.04157.575.0649.378.9419.833.1323.863.5716.336.7310.464.78
13+2614.040.02158.165.5548.747.3419.482.7524.552.3316.675.909.903.58
14+915.080.04160.975.7849.896.3519.201.7124.591.2916.132.0210.332.93
15+2916.040.03160.476.3959.1812.2422.934.1327.163.1420.695.1712.554.48
16+
Table 3: Age wise Mean BMI values for Boys and Girls
Boys (n=404)Girls (n=286)
Age (years)Sample Size (n)BMI (Kg/m2)Sample Size (n)BMI
(Kg/m2)
6+4115.652.373616.202.58
7+2315.191.751915.792.99
8+3116.852.43717.392.26
9+6118.322.971517.122.68
10+6417.272.985217.732.82
11+3217.733.50818.492.74
12+3019.103.083119.752.92
13+4020.103.085419.833.13
14+3921.023.672619.482.75
15+421.913.24919.201.71
16+3921.643.242922.934.13
Table 5. Age wise Mean MUAC values for Boys and Girls
Boys (n=404)Girls (n=286)
Age (years)Sample Size (n)MUAC (cm)Sample Size (n)MUAC (cm)
6+4119.335.843618.692.30
7+2318.442.161918.582.85
8+3120.643.32721.473.29
9+6122.793.171522.183.18
10+6422.513.595222.792.79
11+3223.164.07822.871.89
12+3024.493.573124.282.48
13+4025.273.455423.863.57
14+3926.723.222624.552.33
15+428.502.08924.591.29
16+3927.593.682927.163.14
BoysGirls
6+19.3318.695.842.3
7+18.4418.582.162.85
8+20.6421.473.323.29
9+22.7922.183.173.18
10+22.5122.793.592.79
11+23.1622.874.071.89
12+24.4924.283.572.48
13+25.2723.863.453.57
14+26.7224.553.222.33
15+28.524.592.081.29
16+27.5927.163.683.14
BoysGirls
6+1011.394.664.08
7+9.3711.313.64.27
8+10.5714.734.375.77
9+13.5215.324.665.59
10+12.3715.515.84.91
11+13.1313.55.783.77
12+13.4715.726.444.98
13+13.4216.336.596.73
14+16.0516.677.675.9
15+13.3516.133.092.02
16+14.0120.696.415.17
BoysGirls
6+6.547.133.232.6
7+6.176.382.761.97
8+6.679.545.44.45
9+8.039.23.144.31
10+7.269.893.73.67
11+7.688.184.013.06
12+8.069.644.123.54
13+7.3210.463.64.78
14+9.379.94.973.58
15+6.3510.331.282.93
16+8.3912.554.334.48
Age (years)Impedence (ohms)
7+7750.00
8+70068.91
9+70266.42
10+69785.78
11+69263.83
12+65781.22
13+59991.32
14+61766.08
15+54952.02
16+580115.73
Age (years)Sample Size (n)Subscapular (mm)Suprailliac (mm)Sum of
4 SFT(mm)
6+417.653.788.205.0332.3916.02
7+236.442.286.903.5628.8911.12
8+318.053.678.175.0733.4715.23
9+6111.465.6512.066.9945.0619.34
10+6410.426.4111.667.0341.7122.22
11+3211.167.0611.208.0443.1623.77
12+3012.708.6714.118.8248.3426.62
13+4011.847.5815.348.9547.9125.48
14+3913.617.3017.458.4556.4827.22
15+410.002.8913.902.8.43.608.57
16+3913.628.3015.489.4251.4827.08
boys
Height (cm)Weight (Kg)BMI (Kg/m2)heightweightbmi
122.1123.5415.656.245.192.37
126.3524.315.195.373.561.75
133.2330.0816.855.225.842.43
138.4335.3118.326.357.162.97
142.5335.3617.276.387.962.98
147.5138.8317.736.449.183.5
156.0046.8119.109.5210.133.08
162.8453.5520.107.2110.233.08
165.8357.9521.028.3311.853.67
177.6369.1321.915.0210.443.24
girls13.52
Height (cm)Weight (Kg)BMI (Kg/m2)heightweightbmi
120.0123.4016.205.884.412.58
125.3325.0115.795.676.272.99
130.9029.9117.396.755.012.26
138.6133.1317.128.367.692.68
145.2737.6617.737.438.092.82
152.9643.2418.494.156.242.74
154.7347.4819.756.788.852.92
157.5749.3719.835.068.943.13
158.1648.7419.485.557.342.75
160.9749.8919.205.786.351.71
160.4759.1822.936.3912.244.13
BOYS
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
HEIGHT (cm)
Figure 3. Comparison of median heights of HIG boys with NCHS
median
GIRLS
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
WEIGHT (Kg)
Figure 1. Comparison of median weights of HIG boys with NCHS
median
Chart1
00
00
00
00
00
00
00
00
00
00
00
HIG Boys
NCHS
AGE (years)
BMI (Kg/m2)
Figure 5. Comparison of median BMI of HIG boys with NCHS
median
GRAPHS
005.845.842.32.3
002.162.162.852.85
003.323.323.293.29
003.173.173.183.18
003.593.592.792.79
004.074.071.891.89
003.573.572.482.48
003.453.453.573.57
003.223.222.332.33
002.082.081.291.29
003.683.683.143.14
Boys
Girls
Age (years)
MUAC (cm)
Age wise trend of MUAC (Mean SD) in HIG boys and girls
Prevalence 2
004.664.664.084.08
003.63.64.274.27
004.374.375.775.77
004.664.665.595.59
005.85.84.914.91
005.785.783.773.77
006.446.444.984.98
006.596.596.736.73
007.677.675.95.9
003.093.092.022.02
006.416.415.175.17
Boys
Girls
Age (years)
Triceps (mm)
Age wise trend of Triceps (Mean SD) in HIG boys and girls
Prevalence 1
003.233.232.62.6
002.762.761.971.97
005.45.44.454.45
003.143.144.314.31
003.73.73.673.67
004.014.013.063.06
004.124.123.543.54
003.63.64.784.78
004.974.973.583.58
001.281.282.932.93
004.334.334.484.48
Boys
Girls
Age (years)
Bicep (mm)
Age wise trend of Biceps (Mean SD) in HIG boys and girls
0
0
0
0
0
0
0
0
0
0
Impedence (ohms)
Age (years)
Impedance (ohms)
Figure 14. Impedence in HIG boys (n=100)
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (years)
Triceps (mm)
Figure 12. Age-wise trend of Triceps in HIG boys and girls
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (yrs)
Biceps (mm)
Figure 13. Age-wise trend of Biceps in HIG boys and girls
00
00
00
00
00
00
00
00
00
00
00
Boys
Girls
Age (years)
MUAC (cm)
Figure 11.Age-wise trend of MUAC IN HIG boys and girls
GIRLS(HEIGHT FOR AGE)
AGEHIG GirlsNCHS
6+120117.25
7+125.1126.72
8+130.70128.18
9+136.00136.43
10+144.85141.52
11+154.00149.38
12+155.50154.32
13+158.25158.76
14+159.50160.91
15+163162.20
16+161.50162.63
GIRLS(WEIGHT FOR AGE)
AGEHIG GirlsNCHS
6+22.920.48
7+24.225.03
8+30.5025.91
9+31.4031.26
10+36.6034.74
11+42.4040.05
12+48.1043.72
13+48.2048.02
14+46.4051.42
15+50.955.06
16+55.5056.24
GIRLS(BMI FOR AGE)
AGEHIG GirlsNCHS
6+15.9514.89
7+15.5315.59
8+17.7115.77
9+16.7616.79
10+17.8617.34
11+17.8517.94
12+19.1418.35
13+19.4519.05
14+19.0219.86
15+19.4320.93
16+22.0021.26
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
HEIGHT (cm)
Figure 4. Comparison of median heights of HIG girls with NCHS
median
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
WEIGHT (Kg)
Figure 2. Comparison of median weights of HIG girls with NCHS
median
00
00
00
00
00
00
00
00
00
00
00
HIG Girls
NCHS
AGE (years)
BMI (Kg/m2)
Figure 6. Comparison of median BMI of HIG girls with NCHS
median
19.4419.4447.2311.112.78
10.535.2657.921.055.26
028.5757.1414.290
6.6708013.330
01.9282.6915.390
0010000
6.45093.5500
3.75.5690.7400
0088.4611.540
0088.8911.110
10.3510.3579.300
(+3SD) and above
(+2SD) and above
(-2SD)-(+2SD)
(-2SD) and below
(-3SD) and below
WEIGHT FOR AGE
BMI FOR AGE
078.0512.29.8
095.74.350
090.329.70
086.911.51.2
3.1390.636.30
6.2587.56.250
093.36.70
2.5907.50
097.4202.56
010000
2.5687.1810.260
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 9. Frequency distribution for weight for age in HIG
boys
2.7877.7813.895.56
089.475.265.26
010000
093.36.670
080.7713.465.77
010000
090.326.453.23
094.443.71.85
010000
010000
086.213.4510.34
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 10. Frequency distribution for weight for age in HIG
girls
1.377.9212.997.79
092.864.762.38
092.17.90
088.1610.531.32
1.786.239.482.59
59050
091.86.561.64
1.0692.565.321.06
098.4601.54
010000
1.4786.767.354.42
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 8. Frequency distribution for weight for age in HIG
children (Boys+Girls)
7.7914.250.611.615.5
2.328.559.54.74.7
0076.37.813.1
07.87110.510.5
016.379.32.51.7
2.522.567.52.55
09.878.63.28.1
13.182.96.36.3
016.969.26.17.6
030.769.300
4.410.267.610.27.3
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 12. Frequency distribution of BMI for age in HIG (BOYS +
GIRLS)
11.916.752.44.811.9
034.860.94.30
0080.653.2316.12
06.5668.8513.1211.48
017.1976.553.133.13
3.1328.1359.383.136.23
02063.336.6710
2.57.572.57.510
020.5256.4210.2612.8
0752500
7.6917.9558.9710.265.13
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 13. Frequency distribution of BMI for age in HIG boys
2.7811.1147.2319.4419.44
5.2621.0557.95.2610.53
014.2957.1428.570
013.338006.67
015.3982.691.920
0010000
0093.5506.45
0090.745.563.7
011.5488.4600
011.1188.8900
0079.310.3510.35
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
Figure 14. Frequency distribution of BMI for age in HIG
girls
2221.65
2323.42
29.727.04
35.829.82
33.8533.32
36.737.12
44.942.05
52.9547.8
55.653.08
6961.38
61.563.7
HIG Boys
NCHS
AGE (years)
WEIGHT (Kg)
Figure 1. Comparison of median weights of HIG boys with NCHS
median
22.920.48
24.225.03
30.525.91
31.431.26
36.634.74
42.440.05
48.143.72
48.248.02
46.451.42
50.955.06
55.556.24
HIG Girls
NCHS
AGE (years)
WEIGHT (Kg)
Figure 2. Comparison of median weights of HIG girls with NCHS
median
121118.68
128123.08
132.5130.2325983871
139134.9335418033
142.7140.36
147.05145.88
154.5152.75
161.9159.76
165.4165.42
177172.98
172.8174.6
HIG Boys
NCHS
AGE (years)
HEIGHT (cm)
Figure 3. Comparison of median heights of HIG boys with NCHS
median
120117.25
125.1126.72
130.7128.18
136136.43
144.85141.52
154149.38
155.5154.32
158.25158.76
159.5160.91
163162.2
161.5162.63
HIG Girls
NCHS
AGE (years)
HEIGHT (cm)
Figure 4. Comparison of median heights of HIG girls with NCHS
median
15.0115.37
15.3315.5
16.2715.94
17.942386831316.37
16.822827412516.9
17.166520846817.43
18.69024147318.01
20.066040694618.7
20.428109783519.39
21.804767905920.5
21.320.89
HIG Boys
NCHS
AGE (years)
BMI (Kg/m2)
Figure 5. Comparison of median BMI of HIG boys with NCHS
median
15.9514.89
15.5315.59
17.714585397115.77
16.760380622816.79
17.864695981517.34
17.852234685117.94
19.14332587518.35
19.445604657219.05
19.023713307119.86
19.428972413520.93
21.999166840121.26
HIG Girls
NCHS
AGE (years)
BMI (Kg/m2)
Figure 6. Comparison of median BMI of HIG girls with NCHS
median
Normal
8
70
13
2
#REF!
Figure 11. Overall prevalence of overweight and obesity in HIG
children using BMI-for-age
19.3318.695.845.842.32.3
18.4418.582.162.162.852.85
20.6421.473.323.323.293.29
22.7922.183.173.173.183.18
22.5122.793.593.592.792.79
23.1622.874.074.071.891.89
24.4924.283.573.572.482.48
25.2723.863.453.453.573.57
26.7224.553.223.222.332.33
28.524.592.082.081.291.29
27.5927.163.683.683.143.14
Boys
Girls
Age (years)
MUAC (cm)
Age wise trend of MUAC (Mean SD) in HIG boys and girls
1011.394.664.664.084.08
9.3711.313.63.64.274.27
10.5714.734.374.375.775.77
13.5215.324.664.665.595.59
12.3715.515.85.84.914.91
13.1313.55.785.783.773.77
13.4715.726.446.444.984.98
13.4216.336.596.596.736.73
16.0516.677.677.675.95.9
13.3516.133.093.092.022.02
14.0120.696.416.415.175.17
Boys
Girls
Age (years)
Triceps (mm)
Age wise trend of Triceps (Mean SD) in HIG boys and girls
6.547.133.233.232.62.6
6.176.382.762.761.971.97
6.679.545.45.44.454.45
8.039.23.143.144.314.31
7.269.893.73.73.673.67
7.688.184.014.013.063.06
8.069.644.124.123.543.54
7.3210.463.63.64.784.78
9.379.94.974.973.583.58
6.3510.331.281.282.932.93
8.3912.554.334.334.484.48
Boys
Girls
Age (years)
Biceps (mm)
Age wise trend of Biceps (Mean SD) in HIG boys and girls
BOYS
PREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and
above(+3SD) and above
6+11.916.752.44.811.9
7+034.860.94.30
8+0080.653.2316.12
9+06.5668.8513.1211.48
10+017.1976.553.133.13
11+3.1328.1359.383.136.23
12+02063.336.6710
13+2.57.572.57.510
14+020.5256.4210.2612.8
15+0752500
16+7.6917.9558.9710.265.13
GIRLS
PREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and
above(+3SD) and above
6+2.7811.1147.2319.4419.44
7+5.2621.0557.95.2610.53
8+014.2957.1428.570
9+013.338006.67
10+015.3982.691.920
11+0010000
12+0093.5506.45
13+0090.745.563.7
14+011.5488.4600
15+011.1188.8900
16+0079.310.3510.35
OVERALLPREVALENCE(BMI FOR AGE)
AGE(-3SD) and below(-2SD) and below(-2SD)-(+2SD)(+2SD) and
above(+3SD) and above
6+7.7914.250.611.615.5
7+2.328.559.54.74.7
8+0076.37.813.1
9+07.87110.510.5
10+016.379.32.51.7
11+2.522.567.52.55
12+09.878.63.28.1
13+13.182.96.36.3
14+016.969.26.17.6
15+030.769.300
16+4.410.267.610.27.3
(+3)SD
BMI-for-age2137078
Weight-for-age018973
83
Normal7089
131
20
Boys (n=404)
Girls (n=286)
o
(+3)SD
BMI-for-age2969812
Weight-for-age029053
8 (3)
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION OF BMI FOR AGE IN PUBLIC SCHOOL BOYS
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQENCY DISTRIBUTION FOR BMI FOR AGE IN PUBLIC SCHOOL GIRLS
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
(-3SD) and below
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR BMI FOR AGE IN PUBLIC SCHOOL CHILDREN
(BOYS + GIRLS)
0
0
0
0
0
0
0
0
0
0
0
0
#REF!
Figure 11. Overall prevalence of overweight and obesity in HIG
children using BMI-for-age
00000
00000
(+3)SD
Nutritional status of public school children using BMI-for-age
and weight-for-age (NFI, 2004)
00000
00000
(+3)SD
Nutritional status of public school children using BMI-for-age
and weight-for-age (NFI, 2000)
BOYS
PREVALENCE(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and
above
6+078.0512.29.8
7+095.74.350
8+090.329.70
9+086.911.51.2
10+3.1390.636.30
11+6.2587.56.250
12+093.36.70
13+2.5907.50
14+097.4202.56
15+010000
16+2.5687.1810.260
GIRLS
PREVALENCE(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and
above
6+2.7877.7813.895.56
7+089.475.265.26
8+010000
9+093.36.670
10+080.7713.465.77
11+010000
12+090.326.453.23
13+094.443.71.85
14+010000
15+010000
16+086.213.4510.34
TRICEPS(BOYS)
AGETRICEPS (mm)WHO
9+12.811.2
10+10.611.6
11+13.112.2
12+11.912.9
13+12.813.7
14+14.414.5
15+13.615.2
16+12.416
overall(WT FOR AGE)
AGE(-2SD) and below(-2SD)-(+2SD)(+2SD) and above(+3SD) and
above
6+1.377.9212.997.79
7+092.864.762.38
8+092.17.90
9+088.1610.531.32
10+1.786.239.482.59
11+59050
12+091.86.561.64
13+1.0692.565.321.06
14+098.4601.54
15+010000
16+1.4786.767.354.42
00
00
00
00
00
00
00
00
(BOYS) TRICEPS (mm)
(BOYS) WHO
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL
BOYS
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL
GIRLS
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
0000
(-2SD) and below
(-2SD)-(+2SD)
(+2SD) and above
(+3SD) and above
AGE (years)
PERCENTAGE (%)
FREQUENCY DISTRIBUTION FOR WEIGHT FOR AGE IN PUBLIC SCHOOL
CHILDREN (BOYS + GIRLS)
-
Weight for age and BMI for ageBMI which takes into account the
current height while assessing the nutritional status is a
sensitive index for detection of under and over nutrition in
children.It worth while to put in the additional effort to compute
BMI for age to assess nutritional status in children &
adolescents because it will enable early detection of both under
and over nutrition and appropriate management so that these
children grow into healthy adults.
-
Indices to be monitoredRationale for monitoringassess progress,
identify problems and take mid course correction Process indicators
are to be monitored as per the NRHM/ICDS formats. In addition 100%
Civil registration- reconciled at village level Births- check with
No of pregnant women Deaths- assess MMR, neonatal, infant and child
mortality rates Monitor- infant and child feeding
practicesUnder-nutrition rates in children reconcile with the DLHS
data after converting data to IAP classification
