Assignment Code: MFN-006/AST-4/TMA-4/22-23

Course Code: MFN-006

Assignment Name: Public Nutrition

Year: 2022-2023

Verification Status: Verified by Professor

Section A -DescriptiveQuestions (80 marks)

There are eight questions in this part. Each question carries equal marks. Answer all the questions.

1. a) Discuss the concept and levels of health care. (3)

Ans) Concept of Health Care: A basic human right is the right to health. As a result, it is essential for the State to take charge of its citizens' health. Globally, national governments are working to ensure that their citizens have access to quality healthcare in order to attain the goal.

Levels of health care are as follows:

Primary level care: An individual, their family, and their community's first point of interaction with the national health system is at this level.

Secondary level care: At the secondary level, more difficult community health issues are resolved. Through the community health centres and district hospitals, I provide nutrition treatment.

Tertiary level cure: The community's most complex health issues, which cannot be resolved at the primary and secondary level, can be addressed at this highest level of health case.

b) Briefly describe the health system of India at block level and village level. (5)

Ans) Health system at the Block level: A Block Development Officer is normally in charge of the rural planning and development of a block. Rural areas are split into Community Development Blocks, each of which has between 80,000 and 1,20,000 inhabitants and roughly 100 settlements. The idea of the community health centre was developed as a component of the larger plan to enhance the fundamental healthcare services offered to the community. A facility with 30 beds, X-ray and laboratory equipment, and services for surgery, medicine, obstetrics and gynaecology, and paediatrics were envisaged. Gynecology, paediatrics, and other specialised treatments are provided by a community health centre.

Health System at the Village Level: At the village level, three officials are in charge of attending to the community's medical requirements.

Village Health Guide: The Village Health Guide is a volunteer from the community, usually a woman, who acts as a bridge between the informal health system and the community rather than being employed by the government.

Local Dais: The government has launched a comprehensive training programme under the rural health programme to better the knowledge and abilities of all traditional birth attendants working in the nation with regard to maternal and child health.

Anganwadi Worker: For every 1000 people, there is one anganwadi worker under the ICDS programme. She is also a community-selected honorary part-time employee in charge of a range of services provided at the anganwadi.

c) What are the determinants of food security? (2)

Ans) Food security is more closely linked to who consumes food and has the means to purchase it than it is to who produces it. Additionally, it concerns who, when, and what kind of food is consumed. It pertains to how the food is made, administered, and kept, as well as to what degree of expertise. It also concerns how well a food is absorbed and what support it receives from the local environment in terms of cleanliness, hygiene, and physical as well as cultural conditions. In essence, food security is the result of the following four factors:

1. Availability of food.

2. Access to food

3. Use of food

4. Vulnerability.

   
   

2. a) Elaborate the factors which influence individual food behavior. (5)

Ans) The key driver for eating is of course hunger but what we choose to eat is not determined solely by physiological or nutritional needs. Some of the other factors that influence food choice include:

1. Biological determinants such as hunger, appetite, and taste

2. Economic determinants such as cost, income, availability

3. Physical determinants such as access, education, skills (e.g. cooking) and time

4. Social determinants such as culture, family, peers and meal patterns

5. Psychological determinants such as mood, stress and guilt

6. Attitudes, beliefs and knowledge about food

The complexity of food choice is obvious from the list above, which is in itself not exhaustive. Food choice factors also vary according to life stage and the power of one factor will vary from one individual or group of people to the next. Thus, one type of intervention to modify food choice behaviour will not suit all population groups. Rather, interventions need to be geared towards different groups of the population with consideration to the many factors influencing their decisions on food choice.

b) Briefly describe signs and symptoms of different forms of PEM. (5)

Ans) Signs and symptoms of different forms of PEM are as follows:

Kwashiorkor: Oedema, Underweight (40% of normal weight for age), Apathy and irritability, Moon face, Hair and skin changes and Micronutrient deficiencies.

Marasmus: Extreme muscle wasting - "skin and bones", Loose and hanging skin folds, Old man's or monkey faces and Absolute weakness.

Marasmic kwashiorkor: Extreme muscle wasting - "skin and bones", Loose and hanging skin folds, Old man's or monkey's face, Absolute weakness and Oedema.

3. a) Discuss methods to prevent iron deficiency anaemia in the community. (5)

Ans) There are two main methods used to assess iron deficiency.

Measurement of haemoglobin

The simplest way to determine nutritional anaemias in communities is to measure haemoglobin. Large-scale surveys actually use haemoglobin estimation due to the subjectivity involved in diagnosing clinical anaemia. It is determined using the cyanmethemoglobin technique by colorimetly and requires a blood sample that is collected in a haemoglobin pipette. India currently has affordable colorimeter devices available. usage of the hemocue method to measure haemoglobin levels. Haemocue is advised for use since it is simple to utilise in a field situation. However, there are a few accuracy-related constraints that must be taken into account.

Estimation of Iron Stores

The early stage of iron shortage is indicated by the estimation of either bone-narrow iron or serum ferritin, both of which are decreased. The other measurements used to assess the prevalence of iron shortage include serum transferrin receptors, saturation, erythrocyte protoporphyrin, and serum ferritin.

The serum ferritin (SF) test enables assessment of the population's stored iron level. Iron deficiency is also evaluated using serum iron levels. Transferrin saturation aids in determining whether the bone marrow, which is in charge of producing haemoglobin and red blood cells, is receiving an adequate amount of iron. This is a ratio of serum iron to total iron binding capacity, represented as a percentage. 33 percent is the average percentage. Iron insufficiency and recent or contemporaneous infection are both characterised by low serum iron and transferrin saturation. Similar to transferrin saturation, erythrocyte protoporphyrin aids in estimating the availability of iron.

b) Discuss the economic consequences of malnutrition. (5)

Ans) Families have less food accessible for various family members when household real income declines as a result of low economic output. Food consumption for the various family members fails as a result. In our culture, women and children are typically the ones that suffer the most from a lack of access to food at home relative to other family members. The nutritional status of the family members, particularly the mother and the child, is poor due to poor food consumption. Mothers who are malnourished are less able to care for their children, which has long-term effects on the child's development, cognitive ability, morbidities, and mortality, among other things. As a result, schoolwork is less productive. Adults with poor nutritional status have decreased stamina, endurance, and physical capacity, which lowers economic production. Therefore, the family's economic situation is impacted by this loss of productivity, which may cause it to worsen or prevent it from getting better. If no significant actions are done to raise actual household income and enhance nutritional status, this vicious cycle will continue. We can therefore draw the conclusion that nations cannot advance if individual productivity declines cause a decline in national production. This takes us to the problem of the necessity for situational analysis, intervention planning, and implementation to enhance the nutrition status.

4. a) What do you understand by demographic transition? Briefly explain the stages of demographic transition. (4)

Ans) Demography refers to the scientific study of human population. It accentuates three easily discernible human phenomena:

1. Population size changes (growth or decline).

2. What makes up the population.

3. Population dispersion across space.

Stages of Demographic Transition

First Stage: High Stationary - In this stage, a high birth rate and a high mortality rate balance each other out, resulting in a stable population. Up to 1920, India was in this phase.

Second Stage: Early Expanding - The population grows as the death rate starts to drop but the birth rate stays high.

Third Stage: Late Expanding - Further decreases in both the death and birth rates can be seen. Births outnumber deaths, which causes the population to keep expanding. India appears to be in this phase right now, which is characterised by rapid growth but clear signs of slowing.

Fourth Stage: Low Stationary - Low birth and mortality rates are characteristics of this period, which causes the population to stabilise. This is often referred to as population growth at zero. The majority of affluent countries are currently in the demographic transition period, moving from high birth and high death rates to low birth and low death rates.

Fifth Stage: Declining - The population is declining as a result of there being more deaths than births. The negative growth phase is another name for this. Some nations have already reached this stage, including Sweden and Hungary. Socially, this stage of demographic transition is undesirable because it causes complete changes in the age composition of the population, which accelerates ageing.

b) Briefly explain indirect assessment of nutritional status in community. (4)

Ans) In India, the sample registration method uses skilled investigators and defined processes to gather information on a regular basis from statistically valid samples. They release annual reports that may be used for this. Prospective studies on a statistically significant sample employing established criteria and practises are necessary for the collection of morbidity data. By visiting the chosen families either weekly or at least fortnightly, morbidity surveys collect data throughout time. The reference period in a morbidity survey is the interval between two visits. It is advised that this should never last longer than two weeks. The recollection lapse on the part of the people supplying information will increase the longer the gap. Malnutrition is frequently linked to morbidities like diarrhoea, acute respiratory infections, and measles. One could argue that a higher prevalence of these morbidities causes malnutrition. Additionally, because severe malnutrition would have compromised the infant's immune, it is possible that insufficient nutrition predisposes a child to some of these morbidities. Age-specific death rates, cause-specific mortality rates, and cause-specific morbidity rates are only a few of the various indirect indicators used to evaluate the nutritional quality of a community. Data on ecological elements that influence a community's nutritional condition are frequently gathered as well.

b) Define the following: (1+1)

(i) Birth and death rates

Ans) Birth rate: The number of live births per thousand of population per year.

Death rate: The ratio of deaths to the population of a particular area or during a particular period of time, usually calculated as the number of deaths per one thousand people per year.

(ii) Infant mortality rate

Ans) The infant mortality rate is the number of infant deaths for every 1,000 live births.

5. a) Explain the following methods for nutritional assessment: (8)

i) Biochemical assessment

Ans) In order to assess the likelihood of malnutrition, biochemical assessment measures the level of vital dietary components (nutrient concentration, metabolites) in the body fluids (often blood and urine). Before there are any clinical changes in a nutritional deficient condition, certain metabolic alterations happen. These are also thought to represent a subclinical nutritional status in relation to certain nutrients. There is a wide variety of biochemical tests that can be applied.

ii) MUAC

Ans) Mid-Upper Arm Circumference (MUAC) is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow. MUAC is used for the assessment of nutritional status. It is a good predictor of mortality and in many studies, MUAC predicted death in children better than any other anthropometric indicator. This advantage of MUAC was greatest when the period of follow-up was short.  The MUAC measurement requires little equipment and is easy to perform even on the most debilitated individuals. Although it is important to give workers training in how to take the measurement, the correct technique can be readily taught to minimally trained health workers and community-based volunteers.

iii) Anthropometry

Ans) Anthropometry refers to the measurement of the human individual. An early tool of physical anthropology, it has been used for identification, for the purposes of understanding human physical variation, in paleoanthropology and in various attempts to correlate physical with racial and psychological traits. Anthropometry involves the systematic measurement of the physical properties of the human body, primarily dimensional descriptors of body size and shape.[citation needed] Since commonly used methods and approaches in analysing living standards were not helpful enough, the anthropometric history became very useful for historians in answering questions that interested them.

iv) Weighment method

Ans) The weighment method of diet survey is weighing actual raw meals on a particular day. Before food is made, the investigator visits the homes and weighs all of the food items that will be prepared that day using a grocery scale or an electronic scale. Previously, food was weighed seven days in a row, using a process known as the "seven-day weighment method." Seven-day surveys required additional time and logistical effort. They also needed the full participation of the houses that were chosen for the job. After comparing the outcomes of the seven-day and one-day techniques, it was decided to implement one-day weighment diet surveys in the 1960s to evaluate family dietary status in villages due to the monotony of rural Indian diets with little change in the diet.

b) Write the unique features of NNMB. (2)

Ans) Unique features of NNMB as follows:

1. To evaluate long-term changes in diet and nutrition surveys, duplicate surveys were conducted in the same villages in all the states that had been polled in 1975–1979 in 1988–1990 and 1996–1997.

2. Regular collection of information on the diet and nutritional status of socially vulnerable populations, such as tribal members living in integrated tribal development project areas and the elderly and young adults who are physiologically at risk.

3. continuous gathering of information on the actual dietary intakes of households and individuals throughout a range of physiological and age categories, as well as in various states. The only company producing this kind of data is NNMB.

4. evaluation of food and nutritional distribution within families.

6. a) Explain the following: (6)

i) Components of ICDS programme

Ans) The ICDS programme is a collection of many services. The programme provides a variety of services, including:

1. Nutrition in addition.

2. Immunization.

3. Regular health examinations, minor illness treatment, and referral services.

4. Growth tracking.

5. Informal early childhood education

6. Education on nutrition and health.

7. Teenage females plan.

8. Safe water to drink.

ii) Programme strategy of NIPI

Ans) This programme is for school going boys and girls (5-10 years) and out of school girls (5-10 years) in urban and rural areas. The programme implemented through the platform of Government/Government aided/ municipal schools and AWCs. The strategy involves a “fixed day – Monday’’ approach for IFA distribution. Teachers and AWWs will supervise the ingestion of the IFA tablet by the beneficiaries.

iii)Ariboflavinosis

Ans) One of the crucial B-complex vitamins, riboflavin, whose insufficiency is regularly seen in our societies. It is common among the poorer sectors of the population of all ages, especially among youngsters and pregnant and nursing women, according to surveys conducted in various parts of the country. In the older population, it is also typical. We are aware that riboflavin functions as a cofactor in several respiratory enzymes involved in energy metabolism, including flavin adenene dinucleotide (FAD) and flavin mononucleotide (FMN). Therefore, it has a significant impact on intestinal metabolism. Therefore, a diet lacking in this vitamin results in a disorder known as ariboflavinosis, which is marked by mouth lesions.

b) Write about consequences and prevention of IDD. (4)

Ans) Consequences of IDD: Mental retardation, various problems in the neurological system's growth, goitre, physical sluggishness, growth retardation, reproductive failure, increased rates of childhood death, and decreased economic production are some of the effects of IDD. Iodine deficit during pregnancy leads to creatinine, which has a negative impact on the thyroid function of the foetus. Poor cognitive function, deaf mutism, speech impairments, and proximal neuromotor rigidity are the hallmarks of neurological cretinism.

Prevention of IDD: There are many strategies that have been developed to lessen iodine deficit. Iodized salt distribution, communication campaigns, double-fortified salt, and iodized oil are a few of these that are discussed below.

7. a) What is food fortification? Explain fortification of atta, maida and rice to combat micronutrient deficiencies. (6)

Ans) Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food. It can be carried out by food manufacturers, or by governments as a public health policy which aims to reduce the number of people with dietary deficiencies within a population. The predominant diet within a region can lack particular nutrients due to the local soil or from inherent deficiencies within the staple foods; the addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases.

Fortification of wheat flour is a cost-effective public health intervention that can reduce Micro Nutrient Deficiencies (MNDs) and prevent birth defects such as Neural Tube Defects (NTDs) due to folic acid deficiency. Wheat flour fortification can potentially reduce iron deficiency and iron deficiency anaemia.

The calcium carbonate powder, if added for fortification, shall be in such amount that 100 parts by weight of fortified maida shall contain not less than 0.30 and not more than 0.35 parts by weight of calcium carbonate. It shall be free from Rodent hair and excreta. Total ash – Not more than 1.4 per cent on dry basis.

Rice fortification, a process of adding micronutrients like iron, folic acid and vitamin B12, is an effective, preventive and cost-efficient complementary strategy to address the nutrition problem within a short period.

b) What is the importance of immunization? Briefly describe the common vaccine preventable diseases in human. (4)

Ans) In order for children to grow well, it becomes crucial to prevent infection. Immunization is a key tactic in the fight against public nutrition issues and one of the most economical ways to avoid illnesses.

Immunization boosts the body's capacity to fight off various hazardous diseases, providing protection against them. Therefore, vaccination prevents:

1. Physical and mental impairments can last a lifetime.

2. Dying due to terrifying diseases.

Common vaccine preventable diseases in human

Tetanus: The bacillus Clostridium tetani produces a toxin that causes tetanus. Typically, the bacteria is discovered in animal faeces. The disease is more prevalent in people between the ages of 5 and 40 since they are more likely to sustain injuries of all types and have a higher risk of contracting tetanus.

Poliomyelitis: A virus is the primary cause of the severe communicable disease poliomyelitis. Although it primarily affects the digestive tract, it also affects the central nervous system, frequently resulting in paralysis. It primarily affects children and young adults. The age range between 6 months and 3 years is the most vulnerable.

8. a) Describe the phases in planning Nutrition Education Programme. (6)

Ans) Phases in planning Nutrition Education Programme as follows:

Conceptualization is the first stage of designing and preparing a nutrition education programme. During the conceptualization stage, we identify the demographic groups at risk, as well as the kind and severity of nutritional disorders, and we analyse their root causes.

We give the elements we conceptualised in the conceptualization phase shape and structure in the formulation step. Clearly defining the NEC program's goals is the first step in the formulation process.

Implementation refers to performing the tasks on the ground, the word "implementation" will appear. The three components of the implementation phase are the creation of support materials, providing training, and carrying out the communication intervention.

Evaluation is the measurement and assessment of a communication program's effectiveness in achieving its objectives. Evaluation must be viewed as a crucial auxiliary activity, a tool for streamlining or reorganising communication efforts.

b) What are the components of communication process? Explain. (4)

Ans) The main components of communication process are as follows:

Sender/Encoder - Sender/Encoder is a person who sends the message. A sender makes use of symbols to convey the message and produce the required response.

Message - Message is a key idea that the sender wants to communicate. It is a sign that elicits the response of recipient. Communication process begins with deciding about the message to be conveyed.

Medium - Medium is a means used to exchange/transmit the message. The sender must choose an appropriate medium for transmitting the message else the message might not be conveyed to the desired recipients.

Recipient/Decoder - Recipient/Decoder is a person for whom the message is intended/aimed/targeted. The degree to which the decoder understands the message is dependent upon various factors such as knowledge of recipient, their responsiveness to the message, and the reliance of encoder on decoder.

Feedback - Feedback is the main component of communication process as it permits the sender to analyse the efficacy of the message. It helps the sender in confirming the correct interpretation of message by the decoder.

Section B - OTQ (ObjectiveTypeQuestions) (20marks)

1. Explain the following in 2-3 sentences each: (10)

i) Consequences of PEM

Ans) The consequences of PEM are frequently permanent and irreversible. The typical effects include:

1. Permanent growth retardation

2. Heightened vulnerability to infections

3. Increased mortality risk.

4. Poor mental performance

ii) Public Nutrition

Ans) Public health nutrition takes on a general approach, focusing on the research of disease prevention and quality of life. This area of nutrition will concentrate on research on dieting and food science. Community health nutrition is about the development of health programs that promote nutritional services.

iii) Targeted Public Distribution System

Ans) In June, 1997, the Government of India launched the Targeted Public Distribution System (TPDS)with focus on the poor. Under the PDS, States were required to formulate and implement fool proof arrangements for identification of the poor for delivery of foodgrains and for its distribution in a transparent and accountable manner at the FPS level.

iv) Aim of National Nutrition Policy

Ans) The National Nutrition Policy's objectives include highlighting the urgent need for inter-sectoral coordination to achieve nutritional goals, calling attention to the urgent need to reduce malnutrition in the nation, guiding relevant sectors to view nutrition as a result of their sectoral activities, etc.

v) Scurvy

Ans) One of the oldest diseases known to humanity, scurvy was common during the Middle Ages and caused harm to European armies. It was thought that a lack of consumption of fresh foods was to blame.

2. Explain the following terms: (5)

i) SAM

Ans) Severe acute malnutrition is defined by very low weight-for-height/length (Z- score below -3 SD of the median WHO child growth standards), or a mid-upper arm circumference < 115 mm, or by the presence of nutritional oedema. Severe Acute Malnutrition is both a medical and social disorder.

ii) Sex ratio

Ans) Sex ratio is defined as the number of females per 1000 males in a given population. In a society that has males and females equal in number, the sex ratio is 1:1 or 1000 females for every 1000 males.

iii) Low weight-for-age

Ans) Under-weight refers to low weight-for-age, when a child can be either thin or short for his/her age. This reflects a combination of chronic and acute malnutrition. Stunted and Under-weight children are most likely to suffer from impaired development and are more vulnerable to disease and illness.

iv) 24-hour recall method

Ans) The most used nutritional assessment technique is likely the 24-hour recall technique. It is used in large nutritional surveys to gather information on people's dietary intake.

v) Community participation

Ans) Community participation can be loosely defined as the involvement of people in a community in projects to solve their own problems. People cannot be forced to 'participate' in projects which affect their lives but should be given the opportunity where possible.

3. Match the following: (5)

Ans)