5- Measuring a Malnourished Child.pptx

Malnourished

1. How to identify a Malnourished Child

2. Objective To review common Nutrition and Anthropometric Terms Overview of methods used to determine a child malnutrition status Acquire Practical skills on how to measure acute malnutrition in children 2

3. Screening Investigation of a great number of something (for instance, people) looking for those with a particular problem or feature In medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease 3

4. Anthropometry Measurement of humans Refers to the measurement of the human individual for the purposes of understanding human physical variation Alphonse Bertillon, French Policeman – 1883 Widely used, inexpensive and non-invasive measure of general nutritional status of an individual or population group 4

5. Variables & Index Age Sex Weight Height Indices When 2 variables are used together and compared to a reference value, it is called an Index (WFA, WFH & HFA) 5

6. Anthropometric Indices Height and age (HFA) - measures for chronic malnutrition; measurements which are low height-for-age indicate long-term malnutrition, i.e. “stunting”. Weight and height (WFH) - measures for acute malnutrition; measurements which are low weight-for-height indicate short-term malnutrition, i.e. “wasting”. Weight and age (WFA) – Combine measure for chronic and acute malnutrition; measurements which are low for WHA indicate malnutrition. 6

7. Assessment of Nutrition Status Bilateral pitting Oedema Mid Upper Arm Circumference - MUAC Weight For Height - WFH Height For Age - HFA Weight For Age - WFA 7

8. Classification Severely Acute Malnourished - SAM Moderately Acute Malnourished - MAM 8

9. Cut Off Values SAM MUAC < 11. 5 cm (< 115 mm) WFH (z score) < -3 SD MAM MUAC 12.5 cm – 11.5 cm (125 – 115 mm) WFH (z score) > - 3 and < - 2 SD 9

10. 10 ASSESSMENT What needs to be done ???

11. Variables Age Sex Oedema MUAC Weight Height / Length 11

12. Age (6 – 59 months) Birth certificate, B form, EPI card Ask Mothers / Caretaker’s recall Use local events calendar Family ( Khandan ) register of Lady Health Worker 12

13. Oedema Oedema is the retention of water and sodium in the extra-cellular spaces Generally water accounts for 10–30% of bodyweight, but in the most severe cases of malnutrition the proportion can reach 50%. 13

14. Oedema … Gently press both feet for 3 seconds (the time to say 101, 102, 103) with your thumb. Remove your thumb from the feet. If a pit (depression) remains for several seconds, the child has Oedema Pitting Oedema is graded as +, ++, +++ If bilateral pitting oedema is noted then it is important to have a second opinion to confirm 14

15. How to check! 15

16. Oedema + ve ! 16

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18. MUAC Explain the procedure to the child’s mother or care giver Ask the mother to remove extra clothing that may cover the child’s left arm Bend the left arm at 90 degrees to the body Place a measuring tape along the upper arm and find the mid-point of the upper arm. The mid-point is between the tip of the shoulder and the elbow. Mark the mid point with a pen Straighten the child’s arm and wrap the tape around the arm at midpoint. Inspect the tension of the tape on the child’s arm. Record MUAC measurement to the nearest 0.1cm 18

19. MUAC Tape 19

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30. Weight Place the scale on a flat surface. Remove extra clothing from child as much as possible Press the Weighing Scale to turn it on Ask Mother / Caretaker to stand on the scale without child Store weight of the mother by pressing store button Pass child to be weighed to the mother on scale The scale indicate the child’s weight Record child's to the nearest 0.1 gm 30

31. Height For increased accuracy & precision 2 people are needed Children aged ≥ 2 years are measured standing up and <2 years are measured lying down If age is difficult to assess then children >87 cm are measured standing and <87 cm are lying down It is important to Record child height to the nearest 0.1 cm A height stick or tape fixed on a wall/table can also be used to quickly measure child height/length 31

32. Hands cupped over ears; head against base of board 1 Child Flat on Board 3 Hand on Knees or shins; legs straight 4 Child’s feet flat against foot piece 5 Arms comfortably straight 2 32

33. Height & Weight Table Boys Girls 33

34. THANKS 34