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Good afternoon. NUTRITIONAL ASSESSMENT AT COMMUNITY AND INDIVIDUAL LEVEL. 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

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  1. Good afternoon

  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 • Map out the magnitude and geographical distribution of nutritional problems. • Pinpoint the factors responsible, directly or indirectly, • Identify the individuals or population groups at risk or in greatest need of assistance and • Suggest appropriate corrective measures with continuing community participation. • 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 • Direct method • Clinical examination • Anthropometry • Biochemical evaluation • Functional assessment • Indirect method • Assessment of dietary intake • Vital and health statistics • Ecological studies

  8. Clinical Examination • Aim • Assess the level of health of individual or population groups in relation to the food they consume • Advantage • Is a simple and practical method • Rapid and inexpensive • Training and supervision by health workers can be taught detect certain crucial clinical signs

  9. Disadvantage • Malnutrition cannot be quantified on the basis of clinical signs • Many deficiencies are unaccompanied by physical signs • Lack of specificity and subjective nature • The value of the method decreases as the nutritional status of the community improves.

  10. WHO expert committee classified signs into 3 categories • not related to nutrition e.g., alopecia, pyorrhoea, • that need further investigation e.g., malar pigmentation, corneal vascularisation, • known to be of value e.g., bitots spots, calf tenderness, etc….

  11. 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.’’

  12. Advantages • Simple, safe, non-invasive and applicable to large sample size • Equipment is inexpensive, portable and durable • Relatively unskilled personnel • Methods are precise and accurate, provided that standardized techniques are used.

  13. Disadvantages • Relatively insensitive and cannot detect disturbances in nutritional status in short period of time, or identify specific nutritional deficiencies.

  14. Measurements taken • Height • Weight • Skinfold thickness • Mid arm circumference • Head and chest circumference • Evaluate long term nutritional status

  15. WEIGHT • Simple, most common and fundamental measurement • Measured on – beam balance, electronic scale or Salter • Stand barefoot with minimal clothing

  16. 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

  17. 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.

  18. LABORATORY AND BIOCHEMICAL ASSESSEMENT • LABORATORY TEST • Hb estimation • Most important lab test • Useful index of overall nutritional status • Stool and urine • Stools for parasitic infestation, chronic diarrhea and dysentery • Urine for albumin and sugar

  19. 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

  20. Disadvantages • Time consuming and expensive • Cannot be applied on large scale • Reveal only current nutritional status

  21. FUNCTIONAL INDICATORS • Emerging as an important class of diagnostic tools • Structural integrity Erythrocyte fragility Vit E, Se Capillary fragility Vit C Tensile strength Cu

  22. 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

  23. 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

  24. Limitations • Time consuming and expensive • Training of workers • May not be representative of total population

  25. Types • 1) Qualitative food intake • Rapid method • Frequency of consumption, daily, weekly, or once a while • Food preferred and avoided • Dietary beliefs and practices

  26. 2) Quantitative intake of food • Quantitative of food item consumed are recorded and nutrient composition are determined from tables of food consumption

  27. METHODS • Food balance sheets • 24 hr recall method • Weighing of food • Inventory method list • Expenditure pattern method • Diet history • Duplicate samples • Recording methods

  28. Before survey – • List all the family members who took part in the meals • Ages • Physiological status • Occupation • Economic status

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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.

  36. 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

  37. 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

  38. 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

  39. 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.

  40. THANK YOU

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