Recomend a strategy for mu2 2013
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  • 1. Recomend a strategy for tackling stunting U2 PREVENTIVE & EARLY INTERVENTION COMMUNITY EMPOWERMENT IMPROVEMENT HEALTH CARE SERVICES ASSURE SUSTAINABILITY THROUGH QUALITY IMPROVEMENT PROCESS
  • 2. Exposición de la visión
  • 3. Metas y objetivos
  • 4. Today’s Situation  CENSUS OF CHILDREN UNDER TWO: Localization. Age. Nutritional status. Interventions for.  SCREENING OF CHILDREN IN NEEDS (underweight for age + stunted)
  • 5. What we do  Quality improvement  Maintain the screening for children needs  Close the gaps providing nutritional interventions evidence based  Assure that the proved interventions reach the children with needs and keeps them exactly
  • 6. Líneas de intervención CORD CLAMP DELAY: In term neonates led to significant increase in newborn haemoglobin and higher serum ferritin concentration at 6 months of age. In preterm neonates was associated with 39% reduction in need for blood transfusion and a lower risk of complications after birth McDonald SJ, Middleton P. Eff ect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.Cochrane Database Syst Rev 2009; 2: CD004074. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Eff ect of timing of umbilical cord clamping and other strategies to infl uence placental transfusion at preterm birth on maternal and infant outcomes.Cochrane Database Syst Rev 2011; 8: CD00324
  • 7. Líneas de intervención Breast feeding initiation within 24 h of birth is associated with a 44–45% reduction in all-cause and infection-related neonatal mortality, and is thought to mainly operate through the effects of exclusive breastfeeding. Counselling or educational interventions increase exclusive breastfeeding by 43% at day 1, by 30% till 1 month, and by 90% from 1–5 months Debes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC Public Health (submitted). Imdad A, Yakoob MY, Bhutta ZA. Eff ect on breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health 2011; 11 (suppl 3): S24.
  • 8. Líneas de intervención Promotion of dietary diversity and complementary feeding:14 Demographic Health Survey datasets from low-income countries; consumption of a mínimum acceptable diet with dietary diversity reduced the risk of both stunting and under weight whereas mínimum meal frequency was associated with lower risk of underweight only Marriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 2012; 8: 354–70
  • 9. Líneas de intervención Facility-based management of SAM and MAM according to the WHO protocol: Following the WHO protocol, would lead to a 55% reduction in deaths; SAM treated in hospitals or rehabilitation units, shows mortality rates higher specially for oedematous malnutrition (50–60%). WHO recommends inpatient treatment forchildren with complicated SAM, with stabilisation and appro priate treatment of infections, fluid management and dietary therapy WHO. Guideline update: technical aspects of the management of severe acute malnutrition in infants and children. Geneva: World Health Organization, 2013
  • 10. Líneas de intervención Community-based management of SAM / MAM: Facility-based treatment of SAM remains important, community manage ment of SAM continues to grow rapidly globally.This shift in treatment norms from centralised, inpatient care towards community-based models allows more aff ected children to be reached and is cost eff ective Collins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006; 27: S49–82
  • 11. Líneas de intervención Identification of children at risk for undernutrition or undernourished: The need to focus on the crucial period of the 1000 days from conception to a child’s second birthday during which good nutrition and healthy growth have lasting benefi ts throughout life. Almost all stunting takes place in the fi rst 1000 days. The few randomised controlled trials that included nutritional status outcomes show effects on the weight or length of infants Bhutta ZA, Das JK, Rizvi A, et al, The Lancet Nutrition Interventions Review Group and the Maternal and Child Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; published online June 6. http://dx.doi.org/10.1016/S0140-6736(13)60996-4
  • 12. Líneas de intervención Fortified food supplements: Micronutrient powders significantly improved haemoglobin concentration and reduced IDA by 57% and retinol defi ciency by 21%. Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children. BMC Public Health (in press)
  • 13. Líneas de intervención Deworming in children (for soil- transmitted intestinal worms): Significant effects: Reduced anaemia,reduced iron defi ciency anaemia Reduced retinol deficiency. Improved haemoglobin concentrations. Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children. BMC Public Health (in press)
  • 14. Líneas de intervención Zinc therapy for diarrhea: Preventive zinc supplementation in populations at risk of zinc deficiency reduces the risk of morbidity from childhood diarrhoea and acute lower respiratory infections and might increase linear growth and weight gain in infants and young children Yakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Public Health 2011; 11 (suppl 3): S23
  • 15. Líneas de intervención MMN supplementation including iron in children [multivitamins tablets with iron]: MMN supplementation: Significant effects: increased length, increased weight. MMN might be associated with marginal increase in fluid intelligence and academic performance in healthy school children Allen LH, Peerson JM, Olney DK. Provision of multiple rather tan two or fewer micronutrients more eff ectively improves growth and other outcomes in micronutrient-defi cient children and adults J Nutr 2009; 139: 1022–30
  • 16. Líneas de intervención Vitamin A supplementation reduced all- cause mortality by 24% and diarrhoea- related mortality by 28% in children aged 6–59 months Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA.Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age.Cochrane Database Syst Rev 2010; 12: CD008524
  • 17. Metas y objetivos Assure nutritional evaluation of every children under two in the community and in health facilities Assure evidence based nutritional interventions of every children under two, in risk of malnutrition or malnourished in the community and in health facilities Decrease Malnutrition in children under two Assure monthly meetings of QI Team in district and regional levels
  • 18. Recommendations  Apply the census once, and update it annually  Monthly, alternatively to ambulatory visit to health facility, visit the children under two, specially those in risk or undernourished  Refer the children under two in risk of malnutrition or undernourished, for treatment in the health facility  Monitor accomplish of interventions at home  Keep the surveillance health system in function  Monthly, without any exception, do the meeting of QI team at district and regional levels