Nutrition -2

Nutritional Problems in Public

Health

Dr. Wafa Taha Hussein

(MBBS, MD- COM. MED)
 Outlines:

1/ Common Nutritional Problems

2/ Common Nutritional Problems in Sudan.
 • Nutritional problems or deficiency occur when a
person's dietary intake does not contain the right
amount of nutrients for healthy functioning, or
when a person cannot correctly absorb nutrients
Nutritional from food .
• Nutrition disorders can be caused be
Problems undernutrition, over nutrition or an incorrect
balance of nutrients.
• Nutritional problems or Deficiencies can lead to a
variety of health problems.
1/ Common Nutritional Problems
Nutritional Problems in Public Health

Types of
nutritional
problems

Undernutrition
(Malnutrition) Overnutrition
Types of Malnutrition

Malnutrition

PEM MICRONUTRIENT
 PEM or PE Undernutrition is a major
health problems in developing countries
and is most common in Sudan

Protein –Energy Malnutrition (PEM) is an

important cause of morbidity and
mortality and can lead to impairment of
1/ Protein –Energy physical and mental growth in childhood
Malnutrition(PEM) Globally in 2020, 149 million children
under 5 were estimated to be stunted
(too short for age), 45 million were
estimated to be wasted (too thin for
height)
PEM has mild, moderate, and severe
degrees
Around 45% of deaths among children
under 5 years of age are linked to
undernutrition
 Inadequate intake of food
Respiratory infections
Measles
Poor event/Hygiene
Causes/ Contributory
Large family size
Factors for
Undernutrition(PEM)-:- Failure of lactation
Premature termination of
breastfeeding
Premature termination of
breastfeeding
Delayed supplementary feeding
Use of over-diluted cow’s milk
 Undernutrition

 Undernutrition includes:
Stunting
Wasting
Severe acute malnutrition
Kwashiorkor
Marasmus
 • Child stunting, defined by significantly impaired
growth and development( low height-for-age).
• Stunting is measured by a height-for-age (z-score of
more than 2 standard deviations below the World
Health Organization (WHO) Child Growth Standards
median).
• Child stunting can be related to many factors,
including:-
 socioeconomic status
 Stunting:-  dietary intake
 infections
 maternal nutritional status
 infectious diseases
 micronutrient deficiencies and the environment.
 • Wasting is defined as low weight-for-height. It
often indicates recent and severe weight loss,
 Wasting:- although it can also persist for a long time. It
usually occurs when a person has not had food of
adequate quality and quantity and/or they have
had frequent or prolonged illnesses
 • Is defined as very low weight–for–
height/length (Z-score below 3SD of
 Severe Acute the median WHO child growth
standard), a mid-upper arm
Malnutrition:- circumference <115mm, or the
presence of nutritional oedema.
 • Kwashiorkor is the most widespread
nutritional disorder in developing
countries. It is a form of severe
malnutrition caused by inadequate
protein intake and low concentration of
 Kwashiorkor essential amino acids.
• The main symptoms of Kwashiorkor are
oedema, wasting, liver enlargement,
hypalbuminaemia, steatosis, and possible
depigmentation of skin and hair.
Kwashiorkor
 • Marasmus is a severe form of malnutrition
that consists of the chorionic wasting away of
fat, muscle, and other tissues in the body.
• It is a form of severe cachexia with weight
 Marasmus loss because of wasting in infancy and
childhood.
• The main symptoms of marasmus are severe
wasting, with little or no oedema, minimal
subcutaneous fat, severe muscle wasting, and
non-normal serum albumin levels.
 Comparative chart between Kwashiorkor and Marasmus :-

Kwashiorkor Marasmus
 Acute illness/infections .  Severe prolonged starvation.
 Protein is principal nutrient.  Chronic /recurring infections.
 18 months to 3 years.  Calories and Protein are principal
 Some weight loss. nutrients.
 High mortality  6 months to 2 years.
 Edema, swollen legs  Severe weight loss
 Low mortality
 • Vitamin A deficiency is a major health
problem affecting an estimated
preschool-age.
• Inadequate intake of Vitamin A for
3/ Xerophthalmia( dry eye):- infants and children could lead to
Vitamin A deficiency, which can cause
visual impairment ( night blindness)
or increase the risk of illness and
mortality from childhood infections
such as measles.
 • Administering large doses of vitamin A
orally periodically.
Prevention and • Regular and adequate intake of vitamin A.
Control:-
• Fortification of certain foods with vitamin
A periodically
 • Nutritional Anemia is a condition in the
blood that is lower than normal as the result
4/Nutritional Anaemia:- of a deficiency of one or more essential
nutrients, regardless of the cause of such
deficiency.
 • Inadequate diet.
• Insufficient intake of iron.
• Iron malabsorption.
• Pregnancy.
 Causes / Risk Factors
• Hookworm infection.
• GIT bleeding.
• Others.
 • Estimation of Hb to assess the degree
of anemia
• Blood transfusion in severe cases of
anemia (<8g/dl)
Prevention:- • Iron and Folic acid supplements
• Change dietary habits
• Control of parasites
• Nutritional education and awareness
 Globally IDD is estimated that 2 billion
individuals have insufficient iodine intake.
Iodine deficiency during pregnancy and
infancy may impair the growth and
neurodevelopment of the offspring and
5/Iodine Deficiency :- increase infant mortality.
Iodine deficiency during childhood reduces
somatic growth and cognitive and motor
function.
 Iodine Deficiency Disorders:-
Subnormal Delayed motor
Goiter Hypothyroidism
intelligence milestones

Mental Mental
Hearing defects Speech defects
deficiency retardation
6/ Endemic Fluorosis:-
• Is the result of an excessive amount of
Fluorine in drinking water.
• Fluoride is the 13th most abundant
element available in the earth crust
• Permissible limit of Fluoride is 1.0mg/l
as safe limit for human consumption
 The toxic manifestations of Fluorosis
are:-
Dental fluorosis
Skeletal fluorosis
Genu valgum
 Earth’s
Dental Fluorosis

 It occurs when excess fluoride is ingested during

the years of tooth calcification(first 7 years of
life)
 Characterized by mottling of dental enamel
which has been reported
 Fluorosis seen on the incisors of the upper jaw
 Skeletal fluorosis

Is associated with a lifetime daily

intake of 3-6mg/L or more
Heavy deposition of fluoride in the
skeleton
When a concentration of 10mg/L is
exceeded, it leads to permanent
disability
Genu valgum

Is a form of F fluorosis characterized by genu

valgum and osteoporosis of lower limbs
  Changing the water sources
 Chemical defluorination
Intervention  Preventing use of fluoridated toothpaste
 Cardiovascular Diseases

Cardiovascular Diseases are classified as food habit-

related illnesses
Food habits and lifestyle have increased the risk of
CVD
 2/ Overnutrition

• Is defined as a pathological state resulting from an absolute or relative

excess of one or more essential nutrients
• Overnutrition can lead to:
Obesity.
Oversupplying a specific nutrient, such as dietary minerals or vitamin
poisoning.
2/ Common Nutritional Problems in Sudan
 Sudan suffers from the chronic burden of
malnutrition in its many forms and for various
populations of interest.
Child stunting and wasting are persistently high
with prevalence higher than the average for
Sudan nutritional situation:- developing countries.
Levels of anemia are high in children and adults
alike and there is an increasing prevalence of
obesity and overweight in these groups as well
 • Iron Deficiency Anemia:
• no national estimates; In some states, it ranges
from 55 % to 80% (under-five children and
pregnant women (2004)

• Iodine deficiency disorders :

Micronutrient Deficiencies:
• 22% of school-age children have goiter (MOH
1999)
• Iodized salt consumption is less than 10 %.

• Vitamin A deficiency :
• No national estimates, but night blindness
prevalence is: 1- 4.8 ( more than 1% is a public
health problem )
 Nutrition Situation in Sudan
Indicator %

Underweight 32

Stunting 33

Wasting 14.8 (900,000)

• Source: SHHS 2006
SAM 3.5 (210,000)

EBF 0-5 months 34

Timely complementary feeding 56

 Sudan has a challenging context:
 Long-standing conflicts.
 Recurrent drought
Sudan Context:  Low income (economy).
 Food shortage
 Environmental deterioration and
 Infectious diseases
 •54% of child deaths in Sudan are
underweight.
• Severe wasting is an important cause of
these deaths.
Undernutrition and
•Proportion associated with acute
Child Mortality malnutrition often grows dramatically in
emergency contexts.
Causes of Child Mortality and Mobility

Pneumonia
16% 20%11%

6% 11%
Others
Diarrhoea
27%
20%
Malnutrition
60%

13%

Measles
10% Malaria
23%
43%
Prevalence of stunting in Sudanese children < 5 years old

40% 38.7% 38.2%

36.4%
35.0%
35%
% of child < 5 stunted

30%

25%

20%

15%

10%

5%

0%
2006* 2010 2014 2019
Year
The prevalence of wasting in Sudanese
children <5 years old

18%
16.8% 16.4% 16.3%
16%
13.6%
14%
% of child <5 wasted

12%

10%

8%

6%

4%

2%

0%
2006* 2010 2014 2019
Year
Acute Malnutrition-trend
Vitamin A
situation in
Sudan
Consumes
plant sources
of vitamin A
Consumes animal
sources of vitamin A
Vitamin A coverage in Sudan
Child : Vitamin A supplementation coverage
79.95

67.73
59.90
58.24
51.52 55.20
48.31 49.68
44.06
37.44 39.87
35.49
26.92

19.17 21.89
19.03
12.71
8.03
7.16

Northern River Nile KhartoumAl-Gazeera Sinar Blue Nile White Nile Red Sea Kassala Al-Gadarif North South West North South East West Central Sudan
Kourdofan Kourdofan Kourdofan Darfur Darfur Darfur Darfur Darfur
 Strategies and Interventions

Based on National Policy and Guidelines

1. PEM:
• Growth Monitoring and Promotion
• Promote Infant and Young Child Feeding.
• Selective feeding programs:
• Supplementary Feeding
• Therapeutic feeding P (TFP)
• Nutrition education and Counseling
Strategic No:1

distribution of
micronutrient tablets
to the target people
Strategic No:2

Food Fortification in Sudan

Industrial ,Wheat Fe, folic acid, Zinc Oil vit A Salt with Iodine

Bio fortification : Sourgam and Millet

Home Fortification
Strategic No:3 Community
Mobilization
 Other Intervention

• Nutrition Surveillance
• Emergency Interventions
Thanks