Nutrition Session 2: Community based management of acute malnutrition

Income or other resources are adequate to obtain sufficient and appropriate food through home production, buying ,bartering , gathering

Access

it weakens the immune system, increasing the chance of death from infectious diseases

Acute malnutrition can be a direct cause of death, however more commonly it can:

Extreme weight loss, resulting in low weight for height, and/or bilateral oedema, , and, in its severe form, can lead to death.

Acute malnutrition is characterized by:

True.

Adolescent and child marriage continues to be a strong social norm in the developing world, True or false

so naturally, raising the marriage age, means later births, and a reduced proportion of low birth weight infants

Age at marriage is highly correlated with age at first birth. What would help to increase normal weight babies for these younger mothers?

Sufficient quantity of appropriate food is physically available.

Availability

cultural barriers, women's work burden - especially in urban environ-ments where infants and mothers may be separated due to wage labour circumstances.

Barriers to optimal breastfeeding include:

Seasonal cycles of food availability and access as a result of agricultural cycles which contributes to variations in household income and expenditures. 1) Food stocks down and prices high just before rainy seasons...referred to as the "hungry period" 2) This may have impact on quality and adequacy of the diet. 3) When farmers are busy it can impact the degree of care they give to their children 4) During the rainy season, drinking water may be collected from nearby contaminated pools rather than walking further distances to clean water sources. 5) Due to this, diarrhea is often common during rainy seasons, while diseases such as malaria, dengue, fever and yellow fever may be common after the rains, the period when mosquitoes breed. 6) In emergencies, the impact of these seasonal changes may become more pronounced and have greater effect on the poorest people and the prevalence of malnutrition may increase. 7) Some shocks may not be seasonally dependent ie tsunamis and may impact on the nutrition at all levels of causality. 8) Flooding and conflict may increase during particular seasons.

Causal pathways which act directly or indirectly on nutritional status may be affected by the seasons of the year. Give an example:

reduced cognitive development and subsequently lower income-earning potential as adults

Children who suffer SAM or MAM between conception and the age of two are likely to pay the price of:

3 x; 9.4 x

Children who suffer from MAM are ________times more likely to die than those who are not malnourished, and children with SAM are _________ times more likely to die than a child who is not malnourished

under 2 year olds

Chronic and acute malnutrition are not mutually exclusive but often overlapping and are particularly crucial in the vulnerable under-________yearolds.

chronic disease include 1. obesity,2. coronary heart disease, 3.diabetes and 4.hypertension, and can significantly add to the health burden of poor households.

Chronic diseases as a result of rapid weight gain in adulthood after malnutrition as a child can include: (4 )

True. Increased rainfall and changes in temperature all have an impact on disease.

Disease patterns are affected by seasonal changes. True or False?

False. Increased rainfall and changes in temperature all have an impact on disease

Disease patterns are not affected by seasonal changes. True or False?

checklist to identify and prioritise the short and long term needs and gaps in services for the population and in particular for the identified vulnerable groups.

During an emergency the conceptual model of nutrition can be used as a :

The poorest countries that already have raised rates of chronic malnutrition.

Emergencies that result in high acute malnutrition rates tend to be in which TYPES of countries?

Fill in the chart from Module 2, pg 11

Explain the nutritional conceptual framework including basic, underlying and immediate causes, and long and short term consequences.

when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active, healthy life.

Food security exists when:

to both a growth spurt and loss of iron during menstruation.

Girls' nutritional requirements increase during adolescence due:

True

Global nutrition learning, research, policy and guidelines are constantly changing and it is important to stay updated. True or False

Undernutrition negatively impacts on health and economic development by reducing productivity and increasing health costs

How does undernutrition impact health and economic development?

factors such as overcrowding, inadequate sanitation, poor water quality / supply and lack of health care

In emergencies, What other factors increase risks of diseases proliferating besides seasonal changes?

True

In order for a person to be adequately nourished, all 3 underlying causes of malnutrtion must be addressed: T or F ?

1.Household food insecurity 2. Inadequate care/lack of health services Unhealthy household environment

Income poverty as an UNDERLYING cause of maternal and child mortality 3 major impacts:

a dramatic reduction in child mortality

Increasing the number of babies who are breastfed optimally could result in:

Increasing nutrient requirements and reducing nutrient absorption.

Infections are an additional and important cause of micronutrient malnutrition and can negatively affect nutritional status by:

an inadequate intake of vital minerals (e.g., zinc), vitamins, and essential fatty acids24.

It is now recognised that poor growth in under-fives results not only from a deficiency of protein and energy, but also:

1. Bilateral pitting oedema (affecting both sides of the body). 2. The child may not appear to be malnourished because the body swells with the fluid, and their weight may be within normal limits. 3. In its severe form, Kwashiorkor results in extremely tight, shiny skin, skin lesions and discoloured hair

Kwashiorkor is characterized by

Levels of acute malnutrition tend to be highest in children from 12 to 36 months of age 1)when changes occur in the child's life such as rapid weaning due to the expected birth of a younger sibling or 2) a shift from active breastfeeding to eating from a family plate, which may increase vulnerability.

Levels of acute malnutrition tend to be the highest in which age group? Why?

adult onset of chronic diseases

Links between malnutrition survival in childhood and an increased susceptibility to ___________________________________ have been identified, especially where there has been rapid weight gain in later childhood.

Moderate; severe

MAM is characterized by ______________________ wasting and SAM is characterized by ________________wasting.

True

Malnutrion can mean overnutrition and undernutrition. T or F :

Severe acute malnutrition (marasmus) and kwashiorkor (bilateral pitting edema).

Marasmic-kwashiorkor is a condition which combines:

True

Marasmus can be moderate OR severe wasting. True or False?

1. severe wasting of fat and muscle, which the body breaks down to make energy leaving 'skin and bones'. 2. a child with marasmus is extremely thin with a wizened 'old man' appearance.

Marasmus is characterized by:

Program coverage %

Number in the program ___________________________________ Number of who should be in program x 100 =

True

SAM is associated with higher mortality rates than moderate acute malnutrition (MAM). True or false?

Mortality, morbidity, disability

SHORT- TERM consequences of maternal and child malnutrition?

Standardized Monitoring and Assessment of Relief and Transitions

SMART methodology stands for:

1. Famine Early Warning Systems Network (FEWSnet): 2.Integrated Food Security Phase Classification 3. Nutrition Information in Crisis Situations (NICS):

SMART survey results are used in early warning systems such as:

Key basic services: it holds back progress in education, in mortality reduction and in treatment of HIV and AIDS'S

Save the Children's, Hungry for Change paper, states that, 'Malnutrition reduces the impact of investments in what?

True

Sphere standards state that people affected by emergencies have a right to a diet that is nutritionally adequate. True or false

True

Stunting is irreversible after age 2. True or False

1. Nutritional status of children under-five.2. Mortality rate of the population. *These indicators are useful for prioritizing resources as well as for monitoring the extent to which the relief system is meeting the needs of the population, and therefore the overall impact of relief response.

The (Prevalence Survey) SMART Methodology is based on the two most vital and basic public health indicators for the assessment of the magnitude and severity of a humanitarian crisis which are:

True

The 2008 food price crisis demonstrated the negative nutritional impact on the mother, who is often the last to benefit in a food secure household and the first to suffer in a food insecure household. True or False

Availability, access and utilization

The 3 main components of food security are:

South Asia, Africa

The burden of undernutrition (total numbers of combined acute and chronic levels) is greatest in _____________________________ while the highest rates of acute malnutrition are in ________________________.

Chronic malnutrition is the most common form of malnutrition and causes 'stunting' (short individuals). It is an irreversible condition after 2 years of age.

The most common form of malnutrition is:

acute or chronic nutrition; wasting or stunting

The term "Underweight" is a composite indicator which reflects the presence of ________________ or ________________but is not terribly useful because it doesn't indicate whether the child is underweight due to _______________ or ________________.

False. They are very much interrelated....Decisions made at the household level with regards to these 3 are influenced by many factors such as culture, avialable assets including time, income, education and avialable land and livestock. ie a family may need to make decisions to spend money on agriculture expense which may result in not enough money for health care.

The three categories access, availability and utilization are not interrelated. T or F?

Inadequate food, inadequate care and health care, and unhealthy household environment (ie lack of access to safe water and effective sanitation).

Underlying causes of malnutrition can be grouped under 3 broad categories:

1.household food insecurity, 2. inadequate care (parental and health care) and 3. unhealthy environment

Undernutrition can only be improved if the three underlying causes are addressed which are:

1. acute malnutrition (i.e. wasting and/or nutritional oedema),2. chronic malnutrition (i.e. stunting), micronutrient malnutrition and 3. inter-uterine growth restriction (i.e. poor nutrition in the womb)

Undernutrition can result in:

The most common in emergencies and includes acute, chronic and micronutrient deficiencies

Undernutrition is

an inadequate diet and/or disease.

Undernutrition is caused by

death and disease

Undernutrition is closely associated with what outcome(s)?

1.loss of appetite, malabsorption of nutrients, 2. loss of nutrients through diarrhoea or vomiting. This occurs because If the body's metabolism is increased due to illness then there is a greater risk of malnutrition. An ill person needs more nutrients to rehabilitate and if they do not meet their needs they become malnourished.

Undernutrition is the result of inadequate dietary intake, disease or both. Disease contributes through:

True

Undernutrition makes people more susceptible to infections and disease in general and slows recovery. True or false?

3-6% ; billions

Undernutrition reduces gross domestic product (GDP) by an estimated _____________ % and costs ____________ of dollars in lost productivity and healthcare spending.

MDG 1

Underweight is one of the key indicators for

Food is properly used through appropriate food processing and storage practices, adququate knowledge and application of n utrition and child care principles, and adequate health and sanitation services. It also includes how food is shared within a household with each person's nutrient requirements in mind. Biological use also included.

Utilization

1)Social, economic, and political context which leads to 2)Lack of capital: financial, human, physical, social, and natural

What are basic causes for maternal and child malnutrition?

1. Increases the risk of complications during pregnancy 2. Increases the risk of spontaneous abortions, stillbirths, impaired foetal brain development and infant deaths 3. Increases the risk of maternal death from spontaneous abortion, stress of labour and other delivery complications 4.Increases the chance of producing a low birth weight baby 5. Reduces work productivity 6. Increases the risk of infection including HIV and reproductive tract infections 7. Results in additional sick days and lost productivity

What are some of the major impacts of malnutrition in women?

1. Reduces the ability to fight infection 2. Impairs the immune system and increases the risk of some infections 3. Impairs growth 4. Increases the chance of infant and young child mortality 5. Increases fatigue and apathy 6. Causes Impaired cognitive development 7. Reduces learning capacity

What are some of the major impacts of malnutrition on infants and children?

1) Inadequate dietary intake and 2) disease;

What are the IMMEDIATE causes of maternal and child malnutrition?

Income poverty: employment, self-employment, dwelling, assets, remittances, pensions, transfers etc.

What are the UNDERLYING causes of maternal and child malnutrition?

Vitamin C deficiency leads to scurvy • Vitamin A deficiency leads to xerophthalmia • Niacin or Vitamin B3 deficiency leads to pellagra • Iodine deficiency leads to goitre and cretinism (in infants born to iodine deficient mothers) • Thiamin or B1 deficiency leads to beriberi • Riboflavin deficiency leads to ariboflavinosis • Vitamin D deficiency leads to rickets

What are the key nutrient deficiencies by Vitamin or mineral: Iron deficiency leads to iron deficiency anaemia • Vitamin C deficiency leads to: • Vitamin A deficiency leads to: • Niacin or Vitamin B3 deficiency leads to: • Iodine deficiency leads to: • Thiamin or B1 deficiency leads to: • Riboflavin deficiency leads to : • Vitamin D deficiency leads to:

in many developing countries, under- and overnutrition occur simultaneously.

What does the term "double burden of malnutrition" mean?

The way poeple obtain food is often interrupted. emergencies can destroy food stocks in the home or warehouse, as well as affect the land where crops grow. Markets for livestock, food, labor can be disrupted. Overall avialability an be disrupted causing severe food shortages.

What happens to people's abilty to obtain food during emergencies?

It is Poor growth can be transmitted from one generation to the next. *Small women tend to give birth to LBW babies who, in turn, are more likely to become small children, small adolescents and, ultimately, small adults, who later gain too little weight in pregnancy and give birth to LBW babies. * While smallness may be genetically inherited, the vast majority of small individuals in most poor countries are small because they have suffered, or are currently suffering, from chronic and/ or acute undernutrition.

What is The intergenerational cycle of growth failure?

A method designed to give rapid information on the spatial representation of coverage. It was developed for measuring coverage at the Regional Level.

What is the coverage survey SLEAC method?

A comprehensive iterative tool to analyse the barriers and boosters to coverage and give an estimate of coverage. It also provides succinct actions for improving access to coverage.

What is the coverage survey SQUEAC method?

the 33 months from conception to a child's second birthday. If action is not taken during this period the effects of undernutrition are permanent'

What is the crucial window of time during which undernutrition can be prevented?

Malnutrition can increase the risk of infection , while infection can cause malnutrition leading to a vicious cycle. ie a malnourished child who resistance is poor already, falls ill, and becomes more malnourished which reduces his capacity to fight illness even more etc.

What is the infection-malnutrition cycle?

Acute malnutrition and to a lesser degree micronutrient deficiencies

Which forms of malnutrition manifest most rapidly, and therefore more visible in emergencies?

1.Low birth weight (LBW) babies, 2.Children 0-59 months, 3.Adolescents, 4.pregnant and breastfeeding mothers, 5.older people, 6.people with chronic illness and 7.people living with disability

Which groups are most vulnerable to malnutrition?

Acute malnutrition

Which type of malnutrition is less common than chronic malnutrition but carries a higher risk of mortality and can be reversed with appropriate management?

due to 1). their exceptional needs during active growth, and 2) their immature immune and digestive systems (infants 0-6 months).

Why are children more vulnerable than adults to malnutrition?

At this time the child is more exposed to infection through contaminated food or water and is dependent on the mother or caregiver for frequent complementary feeding. It is unlikely to recover growth 'lost' in the first two years as a result of malnutrion.

Why are the consequences of malnutrition on the 6 to 24 month age group the most serious?

Because it can quickly lead to death

Why is acute malnutrition of particular concern during emergencies?

when it inhibits growth and essential cognitive development

Why is chronic malnutrition most critical in childhood?

There are increased nutrient needs during pregnancy to ensure: 1) adequate foetal growth 2) and to build up the body in preparation for breastfeeding. 3)can increase the risk of delivering a low birth weight baby. 4)When mothers are breastfeeding they require extra energy which they can get from the reserves they have built up during pregnancy and from eating extra food after birth. This way they can ensure the quality of breast milk for optimalgrowth of their infant.

Why is nutrition so important to pregnant and lactating women?

underweight

___________________________ is a general measure that captures the presence of wasting and/or stunting

the cluster coordination system

_______________________________________ is one mechanism that is aiming to improve coordination and response analysis in emergencies ensuring nutrition security.

14.6%

acute malnutrition is responsible for a shocking ______________of the total under-five death burden each year.9

This is because Dilution and displacement of breast milk with other fluids such as water, tea or gruel both reduce the nutritional and immunological support from the breast milk and increase the risk of infection from unclean water, cups or bottles.

exclusive breastfeeding is rarely practised in more than: half of the children less than 6 months of age receiving breast milk. Why?

Long-term consequences: 1.Adult size, 2. 3.intellectual ability, 4.economic productivity, 5.reproductive performance, 6.metabolic and cardiovascular disease

lONG-TERM consequences of maternal and child malnutrition?

A height measurement.

underweight is easier to use because it does not require ________________________________________.