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  • Concepts in Public He Alth: A Case Study of Protein Energy Malnutrition (PEM)

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    Aswin Ash
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    Munni is a 2-year-old girl from an urban slum in India who is suffering from protein energy malnutrition (PEM). She comes from a poor family with an illiterate mother who has had 4 daughters and lives in crowded conditions with no access to health services. Munni's malnutrition is the result of multiple interrelated factors including poverty, lack of access to healthcare and nutrition programs, recurrent infections from poor sanitation and living conditions, and improper feeding practices. Her case demonstrates how malnutrition arises from both direct causes like inadequate nutrition intake as well as underlying social, economic, and political determinants.

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    Case study on PEM

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    PEM

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    Munni is a 2-year-old girl from an urban slum in India who is suffering from protein energy malnutrition (PEM). She comes from a poor family with an illiterate mother who has had 4 daughters and lives in crowded conditions with no access to health services. Munni's malnutrition is the result of multiple interrelated factors including poverty, lack of access to healthcare and nutrition programs, recurrent infections from poor sanitation and living conditions, and improper feeding practices. Her case demonstrates how malnutrition arises from both direct causes like inadequate nutrition intake as well as underlying social, economic, and political determinants.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    45 views21 pages

    Concepts in Public He Alth: A Case Study of Protein Energy Malnutrition (PEM)

    Uploaded by

    Aswin Ash
    Munni is a 2-year-old girl from an urban slum in India who is suffering from protein energy malnutrition (PEM). She comes from a poor family with an illiterate mother who has had 4 daughters and lives in crowded conditions with no access to health services. Munni's malnutrition is the result of multiple interrelated factors including poverty, lack of access to healthcare and nutrition programs, recurrent infections from poor sanitation and living conditions, and improper feeding practices. Her case demonstrates how malnutrition arises from both direct causes like inadequate nutrition intake as well as underlying social, economic, and political determinants.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 21

    CENTRE FOR COMMUNITY MEDICINE,

    ALL INDIA INSTITUTE OF MEDICAL


    SCIENCES, NEW DELHI, INDIA

    Concepts in Public He alth:


    A Case Study of Protein Energy
    Malnutrition (PEM)
    Dr. Hars hal R Salve, Dr. Rakesh Kumar,
    Prof. Chandrakant S Pandav
    Ò 2 years old Munni

    Ò Youngest of the four


    children of Yashoda

    Ò Belongs to Scheduled
    caste

    Ò Resident of urban slum

    Ò Family belongs to Below


    Poverty Line

    Source: Accessed from Google images


    THE STORY . . .

    Ò Munni is currently suffering from loose stools, voimiting


    Ò She had experienced recurrent episode of diarrhea and ARI in
    past one year
    Ò Born at home with low birth weight
    Ò Ghutti was given at the time of birth
    Ò Exclusive breast feeding for four months
    Ò Undernourished for age at present
    Ò Incomplete immunization as per age
    Ò Her sisters are also suffering from loose stools, worms in stools,
    vomiting and are undernourished for their age
    THE STORY . . .
    Ò Yashoda - 24 yrs, illiterate , married 7 years back

    Ò Has four daughters, out of which 2 are under five yrs age

    Ò She delivered four girl children in a hope of male child

    Ò Not adopted any family planning method due to fear of its


    complications

    Ò Migrated in urban slum area from village 5 years back

    Ò Lives in jhuggi area in rented jhopadi

    Ò Yashoda and her husband are daily wage labourers

    Ò Eldest daughter takes care of younger ones


    THE STORY . . .

    Ò There is no government health facility in an urban slum


    Ò Yashoda was unable to take Munni to General Hospital which is
    10 kms away as it will lead to daily wage loss
    Ò Yashoda had sought treatment for her children from unqualified
    private practitioner in an urban slums
    Ò None of her daughter are going to Anganwadi as it remains
    closed all the time
    Ò Family belongs to BPL but they does not possess BPL card
    Ò Able to provide food to their daughters once a day only
    PEM IN INDIA…
    Ò 51.1% of children are undernourished at given point of time
    Ò High risk factor for malnutrition in children:
    É Age of mother: 18 – 23 yrs

    É Female gender

    É Rural area

    É Birth order > 3

    É Birth spacing < 47 months

    É Low birth weight

    É Illiterate mother

    É Scheduled caste/ scheduled tribe

    É Underweight status of mothers


    Source : International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health
    Survey (NFHS-3), 2005–06: India. Mumbai :IIPS. Available at http://www.nfhsindia.org/pdf/IN.pdf
    (accessed on 21 October 2010)
    Web of Causation
    in this case
    Increase out of Ge nder No
    No govt. he alth pocket
    facility ne arby pre ference Contraception
    expenditure

    Underweight
    mother
    Fre quent
    Low birth
    pre gnancies U
    we ight
    Large family R
    B
    s ize
    Pove rty A
    N
    Concurrent I
    illness of s iblings Z
    Inadequate Poor living A
    e nergy intake condition T
    Poor pe rs onal I
    hygiene O
    N
    Re current Wrong
    infections bre astfeeding Illiteracy
    practices

    Proximate causes
    Non-functional Incomplete Distant causes
    Anganwadice ntre Immunization Indirect causes
    WAS MALNUTRITION PREVENTABLE?

    Yes
    Non-functional
    Anganwadice ntre

    Underweight
    mother
    Fre quent
    Low birth Large family
    pre gnancies
    we ight s ize

    Concurrent Increase out of


    Inadequate illness of s iblings pocket
    e nergy intake expenditure
    Poor pe rs onal
    hygiene
    No
    Re current
    Wrong Contraception
    infections
    bre astfeeding
    practices No govt. he alth
    Incomplete facility ne arby
    Immunization

    THROUGH HEALTH SYSTEM


    Ge nder
    pre ference

    Pove rty
    OUTSIDE THE HEALTH
    Poor living SYSTEM
    condition

    Illiteracy

    Urbanization
    CONCEPTS OF DISEASE CAUSATION
    Ò Traditional Bio-medical concept
    É Disease caused due to the presence of causative agents
    É Basis in Germ theory of disease
    Ò Socio- Epidemiological Concept
    É Causative agents alone may/may not be sufficient for disease occurrence
    É Social factors important in the disease causation & progression
    Ò Politico- Developmental Concept
    É Comprehensive approach, puts health in the context of politico-
    developmental situations
    É Effects of government policies & outfalls of development on disease
    occurrence,
    É Stems from the multi-factorial causation of disease

    12
    Traditional Bio-Medical Concept
    Inadequate
    energy intake

    Recurrent
    Low birth
    Malnutrition in ARI/GI tract
    weight children infections

    Decrease immunity
    13
    Socio- Epidemiological Concept
    Poverty & Illiteracy Large family size/
    no contraception use

    Inadequate Wrong
    energy intake Breast
    Under- feeding
    weight
    practices
    mother
    Recurrent
    Low birth
    Malnutrition in ARI/GI
    children tract
    weight
    infections Incomp-
    lete
    No access Immuni-
    to govt. Worm
    zation
    health infestation
    facility
    Poor environmental
    Poor personal hygiene conditions
    14
    Politico- Developmental Concept
    Uncontrolled Urbanization

    Poverty & Illiteracy Large family size/


    Availability no contraception use
    Of health
    facility Wrong
    Under- Inadequate energy intake Lack of
    Breast
    weight feeding political
    mother practices Commit-
    Malnutrition Recurrent ment
    Low birth infections/
    weight in children Decrease
    Social immunity
    & No access No
    Political to govt. Immuni
    Worm infestation
    health zation
    Discrimi-
    facility
    nation

    Poor personal hygiene Poor environmental


    conditions

    Poor living conditions in urban slums


    15
    PUBLIC HEALTH TRAINS
    YOU TO HAVE A “HOLISTIC APPROACH”
    TO HEALTH AND DISEASE
    CLINICAL VS PUBLIC HEALTH
    Clinical Medicine Public health
    •Population/
    UNIT OF STUDY • Individual
    Community
    • Mostly Patient – • Diseased and healthy
    TARGET GROUP
    with disease individuals
    VIEWPOINT OF • Mostly passive
    • Active process
    HEALTH SYSTEM process
    • Major focus on
    TYPE OF CARE • Comprehensive care
    curative care

    • Majority by • Both public & private


    SERVICE PROVIDERS
    private sector sector

    • Short term benefits • Long term benefits


    BENEFITS
    • Obvious benefit • Not obvious

    In Public Health – Good work means no patients 17


    AXIOMS OF PUBLIC HEALTH
    Ò Prevention is better than cure

    Ò Best should not be the enemy of good

    Ò Good for many rather than best for few

    Ò Primary health care is NOT primitive care

    18
    19
    BHORE COMMITTEE
    “The physician of tomorrow will be
    Ò naturally be concerned with the promotion of the new e ra of social
    me dicine
    Ò scientist and social worker
    Ò re ady to cooperate in te am work
    Ò in close touch with the pe ople he se rves
    Ò a frie nd and le ader
    Ò directs all his e fforts towards the prevention of dise ase and
    Ò be comes a the rapist whe re prevention has broken down
    Ò the social physician
    Ò Protecting the pe ople, and Guiding the m to a he althier and happier life”.

    BHORE COMMITTEE REPORT(1 9 4 6 ) He alth Survey & De ve lopme nt Committe e , Govt .of India
    20
    CRITICAL APPRAISAL

    Yes Can’t tell No


    Do you believe the
    results?
    Can the results be
    applied to the local
    population?

    Do the results of this Thank You


    study fit with other
    available evidence?

    21/59

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