Talla corta intervenciones

STUNTING:
TACKLING FROM THE VERY BEGINING

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

Auguste Rodin (Paris 12-nov. 1840 - Meudon, 17-nov-1917) escultor francés.
El Pensador (Réplica Macro en Ueno Park Tokyo) Bronce (1880)

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

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

Recomend a strategy
PREVENTIVE & EARLY INTERVENTION
COMMUNITY EMPOWERMENT
IMPROVEMENT HEALTH CARE SERVICES
ASSURE SUSTAINABILITY THROUGH QUALITY
IMPROVEMENT PROCESS

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

1. La seguridad Alimentaria
Causas de Inseguridad alimentaria
Escasez de agua
Degradación de los suelos
Cambio climático
Explosión demográfica
Epidemias
Problemas de gobernanza

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

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

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

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:

Peso/edad en Menores de 5 años -
NIÑAS

Longitud-Talla/edad en Menores de 5 años -
NIÑAS

Perímetro Cefálico en Menores de 5
años - NIÑAS

Peso/edad en Menores de 5 años -
NIÑOS

Longitud - Talla/edad en Menores de 5
años - NIÑOS

STUNTING:

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

GUÍA DE TÉCNICAS ANTROPOMÉTRICAS
LONGITUD

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:

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

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

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

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.

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

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

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

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

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)

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)

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

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

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

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

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

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

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

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

4. Nutrición en
menores de un año

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

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

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

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

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)

Talla corta intervenciones

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