Nursing in Health and Illness 332
Eldon Walker, MS, RN
Childhood Malnutrition in Haiti
Most of the 10 million deaths among children worldwide age 5 years and younger are preventable. Childhood malnutrition is the underlying factor of 3.5 million deaths or 35% of the disease burden in children less than 5 years old. Children in Haiti are born into some of the harshest conditions on the planet, and are “left at a disadvantage in terms of growth, development, and potential to thrive” (Bassett & Ruel-Bergeron, 2010, p. 3). Malnutrition rates in Haiti are amongst the highest in the region, 23% of children have chronic malnutrition, 9% have acute nutrition (Chatterjee, 2008, p. 617), one-third of children under five suffer from stunted growth, and three-quarters of children 6-24 months are anemic (Bassett & Ruel-Bergeron, 2010, p. 3). Malnutrition can take a detrimental and irreversible toll on children, making them “more susceptible to disease and death and compromising their cognitive and physical development” (Bassett & Ruel-Bergeron, 2010, p. 3). Undernourished children have lower resistance to infection and are more likely to die of common childhood illnesses such as diarrhea and lower respiratory tract infections (Parikh et al., 2010, p. 559). Pathophysiology
Malnutrition is defined as “a deficit, excess, or imbalance of the essential components of a balanced diet” (Lewis, Dirksen, Heitkemper, Burcher, Camera, 2011, p. 923) and can refer to alterations in macronutrients (carbohydrates, proteins, and fats) or micronutrients (electrolytes, mineral, and vitamins). According to Dr. Robert Black et al. (2008, p. 243), “Undernutrtion encompasses stunting, wasting, and deficiencies of essential vitamins and minerals as one form of the condition known as malnutrition”. Undernutrtion describes a state of “poor nourishment as a result of inadequate diet or diseases that interfere with normal appetite and assimilation of ingested food” (Lewis et al., 2011, p. 924). In the developing world, approximately one quarter of children under the age of 5 years, or approximately 112 million children, are undernourished (Parikh et al., 2010, p. 559). Clinical manifestations of malnutrition can range from mild to severe, sometimes even resulting in death. The most obvious clinical signs on physical examination are apparent in the skin (dry and scaly skin, brittle nails, hair loss), mouth (crusting and ulceration, changes in tongue), muscles (decreased mass and weakness), and CNS (mental changes). These manifestations are the result of numerous interactions at the cellular level. “As protein intake is reduced, the muscles, which make up the largest reservoir of protein in the body, become wasted and flabby, leading to weakness, fatigability, and decreased endurance” (Lewis et al., p. 926). As a result, there is decreased protein available for repair and healing may be delayed, making the person more susceptible to all types of infection. Diagnosis and Treatment
A nutritional assessment is a comprehensive method to assessing nutritional status that uses “medical, nutritional, and medication histories; physical examination; anthropometric measurements; and laboratory data” (Lewis et al., 2011, p. 927). History and physical examination of undernutrition is key, and each body system should be assessed and documented carefully. A detailed history of food intake will “reveal a great deal about the patient’s dietary habits and knowledge of good nutrition” (Lewis et al., p. 926). Laboratory studies are used in conjunction with physical assessment. Low levels of visceral proteins, including albumin, prealbumin, and transferrin, are considered by some to be markers of current nutritional status (Lewis et al., p. 926). C-reactive protein (CRP) is typically elevated during inflammation and should be obtained to help “determine the extent to which low...