Education Category: Health
Ages: 4-8, 8-12

I've made a healthscreeningsprogramme for children who live in a township in port elizabeth. I have given education about subjects as: nutrition, sex, alcohol & drugs, eye vision and first aid.

Nutritional status

Sorts of nutritional statuses

There are several forms of nutritional statuses. These statuses are the following.

Acute under-nutrition (Underweight, thinness)

Chronic under-nutrition (too short for age)

Normal nutritional status

Over nutrition (Overweight)

Obesity (Overweight)

Acute under nutrition is a form that comes from eating no or a too small amount of food over a relatively short period of time. Chronic under-nutrition comes from having a too low nutrient intake starting during pregnancy until now. In a normal nutritional status there is enough nutritional intake per day. During over nutrition more food than the body needs is taken. The same goes for obesity however the amount of food that is taken is bigger.

Recognizing different forms nutritional status

The main goal of this manual is to measure the nutritional status with several instruments. However abnormal nutritional statuses can be seen by the bare eye. In some cases the given instruments are not valid. If this is the case this will be mentioned.

Acute undernutrition

Acute undernutrition can be found when the child has had a low nutritional intake for a relatively short period. Acute undernutrition can be deadly when not recognized in time. The body mass index can be used to recognize this situation. (

Thinness:

Skin and bones appearance as well in front as in back.

Thin ‘old mans’ face

Loose skin around the buttocks/hips resulting in a baggy pants appearance.

In this case the child must be referred to a doctor or medical clinic to further assess the child’s nutritional - and health status.

Figure 1Thinness

Bilateral oedema

Figure 2: Bilateral oedema                                              Figure 3: Severe bilateral oedema.

In this situation the BMI is NOT reliable. The main cause of oedema is the lack of proteins in the childs body. Without the required amount of proteins the body fluids will be transported from the blood vessels to skin cells.Because extra fluids are held inside the body the weight measurement is not reliable anymore for using the BMI calculation. There can be tested on oedema by pushing into the swollen parts of the body. If a mark as seen in the upper picture stays behind you can be sure there is oedema.

Both sides

Starts in feet

When status gets worse

Lower legs hands and under arms, upper arms, face

BMI not reliable

Chronic under-nutrition

In this situation the child has had too little nutrients too grow according to the growing curve. This process starts during pregnancy and will continue during growth. This status is measured by measuring the height for length curves.

Normal nutritional status

In this situation the nutritional status will fall within the normal limits of the BMI curve. The child will be in between +1 and -2 on the BMI curve.

Overweight and obesity.

The nutritional intake higher than what is used. The child will fall in +1 of the BMI curve. In case of obesity the child will fall in +2 of the BMI curve. The child will look fat. Arms look thick and in some cases children will develop an extra ‘chin’. The belly will start to hang over the pants. When you press into arms or other swollen parts there is no mark left as seen in oedema.

Figure 4Overweight child (methodsofhealing)

Taking measurements

Frequency of measurements

It is advised to measure height on a yearly basis. This is supposed to be done as well with measuring weight. After measuring length and weight a BMI must be calculated. When a learner is expected to be acutely undernourished length and weight should be measured again and a BMI should be calculated. Action needs to be taken when the child falls within the thinness line. (See calculating BMI)

Measuring height

Length has to be measured in the following steps and always with two caregivers.

Explain the learner what is going to happen

Tell the learner to take of his off her shoes and if needed it’s hair knot or other hair ornaments and bulky clothes.

Tell the learner to stand with its back towards the height chart with its back in the middle.

The assisting caregiver pushes the ankles into the wall if needed

The learner has to look straight forward with his head parallel to the wall.

Use a book or something similar to put onto the head and read the height from the measuring tape on the wall as secure as possible on the lower side of the book. The book has to be put straight onto the wall before reading the measurement.

When read speak out the measurement, the assisting caregiver repeats it and writes it down.

Tell the learner to put his or her shoes back on again and thank him or her for cooperating.

Figure 5: Measuring height (cdc.gov)

Point of attention

The children must be calmed down when panicking. It is important to maintain good posture during the measurements. Before measuring length make sure the child is not standing on his or hers toes or heels and knees are not bend.

Measuring weight

Measuring weight always needs to be done by two caregivers. Privacy needs to be taken into account and all doors and curtains need to be closed when weighing is done.

Tell the learner what is going to happen and what the purpose of weighing is.

Let the learner to remove all clothes besides underwear

Let the learner stand in the centre of the weighing scale

Record the weight to the nearest refraction. If 12.55 record 12.6 if 12.54 record 12.5.

Figure 6Measuring weight (cdc.gov)

Body Mass Index (BMI)

Purpose

The BMI is used to make an assessment on the persons nutritional status in being normal weight, overweight or underweight.

How to calculate

The BMI is calculated using the following formula:

Weight in kilograms/(length in metres * length in metres) = BMI

If the calculator used to calculate the BMI does not allow to calculate the BMI at once the following steps can be followed to calculate a correct BMI.

Step 1: Length in metres * Length in metres = Length in metres²

Step 2: Weight in kilograms/Length in metres² = BMI

Point of attention

When a child shows signs of oedema a BMI is not reliable anymore for measuring the nutritional status because of the weight of the fluids that are held by the body.

Length for age curve

Purpose

The length for age curve is used to measure if a child is long enough for his or her age. If a child is too short for his or her age it might be the case that there is chronic malnutrition which starts during pregnancy. This starts when the mother does not eat enough during pregnancy. This process continues during growth of the child when not enough food is given.

How to use and fill in the curve.

On the horizontal axis you can see the age in years divided per 3 months. On the vertical axis you can see the length. On the table itself you can see several curves. Curve 0 indicates the global average on length for age. Every curve with a negative curve number indicates a below average. Every curve with a positive number is above average.

When you fill in the curves you can use a ruler to draw a light line starting from age and going up. After that you can draw a line from the vertical axis starting from the length you measured. The place where these lines cross is where the learner is right now in the curve.

There are curves for girls (figure 7) and boys (figure 8) so make sure you fill in the right curve and are aware of the birth date of the boy or girl.

Body Mass Index for age curve

Purpose

The purpose of this curve is to find out if a child is too light or too heavy for its length and age.

How to use and fill in the curve

On the horizontal axis the age is shown. On the vertical axis the BMI. The curve works similar to the height for age curve. However before you can fill in the curve you must calculate the Body Mass Index. After you’ve calculated the body mass index you can draw a vertical line from the bottom of the horizontal axis. After that a horizontal line starting from the BMI until it crosses the vertical line which started from age.

Similar to the height for age curve there is one for boys (figure 10) and one for girls (figure 11). Yet again it is important to use the right curve.

Introduction

The principle wants to map the physical health status of the children on Sapphire Road Primary School. For this reason a screening programme was developed by volunteers of Ready4Life.

This manual can be used to learn how to use the screening instrument for measuring nutritional status. The screening instrument chosen for screening is used worldwide and is developed by the World Health Organization (WHO). In developing this instrument extensive research on global scale has been done. These scales have proven themselves in measuring malnutrition in projects of for example UNICEF.

Wrong nutritional statuses are a problem throughout South Africa. However, the Eastern Cape has one of the highest rates of malnutrition in South Africa. As told by the principle and caregivers some children only get their once a day meals at school so wrong nutritional statuses are to be expected. However it should be taken in to account that underweight isn’t the only problem, some children might be overweight as well. It is up to you, caregivers to weigh, measure the length and observe these children in a correct way so that the nutritional status on all the children can be visualized, documented and seen.

This manual will start with the basics of taking measurements and then continues with calculating the Body Mass Index (BMI). After that using the length curves and BMI curves will be explained. It is important to first measure length and height in a correct way before a correct BMI can be calculated.

I want to thank you for your efforts in helping too clarify the health status of these vulnerable children whom you are giving a voice.