HORN INTERNATIONAL UNIVERSITY COLLEGE

COLLEEGE OF HEALTH SCIENCE

DEPARTMENT OF HUMAN NUTRITION
Practical internship report done on karamarda Hospital for the Fulfillment of the
course internship for human nutrition

Prepared by: - Hibak Korrane Hassan ID No: 67/10

Advisor Mr. Abdurrahman

On January 1, 2020

Jigjiga, Ethiopia

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Contents
ACKNOLEDGEMENT....................................................................................................................................iii
ABBREVIATIONS................................................................................................................................iv
1.0 EXECUTIVE SUMMARY.................................................................................................................5
2.0 INTRODUCTION.....................................................................................................................6
-Address of the Karamarda Hospital .................................................................................................6
2.2 structure {size, turnover, department, number of employee......................................................7
· Emergency department (ED).................................................................................................8
.......................................................................................................................................................8
Intensive care unit (ICU)...............................................................................................................8
. Pediatric intensive care unit (PICU)............................................................................................9
. Physiotherapy (PT)......................................................................................................................9
. Prenatal care................................................................................................................................9
Operating Theater..........................................................................................................................9
. Therapeutic feeding center (TFC)..............................................................................................10
. Ophthalmology department.......................................................................................................10
. Central sterile services department (CSSD)...............................................................................10
.Obstetrics, gynecology department.................................................................................................11
. General services.........................................................................................................................11
2.3 report of the familiarization phase {introduction and supervising, contact with other
employees. Etc.,}.............................................................................................................................11
.....................................................................................................................................................11
2.4Field of {business} activity\responsibility....................................................................................12
2.5 self-concept...............................................................................................................................12
3.0. Description of internship..........................................................................................................13
3.1 Weekly Timetable......................................................................................................................13
3.2 special regulations /measures concerning internship work.......................................................17
3.4 description of the work station/working place..........................................................................19
3.5 task description {handling, cooperation, work results and their presentation}.........................20
3.6 description of atypical working day...........................................................................................20
4.0 IMPACT OF THE internship.........................................................................................................21
4.1 Social conditions {atmosphere, work climate, internship situation}..........................................22
4.2 EVALUATION OF THE ASSIGNED TASKS AND THE INDIVIDUAL WORK PERFORMANCE........22

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 4.3 Implications for the future study and career planning..............................................................22
.44 comparison of goals and expectations with actual experience...................................................23
5.0 conclusions................................................................................................................................24
5.1 RECOMMENDATION............................................................................................................................25
5.2 Reference...................................................................................................................................25
-Address of the Karamarda Hospital ...............................................................................................25
APPENDIX........................................................................................................................................26
Employee...................................................................................................................................................27

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ACKNOLEDGEMENT
First and for most I would like to thank and acknowledge ALLAH who helped me to
accomplish my field of work. Secondly, I am also great full thanks Horn International
College. Faculty of human nutrition gave me this opportunity, moral and material support
thanks a lot to them. Next I would like to thank many people who have involved themselves
for the successful accomplishment of my practical attachment. Among these, I would like to
extend my thanks goes to my dearest advisor Mr.Abdirahman (my well-wisher) for the
professional comments he rendered me during the whole processes of my efforts to realize
this practical attachment, Iam very much indebted and acknowledged for his valuable
professional guidance, constructive comments and devotion of his precious time in reading
and correcting my report from the beginning up to the end of the study.

My deepest gratefulness goes to the Karamarda hospital employers specially head of the Mr.
Mustafe Mahamed Tawakal and Abdirisak Ahmed, head of department of nutrition.
I would also like to extend my special thanks to my beloved parents for their entire moral and
support, encouragement and material support without which the completion of my study
would have been very difficult.

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ABBREVIATIONS

W/H……………………………….Weight for height

W/L………………………………Weight for length

MUAC……………………………Mid upper arm circumference

NGT………………………………Nasogastric Tube

OTP……………………………….Out-patient therapeutic program

OPD………………………………..Out-patient department

RUTF………………………………Ready to use therapeutic food

ATFC ..............................................Ambulatory Therapeutic feeding center

ITFC.................................................Inpatient therapeutic feeding
F75………………………………..Therapeutic milk used by only phase-1 treatment

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1.0 EXECUTIVE SUMMARY
During my internship period I worked in Somali region specially Karamarda District.
Specially Karamarda Hospital which is governmental hospital I was assigned department of
nutrition and I stayed for one month and half a month (45 days).

Description of internship

 Therapeutic feeding center(TFC) and Inpatient therapeutic feeding center(ITFC) and the
activity are Principle of care screening, Management of medical complications ,Feeding
and daily care and Outpatient feeding program and the all staffs helped me and supported
me to specialize, practice this portion

missions
Karamarda Hospital have a mission which is
 To provide accessible and cost effective health care
 To give a quality service for all patients
 To gain the community attraction by smooth reliable health care
Vision
 Karamarda hospital competes to be the premier hospital in Ethiopia which is
recognized nation
 Provide an excellent standard of service
 Wide for the quality for patient care provided
 Be recognized as an employer of choice in Ethiopia heath system share ideas and
experience with the other Ethiopia hospital s to enhance the service.
Conclusion
There were four main activities which I did during my internship practice which were

Principle of care (screening), Management of medical complications, Feeding and daily care and
Outpatient feeding program for which I assessed SAM in TFC center:

Summary, in generally to finalize my internship was held or done in Karamarda Hospital, i had
worked for about 6 weeks of treatment located in TFC namely:-

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The time I was Therapeutic feeding center(TFC) and Inpatient therapeutic feeding center(ITFC)
the activity that are Principle of care screening, Management of medical complications ,Feeding
and daily care and Outpatient feeding program and the all staffs helped me and supported me to
specialize, practice this portion to assess and collect information based on under five children.

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2.0 INTRODUCTION
2.1 back ground
Karamarda Hospital is one of the largest hospitals in Somali region, it is found in the jarar
province and a distance of 360km away from the capital city jijiga. The hospital was established
1989 EC in karamarda district.

The hospital gives health service for the community those have any types of case such as
OPD, ANC, management of malnutrition fort all age groups especially under five children,
Pregnant and lactating women, TB patient, delivery for mothers, ART for HIV/AIDS
Patients and also gives free service for diabetic mellitus patient.
2.1.2 Reasons and Objective of Karamarda Hospital

 to obtain important knowledge on the essential components of care and monitoring of

SAM
 to reach the promotion of nutrition education
 To provide a responsive recover environment for patients and their families, value priced,
primary health care services
 To improve the quality of life for all members of our community outcomes and the
subsequent nutritional status of a child.

2.2 structure {size, turnover, department, number of employee

Structure of Karamarda Hospital

Senior Management Medical

Team Director
Financial

M.D H.
Pharmacy
R
Logistic

Chairman(COH)
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Nursing
Department
 Out Pt Case Maternity & Out Pt Clinics Emergency
In pt case
Team Leader Child health Case team Case Team
team case team leader Leader Leader

Pediatric
Medica Dental
OPDs
l Clinic Emergency
ANC
Room
Ophthalmic
Pediatric Adult
Clinic
Ward OPDs Delive
Dressing
.&
Family TB Dot Clinic
Surgical Triage Injection
Plannin
Ward Nurse
g
Nutrition OTP
TB Surgical Maternity Observation
Ward OPD IPD ART Clinic Room

Employee of Karamarda Hospital

The staffs of hospital are 12, the nutrition departments are 2 Malnutrition can result both by
under and over intake of food. More than half of all children death is associated with
malnutrition which weak the body resistance to illness. Poor diet, frequent illness and in
adequate care of young child can lead to malnutrition.

 Emergency department (ED)

Emergency department or casualty department, is a medical treatment facility specializing in
emergency medicine, the acute care of patients who presents without appointment; either by their
own means or by that of ambulance it is where you’re likely to be taken if u have arrived in an
ambulance or emergency situation the emergency department of Karamarda hospital operate 24
hours a day. Although staffing levels are varied in an attempt to reflect volume. There are
professional health worker which are present emergency room every time in a day. Emergency
room of Karamarda hospital

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Intensive care unit (ICU)
Also known as an intensive care unit or intensive treatment unit (ITU) or critical care unit
(CCU), is special department of Karamarda Hospital and provides intensive care medicine.

Intensive care unit of Karamarda Hospital cater to patients with severe life-threatening illnesses
and injuries, which require constant, close monitoring and support from specialist equipment and
medications in order to insure normal bodily functions. They are staffed by highly trained
doctors and nurses who specialise in caring for critically ill patients. Patients may be transferred
directly to an intensive care unit from emergency department if required, or from a ward if they
are rapidly deteriorate, or immediately after surgery is very invasive and the patient is at high
risk of complication.

. Pediatric intensive care unit (PICU)

Is an area within a Karamarda Hospital specializing in the care of critically ill infants, children,
and teenagers A PICU is typically directed by one or more pediatric intensive or PICU
consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained
and experienced in pediatric intensive care? Particularly karamarda intensive care units have
mechanical ventilators and patient monitoring systems. Consequently, PICU have a large budget
than many other departments within the Karamarda Hospital.

. Physiotherapy (PT)
Is also one of the departments of Karamarda Hospital is a physical medicine and rehabilitation
specialty that remediates impairments and promotes mobility, function, and quality of life
through examination, diagnosis, prognosis, and physical intervention (therapy using mechanical
force and movements). It is carried out by physical therapists (known as physiotherapists in most
counters) and physical therapist assistants (known as physical rehabilitation therapists or
physiotherapy assistants in some counters).

. Prenatal care
Prenatal care is the health care that you get while when you are pregnant .take care yourself and
your baby bay

 Getting early parental care if you know you’re pregnant, think you might be call
doctor to schedule to visit

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  Getting regular prenatal care .your doctor will schedule your for many checkups over
the course of your pregnant don’t miss any –all important.
 Following your doctor advice.

Operating Theater
Also known as an operating room (OR) or operating suite, is a facility with in Karamarda
Hospital where surgical operations are carried out in a sterile environment. Historically the term
“operating theater” referred to a non-sterile, tiered theater or amphitheater in which students
another spectators could watch surgeons perform surgery.

.Hospital pharmacy

Usually stock a large range of medications, including more specialized and investigational
medications (medicines that are being studied, but have not yet been approved), than would be
feasible in the community setting. Pharmacy of Karamarda Hospital provides a huge quantity of
medications per day which is allocated to the wards and to intensive care unit according to
medication schedule. Karamarda Hospital pharmacy is responsible for drugs in a hospital
including purchasing, supply and distribution.

. Therapeutic feeding center (TFC)

Therapeutic feeding center is the one department of Karamarda Hospital which is located the
left side of Karamarda Hospital consist of 2 rooms and each room contain 10 beds this center,
where the malnourished children that are taking therapeutic feeding, this department is essential
in the treatment of malnourished children. They generally will stay for two to three months, until
they reach their ideal weight. During the time of their stay, the children are accompanied by
family member (mother, grandmother, etc.) and they will receive advice and guidance on health
and nutrition for children. The employees are 2 special doctor which is between the pediatric
ward and the TFC, 2GP Doctors and 2 nurses this department is the department where I was in a
practical attachment.

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. Ophthalmology department
It is one Karamarda Hospital departments which serves as medical, surgical and offers all eye
care service from routine examinations, prescriptions for glasses and contact lenses, surgical
correction of vision, to comprehensive consultations in all sub–specialist of ophthalmology.

. Central sterile services department (CSSD)

Central sterile services department also called sterile processing department (SPD), or central
supply, is an integrated place in Karamarda Hospital that performs sterilization and other actions
on medical devices, equipment and consumables: for subsequent use by health workers in the
operating theater of the hospital and also for other aseptic procedures, e.g. catheterization, wound
stitching and bandaging in medical, surgical, maternity or pediatric ward.

The operations usually consist of previously used devises, like stainless steel tools, whit a
sterilizing liquid. After drying the division a stand (not by hand or cloth) it gates wrapped in a
specialized paper bag (called an acceptor bag). Tape-sealed and then sterilized by gas or in a
steam autoclave, according to the prescripts in place at the facilities.

.Obstetrics, gynecology department

It is one of departments of Karamarda Hospital where investigated and treats problems relating
to the female urinary tract and reproductive organs.

It provides full range of general obstetric and gynecological services ranging from outpatient
care to surgery and from routine visits to complicated consultations in addition to normal
obstetric and gynecological services.

. General services
The main beneficiaries of hospital are the local population and people who live in the
surrounding areas .the free service of the hospital influence the low economic families as the
whole people those who went to get high quality service in addition to city population the
hospital gives the service to the patient

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2.3 report of the familiarization phase (introduction and
supervising, contact with other employees and Etc).

Supervisor and others employee’s work each other and the supervisor may come twice per day
Morning 8:00 and 12:00 the staffs will give what they checked in file

The staffs of hospital are 12, the nutrition departments are 2Malnutrition can result both by
under and over intake of food. More than half of all children death is associated with
malnutrition which weak the body resistance to illness. Poor diet, frequent illness and in
adequate care of young child can lead to malnutrition

2.4Field of {business} activity\responsibility

 To obtain important knowledge on the essential components of care and monitoring of

SAM
 To reach the promotion of nutrition education
 To provide a responsive recover environment for patients and their families, value
priced, primary health care services
To improve the quality of life for all members of our community

2.5 self-concept

If I talk what I belief before I think we may not get a good workers to welcome us and I did not
belief that I am getting this experience which I have today but really we got allot of experience
and also got more knowledge in our internship

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3.0. Description of internship
During my internship I worked with the departments of pediatric (children less than 5 years)
department and therapeutic feeding center (TFC) department both of them are working and
curing children.

I have been done my daily practical internship by helping of hospital staffs and also I worked
with the departments of pediatric (children less than 6 years) department and therapeutic feeding
center (TFC) department both of them are working and curing children

The hospital gives health service for the community those have any types of case such as
OPD, ANC, management of malnutrition fort all age groups especially under five children,
Pregnant and lactating women, TB patient, delivery for mothers, ART for HIV/AIDS
Patients and also gives free service for diabetic mellitus patient.
During my practical internship I worked in Somali region specially Karamarda Hospital.

3.1 Weekly Timetable

First Week Date 23/01/2019

Week Activity

Monday It was the first day that I visited the

hospital and accepted my request paper

Tuesday In the second day of the first week they

give me orientation about organization
and their general situation

Wednesday The third day of my practical attachment

I have taken theoretical lesson about how
to measure for anthropometry
measurement children less than 5years

Thrusday The fourth day of the training I

participated identification of admission

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 criteria for malnutrition patient

Friday Measuring children 6-59 months

Second Week Date: 01/02/2019

Activity

Monday Observing the hospital environment

specially in the therapeutic feeding center

Wednesday Introducing the staffs in stabilization center

Tuesday Classifying the patient in stabilization center

Thursday Admission criteria in therapeutic feeding

center

Friday Revision with my supervisor

Third Week Date: 08/02/2019

ACTIVITY

Monday Participation of health education sessions

to the mother of SAM patient

Tuesday I have taken practical training about how

to measure for anthropometry
measurement for pregnant

Wednesday Screening of nutritional status for

pregnant mother and importance of
Thursday
nutritional support for the pregnant
mother and breast feeding

Friday Screening of nutritional status and the

importance of nutritional support to the

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 TB cases

Fourth Week Date: 15/02/2019

Activity

Monday Vitamin A supplementation children of 6-12

months

Tuesday Vitamin A supplementation children of 12-24

months

Wednesday Folic acid supplementation children under 5years

Thursday

Friday Albendazole supplementation children of > 1 years

Fifth Week Date 22/02/2019

Activity

Monday I was participating the save children’s

workshop for two weeks and I got the
best training that makes me able to see
the things in practical manner and
understanding about orientation,
organization and their general framework

Tuesday In the second day of my fifth week they

gave me an opportunity of discussions
and presenting personal point of views

Wednesday The third day we were learning

theoretical slides from SAM

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My last Week and really lovely week to meDate: 01/03/2019

Activity

Monday They were teaching us F-75 and F-100 and

plumpynut

Tuesday They gave us practical lessons through

watching videos and clips which were
representing mal-nutrition in all of the world
for particular in Africa

Wednesday We were learning Admission criteria in

therapeutic feeding center and how to fill.

Thursday Posttest exam and self-evolutions

Friday off

Signature________________ Organization stamp__________

3.1 Branch of the trade /field

Feeding

There are two types of f-75 and f-100

1. prepackaged f-75 andf-100 these are commercially manufactured and pre packed as large
and small packet and you add either one large packet of f-75 or f-100 to 2 liters of water
or one small packet to 500 ml of water where very
2. few children are being treated smaller volumes can be mixed using the red scoop 20 ml
of water per red scoop of f-75power or 18 ml of water per red scoop 0f f-100

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3.2 special regulations /measures concerning internship work

Procedures for measuring MUAC

1:-Ask the mother to remove clothing that may cover the child’s left arm.
2:-Estimate the midpoint of the child’s left upper arm (arrow 6)
3:-Straighten the child’s arm and wrap the tape around the arm at the midpoint. Make sure the
numbers are right side up. Make sure the tape is flat around the skin (arrow 7)
4:- Inspect the tension of the tape on the child’s arm. Make sure the tape has the proper
tension (arrow 7) and is not too tight or too loose (arrows 8 and 9). Repeat any step as necessary.
5:- When the tape is in the correct position on the arm with correct tension, read and call out the
measurement to the nearest 0.1cm (arrow 10)
6:- Immediately record the measurement.

2. Taking the weight

Children are weighed by using a 25 kg hanging sprint scale graduated to 0.100 kg. Do not forget
to re-adjust the scale to zero before each weighing aplastic washing-basin should be attached by
4 ropes that go under Neath the basin. The basin needs to be close to the ground in case the child
falls out, and to make the child feel secure during weighing then remove the shoes, wear light
cloth after that put the child on it and record weight when indicator stabilizer. Each day, the
scales must Figure: - 2 How to Take Weight
3. Taking the height or length
For children less than 85 cm the measuring board is placed on the ground. The child is placed,
lying along the middle of the board.
The assistant holds the sides of the child’s head and positions the head until it firmly touches the
fixed headboard with the hair compressed the measurer places her hands on the child’s legs,
gently stretches the child and then keeps one hand on the thighs to prevent flexion.
While positioning the child’s legs, the sliding foot-plate is pushed firmly against the bottom of
the child’s feet. To read the measure, the foot-plate must be perpendicular to the axis of the
board and vertical. The height is read to the nearest 0.1 centimeter.
4. CHECKING FOR BILATERAL OEDEMA

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Bilateral edema is the sign of kwashiorkor. Kwashiorkor is always a severe form of malnutrition.
You do not need to take anthropometric measurement of children with bilateral edema during
screening or before admission to the program as they are directly identified to be acutely
malnourished. Those children are at high risk of mortality and need to be treated in a therapeutic
feeding program urgently.
In order to determine the presence of edema, normal thumb pressure is applied to the both feet
for three seconds. If a shallow print persists on the both feet, then the child presents edema.
3.4 description of the work station/working place
OTP; out-patient therapeutic feeding Therapeutic feeding center is the one department of hospital
which is located the right side of hospital consist of 8 rooms and each room contain 4 beds

This center is the center where the malnourished children that are taking therapeutic feeding, this
department is essential in the treatment of malnourished children.

They generally will stay for 6 weeks, until they reach their ideal weight.

During the time of their stay, the children are accompanied by family member (mother,
grandmother, etc.) and they will receive advice and guidance on health and nutrition for children.
Here the employees are 1special doctor and seven nurses which is between the pediatric ward
and the TFC, and this department is the department where I was in my practical attachment.

The majority of severe acute malnutrition cases, around 85% are normally treated in the
outpatient therapeutic components of therapeutic feeding program [TFP] children can be
admitted in to the OTP, treated with routine drugs and give RUTF to eat at home out-patient
therapeutic treatment OTP is normally organized from the same facility hospitals or hospital s
that have in-patient However out -patient care in the community can also organized.

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3.5 Task description {handling, cooperation, work results and their presentation}

1. Total Patient served is 65

2. Outpatient service for 25 Patients
3. Inpatient service for 18 Patients.
4. Emergency service for 9 Patients.
5. Delivery service for 7, mothers.
6. Family planning service for 0
7. Performed minor surgeries for only 1 patient

3.6 Description of Atypical Working Day

 Counseling in Outpatient Therapeutic Care and use of RUTF

Explaining the client/caregiver reasons and purpose for admission to the outpatient
therapeutic care and expected treatment care and support
 Dispense medication and RUTF
Receiving routine and appropriate medication
 Following-up in outpatient therapeutic care
Clients/caregivers should be encouraged/counseled to return for scheduled follow-up
visits to enable monitoring of progress
 Exit process and discharge criteria
The client can exit as cured, non-respondent, dead, transferred and defaulted
WFH or BMI-for-age > -2 z-scores for 2 consecutive visits or Weight gain of > 20% for children
< 18 years admitted by MUAC (as long as they no longer have admission criteria) Weight gain ≥
10% for adults admitted with MUAC and No edema for 2 consecutive visits, clinically well and
alert

Also I have understand Inpatient therapeutic care for the management of severe acute
malnutrition clients with medical complications and steps to managed SAM

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4.0 IMPACT OF THE internship

The impact of the internship were social conditions such as Atmosphere, work climate, and
attachment situation, there were also impacts of saving the time or managing the time.

I got also knowledge on:

I learned how to manage malnutrition

 I learned how to exercise the responsibility given for me and develop a strong teamwork
skill.
 I understood how important it is to be punctual.

There are some impacts that are undertake Karamarda Hospital

 preparation of the quartile and monthly statistics report

 preparation of the weekly reports
 the attendance of the staff workers is managed
 there is well train or skill to perform individual task of the hospital

 It is lack of knowledge about the nutritional needs of children has been suggested one
of the major causes of neglecting this group of hospitalized patients. Nutrition
education is an important element in overall strategy aimed at improving food
security and preventing all forms of malnutrition.

The criteria that determine the children have acute mal nutrition or not screen them by using
anthropometry such as (MUAC.WFH.) checking bilateral edema & by doing appetite First of all
screen the children.

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4.1 Social conditions (atmosphere, work climate, internship
situation)

The social condition of Karamarda Hospital was different or not same during my practical
internship first two weeks of my training it was well and normal condition but second three
weeks my internship it becomes not well because of climate become very cold and you may late
the time of job because of the climate was very bad

4.2 EVALUATION OF THE ASSIGNED TASKS AND THE INDIVIDUAL WORK

PERFORMANCE.

I had good relationship with other employee and with my supervisor and the things that I get
from there is how to measure anthropometric measurement by interviewing and changing into
writing for prescription paper and I have learnt more knowledge from the staffs. .

I had observed a typical working day which was tier some in which I was engaged in a work that
I have no experience however lastly I enjoyed the fruits of the work.

Before I discuss the impact of the evaluation that assigned tasks and the individual performance
of karamarda hospital Evaluation is central to hospital that every sectors of organization is own
learning performance improvement and accountability .through evaluation we can determine the
efficiency relevance, effectiveness, sustainability and institutional development activities .impact
evaluation help us to better understand the extent to which activities reach the initial of the
organization magnitude of their effects on organization welfare .

The impact evaluation is the systemic assessment of the effects on individual organization or
institutions, and the environment caused by given development project, program or policy.

4.3 Implications for the future study and career planning

 Conducting research regarding to improve the existing impact or negative of the

organization.

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 To improve assessment the daily bases of the hospital like attendance
 Weekly report and monthly report
 promoting the accountability and transparency

.44 comparison of goals and expectations with actual experience

When I try to contrast the goals and the expectations with actual experience of the Karamarda
Hospital

 My aim is to improve the impact which reveals the nutritional sector

 To bring the better management system that serving the customers and the public
workers.
 To expands the programs of the every department of the hospital .

During internship I got a lot of knowledge, skill and experience such as

 I have learned how to take medical history by asking patient or under five child or
caretakers nutrition history as abases for farther treatment
 I learnt how to assess and identify the severely malnourished children using the
anthropometric measurement such as MUAC, WFH etc.
 I learnt for same thing feeding process and I got good knowledge on how to prepare and
in what amounts are given a child F-75, F-100 and RUTF
 I learnt how to manage SAM and how to prepare therapeutic milk for children with SAM
 I have also learned how to manage medical complication such as
 I have learned how to apply theoretical education into practical
 I have learned how to communicate the community population specially mother and
their children
 I learnt how to manage a time in work palace and also I understood how it is important
to became punctual
 I learnt how to exercise the responsibility given for me and develop as strong team wor

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5.0 conclusions

Summary: generally to summarize my internship was held or done in Karamarda Hospital.

I had worked for about 6 weeks of treatment located in TFC namely

The time I was Therapeutic feeding center(TFC) and Inpatient therapeutic feeding center(ITFC)
the activity that are Principle of care screening, Management of medical complications ,Feeding
and daily care and Outpatient feeding program and the all staffs helped me and supported me to
specialize, practice this portion to assess and collect information based on under five children.

The lack of knowledge about the nutritional needs of children has been suggested as one of the
major causes of neglecting this group of hospital ized patients by the specific staffs of TFC
center in the hospital so I participated these activities.

We used admission criteria to c check complication & and I gain do appetite test so If a child
has complication & failed appetite test he/she direct admission to phase-1 in-patient care.

If a child has no complication & passing appetite test he/she direct admission to phase-2 or
outpatient program. Then manage them by the level of risk of malnutrition .finally discharge out
the service if they are treated & may in another case.

 Finally, I’m concluding my finalization by saying let the children get the service and care
that they deserve from anywhere.
 Government and nongovernment organizations should have made policies for children
perspectives.
 Children association to give different nutritional education for health professional and to
work on awareness creation for the society using different media.

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5.1 RECOMMENDATION
 The student should be given courses specially concerning pharmacology and
management of nutrition related to complications before they take internship
 Students should be given courses related their internship before practical internship
program done in order to work efficiently
 The people those have Therapeutic feeding center (TFC) promotion program conducts
by health center.
 It is needed to be made to exercise by the children who have glucose because of
lowering blood glucose. There are a lot of kids who have glucose problems so they
need much care and concern
 Assess the dietary habit with a better dietary assessment mechanism and design.
 Special dietitian’s department should be established in all public and private hospitals
for preparing diet plans and providing health education regarding the importance of diet
and exercise for diabetic patients for prevention of diabetic related complications
 Department must build student skill particularly laboratory classes before sending of
internship
 The TFC center must fulfill all the necessary materials to cover treatment
 The staff should also make other family members feel welcome and all family members
are important to the health and well-being of the Child
 The staffs must be friendly and treat mother as partners or as your parent in the care of
the children
 A mother should never be scolded or blamed for her Childs problems or made to feel un
welcome
 The staff should also make other family members feel welcome and all family members
are important to the health and well-being of the child
 The period of practical training is not enough for the students to acquire all the
necessarily skills and knowledge needed there for department of human nutrition and
university should try to increase the internship time

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5.2 Reference
Training course on the management of severe acute malnutrition 2010giude

1. WBDepartment of Health (1995) Nutrition Guidelines for Karamarda Hospital

Catering; .Screening tool for adult acute hospital patients. Nutrition (1999)15:458-464.
2. Hudon, C., Soubhi, H., Fortin, M. (2008), Relationship between multi-morbidity and
physical
3. Activity: Secondary analysis from the Quebec health survey. BMC Public Health, 8: 304
-311.
4. Ludwig, D.S., Peterson, K.E., Gortmaker, S.L. (2001). Relation between consumption of
5. Sugarsweetened drinks and childhood obesity: a prospective, observational analysis.
Lancet, 357: 505-8.

-Address of the Karamarda Hospital

Tell: - +251915433775/+251915442464

Email: karamardahealth99@gmail.com

APPENDIX

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Figure: - 1How to take MUAC

Figure: - 3 Checking for Bilateral Edema

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Be checked by using a known weight.

Employee

Types of professionals Number

BCS nurses 4

Midwifes 5

Laboratory 1

Dental 0

Public health 2

Other nurses 0

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