Introduction of Child Health

& Assessment of
Nutritional Status
Prof. Diaa Marzouk Abd El Hamid
Community Medicine Department
Ain Shams University
 Community Medicine

Is a branch of medicine, which

deals with:
 Populations or groups rather than
 Individual patients
Stages of Health Spectrum

Positive
Susceptibility
Health

Prepathogenesis
Death

Disease
Disability
 Stage of Positive Health

The person enjoys the highest

degree of physical, mental,
psychological and social wellbeing
 Stage of Susceptibility

The person is in good health but

has certain factors which render
him susceptible for diseases
 Stage of Pre-pathogenesis

 Where the person is in the stage

of subclinical illness or in the
incubation period
Stage of Manifest Disease

 The individual shows the symptoms

and signs of diseases
 He may be cured
 Or proceed to a complication that
may be followed by death
 Stage of Disabilities

 Stage of Complications
 Death:
Due to failure of treatment
 Child Health

 Children constitute a vulnerable

group who are in need of special
health services.
 Children represent about 40 % of
the population in Egypt
 Infants

The first year of life

 Neonate: the 1st 28 days of life.
 Post-neonate: from 29th day to
end of first year
 Preschool Children
1st year to the 5th year of life

School Children up to 19 years

Up to 19 years
 Determinants of Child
Health

Determinants
of
Child Health

Availability
Socio-demograpic Environmental
Nutrition Genetic Factors Of
Factors Exposures
Health Services
 Socio-demographic Factors

Education & Occupation

Habits, Beliefs &

Family Income
Cultures
 Environmental Exposures

Physical

Chemical Biological

Mechanical
 Habits, Beliefs &
Cultures

 Female Circumcision
 Excessive wrapping in rural areas
and Rickets
 Genetic Factors

Chromosomal aberrations
•Down Syndrome
•Turner Syndrome
 Availability of Health
Services

1. Child Health Program

2. Expanded Program of Immunization
(EPI)
3. School Health Services
4. Screening services for children
 Child Health Program

Continuous growth monitoring will

identify:
 Failure to thrive as early as possible
giving chance to adequate
management and intervention
Growth Charts
 Marazmus

1. Very low body weight

2. Severe muscle wasting
3. Loss of subcutananeous fat
4. Absence of edema
Kwashiorker
 Marasmic Kwashiorker
A child with kwashiorker may develop
marazmic picture after oedema subsides
 Expanded Program of
Immunzation
Un-immunized children are
susceptible to various infectious
infectious diseases
 Assessment of
Nutritional Status

Direct Tools: Indirect Tools Ecological

Dietary Surveys
Morbidity Factors
Clinical Examination
Mortality Rates Magnitude of
Anthropometry
Biochemical tests Health services
 Nutritional Survey

Objectives:
1. To determine the magnitude & geographical
distribution of malnutrition
2. To determine underlying ecological factors of
malnutrition
3. To plan for control & prevention of malnutrition
 Types of Nutritional Survey

 Longtidunal surveys
 Cross-sectioal surveys
 A-Dietary Surveys

They require:
•Updated national statistics on food and
agriculture
•Shows the distribution of national food supply
among different groups of the population
during different seasons
•Uses representative samples
 Dietary Surveys are carried
out on
1. Community Level (Food Balanced Sheet)
2. Family Level (Family Surveys):
• Family members are recorded according to age, sex
and occupation
• Food consumption is measured over
- 24 hours/ 24 hour recall
-over a week or a month
3. Specific Groups
4. Individuals
Disadvantages:
•Failure of house wives to record or recall
•Showy attitude of house wives, they exaggerate in
recalling the food intake of the family
 B-Clinical Examination

General Examination:
•Skin, eyes, hair, buccal mucosa
•Thyroid gland
•Disadvantages:
•Non specific (DD: Environmental factors, dryness
of skin of extremities
 C-Anthropometric
Measurements

 Weight
 Height
 Length: < 2 years

Plotted on Growth Chart

 Weight for age
 Height for age
 D-Biochemical Examination

1. Serum or plasma
• Total proteins or amino acids
• Vit A &carotene Vit C B12
• Iron, Serum Fe and transferrin
2. Red Blood cell Count
3. Hemoglobin
4. Urine: Creatinine, urea, thiamin, riboflavin
 Immunological Tests:
1. Total Lymphocytic Count
- >200 Normal
- 800-1200 Moderate
- < 800 Severe nutritional deficiency
2. Skin Test:
- Cell mediated Immunity: delayed
- Humoral Immunity: delayed or no
response
Indirect tools of Nutritional
Assessment
 I-Mortality Rates:
1. Infant mortality Rate
2. Mortality of under 5 years
3. Ratio of under 5 mdeats/total deaths
4. Perinatal mortality rate
5. Cause specific mortality rate
II- Morbidity Rates
 III- Ecological Factors

Information about:
 No of Heath centers, hospitals
 Feeding habits of the community
 Feeding of vulnerable groups
 Socio economic factors
 Income and food prices