nutrition care services in package rev 080213
TRANSCRIPT
Nutrition Care in package of service
Dr. May Khin Than Deputy Director
( Nutrition)Department of Health
Goal Role of nutrition
Goal 1: Eradicate extreme poverty & hunger
Hunger – undernutrition – undermines economic growth and perpetuates poverty. Malnutrition erodes human capital through irreversible and inter-generational effects on cognitive and physical development
Goal 3: Promote gender equality and empower women
Under nutrition in women (e.g., moderate and severe anemia) is often a reflection of gender inequality.
Goal 4: Reduce child mortality Malnutrition is directly or indirectly associated with more than 50% of all child deaths, and it is the main contributor to the burden of disease in the developing world.
Goal 5: Improve maternal health Maternal health is compromised by malnutrition, which is associated with most major risk factors for maternal mortality. Maternal stunting and iron and iodine deficiencies particularly pose serious problems.
Goal 6: Combat HIV/AIDS, malaria and other diseases.
Malnutrition may increase risk of HIV transmission, compromise antiretroviral therapy and hasten the onset of full-blown AIDS and premature death. It increases the chances of and prolongs tuberculosis infection even while being treated, resulting in spread of disease, and it reduces malaria survival rates.
Nutrition and the MDGs
16
17
5
45
8
27
Pneumonia *
Diarrhoea *
Malaria *
Neonatal
Injuries
Others
Vaccine-preventablediseases*
Causes of children U5 deaths in UNICEF East Asia Pacific region
Ref: WHO causes of death database & Undernutrition as an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria and measles, Caulfield et al, 2004
Total number of deaths: 1.265 million
Undernutrition 53%
“Childhood underweight is the leading cause of the
global burden of disease”
Reduction of U5MR according to intervention
3%
3%
4%
4%
5%
6%
7%
13%
0% 2% 4% 6% 8% 10% 12% 14%
Antenatal steroids
Water, sanitation,hygiene
Clean delivery
Hib vaccine
Zinc
Continued BF withComplementary feeding
Insecticide treatedmaterials
Exclusive Breastfeeding
Source: Lancet Child Survival Series 2003
Infants not breastfed have 6-fold increased chance of dying in first two months;
Aim of Nutrition promotion
"Attainment of nutritional well-being of all citizens as part of the overall social-economic development by means of health and nutrition activities together with the cooperative efforts by the food production sector
General objective
To ensure that all citizens enjoy the nutritional state conducive to longevity and health
Specific objectives
To control/eliminate all forms of nutritional deficiency
To promote healthy dietary habits and lifestyles among people
To prevent over-nutrition and diet-related chronic diseases
Objectives towards achievement of MDG
To reduce underweight among under 5 children
To increase exclusively breast fed rate
To increase receiving high potency vitamin A supplementation among 6 months to 5 years old children
To reduce IDA prevalence among pregnant women and under five children
Public Health Nutrition Problems
1. Protein Energy Malnutrition (PEM)
2. Micronutrient Deficiencies
- Iron Deficiency Anemia (IDA)
- Iodine Deficiency Disorders (IDD)
- Vitamin A Deficiency (VAD)
- Vitamin B1 Deficienciy ( VB1D)
Strategies
Community involvement in nutrition activities
Nutrient supplementation (VA,B1,iron)
Supplementary feeding
Nutrition education
Integrated deworming
National Nutrition Surveillance System
Intersectoral cooperation
Food fortification (IS, Home fortification)
PEM Control activities
by health staff
1. Growth Monitoring and Promotion (GM/P)
2. Community Nutrition Centres (CNCs)
3. Hospital Nutrition Units (HNUs)
Community
based
1. Growth Monitoring and Promotion (GM/P)
2. Community Nutrition Centres (CNCs)
3. Village Food Banks (VFBs)
I. Protein Energy Malnutrition Control Project
1. Growth Monitoring /Promotion by BHS
Started in 1982 Each midwife monitors the
growth of about 100 under-3 children
Coverage -33% of all under-3 Community Nutrition Centres (CNCs)
2. CNC by BHS
Started in 1982 Funds: community donations Each centre takes care of 20-
30 mal-nourished children 100 CNCs all over One meal a day Cooking demonstration
I. Protein Energy Malnutrition Control Project(cont)
3. Hospital Nutrition Unit (HNU) )
Started in 1982
20 HNUs all over the country
Management of severely
malnourished children
Therapeutic feeding (WHO guideline),
Treatment of infections, Nut
Education
4. Village Food Banks ( VFB) Community based-, started in 1999 Management for severely
malnourished children in remote villages
205 VFBs in 34 tsps all over the country
Take care of moderately malnourished children as well
Supplementary feeding/ therapeutic feeding , Nut. education
II. IDD Elimination project
Goal – IDDEStrategy – Universal salt iodisation ( USI)
Visible Goitre Rate Among 6-11 Year Children(by year)
34.4832.48
21.84
7.58
33.08
25.1
12.7 12
5.5
1.01
0
5
10
15
20
25
30
35
40
1994 1997 1999 2001 2003-04 2006
Year
%
TGR
VGR
စ�မ�အ��ငအ��ဒငဆ- ထ�တလ�ပမ�အဆင�- 40-60 ppm လကကအဆင�- > 30 ppm လကလ�အဆင� - 15 မ� 30 ppm အ�မထေထငစ�အဆင�- 15 ppm
III. Vit A deficiency control project High potency vitamin A capsule
- every 6 months for 6-59 m children- once within 1 m after delivery
Coverage;
> 90 % of < 5 children 60 % of lactating women
Prevalence of Bitot's Spot Among Under-5 Children
0.6
0.38
0.23
0.03
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
1991 1994 1997 2000
Year
%
IV. Nutritional Anemia Anemia status of women
as follow.
Non pregnant women (NNC 2001) 45%
Adolescent school girls (NNC 2002) 26%
Pregnant women (NNC 2005) 71%
Under five children (NNC2005) 76%
Prevalence of Anaemia Among Non-pregnant Women by Region (2001)
31
43.4
48.2
55.6
0 10 20 30 40 50 60
Hilly
Plain
Coastal
Delta
Reg
ion
Prevalence (%)
Prevalence of Anaemia Among Adolescent Schoolgirls by Region (2002)
7.6
28.3
31.7
38
0 5 10 15 20 25 30 35 40
Hilly
Coastal
Plain
Delta
Reg
ion
Prevalence (%)
IV. Anaemia Control Project (cont)
4.1. Iron supplementation
for pregnant women (all tsp) for adolescent schoolgirls ( 20 tsp) under five children (with GMP) – iron syrup, Initial trial on iron sprinkles ( also known as
Home fortification) Coverage ; 95% of adolescent school girls received full
dose 70 % PW
4.2. Nutrition education
4.3. Integated Mass Deworming campaign
Since Jan 2006 Coverage > 60 % of 2-9 y children > 70 % of pregnant women
5.1. Vitamin B1 supplementation:
for pregnant – 9 month till 3 month after delivery ( 1/2tab (50mgtab), alternate day* 4 m)
5.2.Effective treatment provided for babies with infantile beriberi
5.3.Nutrition education - Dietary diversification - Proper cooking methods
VI. Nutrition Promotion Month campaignNPW since 2003 – 2008 in September Since 2009 – Breast feeding week & NPWs
in August
V. Infantile Beriberi project
VII. Nutrition in Emergency 4 key areas 1. Comprehensive
information on the nutrition status of children through rapid assessment, surveillance and survey
2. Management of acute Malnutrition
3. Prevention of micronutrient deficiencies
4. Infant feeding in Emergencies
Nut. Situation & targetSituation Target
2015-16
Underweight among
< 5 children
35.3% (2000 MICS) 31.5%(2003MICS)
28.0% (2009MICS) 19.3% by 2015
Vit A last (6) month > 90 % by tsp rep.65% (2003 MICS)
55.9% ( 2009 MICS)
>90%
Bitot’s spot < 5 0.23% in 1997 0.03% in 2000 <0.05%
Iron Deficiency
Anemia
45% NPW (01)
26.4% adol (2002)
71% PW and
75 % <5 children (2003).
<30% NPW
<60% PW
Situation Target
2015-16
VGR among 6-11 year 12% in 2000 2 % in 2006 < 5%
iodated salt
consumption
86% HH in 2003. >90% HH
Median UIE 136ug/l in 2006 >100 ug/ l
BeriBeri 7.12% of death amg 1-11 m old children
<6 %
New HMIS
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အဟရထေစင�ထေရ�ကမ�ထေပမ�သ PEM နနနနနနန နနန ထေလ�က�မညပြ%စပသည။( Growth Monitoring and Promotion)
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နနနနန နနန န နနန နနနနထေချ�ငဆ��ရငကြကပပြ%စသည�ကထေလမ�) နနနနနနနနနနနနနနန နနနနနနနနနန အဟရထေစင�ထေရ�ကမ�ထေပရပမည။
အဟရကျေ�င��ကျေ��ကျ�မ� န နနနထေပသညဆ��သညမ�ယင ကထေလ မ�အ
(က) နန နန န န နနနန နန က��ယအထေလချ� �န၍အဟရအထေပြချအထေန ပြပနလည ဆနစစပြချင၊
(ချ) မ�ချငမ�အအဟရပညထေပထေဆ�ထေန� ပြချင၊ လ��အပပကက�သပြချင/ည/နပ���ခြပြချင
(ဂ) အဟရ ပြ%ည�စ�ကထေက;ထေမ�န��ငထေရအတ�ကစ�စဉထေပပြချင နနနန နနန နနနနနန နနနနနနနနနန နနန၊တ�3 ထေဆငရ�ကပြချငပြ%စသည။
Measure the circumference of left upper arm at mid point
Locate tip of shoulder
(Arrow-1)
Tip of shoulder(Arrow-2)
Locate tip of elbow(Arrow-3)
Note: Elbow is bent 90°
Measure distance between tip of shoulder and tip of elbow
Note: The elbow is bent 90°
Mark mid point between tip of shoulder and tip of elbow (Arrow-6)
Note: The elbow is bent 90°
How do you measure MUAC?
Measure the circumference
of the arm at mid point
with correct tape tension.
Note: The elbow is
extended.
tv,frSwfwGif vufarmif; vHk;ywfukd wkdif;yg/wdyfjudK;=ym;onf ravsmhvGef; rwif;vGef;ygapESifh/uav;.vufarmif;ukd qefhxm;onf/
How do you interpret MUAC?
Less than 11.5 cm: Severe acute malnutrition (SAM)
11.5 -12.4 cm: Moderate acute malnutrition (MAM)
12.5-13.4 cm: At-risk
13.5 cm and above: Well-nourished
Severe with complication=> refer to hospital
Severe without complication/ mod => locally available food
No AMW => NE, Cooking demonstration
G Growth chart န�င�ပတသက၍ ထေဆငရ�ကရန
juD;xGm;r_vrf;ajumif;
aumufcsuf aqG;aEG;7ef
yHkrSefwuf yHkrSefjuD;xGm;
csD;usL;yg
yxrtjudrf--wef; (odkh) us
juD;xGm;r_aES;=cif;pwif
IYCF aqG;aEG;7ef
oHk;judrfqufwdkuf ---wef; (odkh) us
juD;xGm;r_aES;=cif;
usef;rma7;Xmen$ef;ydkh7ef
wef;Iaxmifwuf tav;csdefwdk;e_ef;rsm;ae
formula milk rSefuefpGm a7mpyf=cif;&Sdr&SdESifh အ ေထေjumif; 7if; qef;ppf7ef
Situation
► Low birth wt prev.► 23.5% (NNC -1994) ► 12 % (HMIS -2000) ► 8.6 % (MICS -2009)
BF rate > 90% EBF = 23.6% (MICS 2009) Appropriate initiation of CF-
70%
Nutritional status among < 5 children
Prevalence of wasting among under five children in Myanmar
Vitamin A coverage was high > 90 % by tsp reportsVitamin A coverage was high > 90 % by tsp reports
TargetsSr Particular A/U 2006
/2011
2011-
2012
Target
1 Prevalence of PEMamong under-5 children (WFA < - 2SD, NCHS)WHO; GSTD
(%) 31 29 [ <25%]
2 Visible goitre rate among 6- 11 year children (%) 2 - [<5%]
3 Median Urinary Iodine excretion ug/dl 123 100-
200
>100 µg/dl
4 Proportion of households consuming effectively iodated salt
(%) 47 57 [>90%]
5 Prevalence of Bitot's spot among under-5 children (%) 0.03 .03 <0.03
6 Proportion of under-5 children with normal serum vitamin A status
(%) >95 >95 >95
7 Prevalence of anaemia among non-pregnant women (%) 45 40 [<30%]
8 Prevalence of anaemia among pregnant women (%) 71 67 [<60%]
9 Worm Infestation among under five children % 71 67 (<60%)
10
Vit. B1 deficiency among pregnant women and lactating women
%12.9
<12.9
<5%
11
Vitamin B1 deficiency among under one children % 7.1 <7.1
<6
Integration!!
Nutrition surveillance Growth monitoring
Nutrient supplementation (VA,B1,iron)
Nutrition education
Integrated deworming
Testing iodised salt
Micronutrient supplementation
State/Division Nutrition Teams (SDNT)
S/D Health Director
Nutrition Team Leader
Public Health Public Health Public Health
Nurse(1) Nurse (2) Nurse (3)
Nutritionist Statistician
Functions of
SDNTs
Training
Education
Supervisio
n Nutrition
surveillance
Nutrition surveys
Different way
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ကချ�ငပြပညနယစ�ပ��စချနတ�ငက�ငဆငထေလ�လ