The document discusses community-based rehabilitation and strategies to promote health in communities. It was initiated by the WHO following the Declaration of Alma-Ata in 1978 to enhance quality of life for people with disabilities. Key topics covered include handicaps in the community, nutrition and malnutrition, breastfeeding, immunization, and oral rehydration therapy. Community-based rehabilitation aims to meet basic needs and ensure inclusion of people with disabilities. Nutrition is important for health and growth, and malnutrition can result from inadequate intake of calories, proteins or other nutrients. Breastfeeding provides immunity and nutrition to children while immunization protects against infectious diseases. Oral rehydration therapy treats dehydration from diarrhea by replacing lost fluids and electrolytes

1.  https://www.youtube.com/watch?v=ay
mOSJEArgc

2. Health
 A state of complete physical, mental
and social wellbeing, and not merely
the absence of disease or infirmity.
WHO

3. COMMUNITY BASED
REHABILITATION
Initiated by WHO following the Declaration of Alma-Ata
in 1978 in an effort to enhance the quality of life for
people with disabilities and their families; meet their
basic needs; and ensure their inclusion and
participation.

4. “The need for urgent action by all
governments, all health and
development workers, and the world
community to protect and promote the
health of all the people of the world.“
◦ September 1978, The International Conference on Primary
Health Care Alma-Ata, USSR (now Almaty, Kazakhstan). The
Declaration of Alma-Ata, co-sponsored by the World Health
Organization (WHO)

5. Health in the Community
Handicap & the community
Nutrition & Mal-Nutrition
Breast feeding
Immunization
Oral rehydration

6. Handicap & the community
 A circumstance that makes progress
or success difficult. 1/10 both young or
adult in a community.
 Can be with
◦ Speech and Hearing
◦ Moving
◦ Sight
◦ Thinking and behavior

7.  Community: a group of people living in
the same place or having a particular
characteristic in common. Shares the
same problems and beliefs.

8.  Daily activities and handicapped
◦ More time and equipment will be required to teach them.
 Attitudes to handicapped:
◦ They are disadvantaged and different
◦ Don’t given the opportunity to educate work and participate
in different family and community activities.
◦ If they are doing certain things within limited time extra time
should be given along with assistance if required.

9.  https://www.unicef.org/disabilities/inde
x_65316.html
 What should be taught
◦ What caused it
◦ How it could have been prevented
◦ What complications are likely to
developed
◦ How to avoid these complications
◦ How to stop them from getting worse.

10. NUTRITION &
MALNUTRITION

11. Food
groups:
Energy
food
Body
building
foods
Protective
food
Nutrition: The process of providing or obtaining
the food necessary for health and growth.
Balanced diet??????

12. Energy food:
 Foods with fewer calories per gram
such as fruits, vegetables, low fat
soups, lean protein and fiber-
rich foods have a relatively
low energy density.
 Foods with a high fat and/or low water
content such as chocolate, cakes,
biscuits, deep fried foods and snacks,
butter and oils, have a relatively high-
energy density.

13. Body building food:
 Chicken, turkey, beef, pork, fish, eggs
and dairy foods are high in protein, as
are some nuts, seeds, beans, and
lentils. Casein or whey are often used
to supplement the diet with additional
protein.

14. Protective food:
 Foods (as leafy or yellow vegetables,
citrus fruits, meat, milk, eggs) that
contain adequate amounts of vitamins,
minerals, and high quality proteins and
the protect against development of a
deficiency disease (as pellagra,
beriberi, scurvy)

15. At what stage in persons life a
balance diet is required
 A child or growing individual
 Individual involved in active tasks
 Pregnant and nursing mothers
 When a person is under pressure or
under extra load.

16.  Malnutrition is a condition that results
from eating a diet in which one or
more nutrients are either not enough
or are too much such that the diet
causes health problems. It may
involve calories, protein,
carbohydrates, vitamins or mineral

17. Causes of Malnutrition
 Starvation
 Poverty
 Ignorance
 Illness
 Overcrowding
 Depression
 Alcoholism

18. Types of malnutrition
Underweight child
• Causes: child has
something to eat
but not enough
• Signs: thin ,thin
arms,
underweight, loss
of appetite, loss of
energy ,not
playful, smaller
than other
children.
• Treatment:
balanced diet,
immunized ,TB
should be
checked.
Kawashiokor
• Causes: child has
something to eat
but not body
building food
• Signs: red mouth,
cracked lips,
swollen feet and
hands, moon face,
irritable, not
playfull,loss of
appetite.
• Provision of food
other than starch,
immunized ,TB
should be
checked.
Marasmus
• Causes: child has
nothing to eat
complete
starvation.
• Signs: thin,
underweight,
always hungry,
brown sparse hair,
skin and bones
• Provision of
balance food,
immunized ,TB
should be
checked.

20. BREAST FEEDING

21.  Importance of breast feeding:
◦ Cheaper
◦ Hygienic
◦ Provides immunity
◦ Establishes a bond between mother and
child
◦ Helps children growing faster and quicker.

22.  Handicapped children and breast
feeding:
◦ Positioning of child
◦ Child failed to suck and Swallow
 It should be provided on demand of
the child.
 Ill mother can never transmit disease
to the child if follow all preventive
measures.

23.  Severely spastic child cant breast fed
if so either chock or vomit. What to
do?

24. Immunization
 Process by the administration of a
vaccine whereby a person is made
immune or resistant to an infectious
disease. Vaccines stimulate the body's
own immune system to protect the
person against subsequent infection
or disease.

25.  Immunization through oral and
muscular i.e injections and drops.
 A clinic card or a vaccination card
keeps the track record of not only
vaccination but growth as well.

26.  Diseases children are immunized
against are;
◦ TB
◦ Diphtheria
◦ Whooping cough
◦ Tetanus
◦ Measles

27.  https://www.youtube.com/watch?time_
continue=43&v=db1WzT82a_E
 http://www.epi.gov.pk/vaccine-
preventable-diseases/measles/

28.  Booster doses are top ups

29. ORAL REHYDRATION:

30. Diarrhoea
 Diarrhoeal disease is a leading cause of
malnutrition in children under five years old.
 And the second leading cause of death in
children under five years old. It is both
preventable and treatable.
 Each year diarrhoea kills around 525 000
children under five.
 Globally, there are nearly 1.7 billion cases
of childhood diarrhoeal disease every year.
 Diarrhoea is a leading cause of malnutrition
in children under five years old.

31.  A significant proportion of diarrhoeal
disease can be prevented through safe
drinking-water and adequate sanitation and
hygiene.
 Children who are malnourished or have
impaired immunity as well as people living
with HIV are most at risk of life-threatening
diarrhoea.
 Passage of three or more loose or liquid
stools per day (or more frequent passage
than is normal for the individual).

32. clinical types of diarrhoea:
 Acute watery diarrhoea – lasts several
hours or days, and includes cholera;
 Acute bloody diarrhoea – also called
dysentery; and
 Persistent diarrhoea – lasts 14 days or
longer.

33. Degree of Dehydration
 Severe dehydration (at least two of the
following signs):
◦ lethargy/unconsciousness
◦ sunken eyes
◦ unable to drink or drink poorly
◦ skin pinch goes back very slowly ( ≥2 seconds )
 Some dehydration (two or more of the
following signs):
◦ restlessness, irritability
◦ sunken eyes
◦ drinks eagerly, thirsty
 No dehydration (not enough signs to classify
as some or severe dehydration).

34. Causes
 Infection: A symptom of infections caused by a host of bacterial,
viral and parasitic organisms, most of which are spread by faeces-
contaminated water.
 Malnutrition: Underlying malnutrition makes children more
vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes
their malnutrition even worse.
 Source: Water contaminated with human faeces, for example, from
sewage, septic tanks and toilets. Animal faeces , unavailability of
safe water for drinking, cooking and cleaning.
◦ Rotavirus and Escherichia coli
◦ Cryptosporidium
◦ shigella species
 Other causes:
◦ from person-to-person, aggravated by poor personal hygiene.
◦ Food is another major cause of diarrhoea when it is prepared or stored in
unhygienic conditions.
◦ Unsafe domestic water storage and handling.
◦ Fish and seafood from polluted water

35. Prevention and treatment
 Key measures to prevent diarrhoea
include:
◦ access to safe drinking-water;
◦ use of improved sanitation;
◦ hand washing with soap;
◦ exclusive breastfeeding for the first six
months of life;
◦ good personal and food hygiene;
◦ health education about how infections
spread;
◦ rotavirus vaccination.

36.  Rehydration:
◦ with oral rehydration salts (ORS) solution. ORS is a mixture of
clean water, salt and sugar.
◦ absorbed in the small intestine and replaces the water and
electrolytes lost in the faeces.
◦ with IV fluids in case of severe dehydration or shock.
 Zinc supplements: zinc supplements reduce the duration of a
diarrhoea episode by 25% and are associated with a 30%
reduction in stool volume.
 Nutrient-rich foods: the vicious circle of malnutrition and
diarrhoea can be broken by continuing to give nutrient-rich
foods – including breast milk – during an episode, and by
giving a nutritious diet – including exclusive breastfeeding for
the first six months of life – to children when they are well.
 Consulting a health professional , in particular for
management of persistent diarrhoea or when there is blood in
stool or if there are signs of dehydration.

37. How to prepare ORS at home