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4 MAJOR NUTRITIONAL PROBLEMS IN OUR COUNTRY:

1.       Low Birth Weight.

2.       Protein energy malnutrition.

3.       Exophthalmia (Vit-A Deficiency).

4.       Nutritional anaemia (Iron deficiency anaemia).

ASSESSMENT OF NUTRITIONAL STATUS OF UNDER 5’S IN A COMMUNITY:

  OBJECTIVE: To determine the extent of nutritional problems/ disease in a community & their contributing factors.

  METHOD:

A.      Clinical examination.

B.      Anthropometric examination.

C.      Laboratory & biochemical examination.

D.      Functional indicators.

E.       Biophysical examination.

F.       Vital statistics.

G.      Diet survey.

H.      Assessment of ecological factors.

CLINICAL EXAMINATIONS:

  Examination from head to toe the changes believed to be related to food consumption that can be seen or felt in superficial tissue- hair, eyes, skin, buccal mucosa, tongue, ears, nose, lips, teeth, gum, glands, nails, chest, abdomen & oedema.

  WHO expert committee classified sign used-

1.       Not related to nutrition- alopecia, pyarrhea, pteygium.

2.       Need further investigations- malar pigmentation, corneal vascularisation, geographic tongue.

3.       Known to be of value- angular stomatitis, Bitot’s Spot, Calf tenderness, absence of knee or ankle jerks, enlargement of thyroid etc.

ANTHROPOMETRIC EXAMINATION:

A.      WEIGHT: Weight for age helps in assessing the nutritional status & growth when recorded periodically & plotted in “ROAD TO HEALTH” card.

Describes severity of malnutrition- Low weight for age- under weight (acute & chronic malnutrition).

Low weight for height- nutritional wasting or emaciation (acute malnutrition).

METHOD: Current weight (in Kg) is compared with the expected standard weight & the deficiency in percentage in expressed in terms of degree of malnutrition.

Weight for age is employed in welcome’s classification to assess PEM as Kwashiorkor’s, Marusmus.

Weight is measured using Salter’s Scale in field.

B.      HEIGHT: Linear dimension & a measurement of skeletal elongation.

Height for age gives an indication of duration of malnutrition, best parameter of chronic malnutrition.

Low height for age- nutritional stunting or dwarfing & past or chronic malnutrition.

C.      CIRCUMFERENCE OF CHEST TO HEAD RATIO:

At birth circumference of head is little more than chest, same by one year of age & crossing over takes after 1 year. Chest to head circumference ratio <1- considered as PEM.

D.      CIRCUMFERENCE OF MID-ARM: Gives information about the muscle mass. Muscle wasting is cardinal features of PEM. Internal diameter of 4cm, if goes over upper arm- child is malnourished.

   SHAKIR’S tape is most commonly used:

 

MID ARM CIRCUMFERENCE INTERPRETATION
>13.5 cm Well nourished.
12.5- 13.5 cm Mid to moderate malnourishment.
<12.5 Severe malnutrition.

 

E.       SKINFOLD THICKNESS: Gives information about subcutaneous reserve of calories in the body. Herpenden’s Calipers are used & measured over triceps of left arm or intracapsular region. 10 cm is the cut off point.

LABORATORY & BIOCHEMICAL EXAMINATION:

LABORATORY TEST:

A.      Haemoglobin estimation & serum transferrin- Index of overall nutrition.

B.      Stools & urine- Examined for intestinal parasites- stool. Urine- Albumin, sugar & urinary nitrogen.

C.      Biochemical test- Concentration of nutrients in blood & urine.

FUNCTIONAL INDICATION: Used as diagnostic tools.

A.      Structural integrity.

B.      Host defence.

C.      Haemostasis.

D.      Reproduction.

E.       Nerve function.

F.       Work capacity.

BIOPHYSICAL EXAMINATION:

Cytological examination of buccal mucosa. Percentage of confined cell increases with degree of malnutrition.

ASSESSMENT OF DIETARY INTAKE:

Home visits daily for 7 day- “One Dietary Cycle”.

 METHOD:

A.      Weighing of raw food.

B.      Weighing of cooked food.

C.      Questionnaire method- Recall of previous 24-48 hours food consumption.

D.      Others- Food inventory or log book method. Food list method. Analysis of cooked food.

VITAL STATISTICS:

Age specified death rate among 1-4 years. Cause specific death rate. Proportional mortality rate due to PEM.

ASSESSMENT OF ECOLOGICAL FACTORS:

1.       Conditioning infection & infestations.

2.       Cultural factors.

3.       Socioeconomic factors.

4.       Food production.

5.       Availability of health services.

 

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