MALNUTRITION 1
MALNUTRITION OBJECTIVES: At the end of the lecture students should be able to: Define and classify malnutrition Enumerate causes and effects of malnutrition Identify strategies for prevention of malnutrition 2
MALNUTRITION: INTRODUCTION Malnutrition essentially means bad nourishment. It concerns not enough as well as too much food, the wrong types of food, or the inability to use nutrients properly to maintain health. The World Health Organization cites malnutrition as the greatest single threat to the world's public health. Malnutrition in all its forms is a considerable public health concern and is associated with increases risk of disease and early death. 4
MALNUTRITION: : INTRODUCTION In 2006, more than 36 million people died of hunger or diseases due to deficiencies in micronutrients; accounted for 58% of the total mortality in the same year. Under nutrition contributes to almost 35% of the estimated 7.6 million deaths under-5 deaths; consequently affecting the future health and socioeconomic development and productive potential of the society. The malnourished are unable to live a normal life, are less likely to fulfill their potential as human beings and cannot contribute fully to the development of their own countries. 5
MALNUTRITION The World Health Organization defines malnutrition as "the cellular imbalance between supply of nutrients & energy and the body's demand for them to ensure growth, maintenance, and specific functions. Malnutrition comprises both; 1. Under nutrition 2. Over nutrition 6
TYPES OF MALNUTRITION Under nutrition is depletion of energy (calories) resulting form insufficient food intake over an extended period of time. In extreme cases under-nutrition is called Starvation. While Famine is severe food shortage of a whole community. Specific Deficiency is the pathological state resulting form a deficiency of an individual nutrient such as vitamin A deficiency, iodine deficiency. 7
TYPES OF MALNUTRITION Over nutrition: Many tend to think malnutrition only in terms of hunger, however, overeating is also a contributing factor. Over nutrition is the pathological state resulting from the consumption of excessive quantity of food over an extended period of time. Overweight and obesity are very common conditions in developed society and are becoming more common in developing societies and those in transition. 8
NUTRITIONAL DEFICIENCY DISEASES On global scale the five principal nutritional deficiency diseases are: 1. Kwashiorkor 2. Marasmus 3. Xerophthalmia 4. Nutritional anemia 5. Endemic goiter 9
MALNUTRITION IN CHILDREN: PROTEIN-ENERGY MALNUTRITION In children, protein energy malnutrition is defined by measurements that fall below 2 standard deviations under the normal weight for age (underweight), height for age (stunting) and weight for height (wasting). Protein energy malnutrition usually manifests early, in children between 6 months and 2 years of age and is associated with early weaning, delayed introduction of complementary foods, a low-protein diet and severe or frequent infections. 10
TYPES OF UNDERNUTRITION UNDERNUTRITION ACUTE UNDERNUTRITION CHRONIC UNDERNUTRITION Marasmus kwashiorkor Marasmickwashiorkor Wasting Stunting Underweight
PROTEIN-ENERGY MALNUTRITION 13
KWASHIORKOR MARASMUS 14
MANIFESTATIONS OF MALNUTRITION 15
MANIFESTATIONS OF UNERNUTRITION Under nutrition results in the loss of body weight. The loss of weight is a manifestation of energy depletion. Malnutrition from any cause retards normal growth. Malnourished children grow up with worse health and lower educational achievements. Decrease in immunity increases the susceptibility to infections such as T.B, which add to the morbidity and mortality. Malnutrition is also associated with lowered vitality of the people leading to lowered productivity and reduced life expectancy. 16
MANIFESTATIONS OF OVERNUTRITION In the more developed countries of the world, over nutrition is encountered much more frequently than under nutrition. The health hazards from over nutrition are: 1. Obesity, 2. Diabetes, 3. Hypertension, 4. Cardiovascular diseases, 5. Renal diseases, 6. Disorders of liver and gall bladder. 17
GLOBAL BURDEN OF MALNUTRITION Despite the fact that the world already produces enough food to feed everyone 6 billion people and could feed the double 12 billion people. There were 925 million undernourished people in the world in 2010, an increase of 80 million since 1990. Nearly 17% of people in the developing world are undernourished. 18
Percentage Population Undernourished World Map 19
GLOBAL BURDEN OF MALNUTRITION 1 out of 3 people in developing countries are affected by vitamin and mineral deficiencies and therefore more subject to infection, birth defects and impaired physical and psychointellectual development. Under nutrition, an important part of the complex, affects millions of people, mainly in Africa, Asia and Latin America. 20
SCOPE OF THE PROBLEM Directly or indirectly the concurrent vicious life cycle of malnutrition contributes to almost 35% of the estimated 7.6 million deaths under-5 deaths; consequently affecting the future health and socioeconomic development and productive potential of the society. South Asia is the worst affected region with half of the world s malnourished children are to be found in just 3 countries Bangladesh, India and Pakistan. 21
Malnutrition Contributing to U 5 Mortality, 2008 (percent)
GLOBAL BURDEN OF MALNUTRITION This is one side of picture. 2 out of 3 overweight and obese people now live in developed countries, the vast majority in emerging markets and transition economies. By 2010, more obese people will live in developing countries than in the developed world. Under-and over-nutrition problems and diet-related chronic diseases account for more than half of the world's diseases and hundreds of millions of dollars in public expenditure. 23
PEOPLE AT RISK Protein-energy malnutrition (PEM) occurs more commonly in three situations: 1. In young children in poor communities, usually in developing countries. 2. In adults, even in affluent countries, due to severe illness (hospital malnutrition). 3. In people of all ages in a famine. 24
PEOPLE AT RISK Although the under nutrition affects all age groups; however the most vulnerable groups are pregnant women, lactating women and young children, mainly because they have a relatively greater nutritional requirements and are more susceptible to the harmful consequences of deficiencies. Under nutrition affects all age groups, but it is especially common among the poor and those with inadequate access to health education and to clean water and good sanitation. 25
DETERMINANTS OF MALNUTRITION 26
INFECTION AND MALNUTRITION Malnutrition is primarily due to: 1. An inadequate intake of food (food gap) both in quantity and quality. 2. Infections, particularly diarrhea, measles, intestinal worms and respiratory infections. In fact it is a vicious circle Infections make malnutrition worse and poor nutrition increases the severity of infectious diseases. 27
MALNUTRITION CYCLE Inadequate dietary intake Appetite loss Nutrient loss Malabsorption Altered metabolism Weight loss Growth flattering Decreased immunity Mucosal damage Disease: increase in incidence, duration, severity 28
DETERMINANATS OF MALNUTRITION 29
PREVENTION OF MALNUTRITION 30
PREVENTION OF MALNUTRITION Since malnutrition is the outcome of several factors, it requires a coordinated approach of many disciplines at various levels; 1. Family 2. Community 3. National 4. International 31
ACTION AT FAMILY LEVEL The principal target of nutritional improvement in the community is family. The instrument for combating malnutrition at the family level is Nutrition Education. The community health workers can play an important role in nutrition education to the families in their respective areas. 32
ACTION AT FAMILY LEVEL Nutrition education should educated family on : 1. Selection of right kind of local foods. 2. Planning of nutritionally adequate diets within limits of their purchasing power. 3. Identification and correction of harmful food taboos & dietary prejudice. 4. Promotion of breast feeding and adequate infant & child feeding. 5. Consider the nutritional needs of expectant & nursing mothers and children in the family. 6. Planning a kitchen garden or keeping poultry. 33
ACTION AT COMMUNITY LEVEL The solutions to malnutrition can be assisted by governments, but in the end communities will often have the leading role in reducing malnutrition and promoting social development. People's participation is essential. It is necessary to recognize that the poor will be the principal actors in their own development and to foster policies and programs that empower the underprivileged. Empowerment and participation of women are particularly important, because women have the most important role in food security (and often in food production), in child care and in family health. 34
ACTION AT NATIONAL LEVEL The burden of improving the nutritional status of the people, by and large, is the responsibility of the State. Prevalent malnutrition in a country is clear evidence of poor development. Several approaches and strategies at the national level, suggested by FAO/WHO are as follow: 1. Rural development 2. Increase agricultural production, distribution and storage 3. Stabilization of population 4. Nutrition related health services 35
ACTION AT THE INTERNATIONAL LEVEL Food and nutrition are global problems, and international cooperation can play an important role in reducing the nutrition problems worldwide. The multilateral World Food Program was established in 1963 as a mean of providing enough safe food to those in need and to come to the aid of victims in acute emergencies caused by floods, earth quick, droughts, wars, etc. In September 2000, the United Nations Millennium Declaration was endorsed by 190 countries and was translated into eight Millennium Development Goals (MDGs) to be achieved by 2015. 36
MILLENNIUM DEVELOPMENT GOAL 1 Health Targets Health Indicators Goal 1: Eradicate extreme poverty and hunger Target 1: Halve, between 1990 and 2015, the proportion of people who live below poverty line The proportion of people whose income is less than one dollar a day. Target 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger Prevalence of underweight children under five years of age Proportion of population below minimum level of dietary energy consumption 37
CONCLUSION Under nutrition and malnutrition are widespread problem of poverty and deprivation that affects millions of people, perhaps the majority, in developing countries. The poor, the hungry and the malnourished are unable to live a normal life, are less likely to fulfill their potential as human beings and cannot contribute fully to the development of their own countries. Political actions, more than political will, to implement well conceived policies and programs at the national level, while simultaneously acting internationally, can serve to greatly reduce nutrition problems worldwide. 38
REFERENCES K. Park. Park s Textbook Of Preventive And Social Medicine. 20 th Edition. 2009. 39
THE ORANGE RIBBON AN AWARENESS RIBBON FOR MALNUTRITION 40