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Public Health

Nutrition
Dr Syafri Guricci, M.Sc, DAN

Introduction
Public health nutrition is about applying

knowledge the solution of nutrition related


health problems

Assessment of Nutritional Status in


Individuals and Populations
Approaches to assessing nutritional status :
Anthropometry
Biomarkers
Clinical assessment
Dietary assessment

Public Health Nutrition


Strategies for Intervention at
the Ecological Level
The 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 characteristics
Factors outside the individual
An 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


approach
Levels of organization in the ecological approach :
Interpersonal level
these are attitudes, beliefs and perceptions that individual
towards dietary behavior
Social and cultural environments

interactions that the people have with family, institutions (e.g.


schools, worksite) and government policies law, include
cultural influences
Physical environment

including climate, geography and availability of foods in the


home and neighborhoods

Guidelines for intervention using the


ecological approach
Examine ways in which the physical and social

environment influence health


Consider the relationship between individual and
environmental factors
Intervention should enhance the fit between people
and their surroundings and give people greater control
over their environment
Focus intervention on leverage points
Multiple levels of the environment must be considered
when designing interventions
Interventions that include more than one level of the
ecosystems will be more effective

Public health nutrition strategies


for intervention at the individual
level
Key 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 group
Assess options as to the most effective way to achieve
the target : when, what, how, which, cost
Assess what support and infrastructure is required,
whether it available and if now how it will be develop
Build in an evaluation strategy early on in the
development of the intervention

BMI
Anthropometric measures are the most

commonly used to classify body weight


BMI
Underweight
Normal weight
Overweight
Preobese
Obesity
Obesity class I
Obesity class II
Obesity class III

< 18.5
18.5 24.9
>= 25.0
25-29.9
>=30.0
30 34.9
35 39.9
>= 40.0

MALNUTRITION
OVERNTRITION
OVERWEIGH
OBESITAS
UNDERNUTRITION GIZI KURANG
KEP
AGB
GAKY
KVA

MASALAH GIZI UTAMA DI


INDONESIA
KURANG ENERGI PROTEIN KEP
ANEMIA GIZI BESI .. AGB
GONDOK AKIBAT KURANG YODIUM GAKY
KURANG VITAMIN A . KVA

KLASSIFIKASI
KURANG ENERGI PROTEIN
BERDASARKAN PERJALANAN PENYAKIT
AKUT
KRONIK
BERDASARKAN PENYEBAB
KWASHIORKOR
MARASMUS
MARASMIC-KWASHIORKOR

DIAGNOSIS
MASYARAKAT ;
Nutritional assessment in the community
KMS bb berada dibawah garis merah
Direct assessment
PEMERIKSAAN FISIK..
LABORATORIUM

Indirect assessment
Ekologi = lingkungan
Prilaku masyarakt

PEMERIKSAAN FISIK
KWASHIORKOR ; Causa kurang protein
Udema. Kaki
Moon face
Signa da bandera
Rambut mudah dicabut
Kulit ; crezy pavement dermatosis
BB rendah/umur hitung dgn Udem
Hepatomegali/splenomegali
Nangis monoton

ANEMIA GIZI BESI


DIAGNOSIS MASYARAKAT
Pemeriksaan Klinis
Pucat, lesu, cepat lelah
Sakit kepala hebat
Conjungtiva okuler berwarna kebiruan atau putih
mutiara
Pucat pada mukosa bibir dan faring, telapak tangan
dan dasar kuku
Prestasi sekolah rendah

GAKY
Diagnosa masyarakat
Pemeriksaan klinis
- Tubuh kerdil (kretinisme),
- pembengkakan kelenjar tiroid,
- pada ibu hamil dapat mengganggu
pertumbuhan dan
perkembangan
janin

KVA
Diagnosa masyarakat
Pemeriksaan klinis
Buta senja
Terdapat bercak bitot pada mata
Xerophtalmia
Secara subklinis kadar vit A dalam darah < 20 mg/dl

PENYEBAB - MULTIKAUSA
LANGSUNG

Intake lebih rendah dibanding kebutuhan


Infeksi
Pengasuhan orang tua

TIDAK LANGSUNG
Lingkungan tidak sehat
Pelayanan kesehatan
Prilaku masyarkat
Keamanan pangan tingkat keluarga
Harga
Daya beli
Pengetahuan
Pendidikan formal
Prioritas pembangunan --- kemauan politik

Thank 4 ur attention

Any question?