Prevention and follow up of

Malnutrition

What is follow up?

• After stabilization (2-3days) and rehabilitation

( 2-6wk) , every child should be followed up to

2.5 yr of age.

• In case of older children up to 1yr from the time

of discharge

Prepare to follow up

(1)Primary failure to respond is indicated by :-

• Failure to regain appetite by day 4

• Failure to start loosing edema by day 4

• Presence of edema on day 10

• Failure to gain at least 5g /kg / day by day 10

(2) Secondary failure to response :-

• Failure to gain at least 5g /kg /day for

consecutive days during the rehabilitation phase.

Reasons of failure to response

• Feed not prepared properly

• Inadequate foods

• Child does not take feed properly

• Psychological causes for e.g anorexia

nervosa

Problems encountered during

treatment with high protein diet

• Pseudo tumor cerebri

• Encephalitis like picture

• Nutritional recovery syndrome

Criteria for discharge

• 6-8 wk time is taken to recover

• He should be alert and active

• He must regain 85% of his ideal weight

• Serum albumin must be minimum 3g

Follow up children after

discharge

• Visiting the child at regular intervals

• Child rearing practices should be told to

mothers

• Immunization should be completed

Long terms sequelae1) Growth :-

• Weight and head cicumference decreased

2) Mental development :-

• Sub normality present d/t decreased size of brain .

• General reasoning and spatial perpetual abilities

most severely affected d/t decrease of DNA and

cholesterol content of brain

3) All abdominal organs :-

Usually recover completely but in some cases

a) diabetes may develop (pancreas)

b)scarring may persisting kidney and pyelonephritis

can progress

4) Endo myocardial fibrosis may occur

Preventing measures

• There is no simple solution of to the

problem of PEM

• Many types of action are necessary

• Following is adapted from 8th FAO/WHO

expert committee on nutrition

• A) health promotion :-

I. Measures directed to pregnant and

lactating women(education , distribution

of supplements)

ii. Promotion of breastfeeding:-

( baby friendly hospital)

iii. Development of low cost weaning food:-child

should be made to eat more food at frequent

intervals .

iv. Measures to improve family diet

v. Nutrition education:- promote correct feeding

practices

vi. Home economics

vii.Family planning and spacing of birth

viii.Family environment

Specific protection

• Child diet must contain protein and energy

rich food(milk , egg, fresh foods if possible)

• Food fortification

Early diagnosis and treatment

1. Periodic surveillance

2. Early diagnosis of any lag in growth

3. Infections and diarrhea

4. Development of programs for early

rehydration

5. Supplementary feeding programs during

epidemics

6. Deworming of heavily infested children

Rehabilitation

1. Nutritional rehabiltational services

2. Hospital treatment

3. Follow up care

Preventive and social measures

• Since malnutrition is the outcome of several

factors , the problem can be solved only by

taking action at various levels:-

• Family ,community , national , international

• It requiores a cordinated approach of many

disciplines:- nutrition , food , technology

health adminstration , health education ,

marketing etc.

Action at family level

1. Nutrition education

2. Both husband and wife need to be

educated about the selection of right kinds

of local foods and in planning of

nutritionally adequate diets within the

limits of their purchasing power

3. Since food expenditureoften amounts to

50-70% of family budgets , nutrition

management and planning should be a

good investment

4. Counter the misleading commercial

advertisements with regarding to baby foods

5. Planning a kitchen garden or keeping poultry

6. Combination of locally available and imported

items

Action at community level

1. Nutrition problem analysis in terms of :-

i. Extent ,distribution, and types of

nutritionals deficiency

ii. The population group at risk

iii. Dietary and non dietary factors

contributing to malnutrition

2. Plan realistic and feasible approaches based on

local resources

3. Direct intervention measures such as ICDS,

Mid day school meals, nutritional anemia

prophylaxis program , Vit A prophylaxis

programme

4. Increasing the availability of foods both in

quantity and quality, but much more important:-

making sure that the people suffering or at risk

,can obtain them.

5. Applied nutrition programme :- production of

various type of protective foods by the community

for the community

6. ICDS:-an inter sectoral programme which seeks to

directly reach the children below six yrs(specially

from vulnerable groups and remote areas)

i. Supplementary nutrition:-

Beneficiaries Calories(kcal) Protein(g)

Children upto 6yr 300 8-10

Severely malnourish Double of the above Double of the above

Pregnant and lactating mother 500 20-25

ii. Health check ups includes ANC of expectant

mothers, PNC of nursing mothers and health care

of children.

These services are provided by ANM, medical

officers under RCH program

iii. Immunization

iv. Non formal pre school education

v. Referral services

vi. Nutrition and health education

utilization of these services is still poor.

7. Safe water supply to prevent water born diseases.

In brief broad socioeconomic development of the

entire community .

At the national level

1. Rural development (NRHM ,RCH)

2. Increasing agriculture production:-application of

modern farming practices, expansion of cultivated

areas ,use of fertilizers ,better seeds.

Accompanied by effective marketing , land

tenure ,food price policies and food distribution

system

3. \Stabilisation of population

4. Nutrition related health activities

Action at international level

1. Establishment of multi lateral world food

program in 1963

2. International co-operation in the situations of

natural calamities

3. Some organs of UNO like FAO, UNICEF,

WHO, World Bank, IMF, UNDP and CAR

working in close collaboration.

THANKS

Presented by:-

Md. Aqueel Azhar

20th batch

Department of paediatrics

Katihar medical college katihar

• Prime Minister Manmohan Singh stated,

“The problem of malnutrition is a matter of

national shame.... I appeal to the nation to

resolve and work hard to eradicate

malnutrition in five years.”