WOMEN AND CHILD HEALTH A REJIG OF POLICIES REQUIRED.

WOMEN AND CHILD WOMEN AND CHILD HEALTHHEALTH

A REJIG OF POLICIES A REJIG OF POLICIES REQUIREDREQUIRED

Dr Harshindar Kaur ,M.D. (Paediatrics )Dr Harshindar Kaur ,M.D. (Paediatrics )

Deputy Medical SuperintendentDeputy Medical Superintendent

Govt. Medical College and Rajindra Govt. Medical College and Rajindra Hospital , Patiala (Punjab )Hospital , Patiala (Punjab )

[email protected]@yahoo.com

PRESENT SITUATION IN PRESENT SITUATION IN INDIAINDIA• More than a third of wasted children of world in More than a third of wasted children of world in

India.India.• 20 % of children less than 5 years suffer from 20 % of children less than 5 years suffer from

acute malnutrition .acute malnutrition .• 48 % children have stunted growth.48 % children have stunted growth.• Under nutrition more in rural areas ,illiterate and Under nutrition more in rural areas ,illiterate and

undernourished mothers.undernourished mothers.• Highest no. of LBW babies in world ( 7.4 Million Highest no. of LBW babies in world ( 7.4 Million

every Year )every Year )• Only 46 % of children <6 months are breastfed.Only 46 % of children <6 months are breastfed.• 70 % of children < 5 Years are anemic .70 % of children < 5 Years are anemic .

• <<50 % households use iodized salt .50 % households use iodized salt .

• 200 Million women are in reproductive age 200 Million women are in reproductive age group –benefits of Green Revolution not group –benefits of Green Revolution not transformed into better maternal and child transformed into better maternal and child health.health.

• MMR in India,300-1000/100,000 live births MMR in India,300-1000/100,000 live births accounts for 45 % of maternal deaths of world. accounts for 45 % of maternal deaths of world. In developed world it is 2 /100,000 live births.In developed world it is 2 /100,000 live births.

• Out of 30 years of reproductive lifespan of Out of 30 years of reproductive lifespan of average Indian female 16 years spent in average Indian female 16 years spent in pregnancy and lactation .pregnancy and lactation .

INDIA -14% of population is calorie INDIA -14% of population is calorie deficient.deficient.

Average Female-deficiency of 100 Cal /Day.Average Female-deficiency of 100 Cal /Day.

Average Male—excess of 800 Cal /Day.Average Male—excess of 800 Cal /Day.

Deficiency Statewise-AP Deficiency Statewise-AP (23%),UP(65%),Punjab (25-75% in (23%),UP(65%),Punjab (25-75% in privileged and underprivilegedprivileged and underprivileged ) )

Difference magnified –Poverty, Low Difference magnified –Poverty, Low Socioeconomic status, floods and Socioeconomic status, floods and drought.drought.

Nutritional stress in majority of females Nutritional stress in majority of females

starts in childhood ,aggravates in starts in childhood ,aggravates in

adolescenceadolescence ,pregnancy and lactation ,pregnancy and lactation

leading to premature deaths .leading to premature deaths .

ROLE OF NUTRIENTS IN ROLE OF NUTRIENTS IN PREGNANCYPREGNANCY

• VIT B COMPLEX AND FOLIC ACID –VIT B COMPLEX AND FOLIC ACID –development of brain and spinal cord .development of brain and spinal cord .

• VIT A –prevent developmental defects and VIT A –prevent developmental defects and maintain vision .maintain vision .

• IODINE-prevention of mental IODINE-prevention of mental retardation ,prematurity and stillbirth .retardation ,prematurity and stillbirth .

• IRON-deficiency leads to premature birth, IRON-deficiency leads to premature birth, defective brain development and medical defective brain development and medical problems in mother and child.problems in mother and child.

• ZINC-deficiency leads to ZINC-deficiency leads to IUGR ,congenital malformations and IUGR ,congenital malformations and death in utero.death in utero.

• CALCIUM and VIT D –reqd. for CALCIUM and VIT D –reqd. for strengthening bones of mother and strengthening bones of mother and child.child.

• VIT B 12-deficiency causes growth VIT B 12-deficiency causes growth retardation and IUD.retardation and IUD.

• VIT C, K ,Mg, Phosphorus – reqd. for VIT C, K ,Mg, Phosphorus – reqd. for growth of fetus and health of mother.growth of fetus and health of mother.

• PROTEINS-reqd. for proper growth of PROTEINS-reqd. for proper growth of fetus and health of mother.fetus and health of mother.

MAJOR PROBLEMS IN MCH AND WAYS TO MAJOR PROBLEMS IN MCH AND WAYS TO TACKLE TACKLE A.A. LBW (weight <2500gm)LBW (weight <2500gm)

Worldwide prevalence-14 % of all live births Worldwide prevalence-14 % of all live births (93 % in developing world )(93 % in developing world )

Prevalence in India-28 % ,USA -8% .Prevalence in India-28 % ,USA -8% .

Target < 10 % in 2010 .Target < 10 % in 2010 .

CausesCauses

a)a) Identify pregnancyIdentify pregnancy at risk at risk –maternal –maternal malnourishment, more workload,malnourishment, more workload, Infections and medicalInfections and medical diseases and diseases and BOH.BOH.

INTERVENTIONSINTERVENTIONS

• Supplementary feeding ,FA Supplementary feeding ,FA supplementation ,food fortification and supplementation ,food fortification and enrichment.enrichment.

• Controlling infections like –malaria ,UTI Controlling infections like –malaria ,UTI and TORCH.and TORCH.

• Early detection of medical diseases- Early detection of medical diseases- DM,HT and PIH.DM,HT and PIH.

• Indirect interventions like family Indirect interventions like family planning ,decrease smoking and planning ,decrease smoking and improve health and nutrition of young improve health and nutrition of young girls.girls.

B . INFANT MORTALITYB . INFANT MORTALITY

I M R –World average 47/1000live birthsI M R –World average 47/1000live births

India- 83/1000 (1990 )India- 83/1000 (1990 )

54/1000(2007 )54/1000(2007 )

USA-5/1000live birthsUSA-5/1000live births

Target- <30/1000live births (by 2010 )Target- <30/1000live births (by 2010 )

Causes-LBW , birth weight Causes-LBW , birth weight >4000gm ,age of mother <19 yrs or >4000gm ,age of mother <19 yrs or >30 yrs ,high order of pregnancy and >30 yrs ,high order of pregnancy and

birth spacing <1 year.birth spacing <1 year.

PREVENTION OF INFANT PREVENTION OF INFANT MORTALITYMORTALITY

Birth spacing (>2 Years ) Birth spacing (>2 Years ) postponement of 1postponement of 1stst pregnancy, pregnancy, delaying age of marriage ,free delaying age of marriage ,free education to girls, improving education to girls, improving

health of mothers and health of mothers and girls ,exclusive breast feeding for girls ,exclusive breast feeding for

6 months and immunization.6 months and immunization.

C MATERNAL MORTALITYC MATERNAL MORTALITYLIFE TIME RISKLIFE TIME RISK

1/92 PREGNANCIES (WORLDWIDE )1/92 PREGNANCIES (WORLDWIDE ) 1/76 (DEVELOPING COUNTRIES )1/76 (DEVELOPING COUNTRIES )

1/8000 (DEVELOPED COUNTRIES )1/8000 (DEVELOPED COUNTRIES ) MATERNAL MORTALITY RATE-MATERNAL MORTALITY RATE- India 301/100,000 live birthsIndia 301/100,000 live births

USA 2/100,000 live birthsUSA 2/100,000 live births Target -30/100,000 live births (by Target -30/100,000 live births (by

2010 )2010 )Causes-obstetrical (80 % ) like bleeding, Causes-obstetrical (80 % ) like bleeding,

infections ,eclampsia etc.infections ,eclampsia etc.

AT RISK PREGNANCIESAT RISK PREGNANCIES

1.1. AnemiaAnemia

2.2. Bad Obstetrical History.Bad Obstetrical History.

3.3. Wt <35 KgWt <35 Kg

4.4. DM, HT ,UTI, Heart DiseaseDM, HT ,UTI, Heart Disease

5.5. Parity >5Parity >5

6.6. Age >30 and <19 yearsAge >30 and <19 years

7.7. Height <140cmHeight <140cm

8.8. Low socioeconomic statusLow socioeconomic status

PREVENTION PREVENTION 1.1. At least 3 antenatal visits (37 % at present )At least 3 antenatal visits (37 % at present )

2.2. Early registration of pregnancy Early registration of pregnancy

3.3. Control of infections Control of infections

4.4. Early treatment of medical diseases.Early treatment of medical diseases.

5.5. Correction of malnutrition.Correction of malnutrition.

6.6. Clean delivery practices or by trained Dais (47 % Clean delivery practices or by trained Dais (47 % present rate, target by 2010 was 100 % )present rate, target by 2010 was 100 % )

7.7. 7.Institutional deliveries for high risk cases (39 % 7.Institutional deliveries for high risk cases (39 % present rate ,target was 80 % by 2010 )present rate ,target was 80 % by 2010 )

POLICY MODIFICATIONS POLICY MODIFICATIONS

1.MATERNAL NUTRITION-1.MATERNAL NUTRITION- Micronutrient Micronutrient rich food by food enrichment rich food by food enrichment

and fortification ,e.g. flour, bread ,oil, and fortification ,e.g. flour, bread ,oil, ghee ,sugar and salt .(Iodine in salt, Iron in ghee ,sugar and salt .(Iodine in salt, Iron in flour ,Vit. D and A in Ghee and cooking Oil)flour ,Vit. D and A in Ghee and cooking Oil)

2. Adolescent 2. Adolescent young girls-targetsyoung girls-targets of of nutritional intervention programs like nutritional intervention programs like supplementary nutrition, protective and supplementary nutrition, protective and functional foods in rural areas ,iron and FA functional foods in rural areas ,iron and FA tablets ,propagation of egg intake as good tablets ,propagation of egg intake as good source of proteins and vitamins (NECC source of proteins and vitamins (NECC board )board )

3. Free and compulsory 3. Free and compulsory educationeducation to girls –most to girls –most effective way to delay age of marriage and effective way to delay age of marriage and conception ,postponement of 1conception ,postponement of 1stst pregnancy . pregnancy .

Illiterate mothers have twice the fertility rate Illiterate mothers have twice the fertility rate and more IMR (145-Illiterate mothers,101-and more IMR (145-Illiterate mothers,101-some education and 71 –Primary education )some education and 71 –Primary education )

4. National 4. National awareness awareness programs aimed at rural programs aimed at rural mothers to inculcate healthy and nutritious mothers to inculcate healthy and nutritious dietary patterns amongst them as dietary patterns amongst them as supplementation alone cannot be a supplementation alone cannot be a permanent solution.permanent solution.

5. All 5. All dietary interventionsdietary interventions should be started <3 should be started <3 years of age because disturbed homeostasis years of age because disturbed homeostasis like growth retardation starts at 3 years age.like growth retardation starts at 3 years age.

6.Full coverage through 6.Full coverage through mid day mealsmid day meals in in schools and schools and anganwaadis anganwaadis ,food ,food supplementation started at home for supplementation started at home for children <3 Years age and adolescent children <3 Years age and adolescent girls.girls.

7. To tackle 7. To tackle childhood obesitychildhood obesity awareness awareness programs and changing KAP for healthy programs and changing KAP for healthy dietary habits as drastic shifts in diet dietary habits as drastic shifts in diet patterns and activity levels are leading to patterns and activity levels are leading to adult disease in pediatric age group.adult disease in pediatric age group.

88.Iodised Oil.Iodised Oil injection to pregnant and young injection to pregnant and young girls to tackle endemic iodine deficiency girls to tackle endemic iodine deficiency (effective for 5 Years )(effective for 5 Years )

9. Increase 9. Increase public spendingpublic spending on health to 3 % on health to 3 % of GDP (Present 1 % ) of GDP (Present 1 % )

EFFECT OF MOTHER EFFECT OF MOTHER EMPLOYMENTEMPLOYMENT

10. 10. Income of mother leads to Income of mother leads to better nutritional status of family better nutritional status of family especially the daughters.especially the daughters.

Off Season employment of women Off Season employment of women and food for work programs like and food for work programs like MNREGA need to be strengthened MNREGA need to be strengthened and made corruption free.and made corruption free.

11. 11. Food Food availabilityavailability needs to be increased and be made affordable needs to be increased and be made affordable by Direct market interventions by Direct market interventions

and and Promoting FDI in retail.Promoting FDI in retail.

Food expenditureFood expenditure INDIA-49.5% INDIA-49.5%WORLDWIDE-38 %WORLDWIDE-38 %

Below Poverty Line Below Poverty Line INDIA-68.7%INDIA-68.7%WORLDWIDE-29.5%WORLDWIDE-29.5%

India ranks 66/105 countries in terms of food availability.India ranks 66/105 countries in terms of food availability.

lINDIA-68.7 % lINDIA-68.7 % WORLDWIDE-29.5 %WORLDWIDE-29.5 %India ranks 66/105 countries regarding food availabilityIndia ranks 66/105 countries regarding food availability

FAST FOODSFAST FOODS12.Banning fast foods and junk foods in 12.Banning fast foods and junk foods in

school canteens and around school school canteens and around school premises ,no advertisements of fast premises ,no advertisements of fast foods around schools along with foods around schools along with teaching healthy nutrition to children teaching healthy nutrition to children will aid in fighting childhood obesity . will aid in fighting childhood obesity . Children not to feature in ads of fast Children not to feature in ads of fast foods.foods.

13. All fast food joints be legally liable to 13. All fast food joints be legally liable to include nutritionally balanced recipes in include nutritionally balanced recipes in menu .menu .

14. Ingredients along with calorie content 14. Ingredients along with calorie content displayed in all fast food joints.displayed in all fast food joints.

14. 14. Usage of child care facilitiesUsage of child care facilities

Prevalence of Kwashiorkor is 4 times in Prevalence of Kwashiorkor is 4 times in girls than boys ,still 50 % admissions of girls than boys ,still 50 % admissions of

these patients are of boys these patients are of boys

Girls –taken to less qualified doctors while Girls –taken to less qualified doctors while more money spent on boys.more money spent on boys.

Improvement in educational status and Improvement in educational status and income levels would remove this bias income levels would remove this bias

against girls.against girls.

KERALA-Ideal example of women KERALA-Ideal example of women emancipation –literacy, people participation emancipation –literacy, people participation

and responsive government.and responsive government.

CONCLUSIONCONCLUSIONMaternal and Child Health targets have been Maternal and Child Health targets have been

accepted since 1990 (World Summit for accepted since 1990 (World Summit for Children) and revised again and again –India Children) and revised again and again –India still a laggard.still a laggard.

Preventive strategies like Balanced Preventive strategies like Balanced diet ,promotion of exclusive breast feeding diet ,promotion of exclusive breast feeding under 6 months of under 6 months of age ,Immunization ,avoidance of age ,Immunization ,avoidance of addictions ,good sanitation, availability of addictions ,good sanitation, availability of clean water and air along with universal clean water and air along with universal education are more effective measures than education are more effective measures than interventions later on .interventions later on .

THANK YOUTHANK YOU