Prevention of malnutrition

Generally, malnutrition is caused by lack of nutritional components it can be prevented by providing special diet such as fruit, vegetable, milk product, oils, meat and beans etc with sufficient amount in timely. There are primary prevention, secondary prevention and tertiary prevention for malnutrition.

Primary prevention

1.     health promotion

Ø health education to mothers about good nutrition and food hygiene health workers

Ø Distribution of supplements (distribution of iron , folic acid and vitamin a).

Ø Promotion of breastfeeding

Ø Development of low cost weaning foods

Ø Measures to improve family diet

Ø Nutritional education

Ø `Home economics

Ø Family planning and birth spacing

Ø Family environment

2.     specific protection

Ø specific protein diet, eggs, milk, fresh fruit

Ø immunization

Ø fortification of food

Secondary prevention; early diagnosis and adequate treatment

o   Periodic nutrition surveillance .

o   Early diagnosis of any lag of growth .

o   Early diagnosis and treatment of infection including diarrhea.

o   Developing the program for early dehydration of children with diarrhea.

o   Developing supplementary feeding program during epidemics.

o   Regular deworming of school and preschool children.

Tertiary prevention; nutritional rehabilitation

o                        o Nutritional rehabilitation services.

o                        o Hospital treatment .

o                        o      Follow up of cases.

Treatment of malnutrition

·        Treat/prevent hypoglycemia; all severely malnourished children are at risk of developing hypoglycemia which is an important cause of death during the first 2 days of treatment. If the child is losing consciousness , cannot be aroused or has convulsion , give 5 ml/ kg of body weight of sterile 10% of  glucose intravenously(IV), followed by 50 ml of 10% glucose or sucrose by nasogastric (NG) tube.  

·        Treat/prevent hypothermia; if the rectal temperature is below 35.5 ͦc or under arm temperature is below 35 ͦc, the child should be warmed. Either use the “kangaroo care technique” by placing the child on the mother’s bare chest or abdomen and covering both of them, covered with a warmed blanket.

·        Treat/prevent dehydration and Correct electrolyte imbalance; whenever possible, a dehydrated chid with severe malnutrition should be rehydrated orally. IV infusion easily causes over-hydration and heart failure and should be used only when there are definite sign of shock.

·        Treat/prevent infection /deworming; all severely malnourished children should be given their treatment for bacterial infection, measles and viral infections etc.

·        Correct micronutrient deficiencies; different deficiency such as vitamins A, D, E, K and iron, zinc etc should be corrected.

·        Initiate refeeding; Breast feeding, extra diet supplementary foods are provided balanced diet, making food pyramid etc.

·        Facilitate catch up growth.

·        Provide sensory stimulation and emotional support; severely malnourished children have delayed mental and behavioral development, which, if not treated, can become the most serious long term result of malnutrition. Emotional and physical stimulation through playing game and other activities can substantially reduced the risk of permanent mental retardation and emotional impairment.

·        Prepare for follow up after recovery;  Suitable education is provided of their parent for follow up, child should be fulfill their criteria for discharge such as eating well, gaining weight, all infection were treated , able to talk and walk etc.

Iodine deficiency disorder in Nepal

Iodine Deficiency Disorders (IDD) is a major challenge to the health and development of the people in the developing world. In addition to causing goiter, dwarfism and other anomalies, it may result in stillbirth and miscarriage, brain damage and intellectual impairment.

Iodine is required for the synthesis of thyroid hormones that in turn are required for the regulation of cell metabolism through the life cycle.

Thyroid hormones ensure normal growth, especially of the brain, which occurs from fetal life to the end of the third post natal year.

Causes

• Lack of iodine in food

• Iodine –deficient soil resulting in low levels of iodine in locally grown foods and water supplies ause iodine deficiency disorder.

Consequences

• Cretinism

• Goiter

• Impaired cognitive function

• Increased prenatal morbidity and mortality

• Reduced productivity

• Resulting in a lower metabolic rate, growth retardation

• Irreversible mental retardation

• increased school dropout rates

•Delayed socioeconomic development.

Iodized Deficiency Disorders (IDD) in Nepal

Source: National survey and impact study for iodine deficiency disorders (IDD) and availability of iodized salt in Nepal (2007).

In Nepal, % of household level of using adequately iodised salt is increasing day by day .In 1988 consumption rate is 55.2% , in 2005 it became 57.7 % , finally in 2007 it became 77 % in Nepal. This makes also increase in urinary iodine excretion in µg/l (median value) which became 202 in 2007 AD.

Iron deficiency disorder in Nepal

Iron deficiency is the most prevalent nutritional deficiency in the world. It is also major public health problem of Nepal associated with nutritional deficiency.

Globally, it is estimated to 1.25 billion people are affected by iron deficiency. Iron requirement s is highest during infancy, early adolescence, and pregnancy.

In infancy and early childhood, iron is required for rapid growth. In early adolescence, iron requirements are high because of the growth spurt and even higher for girls who experience both a growth spurt and onset of menses. In pregnancy, iron requirement s are driven by tissue synthesis in the mother , the placenta , and the fetus and by blood loss at delivery.

Status in Nepal

The recent NDHS (2006) revealed that anemia levels in children and women are high in Nepal. Nearly one in two (48%) Nepalese children 6-59 months old were reported to be anemic, with 26 % mildly anemic, 22 % moderately anemic, and less than 1 % severely anemic .

Source; NDHS 2006

Causes

• Inadequate intake of iron from daily diets

• Inadequate absorption of dietary iron

• Infestations such as hookworms and malaria

• High requirements of iron particularly during growth and pregnancy

• Blood loss (menstruation, and injury)

• Vitamin A deficiency

Consequences

• Impaired human function at all stages of life

• Impaired work performances, endurance and productivity

• Increased risk of maternal morbidity and mortality

• Increased risk of sickness and death for the baby

•Reduced physical capacity

•Reduced learning capacity etc.

Nepal‘s protocol for iron deficiency disorder

Prevention

• Dose; 60mg iron +400µg folic acid, daily

• Duration; from the beginning of the second trimester in pregnancy (6month)till 45 days postpartum (total 225 days)

Note; if 6 months duration cannot be achieved in pregnancy , continue during the postpartum for 6 months or increase the dose to 120 mg iron in pregnancy.

Treatment

•<2 years; 25mg iron +100-400 µg folic acid daily 3 months

• 2-12 years ; 60 mg iron +400 µg folic acid daily 3 months

• Adolescents and adults, including pregnant women ; 120 mg iron +400 µg folic acid daily 3 months.