CM 5.

5: Describe the Methods of

Nutritional Surveillance, Principles of
Nutritional Education and Rehabilitation
in Context of Socio-cultural Factors

Department of Community Medicine

Jorhat Medical College
Date: 04-07-2024
At the end of the session Phase I MBBS students would be able to-
• Define nutritional surveillance
• Know the objectives of nutritional surveillance
• Enumerate the indicators to be monitored
• Describe the methods of collecting data for surveillance
• Define nutritional education and rehabilitation
• Enumerate principles of nutritional education and rehabilitation in
context of socio-cultural factors
 INTRODUCTION
 Nutritional surveillance has been defined as “Keeping watch
over nutrition, in order to make decisions that lead to
improvements in nutrition in population”.

 The regular and timely collection, analysis and reporting of data on

nutrition risk factors, nutritional status and nutrition- related diseases
in the population.
Objectives of nutritional surveillance

• To aid long-term planning in health and development.

• To provide input for programme management and evaluation.

• To give timely warning and intervention to prevent short-term food

consumption crises.
Indicators to be monitored
• Anthropometric and biochemical indicators are used to assess
nutritional status of the population.

• These indicators aim to answer the following questions:

 Who suffers from malnutrition? (children, elderly, mothers)
 What is the type of malnutrition? (wasting, stunting, iodine
deficiency)
 When? (recent or chronic problem)
 Where? Which areas are most affected?
Indicators to be monitored
• There are three primary anthropometric indices for children under
five years of age
 Wasting (using weight-for-height and Mid Upper Arm
Circumference)
 Underweight (using weight-for-age)
 Stunting (using height-for-age)

• Food security, health and care practice indicators are used to analyze
the causes of the nutritional problem
 Why are people malnourished or at risk of malnutrition?
Methods of data collection

a) Large-scale national surveys

b) Repeated small-scale surveys
c) Clinic-based monitoring
d) Sentinel site surveillance
e) School census data
f) Growth monitoring
 Large-scale national surveys
Examples are demographic Health Survey, National nutrition survey or
national food security surveys

Advantages
 They provide valuable
data to assess trends in
nutrition nationally and
globally
 Long-term trends can be
observed
 Standardized methodology
Disadvantages
 Need to train and supervise large
numbers of surveyors for quality
control
 High cost
 Long period between data collection
and release of findings
 Acute malnutrition could be missed
because of long period between
surveys
Repeated small-scale surveys
• They are the most common method used in emergencies.
• To be comparable, they should be conducted in the same
geographical area and at the same time/season or the year.
• They assess the type, severity and extent of malnutrition, its causes
among a representative sample of the population.

• Limitations
Require technical expertise
High cost
Clinic-based monitoring

• A component of health information system

• Can be applied both in emergency and non- emergency situations

•Limitations
Population attending clinics may not be representative
Captures only younger children
Sentinel site surveillance
• Monitoring of a set of indicators in selected communities or service-
delivery sites.

• Aims to produce trends in the nutrition situation in identified

vulnerable areas in order to provide early warning of deterioration.

• Limitations
 Problems with analysis of data and representativeness
School census data
• To identify high-risk children with poor health, malnutrition and
low socioeconomic status.

• Focuses on stunting and can provide large coverage.

•Limitations
Not useful in emergency situations.
 Representativeness is determined by school attendance
Growth monitoring

• Aims to identify slowing or faltering of growth at the individual level,

thus help to correct the problem promptly.

• Conducted by health professionals at maternal and child health clinics

or by trained members of the community in villages.

• Community based growth monitoring is a function of the Anganwadi

workers in India.
Nutritional education

• Nutritional education is a vital component in promoting healthy eating

habits and preventing chronic diseases.

• It aims to provide people with the knowledge, skill and motivation to

make informed decisions about their food choices and nutritional
practices.
Nutritional rehabilitation
• Nutritional rehabilitation refers to the process of restoring and
maintaining adequate nutritional status in individuals with people
malnutrition.

• Immediate measures are required as soon as malnourished subjects are

located.
Principles of nutritional education and
rehabilitation in context of socio-cultural factors
• Address socioeconomic status:
Poverty is a major driver of malnutrition.
Programs should aim to improve household income, food security and
access to healthcare.

• Understand cultural beliefs and practices:

Certain cultural dietary habits, superstitions and myths can negatively
impact feeding and care practices.
Nutrition education must address these beliefs sensitively.
• Promote optimal infant and young child feeding (IYCF) practices:
Lack of exclusive breastfeeding, inadequate complementary feeding,
and poor hygiene are immediate causes of malnutrition.
Programs should focus on improving IYCF through counseling and
support.

• Leverage community involvement:

Engaging mothers of well-nourished children as peer counselors can
improve the effectiveness of nutrition programs.
Community-based rehabilitation also empowers families.
• Integrate nutrition into broader development:
Malnutrition is linked to infections, food systems, and access to
services.
Holistic approaches integrating nutrition into health, agriculture,
Water, Sanitation and Hygiene (WASH) and social protection are
needed.

• Provide comprehensive rehabilitation:

Hospital-based, center-based and community-based rehabilitation
using specialized diets and developmental stimulation can aid
recovery from severe malnutrition.
• Address gender and social norms:

Cultural biases and power dynamics within households can undermine

women's ability to make decisions about child feeding.
Programs should aim to transform these norms.
Thank you