L8 Assessment of nutritional status.pptx

Assessment of nutritional status

1. Assessing And Intervening Community Nutritional Needs

2. Public Health Nutrition-Assessment public health agencies — in performing their role of assessment — monitor food and nutrition-related health status to identify and solve nutrition-related health problems.

3. Conti.. Activities of state and local public health agencies include: • Diagnosis of a community’s health status • Identification of food and nutrition-related threats to health • Periodic collection, analysis, and publication of information on access, utilization, costs, and outcomes of nutrition services • Attention to the vital statistics and nutrition-related health status of specific groups at higher risk than the total population.

4. Nutritional assessment Three types of assessment discussed in this chapter focus on food and nutrition-related matters in the community: the nutrition assessment the food assessment (sometimes referred to as a food system assessment), and the food security assessment In clinical practice, community nutrition assessment and food assessment would be the nutritional assessment and the diet history, respectively. The food security assessment collects information to determine the extent to which existing community resources provide adequate, culturally acceptable foods to households in the area

5. Nutritional Assessment-Goal The goals of food and nutrition assessments in the community are to: • Improve the health of the people in a defined area by building the capacity of local health jurisdictions to reduce nutritional risk and promote optimal nutritional health of community members • Raise official awareness of food and nutrition issues to promote the inclusion of nutrition questions in local health assessments and otherwise get food and nutrition issues on the local agenda • Determine how to allocate limited resources • Evaluate the efficacy of food and nutrition programs and services in the community • Identify current and potential food and nutrition problems in the community

6. Requirements 1. Organize a planning group 2. Define community boundaries 3. Gather quantitative data that includes a statistical profile of the community and community resources 4. Collect qualitative data that reflects the food and nutrition concerns of representatives of key community groups 5. Analyze and prioritize common issues, high-risk individuals and populations, and unmet needs

7. Assessment A nutrition assessment examines, in particular, the health and nutrition status of community members, including: • Pregnancy-related status, including prepregnancy weight, weight gain during pregnancy, and anemia • Prevalence of diseases affected by nutrition such as diabetes, cardiovascular disease, and HIV/AIDS • Physical activity and food-related behaviors • Food intake, such as amount of fruits and vegetables consumed • Dental health • Food security

8. 2.Food Assessment A community food assessment is a participatory and collaborative process spearheaded by members of the community rather than health professionals. Community members along with officials representing public and private agencies examine a broad range of food-related issues and community assets in order to improve the community’s food system.

9. Food Assessment A community food assessment includes four components: Organization to identify key stakeholders, arrange initial meetings, determine the group’s interest in conducting an assessment 2. Planning to review other assessments that have been conducted, determine assessment purpose and goals, develop an overall plan and decision-making process and clarify roles, define geographic population boundaries, and identify and secure grants, in-kind resources, and/or project sponsors.

10. Conti.. 3 Research to develop questions and indicators, identify existing data and information needed, develop research tools, collect and analyze data, and compile and summarize findings. 4. Advocacy to discuss findings with community and develop recommendations, create action plans to implement priority recommendations, determine whether additional partners should be recruited, disseminate findings to the public, policymakers and journalists, urge policymakers and others to take action based on recommendations, and evaluate the assessment project.

11. Food Security assessment C ommunity food security assessment more specifically focuses on communities at risk for food insecurity than does a community food assessment In 1999–2000, the Sacramento Hunger Commission conducted a food access study in 2 low-income neighborhoods in Sacramento County, CA. Their subsequent report outlined recommendations made by low-income residents about how to improve food access in their community. The assessment identified a need for improved public transportation to markets supplying fresh, nutritious, affordable food. In response, the commission received funding to implement some of the recommendations in the report. The group’s research and advocacy helped implement a neighborhood shuttle and generated a new bus route connecting underserved aneighborhoods to a grocery store on the opposite side of a freeway.

12. Assessment of Nutritional Status

13. Identifies people at risk for malnutrition for early intervention or referral before severe malnutrition Detects diet habits that increase the risk of disease Identifies needs for nutrition education and counselling Identifies local food resources Tracks growth and weight trends Establishes a framework for a Nutrition Care Plan IMPORTANCE OF NUTRITION ASSESSMENT Photo: Wendy Hammond

14. A nthropometric B iochemical C linical D ietary TYPES OF NUTRITION ASSESSMENT

15. Bilateral pitting oedema Wasting Anorexia, poor appetite Persistent diarrhoea Nausea or vomiting Severe dehydration High fever (≥ 38.5 o C) Rapid breathing Convulsions Severe anaemia CLINICAL NUTRITION ASSESSMENT Mouth sores or thrush HIV Hypothermia Hypoglycaemia Lethargy or unconsciousness Extreme weakness Opportunistic infections Extensive skin lesions 1. Check for medical complications. 2. Find out what medications the client is taking.

16. Anthropometry is the measurement of the size, weight and proportions of the human body. Anthropometric measurements also can be used to assess the nutritional status of individuals and population groups. ANTHROPOMETRY

17. Weight Height Mid-upper arm circumference (MUAC) Measurements presented as indexes Weight-for-age z-score (WAZ) Weight-for-height z-score (WHZ) Body mass index (BMI) BMI-for-age z-score TYPES OF ANTHROPOMETRIC MEASUREMENT

18. Severe acute malnutrition (SAM) with no appetite or with medical complications SAM with appetite and no medical complications Moderate acute malnutrition (MAM) Normal nutritional status Overweight Obesity CLASSIFICATIONS OF NUTRITIONAL STATUS

19. BMI = weight (kg) height (m 2 ) BMI is a reliable indicator of body fatness and an inexpensive and simple way to measure adult malnutrition. BMI cutoffs are not accurate in pregnant women or adults with oedema, whose weight gain is not linked to nutritional status. For these groups, use MUAC. BODY MASS INDEX

20. Bilateral pitting oedema Dull, dry, thin or discoloured hair Dry or flaking skin Pallor of the palms, nails or mucous membranes Lack of fat under the skin Fissures and scars at the corner of the mouth Swollen gums Goitre Bitot’s spots in the eyes PHYSICAL SIGNS OF MALNUTRITION

21. Measurement of nutrient concentration in blood Measurement of urinary excretion and metabolites of nutrients Detection of abnormal metabolites in blood from a nutrient deficiency Measurement of changes in blood constituents or enzyme activities that depend on nutrient intake Measurement of ‘tissue specific’ chemical markers BIOCHEMICAL TESTS USED IN NUTRITION ASSESSMENT

22. CRITERIA FOR SAM Adolescents and adults MUAC < 18.5 cm OR BMI < 16.0 OR weight loss > 10% since the last visit Women who are pregnant or up to 6 months post-partum MUAC < 19.0 cm Children Bilateral pitting oedema OR severe visible wasting OR MUAC 6 to 59 months: < 11.5 cm 5 to 9 years: < 13.5 cm 10 to 14 years: < 16.0 cm OR WHZ OR BMI-for-age z-score < –3

23. Routine SAM medicines Ready-to-use therapeutic food (RUTF) High-energy fortified-blended food (FBF) or ready-to-use supplementary food (RUSF) HIV testing and PCP prophylaxis Counselling on the CNAs Weekly or bi-weekly monitoring Appetite test, oedema assessment, weight monitoring and medical checks on each visit Referral to food security and livelihood support, home-based care, psychosocial counselling, etc. NUTRITION CARE FOR CLIENTS WITH SAM

24. CRITERIA FOR NORMAL NUTRITIONAL STATUS Adults MUAC ≥ 22.0 cm OR BMI ≥ 18.5 to < 25.0 Women who are pregnant or up to 6 months post-partum MUAC ≥ 23.0 cm Children MUAC 6–59 months: ≥ 12.5 cm 5–9 years: ≥ 14.5 cm 10–14 years: ≥ 18.5 cm OR WHZ ≥ –2 to ≥ +2 OR BMI-for-age z-score ≥ –2 to ≤ +1

25. Counselling to prevent infection and malnutrition Critical Nutrition Actions Child spacing and reproductive health Optimal infant and young child feeding Micronutrient supplementation Growth monitoring and promotion Deworming Malaria prevention NUTRITION CARE FOR NORMAL NUTRITIONAL STATUS

26. Adults BMI ≥ 25.0 to < 30.0 Children and adolescents 5–17 years BMI-for-age z-score > +1 to ≤ +2 Children 6–59 months MUAC: > 21 cm OR WHZ > + 2 to ≤ +3 CRITERIA FOR OVERWEIGHT

27. Adults (non-pregnant/ post-partum) BMI ≥ 30.0 Children and adolescents 5–17 years BMI-for-age z-score > +2 Children 6–59 months WHZ +3 CRITERIA FOR OBESITY

28. Medical assessment to rule out diabetes or high cholesterol Counselling to eat more fruits and vegetables, fewer fried and sugary foods and to drink water instead of juice or soda Counselling to get at least 1 hour of exercise a day NUTRITION CARE FOR OVERWEIGHT AND OBESITY

29. Targeting at risk population

30. High Risk Population In any community high risk population include those people which are most vulnerable for any kind of illness . -Children -Women of reproductive age -Elderly -People with special conditions

31. When assessing nutritional status of a population always give priority to the vulnerable group of community. Target for treatment and give priority according to their malnutrition status.

32. Find malnourished people early and refer them for treatment before they develop serious complications. Increase awareness of the importance of nutrition and the causes, signs and treatment of malnutrition. Increase awareness of available nutrition services. Increase coverage and follow-up of clients. Link prevention and treatment of malnutrition. AIMS OF COMMUNITY OUTREACH

33. Home-based care (HBC) and most vulnerable children (MVC) services: Measure MUAC to screen for malnutrition, refer malnourished people to health facilities and counsel people on the CNAs. ( Critical Nutrition Actions ) Local leaders: Mobilise communities to seek NACS ( Nutrition Assessment, Counselling and Support ) services. Networks and support groups for people: Encourage members to practice the CNAs, measure MUAC and refer members to NACS services. Local media: Inform communities of NACS services and entry and exit criteria. CHANNELS OF COMMUNITY OUTREACH

34. Infant Feedings

35. Infant and young child feeding The concept of infant and young child feeding was introduced in 2002. Fetal and infant nutrition is the foundation for growth, development , intelligence , emotional wellbeing and immunity .

36. Timely initiation of breast feeding within 1hr of birth. Exclusive breast feeding during first 6m of life. Timely introduction of complementary foods at 6m. Age‐appropriate foods for children 6m‐2yrs. Hygienic complementary feeding practices. Immunization and bi‐annual vitamin A supplementation with deworming Appropriate feeding for children during and after illness Therapeutic feeding for children with severe acute malnutrition. Breast Feeding

37. When mother is unavailable, critically ill or no more, and in any case breast feeding is not possible baby have to be fed artificially Infant formula. Unmodified bovine milk. Decision of choosing the formula feeding is done by healthcare professional based on socio‐economic status of family. Detailed information regarding the hygienic preparation in right proportion has to be advised. Artificial Feeding

38. BreastFeed Vs Artificial Feed

39. The giving of foods to infants starting at six months, in addition to breast milk. Complementary Feeding ‐  NOT sufficient as on their own as a diet ‐  Should NOT displace breastmilk

40. WEANING OR COMPLEMENTARY FEEDING BRIDGE

41. Changing Public Eating Behavior

42. Giving advice is directive. Educating is conveying information from an expert to a group of people. Counselling is non-directive, non-judgemental, dynamic, empathetic, interpersonal communication to help someone use information to make a choice or solve a problem. COUNSELLING VS. EDUCATION AND ADVICE

43. Using helpful non-verbal communication Showing interest Showing empathy Asking open-ended questions Reflecting back what the client says Avoiding judgement Praising what a client does correctly Giving a little relevant information at a time Using simple language Giving practical suggestions, not commands SKILLS THAT FACILITATE COUNSELLING

44. G – Greet A – Ask T – Tell H – Help E – Explain R – Reassure/Return date GATHER COUNSELLING STEPS

45. Inability to find or buy nutritious foods Feeling that nutrition is not important compared to other problems Inexperienced counsellors Belief that illness is caused by supernatural forces CHALLENGES IN COUNSELLING ON NUTRITION

46. Refer clients to food or economic support. Counsel on the importance of nutrition to prevent and recover from illness, perform better at school and work and help medicines work effectively. Learn more about nutrition and counselling methods. Counsel people in private and assure them that their information will be kept confidential. Show evidence of improvement from nutrition interventions. ADDRESSING COUNSELLING CHALLENGES

47. Food Choices and Food Guidelines

48. People should eat a variety of foods from all the food groups to get all the nutrients the body needs. Cereals, green bananas, roots and tubers (carbohydrates for energy) Pulses, nuts and animal-source food (protein for body building) Fruits (vitamins and minerals for protection) Vegetables (vitamins and minerals for protection) Sugar, honey, fats and oils (extra energy) Choose from all FOOD GROUPS

49. Food Guidelines From Food Pyramid

50. Group Kilocalories (kcal)/day 6–11 months 680 12–23 months 900 2–5 years 1,260 6–9 years 1,650 10–14 years 2,020 15–17 years 2,800 ≥ 18 years 2,000–2,580 Pregnant/lactating 2,460–2,570 Source : WHO, FAO and United Nations University (UNU). 2001. Human Energy Requirements: Report of a Joint WHO/FAO/UNU Expert Consultation, 17–24 October, 2001. Geneva: WHO. DAILY ENERGY REQUIREMENTS

51. THANK YOU !