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Vision : The people of Bangladesh will attain healthy and productive lives through gaining
expected nutrition .
Goal
Objectives
1. Improve the nutritional status of all citizens, including children, adolescent girls,
pregnant women and lactating mothers
2. Ensure availability of adequate, diversified and quality safe food and promote healthy
feeding practices
2, Discuss nutrition specific intervention for children, adolescent girls and women.
Ans. Nutrition-specific or direct interventions for children :
Supplementary feeding
good nutrition
11. Reduction of severe protein -energy malnutrition (PEM) in under 2
children by 50 percent.
12. Reduction of moderate Protein Energy Malnutrition among Under
2 children by one-third
13. Reduction of low birth weight (LBW) incidence by 50 percent
pregnant women
15. To lay the foundation for proper psychological, physical and social
When to start:
1. When an emergency first arises, before the food pipeline and general food ration are
improved and sustained.
2. Scurvy, beriberi, or pellagra outbreaks among the target group.
When to close:
When to start : When there is a need for large-scale therapeutic feeding and to
prevent a decline in the nutritional health of the population’s most vulnerable
groups (children under five, pregnant women, nursing women, families affected by
HIV/AIDS, and the elderly).
When to stop : When the rate of acute malnutrition around the world is steady or
decreasing.
Food fortification
Biofortification
• Breeding of crops with higher levels of vitamins and minerals or higher proteins and
healthier fats
• seen as an upcoming strategy for dealing with micronutrient deficiencies in low and
middle income countries
• In the case of iron, the WHO estimated that biofortification could help curing the 2
billion people suffering from iron deficiency induced anemia .
Nutrition-sensitive value chains can occur along the consumption side of the food and
agriculture sector framework through nutrient enhancement during food processing
provide an opportunity for fortification of grain products, such as wheat or maize
flour. Fortification of wheat flour with folic acid is one example of post harvest
fortification
• Value chain interventions :
especially adept to be able to target specific micronutrient deficiencies
will have less of an impact on holistic diets as they generally only focus on
one food at a time .
interventions in a nutrition-sensitive value chain can create rural–urban linkages by
ensuring that
agricultural producers receive increased income from their products
urban consumers receive products that are fresh and nutritionally beneficial
have the potential to address food-borne illnesses through food safety
interventions, which will have a positive outcome on nutritional
status enhanced storage techniques or fortification
to prolong the shelf life of foods with high nutritional value (Cheema et al.,
2018), such as fruits and vegetables
To prevent food loss and waste
Mainstreaming and scaling up nutrition services
• The Government of Bangladesh (GOB) formulated the 5year (July 2011–June 2016)
health sector plan, the “Health, Population and Nutrition Sector Development
Program” (HPNSDP), which includes an operational plan for mainstreaming and
scaling up nutrition services nationally .
• This is a major shift from the government’s previous strategy, and for the first time
nutrition will be mainstreamed and scaled up through the National Nutrition Services, in
co-ordination with relevant ministries
• Ensure a structure is in place to integrate nutrition into the health system at every
level
• Let development partners know how we can support the GOB more effectively
Steps the Government of Bangladesh Can Take to Mainstream Nutrition
• Ensure that the health system has capacity to manage acute malnutrition cases
• The Annual Program Review (APR) of HNPSP in 2009 recommended that to scale up
the nutrition interventions the only option is to mainstream the critical nutrition interventions
in the services provided through DGHS and DGFP.
• If the present model of NNP is continued country wide by contracting NGOs, the cost
for NNS interventions will be about Tk. 5000.00 crore and it would not possible to achieve
MDG target by 2015 with the implementation of the existing model
• In light of this situation, the Government of Bangladesh has planned to accelerate the
progress in reducing the persistently high rates of maternal and child under nutrition by
• The key activities that lie outside the mandate of the health sector, NNS will play a
coordination as well as advocacy role and ensure active engagement with other the
key sectors (for example, Ministries of Agriculture, Food and Disaster Management,
Ministry of Industry, etc)
• The nutrition program will seek to intervene at the different stages of the lifecycle
– during pregnancy, at delivery/neonatal, post natal, childhood, adolescence,
newly weds .but with a strong focus on the “window of opportunity”, that is,
Food security is broadly defined as physical and economic access by all people at all times
to sufficient food to meet their dietary needs for a healthy and productive life.
All individuals :
Population-based strategies
Provide iron-folate (IFA) or multiple micronutrient (MMN) supplements to low birth weight infants
aged 2-5 months and all children aged 6-23 months, pregnant women, and breastfeeding women for
the first three months after delivery, adolescent girls and newly wed women in the recommended
dose and frequency.
If resources are available, provide IFA or MMN supplements to other vulnerable groups, such as
children aged 24-59 months, school-aged children and non-pregnant women of reproductive age in
the recommended dose and frequency.
Counsel women and caregivers on how to take the IFA/MMN supplements, the importance of taking
the full dose, and help them solve any problems they have in complying, such as managing side
effects.
Screen all children, adolescent girls and women for severe anaemia at every contact with a health
service provider using the most appropriate and feasible screening method at the health care level.
Provide appropriate treatment for anaemia or refer children and women for treatment.
In emergencies, provide MMN supplements or therapeutic spreads to children aged less than 5 years,
pregnant women, and breastfeeding women.
Provide information to women and caregivers on the danger signs of malaria, and
when and how to seek treatment.
Provide rapid malaria treatment to young children and pregnant women with
symptoms of fever or malaria in line with national malaria management protocol
Promote protection measures against malaria (use of insecticide-treated bed-nets,
particularly by pregnant women and children aged less than 5 years, and
environmental control of mosquitoes)
Set legislation and regulations for fortification with iron and other micronutrients.
Develop, produce and market foods fortified with iron and/or other micronutrients
(including folic acid, vitamin B-12 and vitamin A) for the general population.
Develop, produce, and market low cost foods fortified with iron and/or other
micronutrients for specific vulnerable groups, particularly infants and young children.
Fortify food aid products for development and emergency response programmes with
iron and other micronutrients, including school-feeding programmes.
Promote (through social marketing) foods fortified with iron and other micronutrients.
Non nutritive sweeteners are no-calorie or low-calorie artificial and natural sweeteners that
have been developed as an alternative to sugars .
Saccharin
Aspartame
Acesulfame-K
Sucralose
Stevia
Analysis of national health and nutrition examination survey data that NNs are high
intensity, low calorie, high potency, and non nutritive.
This intense sweetness allow for smaller portion yield sugar like sweetness in food
products.
Food manufacturer label them as virtually sugar free or non-calorie.
Use of NNs is that individuals struggling with obesity can enjoy the food and
beverages without the risk of consuming additional calories.
Growing concern about NNs about health and quality of life encouraged people to
avoid consumption of food rich in sugar, salt and fat.
Weight control
Diabetes control
Prevent tooth decay
Pleasant taste without increasing energy intake.
Can be used to replace sugar in cooking or baking.
Decrease calorie content of food.
Only require small amount to sweeten foods and beverages.
Obesity
Causes of Obesity :
High energy diet and over eating: daily excess of 100 kcal(equivalent to a small
chocolate bar) leads to increased body weight by 5kg over 1 year and 50 kg over
10 years.
Lack of physical activity: Sedentary life style, More involvement with media
time.
Endocrine causes : Thyroid disorder, Cushing syndrome, growth hormone
deficiency
Diagnosis of obesity
(CAT SCAN)
Surgical treatment
Prevention
Eat healthy diet-low fat die high fiber(fruit and vegetables) whole grain, nut
Limit intake of CHO, sugar free diet(now NNs show healthy and beneficial effect.)
Dietary Fiber
Write down consequences of over nutrition. 'Obesity is a leading nutritional problem'-
Justify?
The latest WHO projections indicate that at least one in three of the world's adult
population is overweight and almost one in 10 is obese. Additionally, there are over
40 million children under age five who are overweight.
Being overweight or obese can have a serious impact on health. Carrying extra fat
leads to serious health consequences such as :
16. Cardiovascular disease (mainly heart disease and stroke)
17. Type 2 diabetes
18. Musculoskeletal disorders like osteoarthritis
19. some cancers (endometrial, breast and colon).
The risk of health problems starts when someone is only very slightly overweight,
and that the likelihood of problems increases as someone becomes more and more
overweight. Many of these conditions cause long-term suffering for individuals and
families. In addition, the costs for the health care system can be extremely high.
Examples include
The Geo Nutrition Project has demonstrated results that micronutrient deficiencies of
selenium can be alleviated through adding selenium fertilizers to staple cereal crops in
Malawi (Joy et al., 2019) .
Write down the impact of nutritional anemia. Mention the strategies for prevention of
nutritional anemia in Bangladesh.
Distinguish between bulimia nervosa and binge eating disorder.
Malnutrition in its many forms has previously been understood and approached as a
separate public health issue
new emergent reality is that under-nutrition and overnutrition are interconnected and,
therefore, double-duty actions that simultaneously address more than one dimension
must be implemented for policy solutions to be effective
• Early life under-nutrition is an underlying cause associated with about a third of young
child deaths
• Among the survivors that become stunted in the first two years of life, their capacity to
resist disease, to carry out physical work, to study and progress in school, are all
impaired across the life course
• Later in the life course, diet and nutrition, and especially obesity, are important
underlying causes of many noncommunicable diseases (NCDs), including hypertension,
diabetes, cancer, stroke, and ischemic heart disease
• NCDs are responsible for the majority of deaths worldwide and are disproportionately
high in LMICs where nearly 80 percent of NCD deaths occur
• Nearly half of NCD deaths in 2008 were caused by cardiovascular disease (CVD)
• The metabolic syndrome, in which abdominal obesity and type 2 diabetes play a central
role, is associated with a doubling of cardiovascular disease risk
• The costs of treating the metabolic syndrome are considerable and growing, consuming
increasingly larger proportions of health budgets in both LMICs, and higher income
countries
Define Mainstreaming and Scaling Up of Nutrition.
1. Anorexia nervosa:
Anorexia nervosa is likely the most well-known eating disorder.
It generally develops during adolescence or young adulthood and tends to
affect more women than men .
People with anorexia generally view themselves as overweight, even if
they’re dangerously underweight. They tend to constantly monitor their
weight, avoid eating certain types of foods, and severely restrict their calorie
intake.
Common symptoms:
2. Bulimia nervosa :
Binge eating disorder is the most prevalent form of eating disorder and one of
the most common chronic illnesses among adolescents.
Common symptoms :
Eating large amounts of food rapidly, in secret, and until uncomfortably full,
despite not feeling hungry
Feelings of distress, such as shame, disgust, or guilt, when thinking about the
binge eating behavior
4. Pica
Pica is an eating disorder that involves eating things that are not considered food and
that do not provide nutritional value .
Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap,
paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch.
Pica can occur in adults, children, and adolescents.
It is most frequently seen in individuals with conditions that affect daily functioning,
including intellectual disabilities, developmental conditions such as autism spectrum
disorder, and mental health conditions such as schizophrenia .
Individuals with pica may be at an increased risk of poisoning, infections, gut injuries,
and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.
5. Rumination disorder
Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.
The term has replaced the term “feeding disorder of infancy and early childhood,” a
diagnosis previously reserved for children under age 7 .
Individuals with this disorder experience disturbed eating due to either a lack of
interest in eating or a distaste for certain smells, tastes, colors, textures, or
temperatures.
Common symptoms of ARFID include :
avoidance or restriction of food intake that prevents the person from eating
enough calories or nutrients
eating habits that interfere with typical social functions, such as eating with
others
In addition to the six eating disorders above, other less known or less common eating
disorders also exist.
Eating disorder treatment plans are specifically tailored to each person and may
include a combination of multiple therapies.
Treatment will usually involve talk therapy, as well as regular health checks with a
physician
It’s important to seek treatment early for eating disorders, as the risk of medical
complications and suicide is high ,
Listening to them. Taking time to listen to their thoughts can help them feel heard,
respected, and supported. Even if you don’t agree with what they say, it’s important
that they know you’re there for them and that they have someone to confide in.
Including them in activities. You can reach out and invite them to activities and social
events or ask if they want to hang out one-on-one. Even if they do not want to be
social, it’s important to check in and invite them to help them feel valued and less
alone.
Trying to build their self-esteem. Make sure they know that they are valued and
appreciated, especially for nonphysical reasons. Remind them why you are their
friend and why they are valued.
Lactose intolerance
Autosomal recessive genetic disorder that prevent lactose tolerance from 1st
feed
Infant fail to thrive unless given lactose free formula feed.
Symptoms
• Can be mild to moderate, depending how much lactase body can make. Symptom
usually begin 30 minutes to 2 hours after drinking milk or milk product.If have, LI
may include
• Bloating
• Pain
• Crump
• Gurgling or rumbling sound in belly
• Diarrhea
Diagnosis
• Dietary history
• Family History
• Patient has underwent partial gastrectomy and other related procedure
• Test
• Stool acidity test, Hydrogen breath test
Treatment :
There is no cure for Lactose intolerance but treatment is by limiting or avoiding milk
& milk products. Some people use milk with reduce milk or substitute soy milk, soy
cheese for milk or milk product.
Disease Treatment
There is no cure for Lactose
intolerance but treatment is by
limiting or avoiding milk & milk
Lactose intolerance
products.
Some people use milk with reduce
milk or substitute soy milk, soy
cheese for milk or milk product.
Control by nutritional therapy,
mainly both galactose and lactose
free diet.
Galactosemia and galactosuria
Infant should fed soya formula.
Continued dietary restriction of
dairy products in older child