Nutrition Assessment

Nutrition Assessment, Part I 2005 © WFP/Laura Melo WFP/UNHCR Joint Assessment Mission Training Session Objectives After this session, participants should be able to: • Define malnutrition: definition, underlying and immediate causes, types • Recognize some key clinical signs • Describe fundamentals of malnutrition assessment & measurement techniques WFP/UNHCR Joint Assessment Mission Training What is malnutrition? WFP/UNHCR Joint Assessment Mission Training In your own words… what is it? WFP/UNHCR Joint Assessment Mission Training Malnutrition State in which physical function of an individual is impaired to the point where he/she can no longer maintain adequate bodily performance processes (growth, pregnancy, lactation, physical work, resisting/recovering from disease) WFP/UNHCR Joint Assessment Mission Training What causes malnutrition? WFP/UNHCR Joint Assessment Mission Training …part of a vicious cycle Malnutrition High Req of nutrients Poor Appetite Infection Lowered Resistance • Measles • Diarrhea • Pneumonia • Malaria WFP/UNHCR Joint Assessment Mission Training The Intergenerational Transmission of Malnutrition Reduced capacity to care for baby Baby •Low Birth Weight • Small size Elderly • Malnourished Untimely weaning Frequent infections Reduced capacity to care for family Inadequate fetal nutrition Fetal growth faltering Risk of premature birth Infant Adult Man • Malnourished •Impaired stature • Micronutrient deficiencies Adult Woman • Malnourished •Low-pregnancy weight gain • Anemic • High maternal mortality • Impaired growth • Impaired mental development Growth Faltering Delayed entry into workforce Reduced labour producttivity Lower earnings potential Chronic morbidity Child •Stunted • Reduced Mental capacity •Ill-health Adolescent • Micronutrient deficiencies •Stunted Delayed school entry Ill health Delayed puberty Adapted from James et. al. (2000) WFP/UNHCR Joint Assessment Mission Training Types of Malnutrition • Acute Malnutrition: protein energy malnutrition (PEM) wasting result of deficiencies in any or all nutrients (includes micronutrients, as well as macronutrients) -Chronic Malnutrition: Stunting • micronutrient deficiency diseases (MDD’s) result of deficiencies in specific micronutrients (vitamins and/or minerals) WFP/UNHCR Joint Assessment Mission Training pem: kwashiorkor clinical signs? • nutritional oedema • loss of appetite • hair changes • skin lesions, depigmentation • children are usually apathetic, miserable, irritable • moon face WFP/UNHCR Joint Assessment Mission Training Oedema test WFP/UNHCR Joint Assessment Mission Training pem: marasmus severe wasting of fat, muscle clinical signs? • thin „old man‟ face • „baggy pants‟ loose skin around buttocks • no nutritional oedema • prominent ribs • children are usually active, may appear to be alert WFP/UNHCR Joint Assessment Mission Training [photo here] [photo here] children with PEM all suffer growth failure, either: wasting (thinness) acute malnutrition result of recent rapid weight loss or failure to gain weight or: stunting (shortness) chronic malnutrition result of inadequate nutrition over long time; usually not apparent until after 2 years of age or both = Underweight WFP/UNHCR Joint Assessment Mission Training Who is stunted and who is wasted? A B C D A: Healthy B: Stunted C: Wasted D: Stunted & Wasted WFP/UNHCR Joint Assessment Mission Training What are the 3 most common micronutrient deficiency diseases? Micronutrient Iron Vitamin A Iodine Disease Anaemia Xerophthalmia (blindness) Iodine deficiency disorders (goiter) WFP/UNHCR Joint Assessment Mission Training Xerophthalmia (blindness) Vitamin A deficiency WFP/UNHCR Joint Assessment Mission Training Sign of Beauty or Malnutrition? WFP/UNHCR Joint Assessment Mission Training How do we measure malnutrition? WFP/UNHCR Joint Assessment Mission Training Measuring PEM wasting (thinness) acute result of malnu- recent rapid trition weight loss Weight-forHeight (WFH) Height-forAge (HFA) stunting chronic result of (shortness) malnu- inadequate trition nutrition over long time WFP/UNHCR Joint Assessment Mission Training Weight for Height Measure WfH measure is >70 but < 80% (roughly equivalent to -2 to -3 z-scores) of WHO reference norm: “moderate acute malnutrition” or MAM WfH measure is < 70% (roughly equivalent to -3 z-scores) of WHO reference norm “severe acute malnutrition” or SAM MAM + SAM = Global Acute Malnutrition or GAM (includes all who are: < 80% or < - 2 z-scores) WFP/UNHCR Joint Assessment Mission Training mid-upper arm circumference or “MUAC” Normal Moderate malnutrition Severe malnutrition > 12.5 cm < 12.5 cm < 11.0 cm • Useful for rapid screening of large group of children • Screen those to be sent for further WfH measurement • Can be imprecise if the people taking measurements are WFP/UNHCR not well trained Joint Assessment Mission Training