Ch 3 public nutrition and health

• What is public health? And it's mission

  Collective action taken by society to protect and promote the health of the whole population.

  Its mission is to prevent both over nutrition and under nutrition and to maintain optimal nutritional status of the population.
• Significance

  Malnutrition is the underlying cause of at least 50% deaths of children under 5 years of age.

  Almost 1/5 of infants born in India are low birth weight, weigh less than 250g or 2.5kg

  Widespread prevalence of growth retardation among preschoolers

  Prevalence of micronutrient deficiencies (hidden hunger)

  Large number of people altered their dietary patterns and lifestyle with less physical activity And unhealthy food

  these can have negative impact on the productivity and quality of life
• India is set to face the double Burden of malnutrition the existence of both under nutrition and over nutrition.
• What is public health nutrition

  Promotion of good health through prevention of nutrition related illness/problems in the population and the government policies and programs that are aimed at solving these problems.
• Community

  Specific group of people who share common characteristics example language conditions lifestyle etc
• Malnutrition includes both under nutrition and Over nutrition.
• Public health nutrition is a science and an art, as an art to convince someone. As a science, it uses nutritional values.
• Nutritional problems faced by india (PEM)


  Found in every society

  It Is caused by insufficient intake of Macro nutrients energy and protein

  It is assessed by evaluating the anthropometric measures weight height head-chests circumference etc

  Severe undernutrition due to deficiency of food and energy is termed as merasmus.

  Undernutrition caused by protein deficiency is termed as kwashiorkor
• Symptoms of PEM

  Pigeon chest

  Hair will be rough and orangish

  Head will be big but the body will shrink.
• Underweight 


  When body weight is less than adequate for age(w<a)
• Stunting 


  When height is less than adequate for age(h<a)
• Wasting


  When weight is not adequate to height.(w=h)
• Micronutrient deficiencies


  Also called hidden hunger

  Zinc defficiency causes itching

  Lack of ion causes iron deficiency anemia (IDA)

  Lack of iodine causes iodine deficiency disorder (IDD)

  Lack of Vitamin A causes Vitamin A deficiency. (VAD)
• IDA iron deficiency anemia 


  Most common nutritional disorder in the world

  Vulnerable groups include women in childbearing age adolescent girls pregnant women and school age children

  It results in low levels of hemoglobin in blood.

  Hemoglobin is required for carrying oxygen in the body.

  Functions of iron includes cognitive function such as attention span, memory, concentration.
• IDA symptoms

  Fall In hemoglobin levels

  Shortness of breath due to fall in oxygen finding capacity

  Low concentration

  Decreased memory and attention span

  Feel sleepy and tired or lethargic

  Tongue has white patches and dull appearance

  Look Pale

  Brittle nails

  Paleness of conjectava
• VAD vitamin a deficiency 


  Vitamin is required for maintaining healthy skin, Normal vision, Growth and immunity.

  It results in night blindness which progresses to complete blindness if not taken care

  It is irreversible for children below the age of 12.

  There is a vicious cycle between vitamin a deficiency and infection.

  
• IDA Iodine deficiency disorder

  Function of iodine: normal mental and physical growth and development

  It occurs largely due to deficiency Of iodine in the soil

  It results in insufficient amount of thyroid hormones synthesized by the thyroid gland

  Enlarged thyroid known as goitre

  In children it manifest as cretinism

  During pregnancy results in mental retardation and congenital abnormalities of the fetus and is irreversible
• PHOSHAN abhiyaan

  *Launched in rajasthan in march 2018

  *Target's stunting, under nutrition, anemia and low birth rate

  *The ministry of women and child development (MWCD) is implementing this in 315 districts in the first year 235 districts in the second year and remaining districts will be covered in the Third Year
• Short term interventions 


  (ICDS) integrated child development services:

  Covered children 026 years as well as pregnant and lactating women

  Fortification of essential foods:

  Add nutrients to regular foods like iodized salt

  Production and popularization of low cost nutritious foods:

  Lowing cost but high in nutrition and basic ingredients

  Supplements:

  Will either be free of cost or negligible amount.

  Short strategies are Direct
• Long term strategies are indirect 


  1 Ensuring food security by Improving availability of Food

  2 Improving Dietary patterns , by ensuring availability of nutritionally rich foods.

  3 Poverty elevation through employment generation schemes and public distribution systems.
• Diet or food based strategies 


  They are preventive and comprehensive strategies that use food as a tool to overcome nutritional deficiencies
• Advantage of foodbase strategies

  Sustainable

  Long term benefits

  Cost effective

  Adaptable

  Do not carry risk of overdose or toxicity.
• Nutrient Based or medicinal approach

  Nutrients supplements are given to vulnerable groups.

  It is a short-term strategy particularly used for Vitamin a, iron, and folic acid.

  It's long-term goal is to shift from supplementation towards food based approach.
• Disadvantage of medicinal approach.

  Expensive

  Problems in coverage

  Risk of overdose.

  Different target groups for various nutrients.
• nutritional programs Operating in our country

  * ICDS - It is an programme for pregnant & nursing mothers & infants & young children upto 6 years

  * Nutrient deficiency Control programme - National Prophylaxis Programme, National Nutritional Anemia Prophylaxis programme , National Iodine deficiency Disorder Control Programme

  * Food Supplementation Programmes like mid-day meal programmes

  * food Security Programmes - Public distribution system , Antodya Anna Yojana, Annapura schemes, Nutritional food for work Programme

  * Self-employment & Wage employment schemes
• health care

  health is a fundamental human right

  Primary - 1st level of contact with health system (Primary heath centres - PHCS )

  Secondary - more complex problems are resolved in secondary level through district hospitals & Community Centres.

  Tertiary - is the 3rd & highest level it deals with more complex problems that can not be dealt at the other 2 levels. Medical college hospitals, regional hospitals etc
• Public nutritionist is also called community nutritionist.
• Career avenues

  Consultants

  Nutritionist/counselor for schools , industries etc

  Teaching & academics

  Research

  Nutritionist in voluntary organisations