Plenary

Group 9B 1. Zulherman 2. Ulfia Rahmanita 3. Aulia Rahmi 4. Hidayaturrahmi F 5. Nova Suryati 6. Rahmi Fitri 7. Denada Leona F 8. Kurnia Fitra H 9. Feby Rahma Astri

5th Module Scenario 5 : The Story of the Tigo Kaum Village

At the event of weighing at Tigo Kaum in clinic was visited by The Regents, found a boy who was 17 months with his weight below the red line. This cause an uproar at the event . Head of clinic hurriedly instructs the child 's height measurement to the officer in charge of clinic nutrition programs . The results of these measurements indicate that the weight/height of the child was located on the z-score of less than - 3SD of the standard WHO - NCHS . At interview by Ms. Regent on the child 's mother and cadres posyandu found that the child is a fifth child , who was born with low birth weight ( LBW ) and do not get breast milk exclusively . Because the mother busyness for earn a living and education are low , the mother did not do enough ANC during pregnancy . On the interview is also known that in that current age of the child often falls stumble in the afternoon. On physical examination performed by a doctor on maternal , found that the mother also suffered from enlargement of the thyroid gland . Then the doctor immediately gave instructions to the person in charge of nutrition programs to provide Supplementary Feeding on the child and if the child needs to be sent to the Therapeutic Feeding Centre in the district .

I. Terminology
1 . Below the red line describe the state of a toddler with a Weight/Age is under the red line on the KMS , which showed that children suffering from nutritional problems .

2 . Z -score the lines contained in the WHO growth curve as an indicator of the growth of the baby .
3 . Standard WHO NCHS Anthropometric standards for assessing the nutritional status of a person . 4 . Supplementary Feeding nutrient recovery facility within the meaning of curative , rehabilitative and counseling facility is one form of activities such as the provision of food from outside the family , in order to Family Nutrition Improvement Effort program . 5 . TFC poor nutrition recovery center with child care and feeding intensively and adequately according to age and condition , involving the participation of parents .

Problems
1 . Why boys ( 17 months ) had a body weight below the red line ? Below the red line poor nutritional status in children . factor : a. age high prevalence of malnutrition at the age of 1-3 years . b . gender prevalence of malnutrition in many women . c . genetics d . nutritional status e . immunity status 2 . Why health center chief instructed the child's height is measured ? Measurement W / A is sensitive but not specific increased age would be followed by weight gain. To determine the long- term nutritional status can be measured height . 3 . Why W/ H are smaller than - 3SD ? How about the interpretation ? Causes : a. Direct : food intake is less than required , the disease b . Indirect : parenting , food availability in the family , health care , the environment .

Category and threshold of childrens nutitional status

Index Nutritional Status Threshold ( Z score)

Malnutrition
Weight for age ( W / A) Less nutrition Good nutrition Nutrition More Very Short Body Length by Age ( L / A ) or Short Height According to age ( H / Normal A) Height

<-3 SD
-3 SD until -2 SD -2 SD until +2 SD >+2 SD <-3 SD -3 SD until -2 SD -2 SD until +2 SD >+2 SD

Body weight for length ( W / L Skinny ) or Height Weight Loss by Normal weight / height ) Chubby Body Mass Index According to Skinny Age ( BMI / A ) Normal
Chubby

Very Thin

<-3 SD
-3 SD until -2 SD -2 SD until +2 SD >+2 SD <-3 SD

Very Thin

-3 SD until -2 SD
-2 SD until +2 SD >+2 SD

4 . What is the relation of labors history and breastfeeding with child's condition ? The fifth child busy mothers with many children , so that care and provision of food becomes less, so that children at risk of malnutrition . LBW disorder as result of not perfect organ maturation and the presence of complications. Not breastfed children risk for a disease . If a child is sick less intake . Children who drink formula at risk of glucose intolerance impaired absorption
5 . What is the relationship between mothers busyness for making a living , low education , and incomplete ANC with childs condition? Mother was too busy working child care to be less . Low education do not know the number and composition of proper nutrition. Low socioeconomic circumstances difficulty in providing nutrients. ANC incomplete mother does not gain knowledge about nutrition and care for pregnant women and children , how to breastfeeding , the risk of disease , etc. 6 . Why are children in that age often fall ? Children deficient in vitamin A disruptive changes in molecular radiation received by the retina to be an image in the brain impaired vision in less light (night blindness)

7 . What is the relation of an enlarged thyroid gland of mother with child's condition? Enlarged thyroid glands may be caused by iodine deficiency . If IDD occurs in pregnant women , fetus is risk to born with impaired psychomotor because in the first trimester iodine required for neuropsycologic development of the fetus .
8 . How are Supplementary Feeding administration ? Objective : achieve nutritional status and condition of good nutrition in according the age of a toddler . Indications : children with poor nutritional status : children with weight under normal : weigh in 3 times in a child's examination not showed improvement nutritional state Activities : provision of a snack or a full meal with small portions without reducing the amount of food eaten every day at home . Supplementary Feeding performed at least 3 times a week for 100-160 days. 9 . What can doing at TFC ? Objective : toddlers who are very thin or is under the red line . Activity : medical and nutritional therapy in children suffering from malnutrition with the aim of reducing child mortality .

Scheme

Boy 17 month
W / A below the red line Nutrition Programs

H/A

WHO - NCHS

W / H smaller than -3SD

Night Blindness

Malnutrition

IDD

Supplementary Feeding Failed

Without exclusive breastfeeding LBW Socioeconomic Low education

TFC