Persistent Integrated Drought Management Health Component

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Nonstop & Integrated Drought Management Health Component Dr. Bela Shah, ICMR Dr. R. C. Sharma Desert Medicine Research Center JODHPUR dmrc Desert Medicine Research Center

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Network of ICMR Institutes

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Rajasthan India IGNP

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DMRC Current Programs Dengue RF/RHD registry Malaria Diabetes Tuberculosis Hypertension Nutrition Musculoskeletal disorders Emphasis on: Focused research of pertinence to Public Health dmrc Desert Medicine Research Center

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Micronutrient lack issue, Nutritional Status & horribleness in pregnant & lactating ladies 28 towns from Luni Panchayat Samiti, Jodhpur tehsil Covered 1193 ladies 384 Pregnant ladies 400 Lactating ladies 409 NPNL ladies (Control)

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Iron Deficiency: Hemoglobin levels Iodine insufficiency issue : UIE levels (WET processing strategy) Iodine substance of salt example (standard iodometric titration technique) Nutritional inadequacy signs & Morbidities Dietary example (24 hour review technique)

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Iron Deficiency Disorder (Figures are in percent)

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Iodine Deficiency Disorder Figures are in percent

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Major Nutritional Deficiency Signs Pregnant Controls n=384 n=409 VAD-Night visual deficiency 8.8 % 0.9 % Thyroid extension 3.1 % 0.5 %

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Dietary Intake Pregnant & lactating ladies Percent of RDA Cereals utilization 79 Fats & Oils 80 Pulses & vegetables 56 Leafy Vegetables 9.5 Milk & Milk nourishments Adequate n=148

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Dietary Deficiencies Protein (20%) & Calories 40 % Iron (36%) & Folic Acid 57 % IFA tablets consumption–43 % Consumption of Iodized salt-19.1 %

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Nutrition Monitoring Jodhpur District 30 towns from six Tehsils Covering 600 family units

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Nutritional inadequacy signs Anthropometric estimations Ht, Wt, MUAC & FFT Dietary admission 24 hour review technique Nutritional morbidities

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Major Nutritional Deficiency Signs n=3540 Dental caries-31.2 % Dental Fluorosis-25.2 % Hair Discolouration-6.0 % Gums elastic/dying 2.6 %

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Nutritional Morbidities n=3540 ARI - 5.4 % Fever - 4.5 % Diarrhea - 1.1 % N.A.D. - 88.7 %

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Nutritional Status Preschool kids 1-5 (n=553) Grades Normal Mild Moderate Severe Under Nutrition 18.6 27.3 15.9 38.2 (Wt for age) Stunting 28.4 14.8 56.2 (Ht for age) Adults Obesity Normal CED I CED II CED III n=1148(BMI) 7.8 57.2 18.7 9.1 7.2

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Dietary Deficiencies (n=1565) Diet terribly inadequate in GLV - 91.0 % Fats - 55.0 % Pulses & vegetables - 59.5 % Other Vegetables - 35.0 % Cereals - 20 % of RDA

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Sub-Clinical Vitamin-A Deficiency among offspring of Rajasthan A UNICEF supported m ulti driven and cross sectional study Covering seven locale of Rajasthan from seven distinctive agro-climatic zones Sample Size: 3000 youngsters (6-71 months) from Rural and Urban areas

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Nutrition Research center: - Nutrition map book for Desert - Monitoring of Nutritional Deficiencies and related morbidities - Development of Nutritional intercession bundle considering Socio-behavioral & social perspectives dmrc Desert Medicine Research Center

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Projects Proposed Fortification of wheat & millet flour with iron alongside twofold fortress in salt & their effect on nourishment status of preschool kids DBT-NIN organizing Development of sustenance bundle for Micronutrient insufficiencies & its effect appraisal on pregnant & lactating ladies Impact evaluation of utilization of three electrolyte items on mineral profile & general wellbeing profile of Jawans in betray regions of Rajasthan DFRL,Mysore Estimation of Zinc def. in school youngsters

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Expertise Medical anthropologists Clinicians Social researchers Trained Technicians

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Infra structure Anthropometric types of gear for Anthropometry Dietary mugs, parities and so on for Dietary admission Colorimeter, spectrophotometer & HPLC for biochemical examination of MDDs (Iron, Iodine, Vitamin A)

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Suggested Monitoring Crude Mortality-Secondary & Primary Acute Malnutrition } Anthropometry Chronic Malnutrition } Food Access/Availability } Dietary Diversity } Intake

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Target Group Pregnant Women Preschool kids

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Monitoring Parameters Nutritional status: Anthropometry Dietary Intake Nutritional lack signs Biochemical tests Outcome of pregnancy: Abortions Still Birth Under weight new conceived

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Impact of Under-Nutrition Under weight kids Anemic moms Marasmic babies Vitamin An inadequacy visual deficiency Vitamin B insufficiencies Vitamin C insufficiencies

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Monitoring Parameters Anthropometry Acute Malnutrition: Weight/Height (Wasting) Weight/Age Chronic Malnutrition: Height/Age (Stunting) Dietary Intake 24 hour review strategy: Food Access Food Availability Food Diversity

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Nutritional Deficiency Signs Protein-vitality hunger Popn. Aggregate Clinical Symptoms/Signs Children Always display Marasmus Wasting Kwashiorkar Oedema Marasmic Wasting + Oedema Kwashiorkar Adults Wasting & shortcoming

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Nutritional Deficiency Signs 2. Frailty - Pallor (palms, Tongue, conjunctiva) 3. Vitamin An inadequacy (XN) Night visual impairment (X1A) Xerosis of conjunctiva (X1B) Bitot spot (X2) Xerosis of cornea (X3A) Xerosis of cornea + ulcer (X3B) Keratomalacia (XS) Corneal scar + history of VAD

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Nutritional Deficiency Signs 4. Vitamin B complex lack 1. Riboflavin (B2) & Pyridoxine (B6) inadequacy Angular stomatitis Chelosis Glossitis 2. Thiamin insufficiency (B1) Beriberi * 3. Nicotinic corrosive insufficiency (B2) Pellagra *

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Nutritional Deficiency Signs 5. Vitamin C lack - Scurvy Fluoride - Dental Caries Dental Fluorisis 7. Iodine lack issue - Goiter Cretinism

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Response DMRC proposes to take an interest and share obligation in endeavors towards 1.Development of financial dry spell observing pointers and 2. Affect evaluation of moderating measures on five parameters Crude Mortality, Acute Malnutrition, Chronic Malnutrition, Food Access/Availability, Dietary Diversity

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THANKS dmrc Desert Medicine Research Center