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30.01.2016
At just more than 100 calories per cup, nonfat cottage cheese is considered a low-energy-density food. Cottage cheese is a good source of protein, as each cup contains 15 grams of this important nutrient. Each cup of nonfat cottage cheese contains 125 milligrams of calcium, which is the most prevalent mineral in your body. By buying nonfat cottage cheese instead of the regular variety, you help minimize your intake of saturated fat. Despite the health perks, nonfat cottage cheese may contain about 540 milligrams of sodium per cup -- nearly one-fourth of the 2,300-milligram daily maximum recommended for healthy adults. For heart health, aim to include two portions of fish per week, one of which should be oily. A diet high in fat, especially saturated fat, is linked with an increased risk of developing coronary heart disease. Try to take sugary foods only at the end of a meal and not between meals, to prevent tooth decay. Good nutrition is one of the factors that can help to promote better health and to prevent disease, illness and low birth weight in newborn babies. Malnutrition results from or is the end result of diverse and interrelated factors that may operate singly or in combination.
While a woman is breastfeeding, she needs extra protein and calories to keep her own body strong and to produce enough milk for the baby. In this unit we shall look at how nutrition is a major determinant of health and growth of children. Define these terms: nutrition, nutrients, baby friendly hospital initiative (BFHI), protein energy malnutrition (PEM), and growth promotion monitoring (GPM). Discuss the role of the health worker and the community in prevention and control of malnutrition.
Having defined the word nutrition, let us discuss foods commonly eaten in our community and their nutrients. It may sound a little strange or even silly to ask the question “What is food?” But think about it. Although most foods are mixtures of nutrients, many of them contain a lot of one nutrient and a little of the other nutrients.
Now that you know about nutrients, go back to the list you made of common foods in your community.
If children are to stay healthy they must eat a mixed diet of different foods which contain the right amount of nutrients.
Pregnant women need protein nutrients to build their bodies an that of the babies and placentas, and to make extra blood and storage of fat. Now that we know why we need protein, the next thing to think about is the kind of food that contains it.
All animal foods contain more protein than plants and are usually better sources of body building foods. Similarly, energy foods have a higher concentration of carbohydrates compared to other nutrients. Fats and oils are a concentrated source of calories and so are important nutrients for young children who cannot eat large meals. Fat is present beneath the skin as an insulation against cold and it forms a supporting tissue for many organs such as the heart and intestines.
Fats and oils are the best energy foods there are, but they are also so expensive that many families cannot afford them. Good staple food such as wheat, maize, rice and millet contain about 8% protein and are thus much better than staples like bananas and cassava which only contain about 1% of protein. Vitamins are organic substances present in minute amounts in foodstuffs and are necessary for metabolism.
Vitamin A and its deficiencies will be explained more in the section on common nutritional problems. Vitamin C is found in many fruits such as oranges, lemons, guavas, and tangerines and in green vegetables. Vitamin D is important in the formation of bones in the body it helps calcium to be deposited in the growing bones of the children. Fibre is composed of material that is not usually digested so that it passes through the gut nearly unchanged. As a health worker you play an important role in up lifting the nutritional status of your people.
In order to achieve this, you need to advise members of the community in the following areas. As you can see, most of those areas are the responsibility of extension agents from the agricultural livestock or fisheries departments. Think and write the answer to the following question: What do people in your community do in an attempt to increase food production?
To increase and improve food production a farmer needs to grow plenty of food as well as a wide variety of crops in order to meet the family's dietary requirements. Food should be equitably distributed, not only between communities, but within families as well. Improving communication to ensure that excess stocks in one area reach another area short of that commodity. Fair distribution within the family to ensure a fair share of protein-rich and other foods for children.
Instituting mid day meals for day-school children, encouraging children to take food to school, supplying milk at school, improving meals at boarding schools.
Having looked at the above factors in relation to food distribution, how does transport in your area affect food distribution? Control insects by use of insecticides, better food stores and use of airtight food containers. Control fungus and food rot by storage of food in as dry a state as possible and by use of better containers. Proper food processing can ensure that nutrient values of food are maintained at the highest possible level.
List some of the vegetables and fruits that are preserved in your area and how this is done.
As we mentioned earlier, some of the activities necessary to ensure food production and security need the involvement of an agricultural officer. If sick children are not treated in good time, their nutritional status can suffer and this can result in malnutrition. Take an opportunity within your community to give nutrition education in schools, clinics, wards, etc.
Distribute pamphlets and posters, and publicise nutrition facts through radio broadcasts, etc. Offer demonstrations of the preparation and cooking of food, especially food suitable for children. Having gone through this section of food production and security, you should now recognise that if children are going to eat enough of the right kind of food, the community must know how to increase and improve food production, distribution storage and processing. The Ministry of Health recognises the importance of breastfeeding for the healthy growth and development of infants. You should encourage mothers to breastfeed their babies because of the multiple benefits to the child, to herself, to her family and to society. Oxytocin, a hormone that is released while breastfeeding, contracts the uterus and helps to stop bleeding after delivery.
Frequent breastfeeding delays the return of menses in some women and helps to protect against another pregnancy. There is no worry about infant formula shortages due to poor distribution, drought or crises. The cost of an adequate diet for the mother is less than the cost of feeding a baby with artificial formula. The costs of medical consultation, medicine, laboratory tests and hospitalisation are reduced because mothers and babies are healthier. Unlike the prolactin reflex, a mother’s thoughts, feelings and sensations influence the oxytocin reflex. Always advise mothers to hold their baby in the correct position and to sit or lie in a comfortable position (see Fig.
The Baby Friendly Hospital Initiative is a global campaign that gives health care and provides a leading role in the promotion, protection and support of breastfeeding.
The health facility first sets up some rules regarding breastfeeding that are to be routinely followed by all health staff.
Show mothers how to breastfeed and how to maintain breastfeeding even if they are separated from their infants. Give newborn infants no food or drink other than breast milk for the first 4-6 months of life unless medically indicated. Give no artificial teats or pacifiers (also called “dummies” or “soothers”) to breastfeeding infants. Encourage the formation of breastfeeding support groups and refer mothers to them on discharge from the health facility. Ensure that all infants delivered in the health facility receive BCG and Polio vaccines before discharge. When all twelve steps are fulfilled, your unit can be assessed and rewarded for being baby friendly. There are a few common problems that mothers can have with breastfeeding, especially in the first one or two weeks. The health worker is a very important person who can support and encourage a new mother so that she breastfeeds successfully.
The mother should be taught to pull out the nipples and gently press out a few drops of fluid. As you learned in Unit 3, if the breast is not emptied normally it becomes painful and swollen with milk. To prevent sore nipples, the mother can keep the skin soft by rubbing the areola and nipples with some oil. Cultural beliefs and practices affecting breastfeeding: Many cultural and local beliefs can affect breastfeeding. We know very well that all people have their likes and dislikes and their beliefs about food. While we examine bad cultural practices, we should also keep in mind the recent influences that are changing good breastfeeding practice.
As a health worker you should act to reduce the effects of these negative influences on breastfeeding. It is very important for you to find out which foods are grown locally in your area and which foods are available in shops and markets. The above foods, as well as providing energy and protein, will also provide vitamins and minerals. When a caretaker is beginning to give supplemental foods to a breastfeeding infant, certain practices should be put into place. If cooked food is prepared two hours in advance, boil it again before feeding it to the baby. You have learned that weaning is a process by which an infant is gradually introduced to the adult diet. Growth promotion monitoring (GPM) is usually carried out in young child clinics or in the community. Plotting children's weights on growth charts allows parents and health workers to see how they are growing.
Families and health workers can identify children with growth failure early when it is easy to help them. Growth Promotion Motoring gives you a chance to meet mothers regularly and deal with problems quickly.
A Salter scale has one hook above to hang from a beam or a branch of a tree, and one hook below from which hangs a pair of pants in which the child is placed.
Some health units have been supplied with uni scales which come with instruction on how to use them. Why do you think parent fail to bring the health cards along each time they bring their children for weighing?
A local events calendar helps much more in estimating the ages of younger children before the age of four years. The most common type of weighing scale in our health units is the salter scale, which we have already described.


Hang up the scale securely, keeping the dial at eye-level so that the weight can be read easily. Put the loop of the trousers over the hook of the scale and ask the child to hold on to the straps that hold the pants (if the child is old enough to understand). 6.Remember the dot should be placed in the middle of the column corresponding to the month of weighing. Sometimes you will come across a weight line that is rising much faster than the reference line, as in the left-hand illustration in Fig. A weight line that is flatter than the reference line means that the child is gaining weight too slowly.
The position of the line on the chart: The slope of the line is more important than its position on the chart. It is very important for you to take as much time as possible to explain about the Growth Chart to the caretaker. The top line represents the average growth line of healthy children in a well-nourished community. A note should be made on the Growth Chart of important events that affect the child’s growth and health. Similarly, the day that the baby is first given food other than breast milk, the day when the child is weaned, and the birth of another child are important events.
There is a box at the top of the Growth Chart marked “Reasons for special care.” Some of the factors listed may make a child particularly vulnerable to malnutrition.
How can information from the Growth Chart be used to help a community improve health and nutrition? The information from Growth Charts can be used to show a health unit staff how nutrition in the community is changing from one time to another. Discuss this type of information with other community workers, especially those working in the fields of agriculture and community development. Remember: In order to detect growth failure and prevent malnutrition, encourage caretakers to have their children weighed regularly – at least once every two months, even if the child is not ill. You must have JavaScript enabled in your browser to utilize the functionality of this website.
Augason Farms Country Fresh 100 percent Instant Nonfat Dry Milk is a first-rate substitute for the real thing, and a useful part of any food storage program. This diet-friendly food is rich in calcium and protein, and it's versatile enough to be eaten plain or in recipes such as lasagna.
This means that it provides relatively few calories in a high volume, filling you up without guilt. Every cell in your body uses protein, and you rely on it to build strong muscles and maintain healthy skin.
Saturated fat is found in meat, full-fat dairy, lard and other animal products, and it's linked to high cholesterol levels.
While low-sodium nonfat cottage cheese is rare, low-fat versions sometimes come with no sodium added.
It is used to showA the proportions and types of different foods from the five food groups that should be included in a healthy diet. Similarly, good nutrition is an important factor in helping a child achieve normal growth and development.
We feel that this is an opportune time to discuss nutrition because good nutrition has far reaching consequences on everybody, but more so on children. In most parts of the country we are lucky to have plenty of natural resources, favourable climate and adequate food supply. The immediate factors that affect nutrition are food availability and intake, and the state of health of the individual or community. This is because there has been a lack of appropriate information about the magnitude of the problem. During pregnancy the mother must eat enough to supply the nutritional needs of two people – herself and the developing foetus. Meanwhile, small children require a lot of food because they grow quickly and use a lot of energy in their activities. This is not a very good message because it tells us to eat any food, and not food with particular nutrients that we may need such as proteins, carbohydrates etc. Even though plant proteins are usually not as good for body-building as animal proteins, they can become better by mixing them.
They provide the energy in the form of calories the body needs for work and other functions. Further, some foods contain higher concentration of one nutrient, for example meat has more protein than it has other nutrients, and that is why it is classified as a body building protein food. It must be remembered that the fat in the body is not necessarily derived from fat that has been eaten. People who have high protein food, as staples are usually better nourished than those who have low protein foods as staples. People need folate to make healthy red blood cells, to help some body processes to happen, and for growth Lack of folate is a common cause of anaemia among pregnant women, people who have malaria often and sometimes, young children. You have to make sure that you improve the quantity and quality of food eaten with the aim of ensuring an adequate diet at all times in every household.
However if you want your nutritional programme to succeed, you will have to work hand in hand with them. A sick farmer who is down with malaria may delay in planting because he is too weak to clear his field.
However, as you are well aware, there are some communities that produce enough food with good variety, yet they have many children who suffer from malnutrition. You can do this through asking government and respected leaders to include the topic in their speeches. The health workers, community development workers or science teachers can do this at clinics or schools. A child can be breastfed exclusively, without the introduction of other foods or liquids, until he or she is 4 to 6 months of age. Therefore, the Ministry is committed to the promotion, protection and support of breastfeeding in Kenya. Exclusive breastfeeding is when a baby is fed on breast milk alone without giving any other foods or liquids for the first six months of life.
Breastfed babies have less diarrhoea, and fewer gastrointestinal and respiratory infections. This is why it is so important that breastfeeding begins immediately after birth and continues frequently. There is no need to purchase breast milk substitutes or feeding equipment, and no need for extra fuel or water.
If you watch a woman breastfeeding, you sometimes see fine streams of milk flowing from the nipple. If a mother is worried or afraid for some reason, or in pain – especially if breastfeeding is painful – or embarrassed, it can hinder milk ejection.
You have seen that if something touches the side of a baby’s mouth, the baby opens the mouth and turns towards it.
You as a health worker, especially when you are working in a facility with a maternity unit, have an important role to play in protecting, promoting and supporting breastfeeding. The mother should give the baby the breast every time the baby indicates a need to breastfeed. If you find that the above information on BFHI is inadequate, you can discuss the matter with your supervisor who will give you more information about BFHI. The most frequent are a mother’s anxieties about her performance and the amount and quality of her milk. A blocked milk duct in the breast can sometimes cause a tender lump in the first week of breastfeeding. Sometimes germs enter the breasts, perhaps through a crack in the nipple, and this causes infections. As a health worker it would be very important for you to find out about feeding practices in your community. Here are some useful questions that may help you find out about infant feeding practices in the community.
Feeding habits, however, can be changed as a result of both the influences of other people and sensible adaptation to local circumstances. These influences include the urban way of life, women working away from home to earn additional income, the advertising of infant foods, and the idea that breast milk substitutes are modern and therefore better. Encourage the development of useful cultures such as breastfeeding a child exclusively for six months, and gradually introducing foods while continuing breastfeeding.
This is because at this stage the breast milk is relatively deficient in iron and an infant’s store of iron is sufficient only until about 6 months of age. Legumes such as beans, peas, lentils, cowpeas and groundnuts are good sources of protein and should be added to the diet of the child.
Additional vitamins and minerals can be obtained from dark green leafy vegetables and coloured fruits. By the age of 2 years, breastfeeding will usually have ceased and the child is completely weaned.
You have identified the local foods used for weaning and how weaning is done using these foods. The growth and development of the brain requires adequate nutrition just like other parts of the body. If the child is gaining weight at the same rate as the reference line, the parents know they are caring well for the child. Body weight is the simplest measurement, and in children, change in weight is the most reliable indicator of growth.
You should remind the caretaker to bring the card every time they visit the health unit with the child. In such cases you can estimate the age of a child by asking the caretaker certain questions and by using a local events calendar.
Weighing a child requires reliable equipment and a standard method to achieve accurate results. If a child’s weight on the first weighing is much below the lower line there is some reason for concern, and you should look for the reason. However, a small child who becomes ill or has a poor diet has less body stores of fat and other nutrients and so is more at risk of under-nutrition than a bigger child. Nearly all (97%) well-nourished children should fall above the lower curved line on the chart. Examples of events that can affect a child’s growth and health are listed at the bottom right hand corner of the inside of the Growth Chart.
Particular groups of people or people living in particular places might be found to be more malnourished than others.
Best when stored in a cool dry place at temperatures between 55F and 70F (ideal humidity 15 percent). She has a philosophy degree from the University of Colorado and a journalism certificate from UCLA. For added flavor, try your cottage cheese topped with berries, a teaspoon of honey or a sprinkle of granola. The Centers for Disease Control and Prevention recommends that you should eat these types of foods for weight management; other examples of low calorie, high nutrient foods include fresh fruits and fresh or steamed vegetables. For context, the 2010 Dietary Guidelines for Americans recommends that you get 10 to 35 percent of your daily calories from protein.
Regularly eating calcium-rich foods may help prevent osteoporosis, a condition in which bones become brittle and more prone to fracture.
High cholesterol increases your risk of heart disease and stroke, so cutting back on saturated fat can be important for your health. A cup of cottage cheese with 1-percent milk fat and no added sodium may contain about 2 grams of fat -- of which 1.5 grams is saturated -- and just 30 milligrams of sodium.
We learned that counselling and health education can influence positive behaviour change, resulting in better health and fewer illnesses among our children. Despite the apparent abundance of food, however, malnutrition and under-nutrition still exist and are now a major public health problem, especially among children and women of childbearing age.
These factors interact and are also affected by socio-cultural, political economic and environmental factors. There has also been inadequate information about the relationship between nutritional status and socio-economic development. If a pregnant women fails to take in enough of the right kinds of foods, both she and the baby inside her will suffer.


One possible definition is as follows: Food is any substance that contains a nutrient which, when eaten, nourishes the body.
Foods that contain a lot of protein are called body-building foods because protein is the most important nutrient in them. For example, the importance of fibre lies in keeping up the bulk of the contents of the intestinal tract and binding them in the large intestine into a soft faecal mass that can be properly expelled. The cells of a child's body also wear out, so a child needs protein for repair as well as for growth.
We shall also see that they are very important because they are cheaper and much easier to grow. Excess calories from a carbohydrate source such as maize, cassava, or banana can be converted into fat in the human body. For example, if a child is fed only on almost pure carbohydrate foods like cassava, he will not grow. For example, Masai have milk as the staple food as compared to the Luo whose staple is ugali. They are grouped together not because they are chemically related or have similar physiological functions, but because, as their name implies, they are a vital factor in the diet. There are various types of Vitamin B, such as Vitamin B1 (thiamine or aneurine), Vitamin B2, (Riboflavin), and Vitamin B12, (cyanocobalmim), nicotinic acid and folic acid. Deficiency of Vitamin B2 (riboflavin) causes angular stomatitis, sore cracked lips, and glossitis. The minerals that are of most importance in human nutrition are calcium, iron, iodine, and fluorine.
Similarly, a malnourished farmer may only plant cassava instead of maize because he doesn't have the energy to work hard. The goal for the MOH is that all women in this country be empowered to practice exclusive breastfeeding.
When the baby begins to feed, two hormones make the milk come in the right quantity and at the right time. Once a baby sucks at the breasts, the nerve endings in the nipples send messages to the pituitary gland to release prolactin into the bloodstream.
A bad sucking position can contribute to many common problems, such as sore nipples, not enough milk, or refusal to feed. This is a world-wide effort to ensure that mothers give their babies the best start in life.
As a health worker, you should give encouragement, support and comforting answers to the mother’s questions. Sometimes the baby is too weak to suck all the milk, and sometimes it is just more than the baby needs to drink. Placing a cold cloth on the breast just after milk has been removed can help relieve oedema. Tell the mother to empty the breasts by expressing them if the baby does not suckle them empty. In all communities, people have cultural beliefs, taboos and special practices concerning food production, preparation, serving and eating.
Other common local beliefs include taking the baby off the breast because the mother has stayed away overnight, or abruptly stopping breastfeeding because of an eminent pregnancy.
Teach mothers that working outside the home need not keep them from breastfeeding, and that breast milk is far superior to breast milk substitutes.
If the staple is a cereal such as maize, millet or rice, it will provide a useful quantity of protein. A fresh egg beaten into the porridge while it is simmering in the pan is another simple way of providing excellent protein for a toddler.
The easiest way to measure growth is to weigh a child regularly and to note how his body weight is increasing with age in comparison to the weights of healthy children of the same age. The caretaker can also put the blue plastic pants on the child in preparation for weighing. You should check, however, that the caretaker is not holding the child and that the child’s feet are off the ground. If the pointer points halfway between the four and five on the scale, place a dot half way between four and five kilograms on the Growth Chart (see Fig. However the direction of the child’s own growth line, based on weighing at regular intervals, is of much more significance than any single weight recorded below the lower reference line. This is to remind you that the direction of the curve tells us a great deal about the condition of the child. This probably means that the child is catching up on weight lost during a previous illness or a period of growth failure. If a child has measles, for example, this should be written on the Growth Chart next to the dot representing the child’s weight at the time the child was seen. This will then remind you to be particularly alert to any signs of growth faltering and may suggest the reason for poor growth.
All the information recorded on the child health card will assist you in assessing the direction of progress. Nutrition work therefore should be planned and implemented by all the health workers and community members. This information can be used by the health unit staff to try to understand more about causes of malnutrition in the community and how nutrition and health of young children can be improved.
The most common forms of malnutrition in our communities are due to shortages (deficiencies) of energy giving food. Great cooks know that Instant Nonfat Dry Milk helps enhance their baked items, giving them that wonderful golden brown look. In a 2,000-calorie diet, that works out to 200 to 700 calories -- or 50 to 175 grams -- of protein per day. That's why the Centers for Disease Control and Prevention advises that you should choose nonfat or low-fat dairy and skipping the full-fat versions. Good nutrition protects children from many illnesses and ensures that they attain their full potential.
Collectively, all these factors affect the dietary intake and health status of the population. We have tended to only concentrate on treatment and rehabilitation of the very severely malnourished.
She may become weak and anaemic and the baby may have a low birth weight and a reduced chance of survival. The more important reason is that we eat because our bodies need food to keep alive and stay healthy. Foods that contain a lot of fat or carbohydrates and perhaps only a little protein are called energy foods. Children of all ages need energy with which to grow, to run and play and to walk to school. However, even though protein is not an energy food, the body can convert it into energy if need arises. As a health worker there are several things you can do to make sure that once food is produced, it is properly eaten.
Further, there are certain diseases, such as worm infestation, that stops the body from using food properly. It is important for you to know these hormones so that you can advise mothers and help them to produce enough milk.
However, if she thinks lovely thoughts of her baby, is comfortable during breastfeeding or even hears her baby crying, this may help milk ejection. The World Health Organisation (WHO) and UNICEF have drawn up some guidelines for health units to follow. Ask her to take enough food and fluids so that she has the energy she needs to produce enough milk. Tell the mother that she can prevent and treat engorged breasts by emptying them regularly. You need to know which ones exist in your area, as you may need to give advice about them during your work. If the staple is banana or a root such as cassava or yam, it will supply very little protein.
Meat or fish, if cut up finely, cooked well and mashed with the staple food also will provide protein of good quality.
It may show the different seasons, months, phases of the moon, local festivals and events in the agricultural cycle. It is important to explain to the caretaker about the two curved lines that are printed on the Growth Chart. These shortages give rise to the group of diseases called “protein energy malnutrition” (PEM). Another type of workouts are for people who are body building or working out to build muscle mass. It also improves the strength and structure of baked goods, retaining moisture and keeping them fresh longer. Women over 50 and men over 70 need a bit more, so aim for 1,200 milligrams of calcium per day if you fit into these groups. In a 2,000-calorie diet, the American Heart Association recommends consuming no more than 16 grams of saturated fat per day.
We hope that in subsequent units, especially in the unit where we discuss common conditions of childhood, you will be able to see the relationship between poor nutrition and ill health. Foods in which the most important nutrients are vitamins or minerals are called protective foods.
Scurvy is common in people who cannot grow or afford fresh fruits and vegetables for long periods. So to help a mother's milk ejection, we should be kind and supportive, help her not to worry, and reassure her that she can breastfeed. The baby’s tongue cups along the sides of the teat, and a wave of compression moves along the tongue toward the back of the mouth. If you find it is not a problem with the breasts, then assess the child for other problem such as fever, blocked nose, oral thrush, etc., and manage accordingly. In either case, but especially in the latter, it is vitally important to provide extra protein-rich foods.
The weight measurement that is obtained from the salter scale is then plotted on the growth chart. National and local occurrences of importance are also marked on it: these include storms, political elections, the opening of nearby roads, shops, etc. A look at the child’s health record should indicate whether or not there needs to be further investigations. Important sources are dark green leafy vegetables, livers, kidneys, whole meal cereals, legumes, citrus fruit and fish. It is also common in old people who find difficulty buying or eating fruits and vegetables. All these foods have to get to a child's body from the fields and gardens where they are grown. Therefore, if a mother wishes to increase her milk supply, she should have the baby suck longer and more often.
She should not miss a feed to try to “save milk” because that will make her breasts produce less. In fact, many women feel the squeeze in their breasts – sometimes called the “letdown reflex” – at the beginning of a feed. Remember that poor positioning of the baby may cause breastfeeding problems such as cracked nipples, infections or breast abscesses. Increase the amount of food slightly later when the child is used to the food, given 4 to 5 times a day in small amounts. Crab is healthy non-vegetarian foods that have lesser calories than meats and contains a lot of vital nutrients. Having mutton or lamb meat will literally beef you up because of its high content of amino acids. The male hormone testosterone helps in beefing up the muscles and giving you a very manly look.



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