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ASSESSMENT OF NUTRITIONAL STATUS OF A COMMUNITY & ANTHROPOMETRIC ASSESSMENT OF PRESCHOOL CHILDREN

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HOW TO PRESENT THIS IN THE EXAM

1. Introduction (2-3 lines)
2. Part 1 - Methods of assessment with a numbered list + brief description of each
3. Flowchart from Park's (copy into answer)
4. Part 2 - Anthropometry in preschool children in detail
5. Classification tables
6. Conclusion (2-3 lines)

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INTRODUCTION

• Obtain information on prevalence and geographic distribution of nutritional problems
• Identify individuals/population groups "at risk" or in greatest need
• Develop health care programmes based on assessment findings

Park's, p. 743

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PART 1: METHODS OF ASSESSING NUTRITIONAL STATUS OF A COMMUNITY

FLOWCHART: Methods of Nutritional Assessment and Their Relationship to Natural History of Disease

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1. CLINICAL EXAMINATION (p. 744)

• Simplest and most practical method
• Assesses physical signs associated with malnutrition
• WHO classified clinical signs into 3 categories:

• Malnutrition cannot be quantified on clinical signs alone
• Many deficiencies are unaccompanied by physical signs
• Lack of specificity and subjective nature

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2. ANTHROPOMETRY (p. 744)

• Height, weight, skinfold thickness, arm circumference
• In young children: head circumference and chest circumference also measured
• Can be collected by non-medical personnel after training
• (Discussed in detail in Part 2 below)

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3. LABORATORY AND BIOCHEMICAL ASSESSMENT (p. 744-745)

• Haemoglobin estimation - most important test; useful index of overall nutrition
• RBC count and haematocrit
• Stool examination - intestinal parasites
• Urine - albumin, sugar

Note: Biochemical tests are time-consuming and expensive; cannot be applied on a large scale. Done on a subsample. Most reveal only current nutritional status.

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4. FUNCTIONAL INDICATORS (p. 745)

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5. ASSESSMENT OF DIETARY INTAKE (p. 745)

• Mean intake (grams) of food groups
• Mean intake of nutrients per "consumption unit"
• Reference: ICMR publication "Nutritive Value of Indian Foods"

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6. VITAL AND HEALTH STATISTICS (p. 746)

• Mortality in age group 1-4 years is particularly related to malnutrition
• In developing countries, this may be 20 times that in developed countries

• Infant mortality rate (IMR)
• Second-year mortality rate
• Rate of low birth-weight babies
• Life expectancy
• Morbidity data: PEM, anaemia, xerophthalmia, endemic goitre, diarrhoea

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7. ECOLOGICAL STUDIES / ASSESSMENT OF ECOLOGICAL FACTORS (p. 746)

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PART 2: ASSESSMENT OF NUTRITIONAL STATUS OF PRESCHOOL CHILDREN BY ANTHROPOMETRIC MEASUREMENTS

Park's, p. 637-638

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ANTHROPOMETRIC MEASUREMENTS USED IN PRESCHOOL CHILDREN

ANTHROPOMETRIC MEASUREMENTS IN PRESCHOOL CHILDREN
├── 1. Weight
├── 2. Height / Length
├── 3. Mid-Upper Arm Circumference (MUAC)
├── 4. Head Circumference
├── 5. Chest Circumference
└── 6. Skinfold Thickness

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INDICES DERIVED FROM MEASUREMENTS

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INDICATORS BY POPULATION GROUP (Table 36, Park's p. 747)

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CLASSIFICATION OF MALNUTRITION (Gomez Classification)

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MID-UPPER ARM CIRCUMFERENCE (MUAC)

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GROWTH MONITORING AND GROWTH CHART

• Rises parallel to reference = growing well (Good/Normal)
• Flattens = growth faltering (early warning)
• Falls = danger (Underweight / Severely underweight below -2SD/-3SD)

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NUTRITIONAL SURVEILLANCE vs GROWTH MONITORING

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ALTERNATIVE ANTHROPOMETRIC METHODS

• Height-for-age - reflects chronic/long-term nutritional status; detects stunting
• Weight-for-height - reflects acute nutritional status; detects wasting; independent of age (very useful when age unknown)
• Arm circumference - independent of age, simple, does not require weighing scale

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EXAMINATION ANSWER STRATEGY

1. Write a 2-line intro about what nutritional status means and what a nutritional survey aims to achieve
2. Draw Fig. 5 (the flowchart) - this earns extra marks - it shows methods along the natural history of disease
3. List and describe all 7 methods using headers - examiners look for all 7 points
4. For Part 2, use the heading "Anthropometric Assessment of Preschool Children"
5. Include the MUAC table and Gomez classification table - these are frequently asked
6. Mention the Growth Chart and ideally draw a small sketch of it
7. Mention indicators table (if age known vs unknown)
8. End with a brief note on growth monitoring vs nutritional surveillance

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CHAPTER LOCATION IN PARK'S

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SUMMARY FLOWCHART TO DRAW IN EXAM

METHODS OF ASSESSING NUTRITIONAL STATUS
              |
    ┌─────────┴──────────┐
    |                    |
DIRECT METHODS     INDIRECT METHODS
    |                    |
    ├─ 1. Clinical        ├─ 6. Vital statistics
    |    examination      |   (mortality/morbidity)
    |                    |
    ├─ 2. Anthropometry  └─ 7. Ecological studies
    |   (height, weight,       (food balance sheets,
    |    MUAC, skinfold)       socioeconomic factors)
    |
    ├─ 3. Biochemical
    |   (Hb, serum
    |    nutrients)
    |
    ├─ 4. Functional
    |   indicators
    |
    └─ 5. Dietary intake
         (weighment,
          24-hr recall)

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