005 Assesment for Malnutrition and Anaemia

7/27/2019 005 Assesment for Malnutrition and Anaemia

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INTEGRATED APPROACH

TO UNDER 5:

MALNUTRITION

DR. NOR AZAM KAMARUZAMAN

KK ROMPIN

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UNMILLENIUM

DEVELOPMENTGOAL

To reduce by 2/3

the under 5

mortality

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Major causes of death under five, 2002

ARI

18%

Diarrhoea 15%

Malaria 10%

Measles 5%HIV/

AIDS

4%

Perinatal

23%

Other

25%

Deaths assoc. withmalnutrition

54%

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% OF POPULATION UNDERNOURISHED

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IMCI

Management

of sick

children

Nutrition Immunization Other diseaseprevention

Promotion ofgrowth and

development

Integrated Management

of Childhood Illness (IMCI)

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MALNUTRITION

ACUTE VS. CHRONIC

Acute malnutrition is a medical emergency.

Chronic also called stunting

> begins in infancy> develops in the first 2 years

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Causes of malnutrition

1. Protein-energy malnutrition Severely wasted (marasmus*)

Develop oedema (kwashiorkor**)

Not grow well (stunted)

2. Lack specific vitamins or minerals

Vitamin A deficiencyrisk of death from measles,diarrhoea, blindness

Iron Anaemia

9*Greek = consumption**Ghana = the sickness the baby gets when the new baby comes


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Then Check for Malnutrition and Anaemia

Then Ask About Main Symptoms

Cough or difficult breathing?Diarrhoea?

Fever?Ear problem? .

Check for Danger Signs

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(1) Look for visible severe wasting

Remove all the childs

clothes to check for

wasting.

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A child has visible severe wasting if the childlooks all skin and bones.

The outline of ribs is easily seen.

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Wasting of the muscles of the shoulder and

arms.

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The arms and legs of a severely wasted child

look like sticks.

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The buttocks are wasted and there are skin

folds (baggy pants).

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Face may still looks normal.

Abdomen may be large or distended.

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(2) Check for oedema of both feet

With your thumb, press gently for a few

seconds.

Swelling is present if there is depressionleft in the place where you pressed. This

should be checked on the other foot also.

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Check for swelling (Oedema) of both feet

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(3) Determine weight for age

Weight for age chosen as a screening indicator

for malnutrition.

Weight for height assessments most accurate

but not routinely performed.

Weight for age Z-score can be viewed as a proxy

estimate for weight for height.

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Z-score Weight forage Height forage BMI for age

< - 2 Low weight Stunting Wasting

< - 3 Very lowweight Severestunting Severewasting

Growth indicators

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Beam / Spring types

Stable

Flat

Easy

Taking the Weight

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Taking the Weight

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Alat pengukur

panjang Seca

Infantometer

Pengukurtinggi

Bodymeter

Taking the Height

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xVery low weight

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x Not Very low weight

(low weight for age)

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x

Low weight for age

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Classify nutritional status:

Visible severe wasting or

Oedema of both feet

SEVERE

MALNUTRITION

Very low weight for ageVERY

LOW WEIGHT

Not very low weight for ageand no other sign of

malnutrition

NOT VERY

LOW WEIGHT

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Management

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After 14 days:

Weigh the child and determine if the child is

still VLWA.

Reassess feeding.

If the child is no longer VLWA - praise themother and encourage her to continue.

Follow-up

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Treatment:

If the child is still VLWA counsel the mother about

any feeding problem found.

Ask the mother to return again in 14 days.

Continue to see the child 2 weekly until the child is

feeding well and gaining weight regularly or is no

longer VLWA.

Exception: If you do not think that feeding will

improve, or if the child has lost weight, refer the

child.43

Follow-up


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ANAEMIA

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ANAEMIA

Reduced number of red cells or a reduced

amount of Hb in each RBC.

Causes:

Iron deficiency

Infections

Parasites e.g. Hookworm

Malaria

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Check for palmar pallor

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Why palmar pallor?

Simple

Less traumatic to the child

Less transmissions of eye pathogens

Conjunctiva hyperaemia can obscure anaemia

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Shown in studies to have good performance as

a SINGLE SIGN to detect anaemia clinically.

Sensitivity of severe palmar pallor similar to or

better than conjunctival pallor.

Specificity about the same for both;

OK to be less specific because over-treatment usually not harmful.

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Severe palmar pallor52


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No palmar pallor53


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Some palmar pallor54


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Severe palmar pallor55


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Classification:

Severe palmar pallor SEVERE ANAEMIA

Some palmar pallor ANAEMIA

No palmar pallor NO ANAEMIA

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Give Iron

Give one dose daily for 14 days.

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Follow-up

After 14 days: Give iron. Advise mother to

return in 14 days for more iron.

Continue giving iron every 14 days for 2

months.

If the child has palmar pallor after 2 months,

refer for assessment.

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Give Albendazole

ROUTINE WORM TREATMENT

Give every child Albendazole every 6

months from the age of one year.

Recordthe dose on childs card

.

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Give Albendazole 400mg as a single dose in

clinic if the child:

> 1 years of age, and

has not had a dose in the previous 6

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FEEDING

ASSESSMENT

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Management

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For all children < 2 years:

Feeding assessment and nutrition

counselling as preventive measures.

Low weight for age in these children

often indicates current under-nutrition.

Case management CAN reverse stunting.

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For children > 2 years:

Low WFA generally reflects stunting due

to past under-nutrition.

Feeding assessment and nutrition

counselling only if very low WFA.

Stunting is not reversible.

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Feeding assessment

ASK: How are you feeding your child?

If the infant is receiving any breast milk,ASK:

How many times during the day?

Do you also breastfeed during the night?

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FEEDING

RECOMMENDATION

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Up to 6 months of age

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6 months up to 12 months

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12 months up to 2 years

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2 years and older

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QUESTION?

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005 Assesment for Malnutrition and Anaemia

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