PREVALENCE OF PROTEIN ENERGY MALNUTRITION (PEM), VITAMIN A DEFICIENCY AND ANAEMIA
Protein energy malnutrition, micronutrient deficiencies such as vitamin A deficiency and iron deficiency anaemia are common among preschool children.
The primary cause of malnutrition is a faulty and inadequate diet. Besides diet and socio economic factors various environmental factors aggravate the dietary deficiencies. These include
1. chronic infection
2. poor environmental sanitation
3. poor insanitary living conditions and
4. poor personal hygiene.
Protein Energy Malnutrition
PEM is defined as a range of pathological conditions arising from coincident lack of varying proportions of protein and calorie, occurring most frequently in infants and young children and often associated with infection.
The symptoms vary with the degree of malnutrition. Symptoms of different types of PEM is as follows.
1. Kwashiorkor : Oedema of face and lower limbs, failure to thrive, anorexia, diarrhoea, dermatitis, apathy, sparse, soft and thin hair, angular stomatitis, cheilosis and anaemia.
2. Marasmus : Failure to thrive, irritability and apathy, diarrhoea, dehydration. The child is shrunk and there is little or no subcutaneous fat.
3. Marasmic kwashiorkor : These children exhibit symptoms of both marasmus and kwashiorkor.
4. Nutritional dwarfing : Characterised by a marked retardation of growth.
The peak prevalence of protein energy malnutrition is observed in the age group of 2-3 years and marasmus between 1-2 years. Over 80 percent of under five are estimated to be malnourished and 1-2 percent suffer from severe malnutrition. Also, more than 50 percent of deaths in children is attributed to malnutrition either directly or indirectly.
The NNMB survey (1988 - 1990) of rural children reveals that only 10 percent are normal with weights above 90 percent of the standard weights. A majority of the children exhibit mild or moderate malnutrition while 7-8 percent are severely malnourished.
About 1-2 percent of preschool children suffer from severe forms of PEM namely kwashiorkor and marasmus and more than half of the Indian preschool children suffer from sub clinical undernutrition manisfested by low weight for age. About 65 percent of them are stunted which indicates undernutrition of long duration.
Vitamin A deficiency
Inadequate dietary intake of vitamin A or its precursor (b - carotene) is the most contributory factor for vitamin A deficiency.
Blindness due to xerophthalmia is an important public health problem among children in India. The term xerophthalmia includes all ocular manifestations of vitamin A deficiency like Night blindness, conjunctival xerosis, Bitot's spot and corneal xerosis.
Vitamin A deficiency is exhibited as Bitot's spots in 3 percent of preschool children and 30-40 thousand children become blind every year. Vitamin A deficiency increases the risk of disease and death.
Iron deficiency anaemia
This is caused by the dietary lack of iron or inadequate absorption and utilization of iron. The symptoms include
1. skin appears pale
2. fingernails become thin and flat and eventually results in koilonychia (spoon - shaped nails)
3. atrophy of papillae of tongue, glossitis
4. angular stomatitis and dysphagia
5. gastritis resulting in achlorohydria
Long term deficiency symptoms result in malfunctioning of various systems. The general symptom are lassitude, fatigue, breathlessness on exertion, palpitation, dizziness, headache, dimness of vision, insomnia and angina.
More than 50 percent of preschool children suffer from iron deficiency anaemia.
The prevalence of malnutrition in preschool children is shown in List.
List : Prevalence of malnutrition among preschoolers in India
Aspects Prevalence (%)
Low birth weight 30
Kwashiorkor / marasmus 1 - 2
Bitot's spots 3
Iron deficiency anaemia 50
Underweight (weight for age) 53
Stunting (height for age) 65
Source : Dietary Guidelines for Indians - A manual, National Institute of Nutrition, ICMR, Hyderabad, India, 1999.
The high prevalence of these nutrient deficiency diseases stress the need for a balanced, nutritious diet during preschool years.