Talla corta intervenciones

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Intervenciones con el máximo nivel de evidencia disponible, para atacar la desnutrición crónica

Intervenciones con el máximo nivel de evidencia disponible, para atacar la desnutrición crónica

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  • 1. STUNTING: TACKLING FROM THE VERY BEGINING
  • 2. TALLA CORTA/STUNTING: Intervenciones Inteventions http://youtu.be/1e8xgF0JtVg http://youtu.be/YwEhKu3T51Q http://www.youtube.com/watch?feature=player_detailpage&v=cVOjFllP3z8 http://www.youtube.com/watch?feature=player_profilepage&v=aO7yZjK8Dus http://www.youtube.com/watch?v=tZBJTYy2SIk
  • 3. Auguste Rodin (Paris 12-nov. 1840 - Meudon, 17-nov-1917) escultor francés. El Pensador (Réplica Macro en Ueno Park Tokyo) Bronce (1880)
  • 4. Estado nutricional de los niños y las niñas menores de cinco años del Ecuador Fuente: INEC - ECV 2005-2006 Quinta Ronda Realizado por M. A. Hinojosa-Sandoval. Junio 2007 TENDENCIA DEL DIFERENCIAL Z CON LOS DATOS DE REFERENCIA INTERNACIONAL 1,15 0,9 0,74 0,55 1,19 1,19 0,83 0,9 0,4 0,5 0,6 0,7 0,8 0,9 1 1,1 1,2 1,3 1998 1999 2000 2007 Zscore T/E P/E
  • 5. Evaluación del estado nutricional de los niños y las niñas Fuente: INEC - ECV 2005-2006 Quinta Ronda Realizado por M. A. Hinojosa-Sandoval. Junio 2007 Prevalencia de Desnutrición por edad Desnutrición crónica (T/E) Desnutrición global (P/E) Desnutrición aguda (P/T) 0 Meses 3,1 3,1 3,9 0-5 Meses 3,4 1,6 1,5 6-11 Meses 7,9 5 1,8 0-11 Meses 5,9 3,5 1,7 12-23 Meses 24,8 13,7 4,2 24-59 Meses 19,8 8,6 1 0-59 Meses 18,1 8,6 1,7 0 5 10 15 20 25 30 0 Meses 0-5 Meses 6-11 Meses 0-11 Meses 12-23 Meses 24-59 Meses %DesnutricinGlobalycronica TENDENCIA DE LA DESNUTRICION DURANTE LA NIÑEZ
  • 6. Recomend a strategy PREVENTIVE & EARLY INTERVENTION COMMUNITY EMPOWERMENT IMPROVEMENT HEALTH CARE SERVICES ASSURE SUSTAINABILITY THROUGH QUALITY IMPROVEMENT PROCESS
  • 7. 1. La seguridad Alimentaria
  • 8. 1. La seguridad Alimentaria La seguridad alimentaria existe cuando todas las personas (de una familia) tienen acceso en todo momento (ya sea físico, social, y económico) a alimentos suficientes, seguros y nutritivos para cubrir sus necesidades nutricionales y las preferencias culturales para una vida sana y activa
  • 9. 1. La seguridad Alimentaria Causas de Inseguridad alimentaria Escasez de agua Degradación de los suelos Cambio climático Explosión demográfica Epidemias Problemas de gobernanza
  • 10. 2. Consejos Prácticos Evaluar los tres componentes del estado nutricional: ALIMENTACIÓN, SALUD Y AMBIENTE En todo proceso de atención individual o colectiva. En todos los controles de salud del niño
  • 11. 3. Programas Nutricionales CONTROL PRENATALEMBARAZO GESTACIÓN PLAN DE PARTO. MAPA PARLANTE. REGISTRO MENSUAL DE ACTIVIDADES REPORTE MENSUAL DE ACTIVIDADES A NIVEL DISTRITAL EVALUACIÓN NUTRICIONAL EN LOS 1.000 DÍAS NORMAL CUIDADOS Y CONTROL DE SEGUIMIENTO REFERENCIAA HOSPITAL PARA ATENCIÓNDE SU RIESGO Promoción, Prevención, Consejería.Medicación DIAGNÓSTICO + TRATAMIENTO NUTRICIONAL + SEGUIMIENTO NO NORMAL 0 Días 280 DíasPARTO - NACIMIENTO 645 días 1.000 días
  • 12. Exposición de la visión
  • 13. Metas y objetivos
  • 14. Impact on population estimates of child malnutrition will depend on age, sex, anthropometric indicator considered, and population-specific anthropometric characteristics. Thus, it is impossible to construct an algorithm that can derive prevalence estimates based on the WHO standards directly from estimates obtained from the NCHS/WHO reference. A noteworthy effect is that estimates of stunting will be higher throughout childhood when assessed using the new WHO standards compared to the previous international reference. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 15. The construction of the weight-for-length (45 to 110 cm) and weight-for-height (65 to 120 cm) standards followed a procedure similar to that applied to constructing the length/height-for-age standards (see section 3.1). To fit a single model, 0.7 cm was added to the cross-sectional height values. This was the average difference found between length and height in 1625 children aged 18 to 30 months measured for both length and height. After the model was fitted, the weight- for-length centile curves in the length interval 65.7 to 120.7 cm were shifted back by 0.7 cm to derive the weight for- height standards corresponding to the height range 65 cm to 120 cm STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 16. Peso/edad en Menores de 5 años - NIÑAS
  • 17. Longitud-Talla/edad en Menores de 5 años - NIÑAS
  • 18. Perímetro Cefálico en Menores de 5 años - NIÑAS
  • 19. Peso/edad en Menores de 5 años - NIÑOS
  • 20. Longitud - Talla/edad en Menores de 5 años - NIÑOS
  • 21. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 22. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 23. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 24. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 25. STUNTING: TACKLING FROM THE VERY BEGINING Body mass index (BMI) is the ratio weight (in kg)/recumbent length or standing height (in m2). To address the difference between length and height, the approach used for constructing the BMI-for-age standards was different from that described for length/height-for-age. Because BMI is a ratio with squared length or height in the denominator, adding 0.7 cm to the height values and back-transforming them after fitting was not feasible. The solution adopted was to construct the standards for the younger and the older children separately based on two sets of data with an overlapping range of ages below and above 24 months. To construct the BMI-for-age standard based on length (birth to 2 years), the longitudinal sample's length data and the cross-sectional sample's height data (18 to 30 months) were combined after adding 0.7 cm to the height values
  • 26. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 27. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 28. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 29. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 30. GUÍA DE TÉCNICAS ANTROPOMÉTRICAS LONGITUD
  • 31. Aplicar la técnica correcta
  • 32. PAIDOMETRE = ROLLAMETRE
  • 33. ANTROPOMETRÍA Buen registro
  • 34. The Child Growth Standards provide a technically robust tool for assessing the well-being of infants and young children. They were derived from children who were raised in environments that minimized constraints to growth such as poor diets and infection. In addition, their mothers followed healthy practices such as breastfeeding their children and not smoking during and after pregnancy, THAT IS WHY IT provides a solid instrument for helping to meet the health and nutritional needs of the world’s children. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 35. STUNTING: SOLUCIONANDO DESDE EL COMIENZO
  • 36. Focusing on linear growth and relative weight gain during early life – a winner ticket for human capital development and future adult health April 5, 2013 by challengedkidsinternational
  • 37. 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
  • 38. Exposición de la visión
  • 39. Metas y objetivos
  • 40. 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
  • 41. 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.
  • 42. 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
  • 43. 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
  • 44. 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
  • 45. 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
  • 46. 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)
  • 47. 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)
  • 48. 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
  • 49. 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
  • 50. Líneas de intervención MMN supplementation: Working in technical collaboration with International food technology and nutritional scientists, Medicine Mondiale is developing an improved range of a high quality, low cost, predigested protein formulations which may be used to combat acute diarrhea and protein energy malnutrition on a global scale, which are readily absorbed by sick children. Proteinforte 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
  • 51. 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
  • 52. 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
  • 53. 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
  • 54. 4. Nutrición en menores de un año INICIAR ALIMENTACION “Toda cosa nueva, toda la semana” Mas sólidos que líquidos Hasta cinco comidas al día Aplastado no licuado No mezclar muchos sabores Que juegue con la comida NUNCA SENO ENSEGUIDA DE COMER Primero Seno luego comida o en horarios diferentes
  • 55. 4. Nutrición en menores de un año INICIAR ALIMENTACION CEREALES: Arroz (de inicio) Cebada, quinua, avena, sémola, maicena, trigo FRUTAS: Todas excepto cítricos, tomates y bayas Se recomienda Manzana y guineo SOPAS: (Purés) Tubérculos, raíces y legumbres. Carne
  • 56. 4. Nutrición en menores de un año
  • 57. THE MENACE
  • 58. Aportes de la clase •Aclaraciones al tema •No provocar distracción con el formato •Enfatizar las medidas para mejorarla nutrición •Láminas menos cargadas y con más gráficos •Controlar el tiempo •Uso de audiovisuales •Más tiempo para debate
  • 59. 5. Recomendaciones al manejo de la clase •Aclaraciones al tema •No provocar distracción con el formato •Enfatizar las medidas para mejorarla nutrición •Láminas menos cargadas y con más gráficos •Controlar el tiempo •Uso de audiovisuales •Más tiempo para debate
  • 60. 5. Recomendaciones al tema •Es una nueva perspectiva de un problema de salud pública, que hay que tomarla como una oportunidad y, educar a la población diferenciadamente, sobre la base de la seguridad alimentaria con plan de alimentación desde el inicio, a poblaciones de riesgo, con calidad, participación social y con visión positiva de futuro
  • 61. 5. Recomendaciones al tema •Teniendo como aspectos claves, la producción agrícola, el mejoramiento de la productividad (PIB)y las intervenciones en salud tales como lactancia materna, programas de apoyo nutricional, conocimiento y aplicación de signos de peligro, especialmente en la comunidad, promoviendo la calidad en la alimentación asegurando el correcto etiquetado
  • 62. 6. Porcentajes de calificación Explicación: Examen 40% (15 On Line + 25 Presencial Actividad en clase 60% (20 Artículo de investigación + 40 de asistencia y tareas + participación)