Nutritional Assessment in community.pptx
- 1. Nutritional Assessment in Community By: Assoc.Prof.Dr.ir.Faisal
- 2. The Concept of Community • Community • A grouping of people residing in a specific locality who interact and connect through a definite social structure to fulfill a wide range of daily needs. • Sharing 3 components: a location in space, social interaction, and values.
- 3. Community Nutrition Focuses on People: Individuals who will benefit from community nutrition programs Policy: Course of action chosen by public authorities to address a given problem, accomplished through laws, regulations, and programs Programs: Instruments used to seek behavior changes that improve nutritional status and health.
- 4. Definition Community health Community health is concerned with the health problems among different groups of population and includes both identification of nutritional and health problems and causes and prevention as well as control of diseases. Community nutrition Community nutrition is the study of assessing food and nutrition situation in terms of identification of food and nutrition problems, causative factors and possible solutions both for prevention and cure of the problems as well improving the nutritional status and well-being of individuals in community.
- 5. CONCEPT OF NUTRITION AND ITS RELATION TO HEALTH Nutrition is a scientific discipline which essentially deals with food and the related issues. If the right food is not consumed in right quantities by a person it results in malnutrition. Under nutrition means inadequate intake of right food. ‘Nutritional status' is a condition of ' health of an individual as influenced by the utilization of foods consumed.
- 6. Community Nutrition Assessment Purpose of Community Assessment Determine nutritional problem (s) of the target population. Determine factors that contribute to the nutritional problem(s). Determine what can be done to either solve or reduce the problem(s) via: Uses programs for behavior changes in order to improve nutritional status and health. Interventions/programs/policies, raise awareness, nutrition education Evaluation to see if problem has been ameliorated or solved.
- 7. ASSESSMENT OF NUTRITIONAL STATUS Assessment of Nutritional Status - The interpretation of the nutritional status to determine whether an individual or a community is well nourished or malnourished. NEED FOR ASSESSMENT OF NUTRITIONAL STATUS To discover facts and guiding actions intended to improve nutrition and health. To measure the magnitude and epidemiology of malnutrition. To identify the type of malnutrition. To determine the demographic groups at risk of becoming malnourished.
- 8. Methods of Obtaining Data about the Target Population Survey A systematic study of a cross-section of individuals who represent the target population Relatively inexpensive method of collecting information from a large group or people. Surveillance Continuous assessment (nutritional status) for the purpose of detecting changes in trends or distributions. A questionnaire Screenings direct Can be conducted in clinical and community settings and examples include: Blood Pressure Checks Blood Cholesterol Checks Height and Weight Screenings programs are - Direct Data Collection
- 9. Food Security World Food Summit, 1996 has defined food security as ―When all people at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their daily needs and food preferences for an active and healthy life. Food security has interrelated dimensions namely - availability, accessibility, utilization, stability and vulnerability. Initiatives to Improve Food Security: Ensuring that nutrient composition of foods is retained during the food supply. Preventing and controlling contamination of foods. Promoting hygienic practices throughout the food industry. Promoting a safe and nutritious food supply.
- 10. Food Habits The factors which affect food behaviors are : Physical Factors: access to food, education and knowledge on nutrition, cooking skills Psychological Factors: Positive emotions like happiness induce hunger and increase the intake of food, while negative emotions like stress have complex influence. Biological Factors: Hunger, appetite, flavour, taste affecting the sensory organs directly influence the attitude towards food available. Social Factors: Peer effect, cultural influence, family taboos are considered as important social elements which affect food choices and in turn nutritional status. Economic Factors: Affordability to nutritious food is determined by income and expenses incurred towards food.
- 11. METHODS OF NUTRITIONAL ASSESSMENT • Anthropometry • Biochemical and Laboratory estimation • Biophysical or radiological examination • Clinical examination • Dietary survey • Functional assessment Direct Methods • Vital health statistics • Ecological factors assessment Indirect Methods
- 12. Anthropometry Nutritional anthropometry is the tool concerned with the measurement of the physical dimensions. Common Anthropometric Measurements Body mass as judged by body weight, Linear dimension such as height, Reserves of energy, protein and fat by superficial soft tissues, Muscle development by Mid-Upper Arm Circumference
- 13. Common Anthropometric Measurements 1.Body Weight using weighing scales. 2. Height using Infantometer , Anthropometer or stadiometer. 3.Head Circumference measured using a measuring tape made of fibre glass around the head. 4. Chest Circumference A narrow, flexible and non-stretchable fibre glass tape . 5. Mid – Upper Arm Circumference 6. Subcutaneous Body Fat Measurement by Skin fold callipers.
- 15. Assessment of Adults 1. Body Mass Index (BMI) 2. Waist and Hip Ratio > 1.0 in male and 0.8 in female is obesity. 3. Broka’s Index height -100 = ideal wt
- 16. Merits • Easily carried out without much technical knowledge. • Results can be interpreted easily and immediately. • Inexpensive method. • Faster and not time consuming. • This method can be done even in a remote village where no facilities are available. • It has no side effects. Demerits • The results may not be accurate if the instruments used are not calibrated properly. • This may not be the conclusive method and another method may be needed to support. • Standards need to be revised constantly.
- 17. Biochemical Assessment Biochemical tests which can be conducted on easily accessible body fluids such as blood urine, can help to diagnose disease at the subclinical stage. Laboratory tests for nutritional assessments include: Serum albumin level FOR Iron, Folacin, Vitamin B6 and B12 , Fat soluble vitamin A and D in blood. Blood and urinary glucose levels to determine diabetes. Blood lipid profile which includes cholesterol and triglycerides indicative of heart disease.
- 18. Limitations of Biochemical Assessment Time consuming and expensive. They cannot be applied on whole community ie. Large population To perform tests, experienced and well trained experts are needed. Most tests reveal only current nutritional status.
- 19. Biophysical Assessment Biophysical or radiological tests are uses methods like radiological examinations, physical functional assessment and cytological methods are generally used . In rickets, there is healed concave line of increased density at distal ends of long bones. In infantile scurvy there is ground glass appearance of long bones with loss of density. In beriberi there is increased cardiac size as visible through X-rays. Changes in bone also occur in advanced fluorosis. Endocardiograph, is used for graphing heart sounds. Cytological tests of stained epithelial tissue smears obtained from buccal mucosa indicated changes in nutritional status.
- 20. • The results are more accurate and can be used as a supporting data for other methods. Merits • Instruments required are expensive. • Technical knowledge is a must to interpret data. • It is difficult to transport the equipment to interior parts of remote area or villages. Limitations ·
- 21. Clinical Assessment Clinical examination assesses levels of health of individuals or of population groups in relation to the food they consume. The WHO classification of signs &symptoms associated with malnutrition : Group I: These are often associated with nutritional deficiency. Group II: Signs that require further investigation. Group III: The signs need not necessarily correlate with malnutrition.
- 22. Merits • Relatively inexpensive method. • Field equipments or a laboratory is not required. • Simplest and most practical method. • Gives valuable information to public health workers. Limitations • Proper trained personnel is required. • Non-specific signs may be falsely related to nutritional deficiencies. • Early signs and symptoms are vague and often include weakness, lethargy, irritability etc. • The procedure is non-invasive and co-operation of subjects can be achieved easily.
- 23. Diet Survey Types of Diet Survey Diet survey can be conducted by two types of approaches. Qualitative approach stress on the study about the qualitative approach towards food like the type of foods consumed, opinion and attitude to foods, cultural implications on food and food practices under special physiological conditions like pregnancy, lactation, infancy and old age, Quantitative approach, attempts to quantify the foods and beverage in terms of amount consumed and obtaining the relative nutritive value. Comparison of nutrient intake with RDA provides a measure of adequacy or inadequacy of foods consumed in a particular region. .
- 24. Methods of Diet Survey Food Weighment Method • In this method, food either raw or cooked is actually weighed using an accurate balance • It is ideal to conduct the survey for seven consecutive days to know the true picture of diet. 24- Hour Recall or Oral Questionnaire Method • The dietary data is obtained from the respondent (the person who cooks), through an oral questionnaire, he / she is asked to recapitulate details related to food intake like what was eaten, when was it eaten, how much of food prepared Diet History Method • Step 1: Collection of general information about the subjects‘ food and health status. • Step 2: 24 hour recall method is applied to get information on usual eating habits. • Step 3: Performance of a cross-check on the data given in step 2. • Step 4: 3- day records on the subjects are collected.
- 25. 4. Expenditure Pattern Method • In this method, money spent on food as well as non -food items is assessed by administering a specially designed questionnaire. • The reference period could be either a previous month or week. 5. Food Inventory Method • In this method, the amount of food stuff issued to kitchen as per the records maintained by the warden are taken into consideration, along with the number of individuals partaking the meal. A reference period of one week is desirable. 6. Food Balance Sheets • This method is employed when information regarding the availability of food is needed at macro level -region or country.
- 26. 7. Food Frequency Checklists • The next method of diet survey is the food frequency checklist which ascertains how often an individual eats a specific type of food by interview or checklist method. 8. Chemical analysis/ Duplicate Sample Method • The subjects weigh and record their food at the time of consumption and a duplicate of the diet is weighed and stored and then sent to laboratory for nutrient analysis. 9. Dietary Score • The next method of diet survey to be studied is dietary score, which involves assigning an arbitrary scores to the foods on the basis of its nutrient content. The grading of food is done according to the major sources of a specific nutrient. 10. Food Intake Record or Food Diary Method • This method involves maintenance of dietary records of weighed quantities of food consumed by an individual/family according to the number of days of survey.
- 27. Functional Assessment Functional assessment is used to assess changes in functions co-related with nutrient inadequacy. Submaximal test, using treadmill machine, which asses cardiac efficiency, work performance and respiratory capacity Birth weight of the infant, reflects nutritional status at the population level. Lactation performance- Milk volume, fat and total energy content of milk is reduced in malnourished women. Social performance: The ability of an individual to interact with his or her peers and environment serves an index for functional nutritional status evaluation.
- 28. INDIRECT ASSESSMENT METHODS Vital Statistics The data and analytical methods for describing the vital events occurring in communities such as birth, migration, morbidity and mortality within a population Parameters used under vital statistics are Measures of Morbidity -Morbidity relates to types and varieties of disease one faces or experience affecting the day to day activity. Measures of Mortality a) Infant Mortality Rate (IMR): This is the number of babies dying in the first year of life per 1000 live births. b) Perinatal Mortality Rate (PNMR): This is the number of deaths of infants under one month and stillbirths per 1000 total births. c) Toddler Mortality Rate (TMR): The number of deaths between 1 to 4 years per 1000 toddlers born is known as toddler mortality rate.
- 29. Assessment of Ecological Factors • The commonly associated infections with malnutrition are Bacterial: T.B, whooping cough, diarrhoeal diseases and dysentery,Viral: Measles ,Parasitic: Malaria, Ascariasis ,Protozoal: Amoebiasis Conditioning Infections: • Food attitudes, meal pattern, and local concepts on causation, prevention and cure of diseases all significantly contribute to nutritional status. Cultural Influences: • Demographic factors, Literacy levels, Housing and sanitary amenities, water supply, sewage, occupation, income, expense towards food are the socio- economic factors convenient to consider to assess the nutritional status. Socio-Economic Factors • Information on number of hospitals, number of beds, record keeping, • number of maternal, children and geriatric admissions, diagnosis, methods of treatment, food and nutritional rehabilitation centres available and services provided. Health and Educational Services:
- 30. Vitamin A Deficiency Vitamin A, chemically known as retinol is essential for normal vision, growth, cell differentiation and gene expression, immunity and reproduction . Aetiology Age: Socio Economic Factors Inadequate Dietary Intake: Infections:
- 31. DIAGNOSIS Conjunctival Impression Cytology: A piece of cellulose acetate filter paper is brought in contact with the conjunctiva. Microscopic examination of the cells done. • Dark Adaptation Test: This measures the speed of recovery of vision in dim light. • Breast Milk Retinol: The ratio of vitamin A to fat in breast milk is a better indicator of vitamin A status
- 32. Treatment MDVA (Massive Dose Vitamin A Programme) administers vitamin A . Along with Vitamin A supplementation infection should be controlled by antibiotics, Prevention Dietary Modifications: A daily diet rich in green leafy vegetables and yellow orange fruits and vegetables like mango, papaya and carrot are rich sources of beta-carotene, precursor of vitamin A. Fortification: All fats and vegetable oils are expected to be fortified with vitamin A. Biofortification: Fortification of crops is termed as Biofortification. Supplementation: The National Prophylaxis Programme against Nutritional Blindness implemented since 1970administers a massive dose of 200000 I.U of vitamin A every six months for pre-schoolers. Nutrition Education: Proper education and creating awareness among mothers about the functions and ill effects of vitamin A
- 33. Iodine Deficiency Disorder • High rainfall, snow, flooding and erosion increases the loss of soil iodine by stripping off the fertile top layers of soil. • Goitrogens are substances that interfere with the iodine metabolism at different stages including iodine uptake and conversion of thyroxine to triiodothyronine. Iodine is an element that is required for the normal physical and mental growth. The total body contains 15-23mg of iodine of which 75% is present in thyroid gland. Hence iodine plays an important role in the production of thyroid hormone, triiodothyronine (T3) and thyroxine (T4). Etiology 1.Environmental Factors 2. Goitrogens 3. Intrinsic Factors • Rare congenital defects can inhibit thyroid hormone synthesis causing IDD.
- 34. Signs and symptoms Grade 0 -No visible goitre. Grade 1 -Enlarged thyroid. On swallowing the mass moves upward in the neck. Grade 2 -Visible from minimum distance. Grade 3 -Swelling visible when the neck is in normal position and is consistent with an enlarged thyroid when the neck is palpated. Cretinism: Severe iodine deficiency in intrauterine life causes cretinism. Hypothyroidism: Coarse and dry skin, husky voice and delayed tendon reflexes are characteristics of hypothyroidism. Psychomotor Defects: In children iodine deficiency manifests as low IQ, poor school performance, apathy and poor motor coordination
- 35. Diagnosis The clinical signs and symptoms are effective indicators of IDD. Thyroid Function Tests Prevention Regular consumption of diets with food sources of iodine Food Sources: The iodine contentof foods depends on the iodine content of soil from where it is grown. Sea foods such as marine fish and shell fish are rich source of iodine providing around 144 to 328 mcg/100g.
- 36. COMMON NUTRITIONAL PROBLEMS Macro Minerals Macrominerals are present at levels more than 0.05% in the human body. Calcium, Phosphorus, Magnesium, Sodium and Potassium are macrominerals. Calcium Calcium is a mineral that is required continually at all life stages. In addition to building bones and keeping them solid, calcium enables our blood to clot, our muscles to contract, and our heart to pump. Calcium Deficiency Disease Osteoporosis Osteoporosis is characterized by excessive skeletal fragility and susceptibility to low- trauma fracture among the elderly.
- 37. Ethnicity: European or Asian lineage Age: old age Gender: Women of menopausal age Stature:Smallbone d people Heredity: Family history of osteoporosis · Sedentary lifestyle and Stress: Inadequate and inappropriate diet Alcohol Smoking Caffeine Causative factors
- 38. Manifestations • SIGN NO.1: MUSCLE CRAMPING • SIGN NO.2: DRY SKIN AND BRITTLE NAILS • SIGN NO.3: INCREASED PMS SYMPTOMS • SIGN NO.4: BONE FRACTURES OR BREAKAGE • Loss of height • Fracture from a fall • Stooped posture or compression fracture Diagnosis • Blood calcium level is 8.6 to 10.3 mg/dL. • Serum albumin in blood is 3.4 to 5.4 grams per deciliter. • Parathormone (PTH) is 10- 65 pg/mL or 10-65 ng/L. • Bone mineral density (amount and quality of bone) is measured using Dual energy X-ray Absorptiometer (DEXA).
- 39. Prevention Daily calcium intake prevent calcium deficiency. Dairy foods like milk, curds, butter and cheese are rich sources of calcium. Non-dairy foods like fish, gingelly seeds, ragi, GLV like amaranth, fenugreek and drumstick leaves are also rich sources of calcium. Phytoestrogen genistein in soy has effects similar to oestrogen and protect against osteoporosis Exercise helps to increase lumbar and spinal bone mineral density, Treatment Hormone Replacement Therapies with calcitonin inhibits the reabsorption of calcium into the blood supply and estrogen slows the rate of bone loss, increases the synthesis of parathyroid hormone and Vitamin D synthesis, thus improving intestinal absorption and renal reabsorption of calcium, but does not stimulate new bone formation.
- 40. Vitamin D Deficiency Aetiology • People who does not expose themselves to sunlight are prone for vitamin D deficiency. • Use of sunscreen, living close to Polar Regions, darker skin pigmentation, high levels of air pollution decrease the utilisation of sunlight. • vegans • Gastro Intestinal disturbances and chronic renal disorders • Use of corticosteroids impair the metabolism .
- 41. RICKET S Osteomalacia Softening of bone due to vitamin D deficiency Fractures are uncommon and if occurs healing is delayed. · Skeletal deformity especially kyphosis Ribs, sacrum, lower lumbar vertebrae, pelvis and legs experience dull ache to severe pain. Muscular weakness is a common feature Plasma calcium and phosphorus and urinary calcium levels are often low Osteomalacia shows a dramatic response to treatment with vitamin D.
- 42. Diagnosis • 25-hydroxy vitamin D blood test. • Radiograph of the wrist shows characteristic changes such as blurred and hazy joints and broadened epiphyseal shows classic concave saucer deformity as a result of decalcification of the metaphysis. Prevention • Vitamin D intake is recommended at 400–800 IU/day, or 10–20 micrograms • Inclusion of foods rich in vitamin D and exposure to sunlight Treatment • A daily oral dose of 25-125mcg (1000- 5000 IU/ day) is recommended to treat rickets and osteomalacia. • 1ml of halibut fish oil is recommended for children.
- 43. NUTRITION INTERVENTION PROGRAMMES Ministry of Social Welfare for early childhood care and development remains one of the unique and extensive and community outreach programme. Nutrient Deficiency Control Programmes, run by the Ministry of Health and Family Welfare for children and adult for commonly prevalent nutritional disorders are National Nutritional Anemia Prophylaxis Programme, National Prophylaxis Programme for Prevention of Blindness due To Vitamin A Deficiency, National Iodine Deficiency Disorder Control Programme. Food Supplementation Programmes like Applied Nutrition Programme, Wheat Based Supplementary Nutrition Programme, Special Nutrition Programme, Balwadi Nutrition Programme and Composite Nutrition Programme caters to the need of children, pregnant and nursing mothers. Food Security Programmes namely Public Distribution System(PDS), Antodaya Anna Yojana, Annapurna Scheme, ensures timely availability and accessibility to food. Chief Ministers Noon Meal Programme or Mid-Day Meal Programme and Tamilnadu Integrated Nutrition Project (TINP) are state child welfare programmes pertaining to TamilNadu.
- 45. Summary Through this topic we came to know about community nutrition,relation to health , concept of community nutrition, assessment of nutritional needs, food security, food habits , methods of nutritional assessment, direct and indirect methods ,protein energy malnutrition, causes, symptoms, treatment,various nutritional disorders, strategies and policies to handle them and various nutrition programmes.
- 46. BIBLIOGRAPHY Park . K, Textbook of preventive and social medicine, 26th edition ,2021 ,Banarsidas publishers,pg no 728-752 Arivuchudar Dr. R. , Community nutrition , DIRECTORATE OF DISTANCE EDUCATION ,M.Sc. (Home Science – Nutrition and Dietetics),ALAGAPPA UNIVERSITY PDF, page no- 2-297 Available at : https://alagappauniversity.ac.in/siteAdmin/dde- admin/uploads/3/PG_M.Sc._Home%20Science%20%E2%80%93%20Nutrition%20an d%20Dietetics_36533%20COMMUNITY%20NUTRITION.pdf