Impact of I.C.D.S. on Morbidity Due to Nutritional Deficiency Diseases amongst Tribe and Non Tribe Children

Bansal AK¹* and Chandorkar RK²

¹Deptt. of Community Medicine, Govt. Medical College, Jagdalpur (Bastar) 494001.

²Deptt. of Community Medicine, SAIMS Medical College, Indore (M.P.).

ABSTRACT

On analysis of the collected data, it has been revealed that there was improvement in the morbidity pattern of various nutritional deficiency diseases in both Tribal and Non Tribal preschoolers. This is because the inputs provided by I.C.D.S. inform of Anganwadi workers (AWW) at the grass root level even in tough terrain, but still a lot have to be done. Due linkage with the community through A.W.Ws. is to be strengthened. Health and Nutrition surveillance of eligible vulnerable groups in the offing in these tinge health and nutrition satellite (Anganwadis) at the grass rool level in the rural and tribal areas. Apart from this a “National Tribal Health Mission” must be constituted by looking into the different situation of Tribal Community.

Keywords: National Tribal Health Mission, Satellite, Inter generational cycle, Vulnerable Tribal group.

INTRODUCTION:

A child growing up today can aspire to be an astronaut sending rockets in to space, a cricket batting legend, a governments minister, a Bollywood / Hollywood film star or a teacher set to inspire a new generation of children. India is a party to the united Nations declarations of the rights of the child which gives all children, without any exception, the right to enjoy special protection, opportunities and facilities to enable them to develop physically, mentally, morally, spiritually and socially, in health and normal manner in conditions of freedom and dignify. Keeping in view the united Nations declaration and constitution of India, the Government of India adopted a National policy of the children which declares that children are “supremely important asset” of the Nation, whose nurture is therefore a National responsibility. It affirms that it shall be the duty of the state to provide adequate services to children both before and after birth and through the period of growth to ensure their full physical, mental and social development for correct perspective in health planning, consideration of morbidity pattern in the community are imperative, so as to give meaning full directions to health efforts.

Eliminating malnutrition should be our top priority as it directly contributes to child mortality, school dropout rates, gender equality and poverty reduction. Children who are chronically under nourished before their second birthday are likely to have diminished cognitive and physical development for the rest of their lives. As adults, they are less productive and even less than their health peers and the cycle of under nutrition and poverty repeats it self generation after generation

In 1957 Word Health Organization (WHO) study group emphasized that in order to give a comprehensive health status of a community, vital statistics may not be adequate and more morbidity surveys are required. This survey is in accordance of the above WHO recommendation.

DIAGRAM

Morbidity Pattran of Nutritinal Defficiences

MATERIAL AND METHODS:

A house to house survey was carried out to assess the nutritional morbidity of children (zero to six years of age) belonging to six selected Anganwadi as per sampling procedure in Kasdol block of Raipur District (C.G.).

After recording the initial information in the pre drawn proforma the child was examined clinically and the findings were recorded as per standard nutritional schedule.Nutritional Scientist conventionally defines the extent of malnutrition on the basis of indicators such as (i) Prevalence of Nutritional deficiency diseases (clinical indicator) (ii) Growth deficit or Retardation / Anthropometric indicator (iii) Nutrient deficient (deficiency indicator).

Clinical examination is one of the simplest tools to assess malnutrition, usually of the severe or florid manifestations. It involves looking for changes in the body which are indicative of a particular deficiency. This method of assessment based on recognition of certain physical signs has the advantage of relative in expensiveness as neither elaborate field equipment nor a costly laboratory is needed. Normally clinical signs are end stage of a deficiency and are characterized by anatomical changes (1).

The interpretation of clinical signs has been made by using a “grouping of signs” which have been commonly found to form a pattern as associated with the deficiency of a particular nutrient. In the present study the grouping of signs was made as follows:

1. Signs of Protein Energy Malnutrition (PEM).

Signs suggestive of PEM were Oedema, dys pigmentation of the hair, thin and sparce hair, muscle was ting, diffuse depigmentation of the skin, psychomotor changes, moon face, hepatomegaly and flaky paint dermatosis.

2. Signs and Symptoms of Vitamin “A” deficiency: prevalence rate of vitamin “A” deficiency in the community was observed by taking the history of night blindness, signs of xerophthalmia and on examination for Bitot’s spot, Conjunctival Xerosis, Corneal Xerosis, Keratomalacia.

World Health Organization (W.H.O.) (3) has suggested criteria for assessing the public health significance of xerophthalmia based on the prevalence among children of less than 6 years of ages is as follows.

Criterion: Minimum Prevalence:

i. Night Blindness (XN) - 1.0 %

ii. Bitot’s spots (X1B) - 0.5 %

iii. Corneal xerosis and /or Ulceration - 0.01 %

/ Keratomalacia. (X2 + X3 A + X3 B)

iv. Xerophthalmia related corneal scar (XS).- 0.05 %

v. Serum Retinol less than 100 ug/1. - 5.0 %

3. Signs of Vitamin “B” Complex deficiency: Angular Stomatitis, Chielosis (dry and raw lips), glositis (red and sore tongue).

4. Signs of Anaemia: Pale Conjunctiva, Koilonychia.

OBERVATIONS AND DISCUSSIONS:

On analysis of the collected data it has been revealed that in 1988, there were 13.74 % anemic children in comparison to 16.99 % in 1985. Regarding Anemia among tribes and non tribes; the percentage of anemic child was lowered in both communities.

Gupta et al (4) in Raibarely of U.P. district found 13.2 % of anemic children in ICDS block in comparison to 27.3 % in non ICDS block of same district. These findings were more or less similar to the findings of the present study.

(Table – I) reveals that there was marked reduction in prevalence of night blindness from 3.96 % in 1985 to 0.68 % in 1988 which is still above the minimum prevalence suggested by WHO (0.5 %) indicated that it is still a public health problem in the area.

Patel Renu B (5) in Bombay slums covering under ICDS noted that the prevalence percentage of Vit. “A” deficiency was lowered from 4.4 % in 1977 to only 0.7 % in 1980. Gupta et al (2) also reported of Vitamin “A” deficiency of 0.5 % in ICDS block in comparison to 4.2 % in non ICDS block of Raibarely U.P.

Regarding Vitamin “B” complex - 5.8 % children were suffering from Vit. “B” complex deficiency in 1988 in comparison to 9.06 % in 1985(Diagram). It has been further noted that there were also reduction in percentage of Vit. “B” complex deficient children of both tribal and non tribal community from 9.80 % and 8.77 % to 3.57 % and 6.67 % respectively.

Renu B. Patel (5) found reduction from 1.7 % in 1977 to 0.2 % in 1980 in Bombay slums coverd under ICDS. Gupta et al (4) found that 6.2 % of children suffering from Vit. “B” complex deficiency in an ICDS Block of Raibarely in U.P.

Vitamin “C”:- 1.31 % of children were suffering from Vit. “C” deficiency in 1988. On further analysis of the data it has been revealed that 1.78 % Tribal children were found suffering from Vit. “C” in comparison to only 0.79 % Non Tribals.

Sharma et al ICMR 1977 (2) found Vit “C” deficient children from 0.1 to 3.5 % while Soni et al (1980) in rural Rajasthan reported 0.04 % prevalence rate of Vit. “C” deficiency

TABLE I: A COMPARISON OF NUTRITIONAL DEFICIENCY DISEASES OF CHILDREN

Children Observed	1985 n = 353		1988 n = 582
Various Nutritional Deficiency Diseases	Total		Total
	No.	Percentage	No.	Percentage
Anaemia Vitamin “A” Deficiency Vitamin “B” Complex Deficiency Vit. “C” deficiency Rickets Iodine Deficiency Diseases	60 29 32 DNA DNA DNA	16.99 08.21 09.06 - - -	80 09 34 06 03 00	13.74 01.52 05.84 01.31 00.51 00.00

DNA – Data Not Available.

(Table - I) further reveals that there were 0.51 % cases of Rickets in sampled children in 1988.

Renu B. Patel (5) noted a reduction in percentage of Rickets children from 1.00 in 1977 to 0.4 % in 1980 in Bombay slums covered under ICDS.

There was not even a single case of Iodine deficiency was found in the present study.

Findings of the present study were more or less similar to the findings of the different studies conducted by different authors through out the country from time to time.

CONCLUSION:

From above observation and discussions, the authors reached to the conclusion that though there was reduction in the percentage of nutritional deficiency diseases in both Tribal and Non Tribal children since the inception of ICDS in 1985 to 1988 and the credit goes to the ICDS services which had penetrated in this difficult to reach area but still a lot have to be done in the tough terrain to improve the health and nutritional status the community specially tribal. By keeping in mind the above observations and discussions, authors recommend to constitute a “National Tribal Health Mission” at par of “National Rural Health Mission” which will formulate, implement, monitor and supervise the various health schemes in the tribal areas more effectively.

In general it has been observed that the community looks upon Anganwadis as a centre for obtaining supplementary nutrition only. Special efforts are required to bring about a change in the attitude of the community so as to make Anganwadis more a centre of community participation, not specially for nutritional improvement, but over all development of the community.

It was observed that various Nutritional deficiency diseases are not just due to poor hygiene conditions and lack of nutritional food but also because the mother herself is suffering from anaemia & malnutrition during adolescence and child bearing. They be come trapped in an inter generational cycle of ill health and poverty. Of all the proven interventions, exclusive breast feeding for the first six months together with nutritionally adequate food from six months can have a significant impact on child survival.

ACKNOWLEDGEMENT:

The authors gratefully acknowledge the traveling grant and other scientific and technical assistance provided by the Central Technical Committee of integrated child development services, New Delhi.

The author also acknowledges the services rendered by Mr. Anand Singh Kanwar, Deptt. of Community Medicine, Govt. Medical College, Jagdalpur (C.G.) for his efficient & timely typing without whose help manuscript Could not come to this form.

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Received on 10.09.2009

Accepted on 27.11.2009

Research J. Science and Tech. 1(2): Sept –Oct. 2009: 82-84