Overview of Malnutrition C Classification by benbenzhou


More Info
									Nutrition in Developing Countries (NUTR 555/GH 555)
Jonathan Gorstein, Ph D.

Spring, 2008

Fridays, 9:00-11:50

Room HST T739

Web Site:          https://hserv.washington.edu/courses/course/view.php?id=243


This class will provide an opportunity to examine nutrition problems in developing countries. The class will allow
students to gain a general foundation on the global dimension of malnutrition and micronutrient deficiencies, through
an introduction into the epidemiology of these different problems, their assessment and classification, and a
description of current strategies being implemented to improve nutritional status in developing countries.

There will be an emphasis on the design and evaluation of intervention programs, and will include a description of
current operational research being undertaken to address micronutrient deficiencies, including vitamin A deficiency,
iodine deficiency disorders and iron deficiency anemia. Case studies of national programs and smaller-scale projects
will be used to describe successful interventions, as well as to underscore the challenge of convincing policy makers
of the importance of nutrition given other health problems competing for resources and priority.

Students will be expected to complete all readings. In addition, small groups of students will be required to prepare a
paper and a presentation addressing a specific nutrition problem in the developing world, providing background on
the significance of the problem and identify some plausible interventions or solutions. The paper is expected to be
15-20 pages long, while the presentation will be shared with the class during one of the two final sessions.

Deadline for group formation        18 April
Deadline for topic identification   25 April
Presentations                       30 May and 7 June
The main text to be used for the class will be:

                   West KP, Caballero B, Black RE: Nutrition; in Merson M, Black RE, Mills AJ (eds):
                   International Public Health. Gaithersburg, Aspen Publishers, 2000


         Analyze the relationship between the main determinants of malnutrition, and describe the direct effects of
          food insecurity and infectious disease, as well as underlying factors related to poverty
         Distinguish between the main vitamin and mineral deficiencies that affect populations in developing
         Describe the magnitude of micronutrient deficiencies and their consequences on morbidity, physical growth
          and cognitive development.
         Identify the main intervention strategies employed for the control of micronutrient malnutrition and analyze
          the cost-effectiveness of alternative approaches
         Outline the relationship between food subsidies in industrialized countries, surplus production of cereal
          grains, local agriculture in developing countries and food security
         Compare different approaches to improve the nutritional status and food intake of patients receiving ARV for
          the treatment of HIV/AIDS and consider their sustainability


4 April            Overview of Nutrition/ Global Nutrition Transition (Barbara Bruemmer)

         Basic overview of nutrition – biological basis
         Global patterns of malnutrition – undernutrition and obesity
         Nutrition transitions – changing diets
         Overview of class

                   West KP, Caballero B, Black RE: Nutrition. pp. 187-211

11 April Classification and Vitamin A Deficiency – Etiology, Assessment, Consequences and Interventions
                  (Jonathan Gorstein)

         Assessment and indicators of Vitamin A deficiency – clinical (ocular), functional (night blindness, impaired
          dark adaptation) and biochemical (retinol and RBP)
         Main determinants – dietary inadequacy, infection
         Consequences – xerophthalmia, morbidity and mortality
         Interventions – pharmacological supplementation, fortification
                    Sommer. A. and West, K. Vitamin A Deficiency. Health Survival and Vision. New York:Oxford
                    University Press, 1996. Pp. 1-19 and 27-55.

                    West, K.P., Pokhrel, R.P., Katz, J. et al. The efficacy of vitamin A in reducing child mortality in
                    Nepal. Lancet (1991) 338:67-71.

                    Rice, A., West, K. and Black, R.E. Vitamin A Deficiency. Chapter 4 in: Comparative Quantification
                    of Health Risks. Geneva: World Health Organization. Available on line at:

18 April            Epidemiology of Stunting and Wasting (Paula Brentlinger)

          Global magnitude and distribution of stunting, wasting and underweight
          Description of chronic and acute undernutrition
          Links between socioeconomic status, education, land tenure and armed conflict
          Case study from Latin America

                    de Onis M. Measuring nutritional status in relation to mortality. Bulletin of the World Health
                    Organization (2000) 78:1272-1279.

                    Assefa F, Jabarkhil M, Salama P, Spiegel P. Malnutrition and mortality in Kohistan District,
                    Afghanistan, April 2001. Journal of the American Medical Association (2001);286:2723-2728.

                    Frongillo E, de Onis M, Hanson K. Socioeconomic and demographic factors are associated with
                    worldwide patterns of stunting and wasting of children. Journal of Nutrition (1997) 127:2302-2309.

25 April            Interaction between Nutrition and Infection, with a focus on HIV/AIDS (Grace John-Stewart)

          The link between breastfeeding and HIV Transmission
          Role of nutrition in the progression of HIV/AIDS
          Food and nutrition interventions in the context of HIV/AIDS

2 May               Iodine Deficiency – Etiology, Consequences and Interventions                (Gorstein)

                    Assessment of Micronutrient Deficiencies (Eleanor Brindle)

          Main determinants – ecological factors
          Consequences – thyroid function, cognitive and neurological development, intelligence
          Interventions – universal salt iodization
          Case study – Elimination of iodine deficiency in China
          Assessment and indicators – Clinical signs of severe anemia and Biochemical (Hemaglobin)
                    West KP, Caballero B, Black RE: Nutrition. pp. 216-222
                 UNICEF, WHO and ICCIDD. Assessment of the Iodine Deficiency Disorders and their
                 Elimination. Report of a consultation held in Geneva, from 4-6 May 1999. Geneva, WHO.

                 Hetzel, B.S. S.O.S. for a Million ; The nature and magnitude of the Iodine Deficiency Disorders. in.
                 The Story of Iodine Deficiency, eds. B.S. Hetzel. London, Oxford Publications, 1989. pp. 1-19.

                 Mannar, M.G.V. The Iodization of Salt for the Elimination of Iodine Deficiency Disorders. in. The
                 Story of Iodine Deficiency, eds. B.S. Hetzel. London, Oxford Publications, 1989. pp. 99-118.

9 May            Maternal Nutrition and Breastfeeding (Mary Anne Mercer, Wendy Johnson)

        Improving nutrition through the life cycle.
        Ante-natal measures to improve nutritional well-being and increase nutrient stores
        Importance of breastfeeding in ensuring optimal growth in infancy and early childhood
        International Code of Marketing Breastmilk Substitutes

                 Mora J and Nestel P. Improving prenatal nutrition in developing countries: strategies, prospects,
                 and challenges. American Journal of Clinical Nutrition (2000);71(suppl):1353S-63S.

                 Schack-Nelson, L. and Michaelsen, K.F. Advances in our understanding of he biology of human
                 milk and its effects on the offspring. Journal of Nutrition (2007) 137:503S0510S.

                 INFO Project, Johns Hopkins University. Better Breastfeeding, Healthier Lives. Population Reports
                 (2006) Series L No 14.

                 Ramachandran P. Maternal nutrition -- effect on fetal growth and outcome of pregnancy. Nutrition
                 Reviews (2002) 60 (5 Pt 2):S26-34

16 May           Public-Private Partnerships – Innovations in Global Nutrition Programs (Ellen Piwoz,
                 Katharine Kreis)

        Gates Foundation Nutrition Strategy
        Infant and Young Feeding Project
        Harvest Plus – Biofortification
        Global Alliance for Improved Nutrition (GAIN)
23 May           World Hunger and Global Food Supply          (Britt Yamamoto and iLEAP Fellows)

        Link between agriculture, economics and policy factors determining global food supply
        Agriculture, global grain trade and food security
        Local agricultural systems - viability

                 Oshaug, A., W.B. Eide and A. Eide. 1994. Human Rights. A normative basis for food and
                 nutrition-relevant policies. Food Policy (1996): pp. 491-516.

                 Pinstrup-Andersen, R. Pandya-Lorch, M. Rosegrant. World Food Prospects: Critical Issues for
                 the Early Twenty-First Century. Food Policy Report. Washington: International Food Policy
                 Research Institute, 1999.

                 Diaz-Bonilla, E. and S. Robinson (eds). Getting Ready for the Millennium Round Trade
                 Negotiations. 2020 Vision Focus paper # 1, Washington: International Food Policy Research
                 Institute, 2000.

30 May           Student presentations

6 June           Student presentations / Course evaluation
IV. Evaluation Criteria for Project Presentation

 ELEMENTS           NEEDS IMPROVEMENT                   SATISFACTORY                     VERY GOOD                          EXCEPTIONAL
    Slide design      Spelling /grammatical errors       No errors                       Good visual display of the        Supports challenging of
                      Inconsistent format                Consistent format                information                        concepts
                      No design template                 PowerPoint design template      Main points emphasized by         Graphics and visuals that
                      Font too small                     Legible to audience              format/ graphics                   expand other course
    Content            Not consistent with goals         Consistent with goals and       Clearly focuses on main           Stimulates questions
                        and objectives of the project      objectives of the project        point of presentation             Demonstrates synthesis of
                       Not consistent with the oral      Consistent with the oral        Concise                            concepts
                        presentation                       presentation                    Adds to the oral presentation     Excellent teaching points
    Style              Non-professional slang            Appropriate language and        Presentation is very              Well paced presentation that
                       Appearance inappropriate           presentation style               professional                       emphasizes the focus of the
                        for a professional                Good eye contact                The speaker is able to move        presentation
                        presentation                      Working with the slides and      about and engage the              Demonstrated ability to
                       No eye contact                     notes to demonstrate             audience                           engage the audience to
                       Reading from a script              command of the information      Good eye contact that              stimulate questions and
                                                                                            moves includes the entire          learning
 Overall               Poor quality slide(s) that        Accurate                        Interesting and supports the    Involves the audience in active
                        distract                                                            presentation                    learning
                       Over the time limit
                       Substantially under the time


To top