Malnutrition in the Philippines

MALNUTRITION IN THEPHILIPPINESEdgar M. Gerodias, R.N.,ECF,PCM, Hep. B Prec. CAP I, FMDJoanna Ruth Palermo, R.N., ICF,PBL, AIDS Prec., TB Stage V, FMD

Common Malnutrition Problems in the Philippines

Protein -Energy Malnutrition (PEM) - A lack of energy and protein which results in growth redardation.

Iron Deficiency Anemia (IDA) - A deficiency in iron wherein hemoglobin concentration is below the normal level which results in short attention span, reduced ability to learn and irritability.

Common Malnutrition Problems in the Philippines

Vitamin A Deficiency (VAD) - Lack of vitamin A that may result to xeropthalmia (dryness of the eye), nightblindness (inability to see in dim light) eyes sensitive to bright light, rough dry skin and membranes of nose and throat , low body resistance to disease, poor growth, and blindness in severe cases.Iodine deficiency Disorders (IDD) - Lack of iodine in the body which results in goiter, mental retardation, deaf-mutism, difficulty in standing or walking normally, and stunting of the limbs.

Common Malnutrition Problems in the Philippines

Vitamin A Deficiency (VAD) - Lack of vitamin A that may result to xeropthalmia (dryness of the eye), nightblindness (inability to see in dim light) eyes sensitive to bright light, rough dry skin and membranes of nose and throat , low body resistance to disease, poor growth, and blindness in severe cases.Iodine deficiency Disorders (IDD) - Lack of iodine in the body which results in goiter, mental retardation, deaf-mutism, difficulty in standing or walking normally, and stunting of the limbs.

This condition is characterized by an enlargement of the entire gland, or of one of its two lobes, caused by a deficiency of iodine in the diet.

Simple Goiter

The Food Fortification Program RA 8976

Republic Act 8976 or the Food Fortification Act of 2000 was signed into law on November 7, 2000 for full implementation on November 7, 2004, to address the problem of micronutrient malnutrition This law is complimentary to RA 8172 or the ASIN Law (An Act Promoting Salt Iodization Nationwide), passed in December 1995, mandating the iodization of all salt sold in the country.

Sangkap Pinoya term used by the DOH for micronutrients added to food to enhance its nutritional qualityThese micronutrients are vitamin A, iron and iodine, which cannot be synthesized by the human body, and therefore must be provided through the diet. The intake of these micronutrients through the Filipino diet is often inadequate and is responsible for the micronutrient malnutrition afflicting a majority of the population.

SANGKAP PINOY SEAL Sangkap Pinoy Seal (SPS) is a mark of DOH recognition of a food product that is properly fortified with either vitamin A, iodine or iron or a combination of these micronutrients and that complies with regulations of the Bureau of Food & Drug (BFAD) of the DOH for quality, labeling and addition of fortificants.

a campaign to support various health programs to reduce childhood illnesses and deaths by promoting positive child care behaviors A program of the Department of Health in partnership with the Local Government Units and other government and non-government organizations GARANTISADONG PAMBATA

GARANTISADONG PAMBATA

GP is done twice a year one week in April and one week in October.

Second week of October was designated as "Garantisadong Pambata" week.

GARANTISADONG PAMBATA SERVICESGiving VIT A capsules (VAC) supplement to all 12-59 months old children.

Catch up immmunizations (children who missed the routine immunizations like BCG, OPV, DPT, Measles)

Distribution of iron supplements to infants and pregnant women

GARANTISADONG PAMBATA SERVICESPromotion of child positive caregiving behaviors like

exclusive breastfeeding of infants from 0-6months old, feeding infant micronutrient rich complementary foods starting 6 months old, use of iodized salt daily, Buying and eating fortified foods, brushing of teeth properly and regularly, letting children play safe toys no smoking in front of preschooler

Marasmus speaks:I am derived from a word meaning withering or wasting Hence, my physical manifestations are related to my meaning

Kwashiorkor reacts:I come from the African language meaning the sickness of the older child when the next baby is born. This corresponds to the weaning time of the older child. Therefore, I am the result of the misfortune in the family

Etiology:Marasmus-due to a diet very low in calories (CHO, fats and protein)-BALANCED STARVATIONKwashiorkor-a deficiency of PROTEIN with adequate or even excess of calories.

Age Incidence:Marasmus-often the result of unsuccessful BF or insufficient BM supply with little or no other food given.BF may be given on:ScheduledPer Demand

Marasmus-failure to gain weight leads to loss of weight which leads to emaciation-the face becomes shrunken (old mans face), muscle wasting best seen and felt at the buttocks, thighs , upper arms and scapular region (winged scapula)

Kwashiorkor-usually occurs in a breastfed child until he is weaned gradually into starchy diet, without high protein foods-it is highly probable that deficiencies of other nutrients such as Vit. A, B complex, other minerals and etc. are frequent contributing factors

Clinical FeaturesDiagnosticEdema-is a cardinal sign (meaning syndrome should not be diagnosed in its absence) -1st detected at the anklegeneralized but more marked on the subcutaneous tissues of the dependent parts such as legs, forearms, penis, scrotum, the lower back, and the lower face (moonface)

-protruding abdomen is due to hypotonia of the abdominal muscles and the intestine and edema of the abdominal wall -muscle wasting can be demonstrated functionally by testing the infants ability to hold his head when gently pulled from a lying to a sitting position

Psychomotor changes-looks miserable and does not smile-motor development is retarded

Irritability-psychological trauma d/t maternal withdrawal assoc. with weaning from the breast plays an impt. role

Mental changes-1st 3 years of life is very critical in brain development

2. Common Signs-certain signs though not necessary for diagnosis are common and are usually present singly or in combinationa. Hair changes-occasionally serve to indicate the duration of the deficiency: long scanty, pale,pluckability records a prolonged period of deprivation

FLAG SIGN-alternate light and dark bands in the hair indicates alternating periods of protein adequacy and deprivationb. Depigmentation of the skin-there is general lightening of the color of the pigment of the skin due to interference in melanogenesisc. Anemia-nutritional anemia-the hemoglobin content of the blood is lower than the prescribed value for a given age group as a result of deficiency of folic acid or B12 like hookworm infestation

3. Occasional Signs of KwashiorkorFlaky Paint Rash or Enamel Dermatoses -seen in advanced cases; if present it is pathognomonic of the disease -these are patches of skin turn reddish, then purplish with macules and vesicleslater they become dry, peel off, leaving a raw, weeping areas like burns

-seen mostly in the hidden parts of the body like buttocks, groins and trunk.

Grave Prognosis:Hepatomegaly-there is usually enlargement of the liver which has a smooth surface and edgeMarasmus and Kwashiorkor are assoc. with Vit. A deficiency

Difference Between Marasmus and KwashiorkorMarasmusKwashiorkorMuscle WastingPoor appetiteGrowth RetardationDiarrheaApathetic, QuietDiffuse depigmentationGood AppetiteFlaky-paint/enamel orDiarrheadermatosisMoonfaceHepatic Enlargement

Kwashiorkor Ching!

Kwashiorkor Triple Treat!

Mr. Marasmus

TREATMENT OF PCMEvaluate the Clinical Condition- determine the presence of any medical emergency, make a clinical diagnosis and treat accordingly.

Ex. Severe dehydration secondary to Infectious Diarrhea

Dehydration:REPLACEMENTMild 5% weight loss 50 ml/kg BWModerate 10% weight loss 100ml/kg BWSevere 15% weight loss 150ml/kg BW

Treat with antibiotics

TREATMENT OF PCM2. Assess the Nutritional Status- make Nutritional diagnosis

3. Rehabilitate the malnourished childa.) refer to malward if warranted - institute medical and nutritional managementb.) home basis - enroll in teaching programs if necessary

TREATMENT OF PCM4. Institute follow-up measures such as:Weighing Medical and nutritional adviceImmunization, deworming , sanitation advice, family planning advice food production information Income- generating activities

A child should never be the result of chance, but should always be the product of a responsible gift of love of its parents to each other and to the Creator Himself