Downloaded 148 times
Uploaded byImran Iqbal
Malnutrition in children 2019
This document discusses malnutrition in children in Pakistan. It provides statistics showing high rates of under-five mortality, infant mortality, and neonatal mortality. The top causes of death in children under 5 are prematurity, pneumonia, and diarrhea. Malnutrition is a major contributing factor to under-five mortality. The document then discusses the high prevalence of malnutrition in Pakistan, including stunting affecting 41% of children, wasting 14%, and underweight affecting 31%. It also notes high rates of micronutrient deficiencies. The main causes of malnutrition are identified as inadequate feeding practices, repeated infections, and poverty. The document concludes with descriptions of different types of malnutrition and their clinical management.
More Related Content
Similar to Malnutrition in children 2019
Malnutrition in children 2019
- 1. Malnutrition in Children of Pakistan Prof.Imran Iqbal Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Multan, Pakistan
- 2. In the nameof Allah, the most gracious, the most merciful.
- 4. MALNUTRITION IS A PATHALOGICALSTATE RESULTING FROM DEFICIENCY OF ONE OR MORE ESSENTIAL NUTRIENTS.
- 5. Nutritional status Nutritional statusis determined by balance of Nutritional Intake and Nutritional Expenditure NUTRITIONAL INTAKE NUTRITIONAL EXPENDITURE NUTRITIONAL STATUS
- 6. Clinical Types ofMalnutrition Previous terminology • Marasmus • Kwashiorkor • Marasmic Kwashiorkor New terminology • Low weight • Stunting • Wasting • MAM (moderate acute malnutrition) • SAM (severe acute malnutrition)
- 7. Clinical types ofMalnutrition • Underweight child – Weight for age • Wasting – Weight for Height • Stunting – Ht for age • Micronutrient deficiency
- 11. Malnourished – Weightfor age • Moderate - 2 SD to - 3 SD or 60 - 80% • Severe < - 3SD or < 60 % Wt for age
- 12. Stunting – Heightfor age • Mild - 1 SD to - 2 SD or 90 – 95 % • Moderate - 2 SD to -3 SD or 85 - 90% • Severe < -3 SD or < 85 % Ht for age
- 13. Wasting - Weightfor Height • Mild - 1 SD to - 2 SD or 80 – 90 % • Moderate - 2 SD to -3 SD or 70 - 80% • Severe < -3 SD or < 70 % Wt for Ht
- 14.
- 16. Severe Acute Malnutrition(SAM) (Presence of any of the following) • Weight for Height < -3 SD (< 70 %) • MUAC < 11.5 cm • Edema
- 17. What is thecondition of Children in Pakistan Prof Imran Iqbal
- 18. Statistics for Pakistan •Under-five mortality rate (2012) = 85 • Infant mortality rate = 62 • Neonatal mortality rate = 49 per 1,000 live births
- 19.
- 20.
- 21. Why are thechildren dying ?
- 22. Pneumonia - 11% Diarrhea- 14% Other - 11% Injuries - 2%
- 23. In Pakistan 61%of deaths occur during neonatal period. Main causes being Infections – 31% Preterm – 27% Asphyxia – 24% Congenital – 10% Diarrhea – 3% Tetanus – 2% Other – 4%
- 24. Causes of Deathin children < 5 in 2012 • Prematurity 20 % • Pneumonia 19 % • Others 18 % • Asphyxia 13 % • Diarrhoea 11 % • Neonatal sepsis 9 % • Cong anomalies 5 % • Injuries 5 % • Measles 1 %
- 25. Contribution of undernutritionto under-five mortality by cause, 2000 0% 20% 40% 60% 80% 100% Diarrhoea Malaria Pneumonia Measles All-cause Proportion of deaths associated with undernutrition All Deaths Sources: • For cause-specific mortality: EIP/WHO. • For deaths associated with malnutrition: Caulfield LE, Black RE. Malnutrition and the global burden of disease: underweight and cause-specific mortality.
- 27. RISK OF DEATHIN A CHILD IN RELATION TO NUTRITIONAL STATUS • NORMAL = 1 • MILD MALNUTRITION = 2 • MODERATE MALNUTRITION = 4 • SEVERE MALNUTRITION = 8 0 1 2 3 4 5 6 7 8 Norm Mild Mod Severe Normal Mild Moderate Severe
- 28. Health Indicators inPakistan
- 29. • Low birthwt =25 – 33 % • Exclusive Mother Feeding = 25 % • Mod and Severe Malnutrition = 40 %
- 30. How Many childrenare Malnourished ?
- 31. PAKISTAN - NNS2011
- 32. Malnutrition in Pakistan Stunted 41% Wasted 14% Underweight 31%
- 33. Anemia in children= 62%
- 34. Iron deficiency inchildren = 44%
- 35. Vitamin A deficiency= 53 %
- 36. Vitamin A deficiency= 53 % KeratomalaciaBitot spot
- 37.
- 38. Vitamin D deficiency= 67%
- 39.
- 40.
- 41.
- 42. What are the causesof Malnutrition in children ?
- 43. Breast Feeding =63 %
- 44.
- 45.
- 46. Current ARI =22 %
- 47. Diarrhea in last2 weeks = 34%
- 48. Nutritional Status and MotherEducation
- 49.
- 50. Micronutrient Deficiency inMothers • Anemia = 51 % • Iron Deficiency = 37 % • Vitamin A deficiency = 44 % • Vitamin D deficiency = 68 % • Zinc deficiency = 47 %
- 51.
- 52. Causes of Malnutrition •Primary causes – inadequate feeding • Secondary causes -- diseases Repeated infections Genetic causes - syndromes Chronic diseases – CLD, CKD Celiac disease Diabetes mellitus Metabolic disorders
- 53. Determinants of Malnutrition •Poor maternal health • Lactation failure • Restriction of food during illness • Unequal distribution of food • Unhealthy feeding habits • Repeated infections • Overcrowding • Unhygienic environment • Poor literacy rate • Poverty (30% of population lives below poverty line)
- 54. How malnutrition occoursin the community
- 55. Nutrition Causal Framework Adaptedfrom Unicef Outcome Under-Nutrition Immediate Causes Inadequate Dietary Intake Disease Underlying Health / Nutrition Causes Inadequate Care for Mothers and Children Insufficient Access to Food Lack of health services unhealthy environment
- 56. The Impact ofMalnutrition Malnutrition-Infection Cycle Inadequate dietary intake Weight loss Growth faltering Lowered immunity Mucosal damage Disease Appetite loss Nutrient loss Mal-absorption Altered metabolism
- 57. MALNUTRITION and INFECTION -Immunoglobulins ↓ - T-CELL FUNCTION ↓ - POLYs FUNCTION ↓ - Complement levels ↓ - Transferrin levels ↓ - Macrophage function ↓ - Intestinal commensel flora-altered ↓ INFECTIONS
- 58. INDEQUATE DIET /DISEASECYCLE INFECTIONS LOW IMMUNITY MALNUTRITION INADEQUATE DIETARY INTAKE
- 59. Main cause ofMalnutrition LOW INTAKE (underfeeding) + RECURRENT INFECTIONS
- 60.
- 61. Reductive adaptation • Smallersize • Thinness • Smaller organs • Reduced immunity
- 62. Physiological Effects of Malnutrition •Cardiovascular • GI • GU • Immune • Liver • Endocrine • Cellular function • Circulatory/Temperature regulation • Skin, muscles, glands
- 63. Cardiovascular System Effects: • ↓cardiac output and stroke volume • ↓ blood pressure • ↓ renal perfusion Concerns: • An increase in blood volume can produce acute heart failure • A further decrease in blood volume will compromise tissue perfusion Management: • If dehydrated, give ReSoMal or F-75 • Do not give IV fluids unless child is in shock • If blood transfusion is necessary, restrict to 10 ml/kg and give a diuretic
- 64. Gastrointestinal System Effects: • ↓production of gastric acid • ↓ intestinal motility • ↓ production of digestive enzymes secondary to pancreatic atrophy • ↓ secretion of digestive enzymes secondary to small intestinal mucosa atrophy • ↓ absorption of nutrients when large amounts of food ingested Management: • Give small, frequent feeds
- 65. Genitourinary System Effects: • ↓glomerular filtration • ↓ ability for renal excretion of acid or water load • ↓ sodium excretion • ↓ urinary phosphate output • ↑ incidence of UTI Concerns: • A large protein load may not be well tolerated by the kidneys • Further protein deprivation will lead to continued tissue breakdown Management: • Caloric intake should be targeted at 80-100 kcal/kg/day • Restrict sodium intake
- 66. Immune System Effects: • ↓cell-mediated immunity • ↓ secretion of IgA • ↓ levels of complement components • ↓ efficacy of phagocytes Concerns: • Typical signs of infection (↑ WBC count, fever) are often absent • Hypoglycemia and hypothermia are signs of severe infection Management: • Treat all inpatients with broad-spectrum antibiotics • Protect against infection
- 67. Liver Effects: • ↓ synthesisof all proteins • ↓ gluconeogenesis Concerns: • Risk of hypoglycemia is high, particularly with infection Management: • Protein intake should be 1-2 g/kg/day • Ensure sufficient carbohydrate intake • Do not give iron supplements
- 68. Endocrine System Effects: • ↓insulin levels, leading to glucose intolerance • ↓ levels of IGF-1 • ↑ levels of growth hormone • ↑ levels of cortisol Management: • Do not give steroids
- 69. Cellular Function Effects: • ↓synthesis of proteins • ↓ activity of sodium pump • ↑ permeability of cell membranes Concerns: • This leads to an increase in intracellular sodium and a decrease in intracellular potassium and magnesium Management: • Restrict sodium intake • Give potassium and magnesium to all children
- 70. Circulatory System and TemperatureRegulation Effects: • Heat generation as well as heat loss are impaired • ↓ energy expenditure and basic metabolic rate Concerns: • Child becomes hypothermic in cold environment and hyperthermic in hot environment Management: • Keep child dry and warm • Room temperature should be at 25-30 °C • If child has fever, cool with tepid water
- 71. Skin, Muscles, Glands Effects: •Skin and subcutaneous fat are atrophied • Atrophy of sweat, tear, and salivary glands • Respiratory muscles are fatigued easily Concerns: • Typical signs of dehydration (sunken eyes, abdominal skin pinch) are unreliable due to the loss of subcutaneous fat. • No of stools, vomits, thirst, pulse, urine output can be used Management: • Rehydrate with ReSoMal when necessary
- 72.
- 73. Management of Malnutrition •Adequate calories • Micronutrients • Growth monitoring • Follow-up
- 74. PRINCIPLES of Management Assessment -Severity and type of malnutrition - Any complications - Associated deficiencies - Epidemiological factors Hospital treatment - Severe and complicated malnutrition Home treatment - Severe malnutrition--uncomplicated cases - Moderate malnutrition
- 75. Community-based Management ofAcute Malnutrition (CMAM) • Inpatient care or Stabilization Centre (SC) to treat severe acute malnutrition with • Medical complications • Anorexia • Severe edema • Severe wasting and edema
- 76. Time frame forthe management of a child with severe malnutrition Stabilization Rehabilitation Days 1-2 Days 3-7 Weeks 2-6 1. Hypoglycaemia 2. Hypothermia 3. Dehydration 4. Electrolytes 5. Infection 6. Micronutrients no iron with iron 7. Initiate feeding 8. Catch up growth 9. Sensory stimulation 10. Prepare for follow-up Source: WHO
- 77. ReSoMal (Rehydration Solution forMalnutrition) • Sodium Chloride 1.75 gm • Sodium Citrate 1.45 gm • Potassium Chloride 2.54 gm • Potassium Citrate 0.65 gm • Magnesium Chloride 0.61 gm • Zinc Acetate 0.0656 gm • Copper Sulphate 0.0112 gm • Glucose 10 gm • Sucrose 25 gm
- 78. Recipe for F-75and F-100 Alternatives Ingredient Amount for F-75 Amount for F-100 Dried whole Milk Dried whole milk sugar vegetable oil Mineral mix* water to make 1000ml 35 g 100 g 20 g 20 ml 1000 ml** 110 g 50 g 30 g 20 ml 1000 ml** Fresh cow’s Milk Fresh Cow’s milk, or full cream (whole) long life milk sugar vegetable oil Mineral mix* water to make 1000 ml 300 ml 100 g 20 g 20 ml 1000 ml** 880 ml 75 g 20 g 20 ml 1000 ml**
- 79. RECOVERY • WEIGHT GAINshould be 10 gm / kg / day • Child is considered to be recovered when 90 % of expected weight for length has been achieved
- 81. Hifsa’s journey frommalnutrition to health
- 82.
- 83.
- 84. Main cause ofMalnutrition LOW INTAKE (underfeeding) + RECURRENT INFECTIONS
- 85. FEEDING PRACTICES LEADING TOMALNUTRITION 1. BOTTLE FEEDING - DILUTED MILK - UNHYGENIC PREPARATION 2. DELAYED WEANING - INADEQUATE CALORIES - IRON DEFICIENCY 3. FOOD RESTRICTIONS - IN A NORMAL CHILD - DURING DISEASE
- 86. PREVENTION OF MALNUTRITION 1. Nutritioneducation 2. Adequate feeding and diet 3. Growth monitoring 4. Protection against infections
- 87. Nutrition education • Healthcare providers • Parents • Caregivers
- 88. Adequate feeding anddiet • Breast feeding for 2 Yrs. • Weaning at 4 months • Adequate diet • Feeding during illness
- 89. During an illness Preventmalnutrition by: • Frequent small feeds • Extra food after the child recovers
- 91. Strategies to prevent Infections •Vaccination • Handwashing • Avoid overcrowding • Unpolluted air • Breastfeeding • Nutrition • Micronutrients • Safe water • Clean food
- 93. 31% of allchild deaths can be prevented through nutrition related interventions Intervention Deaths (x 103) % deaths Oral Rehydration Therapy* 1477 15 Breastfeeding 1301 13 Zinc (prophylaxis & treatment*) 810 9 Insecticide-treated bednets 691 7 Complementary feeding 587 6 Antibiotics for sepsis* 583 6 Antibiotics for pneumonia* 577 6 Clean delivery 411 4 Vitamin A 233 3
- 94. What can Ido ? Give at least 1 - 5 Preventive Health care message to Parents of each child whom I see in my OPD, Ward, Clinic
- 95.
- 96.