Identification of Severe Acute Malnutrition among Anganwadi Children in the Vellore Urban ICDS Project Area.

Verghese Anjilivelil, Thomas (2013) Identification of Severe Acute Malnutrition among Anganwadi Children in the Vellore Urban ICDS Project Area. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Malnutrition is a major contributor to child mortality in India. In 1995 it was estimated that Up to 67% of child deaths in India were attributed to malnutrition. Studies in 2003 and 2004 have found that malnutrition is a contributing factor in 56% of all child deaths in Developing countries. Wasting is a form of under nutrition in which the expected weight For a given height is not achieved, is due to acute malnutrition. Severe wasting is considered An important nutritional risk factor for other causes of death in children but can also be seen As a disease in itself. The WHO and UNICEF have defined Severe Acute Malnutrition (SAM) For the purpose of identifying severely wasted children who require nutritional and medical Therapy. In 2006 the WHO released Child Growth Standards for which it has been shown that The risk of mortality for children with weight for height below -3 standard deviations of the Median of the reference population is 9.4 times higher than that of children with weight for Height above -1 standard deviation from the median of the reference population. Mortality Among children with less than 115 mm mid upper arm circumference (MUAC) has also been Found to be higher than among those with MUAC above 115 mm. Since 2009 the WHO And UNICEF have adopted these cut offs together with the clinical sign of pedal edema to Define severe acute malnutrition which have been found to detect more children with Wasting, as well as identifying wasting at an earlier and more remediable stage than while Using weight for height cut offs of the NCHS reference population. OBJECTIVES : The objectives of the study were: 1. To train Anganwadi Workers of Vellore Urban Integrated Child Development Scheme Project area to identify Severe Acute Malnutrition among children attending Anganwadi Centres of the project. 2. To validate the identification of Severe Acute Malnutrition carried out by Anganwadi Workers. 3. To determine the prevalence of Severe Acute Malnutrition among children attending Anganwadis in the Vellore Urban ICDS project area. CONCLUSIONS : From the results and analysis it is concluded that: 1. The identification of SAM by the AWWs is both feasible and valid within the ICDS project that was studied. 2. The prevalence of SAM in the study population was lower than the state and national level but wasting has similar prevalence. 3. SAM has public health significance in the urban area of Vellore. In view of the public health significance of SAM and the validity of the AWW identification of children with SAM shown in this study it is recommended that the ICDS adopts the identification of SAM and wasting by the AWWs into its services with improvements in instruments and training course as suggested above. In view of the public health significance of Moderate Acute Malnutrition and the data showing that children with SAM have been misclassified as having Moderate Acute Malnutrition, it is further suggested that every child found to be wasted, i.e. WHZ less than -2 should be referred to a clinical centre for further evaluation. To improve accuracy in nutritional assessment the WHZ categorization could be done centrally by designated workers who have received further training in WHZ categorization for example the supervisors could be specially trained in WHZ categorization. The most accurate categorization would be done if the computer programme WHO Anthro was used by the ICDS. The computer programme is freely available but requires a basic desk top or laptop computer. Alternatively the programme can also be run on mobile devices such as smart phones which run on the Windows™ operating system or the Apple iOS™. This raises the possibility of using WHO Anthro during camps and giving accurate WHZ scores as soon as the measurements have been taken.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Identification ; Severe Acute ; Malnutrition ; Anganwadi Children ; Vellore Urban ; ICDS Project.
Subjects: MEDICAL > Community Medicine
Depositing User: Subramani R
Date Deposited: 24 Jul 2017 07:21
Last Modified: 24 Jul 2017 07:21

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