Test 5 - Nutritional problems Flashcards
1
Q
Endemic fluorosis areas - water flourine content
A
3-5 mg/L
2
Q
endemic fluorosis areas
A
Andhra pradesh, Tamil nadu, Panjab, HHarayana, Karnataka, Kerela
3
Q
Toxic manifestations of endemic fluorosis are
A
- dental fluorosis
- skeletal fluorosis
- Genu valgum
4
Q
amt of fluorine that causes Fluorosis of dental enamel
A
1.5 mg/L
5
Q
groups susceptible to develop dental fluorosis
A
children under 7 years of age - when tooth calcfication is occuring
6
Q
symptoms of dental fluorosis
A
- dental enamel mottling
- teeth lose their shine
- chalky white patches develop on them
- white patches become yellow then black or brown
- enamel - subsequent loss and corrosive appearance
7
Q
mottling is best seen in which teeth
A
upper jaw incisors (permanent ones)
8
Q
skeletal flurosis - amount that cause it
A
3-6 mg daily intake for a life time
9
Q
symptoms of skeletal fluorosis
A
- deposition of F in the skeleton
2. disability
10
Q
when there is more than 10 mg /L Fluorine in drinking water
A
crippling fluorosis - permanent diability
11
Q
genu valgum - symptoms
A
- genu valgum - knock knees
2. osteoporosis of lower limbs
12
Q
genu valgum - prevelance
A
- Andhra pradesh and tamil nadu people
2. people who eat sorgham as staple diet
13
Q
role of sorghum in causing genu valgum
A
sorghum promotes higher retention of fluorine
14
Q
interventions to fluorosis
A
- 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
- chemical treatment of the water - nalgonda technique for deflouridation
- do not give fluoride supplementation to children who drink fluorinated water
- fluorine toothpaste are not recommended for children under the age of 6 years
15
Q
Nalgonda technique
A
- add lime then alum
- flocculation
- sedimentation
- filtration
16
Q
Larythrism
A
- paralysing disease of humans and animals
- neurolathyrism in humans
- osteolathyrism (odoratism) - lathyrism with skeletal deformities
17
Q
neurolathyrism
A
- crippling disease of nervous system
2. spastic paralysis of lower limbs in adults taking the pulse lathyrus sativus
18
Q
lathyrism is common in
A
- madhya pradesh
- uttar praesh
- bihar
- odissa
- where masur is grown - maharashtra, assa, rajasthan, west bengal, gujrat
- spain
- algeria
19
Q
Rewa - MP- case prevelance
A
25,000
20
Q
Satna - MP - case prevelance
A
32,000
21
Q
No fresh outbreaks in endemic areas because of
A
changes in agronomical practices
22
Q
lathyrus - local names
A
- kesari dal
- teora
- lak
- batra
- gharas
- matra
23
Q
seeds of lathyrus
A
- triangular
2. grey
24
Q
dehusked kesari dal looks like
A
- red gram or bengal gram
25
nutritional profile and other advantages of lathyrus
1. rich in proteins
| 2. cheap
26
neurotoxic dose of lathyrus
30% of total daily diet for 2- 6 months
27
lathyrus toxin
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
28
age ans sex susceptible to lathyrism
1. 15-45 years old
| 2. men
29
stages of lathyrism
1. latent
2. no stick stage
3. one stick stage
4. two stick stage
5. crawler stage
30
latent stage of lathyrism
1. apparently healthy
2. ungainly gait
3. physical signs on neurological examination
31
what among the 5 stages of lathyrism is important for preventive aspect
latent
| complete remission can occur in case of removal of lathyrus from diet in this stage
32
no stick stage of lathyrism
1. most common
| 2. short jerky steps
33
one stick stage of lathyrism
1. muscular stiffness - require stick to maintain balance
2. crossed gait
3. walk on toes
34
two stick stage of lathyrism
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
35
crawling stage of lathyrism
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
36
interventions for lathyrism
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
37
role of vitamin C in prevention of lathyrism
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)
38
banning of lathyrus sativus
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)
39
removal of toxin
1. steeping methods
2. parboiling
3. education
4. genetic approach
5. socio economic changes- overall development
40
steeping method for removal of BOAA toxin
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
41
disadvantage of steeping method
1. there is loss of vitamins and minerals of the lathyrus sativus
42
parboiling of lathyrus sativus
```
improved detoxification
1. for large scale operation
2. soak in lime water overnight
3. boil
toxin will be destroyed
trypsin inhibitors
```
43
education about prevention of lathyrism
1. dangers of consuming lathyrus
| 2. need for removing its toxin conveyed
44
genetic approach in prevention of lathyrism
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
45
low toxin varieties of lathyrus - obtained From
IARI, New Delhi
46
iodine deficiency leads to
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)
47
iodine deficiency disorders
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
48
Iodine deficiency disorders - endemic
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
49
states in himalayan belt
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
50
1960 iodine deficiency scenario of india
9 million people were affected from goitre
51
current iodine deficiency scenario of India
survey of 325 districts
- 263 districts were endemic where IDD prevalence is more than 10%
- more than 71 million persons are suffering
52
goitre control or national iodine deficiency disorder programme components
1. iodised salt or oil
2. monitoring and surveillance
3. manpower training
4. mass communication
53
salt iodisation guidelines as given PFA act
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
prophylactic public health measure against endemic goitre
iodised salt
55
iodised salt - general advantages
1. economical
2. convenient
3. effective means of mass prophylaxis
56
new product by National institute of nutrition, hyderabad
common salt fortified with iodine and iron
community trial to examine the efficacy of the two-in-one salt
57
iodised oil
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
iodised oil -adminsitration
1. 1ml i.m injection
| 2. oral
59
iodised oil
1. iodised oil
2. Na iodate
3. more costly than i.m
60
iodine monitoring
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
manpower training
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
mass communication
1. nutrition education
2. create public health awareness
3. important for public health programme success
63
hazards of iodisation
1. thyrotoxicosis
2. lymphocytic thyroiditis (hashimoto's)
3. iodism or iodide goitre
64
xerophthalmia
dry eyes
all ocular manifestations due to
due to vitamin A deficiency
65
non ocular vitamin A deficiency symptoms
1. follicular hyperkeratosis
2. anorexia
3. growth retardation
4. increased infection in children
66
vitamin A deficiency - complication
blindness
67
xerophthalmia is common in what area
south east asia
68
xerophthalmia is common in what age group
1-3 years of age
69
xerophthalmia is associated with what feeding practice in children
weaning
70
risk factors for xerophthalmia
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
states affected by xerophthalmia are
1. southern and eastern (rice eating states)
| 2. andhra, tamil, karnataka, Bihar and WB
72
what cereal lack carotene
rice
73
prevention and control of xerophthalmia - integral part of primary health care
strategy according to WHO
1. short term
2. medium term
3. long term
74
short term action for xerophthalmia prophylaxis
1. oral
2. large doses
3. in susceptible groups
4. periodically
* quick organizing
* minimum infrastructure
75
medium term action for xerophthalmia prophylaxis
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
long term action for xerophthalmia prophylaxis
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
children suffering from eye signs of vitamin A deficiency
5.7%
78
Vitamin A deficiency - features
1. even mild form cause -morbidity and mortality
| 2. one of major deficiencies in lower income strata children
79
forms of VAD
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
WHO cut off level for bitot's spots in the community to deem the community as vitamin A deficient
0.8-1 %
81
public health significance of VAD is given by
1. mortality
2. morbidity
- bitot's spots
82
% of vitamin A prophylaxis of children 12 to 35 months old
21%
| less than 10% in nagaland, 7.3% in uttar pradesh
83
vitamin A prophylaxis coverage - state wise
1. tamil nadu -37.2%
2. goa - 37.3%
3. kerela 38.2%
4. WB - 41.2%
84
1970 national programme for prevention of blindness - beneficiaries
1-5 years preschool children
85
modification of 1970 programme
1992
| - covered children 9 months to children of 3 years only
86
Tenth 5 year vitamin A supplementation plan - 2006 guidelines
1. under RCH programme/ NRHM programme
| 2. cover children upto age 5 years
87
Tenth 5 year vitamin A supplementation plan - focus
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
Nutritonal anemia
1. caused by malnutriton
89
definition of nutritional anemia by WHO
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
establishment of anemia
Hb below cut off points of WHO criteria
91
common causes of nutritional anemia
1. iron
| 2. vitamin B12, folate
92
prevalence of nutritional anemia
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
most common micronutrient deficiency in india - in all groups
1. iron
94
emergency of iron deficiency - rampant in which groups
1. women of age 15-49 years
2. children 6- 35 months
3. low socioeconomic strata
95
% of children aged upto 3 years who are anemic
urbans - 72.7%
| rural - 81.2 %
96
relationship between children and mother's anemic status
states with 70% children affected
also has
over 50% pregnant women affected (except in case of punjab)
97
overall prevalence of anemia in india
increasing
1. 1998-99 - 74.2%
2. 2005-2006 79.2%
98
statewise prevalence of anemia in india
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
reasons for prevalence of anemia
1. diet intake is less
| 2. access to health care is less
100
prevalence of anaemia in adolescent girls
1. according to district level health survey
2. 2002-2004
3. 72.6%
101
prevalence of severe anaemia in adolescent girls
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
prevalence of severe anaemia in preschool children
2.1%
103
reasons for iron deficiency
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
iron bioavailability
(less than 5% absorbed from habitual diet)
105
megaloblastic anemia - risk group
pregnant women of low income groups
106
megaloblastic anemia is masked by
widespread iron deficiency (microcytic anemia)
107
subclinical folate deficiency in pregnant women of north india rural areas
1. 30%
108
subclinical folate deficiency is common in
1. pregnant women
2. semi urban school children
3. sporadic reports about adults
109
detrimental affects of anemia
1. pregnancy
2. infections
3. work capacity
110
effect of anemia in pregnancy
1. child and mother mortality and morbidity
2. abortion
3. premature birth
4. hemorrhages
5. low birth babies
111
effect of anemia in case of infections
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
effect of anemia on work capacity
1. even mild degree - reduce maximal work capacity
2. productivity directly proportional to performance inversely proportional to anemia - inversely proportional to economy
113
interventions for anemia
1. iron folic acid supplementation
2. iron fortification
3. other strategies
114
iron folic acid supplementation
1. prevent nutritonal anemia in mothers and children
115
national anemia prophylaxis programme
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
eligibility criteria for ifa supplementation
12-10 g per dl Hb - ifa tablets supplied
| less than 10 - refer to phc
117
dosage of ifa - mothers
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
dosage of ifa for children
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
fortifying salt with iron (NIN, H)
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
commercial production of iron fortified salt was started in
1985
121
advantages of fortifications over supplementation
all segments of population will benefit because salt is taken by all of them
122
other strategies for anemia control- where severity and prevalence is low
1. change diet habits
2. control parasite
3. improve nutrition
high cost and time required
123
low birth weight
less than 2.5 kg
124
rapid survey report on children 2014 - % of babies lbw in india
18.6 %
125
rapid survey report on children 2014 - % of babies lbw in developed countries
4%
126
lbw babies in india - complications
1. high proportion of babies are lbw
| 2. foetal growth retardation
127
lbw babies in developed world - complications
1. low proportions are lbw
| 2. mainly those babies are preterm babies
128
causes of LBW
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
interventions for low birth weight problems
cause specific
| treat the underlying cause like malnutrition and anemia etc.
