Measuring and Monitoring Malnutrition
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Transcript of Measuring and Monitoring Malnutrition
« IS IT SERIOUS DOCTOR ? »
Measuring, monitoring & assessing malnutrition in individuals & a community
...
Anthropometry ?
Non-invasive technique for measuring specific features of the human body
« Anthropometry provides the single most portable, universally applicable, inexpensive and non-invasive technique for assessing the size, proportions and composition of the human body. It reflects both health and nutritional status and predicts performance, health and survival. » (World Health Organisation)
Children under 5 years old•Growth indicators•Height•Weight•MUAC•Other indicators : head circumference, skin pinch ...
Age-sensitive
Measuring individuals
Adults•Height•Weight•MUAC•Skin pinch
Independent of age
Anthropometric measurements
MUAC ?Mid-Upper Arm Circumference
More on this later ...
Main anthropometric indicatorsChildren under 5Weight to Height inadequate = Acute malnutrition -Wasting
Height to age inadequate = Chronic malnutrition – Stunting
Weight to age inadequate = UnderweightBilateral oedema (2 legs or 2 feet) = Severe Acute MalnutritionChildren & AdultsMUAC = Acute malnutritionAdultBody Mass Index (BMI) > Malnutrition & obesity (except pregnant women)
Age Height Weight
To measure a person's nutritional state, you need to know:
The MUAC tape
Measure the left arm midway between the tip of the elbow & the tip of the shoulder-blade. The arm must be relaxed.
The Mid-Upper Arm Circumference (MUAC) is an indicator of body mass.
SimpleQuickCheap
Screening
For a child, you need to know:
Presence of oedema
Sex Boy or girl
Clinical examination
A nurse or doctor looks for oedema on the feet, calves or face
A child with oedema is always deemed to have Severe Acute Malnutrition
orSAM
Body Mass Index (BMI)
BMI measures body fat. It is used to detect whether adolescents, adults or old people are underweight or suffering from malnutrition but also whether they are overweight or obese.
Adults (except pregnant women) :
Calculating your BMI
weight(kg)[height(m) x height(m)]
BMI <18.5: underweightBMI 18.5 – 24.9: normalBMI >25: overweightBMI >30: obesity
QUICK QUIZ- What does an anthropometric indicator
measure?
- Name 3 things you have to know about a person.
- What does BMI mean? What does it measure?
- What does MUAC mean? What does it measure?
Non-anthropometric indicatorsMICRONUTRIENT DEFICIENCY- Clinical examination- Biochemical tests
FOOD CONSUMPTION- Survey of food consumption patterns- Food diversity score
Jargon Buster: MORTALITY• Crude Death Rate (CDR)• Under-5 Death Rate (U5DR) Under-5 Mortality Rate (U5MR)
Maternal Mortality Ratio (MMR) Mainly in crisis or emergency feeding stations
Number of deaths for given population per day
e.g. : 1,06 / 10 000 people / day
Jargon Buster: MORBIDITY
Number of people with a given illness during a given time period in a given population
Diarrhoea, Cholera, Respiratory disease ...
Is it serious, Doctor ?To know whether an individual has a nutritional problem or to know the PREVALENCE of malnutrition for a group of individuals (population), compare the indices with benchmarks. This enables us to calculate significant numbers or indicators.
Anthropometry => needs reference
points
Measure the divergence from «normality»
International REFERENCE CHARTS:
- OLD (National Centres for Health Statistics/WHO – 1978)- NEW (WHO/Multicentre Gowth Reference Study - 2006)
To find the ANSWERS …
Consult the NORMS …
INDIVIDUALS
Children
« What if I'm a pygmy ? »
« It's not the same if I'm a Dogon, a European or an American ! Or is it ? »
WHO growth norms describe normal growth in infancy.
Everywhere in the world, between the ages of 0 and 5, children grow in the same way …
WHO norms can be used to evaluate children anywhere in the world, whatever their ethnic group, their socio-economic situation or the type of food they eat because ...
Classifying Acute Malnutrition or “Wasting”
Acute Malnutrition (Weight/Height
index)Percentage Z-score Bilateral Oedema
Severe (SAM) <70% <-3 z-score Yes/No
Severe (SAM) >70% >-3 z-score Yes
Moderate (MAM) <80% à ≥ 70%
<-2 z-score à ≥ -3 z-score No
Global (GAM) <80% <-2 z-score Yes/No
Mid-Upper Arm Circumference
Red < 115 mm
SevereMalnutrition
Orange 115 to 124
mmModerate
Malnutrition
Yellow 125 to 134
mmRISK of
Malnutrition
Green > 135 mm
Normal
MUAC
Body Mass Index (BMI)
Adults (except pregnant women)
weight(kg) / [height(m) * height(m)]
BMI can be used with children, but the thresholds are different.
GROUPS OF INDIVIDUALS
« Does this country face a nutritional crisis ? »
« Is the nutritional situation in this region worrying ?»
« Is there a risk of ... famine ? »
GAM?
Global Acute Malnutrition Proportion or % of people with acute
malnutrition in a given populationExperts refer to “prevalence” of acute
malnutritionChildren six to 59 months assessed
Gathering the informationSurveys (general population)
National (ou regional)oOccasional (variable timeframes)oPermanent (existing systems)
Targeted (zones at risk)Focus sites (selected population)
CentralisedCommunal
Health system (self-selected population)Registration/identification of malnutrition casesGrowth monitoring & promotion statistics
Prevalence of Malnutrition
Proportion (%) of a given population UNDER a given threshold
• Reference population (Bell-shaped Gaussian curve) defines what is normal
• Chart a curve with measurements from individuals you survey
• COMPARE
Early-warning signs … Alarm bells ...
The ThresholdsPrevalence level
Description of the situation
Chronic Malnutrition
Global Acute Malnutrition
Underweight
Low Good < 20 % < 5% < 10%
Moderate Monitor 20 to 29 % 5 to 9 % 10 to 19%High Alert
intervention required30 to 39% 10 to 14 % 20 to 29%
Very high
40% and + 15 % and + 30% and +
Other indicators Alert EmergencyUnder-5 Death Rate (U5DR)
2/10,000/day
4/10,000/day
Crude Death Rate (CDR)1/10,000/day
2/10,000/day
Emergency
Humanitarian crisis
Source: DHS/MICS/SMART Surveys
Benin4.7%<-2SD WHZDec 2008
Burkina Faso10.8% GAM
Aug/Sept 2011
CAR7.4%<-2SD WHZMICS 2010
Ivory Coast5.4% GAMJune/July 2011
Cameroon5.6%<-2SD WHZDHS-MICS 2011
DRC9.0%<-2SD WHZMICS 2010
Congo7.0%<-2SD WHZEDS 2005
Cape Verde
Gabon2.7%<-2SD WHZEDS 2000
Ghana8.5%<-2SD WHZDHS 2008
Guinea8.3%<-2SD WHZMICS 2008
Gambia6.4%<-2SD WHZMICS 2006
Guinea-Bissau5.8% <-2SD WHZMICS 2010
Liberia2.8% GAMJune 2010
Mali 10.9% GAMJune/July 2011
Mauritania6.8 % GAM Dec 2011
Niger 12.3% GAM May/June 2011
Nigeria11.0%<-2SD WHZDHS 2008
Senegal10.1%<-2SD WHZDHS 2010-2011
Sierra Leone7.6% GAMJune/Aug 2010
Sao Tome and Principe10.5%<-2SD WHZDHS 2008-2009
Chad16.3%<-2SD WHZMICS 2010
Togo4.5% GAMDec 2010
GAM > 15%
GAM 10 - 14.9%
GAM 5 - 9.9%
GAM 0 - 5%
Global Acute MalnutritionWest & Central Africa
UPDATED February, 2012
Source: DHS/MICS/SMART Surveys
Benin37%Dec 2008
Burkina Faso34.1%
Aug/Sept 2011
CAR40.7%MICS 2010
Ivory Coast27.3% June/July 2011 Cameroon
32.5%DHS-MICS 2011
DRC43%MICS 2010
Congo26%EDS 2005
Cape Verde
Gabon20.6%EDS 2000
Ghana28%DHS 2008
Guinea36.2%MICS 2008
Gambia22.4%MICS 2006
Guinea-Bissau32.2%MICS 2010
Liberia41.8%Jun/Aug 2010
Mali 27.1% June/July 2011
Mauritania25.5% Dec 2011 Niger
51.0% May/June 2011
Nigeria38.3%DHS 2008
Senegal26.5%DHS 2010-2011
Sierra Leone34.8%Jul/Aug 2010
Sao Tome and Principe29.3%DHS 2008-2009
Chad38.7%MICS 2010
Togo28.4%Dec 2010
Stunting > 40%
Stunting 30 – 39.9%
Stunting 20 – 29.9%
Stunting 0 – 19.9%
Chronic MalnutritionWest & Central Africa
UPDATED February, 2012
IPC: Integrated Food Security Phase Classification developed by UN agencies & NGOs using existing data (mortality rates, GAM, access to food and water, security, etc) to place geographical areas into categories ranging from “Generally food secure” to “Famine”
The « F » word
CDR - Crude death rate: Deaths per 10,000 people per day in a given area over a specified period.
A loaded word
To be accurate, you need to understand the jargon:
GAM: Global Acute Malnutrition – Proportion or % of cases for a given population
Famine is declared when GAM (Global Acute Malnutrition) exceeds 30 % ... CDR (Crude death rate) exceeds two ... at least 20 % of a population receives less than 2,100 calories per day. Source: IRIN
FamineIPC definition of Famine/Humanitarian catastrophe : « Extreme social upheaval with complete lack of food access and/or other basic needs where mass starvation, death, and displacement are evident. »
Strong words Used accurately the « F » word
can be a wake-up call!
Thank You