Nutritional classification - Definition of Malnutrition Causes, Problems, Articles
In determining the classification of nutritional status should be a standard measure that is commonly called a reference. Antopometri books are now used in Indonesia is WHO-NCHS with an index weight for age, height index according to age, body weight compared to height (Supariasa, 2002).
Factors causing nutritional problems
UNICEF (1988) has developed the concept of macro-framework as a strategy to address the problem of malnutrition. Within this framework demonstrated that the problem of malnutrition can be caused by:
Food and diseases may directly lead to malnutrition. The incidence of malnutrition is not only due to the lack of food intake, but also diseases. Children who got quite a lot of food but often suffer from illness, may ultimately suffer from malnutrition. Similarly, children who do not get enough food, the body resistance will be weakened and will be susceptible to disease.
There are three indirect causes that lead to nutritional problems, namely:
Family food security are inadequate.
Each family is expected to be able to meet the food needs of the whole family in the quantity and nutritional quality.
Inadequate parenting. Every family and community is expected to provide time, attention and support to children in order to grow and develop properly, both physically, mentally and socially.
Health care and inadequate environment. The existing health care system is expected to ensure the provision of clean water and basic health facilities (IHC) which is affordable by every family in need. (Supariasa, 2002)
Signs of malnutrition
Anthropometric measurements, if the weight for age (W / A) compared with the table Z-score, if they are less than - 3 SD positive malnutrition then matched with a z-score (TB / PB against BB) where also positive malnutrition means including Chronic malnutrition when the TB / B is not positive, including acute malnutrition, if no measuring instrument TB and PB can also be followed by measuring LILA left part of infants, if LILAnya less than 11.5 cm then the toddler from acute malnutrition.
Clinical signs can be divided into three, namely:
a. Marasmus with signs:
Children are very thin
Face as a parent.
Wrinkled skin, very little fat tissue
Edema throughout the body, especially on the face rounded and swollen, dull hair, easily removed.
c. Combined marasmus and kwashiorkor called kwashiorkor at KMS marasmic there is also the term BGM is a state where the location of body weight infants are below the red lines bada KMS Toddlers BGM is not necessarily bad but the nutritional status of malnourished children under five that certainly BGM. (Abdur 2008)
Management of Malnutrition
Mother brought the child to be weighed at Posyandu regularly each month to determine the growth of body weight.
Mother give only breast milk to infants aged 0-4 months
Mothers still breastfeeding for children up to the age of 2 years.
Mother giving appropriate complementary feeding age and health condition of children as recommended feeding.
Mother immediately notify the health personnel / cadre when infants experience pain or
Kader do a child's weight every month at Posyandu and record weighing results at KMS.
For children with body weight does not rise ("T") is given a balanced nutrition counseling and PMT Extension.
Cadres give PMT-Recovery for underweight children do not go up 3 times ("3T") and weight below the red line (BGM).
Kader refer children to the clinic if found malnutrition and other comorbidities.
3. Nutritional Rehabilitation Centres (PPG)
PPG is a place nutrition services to the community in the village and can be developed from the Posyandu. Nutrition services at PPG focused on complementary feeding for infants KEP recovery. PPG handling carried out by a group of parents toddlers (5-9 children), assisted by a cadre for conducting PMT Recovery toddlers. Services that can be provided are:
Toddler severe PEM / malnutrition who are not suffering from other concomitant diseases can be served at PPG.
Kader provide nutrition counseling / health as well as the demonstration how to prepare food for children severe PEM / malnutrition.
Kader weigh children every two weeks to monitor changes in body weight and state of health record.
If the child's weight is in the yellow tape or below the red line (BGM) in KMS, cadres give PMT Recovery.
Food additives are given in the form of processed food and are given every day.
If the child's weight is in the yellow band on the KMS continue giving PMT recovery to 90 days.
If after 90 days, the weight of children not yet in the green color band on the KMS cadres refer the child to the clinic to look for other possible causes.
If the child's weight is in the green color band on KMS, cadres advocated the mother to follow the service in Posyandu each month and continue to implement nutrition and health advice that has been given.
4. Health Center
Puskesmas receive referral KEP Weight / malnutrition of Posyandu in its territory as well as patients from the inpatient hospital.
Selecting a way to reconsider the case and checked with Table W / Raw Median WHO-NCHS.
If it turns out the child's weight is below the red line (BGM) recommended a return to the PPG / Posyandu to obtain recovery PMT.
When children with severe PEM / malnutrition (weight <60% Table B / U Raw Median WHO-NCHS) without complications, the child can be treated in the clinic until his weight began to rise 0.5 Kg for 2 weeks and got PMT- P from PPG.
If after 2 weeks of weight does not go up, do the examination for evaluation of food intake and possible comorbidities, refer to the hospital to look for other causes.
KEP child weight / malnutrition with complications and no signs of emergency immediately referred to a public hospital
Actions that can be performed in the clinic in children severe PEM / malnutrition without complications
Provide nutrition counseling and dietary counseling severe PEM / malnutrition (done in a corner of malnutrition).
Perform a physical examination and treatment at least 1 time per week.
To evaluate the growth of children malnutrition weight every two weeks.
A demonstration of how to prepare food for weight PEM / malnutrition.
Do the recording and reporting of weight development and advancement of food intake