Public Health Nutrition

Public Health NutritionDr Syafri Guricci, M.Sc, DANIntroductionPublic health nutrition is about applying knowledge the solution of nutrition related health problemsAssessment of Nutritional Status in Individuals and PopulationsApproaches to assessing nutritional status :Anthropometry BiomarkersClinical assessmentDietary assessmentPublic Health Nutrition Strategies for Intervention at the Ecological LevelThe ecological model of health promotion presents health as a product of the interdependence between the individual and subsystems of the ecosystem

In the ecological approach health is determined by :Individual actions and characteristicsFactors outside the individualAn interaction between the two

Defining characteristics of the ecological approach Behavior is determined by multiple levels of influences, including intrapersonal factors and environmental factors

Health is a product of the interdependence between the individual and subsystems of the ecosystems (e.g. family, community, physical and social environment)Key principles in the ecological approachLevels of organization in the ecological approach :Interpersonal levelthese are attitudes, beliefs and perceptions that individual towards dietary behavior

Social and cultural environmentsinteractions that the people have with family, institutions (e.g. schools, worksite) and government policies law, include cultural influences

Physical environmentincluding climate, geography and availability of foods in the home and neighborhoodsGuidelines for intervention using the ecological approach Examine ways in which the physical and social environment influence healthConsider the relationship between individual and environmental factorsIntervention should enhance the fit between people and their surroundings and give people greater control over their environmentFocus intervention on leverage pointsMultiple levels of the environment must be considered when designing interventionsInterventions that include more than one level of the ecosystems will be more effective Public health nutrition strategies for intervention at the individual levelKey point required in developing an individual intervention program :Assess behavior (diet and activity levels) before the intervention and identify sources of variation within population : indentify the problem and develop goals and targets for the at risk or target groupAssess options as to the most effective way to achieve the target : when, what, how, which, costAssess what support and infrastructure is required, whether it available and if now how it will be developBuild in an evaluation strategy early on in the development of the intervention

BMIAnthropometric measures are the most commonly used to classify body weight

BMI Underweight Normal weightOverweight Preobese ObesityObesity class IObesity class IIObesity class III< 18.518.5 24.9>= 25.025-29.9>=30.030 34.935 39.9>= 40.0MALNUTRITIONOVERNTRITIONOVERWEIGHOBESITAS

UNDERNUTRITION GIZI KURANGKEPAGBGAKYKVA

MASALAH GIZI UTAMA DI INDONESIAKURANG ENERGI PROTEIN KEPANEMIA GIZI BESI .. AGBGONDOK AKIBAT KURANG YODIUM GAKYKURANG VITAMIN A . KVAKLASSIFIKASIKURANG ENERGI PROTEINBERDASARKAN PERJALANAN PENYAKIT AKUTKRONIKBERDASARKAN PENYEBABKWASHIORKORMARASMUSMARASMIC-KWASHIORKORDIAGNOSISMASYARAKAT ;Nutritional assessment in the communityKMS bb berada dibawah garis merahDirect assessment PEMERIKSAAN FISIK..LABORATORIUMIndirect assessment Ekologi = lingkunganPrilaku masyaraktPEMERIKSAAN FISIKKWASHIORKOR ; Causa kurang proteinUdema. KakiMoon faceSigna da banderaRambut mudah dicabutKulit ; crezy pavement dermatosisBB rendah/umur hitung dgn UdemHepatomegali/splenomegaliNangis monotonANEMIA GIZI BESIDIAGNOSIS MASYARAKATPemeriksaan KlinisPucat, lesu, cepat lelahSakit kepala hebat Conjungtiva okuler berwarna kebiruan atau putih mutiaraPucat pada mukosa bibir dan faring, telapak tangan dan dasar kukuPrestasi sekolah rendah

GAKYDiagnosa masyarakatPemeriksaan klinis- Tubuh kerdil (kretinisme), - pembengkakan kelenjar tiroid, - pada ibu hamil dapat mengganggu pertumbuhan dan perkembangan janinKVADiagnosa masyarakatPemeriksaan klinisButa senjaTerdapat bercak bitot pada mataXerophtalmiaSecara subklinis kadar vit A dalam darah < 20 mg/dl

PENYEBAB - MULTIKAUSALANGSUNG Intake lebih rendah dibanding kebutuhanInfeksiPengasuhan orang tuaTIDAK LANGSUNGLingkungan tidak sehatPelayanan kesehatanPrilaku masyarkatKeamanan pangan tingkat keluargaHargaDaya beliPengetahuanPendidikan formalPrioritas pembangunan --- kemauan politikThank 4 ur attentionAny question?