its about nutrition screening and surveillance for health students

1. Nutritional Screening and
Surveillance
July , 2017

2. Nutritional assessment systems
• Nutritional assessment systems can take one of four forms:
surveys, surveillance, screening, or intervention.
• The interpretation of information from dietary, laboratory,
anthropometric and clinical studies.
• The information is used to determine the nutritional status of
individuals or population groups as influenced by the intake
and utilization of nutrients.
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3. Nutrition surveys
—Cross-sectional nutrition surveys can identify and describe
population sub-groups “ at risk” for chronic malnutrition.
—Data collected only once:
• Establish baseline nutritional status of a population
• Identify geographic areas and/or sub-population groups
at risk for chronic malnutrition
• Formulate policies
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4. Nutrition Screening
• A tool for identifying individuals at risk;
• Purpose: to quickly identify individuals who are
malnourished or at nutritional risk and to determine if a
more detailed assessment is warranted
• Used in Emergency situation for selective feeding
programs
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5. Nutrition screening . . . .
• Identify patients who are at risk of:
– developing nutrition related complications
– getting more malnourished during hospital stay
• Involves a comparison of measurements on individuals
with predetermined risk levels or “cut off” points,
• Can be carried out on the whole population, targeted to
a specific sub-population considered to be at risk
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6. An effective Screening process
• Simple and easy to complete
• efficient, quick, reliable, and inexpensive
• Effective in identifying nutritional problems
• poses low risk to the individual being screened,
• has acceptable levels of sensitivity, specificity, and
positive and negative predictive values
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7. Criteria often used for Nutrition Screening
• Height, Weight
• Unintentional change in
weight
• Diet, Food allergies
• Change in appetite
• Nausea/vomiting
• Bowel habits
• Chewing/swallowing
ability
• Diagnosis
• Laboratory data
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8. Malnutrition Universal Screening Tool
—Step 1: Measure height and weight to get a BMI score using
chart provided.
—Step 2: Note percentage of unplanned weight loss (in the past
3-6 months) and score using tables provided.
—Step 3:Establish acute disease effect and score.
—Step 4: Add scores from steps 1, 2 and 3 together to obtain
overall risk of malnutrition.
—Step 5: Use management guidelines and/or local policy to
develop care plan 8

9. Nutrition surveillance
• The characteristic feature of surveillance is the
continuous monitoring of the nutritional status of
selected population groups.
• Surveillance studies can identify the possible causes of
both chronic and acute malnutrition (used to formulate
and initiate intervention measures)
• Monitoring the effect of government policies &
evaluating the efficacy & effectiveness of nutrition
intervention programs. 9

10. Objectives of nutritional surveillance systems
• Identify possible causes of malnutrition and trends in
nutrition status over time
• Describe the nutritional status of the population,
particularly those at risk
• Formulate and initiate intervention measures
• Analyze causes (determinants) and associated factors
• Monitoring and evaluation of nutrition programs
• Prediction of future nutritional problems
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11. Methods of Surveillance
1. Active surveillance:
 Data are collected actively by the group/individuals running
the program and hence more reliable & in accordance with
the need.
Limitation
 However, it takes time and other resources.
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12. Methods of Surveillance . . . .
2. Passive surveillance:
— Data are collected from the on going programs and it
doesn’t incur too much in terms of cost, time and
personnel as compared to active surveillance.
 Limitation:
— Data are less reliable & less relevant to the program
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13. Application of Nutritional Surveillance
1. Timely warning and intervention
 To prevent short term critical reductions in food
consumption
2. Policy and program planning
 To assess policies and programmes
 Enhance nutritional effects of development
policies
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14. Application of Nutritional Surveillance . . . .
3. Management and evaluation
• To rationalize and maximize effectiveness of health and
nutrition programmes
4. Advocacy
• To assess and / or monitor indicators related to
nutritional status
• Basis for directing funds towards particular nutritional
problems
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15. Basic steps in carrying out nutritional surveillance
1. Problem identification, including desired impact of action taken
2. Proposed policies and intervention strategies
3. Potential decisions regarding policies and interventions
4. Information needed to aid in decision-making
5. Data needed to generate information
6. Data collection action
7. Data analysis: the transformation into information
8. Decision(s) made based on information
9. Intervention enacted based on decision
10. Actual impact
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16. Nutrition Surveillance Systems
• Are many approaches to establishing a nutrition
surveillance system.
• Deciding which approach to adopt will depend on the
objectives, resources, environment and capacities
available.
• The following are the main methods used for surveillance:
Large scale national surveys (DHS, MICS)
Repeated small scale surveys
Clinic based monitoring
Sentinel site surveillance
School census data
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17. Indicators used in nutrition monitoring
(Early warning signs(EWS)
• Food crises
_ Food stocks (food balance sheets)
_ Production patterns
_ Market prices
_ Fall In body weights
_ Rainfall pattern
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18. Indicators used in nutrition monitoring . . . .
• Household Food Security
_ Employment levels
_ Market prices
_ Changes in real income and
_ purchasing power
_ Dietary energy supply
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19. Indicators used in nutrition monitoring . . . .
.
• Protein-Energy Malnutrition(PEM)
_ Wt/age, wt/ht ( Child growth)
_ BMI
_ Infectious disease rates
_ Food intake relative to need
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20. Indicators used in nutrition monitoring . . . .
• Caring capacity
_ Maternal education
_ Literacy rates
_ Maternal employment
_ Public expenditure
_ Breast feeding duration and percentage
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21. Indicators used in nutrition monitoring . . . .
• Micronutrient deficiencies
_ Iron deficiency (rates of anemia)
_ Vitamin A Deficiency (Night blindness) in children
_ IDD (goiter, cretinism)
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22. Indicators used in nutrition monitoring . . . .
Malnutrition-infection complex
_ Incidence of diarrhea
_ EPI coverage
_ Availability of clean water
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23. Selection of indicators
– Climate
– Crops
– Livestock
– Water
– Market
– Nutrition
– Health and Vital
Statistics
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• Types of information needed for nutritional surveillance
in largely rural, less technically developed countries

24. Source of information
1. Agricultural Data Food
Balance Sheets
2. Socio-economic Data
3. Food Consumption
Patterns
4. Dietary Surveys
5. Special Studies òn Foods
6. Vital & Health Statistics
7. Anthropometric Studies
8. Clinical Nutritional
Surveys
9. Biochemical Studies
10. Additional Medical
Investigation
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25. Challenges of nutrition surveillance systems
• Sustainability of problem
• Institutional issues
• Lack of linking information to action
• Poor definition of objectives
• A weak participation of different stakeholders
• A weakness in sampling, data collection, analytical capacities
• Problems in addressing the underlying cause
• Absence of an explicit conceptual framework concerning causes
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26. The ‘TRIPLE A’ Cycle
• Surveillance should be followed by intervention action
in a cyclic manner
Assessment
of the nutrition
Situation of
A country or
A region
Action based
on analysis
and available
resources
Analysis of the
cause of nutritional
Problems

27. Surveillance
• Continuous, not one point in
time
• Interpret in light of environmental,
social , and medical factors
• Multiple sources of information,
may include screening
• Informal, yet structured,
monitoring of developmental
achievements
Screening
• Brief assessment
utilizing standardized
instrument to screen
development
– General Screen
• Multi-domain
– Focused Screen
• Single domain
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28. Thank You!
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