Prevention of kwashiorkor and Marasmus
Encouragement of breast feeding among mother
Introduction of adult diet before weaning
Adequate intake of balance diet
Regular attendance at child welfare clinic for nutrition demonstration etc.
Spacing of children in order to have sufficient food for the family
Treatment of minor ailment the can lead to dehydration
Immunization to prevent and control communicable diseases
Health education of parents on taboos and local beliefs of dietary habits
The education of parent on the importance of giving quantity of essential food to the younger ones particularly protein foods.
CHILDREN AT RISK OF DEVELOPING MALNUTRITION
School children
Motherless babies
Children having eating disorders
Premature babies
Abandoned children
Refugees
Health education on prevention of malnutrition
Ensure the intake of balanced diet
Educate on more fluid administration to a child when having diarrhea
Educate on exclusive breastfeeding
Discouraging food taboo
Educating on adequate nutrition of pregnant and lactating mothers
Educate on food hygiene
Educate on proper food preparation
Encourage then on domestic gardening
Educate pregnant women on antenatal clinic visit
Assessment of Nutritional Status in the clinic and community
These maybe done using various methods which includes:
Anthropometric techniques
Biochemical and other laboratory test.
Clinical techniques.
Dietary survey
Measuring arm circumference using shirkers strip.
Regular or periodic weighing and charting
Anthropometrics measurement
Anthropometry is the measurement of the size, weight and proportions of the body. Common anthropometric measurements include weight, height, MUAC, head circumference, and skinfold.
BODY MASS INDEX (BMI) is an anthropometric indicator based on weight to height ratio. It is used to classify malnutrition in non-pregnant/non-postpartum adults. BMI is not an accurate indicator of nutritional status in pregnant women or adults with edema. Use MUAC for these groups. Calculate BMI by dividing a person’s weigh in kg by the square of the person’s height in meters. You will have to convert measurements in cm to m (100 cm = 1 m).BMI = weight (kg) height2 (m) BMI can also be found using look-up tables or a BMI wheel.
BMI values below or above the WHO range for normal nutritional status (shown below) indicate a need for nutrition interventions to slow or reverse weight loss or to reduce overweight.
BMI Nutritional status
< 16.0 Severe malnutrition
≥ 16.0 to < 17.0 Moderate malnutrition
≥ 17.0 to < 18.5 Mild malnutrition
≥ 18.5 to < 25.0 Normal nutritional status
≥ 25.0 to < 30.0 Overweight
≥ 30.0 Obesity
Sources: WHO. 1999. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO; WHO. 2013. “Obesity and Overweight.”
Recommended pre-pregnancy BMI
Underweight Less than 18.5
Normal weight 18.5‒24.9
Overweight 25.0–29.9
Obese 30 or more
BMI is not an accurate indicator of nutritional status during pregnancy
-Weight Weighing is usually the first step in anthropometric assessment. Weight is strongly correlated with health status. Unintentional weight loss can mean poor health and reduced ability to fight infection. Weighing requires a functional weighing scale that measures weight in kg to within the nearest 100 g. Accurate weight measurement is important because errors can lead to incorrect classification of nutritional status and the wrong care and treatment. Low pre-pregnancy weight and inadequate weight gain during pregnancy are the most significant predictors of intrauterine growth retardation and low birth weight. To reduce the risk of adverse outcomes, women should enter pregnancy with a BMI in the normal weight category.
-Length and height Measuring length or height requires a height board or measuring tape marked in centimeters (cm). Measure length for children under 2 years of age or less than 87 cm long. Measure height for children 2 years and older who are more than 87 cm tall and for adults.
-Weight-for-height
WHZ is an index that is used to assess the nutritional status of children from birth to 59 months of age. It compares a child’s weight to the weight of a child of the same length
-MUAC
MUAC is the circumference of the left upper arm measured at the mid-point between the tip of the shoulder and the tip of the elbow, using a measuring or MUAC tape. MUAC measurements in millimeters (mm) are more accurate than measurements in cm. MUAC is a proxy measure of nutrient reserves in muscle and fat that are unaffected by pregnancy and independent of height. MUAC can be used to measure all pregnant women and women up to 6 months postpartum. MUAC is also an appropriate alternative for measuring children (instead of WHZ), adolescents (instead of BMI-for-age), and non-pregnant/postpartum adults whose weight and height cannot be measured (e.g., if they cannot stand or no equipment is available). MUAC is not recommended for infants under 6 months and should not be used to assess nutritional status in people with edema.
MUAC cutoffs to classify nutritional status in children 6 months to 14 years of age
Severe acute malnutrition (SAM): 6–59 months < 115 mm ≥ 115 to < 125 mm ≥ 125 mm
Moderate acute malnutrition (MAM): 5–9 years < 135 mm ≥ 135 to < 145 mm ≥ 145 mm
Normal nutritional status: 10–14 years < 160 mm ≥ 160 to < 185 mm ≥ 185 mm
Biochemical assessment involves checking levels of nutrients in a person’s blood, urine, or stools. Lab test results can give trained medical professionals useful information about medical problems that may affect appetite or nutritional status.
Clinical assessment
Clinical assessment includes checking for:
Visible signs of nutritional deficiencies such as bilateral pitting edema, emaciation (a sign of wasting, which is loss of muscle and fat tissue as a result of low energy intake and/or nutrient loss from infection), hair loss, and changes in hair color.
It also includes taking a medical history to identify comorbidities with nutritional implications, opportunistic infections, other medical complications, usage of medications with nutrition related side effects, food and drug interactions, and risk factors for disease (e.g., smoking, alcohol use, overweight) that affect or are affected by diet and nutritional status.
Assessment of nutritional status in infants under 6 months involves checking for clinical signs of acute malnutrition such as visible wasting, bilateral pitting edema, inability to suckle, ineffective breastfeeding, and recent weight loss or failure to gain weight, as well as risk factors such as insufficient breast milk or absence of the mother. Clinical assessment for this age group should also assess infant feeding practices, especially access to breast milk.
Clinical nutrition assessment also includes checking for or asking clients about symptoms of infection that can increase nutrient needs (e.g., fever) and nutrient loss (e.g., diarrhea and vomiting), as well as medical conditions (e.g., HIV, celiac disease) that impair digestion and nutrient absorption and increase the risk of developing malnutrition. Medical records should provide information about illness, hospitalizations, operations, diagnostic tests and therapies, and medications that can affect nutritional status.
Some medications can interfere with nutrient absorption, digestion, metabolism, and utilization. Likewise, nutritional status and diet can affect how medications work. Information about the medications clients are taking allows health care providers to counsel them on how to manage drug-food interactions and drug side effects.
For children, clinical assessment may also include history of growth patterns, onset of puberty, and developmental history Bilateral pitting edema ( also called nutritional edema, is swelling in both feet or legs (bilateral) caused by the accumulation of excess fluid under the skin in the spaces within tissues).
Bilateral pitting edema is a sign of severe malnutrition on its own, regardless of the results of anthropometric assessment. Anyone with severe bilateral pitting edema even with appetite and no medical complications, should be admitted for inpatient management of severe acute malnutrition. A person with bilateral pitting edema with appetite and no medical complications should be treated for severe acute malnutrition on an outpatient basis.
Dietary Assessment
Assessing food and fluid intake is an essential part of nutrition assessment. It provides information on dietary quantity and quality, changes in appetite, food allergies and intolerance, and reasons for inadequate food intake during or after illness. The results are compared with recommended intake such as recommended dietary allowance (RDA) to counsel clients on how to improve their diets to prevent malnutrition or treat conditions affected by food intake and nutritional status (e.g., cardiovascular disease, cancer, obesity, diabetes, and hyperlipidemia). Several common ways(components of dietery assesment) to assess dietary intake are described below.
24-hour recall
This method is designed to quantify the average dietary intake for a group of people, although it can be used to assess individual nutrition intake. During a recall, a client is asked to remember in detail every food and drink consumed during the previous 24 hours. The method can be repeated on several occasions to account for day-to-day variation in intake. Health care providers may prompt clients to remember what they ate or drank by time periods or activities (e.g., just after waking up, before going to bed) or to estimate portion sizes by looking at household measures, food models, household utensils or actual food.
Food frequency questionnaire
A food frequency questionnaire is designed to obtain information on overall dietary quality rather than nutrient composition and intake. The food frequency questionnaire examines how often someone eats certain foods, and sometimes the size of the portions. This method is quick and inexpensive.
Food group questionnaire
Another way to do dietary assessment is to show clients pictures of different food and ask whether they ate or drank any of those foods the previous day.
Family eating time.
Child spacing.
Parent guardian occupation.
Breast-feeding patterns.
Family food budget.
Mother's level of education.
Method of food preparation
Presence of domestic gardening
