MALNUTRITION
Ashley Merritt
ID: L29215326
July 12, 2018
Health 505.B02
Abstract
Malnutrition is used to describe a deficiency, excess or imbalance of a wide range of nutrients, resulting in adverse effects on body composition. Nutrition can be both over or under-nourished. Usually, it is individuals who are undernourished. Malnutrition occurs in the majority of individuals who have psychosocial issues. Malnutrition is connected with many chronic diseases and is also associated with increased morbidity and mortality.

Introduction
Malnutrition is a serious condition that occurs when a person’s diet does not contain the right amount of nutrients.1 In other words, malnutrition is just another word for having poor nutrition. There are two different types of malnutrition; you have undernutrition which means there are not enough nutrients going into the body and you have overnutrition which means the body is in taking too many nutrients. Most individuals diagnosed with malnutrition are in the category of being undernutrition. Nutrition is a standard health issue and needs to be known. Malnutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and decreased productivity.2 Within malnutrition there are also cases such as complicated, severe uncomplicated, and moderate uncomplicated malnutrition. Each is having their symptoms and ways to manage each one.
Background
Psychiatric Health Facility (PHF) in Santa Barbara County have place policies and procedures needed to follow if they feel a patient is not well-nourished. The purpose of this policy is to evaluate and document that the nutritional status of patients and identify those at risk to provide appropriate nutrition care.3 PHF policy is to screen patients for dietary dangers upon admission. If the admitting nurse identifies nutritional risks, a referral to the PHF Registered Dietitian (RD) shall be made for a nutritional assessment. The RD is responsible for the ongoing monitoring of the dietary interventions and conducting nutritional reassessments as needed. The nutritional assessment will be completed by the RD within 72 hours. They have been implementing this process since 2011 and is currently still successful. As part of the care plan’s review, the RD will investigate any nutritional interventions implemented to ensure they are useful and continue to be appropriate. If the RF recognizes the interventions are ineffective, or he/she identifies additional nutritional issues and risks, a dietary reassessment will be completed.3
Policies and procedures are usually the same in a doctor’s office. Diagnosing malnutrition can be done by just collecting blood samples to see if the patient has any vitamin or mineral deficiencies. While completing my research, I did not find any disastrous policies and procedures. Anything that was unsuccessful was from malpractice and was not continued to be talked about in the article.
Current Research Efforts
One of the current research efforts is of children under the age of five in India. It was reported that under-weight among under-five children ranged from 39% to 75%, stunting from 15.4% to 74% and wasting from 10.6% to 42.3% in different parts of the country.4 This is causing issues because the children to not know that they are not in taking the right nutrients or their parents are not educated or do not have the right funds in order to make sure their child has all the nutrients they need. There are various risk factors that showed an association with under-nutrition among under-five children. West Bengal study found that significantly higher proportion of malnutrition among female children compared to the males were among the higher birth order and those belonging to families with lower per capita income.4 We need to find more researched evidence as to why females have a higher risk at being malnourished than males. It is known that malnutrition rate is higher in low income areas because they do not have the funds needed to have their children seen by doctors. During this same research it is known that the place of residence, household income, size of child when born, maternal education about nutrients when pregnant, number of children under the age of 5 in the household, and source of drinking water were strong predictors of the children that are undernourished in developing countries. It has been noted that since 1990 the global prevalence of stunting has decreased by about 36 percent, from an estimated 40 percent.5 This goes to show that people are trying to find ways to help but stunting is something us as people cannot control unless the mother can give the child the nutrients needed to live. At the end of the 2012 Olympic Games, the United Kingdom’s (UK) Prime Minister hosted a summit on global child malnutrition, the Global Hunger Event, that brought together leaders from the developing world, the private sector and international development agencies to chart a new course of action aimed at slashing the number of stunted children by 25 million before the 2016 Olympic Games in Brazil.5 The issue with this is that it may have been partially effective but there are still too many undernourished children in all developing countries.
Haiti is the top country with malnourished children. One in three children are stunted in Haiti, while 100,000 suffer from acute malnutrition.6 We as people need to help find a solution to help these developing countries find ways to feed the children. This is not the only country suffering from low income families not having the funds needed to support themselves, let alone their entire family.
The Outpatient Therapeutic Program (OTP) for treatment brings the management of Severe Acute Malnutrition (SAM) closer to the community. Many lives have been saved through this approach, but little data exists on the outcome of the children after discharge from such pro- grammes. This study was aimed to determine the survival and nutritional status of children at six months after discharge from OTP for SAM.10 When researching what happened to the children after being discharged was that 93.4 percent of the patients who followed up were alive while the other 6.6 percent had passed away. For the individuals that are still alive, they are in good nutritional standings. This study had a high success rate because they kept with the study and did not just discharge the children, they followed up with their progresses.

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Discussions
Malnutrition is a subject that needs to be talked about more. Children all over the world are having issues with nutrition, and some families are not educated on the subject of malnutrition. Malnutrition has the worst damages during pregnancy and early childhood, this is from conception to the first two years. Stunting is another issue when it comes to malnutrition. Stunting is not only of the growth of the child but also can hurt them in education. Having stunting in school is a result of underdeveloped brain and impaired motor skills. According to UNICEF, stunting in early life is linked to 0.7-grade loss in schooling, a 7-month delay in starting school and between 22 and 45 percent reduction in lifetime earnings.

When growing population sizes cannot be sustained with limited natural and economic resources, shortages, including those involving food, often quickly follow. Unfortunately, it is often the children who suffer the most in countries where hunger is an everyday fact of life. When reviewing the data herein, it is essential to keep in mind that “food availability” does not necessarily denote caloric intake/per person/per day.6 The top ten countries that have the most malnourished children or individuals, in general, are those of developing countries. These top ten countries are Haiti, DR Congo, Chad, Kenya, Ethiopia, Mozambique, Madagascar, Tanzania, Sierra Leone, and Guatemala. These countries need to be educated on the significance of malnutrition. Even if there were ways that us as people could send help to these developing countries to be able to help nourish those individuals that are lacking nutrients needed to survive. In the UK, many cases of malnutrition in children are caused by long-term health conditions and hospital treatment is often required.1
Complicated malnutrition means that the individual is less than 80 percent of the median weight of people their age, have bilateral edema, anorexia, lower respiratory tract infection, high fevers, severe dehydration, severe anemia, and altered level of consciousness. These are all the factors that can show that an individual has malnutrition and it is at a higher rate. These cases are ones that receive inpatient therapeutic feedings and medical care.7 Severe uncomplicated malnutrition is close to complicated malnutrition. Severe uncomplicated malnutrition individuals weigh less than 70 percent of the median weight for their height and can have one of the following, bilateral edema or mid-upper arm circumference of fewer than 110 millimeters. With those two aspects, the individual would also have an appetite, are clinically well, and are still alert. This is managed by outpatient therapeutic feedings and care. Lastly, moderate uncomplicated malnutrition is another form. These individuals are 70 to 80 percent of their median weight for their height. When this is discovered, they would then be diagnosed with no edema or having a mid-upper arm circumference of 110-125 millimeters, and also have all the following, appetite, are clinically well, and are alert. When diagnosed with this type of malnutrition they are also seen in outpatient and receive supplementary feedings.7 The rates of malnutrition are not decreasing; they continue to increase. These are because people are not educated about this concept and do not know that this is a disease.
Endemic poverty is perhaps the one feature common to almost all causes of malnutrition. Over 2 billion people live on less than $2 a day, and many rely on small plots of land as their main source of food and income. Without savings, and when harvests fail from drought or deluge, malnutrition is inevitable.7 If we could educate the developing countries on the way to at least help their children not develop malnutrition by knowing what they should eat would help the number decrease. Treating malnutrition once it has been recognized and when resources have been provided is relatively straightforward. Anthropometric surveys can be conducted rapidly, and therapeutic feeding centers constructed and put into operation. In addition to food supplementation, initiatives to combat vitamin A, iron and iodine deficiencies are required.7
Responsive complementary feeding, whereby the mother feeds her child in response to child cues and psychomotor abilities, if low, can contribute to malnutrition. A recent study among 8-20 months old children showed that the responsive feeding intervention provided significant improvements in children’s self-feeding and mother’s verbal responsiveness, but not weight gain. Weight gain required more nutritional availability, especially in areas of high food insecurity.4
Recommendations
Every individual who is diagnosed with being anorexic or bulimia should be tested to find out if the potential of being malnourished could be the issue. A large portion of the world’s undernourished population suffers as well form an inadequate intake of essential vitamins and minerals.8 These vitamins and minerals are vitamin A, iodine, and iron are the main deficiencies that are checked for when looking to see if the patient could be diagnosed with malnutrition. The first is wealth. Families themselves recognize this as important. Focus group discussions among mothers in Gambia revealed that poverty is one of the key constraints preventing mothers from putting into practice their knowledge of child health and nutrition.9 I feel that being wealthy is not a prime reason why their children would not be malnourished. Yes, they would be able to take their children to the doctor to know if they would be malnourished and have the money for them to eat the right foods, but this could lead them to being over nourished, which is still a form of malnutrition.
Education is a second key factor. Children born to Nairobi mothers who had been educated to primary level had a 94% lower chance of stunting than those born to mothers with no education.2 I believe that education is a key factor for parents to know if their child could be malnourished. Having the right education could lower the number of people being malnourished or even stop malnutrition all together. All parents should be educated when they learn they are pregnant. This would help with preventing the children with becoming malnourished. Also, teach the mothers that breastfeeding can help the child. At least try to breastfeed the child to get the right nutrients. However, breastfeeding is not universally practiced. Researchers at Nanoro HDSS in Burkina Faso who conducted a multi-center study of women infected with HIV, highlighted the size of the task facing those engaged in breastfeeding promotion efforts. In sub-Saharan Africa, fluids other than maternal milk are often introduced within the first six months of life, notwithstanding WHO guidelines that recommend exclusive breastfeeding for the first six months.2 Reading about certain deficiencies and how they can be avoided is one of the small things someone can do to educate themselves and pass on to others. Vitamin A deficiency (VAD) is the single most important cause of childhood blindness in low-income countries.8 If they were educated they would know as people that their child needs vitamin A to help their bodies. Iron deficiency which is also known as anemia, is one of the minerals needed to have in your body. Anemia is one of the common attributes to malnutrition.
Knowing that malnutrition is an issue when someone is diagnosed with cancer should be known to all. They should make sure that all patients are eating the right diet and consuming the right vitamins and minerals. Cancer Treatments of America breaks malnutrition in to two categories: not getting enough calories, protein or other nutrients like vitamins and minerals, which can be from the disease, its treatment or various other related complications that can affect appetite and how the body digests, absorbs and uses food; or the consumption of too many calories, which can lead to weight gain and excess weight, which in turn, can increase the risk for cancer recurrence, secondary cancer or another chronic illnesses like heart disease or diabetes.9 Cancer patients already have enough on their plates let alone add another disease to the picture. They should not have to deal with this time of things. They should be told that the need to intake the extra nutrients to make sure they are staying healthy besides having the cancer.
Another way to help prevent becoming malnourished is eating a well-balanced diet. Knowing what foods, you should be intaking is one of the most important aspects. There are four main food groups that an individual should be eating from. First is fruits and vegetables, these should be eaten at least five times a day. Second, would be the carbohydrates which should be consumed at least twice a day. An individual should intake milk and dairy foods at least three times a day and protein related foods at least five times a day as well. Eating these foods could help prevent individuals from not have the nutrients needed in their diet. If malnutrition is caused by the underlying health condition, you may have more complex dietary needs, or you may need additional items in your diet such as nutritional supplements.1
Strengthening public health interventions for mild malnutrition cases among the vulnerable groups with a focus on socioeconomic development and research on overweight, obesity and its etiological factors in the country are the prerequisites required to tackle malnutrition among under-five children in India.4 The prevention of malnutrition is a global collective problem. Providing food and medical care to malnourished populations is but a stopgap measure. Generating real change will only come after a united global community creates peaceful and imaginative solutions.7 All individuals need to come together to create a plan in order to stop malnutrition. It is not something that is going to stop over-night. It is going to take time, even if there was a board able to be created for individuals to sit down to discuss these issues and decide what the next steps could be. Without having this global malnutrition rates are going to continue to increase and this will cause larger issues in the end. The mortality rate will continue to rise if we do not find a way to help these families out.

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