Perspectives on nutrition needs for the new millennium for South Asian regions

South Asia is the most populated region of the world with several nutritional challenges. Though per capita food energy supply, child survival and life expectancy have improved, and even today large segments of the population are below the poverty line with high infant and maternal mortality rates. It is important to recognize the crucial role of nutrition throughout the life cycle-from conception to old age. It is very necessary now to move from food security to nutrition security and improve the quality of foods both in macro- and micronutrients in order to break the transgenerational effects of malnutrition. The key solutions to the problems should address the issue of social development, population stabilization, environmental degradation and inadequate health and nutritional services. Strategies for empowering women and actuating community participation as sustainable programmes for human development, measures to reduce underweight and stunting in children and prevention of micronutrient malnutrition across the population are required. Enhancing food and nutrition security through innovative diversified agriculture and dietary practices, prevention and control of infection, promotion of food safety and fortification of staples with appropriate attention on emerging chronic disorders are essential. Population control measures to stabilize the fertility rates, biotechnological approaches for genetically modified foods, nutrition surveillance based on assessment, analysis and action to address the logistic, technical and compliance issues with emphasis on promotion of breast feeding and complementary foods with adequate attention on the reproductive needs of adolescent girls, pregnant mothers and lactating women would eliminate low birth weight, stunting, and chronic energy deficiency in vulnerable groups. Focused studies on bioavailability of micronutrients and its enhancement, innovative horticulture interventions, fortifications, social marketing strategies would promote the intake of micronutrient and phytonutrient rich foods. In-depth epidemiological research, an insight into foetal origins of adult disease and nutrition-genes interaction and life style alterations will avert the emerging epidemic of chronic diet related disorders. An investment in preventing foetal malnutrition improves nutrition of women in reproductive age, infant and child nutrition and prevents the onset of chronic disease in adult life. Human resource development, IEC measures, technology transfer, operational and logistic research, building of databases, integrated, intersectoral, multidisciplinary plans and sound management information system and surveillance with net working and experience sharing in the region will help to overcome the common challenges and lay the foundation for a better scenario in these regions in the near future.     

Fertility,knowledge, attitude and practice (KAP) study in relation to family planning in a selected population of the Armed Forces

A study was carried out among the civil and military population in Poona, India, to determine their knowledge, attitude, and practices in relation to family planning and the fertility rates of women aged 15-44 in the following catagories: 1) total and age specific marital fertility rate; 2) order of birth of the children born during the previous year; 3) average number of living children per couple; and 4) percentage of currently pregnant women. 251 civilian wives and 230 military wives were interviewed. Both total marital fertility rates and age specific marital fertility rates were high among the Service families, due perhaps to the predominance of young people in the military. Most of the live births occurring in the previous year were of the 1-3 order. Similarly, the average number of children per couple was low, only 1.7, although the number of children in completed families (4.4) was not too much lower than in civilian Poona families (4.8) and in India in general (5.5). Nearly 2/3 considered 3 children the ideal, although the desire for boys was intense and could lead couples to seek more than 3 children. Only 10% favored abortion on demand. More Service than civilian families knew about and practiced family planning, though the number practicing was only 27.8%. The most widely known methods were sterilization, the condom, and the IUD. The image of family planning among the civilian population was of family limitation, whereas some Service personnel regarded it as a means of child spacing. Practice of family planning was highest among Junior Commissioned Officers, the more literate, and those in the 30-34 age group. There was a positive correlation between family planning practice and number of living children. It is recommended that fertility statistics on military personnel be maintained annually. Further, as it was discovered that 20% of the military wives were currently pregnant, the family welfare planning staff and maternal health services and the Military Hospitals have a good opportunity to provide service for both the limitation and spacing of families.     

关于计划生育技术的伦理论争与思考

计划生育技术在经历了漫长的探索与发展后，已为大多数人所认同并采纳，成为调节人类生育行为的重要手段。然而，避孕、人工流产、绝育技术的施行却引发了激烈的伦理道德问题论争。以发展的观点看，人们理性地选择避孕节育手段，于个人、家庭、社会都是有益的，合乎社会道德规范要求。     

India increases spending on health

The government of India announced that the fifth Five-Year Plan (1974-1979) will provide a total of $2,316,000 for health, family planning and nutrition programs. During the next five years emphasis will be placed on increasing the accessibility of health services to rural areas, correcting the uneven distribution of medical manpower, intensifying control of communicable diseases, and improving educational training of health personnel at all levels. The family planning program will continue to receive the highest priority. The main goal will be to achieve a reduction of the birth rate to approximately 30/1000 population. Methods of family planning in India include IUD insertion, sterilization, oral contraception and the presently very popular vasectomy.     

Prevalence and determinants of obesity in the adult population of Kanpur district -- a population-based study

Worldwide, obesity is the most prevalent form of malnutrition. It is one of the most significant contributors to ill health and an indirect cause of morbidity and mortality resulting from hyperlipidaemia and glucose intolerance. Very few studies on the prevalence of obesity have been reported from developing countries like India. The present study was therefore undertaken to determine the prevalence of obesity and its predictors in the Indian community. The objectives are: (1) To determine the prevalence of obesity, (2) to study the relationship of obesity with age, (3) to identify the predictors of obesity. This community-based cross-sectional study was conducted on 801 subjects, aged 20 years and above in Kanpur District, using multistage stratified random sampling technique. Data was analysed using the software statistical package for social sciences 10.0.1 for windows. Prevalence of obesity was found to be 4.7%. An increase in body mass index was seen with increasing age. A higher prevalence of obesity was seen in the urban population and in women. Age, gender and daily intake of saturated fatty acids were found to be the main predictors of the obesity. An increase in the level of physical activity resulted in a decrease in the prevalence of obesity (odd's ratio = 0.36). Obesity is an emerging public health problem in the Indian population which indicates that intervention at the primary healthcare level, especially in diet and activity, are important for its prevention.     

Family planning in India

The government of India is paying increasingly more attention to family planning in the country. For the years 1969-1974, the so-called Fourth Development Plan Period, the budget for family planning and population control is nearly 12 times that for the previous 5-year period. A total of $432.75 million has been appropriated for family planning and population control during the Fourth Development Plan. A large percentage of this money has been marked for research and development of new methods and means for the most practical family planning and fertility control. Most of this research is coordinated by the Indian Council of Medical Research. Fertility control in India consists of public education, family counseling, and direct medical aid.     

2012年韶关市5岁以下儿童营养不良的影响因素分析

目的研究分析5岁以下儿童营养不良的各项影响因素。方法选取该地区2012年5岁以下儿童2 800人,对所有儿童的营养状况、饮食情况、出生情况以及家庭各成员知识程度等方面进行调查,探讨5岁以下儿童营养不良的各项不良因素。结果该次调查的2 800名5岁以下儿童中,有348名儿童存在不同程度的营养不良,占12.4%,其中：体重偏低92人,占3.3%。体重偏重104人,占3.7%。生长发育延缓152人,占5.4%。在348名营养不良儿童中,家庭成员文化程度在初中及以下的共有264人,占75.9%。儿童日常饮食中较为常见的辅助食品为：谷物、薯类、肉类、奶制品、蔬菜以及水果等。结论影响5岁以下儿童营养不良的主要因素为家庭成员的文化程度、日常饮食以及出生情况,对此应该尽量改善儿童膳食结构、建议母乳喂养,对于儿童后期的健康成长具有十分重要的意义。     

维持性血液透析患者营养状况分析

目的 分析维持性血液透析患者营养状况及发生营养不良的危险因素,为营养干预提供依据。方法 对98例患者进行3d内的24h膳食调查及改良定量主观营养评估(MQSGA),并进行必要的人体学测量及生化指标的测定。结果 膳食调查结果显示,实际标准体质量每日能量摄入量(DEI)为(117.15±5.98)kJ/(kg·d)、每日蛋白质摄入量(DPI)为(1.02±0.42)g/(kg·d),优质蛋白质的摄入量为(19.8±12.9)g/d。患者的DPI、DEI及优质蛋白质的摄入量均低于推荐标准。营养评估结果显示营养不良患者比例占48.9%。透析充分患者较透析不充分患者营养不良发生率低,组间差异有统计学意义(P<0.05)。60岁及以上老年患者营养不良发生率明显高于60岁以下患者(P<0.05)。结论 维持性血液透析患者营养不良发生比例较高,主要与透析不充分、蛋白质及能量摄入不足、年龄等因素有关。     

Maternal malnutrition,perinatal mortality and foetal pathology--a clinicopathological study

The close relationship between the maternal malnutrition and consequent birth of low birth weight babies and the perinatal mortality is now an accepted fact and has been studied extensively in developed countries, though the problem is more acute in developing countries. The present study was proposed to find out relationship between the maternal nutritional status and the perinatal mortality. Autopsy was performed on 100 babies dying perinatally and pathological examination of different foetal organs in both well and malnourished mothers was also undertaken. Maternal nutritional status was evaluated by estimating haemoglobin level and total serum protein level. A mother with haemoglobin level below 11 g/dl and/or serum protein level below 5 g/dl was considered as malnourished. Pathological findings in the dead babies included low birth weight (500-1,999g), haemorrhage in multiple organs, atelectasis of the lungs, fatty changes in the liver, cystic changes of the kidneys and ill developed parenchyma of the pituitary.     

A study of some important biological factors influencing infant mortality under Indian conditions

The authors analyze the biological factors affecting infant mortality in Gorakhpur, a district in eastern Uttar Pradesh, India. The data concern 162 families living in rural, semi-urban, and urban areas and were collected in 1984. The factors considered include age of mother, age and sex of infants, family type, birth spacing, birth order, and birth weight.     

An international data analysis on the level of maternal and child health in relation to socioeconomic factors

International data on health and socioeconomic factors were analyzed to understand the trends and the determinants of maternal and infant mortality in the late years. Multivariate analyses were carried out to summarize the structure of the data. Multiple regression analyses were also carried out with these two mortality rates as dependent variables. The range of independent variables included health resource availability, immunization, GNP, illiteracy rates, distribution in working area, the indicators of living standards such as percentage of telephone lines and television sets per capita and the percentages of working children, population with access to safe water and sanitation, people living in urban areas, among others. In the preliminary analysis the indicators of living standards appeared highly correlated to maternal and infant mortality. Working area (industrial or agricultural) showed also an important correlation. In factor analysis indirect variables (economic and living condition) were summarized into two factors. Two regression analyses were executed. In the first the variables were used directly, while factors obtained by the factor analysis were used in the second. The second analysis confirmed the previous analysis: fertility rate, immunization and urbanization appeared as determinants of maternal mortality. Birth rate, percentage of females working in agriculture and total illiteracy appeared as determinants of infant mortality. The factors extracted in the factor analysis made a significant contribution to the second regression analysis. We concluded: 1) The factors extracted by factor analyses from indirect variables had high explanatory ability on infant mortality rates, 2) The presence of immunization together with birth rate and fertility rate in the regression models pointed out the importance of investing in birth rate reduction and disease prevention methods.     

A community based study of Infant Mortality in rural Aligarh

Background

Infant mortality rate is regarded as an important and sensitive indicator of the health status of a community. It also reflects the living standard of the people and the effectiveness of interventions for improving maternal and child health. Multiple factors related to social and economic conditions, health care and environment have a significant role to play on childhood mortality and improving childhood mortality is a national priority. The present study was planned to 1) determine the mortality rate among neonates and infants. 2) identification of pattern of various factors in relation to infant mortality and 3) to identify the causes of death in this age group.

Method

All the deaths in children under 12 months during July 2005 to June 2006 in Jawan block of district Aligarh, India were recorded. The cause of death was ascertained using the standard verbal autopsy procedure.

Results

In the study period, 446 live births and 37 deaths in children under one year of age were reported. The neonatal and infant mortality rates were 49.4 and 83.0 per thousand live births respectively. The main causes of infant deaths were birth asphyxia, diarrhoea, pneumonia, prematurity (including Low birth weight and malnutrition).

Conclusion

Most of the death among infants are preventable, though promotion of institutional deliveries, strengthening of referral system, early recognition of danger signs and periodic retraining of health workers.     

贵州省中间生育率变量分析

应用Bongaarts中间生育率变量模型定量分析了婚姻、避孕、人工流产、哺乳期对我省生育率变化的影响。结果表明:提高避孕率和晚婚率是降低生育率的有效措施,而人流率增高和哺乳期缩短的趋势值得注意。     

Population 70 million: a consideration of health aspects

A 70 million population for Malaysia by the year 2010 has been officially targeted for in the mid-term review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth; infant mortality rates are used as the health indicators. In recognition of the relevance of the medical, economic, and education factors to health, trends in Malaysia's population ratio, per capita gross national product (GNP), and rates of school enrollment are also drawn. The characteristics associated with low mortality and high life expectancy are identified as low population growth, high literacy, and high per capita GNP. Whatever the ideology--Malthusian or Marxist--there is no doubt that population is closely linked to development variables, of which health is a part. Linear regressions on West Malaysian trends show a very high correlation between percent school enrollment and number of medical doctors. Selected cross-country comparisons show that the real issue is not the size of the population but its pace of growth and the social and economic climate at the time. The most dramatic reduction in mortalities from 1957-1980 has been for infant mortality rates (IMR), which have fallen from 76 to 25/1000 live births. Significant control over IMRs has been achieved by effective treatment of malaria, smallpox, tuberculosis, whooping cough, and diarrheal diseases. Attempting a prediction on health outcome at population 70 million, various health statistics from selected countries near that population size were compiled. It is apparent that certain relevant features are associated with low infant mortalities and high life expectancy at birth: 1) low population growth rates, crude birth rates, and fertility; 2) high literacy rates; and 3) high per capita GNP. Overall, health improved for the nation as a whole, and this is highly correlated with school enrollment and health service ratios.     

Effect of zinc intake on fetal and infant growth among Chinese pregnant and lactating women

The relationship between maternal nutrient intake and fetal size or infant growth was studied in 1956 pregnant women,599 Parturients and 1043 lactating women,318 non-pregnant women included as controls,The study was conducted in eight regions that were representative of all geograthical areas of China,The diet was comprised primarily of cereal products with 70% to 85% of the zinc intake derived from plant sources.Women in the third trimester of pregnancy,parturients and lactating women consumed more food than non-pregnant women or women in the first two trimesters of pregnancy.Total energy,protein and iron intakes met the recommended allowances for each stage of reproduction,Calcium and zinc intakes,howerver,were 50% and 47% of the amount recommended.respectively.Only 7.2% of the women exceeded two-thirds of the recommended zinc intake.The mean intake of zinc was 6.5mg to 9.0mg each day among all the subjects.Correlation and stepwise regression analysis shoed that maternal zine intake was a predictor factor for fetal dimensions and birthweight.The results of this study show that fetal growth and birthweight are directly related to maternal zine intake among Chinese women,and that there is no relationship between maternal zinc intake during lactation and infant height,Weight,or weight gain from birth.     

Nutrition in dialysis patients

Adequate nutrition is very important for dialysis patients for a better overall outcome. Protein energy malnutrition is highly prevalent (25-50%) among dialysis patients and is associated with increased morbidity and mortality. Causes of malnutrition in dialysis patients include anorexia (inadequate calorie or protein intake), metabolic acidosis (stimulation of amino acid and protein degradation), and infection/inflammation (stimulation of protein degradation). Anorexia resulting into decreased intake is probably the most important factor. Nutritional assessment can be done by anthropometric measurements, laboratory parameters, subjective global assessment, dialysis malnutrition score, near infra-red interactance and other methods. Subjective global assessment is currently the most accepted one and classifies patients into three nutritional categories: Well nourished, moderately malnourished, and severely malnourished. Prevention of malnutrition by proper dietary counselling and adequate dietary intake starting from redialysis days is probably the most effective therapeutic approach. Other therapeutic approaches include adequate dialysis delivery, avoidance of acidaemia, aggressive treatment of catabolic illnesses and food supplements: Oral, enteral or parenteral, particulary intradialytic parenteral nutrition. Experimental approaches for treatment of malnutrition in dialysis patients include amino acids in peritoneal or haemodialysate, appetite stimulants and use of recombinant human growth hormone and insulin like growth factor I. There are few randomised controlled trials unequivocally proving the efficacy of any treatment modality. Large scale, randomised trials are urgently needed to establish effective therapy for malnutrition in dialysis patients. This applies more so for Indian patients.     

Maternal predictors of infant health outcomes among Hawaiians

Disaggregated data, vital statistics, and a comprehensive literature review were used to assess the relationship between Hawaiian maternal predictors and infant health outcomes. Despite near universal health care coverage, Hawaiians continue to use less prenatal care, have average rates of low birth weight and the highest infant mortality rates compared to other ethnic groups in Hawaii. Specific investigations and interventions are necessary to reduce the disparity of Hawaiian infant health outcomes.     

Characteristics of Induced Abortion in China in the 1990s

Objective To understand the characteristics of induced abortion in China in the 1990s, and to find out the influential factors. Methods The overall number of induced abortions, calculate cohort induced abortion frequency, explore the impact of a child＇s sex and the number of previous children on induced abortions were estimated by using the data from the ＂National Poptdation and Reproductive Health Survey＂ conducted by the National Family Planning Commission in November 1997. Results Induced abortions in China had their own characteristics, which were far different from other countries. The main difference was led by the fact that the country was driven by an implemented family planning program and nationwide population policies. The key cause of induced abortions was due to an inconsistentT with the requirements of the family planning policy. However, as a result of effective and prevalent contraception, the rates of induced abortions were not quite high in the 1990s, when compared with other countries. Even though, in the early 1990s, the government had reinforced the family planning program through administration and legislation, unlike during the early 1980s when the one-child policy was implemented, the induced abortion rate and the number of induce abortions did not increase as the fertility rate substantially decreased. Conclusion This finding implies that the fertility declines in the 1990s were not caused by the number of induced abortions. The transition of the fertility ideology of the people has played an important role in the fertility decline, as institutional reform and socioeconomic development are implemented.     

婴幼儿喂养行为研究

目的 探索婴幼儿喂养行为的研究方法，了解婴幼儿喂养行为现状、影响因素以及喂养行为与热能摄入量之间的关系。方法 采用参与性直接观察的社会人类学研究方法，运用现代音像技术，对39例6－22个月婴幼儿全天的喂养行为进行研究。结果 喂养行为得分最低的是家庭食物资源的利用，其次是卫生状况，得分最高的是喂养人与婴幼儿之间的情感交流，患病对喂养行为得分无影响。有一半婴幼儿的得分在满分的50％以下。喂养行为评分与摄入热能二者之间有相关关系，相关系数为0．6579，P＜0．01。结论 当地幼儿喂养行为存在问题较多。造成幼儿喂养行为问题的主要原因是喂养人缺乏营养知识、传统饮食习惯的影响、食物制作方法单一所致。