Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 424 views

    Malnutrition

    Uploaded by

    Apple Malcampo
    Malnutrition refers to deficiencies or excesses of nutrients that can harm health. Malnutrition includes undernutrition (not getting enough nutrients) and overnutrition (getting too many nutrients). There are two main types of undernutrition - acute malnutrition and chronic malnutrition. Acute malnutrition is a sudden weight loss caused by inadequate food intake or illness and is measured by weight-for-height. Chronic malnutrition develops over time due to inadequate nutrient intake and is measured by stunting or low height-for-age. Community-based management of acute malnutrition (CMAM) is used to treat acute malnutrition through outpatient and inpatient care provided close to communities to improve access and outcomes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd

    Malnutrition

    Uploaded by

    Apple Malcampo
    424 views38 pages
    Malnutrition refers to deficiencies or excesses of nutrients that can harm health. Malnutrition includes undernutrition (not getting enough nutrients) and overnutrition (getting too many nutrients). There are two main types of undernutrition - acute malnutrition and chronic malnutrition. Acute malnutrition is a sudden weight loss caused by inadequate food intake or illness and is measured by weight-for-height. Chronic malnutrition develops over time due to inadequate nutrient intake and is measured by stunting or low height-for-age. Community-based management of acute malnutrition (CMAM) is used to treat acute malnutrition through outpatient and inpatient care provided close to communities to improve access and outcomes.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Malnutrition refers to deficiencies or excesses of nutrients that can harm health. Malnutrition includes undernutrition (not getting enough nutrients) and overnutrition (getting too many nutrients). There are two main types of undernutrition - acute malnutrition and chronic malnutrition. Acute malnutrition is a sudden weight loss caused by inadequate food intake or illness and is measured by weight-for-height. Chronic malnutrition develops over time due to inadequate nutrient intake and is measured by stunting or low height-for-age. Community-based management of acute malnutrition (CMAM) is used to treat acute malnutrition through outpatient and inpatient care provided close to communities to improve access and outcomes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    424 views38 pages

    Malnutrition

    Uploaded by

    Apple Malcampo
    Malnutrition refers to deficiencies or excesses of nutrients that can harm health. Malnutrition includes undernutrition (not getting enough nutrients) and overnutrition (getting too many nutrients). There are two main types of undernutrition - acute malnutrition and chronic malnutrition. Acute malnutrition is a sudden weight loss caused by inadequate food intake or illness and is measured by weight-for-height. Chronic malnutrition develops over time due to inadequate nutrient intake and is measured by stunting or low height-for-age. Community-based management of acute malnutrition (CMAM) is used to treat acute malnutrition through outpatient and inpatient care provided close to communities to improve access and outcomes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 38

    MALNUTRITION

    WHAT IS MALNUTRITION
    Consequence of deficiency in nutrient intake and/or absorption in the body Types of malnutrition 1.)Chronic Malnutrition Growth failure -Underweight (Weight for age index) -Stunted (Height for age index)

    2.) Acute Malnutrition -Wasting (MUAC / Weight for height) -Edema or Manas *** PEM (Protein Energy Malnutrition) - Obsolete term!

    CAUSES OF MALNUTRITION
    IMMEDIATE CAUSES(Affecting the individual) -Inadequate food intake -Disease UNDERLYING CAUSES(Household Level) -Household food security -Inadequate maternal care -public Health

    BASIS CAUSES(Society Level) PEST -Local priorities -Formal and informal infrastructures -Political ideology -Resources -Human, Structural, Financial

    WHAT IS ACUTE MALNUTRITION

    Cause by decreas in food consumption and/or illness leadin to bilatearl pitting edema (mana) or wasting (matinding pangangayayat). Types of Acute malnutrition
    Sever

    Acute Malnutrition (SAM) Moderate Acute Malnutrition (MAM) Global Acute Malnutrition (GAM) = SAM = MAM

    WHY FOCUS ON ACUTE MALNUTRITION?


    20 Million children suffer from SAM worldwide More than 1 Million deaths of under-5 children every year is associated with SAM Higher mortality Related to illness Can be treated to identified, and prevented in the community before complications arise!

    WHAT IS CMAM?

    CMAM = Community-Based management of Acute Malnutrition


    Most

    children with SAM without medical complications can be treated as outpatients at accessible, decentralized sites Children with SAM and medical complications are treated as inpatients Community outreach for community involvement and early detection and referral cases

    First pilot Progamme: 2000 (Africa)

    Philippines: 2009 (Mindanao)

    PRINCIPLES OF CMAM
    1. Maximum Access and Coverage -Bring treatment close to where people live 2. Timeliness -Treat before onset of complication 3. Appropriate Medical Care and Nutrition Rehabilitation -Provide the right treatment to children in need 4. Care as long as it is needed -Reduce barriers to access and prevent relapses

    COMPONENTS OF CMAM
    1. 2. 3. 4.

    Community mobilization Outpatient Therapeutic Programme (OTP) Stabilization Centre (SC) Supplementary Feeding Programme (SFP)

    COMMUNITY MOBILIZATION
    Community assessment and mobilization Active case-finding Education and sensitization (awareness and acceptance) Case follow-up

    SUPPLEMENTARY FEEDING PROGRAMME

    For moderate Acute Malnutrition(MAM)


    Corn

    Soya Blend (CSB) Plumpy Doz Should be coordinated with existing CMAM programs -Referral -Discharges -Admissions -Monitoring and Evaluation

    CMAM PRIORITIES
    Rapid decentralization of care Community Mobilization / Timely Active Case Finding Prevention of deterioration in nutritional status of the population (SFP) Prevention of mortality (OTP) Establish high coverage (geographic & case coverage) Establish SC

    MEASURING AND CLASSIFYING ACUTE MALNUTRITION


    1. 2. 3. 4.

    Four Forms of Malnutrition Acute Malnutrition Chronic Malnutrition or Stunting Underweight Micronutrient deficiency

    Chronic Malnutrition Also known as stunting Indicators


    Weight for age Height for age

    ACUTE MALNUTRITION

    Defined by the presence of: 1.) Wasting


    a.) MUAC b.) Weight-for-Height or Weight-for-Length Or 2.) Bilateral Pitting Edema

    MEASURING WEIGHT WITH SALTER SCALES


    Make sure the child is secure! Read the measurement at eye-level Make sure the meter is at ZERO before measuring the child -If not, adjust until at ZERO before placing the child Do not use the scale to weigh other objects (rice, supplies, equipment, etc) Do not weight beyond maximum capacity (25kg) to prevent damage to the scale

    GRADING OF EDEMA
    +1 Edema = Bilateral pitting edema only on the feet +2 Edema = Bilateral pitting edema on the feet, lower legs (may include hands and lower arms) +3 Edema = Generalized edema Bilateral pitting edema of legs and upper arms and includes dacial edema with swelling around the eyes.

    ACUTE MALNUTRITION
    MUAC WIGHT-FORHEIGHT/LENGTH Z-SCORE Less than -3 SD

    SAM

    Less than 11.5 cm (RED) 11.5 cm to 12.5 cm (YELLOW)

    MAM

    From -3 SD to les than -2 SD

    ACUTE MALNUTRITION

    Clinical Manifestations of Severe Acute Malnutrition:


    Marasmus Kwashiorkor Marasmic Kwashiorkor

    MARASMUS
    CLINICAL SIGNS OF MARASMUS A child with marasmus mught have these characteristics: Thin appearance, old man face Apathy: the child is very quiet and does not cry The ribs and bones are easily seen The skin under the upper arms appears loose On the back, the ribs and shoulder bones are easily seen In extreme cases of wasting, the skin on the buttocks has a baggy pants look No bilateral pitting edema

    MARASMUS

    INDICATOR SEVERE WASTING MUAC < 11.5cm X-Score <-3 SD

    These children have lost fat and muscle and will weight less than other children of similar height

    KWASHIORKOR / BILATERAL PITTING EDEMA


    CLINICAL SIGNS OF KWASHIORKOR (BILATERAL PITTING EDEMA) A child with kwashiorkor (bilateral pitting edema) might have these characteristics: Moon face Dermatosis: flaky skin or patches of abnormally light or dark skin (in sever cases) Apathy, little energy Loss of appetite Hair Changers Irritable, cries easily

    KWASHIORKOR

    INDICATOR BILATERAL PITTING EDEMA

    MARASMIC-KWASHIORKOR
    CLINICAL SIGNS OF MARASMIC-KWASHIORKOR A child with marasmic kwashiorkor has these characteristics: Bilateral pitting edema Severe wasting

    INDICATOR Bilateral pitting edema and Severe Wasting MUAC <11.5cm Z-Score <-3 SD

    ACUTE MALNUTRITION

    Complicated acute malnutrition


    +++edema Marasmic kwashiorkor OR MUAC <11.5cm W/H <-3 Z Scores And one of the following:

    No appetite LRTI/Pneumonia Severe Dehydration Severe Anemia Not alert

    Inpatient care

    ACUTE MALNUTRITION

    Severe acute malnutrition


    MUAC <11.5CM OR W/H <-3-Z scores OR Bilateral pitting edema, AND

    Appetite Clinically well Alert Outpatient therapeutic Care

    ACUTE MALNUTRITION

    Moderate acute malnutrition


    MUAC 11.5cm to <12.5cm OR w/h -3 to -2Z scores AND No edema AND Appetite Clinically well Alert Supplementary feeding

    REDUCTIVE ADAPTATION IN SAM

    Treatments and drugs that are used appropriately in normally nourished patients can be harmful to SAM patients
    Temporary

    electrolyte disequilibrium -> leads to death from fluid overload and heart failure if dehydration is managed with IV fluids
    ORS

    vs ReSoMal

    Liver

    and Kidney function are abnormal -> drugs are not eliminated normally (e.g. Paracetamol)

    REDUCTIVE ADAPTATION

    Presume and treat infection


    Assume

    that infection is present and treat all severe malnutrition admissions with antibiotics specified in the protocol Common infections in the severely malnourished child: pneumonia, ear infection, UTI

    PROVIDING IN-PATIENT CARE

    Hospitals or Major health centers


    24-hour

    care available.

    Treatment

    at night is required for very ill children, those that get refeeding diarrhea and those that have not taken food during the day. 8 meals per 24 hours with full medical surveillance and treatment of complications (there needs to be adequate staff at night).

    USE OF DRUGS IN ACUTE MALNUTRITION


    Drugs that cause appetite loss should not be used such as anti-emetics Drugs affecting liver, pancreatic, renal, cardiac or intestinal functions should not be used Malnutrition is treated first before standard doses of drugs are given If really needed, initially give reduced doses of drugs -Standard doses are given in the later stages of OTP treatment or have lesser degrees of malnutrition Common drugs such as paracetamol do not work in AM and can cause liver damage

    INPATIENT ANTIBIOTIC DOSAGES


    DRUGS AMOXYCILLIN Co-AMOXYCLAV PREPARATION 125mg/5ml 156 mg/5mg(Amox125mg; Clav31) DOSAGES 20-100mg/kg/day BID 50-100mg/kg/day BID

    CEFTRIAXONE GENTAMYCIN CHLORAMPHENICOL CIPROFLOXACIN NYSTATIN 100,000iu/ml

    50mg/kg IM OD for 2 dyas 5mg/kg IM OD 25mg/kg/d BID 10-30mg/kg/d BID 100,000iu PO QID

    APPETITE TEST
    BODY WEIGHT Less than 4kgs 4 - 6.9 7 - 9.9 10 - 14.9 15 29 Over 30kgs PASTE IN SACHETS(PORTION OF WHOLE SACHET 96g) Poor <1/8 <1/4 <1/3 <1/2 <3/4 <1 Moderate 1/8 - 1/4 1/4 - 1/3 1/3 - 1/2 1/2 - 3/4 3/4 - 1 >1 Good >1/4 >1/3 >1/2 >3/4 >1

    RUTF OTP RATION


    Weight of child (kg) 3.5 3.9 4.0 5.4 5.5 6.9 7.0 8.4 8.5 9.4 9.5 10.4 10.5 11.9 >12 Sachets per week 11 14 18 21 25 28 32 35 Sachets per day 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

    FOR <6 MONTH OLD INFANTS


    SUPPLEMENTAL SUCKLING: Amounts of diluted F100 to give for 24 hours (456 gm of F100 in 2.7L water OR 1 scoop in 20ml water) WEIGHT >=1.2kg 1.3 to 1.5 kg 1.6 1.7 1.8 2.1 2.2 2.4 2.5 2.7 2.8 2.9 3.0 3.9 3.5 3.9 4.0 4.4 ml per feed (8 feeds/day) F100 dilute 25ml per feed 30 35 40 45 50 55 60 65 70

    ACUTE PHASE (< 6 MONTHS OLD INFANTS)


    Amounts of infant formula, F100 dilute or F&% to give for non-breastfed infants for 24 hours
    WEIGHT (KG) ml of diluted F100 or F75 or infant formula per feed in Acute Phase (8 feeds/day) 30ml per feed 35 40 45 50 55 60 65 70

    <=1.5kg 1.6 1.8 1.9 2.1 2.2 2.4 2.5 2.7 2.8 2.9 3.0 3.4 3.5 3.9 4.0 4.4

    You might also like