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Preventive and social medicine > Test 5 - Nutritional problems > Flashcards

Test 5 - Nutritional problems Flashcards

1
Q

Endemic fluorosis areas - water flourine content

A

3-5 mg/L

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2
Q

endemic fluorosis areas

A

Andhra pradesh, Tamil nadu, Panjab, HHarayana, Karnataka, Kerela

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3
Q

Toxic manifestations of endemic fluorosis are

A
  1. dental fluorosis
  2. skeletal fluorosis
  3. Genu valgum
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4
Q

amt of fluorine that causes Fluorosis of dental enamel

A

1.5 mg/L

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5
Q

groups susceptible to develop dental fluorosis

A

children under 7 years of age - when tooth calcfication is occuring

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6
Q

symptoms of dental fluorosis

A
  1. dental enamel mottling
  2. teeth lose their shine
  3. chalky white patches develop on them
  4. white patches become yellow then black or brown
  5. enamel - subsequent loss and corrosive appearance
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7
Q

mottling is best seen in which teeth

A

upper jaw incisors (permanent ones)

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8
Q

skeletal flurosis - amount that cause it

A

3-6 mg daily intake for a life time

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9
Q

symptoms of skeletal fluorosis

A
  1. deposition of F in the skeleton

2. disability

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10
Q

when there is more than 10 mg /L Fluorine in drinking water

A

crippling fluorosis - permanent diability

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11
Q

genu valgum - symptoms

A
  1. genu valgum - knock knees

2. osteoporosis of lower limbs

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12
Q

genu valgum - prevelance

A
  1. Andhra pradesh and tamil nadu people

2. people who eat sorgham as staple diet

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13
Q

role of sorghum in causing genu valgum

A

sorghum promotes higher retention of fluorine

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14
Q

interventions to fluorosis

A
  1. change water source into one which has lower fluorine content (0.5-0.8 mg/L) - running surface water contains lesser F than ground water
  2. chemical treatment of the water - nalgonda technique for deflouridation
  3. do not give fluoride supplementation to children who drink fluorinated water
  4. fluorine toothpaste are not recommended for children under the age of 6 years
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15
Q

Nalgonda technique

A
  1. add lime then alum
  2. flocculation
  3. sedimentation
  4. filtration
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16
Q

Larythrism

A
  1. paralysing disease of humans and animals
  2. neurolathyrism in humans
  3. osteolathyrism (odoratism) - lathyrism with skeletal deformities
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17
Q

neurolathyrism

A
  1. crippling disease of nervous system

2. spastic paralysis of lower limbs in adults taking the pulse lathyrus sativus

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18
Q

lathyrism is common in

A
  1. madhya pradesh
  2. uttar praesh
  3. bihar
  4. odissa
  5. where masur is grown - maharashtra, assa, rajasthan, west bengal, gujrat
  6. spain
  7. algeria
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19
Q

Rewa - MP- case prevelance

A

25,000

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20
Q

Satna - MP - case prevelance

A

32,000

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21
Q

No fresh outbreaks in endemic areas because of

A

changes in agronomical practices

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22
Q

lathyrus - local names

A
  1. kesari dal
  2. teora
  3. lak
  4. batra
  5. gharas
  6. matra
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23
Q

seeds of lathyrus

A
  1. triangular

2. grey

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24
Q

dehusked kesari dal looks like

A
  1. red gram or bengal gram
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25
Q

nutritional profile and other advantages of lathyrus

A
  1. rich in proteins

2. cheap

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26
Q

neurotoxic dose of lathyrus

A

30% of total daily diet for 2- 6 months

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27
Q

lathyrus toxin

A

BOAA - beta oxalyl amino alanine

  1. isolated in crytalline form
  2. water soluble
  3. cannot cross BBB unless taken in large amounts for more than 2 months

Other toxins are also present

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28
Q

age ans sex susceptible to lathyrism

A
  1. 15-45 years old

2. men

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29
Q

stages of lathyrism

A
  1. latent
  2. no stick stage
  3. one stick stage
  4. two stick stage
  5. crawler stage
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30
Q

latent stage of lathyrism

A
  1. apparently healthy
  2. ungainly gait
  3. physical signs on neurological examination
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31
Q

what among the 5 stages of lathyrism is important for preventive aspect

A

latent

complete remission can occur in case of removal of lathyrus from diet in this stage

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32
Q

no stick stage of lathyrism

A
  1. most common

2. short jerky steps

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33
Q

one stick stage of lathyrism

A
  1. muscular stiffness - require stick to maintain balance
  2. crossed gait
  3. walk on toes
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34
Q

two stick stage of lathyrism

A
  1. bent knees
  2. crossed legs
    require two crutches
  3. tired on walking short distance
  4. slow gait
  5. clumsy gait
  6. patient get tired after walking short distances
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35
Q

crawling stage of lathyrism

A
  1. erect posture impossible
  2. knee joints cannot support weight
  3. atrophy of the thigh and the leg muscles
  4. patient throws his weight on the hand and crawl
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36
Q

interventions for lathyrism

A
  1. vitamin C prophylaxis
  2. banning the crop
  3. proportion of kesari dal should not be more than 1 quarters of the total pulses and cereal daily intake
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37
Q

role of vitamin C in prevention of lathyrism

A
  1. daily administration of 500-1000 mg of vitamin C for a week or so - may repair some of the damages caused in this irreversible condition
  2. include vitamin c in the lathyrogenic diets (guinea pig and monkey experiments)
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38
Q

banning of lathyrus sativus

A
  1. not feasible for immediate intervention
  2. prevention of food adulteration act- has banned whole split and flour of lathyrus (ban not operative in MP, bihar, orissa, gujrat)
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39
Q

removal of toxin

A
  1. steeping methods
  2. parboiling
  3. education
  4. genetic approach
  5. socio economic changes- overall development
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40
Q

steeping method for removal of BOAA toxin

A
  1. soak pulse in large amount of hot boiling water for 2 hours
  2. soaked water is completely drained off
  3. wash the pulse in clean water again
  4. drain off the water
  5. dry in sun
  6. use for consumption
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41
Q

disadvantage of steeping method

A
  1. there is loss of vitamins and minerals of the lathyrus sativus
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42
Q

parboiling of lathyrus sativus

A 
improved detoxification 
1. for large scale operation 
2. soak in lime water overnight 
3. boil 
toxin will be destroyed 
trypsin inhibitors
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43
Q

education about prevention of lathyrism

A
  1. dangers of consuming lathyrus

2. need for removing its toxin conveyed

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44
Q

genetic approach in prevention of lathyrism

A
  1. some strains of lathyrus sativus has very less (0.1%) toxin
  2. they can be selectively propagated and cultivated
  3. effectively reduce lathyrism without changing food habits
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45
Q

low toxin varieties of lathyrus - obtained From

A

IARI, New Delhi

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46
Q

iodine deficiency leads to

A

wide spectrum of disorders commencing from intrauterine life to childhood to adults with serious health as well as social implications (due to goitre and cns disturbances)

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47
Q

iodine deficiency disorders

A
  1. goitre
    - grade I
    - grade II
    - grade III
    - multinodular goitre
  2. hypothyroidism
  3. subnormal intelligence
  4. delayed motor milestones
  5. mental deficiency
  6. hearing defects
  7. speech defects
  8. strabismus
  9. nystagmus
  10. spasticity EPS
  11. neuromuscular weakness
  12. endemic cretinism
    - hypothroid
    - neurological
  13. intrauterine deaths
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48
Q

Iodine deficiency disorders - endemic

A
  1. third world countries
  2. india, bhutan, bangladesh, myanmar, indonesia, nepal, sri lanka and thialand
  3. himalaya goitre belt (kashmir to naga hills)
  4. madhya pradesh
  5. gujrat (baruch district)
  6. maharashtra
  7. andhrapradesh
  8. kerela (ernakulum)
  9. karnataka
  10. tamil nadu
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49
Q

states in himalayan belt

A
  1. jammu and kashmir
  2. himachal pradesh
  3. punjab
  4. haryana
  5. uttar pradesh
  6. bihar
  7. west bengal
  8. sikkim
  9. nagaland
  10. mizoram
  11. meghalaya
  12. tripura
  13. manipur
  14. arunanchal pradesh
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50
Q

1960 iodine deficiency scenario of india

A

9 million people were affected from goitre

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51
Q

current iodine deficiency scenario of India

A

survey of 325 districts

  • 263 districts were endemic where IDD prevalence is more than 10%
  • more than 71 million persons are suffering
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52
Q

goitre control or national iodine deficiency disorder programme components

A
  1. iodised salt or oil
  2. monitoring and surveillance
  3. manpower training
  4. mass communication
53
Q

salt iodisation guidelines as given PFA act

A

not less than 30 ppm at the production point
not less than 15 ppm at the consumer point

all salt to be replaced by iodised salt in phased manner (under IDD control programme)

54
Q

prophylactic public health measure against endemic goitre

A

iodised salt

55
Q

iodised salt - general advantages

A
  1. economical
  2. convenient
  3. effective means of mass prophylaxis
56
Q

new product by National institute of nutrition, hyderabad

A

common salt fortified with iodine and iron

community trial to examine the efficacy of the two-in-one salt

57
Q

iodised oil

A
  1. i.m injection of
  2. poppy seed/etc oil
  3. 1 ml
  4. 4 year prophylaxis
  5. applied rapidly
  6. expensive
  7. approach is less practicable

8.. in hyderabad (NIN) - pprocess to produce iodised oil in safflower and safola oil

58
Q

iodised oil -adminsitration

A
  1. 1ml i.m injection

2. oral

59
Q

iodised oil

A
  1. iodised oil
  2. Na iodate
  3. more costly than i.m
60
Q

iodine monitoring

A
  1. network of labs - monitor, surveillance
  2. iodine excretion determination
  3. epidemiological - iodine in water, soil, food
  4. quality control - iodine in salt
  5. check for neonatal hypothyroidism - to monitor impact of the programme
61
Q

manpower training

A
  1. vital for success of control programme
  2. train all the workers and people engaged in it
  3. train them about everything including legal enforcement and public education
62
Q

mass communication

A
  1. nutrition education
  2. create public health awareness
  3. important for public health programme success
63
Q

hazards of iodisation

A
  1. thyrotoxicosis
  2. lymphocytic thyroiditis (hashimoto’s)
  3. iodism or iodide goitre
64
Q

xerophthalmia

A

dry eyes
all ocular manifestations due to
due to vitamin A deficiency

65
Q

non ocular vitamin A deficiency symptoms

A
  1. follicular hyperkeratosis
  2. anorexia
  3. growth retardation
  4. increased infection in children
66
Q

vitamin A deficiency - complication

A

blindness

67
Q

xerophthalmia is common in what area

A

south east asia

68
Q

xerophthalmia is common in what age group

A

1-3 years of age

69
Q

xerophthalmia is associated with what feeding practice in children

A

weaning

70
Q

risk factors for xerophthalmia

A
  1. children 1-3 years age
  2. having PEM
  3. belonging to poor
  4. parent’s ignorance about symptoms, faulty feeding practices, infections like diarrhoea, measles
  5. skimmed milk (in food donation programme)
71
Q

states affected by xerophthalmia are

A
  1. southern and eastern (rice eating states)

2. andhra, tamil, karnataka, Bihar and WB

72
Q

what cereal lack carotene

A

rice

73
Q

prevention and control of xerophthalmia - integral part of primary health care

A

strategy according to WHO

  1. short term
  2. medium term
  3. long term
74
Q

short term action for xerophthalmia prophylaxis

A
  1. oral
  2. large doses
  3. in susceptible groups
  4. periodically
  • quick organizing
  • minimum infrastructure
75
Q

medium term action for xerophthalmia prophylaxis

A
  1. promote regular and adequate intake of vitamin A
  2. fortification of dalda ghee, sugar, salt, tea, margerine, dried skimmed milk
  3. choose a food that is likely to be consumed in sufficient quantities by groups at risk
76
Q

long term action for xerophthalmia prophylaxis

A
  1. reduction/ elimination of contributing factors causing ocular diseases
  2. components of PHC
    - social and health education
    - persuading people, mothers - to eat dark green leaves PLS DO IT YOU FKIN and other food with more vitamin A
    - breast feeding promotion - better feeding of infants and children
    - improving environmental health - safe drinking water, sanitary laterines to safe guard from diarrhea
    - immunisation
    - prompt treatment of diarrhea, infections etc.
77
Q

children suffering from eye signs of vitamin A deficiency

A

5.7%

78
Q

Vitamin A deficiency - features

A
  1. even mild form cause -morbidity and mortality

2. one of major deficiencies in lower income strata children

79
Q

forms of VAD

A
  1. keratomalacia - corneal ulcers/ softening - rare

2. bitot’s spot - prevalent 2005-06 according to national nutritional monitoring bureau - more prevalent than WHO cutoff

80
Q

WHO cut off level for bitot’s spots in the community to deem the community as vitamin A deficient

A

0.8-1 %

81
Q

public health significance of VAD is given by

A
  1. mortality
  2. morbidity
    - bitot’s spots
82
Q

% of vitamin A prophylaxis of children 12 to 35 months old

A

21%

less than 10% in nagaland, 7.3% in uttar pradesh

83
Q

vitamin A prophylaxis coverage - state wise

A
  1. tamil nadu -37.2%
  2. goa - 37.3%
  3. kerela 38.2%
  4. WB - 41.2%
84
Q

1970 national programme for prevention of blindness - beneficiaries

A

1-5 years preschool children

85
Q

modification of 1970 programme

A

1992

- covered children 9 months to children of 3 years only

86
Q

Tenth 5 year vitamin A supplementation plan - 2006 guidelines

A
  1. under RCH programme/ NRHM programme

2. cover children upto age 5 years

87
Q

Tenth 5 year vitamin A supplementation plan - focus

A
  1. promote consumption of vitamin A rich foods by pregnant and lactating women and by children under 5 years
  2. promote appropriate breastfeeding
  3. massive vitamin administration up to 5 years
    - first dose - 1 lac IU with MMR at 9 months
    - subsequent doses 2 lac - every six months upto 5 years
  4. sick children
    - eye problems treated in health facilities
    - children suffering from measles - vitamin A dose if not received in the last one month
    - severe malnutrition one additional dose of vitamin A
88
Q

Nutritonal anemia

A
  1. caused by malnutriton
89
Q

definition of nutritional anemia by WHO

A
  1. a condition
  2. in which the Hb content of blood is lower than normal
  3. as a result of a deficiency
  4. of one or more of the essential nutrients,
  5. regardless of the cause of the such deficiency
90
Q

establishment of anemia

A

Hb below cut off points of WHO criteria

91
Q

common causes of nutritional anemia

A
  1. iron

2. vitamin B12, folate

92
Q

prevalence of nutritional anemia

A
  1. developing countries
    - 2/3rd pregnant
    - 1/2 non pregnant
  2. women of child bearing age
  3. young children
  4. pregnant and lactating women
  5. 4-12 % child bearing aged women in developed countries
93
Q

most common micronutrient deficiency in india - in all groups

A
  1. iron
94
Q

emergency of iron deficiency - rampant in which groups

A
  1. women of age 15-49 years
  2. children 6- 35 months
  3. low socioeconomic strata
95
Q

% of children aged upto 3 years who are anemic

A

urbans - 72.7%

rural - 81.2 %

96
Q

relationship between children and mother’s anemic status

A

states with 70% children affected
also has
over 50% pregnant women affected (except in case of punjab)

97
Q

overall prevalence of anemia in india

A

increasing

  1. 1998-99 - 74.2%
  2. 2005-2006 79.2%
98
Q

statewise prevalence of anemia in india

A
  1. bihar - 87.6%
  2. rajasthan - 85.1
  3. karnataka - 82.7%
  4. mizoram - 51.7%
  5. goa - 49.3%
  6. nagaland - 44.3%
99
Q

reasons for prevalence of anemia

A
  1. diet intake is less

2. access to health care is less

100
Q

prevalence of anaemia in adolescent girls

A
  1. according to district level health survey
  2. 2002-2004
  3. 72.6%
101
Q

prevalence of severe anaemia in adolescent girls

A

according to district level health survey
21.1%

reason:
education, economic status doesn’t make much difference
+ prevention, detection and management (PDM) not much

102
Q

prevalence of severe anaemia in preschool children

A

2.1%

103
Q

reasons for iron deficiency

A
  1. inadequate intake
  2. poor bioavailability
  3. excessive losses - example menstruation
  4. malaria
  5. hookworm
  6. less birth spacing (excessive demands and loss in delivery)
104
Q

iron bioavailability

A

(less than 5% absorbed from habitual diet)

105
Q

megaloblastic anemia - risk group

A

pregnant women of low income groups

106
Q

megaloblastic anemia is masked by

A

widespread iron deficiency (microcytic anemia)

107
Q

subclinical folate deficiency in pregnant women of north india rural areas

A
  1. 30%
108
Q

subclinical folate deficiency is common in

A
  1. pregnant women
  2. semi urban school children
  3. sporadic reports about adults
109
Q

detrimental affects of anemia

A
  1. pregnancy
  2. infections
  3. work capacity
110
Q

effect of anemia in pregnancy

A
  1. child and mother mortality and morbidity
  2. abortion
  3. premature birth
  4. hemorrhages
  5. low birth babies
111
Q

effect of anemia in case of infections

A
  1. anemia caused and aggravated due to infections and visa versa
  2. infections like malaria and intestinal parasites
  3. anemia causes decreased cell response and immunity
112
Q

effect of anemia on work capacity

A
  1. even mild degree - reduce maximal work capacity
  2. productivity directly proportional to performance inversely proportional to anemia - inversely proportional to economy
113
Q

interventions for anemia

A
  1. iron folic acid supplementation
  2. iron fortification
  3. other strategies
114
Q

iron folic acid supplementation

A
  1. prevent nutritonal anemia in mothers and children
115
Q

national anemia prophylaxis programme

A
  1. during fourth 5 year plan
  2. ifa daily tablets - to prevent mild and moderate anemia
  3. beneficiaries- pregnant, lactating women, children under 12 years
116
Q

eligibility criteria for ifa supplementation

A

12-10 g per dl Hb - ifa tablets supplied

less than 10 - refer to phc

117
Q

dosage of ifa - mothers

A
  1. 1 tab
  2. 100 mg elemental iron - 300 mg ferrous sulphate
  3. 0.5 mg folic acid
  4. daily
  5. upto 2-4 months after levels are returned to normal (progress of beneficiary)
  6. hb estimation- every 3-4 months
118
Q

dosage of ifa for children

A
  1. screening of susceptible children at 6 months, 1, 2 years
  2. 1 tab of ifa
  3. 20 mg elemental iron - 60 mg ferrous sulphate
  4. 0.1 mg folic acid
  5. 100 days
  6. 6-60 months children - dosage ferrous sulphate - liquid in bottle that dispense 1ml at a time (for safety)
  7. 6-10 years old children - included in programme: 30 mg elemental iron and 250 mcg folic acid for 100 days
  8. adolescents - same dose as adults
119
Q

fortifying salt with iron (NIN, H)

A

public health approach by govt. - reduce prevalence

  1. ferric orthophosphate
  2. ferrous sulphate with ferrous bisulphate
  3. 12-18 months daily intake of fortified salt - decrease anemia prevalence
120
Q

commercial production of iron fortified salt was started in

A

1985

121
Q

advantages of fortifications over supplementation

A

all segments of population will benefit because salt is taken by all of them

122
Q

other strategies for anemia control- where severity and prevalence is low

A
  1. change diet habits
  2. control parasite
  3. improve nutrition

high cost and time required

123
Q

low birth weight

A

less than 2.5 kg

124
Q

rapid survey report on children 2014 - % of babies lbw in india

A

18.6 %

125
Q

rapid survey report on children 2014 - % of babies lbw in developed countries

A

4%

126
Q

lbw babies in india - complications

A
  1. high proportion of babies are lbw

2. foetal growth retardation

127
Q

lbw babies in developed world - complications

A
  1. low proportions are lbw

2. mainly those babies are preterm babies

128
Q

causes of LBW

A
  1. maternal malnutrition
  2. anemia
  3. hard physical labour during pregnancy
  4. illnesses, infection
  5. short stature of women
  6. young age
  7. high parity
  8. smoking
  9. less gap between conception

everything is interrelated

129
Q

interventions for low birth weight problems

A

cause specific

treat the underlying cause like malnutrition and anemia etc.

Preventive and social medicine (13 decks)

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