NUTRITIONAL ASSESSMENT OF COMMUNITY.ppt
- 2. NUTRITIONAL ASSESSMENT AT COMMUNITY AND INDIVIDUAL LEVEL
- 3. INTRODUCTION Nutritional status of community is sum of the Nutritional status of individuals. Nutritional status of individuals is influenced by adequacy of food intake in terms of…… Quantity Quality Physical health of individual.
- 4. Main objectives 1. Map out the magnitude and geographical distribution of nutritional problems. 2. Pinpoint the factors responsible, directly or indirectly, 3. Identify the individuals or population groups at risk or in greatest need of assistance and 4. Suggest appropriate corrective measures with continuing community participation. 5. At individual level also we use all the assessment methods to improve the health of the patient
- 5. Purpose / need…… To know the nutritional status of an individual Develop a health care programme that meets the needs defined by the assessment to community at large Evaluation of the effectiveness of such programme
- 6. Nutritional surveys Random and representative samples Covering all ages All socio-economic status
- 7. Assessment methods 1. Direct method a) Clinical examination b) Anthropometry c) Biochemical evaluation d) Functional assessment 2. Indirect method a) Assessment of dietary intake b) Vital and health statistics c) Ecological studies
- 8. Clinical Examination Aim Assess the level of health of individual or population groups in relation to the food they consume Advantage 1. Is a simple and practical method 2. Rapid and inexpensive 3. Training and supervision by health workers can be taught detect certain crucial clinical signs
- 9. Disadvantage 1. Malnutrition cannot be quantified on the basis of clinical signs 2. Many deficiencies are unaccompanied by physical signs 3. Lack of specificity and subjective nature 4. The value of the method decreases as the nutritional status of the community improves.
- 10. WHO expert committee classified signs into 3 categories 1) not related to nutrition e.g., alopecia, pyorrhoea, 2) that need further investigation e.g., malar pigmentation, corneal vascularisation, 3) known to be of value e.g., bitots spots, calf tenderness, etc….
- 14. NUTRITIONAL ANTHROPOMETRY Defined by Jelliffe “Measurements of the variations of the physical dimensions and the gross composition of the human body at different age levels and degree of nutrition.’’
- 15. Advantages 1. Simple, safe, non-invasive and applicable to large sample size 2. Equipment is inexpensive, portable and durable 3. Relatively unskilled personnel 4. Methods are precise and accurate, provided that standardized techniques are used.
- 16. Disadvantages Relatively insensitive and cannot detect disturbances in nutritional status in short period of time, or identify specific nutritional deficiencies.
- 17. Measurements taken Height Weight Skinfold thickness Mid arm circumference Head and chest circumference Evaluate long term nutritional status
- 18. WEIGHT Simple, most common and fundamental measurement Measured on – beam balance, electronic scale or Salter Stand barefoot with minimal clothing
- 19. HEIGHT Indicator of long term nutritional Measured on Infantometer, Stadiometer ARM CIRCUMFERENCE Indicator of child muscular development Measured at midpoint of upper arm using fiberglass tape
- 20. HEAD AND CHEST CIRCUMFRERENCE Well nourished child crossing over – 9- 12 months SKINFOLDS Sites – triceps, biceps, subscapular and suprailiac Measured using – Harpenden, Holten and Lange calipers.
- 21. LABORATORY AND BIOCHEMICAL ASSESSEMENT 1. LABORATORY TEST a) Hb estimation Most important lab test Useful index of overall nutritional status b) Stool and urine Stools for parasitic infestation, chronic diarrhea and dysentery Urine for albumin and sugar
- 22. 2) BIOCHEMICAL TESTS More precise than clinical examination Nutrient concentration in body fluids eg.,serum retinol and serum iron Metabolites in urine eg., urinary iodine Measurements of enzymes eg., riboflavin deficiency
- 23. Disadvantages Time consuming and expensive Cannot be applied on large scale Reveal only current nutritional status
- 24. FUNCTIONAL INDICATORS Emerging as an important class of diagnostic tools Structural integrity Erythrocyte fragility Vit E, Se Capillary fragility Vit C Tensile strength Cu
- 25. Dietary (Food consumption) survey What people eat and how much they eat, what are their likes and dislikes and dietary beliefs as also dietary practices. USES To ascertain the dietary intake of the vulnerable Improve the diets of people at the household level
- 26. For planning of National Food strategies Gives information on the trends of consumption Helps to know the special preference for food and foods avoided or likes and dislikes
- 27. Limitations Time consuming and expensive Training of workers May not be representative of total population
- 28. Types 1) Qualitative food intake Rapid method Frequency of consumption, daily, weekly, or once a while Food preferred and avoided Dietary beliefs and practices
- 29. 2) Quantitative intake of food Quantitative of food item consumed are recorded and nutrient composition are determined from tables of food consumption
- 30. METHODS 1. Food balance sheets 2. 24 hr recall method 3. Weighing of food 4. Inventory method list 5. Expenditure pattern method 6. Diet history 7. Duplicate samples 8. Recording methods
- 31. Before survey – List all the family members who took part in the meals Ages Physiological status Occupation Economic status
- 32. 1) FOOD BALANCE SHEET Indicates total food available or produced in the country and also buffer stock FAO monitors the food available in each country India produces 211 million tones of food grains every year and buffer stock of 60 million tones
- 33. Gives estimates of food available in the country per person per year or per day No guarantee that this much is consumed by each person Helps national planners for adequacy or inadequacy of available food Per capita availability of cereals in India in 2001 per person day was 390 g and 26 g of pulses
- 34. 2) 24 hr Recall Method Most popular method, Most practical and easy low cost method Assess quantitative dietary intake Ask foods consumed previous day Avoid festivals, fast and feast days
- 35. 3) WEIGHMENT METHOD Weighment of cooked food or raw food More accurate Weighment of raw foods Widely employed in India Weigh all the food that are going to be cooked and eaten as well as that which is wasted and discarded Duration – vary from 1 – 21 days or 7 days – one dietary cycle
- 36. 4)Inventory method list (log book method) Applicable in hostels, orphanages, hospitals. Amount of Foodstuffs issued to incharge are taken into account. calculation stocks at the beginning of week – stock at the end of the week total no of inmates partaking the meals × no of days survey
- 37. 5) EXPENDITURE PATTERN METHOD Money spent on food and non-food items Reference period is fixed and indirectly the amount of food items consumed during the period is arrived If the instructions are correct and family cooperative, this method is good proxy method for weighment method
- 38. 6) Diet history Veg or non-veg Qualitative method 7) DUPLICATE SAMPLES What is consumed in the family same amount of each food items is kept separately per day as a duplicate Samples can be sent to lab for analysis.
- 39. 8) RECORDING METHOD A record of all items of food eaten is maintained by the family or individual for a specified period of time, by actually weighing of the quantities eaten
- 40. 9)VITAL STATISTICS Analysis of morbidity and mortality data Identify groups at high risk and risk to the community Mortality rates - IMR, 2nd year mortality rate, rate of low birth weight babies and life expectancy Morbidity- anemia, xeropthalmia, endemic goiter, diarrhea etc
- 41. 10)ASSESSEMENT OF ECOLOGICAL FACTORS 1 Food balance sheet 2 Socioeconomic factors Family size , occupation, income, customs, cultural practices. 3 Health and educational services Primary health care services, immunization. 4 Conditioning influences Parasitic, bacterial and viral infections Ecological diagnosis
- 42. REFERENCES Text book of community medicine 1st edition by Sunder lal. Text book of preventive and social medicine 20th edition by K Park. WHO monograph series 53 (Part 1).The assessment of nutritional status of community by Jelliffe.