Trends in nutritional status and nutrient intakes and correlates of overweight/obesity among rural adult women (≥18-60 years) in India: National Nutrition Monitoring Bureau (NNMB) national surveys.

OBJECTIVE: To assess trends in nutrient intakes and nutritional status of rural adult women (≥18-60 years) and the association of sociodemographic characteristics with overweight/obesity. DESIGN: Community-based cross-sectional studies carried out during 1975-79 to 2011-12 by the National Nutrition Monitoring Bureau (NNMB) were used. Anthropometric measurements such as height, weight and waist circumference, carried out during the surveys, were used. Association and logistic regression analyses between sociodemographic characteristics and overweight/obesity and abdominal obesity were conducted using a complex samples procedure. SETTING: Ten NNMB states of India. SUBJECTS: Non-pregnant and non-lactating rural women aged ≥18-60 years covered during the above periods from ten states in India. RESULTS: The prevalence of chronic energy deficiency has declined from 52 % during 1975-79 to 34 % during 2011-12, while that of overweight/obesity has increased from 7 % to 24 % during the same period. Median intakes of most of the nutrients have increased over the same period, although they were below recommended levels. The chance of overweight/obesity and abdominal obesity was significantly (P<0·01) higher among women aged 40-60 years, those belonging to Christian religion and other backward communities, women living in pucca houses, literate women, women engaged in service and business, and those having higher per capita income. CONCLUSIONS: Prevalence of chronic energy deficiency has declined significantly; however, overweight/obesity has increased during the same period. This increase in overweight/obesity may be attributed to increased consumption of fatty foods, sedentary lifestyle and improved socio-economic status. There is a need to educate the community about regular physical exercise, low intakes of fats and oils, and a balanced diet.

Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in India.

BACKGROUND & OBJECTIVES: An increase in prevalence of hypertension has been observed in all ethnic groups in India. The objective of the present study was to estimate prevalence and determinants of hypertension among tribals and their awareness, treatment practices and risk behaviours in nine States of India. METHODS: A community based cross-sectional study adopting multistage random sampling procedure was carried out. About 120 Integrated Tribal Development Authority villages were selected randomly from each State. From each village, 40 households were covered randomly. All men and women ≥ 20 yr of age in the selected households were included for various investigations. RESULTS: A total of 21141 men and 26260 women participated in the study. The prevalence of hypertension after age adjustment was 27.1 and 26.4 per cent among men and women, respectively. It was higher in the s0 tates of Odisha (50-54.4%) and Kerala (36.7-45%) and lowest in Gujarat (7-11.5%). The risk of hypertension was 6-8 times higher in elderly people and 2-3 times in 35-59 yr compared with 20-34 yr. Only <10 per cent of men and women were known hypertensives and more than half on treatment (55-68%). Men with general and abdominal obesity were at 1.69 (CI: 1.43-2.01) and 2.42 (CI: 2.01-2.91) times higher risk of hypertension, respectively, while it was 2.03 (CI=1.77-2.33) and 2.35 (CI 2.12-2.60) times higher in women. Those using tobacco and consuming alcohol were at a higher risk of hypertension compared with the non users. INTERPRETATION & CONCLUSIONS: The study revealed high prevalence of hypertension among tribals in India. Age, literacy, physical activity, consumption of tobacco, alcohol and obesity were significantly associated with hypertension. Awareness and knowledge about hypertension and health seeking behaviour were low. Appropriate intervention strategies need to be adopted to increase awareness and treatment practices of hypertension among tribals.

Prevalence of undernutrition, its determinants, and seasonal variation among tribal preschool children of Odisha state, India.

A community-based cross-sectional study was undertaken in the tribal areas of Odisha state, India, covering 1951 preschool children to assess their nutritional status in terms of underweight, stunting, and wasting; its correlates; and seasonal variation in nutritional status. χ(2) Test, one-way analysis of variance, and unadjusted and adjusted odds ratios were used for data analysis. The prevalence of underweight, stunting, and wasting was 58%, 65%, and 20%, respectively. The risk of underweight and stunting was, respectively, 1.9 and 2.4 times higher among children of illiterate mothers, whereas underweight and wasting was 1.4 times higher among children who had morbidities during the preceding fortnight. The prevalence of undernutrition was significantly (P < .01) higher during monsoon as compared with winter season. Undernutrition is an important public health problem and is associated with literacy of mother, morbidity, and season. Thus, improving socioeconomic condition, literacy, and sanitation along with insuring food security during monsoon season might improve nutritional status.

An assessment of a large-scale HIV prevention programme for high-risk men who have sex with men and transgenders in Andhra Pradesh, India: using data from routine programme monitoring and repeated cross-sectional surveys.

OBJECTIVES: To assess a large-scale intervention, the Avahan intervention, using an evaluation framework that included programme coverage, condom use and changes in sexually transmitted infection (STI) and HIV prevalence among high-risk men who have sex with men/transgender (HR-MSM/TG) in the state of Andhra Pradesh, India. DESIGN: Programme monitoring data and results from two rounds of cross-sectional integrated biological and behavioural assessment (IBBA) in 2006 (Round 1) and 2009 (Round 2) were used for current analysis. SETTING: Programme monitoring data and cross-sectional surveys from Andhra Pradesh, India. PARTICIPANTS: Data from 1218 and 1203 participants in Rounds 1 and 2 of the IBBA, respectively, and field level programme monitoring data from the intervention districts. PRIMARY AND SECONDARY OUTCOMES: (1) Assess the reach of intervention in the HR-MSM/TG population; (2) evaluate the association between intervention and the intermediate outcomes (such as condom use and STIs) and (3) assess the association between HIV/STIs and the intervention. RESULTS: By July 2008, the intervention contacted 83% of the estimated HR-MSM/TG population monthly and 16% were attending the STI clinic monthly. HR-MSM/TG exposed to the intervention were significantly more likely to use condom consistently with a regular male partner (adjusted OR 4.62, 95% CI 1.40 to 15.22). Consistent condom use with all types of male partners increased significantly in survey Round 2 compared with Round 1. The proportion of HR-MSM/TG who tested positive for HIV-1 antibodies was similar in both rounds (15.5% in Round 1 vs 17.3% in Round 2, p=0.52). CONCLUSION: The Avahan intervention achieved a good population coverage, and delivered high-intensity peer and STI clinical services in Andhra Pradesh in the highly mobile target population of HR-MSM/TG; this also resulted in positive behavioural outcomes including increased condom use. However, the high prevalence of HIV in this group is an important public health priority.

A study of the geographical clustering of districts in Uttar Pradesh using nutritional anthropometric data of preschool children.

BACKGROUND & OBJECTIVES: Worldwide variations in human growth and its genetic and environmental factors have been described. In this study, an attempt was made to assess the morphological differences and similarities among under 5 year children of rural areas of Uttar Pradesh State in India, and to determine differences or similarities of body size among children living in diverse regions. METHODS: For this purpose, a cross-sectional district nutrition profile study conducted during 2002-2003 was used. The data on 10,096 children drawn from 1080 villages in 54 districts were part of the district level Diet and Nutrition Assessment survey. The mean values for height and weight for 54 districts were taken as the input data for subsequent analysis. The data were first normalized by means of principal component analysis (PCA) and then K-means clustering was performed. RESULTS: The PCA and cluster analysis yielded four distinguishable clusters or patterns in the anthropometric data of children. These clusters were ordered according to the average body size (weight and height) of children. The mean stature and body weight of these children in cluster I were 3.2 cm and 1.4 kg higher than those of cluster IV indicating differences between clusters. Also, the variations between clusters in their social, demographic, health and nutrition parameters were compared. INTERPRETATION & CONCLUSIONS: The use of PCA and cluster analysis methods and their merits in studying the Uttar Pradesh preschool children growth variations are discussed. These results helped in identifying the districts with higher prevalence of undernutrition and the contributing factors.

Prevalence and determinants of undernutrition and its trends among pre-school tribal children of Maharashtra State, India.

A community-based cross-sectional study carried out in tribal areas of Maharashtra covering 1751 pre-school children to assess nutritional status. Nutritional status was assessed using new WHO Growth Standards. Household wealth index was constructed using principle component analysis. The prevalence of underweight, stunting and wasting was 64, 61 and 29%, respectively. There was a significant (p < 0.05) reduction in the prevalence of underweight and stunting over two time periods (1999 and 2008). Logistic regression showed that the risk of underweight was 1.7 times higher among children of illiterate mothers and those suffering from morbidities, while stunting was 1.4 times higher among children belonging to lowest and middle household's wealth indexes. Undernutrition is a public health problem and is associated with literacy of mother, household wealth index and morbidities. Therefore, improving socio-economic condition along with literacy of mothers and preventing infections through personal hygiene might help in improving the nutritional status of children.

Prevalence of hypertension, its correlates and awareness among adult tribal population of Kerala state, India.

BACKGROUND: Increasing prevalence of hypertension is a public health problem in India. AIMS: To study prevalence, correlates, and awareness of hypertension among tribal adult population in Kerala. SETTING AND DESIGN: A community-based, cross-sectional study was carried out in tribal areas of Kerala by adopting multistage random sampling procedure. MATERIALS AND METHODS: Data was collected on socio-demographic and behavioral factors, and anthropometric measurements were carried out. Body mass index (BMI) was categorized using the classification recommended for Asians. Waist circumference ≥ 90 cm for men and ≥ 80 cm for women was used cut off for defining an abdominal obesity. Bivariate and multivariate analysis was carried out to study association of hypertension with socio-demographic variables, personal habits, and obesity. RESULTS: A total of 4,193 adults (men 1,891, women: 2,302) of ≥ 20 years of age were covered. The overall prevalence of hypertension was 40% (n=1671). The prevalence of hypertension increases with increase in age among both the genders. Regression analysis showed that the risk of hypertension was significantly (P<0.001) lower among educated and among higher socio-economic status group. Sedentary activity had 1.3 times (CI=1.09-1.60) and alcohol consumption had 1.4 (CI=1.17-1.73) times higher risk of hypertension. The risk of hypertension was 1.7 times higher among overweight/obese subjects. Overall, only 10% (n=164) of the adult population was aware of hypertension status, and about 8% (n=129) were on regular treatment. CONCLUSION: It was observed that the prevalence of hypertension was higher among tribal adult population of Kerala and was associated with age, gender, education, HHs wealth index, physical inactivity, alcohol consumption, and overweight/obesity.

Correlation of Fat Mass Index and Fat-Free Mass Index with percentage body fat and their association with hypertension among urban South Indian adult men and women.

BACKGROUND: The assessment of Fat Mass and Fat-Free Mass indices provides valuable information about changes in body composition. AIM: To identify cut-off points for Fat Mass Index (FMI) to predict an upper limit of percentage body fat of men (25%) and women (30%) for defining obesity and its association with hypertension. SUBJECTS AND METHODS: A total of 436 men and 596 women were included in the study. Fat mass was calculated using skin-fold measurements. FMI cut-off points to predict an upper limit of percentage body fat of 25% (men) and 30% (women) for defining obesity were assessed using Receiver Operating Characteristic (ROC) curve analysis. RESULTS: ROC curve analysis indicated that the level of FMI was 6.59 kg/m(2) in men and 6.64 kg/m(2) in women at 25% and 30% body fat, respectively. Risk estimation for hypertension with FMI indicated high risk of hypertension in men (OR: 3.4, CI: 2.1-5.5) as well as in women (OR: 5.3, CI: 2.3-12.4). CONCLUSION: The level of FMI was 6.6 kg/m(2) in men and women predicted at upper limits of 25% and 30% body fat, respectively, for defining obesity.

Prevalence of & knowledge, attitude & practices towards HIV & sexually transmitted infections (STIs) among female sex workers (FSWs) in Andhra Pradesh.

BACKGROUND & OBJECTIVES: As part of the baseline survey carried out during 2005-06, biological and behavioural data were generated on about 3200 female sex workers (FSWs), from eight districts of Andhra Pradesh (AP), India. This study describes the relationship between socio-demographic and behavioural factors with consistent condom use (CCU) and HIV among FSWs in AP. METHODS: A cross-sectional community-based study was conducted among female sex workers (FSW) in eight districts of Andhra Pradesh, India, using conventional cluster sampling and time-location cluster sampling. Key risk behaviours and STIs related to the spread of HIV were assessed. Blood samples were collected to detect syphilis, Herpes simplex virus type 2 (HSV-2) Chlamydia trachomatis (CT), Neiserria gonorrhoeae (NG) and HIV serology. RESULTS: About 70 per cent of the FSWs were illiterates, nearly 50 per cent were currently married and 41 per cent of the FSWs had sex work as the sole source of income. More than 95 per cent of the FSWs heard of HIV, but about 99 per cent believed that HIV/AIDS cannot be prevented. Logistic regression analysis showed significantly lesser CCU with high client volume, not carrying condom and could not use condom in past 1 month due to various reasons such as non co-operation by the clients. Similarly, CCU was significantly (P<0.001) lesser (only 8.9%) with regular non-commercial partners. Overall there was 16.3 per cent prevalence of HIV amongst FSWs. C. trachomatis and N. gonorrheae were prevalent in 3.4 and 2 per cent of the FSWs, respectively and about 70 per cent of the FSWs were positive for HSV2 serology. HIV was significantly associated with STIs. INTERPRETATION & CONCLUSIONS: Misconception that HIV/AIDS cannot be prevented is very high. Most of the subjects in the present study had first sexual debut at a very young age. HIV was associated with STIs, emphasizing aggressive STI diagnosis and treatment. CCU must be emphasized right from first sexual debut with all clients and non-commercial partners as well.

Application of factor analysis to identify dietary patterns and use of factor scores to study their relationship with nutritional status of adult rural populations.

The prevalence of chronic energy deficiency (CED) among one-third of the Indian population is attributed to inadequacy of consumption of nutrients. However, considering the complexity of diets among Indians, the relationship between a particular dietary pattern and the nutritional status of the population has not been established so far. A community-based cross-sectional study was undertaken to assess estimates, at district level, of diet and nutritional status in Orissa State, India. Factor analysis was used for exploring the existence of consumption pattern of food and nutrients and their relationship with the nutritional status of rural adult population. Data on 2,864 adult men and 3,525 adult women in Orissa state revealed that there exists six patterns among food-groups explaining 59% of the total variation and three patterns among nutrients that explain 73% of the total variation among both adult men and women. The discriminant function analysis revealed that, overall, 53% of the men were correctly classified as either with chronic energy deficiency (CED) or without CED. Similarly, overall, 54% of the women were correctly classified as either with CED or without CED. The sensitivity of the model was 65% for both men and women, and the specificity was 46% and 41% respectively for men and women. In the case of classification of overweight/obesity, the prediction of the model was about 75% among both men and women, along with high sensitivity. Using factor analysis, the dietary patterns were identified from the food and nutrient intake data. There exists a strong relationship between the dietary patterns and the nutritional status of rural adults. These results will help identify the community people with CED and help planners formulate nutritional interventions accordingly.

Severe drought and the vitamin A status of rural pre-school children in India.

A community-based cross-sectional study was carried out in six drought-affected areas of India in 2003 to assess the impact of drought on the vitamin A status of 3,657 rural pre-school children. The prevalence of Bitot's spots was found to be significantly (p < 0.01) higher (1.8 per cent) during drought (odds ratio (OR) = 2.0; 95 per cent confidence interval: 1.6 -2.7). The dietary intake of vitamin A was lower during drought and in 81 per cent of households it was less than 50 per cent of the recommended rate. Severe drought has an adverse impact on the vitamin A status of rural pre-school children, particularly those with illiterate mothers and belonging to an older age group (p < 0.01). Communities need to be sensitised, therefore, to vitamin A deficiency through health and nutrition education, and there needs to be wider coverage of vitamin A supplementation, particularly among children in drought-affected and drought-prone areas.

Prevalence of under-nutrition and its correlates among under 3 year-old children in rural areas of Andhra Pradesh, India.

BACKGROUND: Under-nutrition continues to be a major public health problem, especially among young children in India. The present study was undertaken to assess the nutritional status of under-3 year-old children and factors associated with under-nutrition. METHOD: A community-based cross-sectional survey was carried out in 40 Anganwadi centre villages of Medak district of Andhra Pradesh, India. A total of 805 children were selected for nutritional assessment in terms of under-weight, stunting and wasting using the new WHO growth standards. Wealth index was calculated using principal components analysis. A conceptual hierarchical framework was used as a basis for controlling for the explanatory factors in multivariate analysis. RESULTS: Prevalence of under-weight, stunting and wasting was ~39%, 30% and 22%, respectively. The risk of under-weight and stunting was 1.80- and 3.02-times higher among 12-23 months and 3.13- and 5.50-times higher among 24-36 months children as compared to children under 12 months, respectively. The risk of under-weight was 2.74- and 1.73-times higher among children belonging to the lowest and middle household wealth index, respectively. CONCLUSIONS: Under-nutrition is a significant public health problem among under 3 year-old children. The prevalence of under-nutrition was significantly higher among boys and those belonging to the lowest and middle wealth index. Thus, implementation of appropriate nutritional intervention strategies and improvement in household socio-economic condition may help in improving nutritional status.

Condom use and prevalence of syphilis and HIV among female sex workers in Andhra Pradesh, India - following a large-scale HIV prevention intervention.

BACKGROUND: Avahan, the India AIDS initiative began HIV prevention interventions in 2003 in Andhra Pradesh (AP) among high-risk groups including female sex workers (FSWs), to help contain the HIV epidemic. This manuscript describes an assessment of this intervention using the published Avahan evaluation framework and assesses the coverage, outcomes and changes in STI and HIV prevalence among FSWs. METHODOLOGY: Multiple data sources were utilized including Avahan routine program monitoring data, two rounds of cross-sectional survey data (in 2006 and 2009) and STI clinical quality monitoring assessments. Bi-variate and multivariate analyses, Wald Chi-square tests and multivariate logistic regressions were used to measure changes in behavioural and biological outcomes over time and their association. RESULTS: Avahan scaled up in conjunction with the Government program to operate in all districts in AP by March 2009. By March 2009, 80% of the FSWs were being contacted monthly and 21% were coming to STI services monthly. Survey data confirmed an increase in peer educator contacts with the mean number increasing from 2.9 in 2006 to 5.3 in 2009. By 2008 free and Avahan-supported socially marketed condoms were adequate to cover the estimated number of commercial sex acts, at 45 condoms/FSW/month. Consistent condom use was reported to increase with regular (63.6% to 83.4%; AOR=2.98; p<0.001) and occasional clients (70.8% to 83.7%; AOR=2.20; p<0.001). The prevalence of lifetime syphilis decreased (10.8% to 6.1%; AOR=0.39; p<0.001) and HIV prevalence decreased in all districts combined (17.7% to 13.2%; AOR 0.68; p<0.01). Prevalence of HIV among younger FSWs (aged 18 to 20 years) decreased (17.7% to 8.2%, p=0.008). A significant increase in condom use at last sex with occasional and regular clients and consistent condom use with occasional clients was observed among FSWs exposed to the Avahan program. There was no association between exposure and HIV or STIs, although numbers were small. CONCLUSIONS: The absence of control groups is a limitation of this study and does not allow attribution of changes in outcomes and declines in HIV and STI to the Avahan program. However, the large scale implementation, high coverage, intermediate outcomes and association of these outcomes to the Avahan program provide plausible evidence that the declines were likely associated with Avahan. Declining HIV prevalence among the general population in Andhra Pradesh points towards a combined impact of Avahan and government interventions.

Micronutrient deficiency disorders among the rural children of West Bengal, India.

BACKGROUND: Multiple micronutrient deficiencies continue to be a major nutritional problem of public health significance in India. AIM: To assess the prevalence of micronutrient deficiencies among rural children of West Bengal, India. SUBJECTS AND METHODS: A community-based cross-sectional study was carried out on 9228 and 437 pre-school children, respectively, for assessment of vitamin A deficiency (VAD) and anaemia. Iodine deficiency disorders (IDD) were assessed in 3490 children of 6-12 years. RESULTS: The prevalence of Bitot's spots, an objective sign of clinical VAD, was 0.6% and was significantly (p < 0.01) higher among children of 3-5 years. Prevalence of blood vitamin A deficiency ( < 20 µg/dL) was 61% and ∼81% of children were anaemic. About 25% children had both sub-clinical VAD and anaemia. The children of Scheduled Caste and Scheduled Tribe (OR = 2.3: 95% CI = 1.3-3.9) were at higher risk of anaemia, whereas children of Scheduled Tribe (OR = 4.5; 95% CI = 2.1-10.5) and 3-5 years (OR = 1.4; 95% CI = 1.0-2.0) were at risk for VAD. The prevalence of goitre was 9%. CONCLUSIONS: Micronutrient deficiencies were found to be of public health significance among rural children of West Bengal. Therefore, there is a need to initiate sustainable long-term interventions for prevention and control of micronutrient deficiencies in children.

Prevalence of vitamin A deficiency and its determinants among the rural pre-school children of Madhya Pradesh, India.

BACKGROUND: Vitamin A deficiency (VAD) continues to be a major public health nutritional problem in India, even though the National Vitamin A Prophylaxis Programme has been in operation for more than three decades. AIM: To assess the prevalence of vitamin A deficiency among rural pre-school children. SUBJECTS AND METHODS: A community-based cross-sectional study was carried out in rural Madhya Pradesh. A total of 8777 pre-school children were clinically examined for VAD and blood vitamin A levels were estimated in a sub-sample by dried blood spot method. RESULTS: Prevalence of night blindness and Bitot's spot, an objective sign of VAD, was 0.8% and 1.4%, respectively, and prevalence increased significantly (p < 0.001) with age. The proportion of children with blood vitamin A deficiency ( < 20 µg/dL) was 88% (95% CI: 84.8-91.2).The prevalence of Bitot's spot was significantly (p < 0.001) higher among children of lower socio-economic communities, 3-5-year age group and those of illiterate mothers. CONCLUSIONS: VAD is a major public health problem among rural children of Madhya Pradesh. Children of 3-5 years and those belonging to lower socio-economic communities are at high risk of VAD. Therefore, appropriate intervention measures are to be initiated to improve the vitamin A status of children.

Prevalence of anaemia among rural pre-school children of West Bengal, India.

BACKGROUND: Micronutrient malnutrition is a major public health nutritional problem in India, and iron deficiency anaemia (IDA) continues to be a major nutritional problem of public health significance, affecting all physiological groups, of which rural pre-school children are the most vulnerable. AIM: The main aim of the present study was to assess the prevalence of anaemia among rural pre-school children. SUBJECTS AND METHODS: A community-based cross-sectional study was carried out in rural areas of West Bengal State during 2002-2003. A total of 437 pre-school children were covered for the estimation of blood haemoglobin levels. RESULTS: A majority (81%) of the rural children of West Bengal were anaemic, and the prevalence was significantly (p<0.001) higher among 1-3-year-old (91%) as compared to 4-5-year-old (74.6%) children. A significantly (p<0.01) higher proportion of 1+ (OR=7.7; 95% CI: 2.6-22.4) and 2+ year children (OR=3.0; 95% CI: 1.5-6.0) and those belonging to lower socio-economic Scheduled Caste and Scheduled Tribe communities were at risk for anaemia (OR=2.3; 95% CI 1.3-3.9). CONCLUSIONS: The prevalence of anaemia is a severe nutritional problem of public health significance. Therefore, iron supplementation and health and nutrition education programmes should be strengthened. The community needs to be encouraged to diversify their diets by consuming iron-fortified and iron-rich foods.

Nutritional parameters and chronic energy deficiency in older adults of desert areas of western Rajasthan, India.

Nutritional status was assessed in 212 older individuals (> or =60 years of age) in a cross - sectional study carried out in desert areas of western Rajasthan during 2003. Heights and weights were recorded and a family diet survey (one-day, 24-hour recall) was carried out in 200 households (HHs) from 20 villages. Body Mass Index (BMI) was used to classify nutritional status. The prevalence of Chronic Energy Deficiency (CED = BMI < 18.5) was > or = 40% in desert areas of India, indicating a "very high" public health problem. It was higher among older women (52%) compared with men (42.4%) and higher in those belonging to Scheduled Caste and Scheduled Tribes and in HHs of laborers, artisans, landless individuals, marginal farmers, and below poverty line families. CED did not differ (statistically) between the desert and plain areas of Rajasthan. CED prevalence among older adults in desert areas was actually lower (p < 0.001) than that found in their rural and tribal counterparts. Intervention programs initiated by the government may explain this finding. Our findings support the conclusion that regular nutritional monitoring of older adults in desert and drought prone areas is needed and can help appropriately target the need for intervention measures.

Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought.

The prevalence of chronic energy deficiency (CED = BMI < 18.5) among older adults (≥60 years) was assessed utilizing a large data set from a community-based cross-sectional study carried out in severely drought-affected rural areas of India. Anthropometric measurements (height, weight) were recorded for a total of 3,147 individuals, and a family diet survey (one day 24-hour recall) was carried out in 1,900 households (HHs) from 190 villages. As per the Body Mass Index (BMI), the prevalence of CED was 51.1% and 48.5% among older males and females, respectively. It was higher (p < 0.001) in the 70 years and older age group compared with those aged 60-69 years. In general, the prevalence of CED was higher (p < 0.001) for those belonging to the Scheduled Caste and Scheduled Tribes, for HHs of agricultural and non-agricultural labor, and for marginal or small farmers. The prevalence of CED was relatively lower (p > 0.05) among older adults during the drought period compared with the non-drought period. This could be attributed to intervention programs initiated by the government of India during the drought. These findings illustrate the value of intervention programs in drought-afflicted and drought-prone areas and underscore the importance of monitoring the nutritional status of older adults so that appropriate programs can be initiated as needed.

Clinical and sub-clinical vitamin A deficiency among rural pre-school children of Maharashtra, India.

BACKGROUND: Although a national vitamin A prophylaxis programme has been in operation for more than three decades, vitamin A deficiency (VAD) continues to be a major nutritional problem of public health significance in India. AIM: The present study was carried out with the aim of assessing the prevalence of clinical and sub-clinical VAD among rural pre-school children. SUBJECTS AND METHODS: A community-based cross-sectional study was carried out in rural areas of Maharashtra State during 2002-2003. A total of 8646 pre-school children were examined for the presence of signs and symptoms of VAD. A sub-sample (494) of them was used to estimate blood vitamin A levels. RESULTS: The prevalence of Bitot's spots (1.3%) and night blindness (1.1%) was higher than the WHO cut-off levels used to define a public health problem, and it increased significantly (p<0.001) with increase in age. The prevalence of Bitot's spots was 13 times higher among children belonging to the Scheduled Caste (OR=12.8), and 20 times higher among the children of labourers (OR=19.8). The prevalence of sub-clinical VAD (55%) was significantly (p<0.001) high among the children with night blindness (100%) and Bitot's spots (89%). CONCLUSIONS: Increased vitamin A supplementation, health and nutrition education and consumption of vitamin A rich foods are essential to prevent VAD.

Diet and nutritional status of adolescent tribal population in nine states of India.

Tribal population constitutes about 8% of the total population in India. They are particularly vulnerable to undernutrition, because of their geographical isolation, socio-economic disadvantage and inadequate health facilities. Recognizing the problem, Government of India launched different programmes for their welfare. Adolescence is a significant period of growth and maturation. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. Therefore an attempt was made to assess the diet and nutritional status of adolescent population from the different tribal areas of India. The available database collected by National Nutrition Monitoring Bureau (1998-99) was utilized for this purpose. Data on a total of 12,789 adolescents (10-17 yrs) was included for the analysis. Four percent of the adolescent girls were married and less than 1% were either pregnant (0.4%) or lactating (0.7%) at the time of the survey. The mean intake of all the foodstuffs, especially the income elastic foods such as Pulses, Milk & Milk products, Oils & fats and Sugar & Jaggery were lower than the recommended levels of ICMR. The intake of all the foodstuffs except green leafy vegetables was lower than that of their rural counterparts. The intake of all the nutrients were below the recommended level, while that of micronutrients such as iron, vitamin A and riboflavin were grossly inadequate in all the age and sex groups. About 63% of adolescent boys and 42% of girls were undernourished (< 5th BMI age percentiles of NHANES). A significant association between undernutrition and socio-economic parameters like type of family, size of land holding and occupation of head of household was observed. Therefore, there is a need to evolve comprehensive programmes for the overall development of tribal population with special focus on adolescents.