logging in or signing up Prevention of childhood malnutrition dr harivansh chopra harichop Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 641 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: August 17, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Prevention of Childhood Malnutrition : Dr. Harivansh Chopra DCH, MD Professor Department of Community Medicine, LLRM Medical College, Meerut. Prevention of Childhood Malnutrition Objectives : Objectives To study the magnitude of Protein Energy Malnutrition and causes associated with it. To study methods of prevention, treatment, and rehabilitation of PEM. Whether this child will grow normally or become malnourished? : Whether this child will grow normally or become malnourished? ? ? Protein Energy Malnutrition : Protein Energy Malnutrition Defined as “chronic pathological condition which arises due to absolute or relative lack of protein and energy in the diet over an extended period of time and is commonly associated with infection albeit infestation in young children”. Nutritional Status of children below 3 years : NFHS II : Nutritional Status of children below 3 years : NFHS II Nutritional Status of children below 3 years : NFHS II : Nutritional Status of children below 3 years : NFHS II Nutritional status of under-three children in relation to living index : Nutritional status of under-three children in relation to living index NFHSII Nutritional status of under-three children in relation to age : Nutritional status of under-three children in relation to age Percentage of underweight children –Comparison between NFHS I & II : Percentage of underweight children –Comparison between NFHS I & II Nutritional Status of children below 3 years : NFHS III : Nutritional Status of children below 3 years : NFHS III Nutritional Status of children below 3 years : NFHS III : Nutritional Status of children below 3 years : NFHS III Percentage of underweight children –Comparison between NFHS II & III : Percentage of underweight children –Comparison between NFHS II & III Distribution of 1-5 years children (Gomez classification) : Distribution of 1-5 years children (Gomez classification) NNMB Causes of Malnutrition : Causes of Malnutrition Inadequate Food Security. Infection. Low weight of adolescent girls. Causes of Malnutrition : Causes of Malnutrition Low Immunization coverage. Maternal Anemia. Low literacy level in female. Causes of Malnutrition : Causes of Malnutrition Poor sanitary conditions. Low birth weight. Lack of knowledge regarding normal growth of children. Causes of Malnutrition : Causes of Malnutrition Poor hygiene. Incorrect child rearing practices. Inaccessible and Inadequate health services. Causes of Malnutrition : Causes of Malnutrition Lack of Comprehensive Child Health Care Programme. Lack of political will. Slide 19: Big problem needs a Big solution. If one wants to Win the battle, the effort has to be intensive and focused. So, it has to be a BIG WIN against MALNUTRITION. BIGWIN approach is to be applied. MALNUTRITION IS A BIG PROBLEM Shift Strategy : Shift Strategy A shift in strategy is the need of the hour. Infants must be made the focus of attention for mothers as – NEITHER a mother would like to deliver a low-birth weight baby; NOR any mother would like to have a malnourished child. The BIGWIN Approach : The BIGWIN Approach Exclusive Breast Feeding for 4 months. Infection Prevention and Immunization. Growth Promotion / Monitoring. Appropriate Weaning Practice. Iron Supplementation. Nutrition education & Extra-Nutrition in pregnancy & lactation, and illness in child. No to next pregnancy. Weight gain in the first five years of life : Weight gain in the first five years of life Kg. Kg. Weight gain in the first year of life : Weight gain in the first year of life Kg. Kg. Weight gain in the next four years of life : Weight gain in the next four years of life Kg. Kg. Kg. Kg. v/s Monitor the Weight : v/s Monitor the Weight F I R S T S E C O N D Weight gain in 1st year of life. Weight gain in next 4 years of life. Exclusive Breast Feeding in India – NFHS II : Exclusive Breast Feeding in India – NFHS II Immunization Coverage : Immunization Coverage Immunization Coverage : Immunization Coverage Anemia in Children : Anemia in Children Iron Supplementation v/sIron Therapy – Cost : Iron Supplementation v/sIron Therapy – Cost Empowering Women : Empowering Women Poor Perpetually Pregnant female Powerful Perceptive Problem-solving Empowering Women : Empowering Women Mass Media Government Health System Mahila Mandals Empowering Women : Empowering Women NGOs Link Women Anganwadi Empowering Women : Empowering Women Health Worker School Health BFCI Nutrition Education : Nutrition Education Education is a learning process by which a change in behaviour is brought about. For providing nutrition education, one must have sound knowledge of locally available foods. Nutrition Education : Nutrition Education The timing of providing education is of crucial importance. All persons involved in decision making, as well as responsible for cooking must be sensitized. Nutrition Education : Nutrition Education The typical jargon of nutritive value in context of calories and proteins must be avoided. Beneficiaries should be sensitized on protective, body building, and essential foods. Nutrition Education : Nutrition Education Vulnerable periods of life, specially infancy, pregnancy, and lactation must be taken into account. Nutrition Therapy : Nutrition Therapy If one is not able to prevent the occurrence of malnutrition, one has to go for treatment of malnutrition. Although prevention is still better than cure. Principles of Nutrition Therapy : Principles of Nutrition Therapy Mild to moderate degree of malnutrition can be managed at home. Principles of Nutrition Therapy : Principles of Nutrition Therapy Only severely malnourished children with complications need to be hospitalized first. The aim is to provide 1.5 – 2 gms. of protein/ kg per day and 150 – 180 calories/kg/day. Management of mild to moderate degree of malnutrition : Management of mild to moderate degree of malnutrition This is usually done with the help of protein and calorie rich diets. 1. Besan Panjiri : 1. Besan Panjiri Contents – Bengal gram flour, Wheat flour, Jaggery, Ghee (1 part each). Calories: 500 calorie/100gm. Protein: 9gm/100gm. 3. Shakti aahar : 3. Shakti aahar Constituents: Roasted wheat 40gm, Roasted gram 20gm, Roasted peanuts 10gm, Jaggery 30gm. Calories: 390 calories/100gm. Protein: 11.4gm/100gm. 4. Hyderabad Mix : 4. Hyderabad Mix Constituents: Whole wheat 40gm, Bengal gram 16gm, Groundnuts 10gm, Jaggery 20gm. Calories: 330 calories/86gm. Protein: 11.3gm/86gm. Management of severely malnourished children : Management of severely malnourished children With complications, they should be hospitalized. Without complications, put straightaway on dietary management. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Feeding must start gradually. Initially approx. 80 Cal/kg/day and 0.7gm protein/kg/day provided; actual body weight rather than expected body weight counted. 2. Sooji Kheer : 2. Sooji Kheer Constituents: Toned milk 750ml, Sugar 100gm, Sooji 25gm, Oil 5gm (aqua add 1000ml). Calories: 143 calorie/100gm. Protein: 2.8gm/100gm. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Small frequent feeds given. Intake gradually increased to 100 Cal/kg/day and 1gm protein/kg/day. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Milk is usually the starting food; for lactose-intolerance, other foods like rice gruel, chicken gruel, soya rice gruel, and cereal pulse gruel are used. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase For enriching milk, generally coconut oil is used. Fluids should be given with cup and spoon; bottle-feeding best avoided. 2. Dietary management – Phase of High Energy Feeding : 2. Dietary management – Phase of High Energy Feeding Caloric intake gradually increased to 150 – 180 Cal/kg/day. Child moved from predominant milk diet to semi solids/solid diet. Protein intake increased to 1.5 – 2gm/kg/day. 3. Dietary Management – Transfer to Family type diet : 3. Dietary Management – Transfer to Family type diet Child should be taking nutritionally wholesome family-type diet (cereals, pulses, vegetables) before discharge from hospital. 3. Dietary Management – Transfer to Family type diet : 3. Dietary Management – Transfer to Family type diet Involves nutrition education of parents. Snacks made from peanuts, bengal gram, jaggery, and oil are useful. Nutritional Rehabilitation : Nutritional Rehabilitation Majority of children, after discharge from hospital, again become victim of Malnutrition. To overcome this, Nutritional Rehabilitation is carried out. Nutritional Rehabilitation : Nutritional Rehabilitation Ambulatory Treatment Rehabilitation in “Nutrition Rehabilitation Centres” Ambulatory Treatment : Ambulatory Treatment In most cases of malnutrition, education alone is sufficient to correct situation. Identify the most serious errors in diet eg. distribution of available food in family, inadequate use of vegetables, etc. The problem may need assistance usually as Food Supplements. Nutritional Rehabilitation Centres (NRC) : Nutritional Rehabilitation Centres (NRC) Severely malnourished children, after taking treatment from hospital, may be transferred to NRCs. The objective is to teach the mother the various methods of preparing nutritious and tasty foods so that the relapse of malnutrition can be prevented. Nutritional Rehabilitation Centres (NRC) : Nutritional Rehabilitation Centres (NRC) Day care NRCs Residential NRCs Day care NRCs : Day care NRCs Similar to crěche or kindergarden. Children spend 6 – 8 hrs daily for 6 days a week in these centres, and take there 3 meals each day. Mothers may attend centre and help preparation of meals, or may attend weekly meeting at centre. Day care NRCs : Day care NRCs Food stuffs and utensils used are familiar to the mothers, and available in local market. Adequate medical supervision is essential at the centres. Residential NRCs : Residential NRCs Larger staff and equipments than day-care NRCs. Children & their mothers live in these as inpatients. Serves mostly children discharged from hospital after treatment for severe malnutrition. Nutrition Supplementation : Nutrition Supplementation Approach by which both prevention and treatment of malnutrition can be met. Supplementary food supplies 300 Cal/day and 10 – 12 gm protein/day to children, and 500 Cal/day and 25 gm protein/day to mothers for 300 days in an year. Nutritional Surveillance : Nutritional Surveillance Surveillance is defined as “Data Collection for Action”. Objectives of Nutrition Surveillance : Objectives of Nutrition Surveillance To aid long term planning in health and development. To provide input for programme management and evaluation. To give timely warning and intervention to prevent short-term food consumption crisis. Triple-A approach : Triple-A approach Resources Effective Demand Conclusion : Conclusion Malnutrition is a preventable problem. Shift in strategy is the need of the hour. Infants must be made the focus of attention in totality. Application of multiple interventions like BIGWIN will produce the desired result. MCQs : MCQs Following is false about weight gain in first year of life except: Weight gain is 4 kg in 1st year. Weight gain is 4 kg in 1st 4 months. Weight gain is maximum during 6 – 12 months of age. None of the above. Ans. – 2. MCQs : MCQs “Hyderabad Mix”, an energy dense supplement, used for malnourished children does not contain : Bengal gram. Groundnut. Soyabean. Jaggery. Ans. – 3. MCQs : MCQs “Hyderabad Mix”, an energy dense supplement, used for malnourished children does not contain : Bengal gram. Groundnut. Soyabean. Jaggery. Ans. – 3. MCQs : MCQs In dietary management of malnutrition, following is provided to children : 100 Cal/kg and 1gm protein/kg. 180 Cal/kg and 2 gm protein/kg. 300 Calorie and 15 gm protein. 500 Calorie and 25 gm protein. Ans. – 2. MCQs : MCQs NRC is : Nutrition Rehabilitation Centre. Nutrition Rehabilitation Council. Natural Resources Council. Natural Rights of Community. Ans. – 1. MCQs : MCQs Giving “timely warning” about food consumption crisis is an objective of : Disaster Management. Food Census. Nutrition Surveillance. Food & Agriculture Research. Ans. – 3. 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Prevention of childhood malnutrition dr harivansh chopra harichop Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 641 Category: Science & Tech.. License: All Rights Reserved Like it (3) Dislike it (0) Added: August 17, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Prevention of Childhood Malnutrition : Dr. Harivansh Chopra DCH, MD Professor Department of Community Medicine, LLRM Medical College, Meerut. Prevention of Childhood Malnutrition Objectives : Objectives To study the magnitude of Protein Energy Malnutrition and causes associated with it. To study methods of prevention, treatment, and rehabilitation of PEM. Whether this child will grow normally or become malnourished? : Whether this child will grow normally or become malnourished? ? ? Protein Energy Malnutrition : Protein Energy Malnutrition Defined as “chronic pathological condition which arises due to absolute or relative lack of protein and energy in the diet over an extended period of time and is commonly associated with infection albeit infestation in young children”. Nutritional Status of children below 3 years : NFHS II : Nutritional Status of children below 3 years : NFHS II Nutritional Status of children below 3 years : NFHS II : Nutritional Status of children below 3 years : NFHS II Nutritional status of under-three children in relation to living index : Nutritional status of under-three children in relation to living index NFHSII Nutritional status of under-three children in relation to age : Nutritional status of under-three children in relation to age Percentage of underweight children –Comparison between NFHS I & II : Percentage of underweight children –Comparison between NFHS I & II Nutritional Status of children below 3 years : NFHS III : Nutritional Status of children below 3 years : NFHS III Nutritional Status of children below 3 years : NFHS III : Nutritional Status of children below 3 years : NFHS III Percentage of underweight children –Comparison between NFHS II & III : Percentage of underweight children –Comparison between NFHS II & III Distribution of 1-5 years children (Gomez classification) : Distribution of 1-5 years children (Gomez classification) NNMB Causes of Malnutrition : Causes of Malnutrition Inadequate Food Security. Infection. Low weight of adolescent girls. Causes of Malnutrition : Causes of Malnutrition Low Immunization coverage. Maternal Anemia. Low literacy level in female. Causes of Malnutrition : Causes of Malnutrition Poor sanitary conditions. Low birth weight. Lack of knowledge regarding normal growth of children. Causes of Malnutrition : Causes of Malnutrition Poor hygiene. Incorrect child rearing practices. Inaccessible and Inadequate health services. Causes of Malnutrition : Causes of Malnutrition Lack of Comprehensive Child Health Care Programme. Lack of political will. Slide 19: Big problem needs a Big solution. If one wants to Win the battle, the effort has to be intensive and focused. So, it has to be a BIG WIN against MALNUTRITION. BIGWIN approach is to be applied. MALNUTRITION IS A BIG PROBLEM Shift Strategy : Shift Strategy A shift in strategy is the need of the hour. Infants must be made the focus of attention for mothers as – NEITHER a mother would like to deliver a low-birth weight baby; NOR any mother would like to have a malnourished child. The BIGWIN Approach : The BIGWIN Approach Exclusive Breast Feeding for 4 months. Infection Prevention and Immunization. Growth Promotion / Monitoring. Appropriate Weaning Practice. Iron Supplementation. Nutrition education & Extra-Nutrition in pregnancy & lactation, and illness in child. No to next pregnancy. Weight gain in the first five years of life : Weight gain in the first five years of life Kg. Kg. Weight gain in the first year of life : Weight gain in the first year of life Kg. Kg. Weight gain in the next four years of life : Weight gain in the next four years of life Kg. Kg. Kg. Kg. v/s Monitor the Weight : v/s Monitor the Weight F I R S T S E C O N D Weight gain in 1st year of life. Weight gain in next 4 years of life. Exclusive Breast Feeding in India – NFHS II : Exclusive Breast Feeding in India – NFHS II Immunization Coverage : Immunization Coverage Immunization Coverage : Immunization Coverage Anemia in Children : Anemia in Children Iron Supplementation v/sIron Therapy – Cost : Iron Supplementation v/sIron Therapy – Cost Empowering Women : Empowering Women Poor Perpetually Pregnant female Powerful Perceptive Problem-solving Empowering Women : Empowering Women Mass Media Government Health System Mahila Mandals Empowering Women : Empowering Women NGOs Link Women Anganwadi Empowering Women : Empowering Women Health Worker School Health BFCI Nutrition Education : Nutrition Education Education is a learning process by which a change in behaviour is brought about. For providing nutrition education, one must have sound knowledge of locally available foods. Nutrition Education : Nutrition Education The timing of providing education is of crucial importance. All persons involved in decision making, as well as responsible for cooking must be sensitized. Nutrition Education : Nutrition Education The typical jargon of nutritive value in context of calories and proteins must be avoided. Beneficiaries should be sensitized on protective, body building, and essential foods. Nutrition Education : Nutrition Education Vulnerable periods of life, specially infancy, pregnancy, and lactation must be taken into account. Nutrition Therapy : Nutrition Therapy If one is not able to prevent the occurrence of malnutrition, one has to go for treatment of malnutrition. Although prevention is still better than cure. Principles of Nutrition Therapy : Principles of Nutrition Therapy Mild to moderate degree of malnutrition can be managed at home. Principles of Nutrition Therapy : Principles of Nutrition Therapy Only severely malnourished children with complications need to be hospitalized first. The aim is to provide 1.5 – 2 gms. of protein/ kg per day and 150 – 180 calories/kg/day. Management of mild to moderate degree of malnutrition : Management of mild to moderate degree of malnutrition This is usually done with the help of protein and calorie rich diets. 1. Besan Panjiri : 1. Besan Panjiri Contents – Bengal gram flour, Wheat flour, Jaggery, Ghee (1 part each). Calories: 500 calorie/100gm. Protein: 9gm/100gm. 3. Shakti aahar : 3. Shakti aahar Constituents: Roasted wheat 40gm, Roasted gram 20gm, Roasted peanuts 10gm, Jaggery 30gm. Calories: 390 calories/100gm. Protein: 11.4gm/100gm. 4. Hyderabad Mix : 4. Hyderabad Mix Constituents: Whole wheat 40gm, Bengal gram 16gm, Groundnuts 10gm, Jaggery 20gm. Calories: 330 calories/86gm. Protein: 11.3gm/86gm. Management of severely malnourished children : Management of severely malnourished children With complications, they should be hospitalized. Without complications, put straightaway on dietary management. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Feeding must start gradually. Initially approx. 80 Cal/kg/day and 0.7gm protein/kg/day provided; actual body weight rather than expected body weight counted. 2. Sooji Kheer : 2. Sooji Kheer Constituents: Toned milk 750ml, Sugar 100gm, Sooji 25gm, Oil 5gm (aqua add 1000ml). Calories: 143 calorie/100gm. Protein: 2.8gm/100gm. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Small frequent feeds given. Intake gradually increased to 100 Cal/kg/day and 1gm protein/kg/day. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase Milk is usually the starting food; for lactose-intolerance, other foods like rice gruel, chicken gruel, soya rice gruel, and cereal pulse gruel are used. 1. Dietary Management – Initial Phase : 1. Dietary Management – Initial Phase For enriching milk, generally coconut oil is used. Fluids should be given with cup and spoon; bottle-feeding best avoided. 2. Dietary management – Phase of High Energy Feeding : 2. Dietary management – Phase of High Energy Feeding Caloric intake gradually increased to 150 – 180 Cal/kg/day. Child moved from predominant milk diet to semi solids/solid diet. Protein intake increased to 1.5 – 2gm/kg/day. 3. Dietary Management – Transfer to Family type diet : 3. Dietary Management – Transfer to Family type diet Child should be taking nutritionally wholesome family-type diet (cereals, pulses, vegetables) before discharge from hospital. 3. Dietary Management – Transfer to Family type diet : 3. Dietary Management – Transfer to Family type diet Involves nutrition education of parents. Snacks made from peanuts, bengal gram, jaggery, and oil are useful. Nutritional Rehabilitation : Nutritional Rehabilitation Majority of children, after discharge from hospital, again become victim of Malnutrition. To overcome this, Nutritional Rehabilitation is carried out. Nutritional Rehabilitation : Nutritional Rehabilitation Ambulatory Treatment Rehabilitation in “Nutrition Rehabilitation Centres” Ambulatory Treatment : Ambulatory Treatment In most cases of malnutrition, education alone is sufficient to correct situation. Identify the most serious errors in diet eg. distribution of available food in family, inadequate use of vegetables, etc. The problem may need assistance usually as Food Supplements. Nutritional Rehabilitation Centres (NRC) : Nutritional Rehabilitation Centres (NRC) Severely malnourished children, after taking treatment from hospital, may be transferred to NRCs. The objective is to teach the mother the various methods of preparing nutritious and tasty foods so that the relapse of malnutrition can be prevented. Nutritional Rehabilitation Centres (NRC) : Nutritional Rehabilitation Centres (NRC) Day care NRCs Residential NRCs Day care NRCs : Day care NRCs Similar to crěche or kindergarden. Children spend 6 – 8 hrs daily for 6 days a week in these centres, and take there 3 meals each day. Mothers may attend centre and help preparation of meals, or may attend weekly meeting at centre. Day care NRCs : Day care NRCs Food stuffs and utensils used are familiar to the mothers, and available in local market. Adequate medical supervision is essential at the centres. Residential NRCs : Residential NRCs Larger staff and equipments than day-care NRCs. Children & their mothers live in these as inpatients. Serves mostly children discharged from hospital after treatment for severe malnutrition. Nutrition Supplementation : Nutrition Supplementation Approach by which both prevention and treatment of malnutrition can be met. Supplementary food supplies 300 Cal/day and 10 – 12 gm protein/day to children, and 500 Cal/day and 25 gm protein/day to mothers for 300 days in an year. Nutritional Surveillance : Nutritional Surveillance Surveillance is defined as “Data Collection for Action”. Objectives of Nutrition Surveillance : Objectives of Nutrition Surveillance To aid long term planning in health and development. To provide input for programme management and evaluation. To give timely warning and intervention to prevent short-term food consumption crisis. Triple-A approach : Triple-A approach Resources Effective Demand Conclusion : Conclusion Malnutrition is a preventable problem. Shift in strategy is the need of the hour. Infants must be made the focus of attention in totality. Application of multiple interventions like BIGWIN will produce the desired result. MCQs : MCQs Following is false about weight gain in first year of life except: Weight gain is 4 kg in 1st year. Weight gain is 4 kg in 1st 4 months. Weight gain is maximum during 6 – 12 months of age. None of the above. Ans. – 2. MCQs : MCQs “Hyderabad Mix”, an energy dense supplement, used for malnourished children does not contain : Bengal gram. Groundnut. Soyabean. Jaggery. Ans. – 3. MCQs : MCQs “Hyderabad Mix”, an energy dense supplement, used for malnourished children does not contain : Bengal gram. Groundnut. Soyabean. Jaggery. Ans. – 3. MCQs : MCQs In dietary management of malnutrition, following is provided to children : 100 Cal/kg and 1gm protein/kg. 180 Cal/kg and 2 gm protein/kg. 300 Calorie and 15 gm protein. 500 Calorie and 25 gm protein. Ans. – 2. MCQs : MCQs NRC is : Nutrition Rehabilitation Centre. Nutrition Rehabilitation Council. Natural Resources Council. Natural Rights of Community. Ans. – 1. MCQs : MCQs Giving “timely warning” about food consumption crisis is an objective of : Disaster Management. Food Census. Nutrition Surveillance. Food & Agriculture Research. Ans. – 3.