talla corta intervenciones

STUNTING:TACKLING FROM THE VERY BEGINING

TALLA CORTA/STUNTING: Intervenciones

Inteventionshttp://youtu.be/1e8xgF0JtVghttp://youtu.be/YwEhKu3T51Qhttp://www.youtube.com/watch?feature=player_detailpage&v=cVOjFllP3z8http://www.youtube.com/watch?feature=player_profilepage&v=aO7yZjK8Dushttp://www.youtube.com/watch?v=tZBJTYy2SIk

http://youtu.be/1e8xgF0JtVg

http://youtu.be/YwEhKu3T51Q

http://www.youtube.com/watch?feature=player_detailpage&v=cVOjFllP3z8

http://www.youtube.com/watch?feature=player_profilepage&v=aO7yZjK8Dus

http://www.youtube.com/watch?v=tZBJTYy2SIk

Auguste Rodin (Paris 12-nov. 1840 - Meudon, 17-nov-1917) escultor francés.

El Pensador (Réplica Macro en Ueno Park Tokyo) Bronce (1880)

Estado nutricional de los niños y las niñas menores de cinco años del Ecuador

Fuente: INEC - ECV 2005-2006 Quinta Ronda

Realizado por M. A. Hinojosa-Sandoval. Junio 2007

TENDENCIA DEL DIFERENCIAL Z CON LOS

DATOS DE REFERENCIA INTERNACIONAL

1,15

0,9

0,74

0,55

1,19 1,19

0,83

0,9

0,4

0,5

0,6

0,7

0,8

0,9

1

1,1

1,2

1,3

19

98

19

99

20

00

20

07

Z s

co

re T/E

P/E

Evaluación del estado nutricional de los niños y las niñas

Fuente: INEC - ECV 2005-2006 Quinta Ronda

Realizado por M. A. Hinojosa-Sandoval. Junio 2007

Prevalencia de Desnutrición por edad

Desnutrición crónica (T/E)

Desnutrición global (P/E)

Desnutrición aguda (P/T)

0 Meses 3,1 3,1 3,9

0-5 Meses 3,4 1,6 1,5

6-11 Meses 7,9 5 1,8

0-11 Meses 5,9 3,5 1,7

12-23 Meses 24,8 13,7 4,2

24-59 Meses 19,8 8,6 1

0-59 Meses 18,1 8,6 1,7

0

5

10

15

20

25

30

0 Meses 0-5 Meses 6-11 Meses 0-11 Meses 12-23 Meses 24-59 Meses

% D

es

nu

tric

in G

lob

al y

cro

nic

a

TENDENCIA DE LA

DESNUTRICION

DURANTE LA NIÑEZ

Recomend a strategy

PREVENTIVE & EARLY INTERVENTION

COMMUNITY EMPOWERMENT

IMPROVEMENT HEALTH CARE SERVICES

ASSURE SUSTAINABILITY THROUGH QUALITY IMPROVEMENT PROCESS

1. La seguridad Alimentaria


La seguridad alimentaria existe cuando todas las personas (de una familia) tienen acceso en todo momento (ya sea físico, social, y económico) a alimentos suficientes, seguros y nutritivos para cubrir sus necesidades nutricionales y las preferencias culturales para una vida sana y activa


Causas de Inseguridad alimentariaEscasez de aguaDegradación de los suelosCambio climáticoExplosión demográficaEpidemiasProblemas de gobernanza

2. Consejos PrácticosEvaluar los tres componentes del estado nutricional: ALIMENTACIÓN, SALUD Y AMBIENTEEn todo proceso de atención individual o colectiva. En todos los controles de salud del niño

3. Programas NutricionalesCONTROL PRENATALEMBARAZO

GESTACIÓN

PLAN DE PARTO. MAPA PARLANTE. REGISTRO MENSUAL DE

ACTIVIDADES REPORTE MENSUAL DE ACTIVIDADES A NIVEL DISTRITAL

EVALUACIÓN

NUTRICIONAL

EN LOS 1.000

DÍAS

NORMAL CUIDADOS Y CONTROL DE SEGUIMIENTO

REFERENCIA A HOSPITAL

PARA ATENCIÓN DE SU

RIESGO

Promoción, Prevención,

Consejería.Medicación

DIAGNÓSTICO + TRATAMIENTO NUTRICIONAL

+ SEGUIMIENTONO NORMAL

0 Días

280 DíasPARTO - NACIMIENTO

645 días

1.000 días

Exposición de la visión

Metas y objetivos

Impact on population estimates of child malnutrition

will depend on age, sex, anthropometric indicator

considered, and population-specific anthropometric

characteristics.

Thus, it is impossible to construct an algorithm that

can derive prevalence estimates based on the WHO

standards directly from estimates obtained from the

NCHS/WHO reference. A noteworthy effect is that

estimates of stunting will be higher throughout

childhood when assessed using the new WHO

standards compared to the previous international

reference.

STUNTING:SOLUCIONANDO DESDE EL COMIENZO

The construction of the weight-for-length (45 to 110 cm) and

weight-for-height (65 to 120 cm) standards followed a

procedure similar to that applied to constructing the

length/height-for-age standards (see section 3.1). To fit a single

model, 0.7 cm was added to the cross-sectional height values.

This was the average difference found between length and

height in 1625 children aged 18 to 30 months measured for

both length and height. After the model was fitted, the weight-

for-length centile curves in the length interval 65.7 to 120.7 cm

were shifted back by 0.7 cm to derive the weight for- height

standards corresponding to the height range 65 cm to 120 cm


Peso/edad en Menores de 5 años -

NIÑAS

Fuente: MGRS. OMS. Geneva 2006

Longitud-Talla/edad en Menores de 5 años -

NIÑAS


Perímetro Cefálico en Menores de 5

años - NIÑAS


Peso/edad en Menores de 5 años -

NIÑOS


Longitud - Talla/edad en Menores de 5

años - NIÑOS


STUNTING:TACKLING FROM THE VERY BEGINING

Body mass index (BMI) is the ratio weight (in kg)/recumbent

length or standing height (in m2). To address the difference

between length and height, the approach used for constructing

the BMI-for-age standards was different from that described for

length/height-for-age. Because BMI is a ratio with squared

length or height in the denominator, adding 0.7 cm to the

height values and back-transforming them after fitting was not

feasible. The solution adopted was to construct the standards

for the younger and the older children separately based on two

sets of data with an overlapping range of ages below and

above 24 months. To construct the BMI-for-age standard

based on length (birth to 2 years), the longitudinal sample's

length data and the cross-sectional sample's height data (18 to

30 months) were combined after adding 0.7 cm to the height

values

GUÍA DE TÉCNICAS ANTROPOMÉTRICAS

LONGITUD

Aplicar la técnica correcta

PAIDOMETRE = ROLLAMETRE

ANTROPOMETRÍA Buen registro

The Child Growth Standards provide a technically

robust tool for assessing the well-being of infants and

young children. They were derived from children who

were raised in environments that minimized

constraints to growth such as poor diets and infection.

In addition, their mothers followed healthy practices

such as breastfeeding their children and not smoking

during and after pregnancy, THAT IS WHY IT

provides a solid instrument for helping to meet the

health and nutritional needs of the world’s children.


Focusing on linear growth

and relative weight gain

during early life – a winner

ticket for human capital

development and future

adult health

April 5, 2013 by challengedkidsinternational

http://challengedkidsinternational.wordpress.com/2013/04/05/focusing-on-linear-growth-and-relative-weight-gain-during-early-life-a-winner-ticket-for-human-capital-development-and-future-adult-health/












http://challengedkidsinternational.wordpress.com/author/challengedkidsinternational/

http://challengedkidsinternational.wordpress.com/author/challengedkidsinternational/

What we do Quality improvement

Maintain the screening for children needs

Close the gaps providing nutritional interventions

evidence based

Assure that the proved interventions reach the

children with needs and keeps them exactly

Exposición de la visión

Metas y objetivos

Líneas de intervención

CORD CLAMP DELAY: In term neonates

led to significant increase in newborn

haemoglobin and higher serum ferritin

concentration at 6 months of age. In

preterm neonates was associated with

39% reduction in need for blood

transfusion and a lower risk of

complications after birthMcDonald SJ, Middleton P. Eff ect of timing of umbilical cord clamping of term infants on maternal and neonatal

outcomes.Cochrane Database Syst Rev 2009; 2: CD004074.

Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Eff ect of timing of umbilical cord clamping and other strategies to

infl uence placental transfusion at preterm birth on maternal and infant outcomes.Cochrane Database Syst Rev

2011; 8: CD00324


Breast feeding initiation within 24 h of birth

is associated with a 44–45% reduction in

all-cause and infection-related neonatal

mortality, and is thought to mainly operate

through the effects of exclusive

breastfeeding. Counselling or educational

interventions increase exclusive

breastfeeding by 43% at day 1, by 30% till

1 month, and by 90% from 1–5 monthsDebes AK, Kohli A, Walker N, Edmond K, Mullany LC. Time to initiation of breastfeeding and neonatal mortality

and morbidity: a systematic review. BMC Public Health (submitted).

Imdad A, Yakoob MY, Bhutta ZA. Eff ect on breastfeeding promotion interventions on breastfeeding rates, with

special focus on developing countries. BMC Public Health 2011; 11 (suppl 3): S24.


Promotion of dietary diversity and

complementary feeding:14 Demographic

Health Survey datasets from low-income

countries; consumption of a mínimum

acceptable diet with dietary diversity

reduced the risk of both stunting and

under weight whereas mínimum meal

frequency was associated with lower risk

of underweight onlyMarriott BP, White A, Hadden L, Davies JC, Wallingford JC. World Health Organization (WHO) infant and young

child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 2012;

8: 354–70


Facility-based management of SAM and

MAM according to the WHO protocol:

Following the WHO protocol, would lead to

a 55% reduction in deaths; SAM treated in

hospitals or rehabilitation units, shows

mortality rates higher specially for

oedematous malnutrition (50–60%). WHO

recommends inpatient treatment

forchildren with complicated SAM, with

stabilisation and appro priate treatment of

infections, fluid management and dietary

therapyWHO. Guideline update: technical aspects of the management of severe acute malnutrition in infants and

children. Geneva: World Health Organization, 2013


Community-based management of SAM /

MAM: Facility-based treatment of SAM

remains important, community manage

ment of SAM continues to grow rapidly

globally.This shift in treatment norms from

centralised, inpatient care towards

community-based models allows more aff

ected children to be reached and is cost

eff ectiveCollins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe

malnutrition.

Food Nutr Bull 2006; 27: S49–82


Identification of children at risk for

undernutrition or undernourished: The

need to focus on the crucial period of the

1000 days from conception to a child’s

second birthday during which good

nutrition and healthy growth have lasting

benefi ts throughout life. Almost all

stunting takes place in the fi rst 1000 days.

The few randomised controlled trials that

included nutritional status outcomes show

effects on the weight or length of infantsBhutta ZA, Das JK, Rizvi A, et al, The Lancet Nutrition Interventions Review Group and the Maternal and Child

Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be

done and at what cost? Lancet 2013; published online June 6. http://dx.doi.org/10.1016/S0140-6736(13)60996-4


Fortified food supplements:

Micronutrient powders significantly

improved haemoglobin concentration

and reduced IDA by 57% and retinol

defi ciency by 21%.Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children. BMC

Public Health (in press)


Deworming in children (for soil-

transmitted intestinal worms):

Significant effects: Reduced

anaemia,reduced iron defi ciency

anaemia Reduced retinol deficiency.

Improved haemoglobin concentrations.Salam RA, MacPhail C, Das JK, Bhutta ZA. Eff ectiveness of micronutrient powders (MNP) in women and children.

BMC Public Health (in press)


Zinc therapy for diarrhea: Preventive

zinc supplementation in populations at

risk of zinc deficiency reduces the risk

of morbidity from childhood diarrhoea

and acute lower respiratory infections

and might increase linear growth and

weight gain in infants and young

childrenYakoob MY, Theodoratou E, Jabeen A, et al. Preventive zinc supplementation in developing countries: impact on

mortality and morbidity due to diarrhea, pneumonia and malaria.

BMC Public Health 2011; 11 (suppl 3): S23


MMN supplementation including iron in

children [multivitamins tablets with iron]:

MMN supplementation: Significant

effects: increased length, increased

weight. MMN might be associated with

marginal increase in fluid intelligence

and academic performance in healthy

school childrenAllen LH, Peerson JM, Olney DK. Provision of multiple rather tan two or fewer micronutrients more eff ectively improves

growth and other outcomes in micronutrient-defi cient children and adults J Nutr 2009; 139: 1022–30


MMN supplementation: Working in technical

collaboration with International food

technology and nutritional scientists,

Medicine Mondiale is developing an

improved range of a high quality, low cost,

predigested protein formulations which may

be used to combat acute diarrhea and

protein energy malnutrition on a global scale,

which are readily absorbed by sick children.

Proteinforte

Allen LH, Peerson JM, Olney DK. Provision of multiple rather tan two or fewer micronutrients more eff ectively improves growth and

other outcomes in micronutrient-defi cient children and adults J Nutr 2009; 139: 1022–30


Vitamin A supplementation reduced all-

cause mortality by 24% and diarrhoea-

related mortality by 28% in children

aged 6–59 months

Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA.Vitamin A supplementation for preventing morbidity and

mortality

in children from 6 months to 5 years of age.Cochrane Database Syst Rev 2010; 12: CD008524

Metas y objetivos

Assure nutritional evaluation of every children

under two in the community and in health facilities

Assure evidence based nutritional interventions

of every children under two, in risk of malnutrition

or malnourished in the community and in health

facilities

Decrease Malnutrition in children under two

Assure monthly meetings of QI Team in district

and regional levels

Recommendations Apply the census once, and update it annually

Monthly, alternatively to ambulatory visit to health facility, visit the children under two, specially those in risk or undernourished

Refer the children under two in risk of malnutrition or undernourished, for treatment in the health facility

Monitor accomplish of interventions at home

Keep the surveillance health system in function

Monthly, without any exception, do the meeting of QI team at district and regional levels

4. Nutrición en menores de un año

INICIAR ALIMENTACION

“Toda cosa nueva, toda la semana”Mas sólidos que líquidosHasta cinco comidas al díaAplastado no licuadoNo mezclar muchos saboresQue juegue con la comidaNUNCA SENO ENSEGUIDA DE COMERPrimero Seno luego comida o en horarios diferentes


INICIAR ALIMENTACION

CEREALES: Arroz (de inicio)

Cebada, quinua, avena, sémola, maicena, trigo

FRUTAS: Todas excepto cítricos, tomates y bayas

Se recomienda Manzana y guineo

SOPAS: (Purés) Tubérculos, raíces y legumbres.

Carne

THE MENACE

Aportes de la clase•Aclaraciones al tema•No provocar distracción con el formato•Enfatizar las medidas para mejorarla nutrición•Láminas menos cargadas y con más gráficos•Controlar el tiempo•Uso de audiovisuales•Más tiempo para debate

5. Recomendaciones al manejo de la clase

•Aclaraciones al tema•No provocar distracción con el formato•Enfatizar las medidas para mejorarla nutrición•Láminas menos cargadas y con más gráficos•Controlar el tiempo•Uso de audiovisuales•Más tiempo para debate

5. Recomendaciones al tema

•Es una nueva perspectiva de un problema de salud pública, que hay que tomarla como una oportunidad y, educar a la población diferenciadamente, sobre la base de la seguridad alimentaria con plan de alimentación desde el inicio, a poblaciones de riesgo, con calidad, participación social y con visión positiva de futuro

5. Recomendaciones al tema

•Teniendo como aspectos claves, la producción agrícola, el mejoramiento de la productividad (PIB)y las intervenciones en salud tales como lactancia materna, programas de apoyo nutricional, conocimiento y aplicación de signos de peligro, especialmente en la comunidad, promoviendo la calidad en la alimentación asegurando el correcto etiquetado

6. Porcentajes de calificación

Explicación:

Examen 40% (15 On Line + 25 Presencial

Actividad en clase 60% (20 Artículo de investigación + 40 de asistencia y tareas + participación)

talla corta intervenciones

Health & Medicine

height standards

los nios y

pesoedad en menores

height range

solucionando desde

nias menores

aos nias

standing height