Nutrition overview Objectives - PowerPoint Presentation

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Nutrition overview

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Objectives

Understand the different types of malnutrition

Be confident in how the different malnutrition indicators and indices work

Work with Z-scores

Be able to identify the nutritional status of children under five years old

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Nutrition overview

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Nutrition overview

Nutrition?

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Types of malnutrition

Acute malnutrition

Chronic

malnutrition

Micronutrient

deficiency

Obesity

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Nutrition overview

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Burden of

malnutrition

Malnutrition is a global problem and is still one of the most common causes of morbidity and mortality in children worldwide.

45% of the 6.9 million deaths occurring in children younger than 5 years in developing countries are associated with malnutrition.

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People are malnourished if their diet isn´t enough or they are unable to fully utilize the food they eat due to illness.

The

vicious

cycle

of

malnutrition

and

disease

Disease and malnutrition are closely linked. Sometimes disease is the result of malnutrition, sometimes it is a contributing cause.

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Causes of malnutrition

Conceptual framework from The Lancet

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Types of malnutrition

Acute malnutrition

Chronic

malnutrition

Micronutrient

deficiency

Obesity

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Nutrition overview

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Children who suffer from chronic malnutrition fail to grow to their full genetic potential, both mentally and physically. The main symptom of this measured is stunting - shortness in height compared to others of the same age group - and takes a relatively long time to develop.

CHRONIC MALNUTRITION

OR STUNTING

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Acute

malnutrition: Clinical

forms

Marasmus

Excessive thinness, also known as “wasting”.

Low weight compared to height/length.Resulting from a recent and rapid loss of weight or other incapacity to gain weight.

Reversible phenomenon through improvements of life conditions.

KwashiorkorPresence of bilateral edema.

Often following weaning, 18 months to 2.5 years.

Causes remain uncertain.

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Marasmus

Recent and acute weight loss as a result of acute food shortage and/or illness.

Emaciation and all its signs are a major feature of Marasmus

It can be Severe or Moderate

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Kwashiorkor

This is the most serious presentation of AM

Characterised by the presence of Bilateral Pitting Oedema

Restoring the fluid balance is a lifesaving priority before stablishing therapy for weight gain

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Stages of Acute Malnutrition

Moderate

Wasting = MAM (previously referred to as Moderate Acute Malnutrition)

Severe

Wasting = SAM (Previously referred to as Severe

Acute malnutrition)

 Global acute malnutrition (GAM) refers to both MAM and SAM.

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Diagnostic

tools

Presence of bilateral

edema

MUAC

Anthropometric

Indices

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Slide15

Diagnosing

edema

:

thumb

pressure test

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Slide16

MUAC

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Indicators

Indices

Wasting

(Acute malnutrition)

Weight/Height

Stunting

(Chronic malnutrition)

Height/Age

Underweight

(Acute and/or chronic)

Weight/Age

Anthropometric

Indices

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Anthropometric Indices

To determine the nutritional status of an individual, ALL those variables are necessary:

Weight

Height

Presence of bilateral

edemaMUAC

AgeSex

Anthropometric surveys based on three indices:Weight/height index (W/H)

Height/age index (H/A)

Weight/age index (W/A)

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Expressing Indices: Z-Score

Z-score is the deviation from the mean value in terms of standard deviation units; the term is used in analysing variables such as heights and weights of a sample.

In the reference population, all the children of the same height are distributed around the median weight, some having a superior weight, and others with an inferior one.

What is standard Deviation?

A measure of the dispersion of a data set, around the mean.

Generally, the larger the distribution of the values around the average, the larger the standard deviation.

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Z-Score

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SD = 1

SD < 1

SD > 1

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Z-Score

The Z-score (for weight) is based upon :

The weight of the child.

The median weight of children of the same height and sex in the reference population.

(Weight of the child – median reference weight) ÷ standard deviation of the weight in the reference population.

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Classification of Acute Malnutrition

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Acute Malnutrition (W/H index)

Z-Score

Bilateral Edema

Severe

< -3 Z-Score

Yes/No

Severe

> -3 Z-Score

Yes

Moderate

< -2 Z-Score to

≥ - 3 Z-Score

No

Global

< -2 Z-Score

Yes

/No

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A group of 905 children are measured over the course of a survey. None of the children suffered from edema. Fifteen children had z-scores <-3, and 45 between <-2 and >= -3.

What is the prevalence of severe, moderate and global acute malnutrition ?

Exercise 1

5 min

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Prevalence of severe acute malnutrition (SAM) = number of children severely malnourished / total number of children x 100:

SAM =(15)/905



100 = 1.7%

Prevalence of moderate acute malnutrition (MAM) = number of children severely malnourished / total number of children x 100:

MAM = (45)/905



100 = 5.0%

Prevalence of global acute malnutrition (GAM) = Prevalence of severe acute malnutrition + prevalence of moderate acute malnutrition.

GAM =

(45+15)/905



100

= 6.6%

Exercise 1 - Answer

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A group of 910 children are measured over the course of a survey. Six children are edematous. Of these six, only one has a W/H z-score of <-3,0, two are between -3,0 et -2,0; and three are >- 2,0. Globally, 17 children have z-scores <- 3, and 55 had a z-score between <- 2 and > - 3.

What is the prevalence of severe, moderate and global acute malnutrition ?

Exercise 2

5 min

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Prevalence of severe acute malnutrition (SAM) = number of children severely malnourished / total number of children x 100:

SAM =(17+6-1)/910



100 = 2.4%

Prevalence of moderate acute malnutrition (MAM) = number of children moderately malnourished / total number of children x 100:

MAM = (55-2)/910



100 = 5.8%

Prevalence of global acute malnutrition (GAM) = Prevalence of severe acute malnutrition + prevalence of moderate acute malnutrition.

GAM =

(17+55+6-1-2)/910 x 100

= 8.2%

Exercise 2 - Answer

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Slide28

Nutrition overview

How do

we

treat Acute Malnutrition?28

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Community-based Management of Acute Malnutrition (CMAM)

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Nutrition overview

How do

we

treat Chronic Malnutrition?

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Nutrition overview

What

is

IYCF?32

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Exclusive Breastfeeding: Under 6 months

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Complementary Feeding: 6-23 months

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Dietary Diversity: 6-23 months

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Estimating

Age

Refer to child’s immunization card or other written document with the child’s age or date of birth written on it.

If the age of a neighbour’s child is known, ask whether or not their child was born before or after the selected child.

Use a local events calendar. Use height cut-offs.

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Estimating Age from Events Calendar

Used when:

Households do not have any reliable document (birth certificate, medical diary, etc.) confirming the date of birth of the children.

Surveyors must check or confirm an age (1 year, 2 and half years, etc.) or a birth date given by a member of the household or a neighbour.

Must contain events from the last 60 months.

4 important sections to have:

Seasons: beginning of rainy season, dry season, etc.

Religious holidays: Tabaski, Christmas, Maouloud, Easter, etc.

Other events: elections, national holidays, etc.

Local holidays: market days, construction, etc.

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Estimating Age from Events Calendar

Start by

locating

the

year

of birth

on the local calendar by

refering to:

Some

major

event

that

occured

that

year

.

Year

of

birth

of

another

child

.

Number

of

religious

holidays

(

e.g

. Child

was

born

since

3

Christmasses

, or 4 Ramadans, etc.)

Locate

the

month

of

birth

within

that

year

:

Before

or

after

this

major

event

.

In a

specific

season (rainy season, dry season, winter, etc.)38

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Height

vs

length

Children less than 87 cm.

:

Measure lengthchildren lying down

Children 87 cm or more.:

Measure height.Child standing

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Z-score tables

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Different tables for:

Indices

WHA, HAZ, WFH

Sex

Boys/girls

Age

<2 years (

lenght

)/>2 years (height)

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2)

Find

the

height

,

for

example

67.5 cm

Get

the

right

table

:

Boys

>2

years

old

3)

Locate

the

weight

,

for

example

6.5kg

4)

Find

the

z score.

In

this

example

between

-2 and -3 SD, so

this

child

has MAM

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Why are the 6-59 months, the most targeted population in anthropometric surveys?

Snapshot Question

5 min

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Children

6 to 59

months

old

Nutritional Status: Indication of the severity of the situation in the whole population.

In growth period.

Particularly vulnerable to disease and food shortage

Face a higher risk of mortality in cases of crises.

Considered to be the most sensitive to nutritional stress.

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Children

6 to 59

months

Easier to measure:

Measurement equipment is less bulky.

Possible to undress them when taking measurements.

Generally at home.

Stakeholders are used to this type of data and appropriate response.

Lots of expertise in surveys for this age group.

Anthropometric indicators and references are internationally recognized.

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Slide45

what types of measurement errors do you think are common when measuring anthropometric indicators?

Snapshot Question

5 min

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Excercise 1

Divide in 4 groups: A, B, C and D

What is the age and nutritional status of these children?

For each child calculate

Age (you need the events calendar)WFH (you need to use the WFH tables)HAZ (you need to use the HFA tables)

Nutritional status: normal, MAM, SAM or stunted

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