Assignment # 4

Assess the Nutritional status of Malnourished Community

Submitted by: Kanza Imran

Registration # FA18-FSN-016

Department: Biosciences

Course: Assessment of Nutritional Status

Submitted to: Sir Zeeshan Ali

Date: 25-12-20
 Assess the Nutritional status of Malnourished Community

Introduction

Community assessment is perhaps the most practical method of obtaining an overview of the
nutritional status of a given community. Poverty, housing, health, disease, cultural and ethnic
differences, food supply, and community health programs, to name a few major factors, affect
the community's nutritional levels. Gathering existing data on these and other factors will help
determine whether the community's nutritional resources are adequate, what groups are
potentially at high nutritional risk, and how well the community's nutritional and related health
needs are being met by existing curative and preventive health programs.

In effect, community assessment paints a picture of the health of the community, its ecology, and
the factors influencing the way its people live. To do this, demographic, epidemiologic, cultural,
and geographic data must all be utilized. The community's entire health-care capabilities-
including medical, educational, and social welfare as well as nutritional-must be surveyed.

Community assessment relies primarily on existing sources of information. These may include
census studies, vital statistics, hospital records, public assistance records, private and public
health and social welfare agency statistics, and any other data which may have been collected by
or about the community. While such data collection may not be simple, community assessment
may be less complex than the other methods, which demand more time, money, qualified
technical personnel, and other resources.

Steps in Conducting a Community Needs Assessment

Following are the steps that are involved in community needs assessment:
Step 1: Set the Parameters of the Assessment

 The scope of the community to be assessed must be specified. Sometimes the community
is a geographical region, state, nation, province, or group of countries. Other times it may
be a group of people served by a particular program, such as elementary school students
attending schools in a defined area
 Define the purpose of assessment. A needs assessment is undertaken to gather
information about the social, political, economic, environmental, and personal factors that
influence a community. The community needs assessment may have one or more of the
purposes
 Goals are broad statements that indicate what the assessment is expected to accomplish.
Objectives are statements of outcomes and activities needed to reach a goal. Statements
of objectives use a strong verb, such as identify, assess, determine, or measure, that
describes a measurable outcome. Each objective should state a single purpose

Step 2: Develop a Data Collection Plan

The types of data required in a needs assessment depend on the scope, purpose, goals, and
objectives of the assessment. In developing a plan for data collection, remember that the
assessment’s overall purpose is to paint a picture of the many factors that are affecting food
choices in a community and what might be done to improve food selection. Begin collecting data
about the “big picture”—namely, the community, environment, and background factors. Then,
when you have begun to get a sense of the big picture, you can decide on a population to target
and collect data about individuals who make up the target population.

Here three categories of data are described: (1) community data (such as demographics,
economic factors, and health indicators); (2) community environment and background factors
(social and cultural norms, food availability, policies, etc.); and (3) target population data (food
preferences and attitudes, health beliefs and knowledge, lifestyle factors, etc.). You will want to
collect data to help you to understand the nutrition status of the community and the multiple
factors that influence it.

Step 3: Collect Data

After developing the data collection plan, you are ready to collect data. Having a good system for
managing data and a plan for analyzing it are important considerations here. Developing data
collection protocols and training those who will be collecting data to ensure consistency in
collection methods are key.

Specific Areas for Inquiry in Community Assessment Programs

Nutritional problems are most commonly found in geographic areas or among population groups
which are socially, economically, educationally, and/or medically deprived. Some of the many
indicators of these deprivations and their causes are listed in this section, along with an
explanation of where pertinent data can be obtained, and their significance. This listing can serve
as a check to assure that no major source of community health information has been ignored.
However, it will be evident that some of the data would be relevant only to specialized areas or
problems.

Specific areas for inquiry in community assessment programs include:

1. Demographic information
2. Socioeconomic stratification
3. Health statistics resources: Morbidity and Mortality
4. Local health resources
 5. Dental health
6. Cultural factors
7. Community political organization
8. Housing
9. Food supply
10. School nutrition programs
11. Social welfare programs
12. Transportation
13. Education
14. Occupational data
15. Geography and environment
16. Other community aspects

In addition to this, data obtained from target population must include:

 Food preferences and attitudes

 Health beliefs and knowledge
 Lifestyle factors
 Nutrition status
 Social and cultural factors
 Priorities and motivation

Methods of obtaining data from target population

A variety of methods exist for collecting data about the target population. The methods range
from simple surveys and screening tools to interviews with key informants.

Surveys

A survey is a systematic study of a cross-section of individuals who represent the target

population. It is a relatively inexpensive way to collect information from a large group of people.
Surveys can be used to collect qualitative or quantitative data in formal, structured interviews; by
phone, by mail, or online; or from individuals or groups. Some survey instruments (such as
questionnaires) are self-administered, whereas a trained interviewer administers others.

The first step is to determine the purpose of the survey. Most food consumption surveys are
carried out to assess the food patterns in households or among individuals, evaluate eating
patterns, estimate the adequacy of the food supply, assess the nutritional quality of the food
supply, measure the nutrient intake of a certain population group, study the relationship of diet
and nutrition status to health, or determine the effectiveness of an education program. Surveys
can also investigate health beliefs, knowledge, self-efficacy, and nutrition-related attitudes that
may impact food selection.

Next, decisions must be made about who will design the survey, who will conduct it, and how it
will be carried out. The survey instrument must be designed and pretested, and the sample must
be chosen. The personnel responsible for conducting the survey and analyzing data must be
trained. Numerous other decisions must be made about the feasibility of the survey; the quality
of data obtained by the survey; the costs of carrying it out; the readability of the survey; literacy
issues; and the manner in which data will be analyzed and used.

Health Risk Appraisal

The health risk appraisal (HRA) is a type of survey instrument used to characterize a
population’s general health status. We mention it here in a separate category because it is widely
used in worksites, government agencies, universities, and other organizations as a health
education or screening tool. The HRA is a kind of “health hazard chart” that asks questions about
the lifestyle factors that influence disease risk, and it has been used successfully to improve
health behaviors.

The HRA instrument consists of three components: a questionnaire, certain calculations that
predict risk of disease, and an educational message or report to the participant. A typical HRA
asks questions about age, sex, height, weight, marital status, size of body

frame, exercise habits, consumption of certain foods (e.g., fruits and vegetables) and ingredients
(e.g., sodium), intake of alcohol, job satisfaction, hours of sleep, smoking habits, and medical
checkups or hospitalizations. An HRA has been developed and tested for people aged 55 years
and older.

Screening

Screening is an important preventive health activity designed to reverse, retard, or halt the
progress of a disease by detecting it as soon as possible. Screening occurs in both clinical
practice and community settings, and it entails procedures that are safe, simple, and cheap. In
community screening programs, people from the community are invited to have an assessment
madeof a health risk or behavior. Their screening value is then compared with a predetermined
cutpoint or risk level.

Focus group

Focus groups can be conducted before, during, and after program planning and are helpful for
assessing needs, generating information, developing plans, testing new programs and ideas,
improving existing programs, and evaluating outcomes. Focus groups usually consist of 5 to 12
people who meet in sessions lasting about one to three hours. The group members are brought
together to talk about their concerns, experiences, or beliefs. Focus groups have traditionally
been used to obtain advice and insights about new products and services, research qualitative
information about key variables used in quantitative studies, and gather opinions about products
or creative concepts such as advertising campaigns or program logos.
Focus group interviews provide qualitative information that helps community nutritionists
understand food and nutrition-related beliefs, attitudes, and practices amongmembers of a target
population. They are less expensive to conduct than face-to-face interviews, and they help
community nutritionists obtain information of a sensitive nature or information that might
otherwise be difficult or costly to get.

Interviews with the key informants

Key informants are people who interact with or whose positions affect the target population and
may be able to shed light on factors that shape the target population’s behaviors, beliefs,
attitudes, lifestyle factors, and so on. Key informants may have worked with or conducted
research related to the population’s health status, beliefs, or practices and may thus be familiar
with its attitudes and opinions.

For example, if the target population is obese persons, then interviews with physicians in family
practice, internal medicine, and endocrinology will provide information about how this group is
managed medically, what advice it is given about weight management, and whether it follows
advice received from physicians. If the target population is teenagers with a high risk of
HIV/AIDS, then interviews with teenagers who work in peer education programs will provide
valuable information about how these high-risk teenagers perceive risky behavior, what they
know about preventing and transmitting HIV/AIDS, how susceptible they are to peer pressure,
and what their overall health beliefs are.

Direct assessment of Nutritional status

Another method of determining nutrition needs is to conduct a direct assessment of individuals.

Direct assessment methods use dietary, laboratory, anthropometric, and clinical measurements of
individuals to identify those with malnutrition or a nutrient deficiency. These methods may be
used alone or in combination.

Dietary methods

Dietary methods are used to determine an individual’s or population’s usual dietary intake and to
identify potential dietary inadequacies. The primary methods of measuring the food consumption
of individuals include the 24-hour recall method, the food diary or daily food record, the diet
history interview, and the food frequency questionnaire. At the household level, food records and
inventory methods are used to estimate food consumption; population dietary intakes are
estimated using food balance sheets and market databases.

One innovation in the diet assessment arena is the use of photography to record dietary intake.
Photography reportedly has provided more valid and precise results than food records. Today,
numerous diet and nutrition apps are available for smartphones and tablets that feature a classic
food diary and physical activity tracker. Another method of estimating food intake is the picture-
sort approach; in this method, participants sort into categories cards with pictures or drawings of
various foods. The method was developed for use with a diverse population of older adults with
low education or literacy levels. It can be self- or interviewer-administered. When tested among
participants in the Cardiovascular Health Study, the method was an easy and quick way to obtain
data on food patterns.

Laboratory methods

Laboratory methods can be used to identify individuals at risk of a nutrient deficiency because
tissue stores of nutrients gradually become depleted over time. The depletion may result in
alterations in the level or activity of some nutrient-dependent enzymes or in the levels of
metabolic products. Thus laboratory methods are used to detect subclinical deficiencies. Static
biochemical tests measure a nutrient in biological tissues or fluids or the urinary excretion rate of
the nutrient.

Examples of static tests include the platelet concentration of -tocopherol and urinary 3-
hydroxyproline excretion. Functional biochemical tests measure the biological importance of a
nutrient and the consequences of the nutrient deficiency. Functional biochemical tests include
taste acuity, a measure of zinc status; dark adaptation, a measure of vitamin A status; and
capillary fragility, a measure of vitamin C deficiency. Functional tests are generally too invasive
and expensive to employ in most field surveys of nutrition status.

Anthropometric Methods

Measurements of the body’s physical dimensions and composition are used to detect moderate
and severe degrees of malnutrition and chronic imbalances in energy and protein intakes. The
most common growth indices are measurements of stature (height or length), weight, and
circumference of the head. Measurements of skin folds, mid-upper-arm circumference, and waist
circumference are used to derive equations that predict muscle and fat mass. The body mass
index (BMI) is a commonly used indirect measure of overweight and obesity in adults.

Anthropometric measurements are useful in large-scale community assessment programs

because they involve simple, safe, noninvasive procedures; require inexpensive and portable
equipment; and produce accurate and precise data when obtained by trained personnel. Such
measurements are used to estimate an individual’s long-term nutrition history. They do not
provide data on short-term nutrition status, nor can they provide information about specific
nutrient deficiencies.

Clinical Methods

Clinical assessment of health status consists of a medical history and a physical examination to
detect physical signs and symptoms associated with malnutrition. The medical history includes a
description of the individual and his or her living situation (e.g., married or single, number of
children, and nature of employment).

It typically obtains information about existing clinical conditions, previous bouts of illness,
presence of congenital conditions, smoking status, existence of food allergies and intolerances,
use of medications, and usual levels of physical activity. In the physical examination, the
clinician evaluates the major organ systems: skin, muscular and skeletal, cardiovascular,
gastrointestinal, and nervous. The hair, face, eyes, lips, tongue, teeth and gums, and nails are also
examined for signs associated with malnutrition.

References

Boyle, M. A., & Holben, D. H. (2012). Community nutrition in action: An entrepreneurial

approach. Cengage Learning.

Community assessment of nutritional status. (1973). American Journal of Public

Health, 63(11_Suppl), 1-10. https://doi.org/10.2105/ajph.63.11_suppl.1