NUTRITION AND PRIMARY HEALTH CARE

PHN 804

January 2012

Causes of and strategies for under-nutrition

throughout the life cycle

Nutrition and the life cycle

Fig 1. Relationship among the life stages

Learning Objectives

• By the end of this module the learner should be able to:– Describe importance of nutrition for all ages

of the life cycle– Outline the effects of malnutrition through the

lifecycle– Discuss strategies to break the malnutrition

cycle.

The Cycle of Under-nutrition

Child growth failure

Early pregnancy

Small adult women

Low birth weight babies

Low weight and height in teens

ACC/SCN, 1992

The cycle of under-nutrition

• Under nutrition that occurs during childhood, adolescent and pregnancy has as additive negative impact on the birth weight of infants.

• Intrauterine growth retardation (IUGR) leads to a far higher risk of dying in the neonatal period or later infancy.

• A low –birth weight infant is thus more likely to be underweight or stunted in early life.

Causes of Under-nutrition

Life time consequences of being born

undernourished

Figure 2. Effects of malnutrition throughout the life cycle

Biological and Social risk factors for under-nutrition

Infancy and early childhood (0-24 months)

– Suboptimal breastfeeding practices– Inadequate complementary foods – Infrequent feeding – Frequent infections

Biological and Social risk factors for under-nutrition

Childhood (2-9 years) – Poor diets

– Poor health care– Poor maternal education

Biological and social risk factors for under-nutrition

Adolescence (10-19 years)– Increased nutritional demands

– Greater iron needs

– Early pregnancies

Biological and social risk factors for under-nutrition

Pregnancy and lactation • Higher nutritional requirements

• Increased micronutrient needs

• Closely-spaced reproductive cycles

Strategies to break the malnutrition cycle

• Solve economic and social problems

• Space pregnancies

• Reduce workloads

• Micronutrient deficiencies

Strategies to break the malnutrition cycle

Infancy through adolescence.– Infancy and early childhood (0–24

months old)

– Childhood (2–9 years old)

– Adolescence (10–19 years old)

Strategies to break the malnutrition cycle

Improve nutrition and health – For all women

– For pregnant women

– For lactating women

Contact points for nutrition action

Contact points– Prenatal

– At delivery

– At immediate post-partum

– Postnatal

Nutrition actions

• During prenatal visits– Counsel on increasing food intake.– Distribute iron/folic acid tablets.– Screen for severe anemia.– Complete 5 antitetanus immunizations for

pregnant women.– Monitor weight gain.– Deworm during 3rd trimester.

Nutrition actions

• During prenatal visits– Encourage family consumption of iodized salt.– Counsel to use treated bed-nets to reduce

malaria infection.– Educate on STIs and HIV and AIDS

transmission and prevention.– Counsel on breastfeeding following WHO

guidelines .

– Counsel on reducing workload

Nutrition actions

• At delivery and immediate post partum period

– Initiate skin-to-skin contact immediately after delivery.

– Counsel to breastfeed within 1 hour of delivery, checking positioning and attachment and following WHO guidelines .

– Give the mother vitamin A.

Nutrition actions

• During post natal visits– Counsel on increasing food intake.– Check iron/folic acid supplementation and continue

supplementation for mother to complete 6 months.– Educate on STIs and HIV and AIDS transmission and

prevention.– Counsel on breastfeeding following WHO guidelines .– Encourage family consumption of iodized salt.– Counsel to use treated bed-nets to reduce malaria

infection.

Nutrition impact indicators

• Birth weight • Mother’s height • Mother’s pre-pregnancy weight: • Body mass index • Mid-upper-arm circumference (MUAC)• Weight gain during pregnancy • Rate of weight gain during pregnancy

• Weight loss during lactation