Forms of Malnutrition 2.

Underlying causes
- Low inadequate income
 Undernutrition- results from the consumption of an
- Inadequate food supply
adequate quantity of food over an extended period of time.
- Overpopulation
 Overnutrition- results from the consumption of an
- Ignorance about food and proper feeding practices.
excessive quantity of food over an extended period of time.
- Poor sanitation
 Specific Deficiency- Results from relative lack or absolute
- Inadequate maternal and child care
deficiency of an individual Nutrient.
- Low educational attainment
 Imbalance- Results from a disproportion among essential
- Lack of potable water supply.
nutrients with or without absolute deficiency of any
3. Basic Causes
nutrients.
- Political, human, social and economic structures.

Types of Malnutrition
Ecology- Relationship of man to his environment.
 According to duration
Exogenous- Environmental Factors/ Outside
 Acute Malnutrition- relates to present state
of nutrition manifested by wasting or 1. Natural Environment- Climate, topography, soil
weight loss. condition that determines what kind and the
 Chronic Malnutrition- relates to the past amount of food to produce.
state of nutrition manifested by stunning. 2. Man- Made environment- Technological
 According to Cause developments and education needed for the
 Primary or dietary malnutrition- due to production, storage and distribution of food and
lack of food. what foods can be made available for consumption.
 Secondary or conditioned malnutrition- 3. Behavioral environment- Religion, ethnicity,
due to certain factors other than food economics, socio cultural traditions that
alone. determines what specific foods will be chosen from
the variety of food available.
Causes of Malnutrition

1. Immediate Cause
- Inadequate quantity and quality of food intake.
- Presence of infection and other diseases, specifically
diarrhea, measles and Respiratory diseases.

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 Endogenous Factors

Agricultural method Consequences of Malnutrition

Education storage method
Inability to
Work Susceptibility
concentrate in
Food Availability Cropping pattern Resistance to diseases
School
Nutritional Status

ecologic factors Disasters

Incentives to
produce School Drop Malnourished
Early Death
out Children
family size

Food wastage
Lack skills/ low
Poverty
state of health literacy
Food Utilization
culture/ beliefs
Income
Under/
social status Low
unemployed
Productivity
cooking losses
Malnourished

2 known Mechanisms in Mental Development

Effects of Malnutrition  Nutrient Deficiency affects the growth and
biochemical maturity of the brain.
1. High Infections and death rates- synergism between
 -2nd Trimester Cell multiplication in the brain is
malnutrition and infections (one condition accentuates
completed.
the other). If there is malnutrition, there is infections
-Brain growth spurt begins at 3rd trimester until 2nd
and vice versa.
yrs. of life.
2. Impaired physical and mental development- Nutrient
- If malnutrition occurs for a long period of time,
deficiency affects the growth and maturity of the brain.
Brain size will be affected.
3. Impaired national development- A malnourished
- 60% of adult’s brain weight is achieved before 1
population will result to malnourished country.
year and 90% before the age of 4 yrs.

Impaired National Development

 In Health, it means more hospitals, more medical services

and medicines.

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  In Education, it means more teachers, more facilities and effectiveness of education productivity of labor and virtually all
more remedial…. The increased number of drop outs due to aspects of human and social development.
malnutrition reduces the number of quality manpower in
The Problems:
agricultural and industry. Malnutrition Results in poor
performance of workers, absenteeism and workers being  Protein Energy Malnutrition (PEM) – Infant and Preschooler
accident prone.  Micronutrient Malnutrition
 In socio- politic context, it means more unrest and disorder. o VDA Vitamin A deficiency – Infant and Preschooler
o IDA Iron Deficiency Anemia – Infant and
Groups Affected:
Preschooler, Pregnant/ Lactating Mother
1. Nutritionally at-risk communities o IDD Iodine Deficiency Disorder- Pregnant women,
 Remote rural areas- For chronic or long-term women of child bearing age, school children
malnutrition
PEM
 Urban poor areas- Acute or short-term malnutrition.
2. Physiologic Groups Classifications:
 Pregnant and lactating mothers
 Infants By Degree:
 Pre Schoolers For Children (wt. for age)
 The aged and elderly
3. Functional Classification (Classifying the undernourished  First Degree/ Mild Underweight
population according to ecological, demographic and socio-  Second/ Moderate Underweight
economic characteristics of a region or population).  Third/ Severe
 Ecological sub-zones: Rural against urban, For Adults (BMI)
subdivision by cropping areas (landless farmers,
fishing communities).  Chronic Energy Deficiency (CED)
 Demographic incidence of malnutrition in relation o Mild CED, Moderate CED, Severe CED
to family size, birth order, sex etc. (women, elderly)
By Duration
 Economic status: Income size of tenancy (children of
poor families, refugees, and displaced people).  Acute
 Chronic
Malnutrition affects not only mortality and morbidity figures but
 Acute Chronic
physical growth and intellectual development, school performance,
By Classic Clinical Syndrome

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  Marasmus, a severe form of malnutrition in infants who
were weaned early from the breast or were not breast fed
at all and who are offered formula that is inadequate to
meet their nutritional needs and/ or is contaminated with
infectious agents;
-most commonly occurring in a setting of urban poverty;
-Diagnosis based on anthropometric criteria that document
poor growth.
 Kwashiorkor, occurs most commonly after the first year in
children who have been breast fed or received adequate
nutrition early, but later fed low protein starch diets.
 Marasmus- kwashiorkor, mix form
Severe infections.
Vitamin A deficiency
 Lack of dark green leafy yellow fruits and vegetables in the
diet.
 Lack of fat or all in the diet to absorb vitamin A.
 Impaired absorption or rapid utilization of vitamin A during
infections especially in measles, chronic diarrhea and acute
respiratory infections.
Signs of VAD
Clinical signs are referred to as xeropthalmia and include:
 Night Blindness (XN)- the child has difficulty seeing in dim
light or refuses to play in the dark; the focal term is “
matang manok”, “ kurap” or “harapon”.
 Bitot’s spot (X1B)- foamy, soap sud like spot on conjunctiva
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 Corneal xerosis (X2)- dry, hazy and rough, appearing
cornea.
 Corneal Ulcer (X3A)- Crater like defect on cornea.
 Keratomalacia (X3B)- softened cornea; sometimes bulging.
IDA
Most common nutritional deficiency, as well as the most common
cause of anemia I children.
 Hypochromic Microcytic Anemia-Manifesting the final
stage of anemia.
 Iron Deficient diet- diet with poor available iron or by injury
hemorrhage, or illness.
IDA- is a condition in which concentration of hemoglobin is below
that level that is normal for a given individual.
 Anemic Pregnant women are prone to deliver low weight
.birth babies.
 Children with IDA have short attention span, reduce ability
to learn, irritable.
 While adults reduced productivity.
Specific causes:
 Lack of green leafy vegetables and animal foods
 Lack of vit C
 Chronic Blood Loss
 Increased Demand
IDD- Spectrum of physical and mental abnormalities, some serious,
some mild, caused by lack of iodine in the body.
  Goiter Pre-American Occupation
Is the most common form of IDD; enlargement of Thyroid
 Friar Fr. Juan Clemente (1577) put up a dispensary for
Gland.
treating the indigents in manila. San Juan de Dios Hospital
Classification:
(1659).
o Grade OA- gland abnormally enlarged
o Grade OB- Enlarged but not visible with neck AMERICANS:
extended
o Grade 1- goiter visible only with neck extended 5 GENERAL HOSPITAL
o Grade 2- Visible with head in normal position 1. San Juan de Dios Hospital (1659)
o Grade 3- Visible in distance. 2. Chinese General Hospital ( 1891)
When the prevalence of goiter is 10% it is endemic 3. Hospicio de San Jose in Cavite (1611)
already. 4. Casa de la Caridad in Cebu
5. Enfermaria de Santa Cruz in Laguna (1870)
 Mental retardation
 Deaf 4 Hospitals for Contagious Disease
 Mutism 1. San Lazaro Hospital (1577)
 Squint 2. Hospital de Palestina ( CamSur)
 Difficulty in standing and walking 3. Hospital de Lesprosos in (Cebu)
 Repro failure 4. Hospital de Argencina ( Manila) for small pox and cholera

2 Military Hospital

1. Hospital de Manila
2. Hospital Militar de Zamboanga

2 Naval

1. Hospital de Marie in Canacao, Cavite

2. Hospital de Basilan in Basilan

Other Hospital Asylumss

1. Hospicio de San Pascual baylon in Manila

Pointers in public health by Kani Maryella

 2. Asylum of St. Vincent de Paul in Manila for Poor Girls 7. Prudence- Caution and circumspection in action.
(1885) 8. Courage- Doing what one sees at right.
3. Hospital of San Jose for orphaned children and the 9. Pride- Inordinate self conceit.
metally ill (1782) 10. Greed- Inordinate acquisitiveness.

 Real work in public Health started with the creation of the

Board of Vaccinators in 1806 to prevent small pox.
 Later the office of Medicos Titulares ( Health Officers) was
created together with Board of Health with a priest
President.
 1855- maritime quarantine was instituted.
 Spain can also be credited for the construction of Carriedo
waterworks ( 1876)
 (UST) University of Sto. Tomas (1872)- First Medical School
 School of Midwifery (1879)
 Public Health Labaratory (1883)
 Medicos forense ( Forensic Medicine) (1892)
 Don Francisco De Carriedo- benefactor of the city of Mnl,
WHO WILLED 10,00 TO THE CITY IN (1733). For construction
of waterworks. Provided manila with piped water.

VALUES

1. Fidelity- Faithfulness
- In a relationship of trust every patient must know that
his health care provider will keep his promises.
2. Honesty- Truthfulness, Telling the truth.
3. Integrity- Acting the same way one says should act.
4. Humility-Recognizing one’s capabilities and limitations.
5. Respect- paying attention. Listening attentively.
6. Compassion- Feelings for those who suffer.

Pointers in public health by Kani Maryella