Input 3 Assessment of Nutritional Status

8/2/2019 Input 3 Assessment of Nutritional Status

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Nutritional Status

Assessment inEmergencies


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Session ObjectivesBy the end of the session, participants will be ableto:explain the importance of assessing the nutritionalstatus of individuals during emergencies;

identify common forms of malnutrition duringemergencies;demonstrate competencies in:

(a) measuring weight, height and MUAC

(b) interpreting anthropometric results forresponse planning


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What is Malnutrition?

pathologicalstate resulting

from . . .

a relative lack of nutrient

an absolute deficiency of

nutrient/s

an excess of nutrient/s


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What is Malnutrition?

physical work

recovering fromeffects of diseasemaintaining adequate

level of growth

processes of

pregnancy and

lactation

Impaired

physical function

to point that

cannot maintain

adequate levels

of performance

at . . . . .


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What are the commonforms of malnutrition?

Undernutrition

Specific-nutrient deficiency

Overnutrition


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What is undernutrition andits common forms?

Refers to consequence of consumingand/or absorbing insufficient nutrients orusing or excreting them more rapidly

than they can be replaced. It refers to a range of conditions:

acute malnutrition (wasting/thinness) chronic malnutrition (stunting/shortness)

micronutrient deficiencies (vitamin Adeficiency, iron deficiency anemia, and iodinedeficiency disorders).


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malnutrition duringemergencies?

Malnutrition and infection are intimately related a malnourished child is more susceptible todisease, and a sick child is more likely to becomemalnourished

Malnutrition increases the risk to infections andfatal diseases such as malaria, measles, diarrhealdisease, pneumonia, HIV and AIDS


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Infection-undernutrition

Inadequate diet

Weight loss

Growthfaltering

Loweredimmunity

Increased incidence,severity and duration of

disease

Loss of appetite

Malabsorption

Increased

nutritionalrequirements


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Moderate acute malnutrition (MAM) needs to beaddressed to:

prevent from getting worse

protect the childs right to sufficient food,growth and well-being and to prevent moreserious illness and death

Moderate malnutrition is also significantly cheaperto treat than severe malnutrition


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Malnutrition contributesto between 35 and 55percent of all childhooddeaths

In acute emergencysituations, malnutritioncan account for evenmore deaths



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Intergenerational cycle of

growth failure


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Who are most vulnerable tomalnutrition?

Low birthweight babies

0-24 month old children

Pregnant and breastfeeding mothers

Older people

Disabled people

People with chronic illnesses

People with HIV and AIDs


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nutrition situation duringemergencies?

Rapid Nutrition Assessment

Survey

Nutrition Surveillance


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What is Rapid NutritionAssessment?

assessment of nutritional status based on simpleanthropometric data:

Weight

Height Mid-upper arm circumference or MUAC

limited to children of preschool age, who serve torepresent the general population

limited to protein-energy malnutrition withoutattempting to assess other nutritional deficienciesas further variables can add workload and causeunnecessary delay

Source: National Policy on Nutrition Management in Emergencies and Disasters


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Nutrition Assessment(RNA)?

RNA can provide:

a quick snapshot of the nutrition situation

important source of information especially at the

onset of emergency to determine the magnitudeand severity of crisis

basis for determining whether a more detailedassessment is required to establish the actual

prevalence of acute malnutrition or whether anemergency response is required

initial screening for inclusion in a selective feedingprogram


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assessment during anemergency?

At the soonest possible time but may not befeasible or practical during the early stage of theemergency

Should be done in the intermediate andextended phases since the disaster oremergency may have negative effects on thenutritional status especially of the nutritionallyvulnerable



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What are the stages ofemergency?

Early Emergency

It is the period immediately following adisaster, lasting from one to two days, oreven for just a few hours depending on thenature of the calamity

The period is characterized by stress,anxiety and in some cases, shock wherefood supply is cut-off; no productive labor is

possible and people are hungry but notstarving.



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What are the stages ofemergency?

Intermediate Emergency

It is the transition period from initial onset ofdisaster to rehabilitation

Conditions are still far from normal but theinitial shock is over.

Extended Emergency.

It is the period after the worst is over

Rehabilitation to near-normal conditionstakes place At this phase, families start togo back to their homes to continue theireveryday life.



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What are the types ofmalnutrition?

Acute Malnutrition (wasting)

Chronic Malnutrition (stunting)


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What is ChronicMalnutrition?

Most common form of malnutrition and causesstuntingdue to long-term state of poor nutrition

Its long-term effects are associated with impairedphysical and mental development in children

It is an irreversible condition


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What is Acute Malnutrition?

A drastic deterioration of nutritional status in ashort time due to deprivation of food or bout ofinfection in the immediate past and is manifestedby muscle wasting

Associated with an increased risk of morbidity andmortality

Strong evidence indicates that a child with severeacute malnutrition has a greatly increased risk ofdying

h i


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What is AcuteMalnutrition? Acute malnutrition or wasting (thin individuals)

can be reversed and is of particular concern duringemergencies because it can quickly lead to death.

The prevalence of acute malnutrition amongchildren under five years is a sensitive andobjective crisis indicator, reflecting the widersituation of emergency affected populations,including their food security, livelihoods, public

health and social environment. Acute malnutrition can be moderate or severe.


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What is Severe AcuteMalnutrition (SAM)?

Characterized by a weight that is below minus 3z-scores of the median growth standards

In the Philippine context, these are thoseclassified as severely wasted, based on therevised tables on weight and heightmeasurements using the WHO Child GrowthStandards (CGS)

SAM is also indicated if mid-upper arm

circumference (MUAC) is less than 115 mm(11.5 cm. or 4.5 in); and when bilateral edemais present.


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SAM a key intervention inemergencies?

Children with SAM have a 10 to 20-fold risk ofdying compared to well nourished children

SAM can be a direct cause of child death, or it

can act as an indirect cause of death bydramatically increasing case fatality in childrensuffering from common childhood illnesses suchas diarrhoea and pneumonia.


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SAM a key intervention inemergencies?

This is particularly heightened in conditions ofpoor sanitation, hygiene and poor provision ofhealth services that often characterizeemergency situations.

Timely and effective interventions for themanagement of SAM, which achieve highcoverage, could prevent hundreds of thousandsof child deaths.


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of Severe AcuteMalnutrition (SAM)?

Marasmus

Kwashiorkor

Marasmic Kwashiorkor


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Marasmus The most frequent form

of protein energymalnutrition found inemergencies

Caused by: prolonged starvation chronic or recurring

infections with marginalfood intake

The main sign is asevere wasting away offat and muscle, whichmakes the child appearvery thin.


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Marasmus


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Marasmus (non-oedematous malnutrition): There may be folds of

skin on the buttocks and thighs that make it look as if the child is

wearing baggy pants. Weight-forage and weight-for-length/height

are likely to be very low.


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Kwashiorkor The second form of

acute protein energymalnutrition


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Kwashiorkor

The main sign is edema,which usually starts in thelower limbs and spreads inmore severe cases to the faceand hands


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Marasmic Kwashiorkor Marasmic kwashiorkor is a

mixed form of ProteinEnergy Malnutrition.

Severe form of acute

malnutrition characterizedby bi-lateral edema andweight for height of lessthan -2 SD.


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What is Moderate AcuteMalnutrition (MAM)?

Characterized by a low weight-for-height(between minus 3 and minus 2 z-scores of themedian growth standards)

In the Philippine context, these are those

classified as moderately wasted, based on therevised tables on weight and heightmeasurements using the WHO Child GrowthStandards (CGS)

MAM is also indicated if mid-upper arm

circumference (MUAC) is less than 125 mm(12.5 cm. or 4.9 in) but 115 mm.

h f l i i


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What types of malnutritionoccur in emergencies?

Acute Malnutrition (wasting)

Micronutrient deficiencies especially in iron,vitamin A and iodine as well as vitamin C,thiamine and niacin deficiencies.

h h h d f


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Anthropometric

Dietary

Biochemical

Clinical

What are the methods ofnutritional assessment?

l t iti ?


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malnutrition?(as per National Policy on Nutrition Management inEmergencies and Disasters)

assessment of nutritional status will bebased on simple anthropometric data:

Weight

Height

Mid-upper arm circumference or MUAC

sex, age and presence of edema

l t iti ?


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limited to children of preschool age who representthe general population

limited to protein-energy malnutrition without

attempting to assess other nutritional deficiencies asfurther variables can add workload and causeunnecessary delay

l t iti ?


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Weighing and height measurement of preschoolchildren should be done monthly until fullnormalcy is achieved, by which time the OPTsystem can be used for nutritional assessment.

The nutrition cluster should spearhead theassessment and supervise its conduct to ensurethat quality data is generated and shared.


Wh t d


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What do we measureduring RNA?

Weight for Height

widely used nutritional or anthropometric index,and is the best indicator of wasting

recommended for assessments of recent nutrition,and is especially important for assessments ofnutrition-related humanitarian emergencies

same height

Wh t d


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If measuring weight and height is notpossible, the MUAC could be used asindex for screening preschool children.

Wh t d


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Bilateral oedema

an essential indicator for determining the presenceof Severe Acute Malnutrition or kwashiorkor. Itpresents first in feet, then in ankles and lowerlimbs.

edema may be detected by the production of adefinite pit as a result of moderate pressure forthree seconds with the thumb just above theankle.

Wh t d


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Bilateral oedema

all children with nutritional edema areautomatically classified as severely

malnourished.


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Weighing the child

*Adapted from the BNS Training Modules developed by IHN-UPLB

Ki d f W i hi


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Kinds of WeighingScales

SalterScaleBeam

Balance

Infant BeamScale


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Proper Handling of WeighingScales

Hooks complete and

in good condition


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Adjustment screwworking



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Needle or pointer

moving freely



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Weighing pants

clean and

without a tear



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Rope, strong,

long enough,

and tied well



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Proper Use of Salter Scale

Hang the scale froma tree branch, ceiling

beam or pole.

Attach the empty weighing

pants to the hook of thescale, adjust the scale to

zero, and then remove from

the scale.


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Check if the face or

dial of the scale is at

eye level, not lower orhigher.


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Check if the child is

barefoot, in minimum

clothing and with

empty pockets.

Ask mother or

someone to hold

the child.

How to weigh the child


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Put the measurers

hands through leg holes.

Gently pull legs through

the leg holes making surethat the strap is in front of

the child.


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Put arms around the child and

attach the strap of the

basket/sling to the hook of thescale and allow the child to

hang freely.

Check the childs position.

Make sure the child is not

touching anything.


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Hold the scale and read the

weight at eye level to the

nearest 0.1kg. Read the

measurement when the scale

needle is not moving and

record data.


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Put arms around the child and

gently lift the child by the

body. Remove the strap from

the scale.

Remove the weighing pants.


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Give child to mother or

caregiver.


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Item Yes/Remarks

Preparation for weighing

1. Hooks of weighing scale complete and ingood condition

2. Adjustment screw is working

3. Needle or pointer moves freely

4. Weighing pants are clean

5. Weighing pants are free from tear

6. Rope is strong and long enough

7. Weighing scale was calibrated and adjustedaccordingly

ecklist for the Practice Weighing


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Actual weighing1. Weighing scale was adjusted to 0 with the

weighing pants2.Face or dial of scale at eye level, not lower or

higher3.Child was barefoot

4.Child was not wearing heavy clothes

5.Childs pocket was checked, heavy objects were

removed6.Child was put in the weighing pants correctly

ITEM YES/REMARKS



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7.The strap of the weighing pants was in front ofthe child

8.One hand held the child while the other hand

placed the weighing pants with the child on thehook

9.The child was not holding on to anything when

being weighed, and no one was holding ontothe child while he/she was being weighed

ITEM YES/REMARKS



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10.Tone in interviewing mother or caregiver wasfriendly

11.Birth certificate was used to validate childs

birthday (Note: For this exercise age of child

will not yet be taken)12.Reading of weight was done when needle was

no longer moving

ITEM YES/REMARKS


Measuring the


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Measuring theheight/length


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Measuring the height Depending on a childs age and ability to stand, measure

the childs length or height. A childs length is measured

lying down (recumbent). Height is measured standing

upright.

Height


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Heightboard To measure height, use

a height board(sometimes called astadiometer) mounted

at a right anglebetween a level floorand against a straight,vertical surface such asa wall or pillar.

Standing


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If the child is aged 2years or older andable to stand,

measure standingheight.

Standingheight


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Length board To measure length use a length board (sometimes

called an infantometer) which should be placed ona flat, stable surface such as a table.

Recumbent


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Recumbentlength

If a child is less than 2years old, measurerecumbent length.


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In measuring height In general, standing height is about 0.7 cm less

than recumbent length.

This difference was taken into account in

developing the WHO growth standards used tomake the charts in the Growth Record. Therefore,it is important to adjust the measurements iflength is taken instead of height, and vice versa.

Reminders in measuring


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Reminders in measuringthe height/length

If a child less than 2 years old will not lie down formeasurement of length, measure standing heightand add 0.7 cm to convert it to length.

If a child aged 2 years or older cannot stand,measure recumbent length and subtract 0.7 cmto convert it to height.

Reading the


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ead g emeasurement This is a picture of part of a measuring tape. The

numbers and longer lines indicate centimetremarkings. The shorter lines indicate millimetres.The gray box shows the position of the footboard

when a length measurement is taken.


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Assessing the

childs

nutritional status

using

MUACMUAC


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What is MUAC?

Mid-upper Arm Circumference is thecircumference of the left upper arm, measuredat the mid-point between the tip of the shoulderand the tip of the elbow (acromion and theolecranon process )


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Why use MUAC?

MUAC is used for rapid screening of acutemalnutrition from the 6-59 month age range

MUAC is used for identification of severe acutemalnutrition (SAM) during screening at the

community level and admission for treatment atthe health facility. Using MUAC alone as independent criteria for SAM

was endorsed by WHO.


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MUAC is: simple

quick

accurate inexpensive

Why use MUAC?


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It is more sensitive. MUAC is a better indicatorof mortality risk associated with malnutrition thanweight-for-height. It is therefore a better measureto identify children most in need of treatment.

It is less prone to mistakes. Comparative

studies have shown that MUAC is subject to fewererrors than weight-for-height (Myatt et al, 2006).

Why use MUAC?

How is MUAC


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How is MUACmeasured?

Keep your work at eye-level and sit down when possible. A

very young child can be held during the procedure by the

parent or carer, who should also remove any clothing thatcovers the childs left arm.

Persons involved:

1 Measurer

1 Assistant/Recorder

How is MUAC


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How is MUAC


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Make sure that the tape is flat against the skin.


How is MUAC


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Read the

measurement to

the nearest 0.1

cm.


What does the MUAC


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What does the MUACtell us?

For Children 6-59 months

RED SAM MUAC < 115 mm and/orbilateral edema

YELLOWYELLOW MAM MUAC 115 mm and < 125 mm

GREEN Normal MUAC 125 mm

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Input 3 Assessment of Nutritional Status

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