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Niutrition communti

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Niutrition communti

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  7. 7. By: Muhanad Mohammed 7
  8. 8. Malnutrition By the side of the weak….that’s where we are… Humble servants of the sick…that’s who we are… To be a vessel for the almighty’s mercy…that’s what we hope… & beyond the most unachievable….that’s our destiny …………. back Main minu next 8
  9. 9. Malnutrition • There were 925 million undernourished people in the world in 2010. back Main minu next 9
  10. 10. Malnutrition • This means an 80 million increase than 1990. • Ironically, the world produces enough food to feed double the actual population (12 billion). back Main minu next 10
  11. 11. Malnutrition is implicated in more than half of all child deaths worldwide, a proportion unmatched by any infectious disease since the Black Death. back Main minu next 11
  12. 12. Malnutrition • One in twelve people worldwide is malnourished, including 160 million children under the age of 5. • About 183 million children weigh less than they should for their age. back Main minu next 12
  13. 13. World nutritional status Mal nourished 33% well fed 34% Starving 33% back Main minu next 13
  14. 14. Undernourished people in the world (millions) Year 1990 1995 2005 2008 843 788 848 923 Undernourished in developing world(%) Year 1970 1980 1990 2005 2007 37 28 20 16 17
  15. 15. back Main minu next 15
  16. 16. • The Indian subcontinent has nearly half the world's hungry people, contributing with 5.6 million child deaths every year, more than half the world's total. back Main minu next 16
  17. 17. • Africa and the rest of Asia together have approximately 40%. • The remaining hungry people are found in Latin America and other parts of the world.
  18. 18. The situation in Sudan back Main minu next 18
  19. 19. The situation in Sudan • More than 90% of the population suffer from poverty and food insecurity. • More than 35% of the population are malnourished . • Sudan has got one of the highest under 5 mortality (108/1000 life births) . • Only 7.3% of the national income is spent on health. back Main minu next 19
  20. 20. Prevalence of child (%) malnutrition timeline Year 199 199 199 199 200 200 200 200 3 5 7 9 0 2 32. 38. 36. 38. 35. 34 8 8 5 4 5 back Main minu 4 6 33. 31. 8 7 next 20
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  22. 22. By : AYMAN ELHADARY back Main minu next 22
  23. 23. Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birthweight.  increased risk for serious health problems as newborns, lasting disabilities and even death.  back Main minu next 23 23
  24. 24. Why are babies born with low birth weight? back Main minu next 24 24
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  26. 26.  Risk factors are at increased risk for delivering prematurely:             Had a premature baby in a previous pregnancy. Are pregnant with twins, triplets or more . Have certain abnormalities of the uterus or cervix. Birth defects. Chronic health problems in the mother. Smoking. Alcohol and illicit drugs. Infections in the mother. Infections in the fetus. Placental problems. Inadequate maternal weight gain. Socioeconomic factors. 26
  27. 27.  What can a woman do to reduce her risk of having a low-birthweight baby? See her health care provider for a preconception checkup.  Work with her health care provider to control chronic health conditions  Take a multivitamin containing 400 micrograms of folic acid daily  Stop smoking  Get early and regular prenatal care.  back Main minu next 27 27
  28. 28.  How is fetal growth restriction treated? About 10 percent of fetuses are growthrestricted. A health care provider may suspect fetal growth restriction if the mother’s uterus is not growing at a normal rate. This can be confirmed with a series of ultrasounds that monitor how quickly the fetus is growing. In some cases, fetal growth can be improved by treating any condition in the mother (such as high blood pressure) that may be a contributing factor. .  back Main minu next 28 28
  29. 29.  The provider closely monitors the wellbeing of a growth-restricted fetus using ultrasound and fetal heart rate monitoring. If these tests show that the baby is having problems, the baby may need to be delivered early back Main minu next 29 29
  30. 30.  What medical problems are common in low-birth weight babies? Low-birth weight babies are more likely than babies of normal weight to have health problems during the newborn period. Many of these babies require specialized care in a newborn intensive care unit (NICU). Serious medical problems are most common in babies born at very low birth weight: • Respiratory distress syndrome (RDS):This breathing problem is common in babies born before the 34th week of pregnancy. back Main minu next 30 30
  31. 31. • Bleeding in the brain (called intraventricular hemorrhage or IVH): Bleeding in the brain occurs in some very low-birth weight premature babies, usually in the first three days of life. • Patent ductus arteriosus (PDA): PDA is a heart problem that is common in premature babies. Before birth, a large artery called the ductus arteriosus lets the blood bypass the baby’s nonfunctioning lungs. The ductus normally closes after birth so that blood can travel to the lungs and pick up oxygen. When the ductus does not close properly, it can lead to heart failure. back Main minu next 31 31
  32. 32. • Necrotizing enterocolitis (NEC): This potentially dangerous intestinal problem usually develops two to three weeks after birth. It can lead to feeding difficulties, abdominal swelling and other complications. Babies with NEC are treated with antibiotics and fed intravenously (through a vein) while the intestine heals. In some cases, surgery is necessary to remove damaged sections of intestine. • back Main minu next 32 32
  33. 33. • Retinopathy of prematurity (ROP): ROP is an abnormal growth of blood vessels in the eye that can lead to vision loss. It occurs mainly in babies born before 32 weeks of pregnancy. Most cases heal themselves with little or no vision loss. In severe cases, the ophthalmologist (eye doctor) may treat the abnormal vessels with a laser or with cryotherapy (freezing) to preserve vision. back Main minu next 33 33
  34. 34.  PREVENTION AND CONTROL back Main minu next 34 34
  35. 35.  Can medical problems in premature, lowbirth weight newborns be prevented? • When a provider suspects that a woman may deliver before 34 weeks of pregnancy, he may suggest treating the mother with a medicine called corticosteroids. Corticosteroids speed maturation of the fetal lungs and significantly reduce the risk of RDS, IVH, NEC and infant death. These drugs are given by injection (a shot) and are most effective when administered at least 24 hours before delivery. back Main minu next 35 35
  36. 36.  Treatment with tocolytic drugs to delay labor can give corticosteroids time to work. The provider also can arrange for delivery in a hospital with a NICU that can give specialized care to a premature, lowbirth weight infant. back Main minu next 36 36
  37. 37.  Does low birthweight contribute to adult health problems?  Some studies suggest that individuals who were born with low birthweight may be at increased risk for certain chronic conditions in adulthood. These conditions include high blood pressure, type 2 (adult-onset) diabetes and heart disease. When these conditions occur together, they are called metabolic syndrome. --One study found that men who weighed less than 6 1/2 pounds at birth were 10 times more likely to have metabolic syndrome than the men who weighed more than 9 1/2 pounds at birth). back Main minu next 37 37
  38. 38.  It is not yet known how low birth weight contributes to these adult conditions. However, it is possible that growth restriction before birth may cause lasting changes in certain insulin-sensitive organs like the liver, skeletal muscles and pancreas. Before birth, these changes may help the malnourished fetus use all available nutrients. However, after birth these changes may contribute to health problems. back Main minu next 38 38
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  41. 41. By : Amal hashim back Main minu next 42 42
  42. 42. KWASHIORKOR •It was identified in 1930 in Ghana, • It is an acute form of childhood PEM, it usually affect children age 1-4 years but can also affect the younger children and adults. back Main minu next 43
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  44. 44. • the word kwash literally means the one who is physically displaced (it is a reference to the fact that kwash develop commonly in children who have just weaned off of breast milk. back Main minu next 45
  45. 45. Epidemiology : back Main minu next 46
  46. 46. Causes: • • • Inadequate food intake both in quantity and quality (food gap): its caused by insufficient protein in diet. Infections as: malaria, diarrhea, measles and TB. Some conditions that interfere with protein absorption as cystic fibrosis. back Main minu next 47
  47. 47. • Low level of nutritional education. • Other contributories factors including: • poor environmental condition • bad food habits • large family size • poor maternal health. * ….. So kwash is an outcome of several factors…… back Main minu next 48
  48. 48. Symptoms and sign: – Edema – muscle wasting – failure to gain weight and grow (failure to thrive) – fatigability and irritability – skin pigmintary changes and dermatitis back Main minu next 49
  49. 49. Edema back Main minu next 50
  50. 50. failure to thrive back Main minu next 51
  51. 51. Muscle wasting back Main minu next 52
  52. 52. Dermatitis back Main minu next 53
  53. 53. the possible complications –Frequent and recurrent infections due to defected immune system. –physical and mental disability –anemia –fatty liver –poor wound healing –in severe cases it may lead to shock and trauma back Main minu next 54
  54. 54. diagnosis: • Diagnosis of kwash is mainly clinically ( i.e.: achieved through physical examination) • Laboratory findings: • low total plasma proteins. • reduced serum albumin . • reduced K level if diarrhea developed. back Main minu next 55
  55. 55. Management: • The general treatment involves 2 phases: • Treatment should be started as early as possible to prevent occurrence of complications. – Stabilization phase: supportive management includes treatment of acute medical conditions by giving IV fluids and also treatment of infections with antibiotics. – Rehabilitation phase: its mainly by getting more calories of protein and improvement of nutrition in general. back Main minu next 56
  56. 56. prevention and control • The preventive measures are: • health promotion • specific protection: mainly regarding the child (the child diet should contain enough protein calories and it should be balanced) • immunization is mandatory • early diagnosis and treatment: surveillance back Main minu next 57
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  58. 58. By : Esraa Hayder back Main minu next 59
  59. 59. MARASMUS Presented by: Dr. Esraa Hayder Supervised by: Dr. Nahla back Main minu next 60
  60. 60. MARASMUS • Marasmus is a form of severe protien energy malnutrition (PEM • Typically, marasmic child is of low weight,severely wasted muscles( skin on bones) and developmental disability and stunting , due to deficiency of nearly all nutrients, especially protein and carbohydrates back Main minu next 61
  61. 61. EPIDEMIOLOGY: Marasmus is one of leading causes of child morbidity and mortality in developing countries, and Approximately 9% of sub-Saharan African children suffer from moderate to acute malnutrition. • Incidence increases prior to st year and Case fatality is of all childhood deaths from malnutrition, of which two thirds will be attributable to low birthweight, and one third directly to malnutrition back Main minu next 62
  62. 62. World distribution of PEM back Main minu next 63
  63. 63. A study by American Society for Clinical Nutrition in relation to Who-2004 • Of 28753 children between the ages of 6 months and 6 years were examined for manutrition every 6 months for 18 months, Two hundred thirty-two children died during this18 months of follow-up . • Low weight-for-height was associated with an increased risk of mortality. Even children with better scores were 50% more likely to die in the following 6 months. back Main minu next 64
  64. 64. • Among breast-fed children, the relative mortality associated for (weight-for-height) was 7.3, and among not breast-fed children, it was 26.0 . This study targeted the most affected areas which were in Darfur-Sudan. back Main minu next 65
  65. 65. Another study by American medical association Darfur-2004 • The resulted Crude mortality rates, expressed as deaths per 10 000, were 3.2 in Kass, 2.0 in Kalma, and 2.3 in Muhajiria. Under 5-year mortality rates were 5.9, 3.5, and 3.5 respectively. During the period of displacement covered by survey Acute malnutrition was common, affecting 14.1% of the target population, violence was reported to be responsible for 72% of deaths mainly in children and young men. back Main minu next 66
  66. 66. Signs and symptoms – extensive tissue and muscle wasting – dry skin, and loss of adipose tissue as well as skin folds hanging over the thigh and buttocks back Main minu next 67
  67. 67. Types of Marasmus • Nutritional marasmus due to – – – – – Failure of breast feeding Inadequate amount of milk formula Starvation Feeding difficulties (mentally retarded Prematurity back Main minu next 68
  68. 68. • Secondary Marasmus due to – – – – – – Chronic infection Chronic diarrhea and/or vomiting Malabsorption syndrome Metabolic disorder Endocrine disease Psychological disturbance of Mother affects child health back Main minu next 69
  69. 69. Investigation • Biochemical findings -Normal plasma protein, unless end stages -Blood urea is low -Blood glucose level is low -Serum enzyme and minerals are usually within normal range unless complicated -Iron deficiency anemia is common -In severe long standing cases, urine may contain excess creatinine and ketone bodies back Main minu next 70
  70. 70. Treatment back Main minu next 71
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  72. 72. Control & Prevention of PEM 1. Encourage breast feeding to last as long as possible (at least in the 1st year). 2. Diets Education of mothers and focus on animal proteins, milk, eggs, meat, fish .Or vegetable proteins, Cereal, beans etc. 3. Family planning allow adequate spacing of child birth. 4. Immunization avoiding communicable diseases and infections. back Main minu next 73
  73. 73. 5. Sanitation and fly control. 6. Getting rid of taboos and faulty traditions. 7. Last but not the least is regular check-up & centiles. back Main minu next 74
  74. 74. Marasmic kwashiorkor – marasmic kwashiorkor is considered as an intermediate form between marasmus and kwash – Its main manifestations are • growth failure • edema • loss of subcutaneous fat • marked wasting of muscles • psychic changed • dermatosis • hair changes back Main minu next 75
  75. 75. Marasmic kwashiorkor back Main minu next 76
  76. 76. Thanks back Main minu next 77
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  79. 79. By : mina hishmat danial back Main minu next 80
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  81. 81. What is Obesity ?   Obesity is the heavy accumulation of fat in the body to such a degree that it rapidly increases the risk of diseases that can damage health and knock years off your life.. back Main minu next 82 82
  82. 82. How to know that you are obese? There are many test and exams can be done to see if you're obese or not. For examples: 1.Body mass index (BMI) Is used to assess your weight relative to your height. It is defined as weight in kilograms divided by height in meters squared (kg/m2) W does B I t el l you? hat M Healthy Overweight Obese Morbidly :18.5-24.9 :25.0-29.9 :30 or greater : 40 or greater 83
  83. 83. 2. Waist circumference central obesity (male-type or apple-type obesity) has a much stronger correlation, particularly with cardiovascular disease, than the BMI alone. The absolute waist circumference Men :> 102 cm in Women :> 88 cm in women. Other tests are:- *Weight-to-height tables *Body fat percentage back Main minu next 84 84
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  86. 86. Causes of obesity: A. Genetic factors B. life style A. Genetic factors:*some people stay thin and some become obese. Research shows that obesity tends to run in families If one of your parents is obese, you are 3 times as likely to be obese as someone with parents of healthy. Genes cause : • Some genes control appetite, making us less able to sense when we are full. • Some genes may make us more responsive to the taste, smell or sight of food. • Some genes may make us less likely to engage in physical activity back Main minu next 87 87
  87. 87.    B. life style 1.Physical inactivity: is a major element in the development of obesity in Sedentary westernized societies 2. Dietary intake: high-fat foods or sweetened drinks. 3. Ethnicity: increased risk of obesity in Native Americans and Hispanic Americans compared with white Americans, although these differences may be largely related to differences in socioeconomic status. 4. Underlying medical disorders : Secondary obesity may occur with medical conditions, including: * Hypothyroidism * hypercortisolism * growth hormone deficiency * hypothalamic damage. 88
  88. 88. 5. Prescription drugs: Some drugs may contribute to obesity. These include 1. glucocorticoids 2. antipsychotic drugs (eg. risperidone) 3. antiepileptic medications. 6.Emotions: Some people overeat because of depression, hopelessness, anger, boredom, and many other reasons that have nothing to do with hunger. 7.Sex: Men have more muscle than women, on average. Because muscle burns more calories than other types of tissue, men use more calories than women. 8.Age: People tend to lose muscle and gain fat as they age. Their metabolism also slows somewhat. Both of these lower their calorie requirements. 89
  89. 89. 9.Pregnancy: Women tend to weigh an average of 4-6 pounds more after a pregnancy than they did before the pregnancy. This can compound with each pregnancy. This weight gain may contribute to obesity in women. back Main minu next 90 90
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  93. 93. Heart Disease and Stroke Overweight people are more likely to have 1.high blood pressure 2. stroke 3. Very high blood levels of cholesterol and triglycerides (blood fats) 4.angina 5.sudden death from heart disease or stroke without any signs or symptoms. The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. back Main minu next 94 94
  94. 94. Diabetes Noninsulin-dependent diabetes mellitus (type 2 diabetes Statistically, overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. back Main minu next 95 95
  95. 95. Cancer Several types of cancer are associated with obesity. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast, and colon Overweight men are at greater risk of developing cancer of the colon, rectum, and prostate. Sleep Apnea The apnea can cause a person to stop breathing for short periods during sleep and to snore heavily. The risk for sleep apnea increases with higher body weights. Yet again, weight loss ultimately reverses this risk. back Main minu next 96 96
  96. 96. Osteoarthritis Osteoarthritis is a common joint disorder that most often affects the joints in your knees, hips, and lower back. Gout Gout is a joint disease caused by high levels of uric acid in the blood. Uric acid sometimes forms into solid stone or crystal masses that become deposited in the joints. Gallbladder Disease Gallbladder disease and gallstones are more common if you are overweight , it may cause a consequence of changes in fat and cholesterol handling by the body leading to supersaturation of bile. back Main minu next 97 97
  97. 97.  Prevention and control of Obesity:-  Most probably Is by health education. • 1.Stay active. • 2.Eat healthy. • 3.Watch your weight.  4.stay out of junk food. • 5.Only eat when you are hungry.  6.Never go all day without eating. back Main minu next 98 98
  98. 98. Treatment of obesity The main treatment for obesity is to reduce body fat by eating fewer calories and exercise more. Much more difficult than reducing body fat is keeping it off. 8095% of those who lose 10% or more of their body mass by dieting regain all that weight back within 2-5years. The body has systems that maintain its homeostasis at certain set points, including body weight. Exercise exercise combined with diet resulted in a greater weight reduction than diet alone". Dieting In general, dieting means eating less. Various dietary approaches have been proposed" back Main minu next 99 99
  99. 99. Drugs  Most available weight-loss medications are "appetitesuppressant" medications. Appetite-suppressant medications promote weight loss by decreasing appetite or increasing the feeling of being full. · In patients with BMI > 40: referral for bariatric surgery may be indicated. The patient needs to be aware of the potential complications. back Main minu next 100 100
  100. 100. What is Bariatric surgery ?!! back Main minu next 101 101
  101. 101.     Bariatric surgery :bariatric surgery (or "weight loss surgery") is the use of surgical interventions in the treatment of obesity. it is regarded as a last resort when dietary modification and pharmacological treatment have proven to be unsuccessful. Weight loss surgery relies on various principles; the most common approaches are reducing the volume of the stomach, producing an earlier sense of satiation while others also reduce the length of bowel that food will be in contact with, directly reducing absorption (gastric bypass surgery).. back Main minu next 102 102
  102. 102.  Stay Healthy  back Main minu next 103 103
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  105. 105. By : fatima abbas back Main minu next 106 106
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  107. 107. INTRODUCTION OF VITAMINS     Vitamins are a class of organic compounds categorized as essential micro nutrient.They are required by the body in very small amounts. Vit are divided in two groups : Fat soluble(A-D-E-K) Water soluble vit B+C back Main minu next 108 108
  108. 108. HISTORY OF VITAMIN (A)DEFICENCY    Vit (A)deficiency is a world wide Health Problem following PEM. Recently, data have indicated the interrelation between vit A deficiency and child hood RTI , diarrhea and measles . Medical articles and reports from Sudanese Ministry of Health were reviewed covering 4 deacades retrospectively to assess the extent of vit A deficiency. back Main minu next 109 109
  109. 109.   There is evidence that vit A deficiency is a Public Health Problem in Eastern Sudan and among communities living around Khartoum from Western and South Sudan . In study conducted in gezira state, involving 1265 people over 3 years old, the incidence was found to be higher in children, especially girls. back Main minu next 110 110
  110. 110. .   In another study, conducted in a number of 69 Villages and 4 Rural Towns in Eastern Sudan, inrolling 3461 under 5 years, the incidence was also found to be higher in girls than in boys. Another survey, performed on a displaced community around Omdurman city, employing the Sensitive Plasma Retinol Binding Protein Test, showed that only 3 children out of 1441 had a Protein level equal to or more than 3 mcg/dl, which is the normal level. 111 back Main minu next 111
  111. 111. Vitamin A      It is a fat soluble vitamin It is found in three forms Retinol . A pro vitamin . Beta carotene ,some of which is converted to retinol in the intestinal mucosa. back Main minu next 112 112
  112. 112. The liver has enormous capacity  forEach child in the age group at inmonth to 5 storing vitamin A mostly 6 the years should recive mega dose of vitA every 6 form of Retinol Palmitate. month Free Retinol is Transported in the blood stream in combination of Retinal Binding Protein which is produce by the liver. back Main minu next 113 113
  114. 114. Daily Requirement of vit A Group Man Retinol mcg 600 B.Carotene mcg 2400 Woman 600 2400 Pregnancy 600 2400 lactation 950 3800 infants 0-12 m 350 1200 children 1-6 yrs 7-12 yrs 400 600 1600 2400 adults adolescent 13-19yrs 600 2400 115
  115. 115. Each child in the age group at 6 month to 5 years should recive mega dose of vitA every 6 It ismonth indispensable for  normal vision , it contribute to production of retinal pigments, which are needed for vision in dim light 116
  116. 116. It necessary for maintaining integrity and the normal functioning of the Glandular and Epithelial tissues.  It has a role in the regulation of gene expresion and tissue differentiation  It’s important role in differentiation of immune system cell  back Main minu next 117 117
  117. 117. It has protective functions against some Epithelial Cancers.  Also it has functions in processes of normal heamopoises.  Embryonic Development and Reproduction.  Bone metabolisms.  118
  118. 118. Vit A deficiency •The signs of vit A deficiency are predominantly ocular but have extraocular signs. •Night blindness. •Conjuctival xerosis (dry, non wetable, smooth, shiny and its appears muddy and wrinkled . 119
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  120. 120. Bitott’s Spots.  Corneal Xerosis (serous stage, cornea appear dull, dry).  Keratomalacia (cornea become soft and burst open). EXRTA OCCULAR MANIFISTATIONS; anorexia, growth retardation, Follicular Hyperkeratosis.  121
  121. 121. TREATMENT  Treatment: should be urgent, nearly all of the early stages of Xerophthalmia should be treated by addministeration of massive doses orally (200,000IU or 110mg) of Retinol Palmitate on two successive days. 122
  122. 122. Prevention And Control    Nutritional education. Improvement of people’s diet so as to ensure a regular and adequate intake of food rich in vit A. Reducing the frequency and severity of cont ributory factor ,eg; PEM , RTI ,Diarrheoa ,and measles 123
  123. 123. The strategy is to administration single massive dose 200,000IU of vit a orally every 6 mounth to pre school children {1y to 6y}  half of dose 100,000IU to children between 6m and one year of age. Since vit A can be stored in the body 6-9 month And liberated slowly.  124
  124. 124. Since 1987 WHO has advocated the administration of vit a with measle vaccine in countries. Great sucess has been mantained for children by including vit A with NID. *provides immunity by high dose to new mother soon after delivary *Provision of vit A supplementaion every 4 to 6 month save children life 125
  125. 125.  Each child in the age group at 6 month to 5 years should recive mega dose of vitA every 6 month 126
  126. 126. KEY MASSEGE     Children need vitA to resist illness and prevent visual impairements vitA can found in many fruits and vegetables , oil, egg , breast milk Breast milk contain adequate amount of vitA exclusive breast feeding during first 6 month prevent vitA deficiency among infants Children more than 6 month should recieve complementry feeding rich in vegatibles &fruits back Main minu next 127 127
  127. 127.  Each child in the age group at 6 month to 5 years should recive mega dose of vitA every 6 month back Main minu next 128 128
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  129. 129. By : zainab kamal
  130. 130. Nutritional anemia Nutritional anemia refers to types of anemia that can be directly attributed to nutritional disorders. The most important types:Iron deficiency anemia. pernicious anemia. back Main minu next 131
  131. 131. Iron deficiency anaemia Introduction: -- In developing countries every second pregnant woman and about 40% of preschool children are estimated to be anaemic. -- In many developing countries, iron deficiency anaemia is aggravated by worm infections, malaria and other infectious diseases such as HIV and tuberculosis. . back Main minu next 132
  132. 132. -- Iron deficiency is the most common and widespread nutritional disorder in the world. --As well as affecting a large number of children and women in developing countries, it is the only nutrient deficiency which is also significantly prevalent in industralized countries. back Main minu next 133
  133. 133. *The numbers are staggering: 2 billion people – over 30% of the world’s population – are anaemic, many due to iron deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases. back Main minu next 134
  134. 134. * The major health consequences include:-poor pregnancy outcome. -Impaired physical and cognitive development . -Increased risk of morbidity in children. -Reduced work productivity in adults. *Anaemia contributes to 20% of all maternal deaths. back Main minu next 135
  135. 135. Causes: 1. Insufficient dietary intake and absorption of iron. 2. Iron loss from intestinal bleeding ,menstruation, etc. 3. The most significant cause of iron-deficiency anemia is parasitic worms(hookworms-whipwormsroundworms). 4.The most common cause of iron-deficiency anemia is chronic gastrointestinal bleeding from nonparasitic causessuch as gastric ulcers. back Main minu next 136
  136. 136. Symptoms and signs Signs: pallor Glossitis Angular cheilitis Koilonychia back Main minu next 137
  137. 137. Symptoms and signs Signs: pallor Glossitis Angular cheilitis Koilonychia back Main minu next 138
  138. 138. Symptoms and signs Signs: pallor Glossitis Angular cheilitis Koilonychia back Main minu next 139
  139. 139. Symptoms and signs Signs: pallor Glossitis Angular cheilitis Koilonychia back Main minu next 140
  140. 140. Diagnosis -Complete Blood picture. microcytic hypochromic poikilocytosis variation in shape anisocytosis variation in size targed cell are also seen back Main minu next 142
  141. 141. -Serum ferritin deplete -Serum iron decreased - Iron binding capacity rises -Bone marrow BM hyperplasia -Examiation of stool and urine for hookworm infestation and shistosomiasis. back Main minu next 143
  142. 142. Treatment 1.Treatment of the cause. 2.Iron replacement. *for iron deficiency anemia focuses on increasing your iron stores so they reach normal levels. back Main minu next 144
  143. 143. Treatment *Taking iron supplement pills and getting enough iron in food will correct most cases of iron deficiency anemia. back Main minu next 145
  144. 144. PREVENTION AND CONTROL back Main minu next 146
  145. 145. *Criteria for defining IDA, and the public severity of anaemia based on prevalence estimates, are provided. *According to this : Approaches to obtaining dietary information, and guidance in designing national iron deficiency prevention programmes. back Main minu next 147
  146. 146. Strategies for preventing iron deficiency: 1.food-based approaches: dietary improvement. modification and fortification. schedule for control and treatment IDA . back Main minu next 148
  147. 147. 2.Attention is given to micronutrient complementarities in programme implementation, e.g., the particularly close link between the improvement of iron status and that of vitamin A. back Main minu next 150
  148. 148. 3.providing fefol (Folic Acid) during antinatal periods.
  149. 149. * Further recommends action:A.oriented research on the control of iron deficiency. B.providing guidance in undertaking feasibility studies on iron fortification in most countries. back Main minu next 152
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  151. 151. By : hasan abed allateef
  152. 152. Definition: Pernicious anemia is a disease in which the red blood cells are abnormally formed, due to an inability to absorb vitamin B12. HISTORY: The British physician THOMAS ADDISON first described the disease in 1849, from which it acquired the common name of Addison's anemia. back Main minu next 155
  153. 153. . back Main minu next 156
  154. 154. Epidemiology: -The incidence of the disease is 1:10,000 in northern Europe. The disease occurs in all races. The peak age is 60, although it is starting to be recognised in younger age groups. -The condition is more common in those : -Scandinavian or Northern European -A positive family history and blood group A. back Main minu next 157
  155. 155. Causes, incidence, and risk factors: *Pernicious anemia is a type of vitamin B12 anemia. The body needs vitamin B12 to make red blood cells. You get this vitamin from eating foods such as meat, eggs, and dairy products. *A special protein, called intrinsic factor, helps your intestines absorb vitamin B12. This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12. back Main minu next 158
  156. 156. Etiology: *Cobalamin (B12) deficiency may result from the following: - Inadequate dietary intake . - Atrophy or loss of gastric mucosa . - Functionally abnormal IF . - Inadequate proteolysis of dietary cobalamin . - Insufficient pancreatic protease. back Main minu next 159
  157. 157. -Bacterial overgrowth in intestine - bacteria compete with the body for cobalamin. - Diphyllobothrium latum (fish tape worm) competes with the body for cobalamin. -Disorders of ileal mucosa. -Disorders of plasma transport of cobalamin. - - Dysfunctional uptake and use of cobalamin by cells back Main minu next 160
  158. 158. *Very rarely, pernicious anemia is passed down through families. This is called congenital pernicious anemia. Babies with this type of anemia do not make enough intrinsic factor or cannot properly absorb vitamin B12 in the small intestine.  * In adults, symptoms of pernicious anemia are usually not seen until after age 30. The average age of diagnosis is age 60. back Main minu next 161
  159. 159. *Certain diseases can also raise the risk. They include: -Addison’s disease -Chronic thyroditis -Hypoparathyroidism -Hypopituitarism -Myasthenia gravis -Type 1 diabetes back Main minu next 162
  160. 160. Symptoms: Some people do not have symptoms. Symptoms may be mild. They can include: -Diarrhea or constipation -Fatigue due to lack of energy, or light-headedness when standing up or with exertion -loss of appetite -Pale skin -Problems concentrating -Shortness of breath, mostly during exercise -Swollen, red tongue or bleeding gums back Main minu next 163
  161. 161. *low vitamin B12 levels for a long time, causes nervous system damage. Symptoms can include: -Confusion. -Depression. -Loss of balance. -Numbness and tingling in the hands and feet. back Main minu next 164
  162. 162. Lab: *To confirm your diagnosis : -Complete blood count (CBC) -schilling test -vitamin B12 level -Bone marrow examination (only needed if diagnosis is unclear). back Main minu next 165
  163. 163. Treatment: -The goal of treatment is to increase your vitamin B12 levels. -Treatment involves a shots of vitamin B12 once a month. -Persons with severely low levels of B12 may need more shots in the beginning. -Some patients may also need to take vitamin B12 supplements by mouth. For some people, highdose -Eating a well-balanced diet. back Main minu next 166
  164. 164. Expectations (prognosis): -Patients usually do well with treatment. It is important to start treatment early. Nerve damage can be permanent if treatment does not start within 6 months of symptoms. Complications: -People with pernicious anemia may have gastric polyps, and are more likely to develop gastric cancer and gastric carcinoid tumors. Brain and nervous system problems may continue or be permanent if treatment is delayed. back Main minu next 167
  165. 165. Prevention: -There is no known way to prevent this type of vitamin B12 anemia. However, early detection and treatment can help reduce complications. back Main minu next 168
  166. 166. IODINE DEFICIENCY EPIDEMIOLOGY back Main minu next 169
  167. 167. By : MOHAMED ABD-ALMONEIM 170
  168. 168. • Iodine deficiency Iodine deficiency is caused by a lack of iodine, a chemical element essential to the body's physical and mental development, in a person's diet. It is the single most common cause of preventable mental retardation and brain damage in the world. iodine The name is from Greek word, meaning violet or purple, due to the color of elemental iodine vapor a nonmetallic element of the halogen group 171 back Main minu next 171
  169. 169. The role of iodine in the body Iodine is an essential element for thyroid function, necessary for the normal growth, development and functioning of the brain and body. It also influences a variety of metabolic processes in the body (converting food to energy, regulating growth and fertility, and maintaining body temperature). Iodine is also widely available in the following foods Seafood's *Plants grown in soil rich in iodine 172 back Main minu next 172
  170. 170. The following are the recommended daily allowances for iodine Infants: :40 - 50 micrograms one to three years : 70 micrograms four to six years : 90 micrograms seven to 10 years : 120 micrograms 11 years: :150 micrograms pregnant women : 175 micrograms lactating women : 200 micrograms adult men & women : 100 - 200 microgram 173 back Main minu next 173
  171. 171. The risk factor that may lead to iodine deficiency: * Low dietary iodine. * Selenium deficiency * Pregnancy * Exposure to radiation. * Increased intake/plasma levels of goitrogens, such as calcium * Sex (higher occurrence in women). * Smoking tobacco * Alcohol . * Oral contraceptive. * Perchlorates. * Thiocyanates. * Age.
  172. 172. Signs and symptoms : iodine deficiency gives rise to hypothyroidism, symptoms of which are: *Extreme fatigue *Goiter *mental slowing *Depression *weight gain *low basal body temperatures Iodine deficiency is the leading cause of preventable mental retardation, a result which occurs primarily when babies or small children are rendered hypothyroidic by a lack of the element.
  173. 173. • A low amount of thyroxin (one of the two thyroid hormones) in the blood, due to lack of dietary iodine to make it, gives rise to high levels of thyroid stimulating hormone TSH, which stimulates the thyroid gland to increase many biochemical processes; • the cellular growth and proliferation can result in the characteristic swelling or hyperplasia of the thyroid gland, or goiter 176
  174. 174. • GOITER • Goiter is said to be endemic when the prevalence in a population is > 5%, and in most cases goiter can be treated with iodine supplementation. • If goiter is untreated for around five years, however, iodine supplementation or thyroxine treatment may not reduce the size of the thyroid gland because the thyroid is permanently damaged 177 back Main minu next 177
  175. 175. Cretinism Cretinism is a condition associated with iodine deficiency and goiter characterized by : 1.mental deficiency. 2. deaf-mutism. 3. Squint. 4.disorders of stance and gait. 5.stunted growth. 6.hypothyroidism. 178 back Main minu next 178
  176. 176. BY:ELIA EMIL GISER 179
  177. 177. IDD world wide • WHO estimates that nearly 2 billion individuals have an insufficient iodine • The number of countries where iodine deficiency is a public health problem was reduced from 110 in 1993 to 54 in 2003 , 40 are mildly iodine deficient and 14 moderately or even severely iodine deficient. IDD in Africa • 67% of households in sub-Saharan Africa are using iodized salt, but coverage varies widely from country to country . In countries like Sudan, Mauritania, Guinea-Bissau, and Gambia, coverage is less than 10%, whereas in Burundi, Kenya, Nigeria, Tunisia, Uganda, and Zimbabwe it is more than 90%. 180 back Main minu next 180
  178. 178. 181 back Main minu next 181
  179. 179. 182
  180. 180. • salt iodization: • the most effective way to control iodine deficiency is through salt iodization because: • Salt is one of few foodstuffs consumed by virtually everyone. • Salt intake is fairly consistent throughout the year. • In many countries, salt production/importation is limited to a few sources • Iodization technology is simple and relatively inexpensive to implement. • The addition of iodine to salt does not affect its color or taste. • The quantity of iodine in salt can be simply monitored at the production, retail, and household levels. 183 back Main minu next 183
  181. 181. • • • • • Prevention and control 1- Health education. 2- iodizing drinking water or irrigation water 3- Iodine-containing milk 4- in animal food to increased the iodine content of foods derived from animal sources • 5- salt iodization 184 back Main minu next 184
  182. 182. Treatment Iodine deficiency is treated by ingestion of iodine, such as found in food supplements. Mild cases may be treated by using iodized salt in daily food consumption, or eating more of milk, egg yolks, and saltwater fish. Iodized salt offers sufficient amounts of iodine. For a salt-restricted diet. • In male : 150 µg/d is sufficient for normal thyroid function. • For female: 150-300 µg/d should be ingested daily. 185 back Main minu next 185