KADUNA POLYTECHNICDEPARTMENT OF NUTRITON AND DIETETICS.

COLLEGE OF SCIENCE AND TECHNOLOGY

EVENING SESSION (2015-2016) 200 LEVEL

COURSE: DIET THERAPY (NUD 233)

PRACTICAL REPORT

ON

“OPERATION ON UNDER FIVE CLINIC”

TO BE SUBMITTEDBY

200 LEVEL NUTRITION AND DIETETICS

SUBMITTED TO:MALLUM UBA AHMAD. A.

JULY, 2017.

DATE: 27TH JULY 2017

TITLE: OPERATION ON UNDER FIVE CLINIC

AIM:

I. To access the nutritional status of under-five using weight, height and arm circumference of individuals

II. To explain to under-five mothers the correct choice of foods for infants e.g. breast feeding, weaning, hygiene

III. To provide dietary advice to mothers of the under-five on kwashiorkor, marasmus, nutritional dwarfing and under weight

IV. To explain to mothers how to prepare a cheap source of diet (complementary diet precisely) for infants

V. To secure remedies for children with acute and chronic illnesses

INTRODUCTION

Under Fives' Clinics, also popularly known as Growth and Development Clinics, are an important part of all comprehensive health care programmes. They permit not only delivery of health care to the most precious section of human community but also allow education of the parents in the matter of their children's health. One of the main problems in organizing an Under Fives' Clinic is defaulting by the mothers. The default rate seems to depend upon distance of the clinic from the community and the personal rapport between the clinic staff and the attending mothers. The default rate is likely to be high particularly in a low socio-economic community that is largely illiterate. We describe in this paper our experience in the organization of an Under Fives' Clinic held at Shehu Mohammad Kangiwa Medical Center Kaduna Polytechnic. It is also a center, where preventive, promotive, curative, referral and educational services are provided in a package manner to under five children under one roof.Goals:

I. To overall goal of under-five clinic is to provide comprehensive health care to young children in a specialized facility

II. The under-five clinic is represented by traditional logo of a triangle with four internal triangles and an outer enveloping triangle as shown below

Activities and Strategies

I. Regular height and weight determination/ monitoring until 5 years old. 0-1-year-old=monthly 1-year-old and above =quarterly

II. Recording of immunization, vitamins supplementation, deworming and feeding

III. Provision of IEC materials (ex. Posters, charts and toys) that promote and enhance child’s proper growth and development

IV. Provision of a state and learning- oriented environment for the childV. Monitoring and evaluation

MATERIAL:

The following are activities conducted in the clinic they include:

i. Sitting arrangementii. Card sorting iii. Weighing (Growth Monitoring)iv. Health talk v. Nutritional Counseling

Preventive Care

Family planning

Monitor growth

Care in illness

Health Education

vi. Food demonstrationvii. Immunization

SITTING ARRANGEMENT

This was the first activities carried out in the clinic so that patients can be attended to accordingly without any misunderstanding. It was done also to make them comfortable before they are being attended to.

Procedure:

The first to the last mother were given a number and was arranged in ascending order before carrying out any activities

CARD SORTING: This is the arranging, compiling, analyzing and collecting of the document or piece of information that contains a brief history of the patient or individual in concern medical state. It was conducted by collecting the hand cards issued to the under-five mothers before sorting their medical sheet history.

GROWTH MONITORINGGrowth monitoring of infants is the accessing of nutritional status of under-

five using weight, length, height and including and arm circumference of infants. It involves following changes in a child physical development of weight and sometimes of height whether is growing too slow or too fast may indicate a malnutrition or other health problems

Growth monitoring consist of weight measurement to detect abnormal growth, combine with some sections when this is detected. Growth monitor is the regular recording of child’s weight and height coupled with some specific removal action if they are abnormal in some way.MATERIALS:

InfantometerMuac tape (Shaker Strip)Baby weighing ScaleGrowth chart and Graph Slope

Note: Before conducting or assessing the under-five disinfect the weighing panPROCEDURE:

I. The card of the babies was sorted first by selected student and the scale was calibrated

II. Some selected student assisted in removing the wares of babies to have correct measurement

III. The babies were placed in the scale and also in the infantometer for their height and weight measurement

IV. The collected body weight was compiled and recorded

Note: The growth is plotted in the growth chart then growth curve is prepared to monitor the growth of the child

RESULT/OBSERVATION:

S/N

Name Age(m)

Sex ReceiptNo.

Weight(Kg)

Height (cm)

Comment

1. Asma’u Shaibu 9 F 061792 6.4 26.5 Dropped 2. Mahmad Ibrahim 8 M 061288 7.8 26.5 Increased3. Iwaloye A. Zulta 7 F 064392 7.3 24.5 Increased4. Muslimat Ismai 6 F 064312 5.8 24.5 Increased5. Prevail Aisha 8 F 064417 9.4 30.0 Increased6. Abdulsalam Usmar 7 M 067093 4.2 30 Increased7. Hibatullah Raji 1 F 061076 8.7 26.7 Increased8. Usmar Lawal Adam 11 M 064328 5.5 29 Increased9. Abdulsalam Alazeez 5 M 066796 4.7 29 Increased10. Fatima Nasir 8 F 060715 8 32 Increased11. Kosinachi Amada 9 F 061286 7.8 29.5 Increased12. Halima Abdulra’at 8 F 062119 8.6 27.5 Dropped

HEALTH TALK

This is clinical approach used to educate the mothers about child care, breastfeeding, and understanding the causes, symptoms of some nutritional diseases and most importantly their dietary management.

Health talk was conducted base on the following topics:

1. The correct diet to be given to under-five2. Nutritional deficiency diseases

The correct diet: Different food group were displayed with posters, food models and food samples. Each food group was explained to the mothers like telling them

the important nutrient and calories present in the food shown. The food model was used to explain the food group. A food pyramid is used to explain the percentage of nutrient requirement as the children requires.

Nutritional Deficiency Diseases: Explained on some pathological changes in under-five children caused as a result of deficiency (insufficient, inadequacy in some nutrient from food) and also diseases caused as a result of food poisoning. It was explained based on the following:

i. Kwashiorkor ii. Marasmus iii. Diarrheaiv. Nutritional stunting (dwarfing)

KWASHIORKOR

Kwashiorkor is a term used for clinical syndrome which results from severe deficiency of protein in the body due to insufficient dietary intake of protein. It is a severe form of protein energy malnutrition. Cicely Williams, a Jamaican physician while working in Ghana during 1930 described the condition in detail and named it as ‘Kwashiorkar’ which in local language of Ghana means ‘disease of deposed child’ (disease in a child who no longer suckles mothers breast). The condition is widely prevalent in developing countries of Asia and Africa where drought and famine leads to restricted food supply. In United States kwashiorkor is rare. Kwashiorkor is most florid form of protein energy malnutrition occurring usually in children between the age of 1 and 3 years when they are completely dependent on weaning.Symptoms of KwashiorkorKwashiorkor starts with symptoms of irritability, fatigue, lethargy, decreased muscle mass and growth retardation. Over time, the physical appearance changes to include a protruded stomach, edema, discolored hair, pigmented skin, rash and a round face. Children with kwashiorkor are also prone to infections due to an impaired immune system, that further increases the severity of malnutrition. Prolonged protein deficiency also affects the intellectual development in young children. While many of the symptoms of kwashiorkor disappear after treatment with a calorie- and protein-rich diet, these children may never attain their full physical and mental potential.

Diet for Treating Kwashiorkor

Nutrition support is the mainstay treatment for kwashiorkor. The child receives adequate amount of food rich in protein and calories. In the beginning foods rich in carbohydrates, fats and sugars are given. Once these foods are found to be enough for energy requirement, protein diet is started. Because patient with kwashiorkor have been deprived of a nutritionally adequate diet for a long time, a medical professional should monitor and plan their food regimen. Treatment should start with a gradual introduction of carbohydrate foods such as fruits, starchy vegetables, breads and cereals to provide calories. Then the persons should consume foods containing proteins such as meat, fish, poultry, eggs, soybeans and legumes. Milk and milk products are also rich in protein. However, children suffering from kwashiorkor may be lactose-intolerant and may need lactase enzyme supplements to digest milk, yogurt and cheese.

MARASMUSMarasmus is a serious form of protein energy malnutrition that most

commonly occurs in children living in developing countries. Poverty, lack of food and inadequate or contaminated water supplies with bacteria and parasites are factors that contribute to this disorder. Although marasmus is not a common occurrence in the developed world, marasmus can result from certain medical conditions in first-world countries. Children with cardiovascular disease, oncologic disease, genetic disorders and neurological disease can develop marasmus without the general contributing factors normally associated with marasmus.Symptoms of MarasmusThe symptoms of marasmus depend on the severity of the malnutrition experienced by the individual, and symptoms can manifest daily or occasionally. Symptoms of marasmus include chronic and persistent diarrhea, weight loss, fatigue and dizziness. In severe cases, of marasmus symptoms also include prolonged vomiting, fainting and varying levels of consciousness, lethargy, full or partial paralysis of the legs and loss of bladder or bowel control.Causes and Risk Factors of MarasmusThe deficiency of both proteins and calories results in insufficient energy for the body, ultimately causing marasmus. There are several risk factors that can precipitate marasmus. However, an individual can develop this disorder without any of these risk factors. Risk factors include chronic hunger, inadequate food supplies, vitamin deficiencies, contaminated water supplies and diets without sufficient grains, fruits, vegetables and protein. You can minimize the risk of

developing marasmus by eating a well-balanced diet, drinking clean water and receiving proper medical treatment for infections.Treating MarasmusOnce a Nutritionist/Dietitian diagnoses marasmus, the treatment involves special feeding and rehydration therapy and requires very close medical observation. The rehabilitation requires intravenous fluids, oral hydration solutions and nasogastric feeding tubes. The nutritional value that an individual will need in the rehabilitation includes 150 kilocalories per kilogram per day. Additionally, the individual will receive treatment for vitamin and mineral deficiencies through supplementation. Further, to reduce the possibility of developing infections, doctors will administer immunizations to individuals with marasmus.

DIARRHEADiarrhea, frequent passage of abnormally loose, watery stool. Diarrhea

usually develops suddenly and may last from several hours to a few days. It is often accompanied by abdominal pains, low fever, nausea, and vomiting. If the attacks are severe or increasingly frequent, exhaustion and dehydration can result. In normal digestion the large intestine absorbs excess water from liquid food residues produced by earlier phases of the digestive process before excreting semisolid stools. When the mucous membrane lining the large intestine is irritated or inflamed, food residues move through the large intestine too quickly and the resulting stool is watery because the large intestine cannot absorb the excess water.Change The Diet

When a baby gets diarrhea, change the baby's diet. A Dietitian might suggests withholding from the diet of a 1-year-old with diarrhea dairy products like milk, as well as juices while the diarrhea persists, as these can make it worse. A woman can continue breastfeeding her 1-year-old if he has diarrhea, because breast milk is healthy and full of fluids to rehydrate the baby as well as necessary nutrients. Many medical personnel recommend that 1-year-olds with diarrhea consume foods on the BRAT diet; bananas, rice or rice cereal, apple sauce and toast.Increase FluidsThe baby must drink plenty of fluids to replace the fluids lost in diarrhea. If a child doesn't drink enough fluids when he has diarrhea, he could become dehydrated, which can make him tired and dizzy. Fluids can help to soothe the stomach and make diarrhea less severe. Water is the best option to replace fluids, while special rehydration drinks for children are also available. Medical practitioners have

stated that oral rehydration drinks can be helpful for children with diarrhea, but they also contain a lot of sugar. He recommends watering these types of drinks down to about half water and half oral rehydration solution, before giving them to the child. Soups can also be given to the 1-year-old to increase fluid intake.

NUTRITIONAL STUNTINGStunting is very low height for age. It is the failure to reach one’s genetic

potential for height. Children who have been chronically deprived of sufficient macronutrients (fat, carbohydrates, and protein) can become stunted. The lack of nutrients – often combined with chronic infection and/or stress – impacts the child’s length more than weight. In these cases, kids will be small but might look chubby because their low weight is distributed across an even shorter body frame. Often, upon adoption, parents might think their child is healthy because of his “chubby” appearance, when in fact the chubby look is a symptom of under-nourishment. Previously, stunting was referred to as ‘psycho-social dwarfism.’ Wasting and stunting can present in mixed forms.

Stunting in early life - particularly in the first 1000 days from conception until the age of two - impaired growth has adverse functional consequences on the child. Some of those consequences include poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life.Causes of StuntingStunting develops over a long period due to a combination of some or all of the following factors:

Intrauterine growth retardation Not enough protein in proportion to total calorie intake Hormone changes triggered by stress hormones (cortisol, for example) Frequent infections early in lifeThe development of stunting is a slow, cumulative process and does not

necessarily mean that the current dietary intake is inadequate. The growth failure may have occurred in the past.Symptoms of Stunting

Short for age Body proportions are likely normal but child looks young for his or her age Low weight for age Appears chubby (disproportionate fat mass relative to height)

Bone growth is delayedDiagnosis of Stunting

Stunting is measured by the height-for-age index and is considered to be present when height for age is more than two standards below the World Health Organization standard.Implications of Stunting

Children over the age of 2 who are stunted may never be able to regain lost growth potential. Children with a history of stunting are at risk for cognitive and learning delays.Treatment of Stunting

Children who are stunted may benefit from additional quantities of nutrients needed for both bone and lean tissue growth; however, a specific nutritional plan should be developed in conjunction with a child’s pediatrician and dietitian.NUTRITIONAL COUNSELLING

Are free community Seminar or dialogue between the medical personnel and the patient in reaching conclusive agreement or arrangement to know about the nutritional status assessment and surveillance. These are the counseling skills required for one to have which are:

Ought to reflect on patient complains Should be able to use non-verbal communication skills A counselor should not be rule to patient Should not be judgmental Need to show love and care to patient Should be able to show empathy not sympathy Keep secret

FOOD DEMONSTRATION

IMMUNIZATION

Immunization is the process where by a person is made immune or resistant to an infectious disease typically by the administration of a vaccine. Vaccine stimulate the body’s own immune system to protect the person against subsequent infection or disease.

Reason for Immunization

Immunization is one of the safest and most effective methods of preventing childhood diseases.

Under the Universal Immunization Programme (UIP), significant achievements have been made in preventing and controlling the Vaccine Preventable Diseases (VPDs).

Immunization has to be sustained as a high priority to further reduce the incidence of all VPDs, control measles, eliminate tetanus and eradicate poliomyelitis.

Full immunization (i.e. received one dose of BCG, three doses of DPT, Hep-B and OPV each and one dose of Measles before one year of age) gives a child the best chance for a healthy life. Preventing disease before it occurs saves money, energy, and lives.

Immunization is a key strategy to child survival. By protecting infants from VPDs, immunization significantly lowers morbidity and mortality rates in children. The security provided to families can lead to lower birth rates.

Immunization is an indicator of a strong primary health care system.

The following are the targeted vaccine preventable diseases along with theirsymptoms, mode of spread and methods of prevention. Tuberculosis, Polio, Diphtheria, Pertussis, Tetanus, Hepatitis B, Measles

ROUTINE IMMUNIZATION SCHEDULE FOR CHILDREN 0-11 MONTHS

Note: For full protection aa child must have 1 dose BCG, 3 doses DPT, 4 doses OPV, 3 doses Hepatitis B and 1 dose Measles before the age of one, women of weaning age (15-45 years) must have 5 doses of TT all immunization are Free!

Types of Vaccine

Against what Disease

Age given Dosage How many times

Minimum interval

How and where

BCG {Bacillus Calmette Guerin}

Tuberculosis At birth 0.05ml Once -- Intradermal upper left arm

DPT Diphtheria whooping cough

(pertussis)

6 weeks 10 weeks 14 weeks

0.5ml per-dose

3 times

4 times Intramuscular upper part of

the thigh

Polio Poliomyelitis At birth 6 weeks 10 weeks 14 weeks

2 drops per-dose

4 times

4 weeks minus

dose at birth

Oral mouth

Measles Measles 9 months 0.5ml per-dose

once -- Subcutaneous upper left arm

Yellow fever Yellow fever 9 months 0.5ml per-dose

Every 10yrs

10yrs Subcutaneous upper left arm

Hepatitis B Hepatitis B At birth 6 weeks

14 weeks

o.5ml per-dose

3 times

-- Intra muscular outer part of

thighVitamin A To boost

immunityAt 6 months

and At interval of

6 month until the

baby is 5yrs

100,000IU at 6 months 200,000IU

at 12 months and

above

2 times

a year

6 months Oral Mouth

FOOD DEMONSTRATION

The nutritional demands and requirement of the growing infant (after 6 months of exclusive breastfeeding) entails additional consideration for nutrients in additions to breast milk and unless those additional nutrient are provided the child’s growth rate will be jeopardized repressing cognitive, motor skills, physical social and environmental need for protein, energy, vitamin and minerals. The best recipe for complimentary (weaning) diets is a formulation from the locally available food items most of which the household, particularly the mothers can afford and prepare using the local ingredient for preparation

Materials:

1 tray 1 Blender Disposable cups Heat source (gas cooker) Work surface (table) Bowl Knife Serving tray

Ingredient:

Irish potatoes Fish Carrot

Required nutrient for 1 serving

Food items Ex Qua Cho(g)

Pro (g) Fat(g) Vit A

Ca Fe Kcal

Irish potatoes 1 ½ c 15 2 - 0.95 0.95 0.93 70Fish 1 1oz - 7 3 0.90 - - 55Carrot 1 ½ c 5 2 - 0.20 0.92 0.84 25Total 20g 11g 3g 1.6 1.87 1.77 150kcal

PROCEDURE:

- For the Irish- It was peeled after sorting out the good ones and washed- It was sliced into thin sizes and was cooked for some minute then kept

aside in a bowl- For the Fish

- The fish was washed and prepared and was chopped into blend able sizes

- For Carrot- The carrots were washed and chopped- All the three ingredient were combined and it was blended

- It was parboiled for some minutes before the blending then served on a disposable cup

RESULT/OBSERVATION:

i. It was observed that the diet prepared was having these qualities used in the sensory evaluation

Food Sample

Texture Taste Flavour Appearance

excellent good fair poor Excellent good Fair poor excellent good fair poor excellent good fair Poor

Carrot, Irish potatoes and

fish

SIGNIFICANCEThe first five years of life form the foundations of the child’s physical and mental growth and development. Studies have shown the mortality and morbidity are high among this age group. The Department of Health established the Under Five Clinic Program to address this problem.CONCLUSION:

At the end of the practical on the operation of under-five clinic held at Shehu Mohammad Kangiwa Medical Centre by ND2 evening Nutrition and Dietetics was successfully carried out in all activities been instructed to the class

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