1. Prevention and follow up of
Malnutrition

2. What is follow up?
• After stabilization (2-3days) and rehabilitation
( 2-6wk) , every child should be followed up to
2.5 yr of age.
• In case of older children up to 1yr from the time
of discharge

3. Prepare to follow up
(1)Primary failure to respond is indicated by :-
• Failure to regain appetite by day 4
• Failure to start loosing edema by day 4
• Presence of edema on day 10
• Failure to gain at least 5g /kg / day by day 10
(2) Secondary failure to response :-
• Failure to gain at least 5g /kg /day for
consecutive days during the rehabilitation phase.

4. Reasons of failure to response
• Feed not prepared properly
• Inadequate foods
• Child does not take feed properly
• Psychological causes for e.g anorexia
nervosa

5. Problems encountered during
treatment with high protein diet
• Pseudo tumor cerebri
• Encephalitis like picture
• Nutritional recovery syndrome

6. Criteria for discharge
• 6-8 wk time is taken to recover
• He should be alert and active
• He must regain 85% of his ideal weight
• Serum albumin must be minimum 3g

7. Follow up children after
discharge
• Visiting the child at regular intervals
• Child rearing practices should be told to
mothers
• Immunization should be completed

8. Long terms sequelae
1) Growth :-
• Weight and head cicumference decreased
2) Mental development :-
• Sub normality present d/t decreased size of brain .
• General reasoning and spatial perpetual abilities
most severely affected d/t decrease of DNA and
cholesterol content of brain

9. 3) All abdominal organs :-
Usually recover completely but in some cases
a) diabetes may develop (pancreas)
b)scarring may persisting kidney and pyelonephritis
can progress
4) Endo myocardial fibrosis may occur

10. Preventing measures
• There is no simple solution of to the
problem of PEM
• Many types of action are necessary
• Following is adapted from 8th FAO/WHO
expert committee on nutrition
• A) health promotion :-
I. Measures directed to pregnant and
lactating women(education , distribution
of supplements)

11. ii. Promotion of breastfeeding:-
( baby friendly hospital)
iii. Development of low cost weaning food:-child
should be made to eat more food at frequent
intervals .
iv. Measures to improve family diet
v. Nutrition education:- promote correct feeding
practices
vi. Home economics
vii.Family planning and spacing of birth
viii.Family environment

12. Specific protection
• Child diet must contain protein and energy
rich food(milk , egg, fresh foods if possible)
• Food fortification

13. Early diagnosis and treatment
1. Periodic surveillance
2. Early diagnosis of any lag in growth
3. Infections and diarrhea
4. Development of programs for early
rehydration
5. Supplementary feeding programs during
epidemics
6. Deworming of heavily infested children

14. Rehabilitation
1. Nutritional rehabiltational services
2. Hospital treatment
3. Follow up care

15. Preventive and social measures
• Since malnutrition is the outcome of several
factors , the problem can be solved only by
taking action at various levels:-
• Family ,community , national , international
• It requiores a cordinated approach of many
disciplines:- nutrition , food , technology
health adminstration , health education ,
marketing etc.

16. Action at family level
1. Nutrition education
2. Both husband and wife need to be
educated about the selection of right kinds
of local foods and in planning of
nutritionally adequate diets within the
limits of their purchasing power
3. Since food expenditureoften amounts to
50-70% of family budgets , nutrition
management and planning should be a
good investment

17. 4. Counter the misleading commercial
advertisements with regarding to baby foods
5. Planning a kitchen garden or keeping poultry
6. Combination of locally available and imported
items

18. Action at community level
1. Nutrition problem analysis in terms of :-
i. Extent ,distribution, and types of
nutritionals deficiency
ii. The population group at risk
iii. Dietary and non dietary factors
contributing to malnutrition

19. 2. Plan realistic and feasible approaches based on
local resources
3. Direct intervention measures such as ICDS,
Mid day school meals, nutritional anemia
prophylaxis program , Vit A prophylaxis
programme
4. Increasing the availability of foods both in
quantity and quality, but much more important:-
making sure that the people suffering or at risk
,can obtain them.

20. 5. Applied nutrition programme :- production of
various type of protective foods by the community
for the community
6. ICDS:-an inter sectoral programme which seeks to
directly reach the children below six yrs(specially
from vulnerable groups and remote areas)
i. Supplementary nutrition:-
Beneficiaries Calories(kcal) Protein(g)
Children upto 6yr 300 8-10
Severely malnourish Double of the above Double of the above
Pregnant and lactating mother 500 20-25

21. ii. Health check ups includes ANC of expectant
mothers, PNC of nursing mothers and health care
of children.
These services are provided by ANM, medical
officers under RCH program
iii. Immunization
iv. Non formal pre school education
v. Referral services
vi. Nutrition and health education
utilization of these services is still poor.

22. 7. Safe water supply to prevent water born diseases.
In brief broad socioeconomic development of the
entire community .

23. At the national level
1. Rural development (NRHM ,RCH)
2. Increasing agriculture production:-application of
modern farming practices, expansion of cultivated
areas ,use of fertilizers ,better seeds.
Accompanied by effective marketing , land
tenure ,food price policies and food distribution
system
3. Stabilisation of population
4. Nutrition related health activities

24. Action at international level
1. Establishment of multi lateral world food
program in 1963
2. International co-operation in the situations of
natural calamities
3. Some organs of UNO like FAO, UNICEF,
WHO, World Bank, IMF, UNDP and CAR
working in close collaboration.

25. THANKS
Presented by:-
Md. Aqueel Azhar
20th batch
Department of paediatrics
Katihar medical college katihar

26. • Prime Minister Manmohan Singh stated,
“The problem of malnutrition is a matter of
national shame.... I appeal to the nation to
resolve and work hard to eradicate
malnutrition in five years.”