Nutritional Surveillance Community Medicine.pptx

Surveilalnce nutrition

1. NUTRITIONAL SURVEILLANCE AND REHABILITATION

2. Nutritional surveillance Nutritional surveillance has been defined as “Keeping watch over nutrition, in order to make decisions that will lead to improvement in nutrition in population" Three distinct objectives have been defined for surveillance systems : (A) To aid long-term planning in health and development (B) To provide input for programme management and evaluation (C) To give timely warning and intervention to prevent short-term food consumption crises

3. Nutritional surveillance Nutritional surveillance, can be carried out on a representative sample of children in the community. It gives a reliable idea of the overall nutritional condition It can help to diagnose malnutrition and assess the measures designed to alleviate malnutrition in the community at large.

4. Goals of Nutritional surveillance The goal of a food and nutrition surveillance system is to provide regular and updated information on the nutritional conditions of a population and the influencing factors. This information shall provide the basis for decisions for policy planning and management of programs relating to improvement of food consumption patterns and nutritional status.

5. Objectives of Nutritional surveillance To describe the nutritional status of the population, with particular reference to defined subgroups at risk including defined age groups and geographic areas. This enables the targeting of risk groups for action to provide information on the causes and associated factors of nutritional problems in order to facilitate the adoption of preventive measures

6. Contd. To promote decisions by governments concerning priorities and resource allocation, to formulate policies and program To enable predictions on the basis of current trends of nutritional problems provide early warning signs of impending crisis and emergencies . To monitor nutritional programs and to evaluate their effectiveness

7. Methods of Nutritional surveillance Large scale food and nutrition surveys Repeated small-scale surveys Sentinel site surveillance School census data Growth monitoring

8. Types of Indicators Nutritional status indicators Indicators of causes/risk factors Indicators for monitoring and evaluating nutrition program

9. Nutritional status indicators

10. Steps of Nutritional Surveillance Planning the survey What is the problem status? Who are the population groups at risk? Why is the population group at risk? Where to get the relevant data from? Identify goals: Identify survey goals and objectives, study population and methodology, outcomes variables and data analysis tools.

11. Training: Training of staff is done followed by pretesting of tool Review information: A review of the available information or literature related to the anticipated survey area. Identify relevant indicators: Demographic information like household details, residence, socioeconomic profile Selecting survey methodology Select survey sample Data collection tools and instrument Data collection Compilation of data and report writing

12. Nutritional status indicators

13. Use nutritional indicators to measure quality of life, specially as a means of evaluating both development programmes and health programmes . Many of the indicators used in nutritional surveillance are the same as the socio-economic and health status indicators recommended for monitoring progress in health

14. Under nutrition encompasses : stunting (chronic malnutrition) wasting (acute malnutrition) deficiencies of micronutrients (essential vitamins and minerals) The high mortality and disease burden resulting from under nutrition call for urgent implementation of interventions to reduce their occurrence and consequences

15. Types of Under nutrition The three indices: (1) weight-for- age - underweight (2) height-for-age - stunting (3) weight-for-height- wasting Each of the three nutrition indicators is expressed in standard deviation units (Z-scores) from the median of the reference population.

16. Ecology of malnutrition Conditioning influences Cultural influences Socio-economic factors Food production Health and other services

17. Nutritional Rehabilitation Center

18. Nutrition rehabilitation center (facility-based care for children with SAM and medical complications) Nutrition rehabilitation center (NRC) is a unit in a health facility where children with SAM are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Once discharged from the NRC, the child continues to be in the nutrition rehabilitation program till she/he attains the defined discharge criteria from the program

19. Objectives of NRC To provide clinical management and reduce mortality among children with severe acute malnutrition, particularly among those with medical complications To promote physical and psychosocial growth of children with SAM To build the capacity of mothers and other caregivers in appropriate feeding and caring practices for infants and young children To identify the social factors that contributed to the child slipping into severe acute malnutrition.

20. Services Provided at the Facility 24-hour care and monitoring of the child Treatment of medical complications Therapeutic feeding Providing sensory stimulation and emotional care Social assessment of the family to identify and address contributing factors Counseling on appropriate feeding, care and hygiene Demonstration and practice-by-doing on the preparation of energy dense child foods using locally available, culturally acceptable and affordable food items Follow-up of children discharged from the facility.

21. Criteria for discharge Child Discharge criterion for all infants and children is 15% weight gain and no signs of illness. This should be achieved through facility-based care in NRC when community-based program is not in place.

22. Discharge from nutrition rehabilitation center Edema has resolved Child has achieved weight gain of >15% and has satisfactory weight gain for 3 consecutive days (>5 Child is g/kg/day) eating an adequate amount of nutritious food that the mother can prepare at home All infections and other medical complications have been treated Child is provided with micronutrient Immunization is updated

23. Mother/caregiver Knows how to prepare appropriate foods and to feed the child Knows how to give prescribed medications, vitamins, folic acid and iron at home Knows how to make appropriate toys and play with the child Knows how to give home treatment for diarrhea, fever and acute respiratory infections and how to recognize the signs for which medical assistance must be sought Follow-up plan is discussed and understood

24. Where community-based program is well functioning, child can be transferred from facility-based care to community-based care for achieving target weight gain of 15%, based on the following criteria:

25. Child has completed antibiotic treatment Has good appetite (eating at least 120-130 cal /kg/day) Has good weight gain (of at least 5 g/kg/day for three consecutive days) on exclusive oral feeding No edema Caretakers sensitized to home care and education has been completed 3 Immunization is up-to-date If the child has not recovered in 4 months, she/he is classified as a "non responder":

26. Failure to regain appetite Failure to start to lose edema Edema still present Day 4 Approximate time after admission Day 4 Day 10 * Failure to gain at least 5 g/kg/day for 3 successive days after feeding freely on catch-up diet Failure to respond Criteria

27. Follow-up Children discharged from NRC should be followed up at the community level to ensure appropriate feeding, follow-up at NRC for scheduled visit and to identify the children who are not responding to the treatment.

28. THANK YOU