|
The Banyan Tree: Volume II - Bringing Change
Distribution of Malnutrition in India
Problems, Programmes and Policies
Examination of
national Nutrition Monitoring Bureau (NNMB) data, ICDS
(Integrated Child Development Scheme) and other data
reveal briefly the following features about nutrition.
- Taking average
nutritional status of households, severe
malnutrition is more prevalent in the eastern
states, and in UP, MP and Kerala (See for
instance Table 9A for Rural Bihar).
- The nutritional
status of scheduled castes and tribes was
substantially lower than the recommended minimum
in most states. In particular, the intakes of
scheduled casts in Kerala, Maharashtra, Tamil
Nadu ,MP and UP and tribes in MP, Gujarat and
West Bengal were alarmingly low. (See for
instance Table 9B where this comes out clearly).
The figures for Karnataka which has a high
poverty ratio and for Kerala whose low average in
a spite of a supposed high standrs of health,
remains a puzzle. Kerala’s very poor
agricultural performance and the very high free
market retail price(40% higher than the all India
price of rice) are possible explanations. Also
considering the fact. that the decline in poverty
ratio was lowest among SC and ST groups, their
nutrition probably has not much improved since
1980-81.
- The incidence
of acute malnutrition is definitely high
among children, especially in the age
group 0-3 years in almost all states, it
being higher in tribal tracts. (See Table
9C and 9D). In a number of states, the
percentage of children with adequate
caloric protein intakes were much lower
than the corresponding percentage for
households, Children of Scheduled Castes
and Tribes in all cases where data was
available, suffer from a high incidence
of malnutrition.
- ICRISAT data
for extremely backward arid zone (for
1976) confirms the incidence of seven
malnutrition among children in the age
group 1-3 among all classes, with
incidence of energy deficiencyhigher
among children of landless laboureres and
small farmers.1
- Others have
tried to show the prevalence of
malnourished children of Scheduled Castes
and Tribes groups to be higher in
districts that are less developed
(irrigation ratio was found associated
associated inversely with malnutrition).2
- Table 9E on
‘Summary Nutritional Status by Age
in Bihar Villages’ shows that nearly
half of the children aged less than 54
months suffered from a nutritional
deficiency, the figure being 78% for 6-18
months group. On the average only 53.5%
of all households was normal.
- Although resaerch and
scholarly data is not very conclusive, there is
field experience of several activists to suggest
that there is a gender discrimination in food
intake against very young girls, not only in
North India (which the research data tends to
agree),but elsewhere too. There is general gender
discrimination with respect to providing quality
of life to all women, either it be health care
when sick or education or sharing of drudgery.
However, it should be noted that the NNMB data
does indicate higher incidence of protein-energy
malnutritionamong especially the school children,
even though caloric inadequacy is comparatively
lower among girls. Table 9F also indicates that
during the period 1975-80, both males and females
suffered to the extent from caloric inadequacy
(calorie intake two standard derivations or more
below the average). Infact,Table 9F shows figures
slightly less for females.
Table 9A
Summary Nutritional Status of Households in Rural Bihar by Social Class (% Distribution)*
|
Class |
Normal |
Wasted |
Stunted |
Acute |
N |
|
Agricultutral Labour |
43.7 |
31.0 |
15.1 |
10.2 |
270 |
|
Agricultural Labour tied |
45.6 |
28.6 |
14.5 |
11.3 |
103 |
|
Poor- Middle peasant |
57.6 |
27.9 |
9.3 |
5.2 |
73 |
|
Middle peasant |
75.4 |
17.1 |
4.9 |
2.0 |
90 |
|
Big Peasant |
57.3 |
31.1 |
8.3 |
3.3 |
243 |
|
Landlord |
70.6 |
20.6 |
8.4 |
0.3 |
164 |
|
Non-Agricultural |
-- |
-- |
-- |
-- |
-- |
|
No Activity |
45.2 |
31.4 |
11.8 |
11.6 |
49 |
|
All |
53.5 |
28.4 |
11.3 |
6.8 |
992 |
| * The
norms used by the authors for defining
"normal", "stunted", etc. are
as follows: |
|
|
Weight for age |
|
|
over 85% |
over 85% |
"normal" |
|
less than 85% |
over 85% |
"stunted" |
|
over 85% |
less than 85% |
"wasted" |
|
less than 85% |
less than 85% |
"acute" |
| Source
: P.H Prased et. al "The Pattern of Poverty
in Bihar" (World Employment Programme
Research), Working Paper No. 152. |
Table 9B
Stage-wise calorie intake (Kcal/cu) 1975-80
Average (Rural) by Social Class
| |
|
Calorie
Intake Of Schedule Castes as a percent of |
Calorie
Intake Of Schedule Tribes as a percent of |
| States |
State Average |
State Average |
Recommended Daily
Allowance (2400) |
State Average |
Recommended Daily
Allowance (2400) |
|
Karnataka |
2837 |
86.6 |
102.4 |
SS |
-- |
|
Andhra Pradesh |
2517 |
96.3 |
101.0 |
SS |
-- |
|
Orissa |
2324 |
94.1 |
91.0 |
96.3 |
93.3 |
|
Tamil Nadu |
2292 |
88.7 |
84.7 |
SS |
- |
|
Maharashtra |
2286 |
85.6 |
81.5 |
98.1 |
93.5 |
|
West Bengal |
2227 |
98.7 |
91.5 |
92.2 |
85.5 |
|
Gujarat |
2211 |
98.0 |
90.3 |
92.4 |
85.1 |
|
Madhya Pradesh |
2160 |
92.5 |
83.3 |
89.4 |
80.5 |
|
Uttar Pradesh |
2123 |
97.2 |
86.0 |
SS |
- |
|
Kerala |
1942 |
94.1 |
67.4 |
SS |
- |
SS :
Small Sample
Source : Computed from disaggregated NNMB data. |
Nutritional Problems in India
The major
nutritional problem in India is therefore PCM or protein
calorie malnutrition, especially among most vulnerable
groups like children, pregnant women, lower income groups
and population living in tribal tracts. The term PCM
implies the problem of malnutrition is one of primarily
calorie or energy intake deficiency, the protein
deficiency being secondary, since in Indian conditions,
the dietary sources of proteins and calories are the
same, an adequate qota of calories will expectedly take
care of an adequate proteinin the diet.
The other major nutritional deficiency diseases are
Vitamin A deficiency, goitreand iron deficiency anemia.
In certain parts of India fluorosis is also a problem due
to the presence of excessive amounts of fluoride in
drinking water. Pellagra, caused due to niacin or
nicotinic acid deficiency is prevalent in populations
whose staple diet is maize. Pellagra has also been
reported in jowar caters, although there is no niacin
defiency in this millet
Table 9C
Percentage of Malnourished (Gr. III + IV) Children in ICD Projects by Caste Status, 1981*
| |
Average |
Scheduled Castes |
Scheduled Tribes |
| |
0-36 months |
0-72 months |
0-36 months |
0-72 months |
0-36 months |
0-72 months |
|
|
9.6 |
8.6 |
10.4 |
8.3 |
9.9 |
7.5 |
|
Bihar |
31.8 |
31.7 |
39.5 |
40.9 |
- |
- |
|
Gujarat |
7.3 |
6.2 |
6.0 |
3.9 |
11.7 |
- |
|
Haryana |
4.6 |
3.5 |
- |
- |
|
- |
|
Himachal Pradesh |
5.3 |
4.3 |
7.0 |
9.3 |
|
- |
|
Karnataka |
8.8 |
8.3 |
10.1 |
8.5 |
5.0 |
2.5 |
|
Kerala |
7.7 |
7.8 |
11.0 |
10.2 |
17.5 |
15.6 |
|
Madhya Pradesh |
- |
- |
- |
- |
24.3 |
12.7 |
|
Maharashtra |
15.8 |
13.3 |
16.7 |
14.8 |
23.7 |
20.7 |
|
Orissa |
16.7 |
13.0 |
19.0 |
16.8 |
|
- |
|
Punjab |
8.6 |
8.2 |
13.9 |
12.3 |
|
- |
|
Rajasthan |
8.2 |
8.7 |
17.3 |
12.1 |
8.1 |
7.6 |
|
Tamil Nadu |
8.1 |
6.4 |
10.1 |
7.1 |
|
- |
|
Uttar Pradesh |
13.1 |
10.5 |
17.1 |
13.2 |
16.3 |
13.4 |
|
West Bengal |
19.9 |
17.3 |
26.5 |
21.3 |
17.0 |
12.1 |
*
ICDS authorities follow the Indian Academy of
Paediatrics (IAP) classification, as shown below
:
- <50%
weight for age : Grade IV malnutrition
- 51-60% weight
for age : Grade III malnutrition
- 61-70% weight
for age : Grade II malnutrition
- 71-80% weight
for age : Grade I malnutrition
- >80%
Normal
Source : Compiled
from Child in India. A Statistical Profile,
Ministry of Welfare, Government of India
|
Table 9D
Percentage of Malnourished (Gr. III + IV) children * (0-36) months of Scheduled Castes and Tribes in Rural/Urban/Tribal ICDS Projects, 1981 (%)
|
State |
Average |
Rural@ |
Tribal# |
Urban$ |
|
Andhra Pradesh |
9.6 |
11.0 |
10.8 |
10.3 |
|
Himachal Pradesh |
5.3 |
8.1 |
12.4 |
26.3 |
|
Maharashtra |
15.8 |
27.3 |
14.3 |
16.4 |
|
Uttar Pradesh |
13.1 |
30.8 |
13.9 |
20.8 |
|
West Bengal |
19.9 |
|
16.2 |
33.8 |
- * IAP
classification (defined in footnote to
Table 9C).
- @ and $
Children of Scheduled Castes
- # Children of
Scheduled Tribes
Source : Compiled
from Child in India. A Statistical Profile.
Ministry of Welfare, Government of India.
|
Table 9E
Summary Nutritional Status by Age (% Distribution) in Bihar Villages*
|
Age |
Normal |
Wasted |
Stunted |
Acute |
N |
|
6 Months but less than 18 |
22.8 |
42.5 |
22.8 |
11.9 |
41 |
|
19 Months but less than 54 |
36.7 |
33.1 |
19.3 |
10.9 |
248 |
|
54 Months but less than 114 |
52.5 |
31.0 |
9.9 |
6.6 |
419 |
|
114 Months or more |
76.3 |
17.9 |
3.7 |
2.2 |
279 |
|
All |
53.5 |
28.4 |
11.3 |
6.8 |
992 |
* For
definitions of "normal",
"wasted", etc., see footnote to Table
9A
Source : P.N. Prasad, et al., "The Pattern
of Poverty in Bihar" (World Employment
Programme Research) Working Paper No. 152. |
Table 9F
Calorie Inadequacy* Among Adult Males and Females
(Perecent of Population)
| |
1975-1979 |
1980 |
| States |
Males |
Females |
Males |
Females |
Males |
Females |
|
|
60.8 |
50.9 |
60.6 |
54.6 |
81.8 |
58.5 |
|
Madhya Pradesh |
48.4 |
28.8 |
63.3 |
55.0 |
- |
- |
|
West Bengal |
45.7 |
38.4 |
53.1 |
54.6 |
35.3 |
30.4 |
|
Orissa |
42.6 |
24.0 |
39.6 |
22.1 |
39.3 |
20.3 |
|
Maharashtra |
40.3 |
27.9 |
44.0 |
36.9 |
- |
- |
|
Uttar Pradesh |
36.7 |
32.2 |
28.8 |
29.5 |
38.4 |
25.8 |
|
Andhra Pradesh |
35.6 |
18.5 |
22.9 |
7.7 |
35.1 |
24.1 |
|
Gujarat |
35.2 |
27.3 |
24.2 |
17.2 |
29.3 |
20.9 |
|
Tamil Nadu |
34.8 |
25.4 |
15.7 |
16.7 |
41.4 |
36.1 |
|
Karnataka |
18.8 |
10.4 |
19.8 |
7.9 |
11.0 |
10.3 |
*
Intake two standard deviations or more below the
mean
Source : NNMB data, as reported in Kamala S. Jaya
Rao, "Undernutrition Among Adult Indian
Males", NFI Bulletin, July 1984. |
Lathyrism is especially prevalent in MP, Bihar, UP, etc. among landless labourers and poor farm workers , who are usually the victims and who often get Khesari Dal as a form of wages. The pulse itself is rich in protein. Harmful effects of this pulse are produced if a diet in 2-4 months contains more than 40 percent of Khesari Dal. The disease manifests itself in the form of paraplegia with most victims crippled for the rest of their lives. Khesari is often used for adulteration of other pulses, which is one more vested interest to ensure its cultivation. Soaking of Khesari in hot water to detoxify it is not feasible because of fuel shortage. Studies of the University of Dhaka have shown that boiling the seeds withwater five times did not detoxify it. The only solution seems to be banits cultivation in MP, Bihar and West Bengal as has been done in other states.
Also in India there are a host of other mineral and vitamin deficiency diseases, other deficiency anemias, like folic acid, vitamin B12 and B6 deficiency anemias, and problems caused by food toxicants like epidemic dropsy(adulteration of usually mustard oil with argemone seed oil), alfatoxicosis (due to consumption of ground nut flour becoming now common for the school children’ diets- that has been contaminated by a paricularly toxic fungal growth in groundnutseeds). An epidemic of Veno-Occlusive disease (VOD) of liver hit Surguja district in Eastern MP in 1973 and again in 1975. VOD is apparently caused contamination of seeds of Crotalaria mana with Gondli millet. Guinea worm infestation of water is also a major problem as also a whole host of problems affecting nutrition that are caused by unclean drinking water, chief of which are diarrhoea and intestinal parasitic infestation (including hookworms) that promote chronic blood loss and in turn aggravate iron deficiency.
Table 9G
Average Intake of Food- stuffs (g/cu/day)* in Different Urban Groups
| Income Group |
Middle Class |
Slum Dwellers |
RCI(Sedentary) |
RDI (Moderate) |
| Cereals and
Millets |
316 |
416 |
460 |
520 |
| Pulses |
57 |
33 |
40 |
50 |
| Leafy Vegetables |
21 |
11 |
40 |
40 |
| Other Vegetables |
113 |
40 |
60 |
70 |
| Roots and Tubers |
82 |
70 |
50 |
60 |
| Nuts and Oil
Seeds |
21 |
9 |
-- |
-- |
| Fruits |
124 |
26 |
-- |
-- |
| Fish |
12 |
10 |
-- |
-- |
| Other Fresh Foods |
19 |
9 |
-- |
-- |
| Milk |
424 |
42 |
150 |
200 |
| Fats and Oils |
46 |
13 |
40 |
45 |
| Sugar and Jaggery |
434 |
20 |
30 |
55 |
*Grams
per consumption unit per day
NNMB Reprot on Urban Population (1975-79),
published 1984, NIN |
Table 9H
Average Weights and Heights of Adults (20-25 years) in Different Urban Groups
| |
Males |
Females |
|
Income Group |
Height (cms) |
Weight (Kgs) |
Height (cms) |
Weight (Kgs) |
|
Middle class |
166.4 |
50.4 |
154.6 |
46.8 |
|
Slum–dwellers |
161.4 |
46.6 |
150.1 |
41.7 |
| Source
: NNMB Report on Urban Population (1975-79),
published 1984, NIN. |
Dietary Patterns of the Affluent
As Indian populations, move up in social scale, important changes that appear to take place are:
- Substitution of ‘coarse’ grains like millets for more ‘prestigious’ cereals like wheat and rice. There is also a progressive increase in use of polished varities of rice. The total substitution of millet by rice or wheat would decrease fibre content in diet by about 50% (See Table 10 on ‘Fibre Content of Indian Foods’).
- Increase in intake of vegetable oils and ghee with often vanaspati (hydrogenated fat) replacing, vegetable oils.
- Increase in intake of sugar.
- General increase in calorie intake not related to sedentary nature of occupations.
- Increased intake of pulses, vegtables andmilk--thismay be conasidered beneficial.
- More consumption of market processed and commercialised foods, some of which include junk foods high in calories,fats,salt and sugar--all condusive to heart disease and strokes. The upper five is also the more exposed to international (read Western) dietary tastes and therefore exposed to wider junk food choice.
The affluent group of Indians has had prevalence of economy heart disease (CHD) comparable to the affluent in the first world, with prealence of type II diabetes, there to five times that of similar groups in West. Indian who beome affluent appear to be particularly genetically prone to diabetes and CHD, especially when devoid of dietary discipline. Fat intake (in the form of ghee, vanaspati, edible oils) in Indians is particularly bizarre withe the 5% of population consuming 40% of the available fat. Achaya has shown that practically every Indian diet consists of some fat--as ‘invisible fat’.2 Using more recent information available on total lipids in food materials, especiallly, rice, wheat and other cereals, and the average rural dietary data for 1980,the intake of invisible fat was shown to be 20 to 50 gms a day, averaging 29.0 gms. Large coconut intakes in Kerala and Tamil Nadu led to high levels of invisible fat in these states. Staples (tapioca being included in this category in Kerala) contributed to the bulk of the invisible fat (31-88%; average 68%) and milk and pulses an average of 11.4% and 2.4% respectively. Total fat intakes, both visible and invisible made an average contribution of 14.7% in 10 states of India.
Table 10
Fibre Content of Indian Foods
|
Millets |
|
|
Bajra (Penniseum typhoideum) |
20.4 g % |
|
Jower (Sorghum vulgare) |
14.2 g% |
|
Maize (Zea mays) |
6.8g% |
|
Ragi (Elensine coracana) |
18.6g% |
|
Wheat |
|
|
Wholemeal (100%) |
9.6g% |
|
Refined |
3.0g% |
|
Rice |
|
|
Raw (brown) |
5 to 8 g% |
|
Polished |
2.4 g% |
|
Chemical Nature of Cereal Fibre |
|
|
Non-Celluloid polysaccharide |
48.9 - 61.5% |
|
Celluloid |
31.8 - 32.7% |
|
Liguin |
6.7 - 18.4% |
| Estimated
Total Fibre Contents of Average Indian
Cereal-based Dietaries |
|
Wheat based |
57.7 g/day/person |
|
Rice based |
33.2 g/day/person |
|
Millet based |
90.0 g/day/person |
| Source
: R.D. Sharma, National Institute of Nutrition,
Personal Communication. Quoted in Gopalan, op.
cit. |
The upshot of these findings is that even poor Indian diets are reasonably adequate in fat. For the affluent sections, intakes of edible fat of the order observed are wholly unnecessary if not dangerous.
A related point to be noted is that the fashion among the affluent to go in for safflower oil and sunflower oil, based on their reported superiority due to high content of polyunsaturated fatty acids(PUFA), instead of traditioal vegetable oils like groundnut, may actually be misplaced. These never oils contain 70% of linoleic acid (an essential fatty acid) as compared to 30% linoleic acid for groundnut and sesameoils. Excess linoleic acid could lower blood cholesterol--a feature desirable for coronary heart disease pone populations. Excess linolec acid is also suspected to lead to certain types of tumors and suppressionof immune response.
<
Dietary Guidelines for the Affluent
Lest dietary
guidlines for the affluent be thought of as an
irrelevance,one should remember that even at 5% (let us
assume only 5% have affluent characteristics described
above) of the totalpopulation of India, they constitute
about 40 million, which is a big number of people at
nutritional risk, not to speak of the economic costs of
keeping this 5% healthy.
Dietary guidelines are just that,merely guidelines for
nutritional discipline. They may not solve all health
problems of the affluent but could certainly help
minimise the nutritionally related risk factors in, for
instance CHD or diabetes. These guidelines2 should form
part of school curricula in especially upper class
schools.
- Overall energy intake
should be restricted to levels commensurate to
the sedentary occupations of the affluent, so
that obesity is avoided.
- Highly refined and
polished cereals should be avoided in preference
to under-milled cereals.
- Green leafy
vegetables (a source not only of carotenbe bu
also of linoleic acid derivatives) should be
included at least in levels recommended byICMR.
- Edible fat intake
need not exceed 40 gms and total fat intake
should be limited to levels at which fat will
provide no more than 20% of total energy. The use
of ghee, clarified butter, a prized item in the
Indian culinary system should be restricted for
occasions and should not be a regular daily
feature.
- The intake of sugar
and sweets should be restricted.
- High salt intake
should be avoided. In house-holds in some parts
of the country, diets contain unnecessarily high
levels of salt, spices and condiments. High salt
intake certain certainly serves no useful
nutritional purpose and is generally best
avoided, and especially by those prone to
hypertension.
Dietary Guidelines for the Poor
The Indian
Council for Medical Research (ICMR) makes periodic
recommendations on desirable diets for Indian
populatuions . Considering the fact that at least
one-third of the households in India are not able to
afford even the minimum nutritional requirements (these
households spend 80% of their income on food), the ICMR
felt that its Recommended Diet Intake (RDI) should also
have practical suggestions as to how the recommended
nutrient allowance could be procured from low-cost diets.
The model least cost diets per day that are
‘balanced’ are shown in Tables 11 and 11B. In
rcommending diets for poor Indian Groups, the ICMR has
been guided by the following considerations:
- Diets recommended
should be least expensive and confirm to
traditional and cultural practices as closely as
possible.
- Energy derived from
cereals need not exceed 75% of the total energy
requirement.
- Pulse (legum) intake
should be suh that the ratio of cereal protein to
pulse protein does not exceed 5:1.
This would imply that pulse intake should be
atleast around 9% to 10% of the cereal intake.The
diet should provide for a minimal milk intake of
150 ml. These recommendations regarding intake of
pulses and milk were designed to improe the
protein quality of the predominantly cereal-based
diet, usually devoid of animal protein to minimal
acceptable levels.
- About 150g of
vegetables (leafy and other vegetables) should be
provided. These were considered as levels which
will not unduly increase the bulk of the cooked
food-a major consideration in all diets that are
heavily cereal-based.
- Energy derived from
fat and oil need not exceed 15% of total calories
. This takes into consideration the fact that
cereal diets already provide invisible ats at
levels of about 10% of total energy.
- Energy drived from
refined carbohydrates (sugar or jaggery) need not
exceed 5% of total calories.
In reality as already seen from Table 11A and 11B actual intakes are far lower than RDI.
Table 11A
‘Balanced Diet’s Recommended by ICMR on the Basis of RDI
| |
Adult
Men |
Adult
Women |
Children |
Boys |
Girls |
| Food Items |
Sedentary |
Moderate Work |
Heavy Work |
Sedentary |
Moderate Work |
Heavy Work |
1-3 years |
4-6 years |
10-12 years |
10-12 years |
| Cereals |
460 |
520 |
670 |
410 |
440 |
575 |
175 |
270 |
420 |
380 |
| Pulses |
40 |
50 |
60 |
40 |
45 |
50 |
35 |
35 |
45 |
45 |
| Leafy Vegetables |
40 |
40 |
40 |
100 |
100 |
50 |
40 |
50 |
50 |
50 |
| Other Vegetables |
60 |
70 |
80 |
40 |
40 |
100 |
20 |
30 |
50 |
50 |
| Roots and tubers |
50 |
60 |
80 |
50 |
50 |
60 |
10 |
20 |
30 |
30 |
| Milk |
150 |
200 |
250 |
100 |
150 |
200 |
300 |
250 |
250 |
250 |
| Oil and fat |
40 |
45 |
65 |
20 |
25 |
40 |
15 |
25 |
40 |
35 |
| Sugar or Jaggery |
30 |
35 |
55 |
20 |
20 |
40 |
30 |
40 |
45 |
45 |
*
Grams per day for each category
Source : Recommended Dietary Inta kes for
Indains, ICMR, 1984 |
Table 11B
Average Intake of Nutrients (cu/day) in Different Urban Groups
| |
Middle Class |
Slum-dwellers |
Recommended
Intake
(ICMR-1981) |
| Protein (g) |
73.1 |
53.4 |
55.0 |
| Calories (Kcal) |
2603 |
2008 |
2400(sedentary)
2500(moderate) |
| Calcium (mg) |
1121 |
492 |
400-500 |
| Iron (mg) |
27.3 |
24.9 |
24.0 |
| Vitamin A Retinol
(µg) |
881 |
248 |
750 |
| Thiamine (mg) |
1.47 |
1.27 |
1.20 |
| Riboflavin (mg) |
1.52 |
0.81 |
1.40 |
| Niacin (mg) |
15.3 |
14.6 |
16.0 |
| Vitamin C (mg) |
93 |
40 |
40 |
| Source
: NNMB Report on Urban Population (1975-79),
published 1984, NIN. |
Additional messages
that need to be got across with respect to children are:
- Breastfood as long as
possible.
- Introduce semi-solids
from 6 months.
- Feed young children 3
to 6 times a day.
- Do not reduce food in
illness.
- Use available health
services, immunise your child. Keep the family
and surroundings clean even as you drink clean
water.
- Do not ignore
mother’s health and food needs during
pregnancy and lactation. Most mothers in India
being anaemic require appropriate iron-folic acid
supplements.(See also Table 11C and box).
Table 11C
Additional Allowances During Pregnancy and Lactation
|
Food Items |
Pregnancy |
Calories
(K Cal) |
Lactation |
Calories
(K Cal) |
|
Cereals |
35g |
118 |
60g |
203 |
|
Pulses |
15g |
52 |
30g |
105 |
|
Milk |
100g |
83 |
100g |
83 |
|
Fat |
-- |
-- |
10g |
90 |
|
Sugar |
10g |
40 |
10g |
40 |
|
Total |
-- |
293 |
-- |
521 |
| Source
: RDI, ICMR (1981) |
| A Good
Diet for Pregnancy and Lactation
During
pregnancy and lactation a woman needs more food
and a greeater vcariety of food. More food is the
first and most important thing. Diets based on
cereals are generally good, but the woman needs
more of them. She should eat one-fourth more food
than she was eating before she became pregnant
(25% extra) Find out how much she was eating
before. Divide that into 4 portions. Tell her, or
better show her, how much one of these portions
is. This is the extra food she should eat, not
only in pegnancy, but right through lactation.
Pregnant
and nursing mothers should eat for two persons
A variety
of foods will supply most of the nutrients a
pregnant woman needs. These are listed below:
The cereal which are suitable for her diet
include wheat, maize, sorghum, rice, and millet.
It is better not to use refined or polished
cereals because the nutritious part of the
cereals is lost during such processing. Parboiled
rice is more nutritious than polished white rice.
Similarly, brown wheat flour (whole flour) is
better than white refined flour. In some
countries casava, Yams, plantains, and potatoes
are used in place of cereals.
Legumes or pulses are valuable, particularly for
those cannot afford animal food or who do not eat
them. The legumes include peas, beans, lentils,
etc.
Vegetables, especially dark green leafy and
coloured ones, such as tomatoes and carrots,
supply special nutrients. Other vegetables and
fruits are also useful.
Edible oils, butter, and sugar or molasses and
their derivaties make food more tasty. They also
supply energy in a concentrated form.
Animal foods are valuable but not essential. Do
not emphasize meat, eggs, fish, etc. in group
teaching, if such foods are beyond the means of
the community.
Source: Guidelines
for Training Community Health Workers in
Nuttrition. 2nd Edn. WHO.(Geneva,1986).
|
Guidelines for other Major Nutritional Problems
- Iron-deficiency
anemia: Usually responds well by iron salts
like ferrous sulphate tablets. These are very low
cost, much cheaper than iron tonics and vitamin
preparations.
Iron is found in green leafy vegetables (Palak,
amaranth, drum stick leaves, coriander, etc.)
ragi and . dried fruits. The average Indian diet
provides as high as 30 gm iron daily. However,
the simultaneous presence of phytate and tannins
inhibit iron absorption. There is also low level
of calcium and ascorbic acid (vitamin C)--a
factor that could augment net bioavailability of
iron.
Mass strategies that have been suggested are
prophylatic administration of iron and folic acid
to women and children in poor communities as part
of routine PHC services through MCH centres and
schools.
- Vitamin A
Deficiency : Vitamin S as retinol is mostly
drived from beta-carotene. Absorption of
beta-carotene from carrots and papayas has been
shown to be good when diets have even low fat
content.
Intake of green leafy vegeables are recommended
by ICMR in its model least-cost blanced diets for
adults would provide 600mg of retinol dilay and
300 mg daily for the pre-school children (about
40 gms of green leafy vegetables). Usually many
of the foods rich in iron are also rich in
retinol. Thus intake of greens will help in both
vitamin A and iron deficiency. It is an irony
that green leafy vegetables, though comparatively
inexpensive, are as people go up the social
scale, not considered ‘prestige food’.
The colostrum, usually not given to the child by
many mothers on accounts of certain beliefs, is
rich in vitamin A. Other strategies for
combatting vitamin A deficiency, especially in
cases of repeated infections and despite
recommended intake of green leafy vegetables (and
at present low levels of knowledge about
bioavailability of retinol from various varieties
of greens), is prophylactic administra tion of
massive doses of vitamin A ( 2 lacs IC once in 6
months) for children under 3 years.
- Goitre/Iodine
Deficiency : Studies need to be made as to
how new goitre-endemic areas emerge. It has been
sugested that the Green Revolution type
technology could have induced iodine deficiency
in soils and foods that are grown in such soils.
But for the present, strategies to combat goitre
seem to be universal iodisation of common salt
and banning of unfortified salt. There are of
course many logistical problems about universal
iodisaion of salt.
- Fluorosis:
Simple techonologies for defluoridation or
drinking water with the upper limit for flouride
set at 1 PPM. Strategies for lowering fluoride
content found to be extent of 10 mg/kg in staple
food items like rice, corn, wheat, cabbage,
potatoes, etc. are yet to be clearly thought
about.
- Lathyrism : No
other alternative, but banning of cultivation of
Khesari dal is the most appropriate and just
policy.
There are dietary
guidelines that have been formulated for a host of other
deficiency problems but the above to be the major ones.
Particular guidelines will have to be worked out
considering location specific conditions.
|
