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MALNUTRITION - Screening and referral PowerPoint Presentation

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Description : Check out this medical presentation on Child Nutrition, which is titled "MALNUTRITION - Screening and referral", to know about the basics about undernutrition.

Tags : Child Nutrition, MALNUTRITION, Screening, referral

Published on : Jul 07, 2021 | Views : 3032 | Downloads : 22

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9 juillet 2021 MALNUTRITION – Screening and referral BALKH Nutrition Team
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9 juillet 2021 2 Objectives of training To understand basics about undernutrition: definition, causes and consequences To know how to perform anthropometric measurements – identify MAM and SAM children / PLW To know and understand the management of acute malnutrition
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9 juillet 2021 3 NUTRITIONAL REQUIREMENTS FOOD INTAKE Nutrition Nutritional status: balance physiological state of an individual, which results from: the relationship between nutrient intake and requirements, and the body’s ability to digest, absorb and use these nutrients.
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9 juillet 2021 4 FOOD INTAKE NUTRITIONAL REQUIREMENTS Nutritional Status: not well balanced diet Over-nutrition Obesity
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9 juillet 2021 5 FOOD INTAKE NUTRITIONAL REQUIREMENTS Nutritional Status: not well balanced diet Under-nutrition
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9 juillet 2021 6 Non-balanced nutrition can be caused by : Sufficient quantity but insufficient quality of food (lack of diversified food) Sufficient quality but insufficient quantity of food (lack of intake) Insufficient quantity and quality of food (lack of intake and diversified food) MALNUTRITION : Term for bad nutritional status Definition: situation when the body does not receive the sufficient quantity and/or quality of nutrients.
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9 juillet 2021 7 Food intake Food intake depends on different factors: Availability of the food For example: food available in the market Accessibility of the food For example: cost of the food in the market Possible influences?? Harvest, price, soil, culture/beliefs, etc
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The tree of malnutrition 09/07/2021 Malnutrition unbalanced nutritional status Over nutrition overweight OBESITY Micronutrient deficiency Under-nutrition Chronic malnutrition stunting Under-weight Acute malnutrition wasting MAM SAM Installed status Episodic status MALNUTRITION Incorrect definition: Malnutrition= acute undernutrition Correct definition: Mal + nutrition= “bad nutrition” ACF: Focus on Acute malnutrition ++
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Consequences of malnutrition Short term consequences Mortality, morbidity, disability Long term consequences Intellectual capacity Economic productivity Reproductive performance Diseases Future psychological well being 9 juillet 2021 9
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9 juillet 2021 10 Consequences and risks of malnutrition... Reduced physical activity Lowered resistance to disease Even not dangerous disease becomes dangerous Increased risk of mortality Learning difficulties
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9 juillet 2021 11 Acute Malnutrition Acute Malnutrition = DISEASE Acute malnutrition Sudden deprivation / Short-term process Sudden weight loss More vulnerable population : Children 6-59 months and PLW Consequences if no treatment : DEATH
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9 juillet 2021 12 Under-nutrition : Causes Malnutrition & mortality Insufficient food intake Diseases Poor acces, availability and quality of food Inadequate child care practices and psychological environment Poor acces, availability and quality of health services, unhealthy environment Quantity, quality, and control of true resources (human, economic, institutional) Potential resources Manifestations Immediate Causes Underlying Causes Basic causes within society Impairs growth and development
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9 juillet 2021 13 Classification of Acute malnutrition 2 classifications according to gravity: Moderate Acute Malnutrition (MAM) Lost of weight is started Precede severe acute malnutrition if not treated Severe Acute Malnutrition (SAM)
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09 July 2021 14 Severe Acute malnutrition 3 forms MARASMUS Severely wasted KWASHIORKOR Bilateral Oedema MARASMIC-KWASHIORKOR Both
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9 juillet 2021 15 Marasmus Skinny: underweight Old man’s face, Sunken eyes Irritability Subcutaneous fat and muscles loss Distended abdomen Impression of too much skin at the buttock Hungry
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9 juillet 2021 16 Kwashiorkor Nutritional bilateral oedema Skin lesions Lethargy Moon face Depigmentation: skin and hair Anaemia No appetite
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9 juillet 2021 17 Marasmic-kwashiorkor Combination of Weight loss AND Nutritional bilateral oedema Skinny arms and swollen feet
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9 juillet 2021 18 Different types of severe acute malnutrition Marasmus Marasmus-kwashiorkor Kwashiorkor
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Acute malnutrition How can we measure it ?? 09/07/2021
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Anthropometric measurement Anthropometry is human body measurement: nutritional status of a person is estimated by the measure of some corporeal parameters. In addition to the clinical picture, malnutrition diagnosis will be confirmed by anthropometric measurements. That’s why they need to be taken properly and be accurate 9 juillet 2021 20
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Diagnosis of malnutrition 9 juillet 2021 21
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Anthropometric measurements What is necessary to do a good anthropometric measurement? Good measurement equipment Standardized measurement procedure Well trained personnel … 9 juillet 2021 22
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MUAC Measurement 09/07/2021
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MUAC measurement 09/07/2021 MUAC : Mid Upper Arm circumference CHILDREN >6 months On the left folded arm, between shoulder bone and tip of the elbow Put the tape to the length of the folded arm, Mark midpoint
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MUAC measurement 09/07/2021 Left arm is unfolded and relaxed; Tape is wrapped aroune the arm,at the midpoint, neither too tighten or too loose/slack. Do not lean fingers on the tape or the arm Read the measure between the arrows of 1mm for precise
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How check oedema ? 09/07/2021 Have a light pressure for 3 seconds on the top of the feet at the same time Observe the depression on both feet = pit If it is the case => check the legs, then hands, then face
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Oedema Graduation of oedema according severity: Grade 1+ : Bilateral pitting oedema of the feet Grade 2+(or ++) :Bilateral oedema of the feet and lower limbs / hands Grade 3+(or +++) : Generalised oedema of feet, lower limbs, hands and periorbital 9 juillet 2021 27
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Bilateral oedema Immune and inflammatory fonctions are severly affected for kwashiorkor children, in such a way that cutaneous lesions aren’t painful for them. 09/07/2021
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Height measurement For all children < 87cm Child straight along the scale, chin raised and feet down flat on the cursor Read the measure on the cursor level of 1mm for precise 9 juillet 2021 29
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Height measurement 09/07/2021 Correct position
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9 juillet 2021 31 Height measurement Ideal position
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9 juillet 2021 32 Standing height measurement For all children > 87cm Child straight along the scale, joint feet Straight head, maintain the chin Arms along the body Read the measure on the cursor level of 1mm for precise
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9 juillet 2021 33 Standing height measurement
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Weight measurement SALTER scale Tare the scale before each weighing, with the empty basin or pants (the needle need to be in front of the 0) Put the child in the pants Calm down the child if needed Place yourself in front of the scale, your eyes at the same level as the needles Read the weight indicated, of 100g for precise 9 juillet 2021 34
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9 juillet 2021 35 What are the common mistakes?
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How identify malnourished children? Using combination of indexes : Index = difference between the value of the measured parameter and the reference value (mean or median) in the international standards 2 indexes: MUAC index W/H index + oedema 9 juillet 2021 44
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9 juillet 2021 45 Weight for Height Emaciated child has a lower weight than a « standard » child, who has the same Height and Sex. Weight for Height (W/H) measure the child’s corpulence . Weight gain is sensitive to the actual situation. So W/H reflects a recent situation. It is a reliable and admitted. Doesnt require age estimation It is used for show recent food or health situation.
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W/H reference table Exercice 9 juillet 2021 46 Exercice Weight for Height Reference Card (WHO, 2006)
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9 juillet 2021 47 Identification of malnourished children 6-59 months Classification of acute malnutrition in children 6-59 months based on anthropometry
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9 juillet 2021 48 Identification of malnourished children less than 6 months or < 4Kg Criteria for referral of infants aged less than 6 months to inpatient SAM treatment
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Identification of malnourished PLW 09/07/2021 49 Eligibility criteria for identification of malnourished PLW is only MUAC
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IMAM Implementation IMAM = Integrated Management of Acute Malnutrition Integrated to BPHS (and EPHS at provincial level) Target children 0-59 months and PLW 2 levels Community Health Facility 9 juillet 2021 50 Community - Active screening and referral - Sensitization - Follow-up (home visits) Health Facility - Passive screening / orientation - Treatment / Follow-up - Sensitization CHWs Health staffs CHS
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IMAM Implementation : COMMUNITY Goals of community outreach Maximize coverage and access Maximize the timeliness of treatment Maximize compliance with treatment 9 juillet 2021 51
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IMAM Implementation : COMMUNITY Focal point in community : CHWs Main activities: Active case finding => screening (house to house / massive screening) : MUAC and Oedema Early Referral => referral slip Sensitization / health education => to raise knowledge about malnutrition and its treatment (prevention ++) Follow-up => home visits (Beneficiaries, absentees, defaulters..) : increase the impact and sustainability of nutrition activities 9 juillet 2021 52
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ACTIVE CASE FINDINGS/SCREENING and EARLY REFERRAL 9 juillet 2021 53
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IT IS ALSO… The HOME VISITS for the high-risk cases Non-response/ absents/ defaulters of the program… AWARENESS SESSIONS/SENSITIZATION/HEALTH EDUCATION Nutrition, health, hygiene promotion... © ACF, Christina Lionnet - Tchad 9 juillet 2021 54
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IMAM : HEALTH FACILITY Reception of referral from community : check again anthropometric measurements to confirm diagnosis Passive screening : each child from 0-59 months and PLW (from 2nd trimester of pregnancy to 6 months of breastfeeding) Orientation : MAM/SAM identified => orientation to the right service (OPD-MAM / OPD-SAM / IPD-SAM) Treatment and follow-up : nutritional product and systematic medical treatment, follow-up of nutritional status (referral if needed) Transversal => Sensitization-Counseling nutrition / health topics 9 juillet 2021 55
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In HF where treatment is available 9 juillet 2021 56 PASSIVE SCREENING All children 0-59m APPETITE TEST CLINICAL EXAM ORIENTATION TO THE RIGHT SERVICE (OPD-MAM/SAM or IPD-SAM) All the children who fit the criteria for acute malnutrition Depending on: - Anthropo measures - Appetite result - Clinical result TREATMENT & FOLLOW-UP
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Appetite test For each child identified as acutely malnourished (MAM/SAM) Aim: To see if the child is able to eat sufficient quantity of nutritional product to recover The loss of appetite in a child with acute malnutrition may indicate a serious pathophysiology Appetite test: Part of the initial diagnosis At every follow-up visit 9 juillet 2021 57
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Complications associated to acute malnutrition (during clinical exam) 9 juillet 2021 58 + any other diseases that need to be treated at the hospital (inpatient)
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Referral and treatment of acute malnutrition 09/07/2021 59 Inpatient Department for SAM Outpatient Department for SAM* Child has SAM and No complications Appetite for RUTF Child has MAM and No complications Appetite for RUSF Child has SAM and Any complications No appetite for RUTF Inpatient Department for SAM Outpatient Department for SAM* Child has SAM and No complications Appetite for RUTF Child has MAM and No complications Appetite for RUSF Child has SAM and Any complications No appetite for RUTF Acute Malnutrition Child has SAM and - Any complications and/or - No appetite for RUTF Child has SAM and - No complications and - Appetite for RUTF Child has MAM and - No complications - Appetite for RUSF Inpatient Department for SAM (IPD-SAM) Outpatient Department for SAM (OPD-SAM) Outpatient Department for MAM (OPD-MAM)
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