Community Nutrition

Dr. Kazi Selim Anwar

MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)

Faculty, Dept. Infectious Disease /Microbiology

Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
 Community Nutrition
  Former Professional, Technical & Academic Positions (Main):
 Asst. Surgeon: Dhaka Medical College Hospital (DMCH)
 Med. Officer, ECPP, ICDDR, B (Int'l Center for Diarr Dis Research),
Dhk
 Medical Officer/Bacteriologist. Institute of Public Health (IPH) Dhaka
 Consultant/Project Physician: ICDDR, B Ascaris Proj. Mirpur Slum,Dhk
 Specialist Hota S Hosp, Riyadh, Health Min., Saudia Arabia
 WHO Surveillance Med Officer, VPD WHO SEARO’s IVD Prog, Dhk, BD
 Faculty, Microbiology Dept., Med School, AIMST University, Malaysia
 Consultant, Biosafety-Biosecurity, US-CDC Global Health Sec
Agenda,
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 21.05.2021
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
https://www.slideshare.net/aldhamadi/community-nutrition?
utm_source=slideshow&utm_medium=ssemail&utm_campaign=download_notification
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 Strategic Planning, cont.

 Analyze Information
 Common issues
 High risk individuals
 Unmet needs
 Prioritize
 Develop and implement community health plan
 Monitor and evaluate community health plan
Steps to Assessment
 Convene a planning group
 Define community
 Identify Community Assets
 Identify Perceived Needs
 Build Demographic Profile
 Analyze Community Health Status
 Analyze Community Nutrition Status
 Identify Community Resources and Service
Utilization
 Identify common issues and unmet needs
 Prioritize
 Community Nutrition Planning Group:
Responsibilities

 Collect data and information

 Identify health needs and gaps in service
 Set priorities
 Develop a plan
 Help to implement interventions
 Assist in evaluation
 Of assessment, planning, and intervention process
 Of impact of intervention
 Community Nutrition Planning
Group: Potential Members

 Community leaders
 Consumers
 Health and Nutrition Service providers
 Health organizations
 Schools
 Political office holders or their staff
 Fitness professionals
 Representatives from greater community health planning
groups
 Define the Parameters

 Public Health Nutrition: Assuring conditions in which people can be

nutritionally healthy
 Community: “A community is any group sharing something in common”

Community Tool Box

Community Description

 Geographic boundaries
 General history
 Key people and leaders
 Demographics
 Financial & economic information
 Important issues
 Morale and involvement levels
 Key allies and rivals
 Unspoken rules and norms
 Attitudes and opinions
 Strengths and shortcomings
 Identify Perceived Needs

 WHY?
 To understand public opinion
 To become aware of needs the planning group doesn’t know about
 To gather support & expand group expertise
 To make decisions about priorities
 To plan programs in ways that will be acceptable to stakeholders
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Community Health Status

 Causes of Mortality
 Hospital discharge data
 Disease prevalence data
 Food bourne illness reports
 Years of potential life lost
 Infant mortality
 Community Nutritional Status

 Pregnancy related:
 weight gain in pregnancy
 Pre-pregnancy weight
 Anemia
 Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes
 Activity levels (BRFSS)
 Food intake: fat, fruits & vegetables (BRFSS)
 Dental health
 Food/dieting related behaviors (YRBS)
 Food Security (BRFSS)
 Community Resources & Service
Utilization

 What resources are available?

 To what extent are people using them?
 Sources of Information:
 Citizens
 Service providers
 Tools
 Existing data
 Interviews
 Surveys
 Examples of Community Nutrition
Resources
• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling
 Criteria for defining/prioritizing
community problems

 Frequency
 Duration
 Scope or range
 Severity
 Perceptions
 Root causes (“but why?”) & ability to impact root causes
(effectiveness of interventions)
 Barriers to resolutions
 Political and financial support
Thank
you
57
Highlights

• We analyse the profile of consumers

interested in nutrition or in health claims.

• The analysis is based on 240 face-to-face

interviews and OLS estimations.

• Nutrition claims interest consumers focused

on wellbeing and with high knowledge.

• Age, income and health conditions influence

the interest for health-related
claims.
 Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)

Faculty, Dept. Infectious Disease /Microbiology

Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 21.05.2021
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
Nutrition Education In Schools
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
https://propranolols.blogspot.com/2020/01/nutrition-education-in-schools-ppt.html
HEALTHY EATING
First thing first: Basics of Nutrition
Protein
CHO- Carbohydrates
Complex CHO
Fat
Sources of Fat
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
https://www.slideshare.net/aldhamadi/community-nutrition?
utm_source=slideshow&utm_medium=ssemail&utm_campaign=download_notification
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 Strategic Planning, cont.

 Analyze Information
 Common issues
 High risk individuals
 Unmet needs
 Prioritize
 Develop and implement community health plan
 Monitor and evaluate community health plan
Steps to Assessment
 Convene a planning group
 Define community
 Identify Community Assets
 Identify Perceived Needs
 Build Demographic Profile
 Analyze Community Health Status
 Analyze Community Nutrition Status
 Identify Community Resources and Service
Utilization
 Identify common issues and unmet needs
 Prioritize
 Community Nutrition Planning Group:
Responsibilities

 Collect data and information

 Identify health needs and gaps in service
 Set priorities
 Develop a plan
 Help to implement interventions
 Assist in evaluation
 Of assessment, planning, and intervention process
 Of impact of intervention
 Community Nutrition Planning
Group: Potential Members

 Community leaders
 Consumers
 Health and Nutrition Service providers
 Health organizations
 Schools
 Political office holders or their staff
 Fitness professionals
 Representatives from greater community health planning
groups
 Define the Parameters

 Public Health Nutrition: Assuring conditions in which people can be

nutritionally healthy
 Community: “A community is any group sharing something in common”

Community Tool Box

Community Description

 Geographic boundaries
 General history
 Key people and leaders
 Demographics
 Financial & economic information
 Important issues
 Morale and involvement levels
 Key allies and rivals
 Unspoken rules and norms
 Attitudes and opinions
 Strengths and shortcomings
 Identify Perceived Needs

 WHY?
 To understand public opinion
 To become aware of needs the planning group doesn’t know about
 To gather support & expand group expertise
 To make decisions about priorities
 To plan programs in ways that will be acceptable to stakeholders
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Community Health Status

 Causes of Mortality
 Hospital discharge data
 Disease prevalence data
 Food bourne illness reports
 Years of potential life lost
 Infant mortality
 Community Nutritional Status

 Pregnancy related:
 weight gain in pregnancy
 Pre-pregnancy weight
 Anemia
 Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes
 Activity levels (BRFSS)
 Food intake: fat, fruits & vegetables (BRFSS)
 Dental health
 Food/dieting related behaviors (YRBS)
 Food Security (BRFSS)
 Community Resources & Service
Utilization

 What resources are available?

 To what extent are people using them?
 Sources of Information:
 Citizens
 Service providers
 Tools
 Existing data
 Interviews
 Surveys
 Examples of Community Nutrition
Resources
• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling
 Criteria for defining/prioritizing
community problems

 Frequency
 Duration
 Scope or range
 Severity
 Perceptions
 Root causes (“but why?”) & ability to impact root causes
(effectiveness of interventions)
 Barriers to resolutions
 Political and financial support
Thank you

146
Highlights

• We analyse the profile of consumers

interested in nutrition or in health claims.

• The analysis is based on 240 face-to-face

interviews and OLS estimations.

• Nutrition claims interest consumers focused

on wellbeing and with high knowledge.

• Age, income and health conditions influence

the interest for health-related
claims.
 RECAP on Public Health &
Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)
Faculty, Dept. Infectious Disease /Microbiology
Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Re-capitulations on
Public health & Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 3 June 2021

 Public health (Pub-H):
 The science & art of preventing dis,
 Prolonging life
 Improving QoL
QoL organized effort/informed choice
of society, organizations: PPP 
(Public-Private-Partnership) programs:
Comm, individual, groups involvement  
 "Winslow, Charles-Edward Amory.", Encyclopedia of Public Health, Ed. 
Lester Breslow, Gale Group, Inc., 2002. eNotes. com. 2006, 24 March 2008 <
http://www.enotes.com/public-health-encyclopedia/winslow-charles-edward-amory
Global concentrations of healthcare resource
depicted by Physicians/10,000 individuals.
Health care, or health-care, or healthcare:
Maintenance & Improvement of health:

prev, diag, treatmnt, and …

cure/ recovery or cure of disease: 

… illness, injury, and other 

physical and mental impairments in

A very straightforward definition of Pub Hlth by
Look at the
Popl & Act on
demand need
for Popl Hlth
 A RTA Occurred: What will doctor do?
Pub Health
https://www.youtube.com/watch?v=jA8uYvJ_i8Y
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 18 June DIU 5th Lect
DIFFERENT TYPES AND
STAGES OF MALNUTRITION

Quick Recap (Recapitulation) on:

Comm Hlth
Pub Hlth
Interrelation among these
Pub Hlth Pub Hlth Nutr 
Comm Hlth Nutr Pub Hlth Nutrn
Now…. Todays Lecture: Types of Malnutr
 Public health (Pub-H):
 The science & art of preventing dis,
 Prolonging life
 Improving QoL
QoL organized effort/informed choice
of society, organizations: PPP 
(Public-Private-Partnership) programs:
Comm, individual, groups involvement  
 "Winslow, Charles-Edward Amory.", Encyclopedia of Public Health, Ed. 
Lester Breslow, Gale Group, Inc., 2002. eNotes. com. 2006, 24 March 2008 <
http://www.enotes.com/public-health-encyclopedia/winslow-charles-edward-amory
Global concentrations of healthcare resource
depicted by Physicians/10,000 individuals.
Health care, or health-care, or healthcare:
Maintenance & Improvement of health:

prev, diag, treatmnt, and …

cure/ recovery or cure of disease: 

… illness, injury, and other 

physical and mental impairments in

A very straightforward definition of Pub Hlth by
Look at the
Popl & Act on
demand need
for Popl Hlth
 A RTA Occurred: What will doctor do?
Pub Health
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management

 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
- - Macro-nutrients (carbohydrate, fat, protein)
- - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
.
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
 PUBLIC HEALTH COMMUNITY
PUB HLTH NUTRITION NUTRITION
PUB HLTH & NUTRITION

In terms of disease causation

Infect Dis remains the most Magic of Deaths
https://www.youtube.com/watch?v=DbRtS9SE5I0
 Life span increases but
Progresses rapidly
NCDs grows more & more
Healthcare is vital to all of us some of the time,
but public health
is vital to all of us all the time. - C. Everett Koop
(1916-2013)
by Chester Buckenmaier III,
MD, COL (ret), MC, USA | May 14, 2019
COMMUNTY NUTRITION: WHAT WE BASICALLY NEED- THE FOOD,
THE DIEST, THE NUTRITENTS THE ENERGY TO LIVE IN
Nutrition Education In Schools
Causes of child under-nutrition
Direct causes
Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
Inadequate maternal and child caring practices
Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
Protein
CHO- Carbohydrates
Complex CHO
Fat
Sources of Fat
 Disease Malnutrition

 Diseases and malnutrition are closely linked.

 Nutritional disorders include diseases those
result from excessive or inadequate food/ nutrient
intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management

 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 18 June DIU 5th Lect
DIFFERENT TYPES AND
STAGES OF MALNUTRITION
 Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)

Faculty, Dept. Infectious Disease /Microbiology

Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
 Community Nutrition
  Former Professional, Technical & Academic Positions (Main):
 Asst. Surgeon: Dhaka Medical College Hospital (DMCH)
 Med. Officer, ECPP, ICDDR, B (Int'l Center for Diarr Dis Research),
Dhk
 Medical Officer/Bacteriologist. Institute of Public Health (IPH) Dhaka
 Consultant/Project Physician: ICDDR, B Ascaris Proj. Mirpur Slum,Dhk
 Specialist Hota S Hosp, Riyadh, Health Min., Saudia Arabia
 WHO Surveillance Med Officer, VPD WHO SEARO’s IVD Prog, Dhk, BD
 Faculty, Microbiology Dept., Med School, AIMST University, Malaysia
 Consultant, Biosafety-Biosecurity, US-CDC Global Health Sec
Agenda,
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 21.05.2021
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
https://www.slideshare.net/aldhamadi/community-nutrition?
utm_source=slideshow&utm_medium=ssemail&utm_campaign=download_notification
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 Strategic Planning, cont.

 Analyze Information
 Common issues
 High risk individuals
 Unmet needs
 Prioritize
 Develop and implement community health plan
 Monitor and evaluate community health plan
Steps to Assessment
 Convene a planning group
 Define community
 Identify Community Assets
 Identify Perceived Needs
 Build Demographic Profile
 Analyze Community Health Status
 Analyze Community Nutrition Status
 Identify Community Resources and Service
Utilization
 Identify common issues and unmet needs
 Prioritize
 Community Nutrition Planning Group:
Responsibilities

 Collect data and information

 Identify health needs and gaps in service
 Set priorities
 Develop a plan
 Help to implement interventions
 Assist in evaluation
 Of assessment, planning, and intervention process
 Of impact of intervention
 Community Nutrition Planning
Group: Potential Members

 Community leaders
 Consumers
 Health and Nutrition Service providers
 Health organizations
 Schools
 Political office holders or their staff
 Fitness professionals
 Representatives from greater community health planning
groups
 Define the Parameters

 Public Health Nutrition: Assuring conditions in which people can be

nutritionally healthy
 Community: “A community is any group sharing something in common”

Community Tool Box

Community Description

 Geographic boundaries
 General history
 Key people and leaders
 Demographics
 Financial & economic information
 Important issues
 Morale and involvement levels
 Key allies and rivals
 Unspoken rules and norms
 Attitudes and opinions
 Strengths and shortcomings
 Identify Perceived Needs

 WHY?
 To understand public opinion
 To become aware of needs the planning group doesn’t know about
 To gather support & expand group expertise
 To make decisions about priorities
 To plan programs in ways that will be acceptable to stakeholders
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Community Health Status

 Causes of Mortality
 Hospital discharge data
 Disease prevalence data
 Food bourne illness reports
 Years of potential life lost
 Infant mortality
 Community Nutritional Status

 Pregnancy related:
 weight gain in pregnancy
 Pre-pregnancy weight
 Anemia
 Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes
 Activity levels (BRFSS)
 Food intake: fat, fruits & vegetables (BRFSS)
 Dental health
 Food/dieting related behaviors (YRBS)
 Food Security (BRFSS)
 Community Resources & Service
Utilization

 What resources are available?

 To what extent are people using them?
 Sources of Information:
 Citizens
 Service providers
 Tools
 Existing data
 Interviews
 Surveys
 Examples of Community Nutrition
Resources
• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling
 Criteria for defining/prioritizing
community problems

 Frequency
 Duration
 Scope or range
 Severity
 Perceptions
 Root causes (“but why?”) & ability to impact root causes
(effectiveness of interventions)
 Barriers to resolutions
 Political and financial support
Thank
you
317
Highlights

• We analyse the profile of consumers

interested in nutrition or in health claims.

• The analysis is based on 240 face-to-face

interviews and OLS estimations.

• Nutrition claims interest consumers focused

on wellbeing and with high knowledge.

• Age, income and health conditions influence

the interest for health-related
claims.
 Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)

Faculty, Dept. Infectious Disease /Microbiology

Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
 Community Nutrition
  Former Professional, Technical & Academic Positions (Main):
 Asst. Surgeon: Dhaka Medical College Hospital (DMCH)
 Med. Officer, ECPP, ICDDR, B (Int'l Center for Diarr Dis Research),
Dhk
 Medical Officer/Bacteriologist. Institute of Public Health (IPH) Dhaka
 Consultant/Project Physician: ICDDR, B Ascaris Proj. Mirpur Slum,Dhk
 Specialist Hota S Hosp, Riyadh, Health Min., Saudia Arabia
 WHO Surveillance Med Officer, VPD WHO SEARO’s IVD Prog, Dhk, BD
 Faculty, Microbiology Dept., Med School, AIMST University, Malaysia
 Consultant, Biosafety-Biosecurity, US-CDC Global Health Sec
Agenda,
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 21.05.2021
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
https://www.slideshare.net/aldhamadi/community-nutrition?
utm_source=slideshow&utm_medium=ssemail&utm_campaign=download_notification
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 Strategic Planning, cont.

 Analyze Information
 Common issues
 High risk individuals
 Unmet needs
 Prioritize
 Develop and implement community health plan
 Monitor and evaluate community health plan
Steps to Assessment
 Convene a planning group
 Define community
 Identify Community Assets
 Identify Perceived Needs
 Build Demographic Profile
 Analyze Community Health Status
 Analyze Community Nutrition Status
 Identify Community Resources and Service
Utilization
 Identify common issues and unmet needs
 Prioritize
 Community Nutrition Planning Group:
Responsibilities

 Collect data and information

 Identify health needs and gaps in service
 Set priorities
 Develop a plan
 Help to implement interventions
 Assist in evaluation
 Of assessment, planning, and intervention process
 Of impact of intervention
 Community Nutrition Planning
Group: Potential Members

 Community leaders
 Consumers
 Health and Nutrition Service providers
 Health organizations
 Schools
 Political office holders or their staff
 Fitness professionals
 Representatives from greater community health planning
groups
 Define the Parameters

 Public Health Nutrition: Assuring conditions in which people can be

nutritionally healthy
 Community: “A community is any group sharing something in common”

Community Tool Box

Community Description

 Geographic boundaries
 General history
 Key people and leaders
 Demographics
 Financial & economic information
 Important issues
 Morale and involvement levels
 Key allies and rivals
 Unspoken rules and norms
 Attitudes and opinions
 Strengths and shortcomings
 Identify Perceived Needs

 WHY?
 To understand public opinion
 To become aware of needs the planning group doesn’t know about
 To gather support & expand group expertise
 To make decisions about priorities
 To plan programs in ways that will be acceptable to stakeholders
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Community Health Status

 Causes of Mortality
 Hospital discharge data
 Disease prevalence data
 Food bourne illness reports
 Years of potential life lost
 Infant mortality
 Community Nutritional Status

 Pregnancy related:
 weight gain in pregnancy
 Pre-pregnancy weight
 Anemia
 Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes
 Activity levels (BRFSS)
 Food intake: fat, fruits & vegetables (BRFSS)
 Dental health
 Food/dieting related behaviors (YRBS)
 Food Security (BRFSS)
 Community Resources & Service
Utilization

 What resources are available?

 To what extent are people using them?
 Sources of Information:
 Citizens
 Service providers
 Tools
 Existing data
 Interviews
 Surveys
 Examples of Community Nutrition
Resources
• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling
 Criteria for defining/prioritizing
community problems

 Frequency
 Duration
 Scope or range
 Severity
 Perceptions
 Root causes (“but why?”) & ability to impact root causes
(effectiveness of interventions)
 Barriers to resolutions
 Political and financial support
Thank
you
381
Highlights

• We analyse the profile of consumers

interested in nutrition or in health claims.

• The analysis is based on 240 face-to-face

interviews and OLS estimations.

• Nutrition claims interest consumers focused

on wellbeing and with high knowledge.

• Age, income and health conditions influence

the interest for health-related
claims.
 Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)

Faculty, Dept. Infectious Disease /Microbiology

Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 21.05.2021
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
Nutrition Education In Schools
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
https://propranolols.blogspot.com/2020/01/nutrition-education-in-schools-ppt.html
HEALTHY EATING
First thing first: Basics of Nutrition
Protein
CHO- Carbohydrates
Complex CHO
Fat
Sources of Fat
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
https://www.slideshare.net/aldhamadi/community-nutrition?
utm_source=slideshow&utm_medium=ssemail&utm_campaign=download_notification
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research

 Strategic Planning, cont.

 Analyze Information
 Common issues
 High risk individuals
 Unmet needs
 Prioritize
 Develop and implement community health plan
 Monitor and evaluate community health plan
Steps to Assessment
 Convene a planning group
 Define community
 Identify Community Assets
 Identify Perceived Needs
 Build Demographic Profile
 Analyze Community Health Status
 Analyze Community Nutrition Status
 Identify Community Resources and Service
Utilization
 Identify common issues and unmet needs
 Prioritize
 Community Nutrition Planning Group:
Responsibilities

 Collect data and information

 Identify health needs and gaps in service
 Set priorities
 Develop a plan
 Help to implement interventions
 Assist in evaluation
 Of assessment, planning, and intervention process
 Of impact of intervention
 Community Nutrition Planning
Group: Potential Members

 Community leaders
 Consumers
 Health and Nutrition Service providers
 Health organizations
 Schools
 Political office holders or their staff
 Fitness professionals
 Representatives from greater community health planning
groups
 Define the Parameters

 Public Health Nutrition: Assuring conditions in which people can be

nutritionally healthy
 Community: “A community is any group sharing something in common”

Community Tool Box

Community Description

 Geographic boundaries
 General history
 Key people and leaders
 Demographics
 Financial & economic information
 Important issues
 Morale and involvement levels
 Key allies and rivals
 Unspoken rules and norms
 Attitudes and opinions
 Strengths and shortcomings
 Identify Perceived Needs

 WHY?
 To understand public opinion
 To become aware of needs the planning group doesn’t know about
 To gather support & expand group expertise
 To make decisions about priorities
 To plan programs in ways that will be acceptable to stakeholders
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 How do we assess perceived needs?

 Listening sessions
 Public forums
 Key informant interviews
 Needs assessment survey or survey of concerns
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Demographic Profile

 Economic status: income, employment, % below poverty

 Education levels
 Age and gender
 Race & ethnicity
 Social factors: homelessness, immigration status, family composition, TANF
utilization
 Community Health Status

 Causes of Mortality
 Hospital discharge data
 Disease prevalence data
 Food bourne illness reports
 Years of potential life lost
 Infant mortality
 Community Nutritional Status

 Pregnancy related:
 weight gain in pregnancy
 Pre-pregnancy weight
 Anemia
 Disease prevalence: HIV/AIDS, cardiovascular disease, diabetes
 Activity levels (BRFSS)
 Food intake: fat, fruits & vegetables (BRFSS)
 Dental health
 Food/dieting related behaviors (YRBS)
 Food Security (BRFSS)
 Community Resources & Service
Utilization

 What resources are available?

 To what extent are people using them?
 Sources of Information:
 Citizens
 Service providers
 Tools
 Existing data
 Interviews
 Surveys
 Examples of Community Nutrition
Resources
• Food assistance programs (WIC, Basic Food, etc.)
• Grocery stores with high quality produce
• Food Service with health promoting food options
• Educational programs
• Media
• Profession and non-profit organizations
• Nutrition counseling
 Criteria for defining/prioritizing
community problems

 Frequency
 Duration
 Scope or range
 Severity
 Perceptions
 Root causes (“but why?”) & ability to impact root causes
(effectiveness of interventions)
 Barriers to resolutions
 Political and financial support
Thank you

470
Highlights

• We analyse the profile of consumers

interested in nutrition or in health claims.

• The analysis is based on 240 face-to-face

interviews and OLS estimations.

• Nutrition claims interest consumers focused

on wellbeing and with high knowledge.

• Age, income and health conditions influence

the interest for health-related
claims.
 RECAP on Public Health &
Community Nutrition
Dr. Kazi Selim Anwar
MD (USSR), M. Phil (England)
Higher Training Pub Health & Microbiol (Japan)
Faculty, Dept. Infectious Disease /Microbiology
Intern’l Univ. of Health & Welfare (IUHW)
Narita Campus, Japan (until Mar 2021)

Visiting Professor, Dept. Pub Health,

Daffodil Intern’l Univ (DIU), Dhaka
Semester: Summer 2021

Course Code: MPH 5162

Course Name: Re-capitulations on
Public health & Community Nutrition

Class Time: 11:00 AM - 01:00 PM

Class Date: 3 June 2021

 Public health (Pub-H):
 The science & art of preventing dis,
 Prolonging life
 Improving QoL
QoL organized effort/informed choice
of society, organizations: PPP 
(Public-Private-Partnership) programs:
Comm, individual, groups involvement  
 "Winslow, Charles-Edward Amory.", Encyclopedia of Public Health, Ed. 
Lester Breslow, Gale Group, Inc., 2002. eNotes. com. 2006, 24 March 2008 <
http://www.enotes.com/public-health-encyclopedia/winslow-charles-edward-amory
Global concentrations of healthcare resource
depicted by Physicians/10,000 individuals.
Health care, or health-care, or healthcare:
Maintenance & Improvement of health:

prev, diag, treatmnt, and …

cure/ recovery or cure of disease: 

… illness, injury, and other 

physical and mental impairments in

A very straightforward definition of Pub Hlth by
Look at the
Popl & Act on
demand need
for Popl Hlth
 A RTA Occurred: What will doctor do?
Pub Health
https://www.youtube.com/watch?v=jA8uYvJ_i8Y
 Community Nutrition
References cited/ Literature read/
Concepts/ Slides borrowed to modify
 Looked at the Pub Med
 Searched on Goggle/Scholar, Browsed Web sites
USA. Nat Nutr Assessment Information

Javier Arancita. Community Nutrition. Arch latinoam Nutr

2004; 54 (S-2):9-13. NIH Pub Med

And, mostly taken from Shayla Nasrin, MSc, M Phil, PhD.

Head of Department (Nutrition), ICMH, Dhaka

And several other references: Cited right on the bottom of the texts
In last 20 Yrs: Com/Pub Hlth Nutr focus on Qual aspect dealt wth Chrn
Dis, Phys/Mental QoL  DALY/QALY  Prev./Hlth  Led to Comm Nutr
Comm Nutr Aims:
 Enhance QoL through food consumption in a definite Comm/Unit
 Identify/Assess Nutr Problm whr design/Implemnt/ Evaluatn/ Intervn
 Using appr. strategy aiming at different popul/ Gps and Setting:
work place/school, high risk Gp/Pub
Currently: Com Nutr efforts on 3 main aspects:
 Nutrition educ …. in schools or, … a given community as needed
 Food safety
 Food security
These are the development/reinforcement of food preparation skills.
Social catering services: schools/work place/communities
Ensure adequate food/nutr supply  contribute to healthy eating prac.
Even
in the
USA
 Concept of Community Nutrition

Concept of Community
Community: Gp of people who decide locality,
interact and connect through a social structure.
Community has Four components:
 People living around
 Location in space,
 Social interaction,
 Shared values.
Communities are defined on different scales:
 Local
 National
 Regional
 Global
 The concept of community
Opportunities in Community Nutrition
 Program/instruments used by Comm Health Worker (CHW)
to seek behavior change to improve Health & Nutrition
 Focus of community Nutrition includes: 3 Ps
 People
 Policy
 Program
 People of various community benefit from comm nutr progs
 Policy is a course of action chosen by public authorities
 Programs are addressed for a given problem that are
accomplished through laws and regulations.
….. Cont.… The Concept of Health
Proper definition of Health focuses on interaction of
humans among themselves/with surrounding environ
Following factors influence health:
 Individual factors,
 Lifestyle factors,
 Working conditions/ atmosphere,
 Social networking
 Community services
 National health policies
….. Cont.…. The Concept of Health

Public Health and Community Interventions

 Pub Health focuses on protecting &

promoting people’s health through robust
societal actions.

 Scope of Pub Hlth includes Infect Dis:

TB, AIDS, Malaria, Dengue, COVID-19, etc.
 Chronic Dis: DM, CVD/CHD, Stroke, Ca, etc.
Nutrition Program Planning
Malnutrition
Community Nutrition
and NCD Management
 Food Security
 Food Safety
 Malnutrition
 Non-communicable Dis
 Objectives of Community Nutriton
The students will learn after this session on:
 Concept of ‘Malnutrition’
 Causes and Effects of Malnutrition
 Disease and Malnutrition
 Nutritional deficiency disorders
 Nutritional Imbalance (Overweight/ Obesity)
 Nutrition Program Planning
 Essential Nutrition Actions (ENA)
 Definition of Malnutrition:
‘Lack of Nutrition’
Persons not getting enough or right type of food
according to body’s daily requirements of:
 - Macro-nutrients (carbohydrate, fat, protein)
 - Micro-nutrients (Vitamins and minerals).

WHO defines Malnutrition as :

‘Cellular imbalance between supply of nutrients
& energy, & body's demand for them to ensure
growth, maintenance & specific functions’
Classification of Malnutrition:
Under-nutrition & Over-nutrition stands at the
opposite ends of spectrum of Malnutrition
Under-nutrition:
Cause of inadequate intake (both quality
and quantity) of micro-nutrients
Over-nutrition:
Imbalance of nutrition due to excessive intake
of macronutrients: both Saturated Fat and
Simple Carbohydrates.
Causes of child under-nutrition
Direct causes
 Inadequate dietary intake of macro & micronutrients that
leads to diseases & Nutritional deficiency disorders (NDD)
Underlying causes at household/family level
 Insufficient access to food
 Inadequate maternal and child caring practices
 Poor water/sanitation and inadequate health services
All these are influenced by poverty, Agri, Educ, etc.
Basic causes at society level: Quantity & Quality of
actual resources-human, economic, organizational
& controlling those. Ref: Marie Ruel,2008,revised
 Disease Malnutrition
 Diseases and malnutrition are closely linked.
 Nutritional disorders include diseases those result
from excessive or inadequate food/ nutrient intake
 Sometimes disease is the result of malnutrition,
sometimes it is a contributing cause.
 In fact, malnutrition is the largest single
contributor to the diseases in the world
(UN’s standing committee on Nutrition)
 Effects of Malnutrition
Vulnerable groups for Malnutrition are
- Under-5 children
- Women especially pregnant &
lactating mother - Elderly
Under-nutrition
 Contributes ~1/2 (3 mil) of all U-5 child death in Asia & Africa
 Starts in Mom’s ‘uterus’ & extends particularly for girls/women.
 Affects ‘fetus’ and suffered intrauterine growth retardation (IUGR)
results in LBWs infants
 Cause of ‘foetal origin of adult dis’ (Barker’s hypothesis, 1980),
Link between LBWs & incidence of CHD in mid-aged men/women
 EFFECT OF UNDER-NUTRITION ……
.
CONTN
Further under-nutrition
Puts children at greater risk of dying from common
infections
 Increases the frequency and severity of such
infections and delayed recovery
“Malnutrition-Infection cycle” deteriorating
nutritional status of children
Poor nutrition in the first 1,000 days of a child’s life
can also lead to stunted growth, which is irreversible
Impaired cognitive ability and reduced school and
work performance.
Nutritional deficiency disorders (NDD)
Macronutrients deficiency
PEM Marasmus (Greek word, means wasting)
 inadequate intake of protein and calories
 characterized by emaciation
 edema absent
 children younger than 5 years.
Kwashiorkor ("the sickness of the weaning“, 1933 1st used
from Ga language of Ghana)
 an inadequate protein intake with reasonable calorie (energy) 
 Edema is characteristic feature of Kwashiorkor
 Vit. A , Iron and Zn deficiency could aggravate
Marasmic Kwashiorkor is another feature of PEM
 Worst victims of PEM
 PEM more common in low-income countries
 Children and elderly people both affected
 Children from large urban areas in low
 socioeconomic neighborhoods (developing
countries)
 Children with chronic diseases
 Children who are institutionalized or
hospitalized for a different diagnosis.
Nutritional Imbalance
Overweight: BMI ≥ 25 kg/m2
 Increased risk: BMI 23.1-24.9 kg/m2
 High risk: BMI ≥27.5 kg/m2
or

 Pre-obese: BMI 25-29.9 kg/m2

Source: WHO, 2004, The Lancet

Obesity: BMI ≥30 kg/m2

 Obese-I: BMI 30-39.9 kg/m2
 Obese class-II: BMI 35-39.9 kg/m2
 Obese class III: BMI ≥40 kg/m2
 Cause and Effect of Imbalance Nutrition
(Obesity and overweight)
Causes:
 Consuming too many calories compared to the
amount of exercise performed by one’s body
 Causing a distorted energy balance

Effects
 Rates of obesity and overweight related Non
communicable Diseases (NCDs) like DM HTN, C,
CKD: Chron Kidney Dis, CHD- Heart diseases, etc…
……. Escalates at great level.
 Prevalence of obesity
 .. World has more Overweight > Underweight people now
(BMJ, The Lancet )
 Previously overweight and obesity were largely associated with
high-income countries but now-a-days obesity is a challenge for
low and middle-income countries
 Bangladesh faces dual burden of malnutrition (under & over Nutr)
 About 1.4% under-5 children and 18.1% adult population are obese
(GNR, 2016)
 One in five married women are obese and a range of factors such as
wealth, educational status, hours spent behind television that
contributed to excess weight.
 Women are more obese than men
 (Sharma et al, BMC obesity, 2016)
 Nutrition Program Planning
Nutrition Plan
 A scheme of action prepared in advance = A plan
 Nutrition planning is a scheme of action about
‘nutrition’ prepared in advance.
 Nutrition planning is a dynamic process and slightly
different from economic plan as it deals with
undernourished and nutritionally imbalanced people
Characteristics of a plan
Orderly construction of steps to achieve them
Orderly construction of major objectives (short term/long
term)
Basics of Program Nutr Planning

 Systematic process
 Continual feedback and evaluation

 Cyclical:

Based on increasing understandings of the

true nature of the situation and the
effectiveness of interventions.

 Starts with an assessment of current Nutr

situation in a given community
 Nutrition Program Planning
 Before plan: gathering and synthesizing existing
data (quantitative and qualitative data from:
BDHS, MICS, BD National surveys etc.) as follows:
5 areas of public health significance:
 A. Nutritional status :
Anthropometry, dietary, biochemical
 B. Infant and young child feeding
 C. Maternal nutrition
 D. Micronutrient status of children
 E. Underlying disease burden
Stages of Nutrition Planning

Identification of the problem

Prioritization

Setting objectives

Comparing alternatives

Decision Making

Implementation

Evaluation
 Stages of Nutrition Planning—cont.
1. Identification of the problem
 Identification of the nature and extent of malnutrition by
considering following systematically
1. What are the specific nutritional deficiencies?
2. How severe are they? (intensity)
3. What group of population affected? (e.g. mother or child)
4. Where are they? (location)
5. What are the trends?
 Methods for the Identification of the problem
 Existing sources (BDHS, MICS, national surveys etc)
 Food Balance Sheet Approach
 Stages of Nutrition Planning—cont.
2. Prioritization
 On the basis of the need and severity of the problem
3. Setting objectives
2 types of objectives e.g. long term and short term which
depend on
 selection of targets (based on findings of earlier problem
identified)
-Target groups
-Targeted nutrition deficiency to be addressed
 Selection of time frame
 Resource requirements (capital, materials, manpower)
Stages of Nutrition Planning—cont.
4. Comparing among alternatives methods to eradicate
malnutrition, e.g. Addressing vitamin A deficiency by
combination of the methods or by
 Supplementation of vitamin A capsule
 Home gardening
 Food fortification
 Nutrition education
It depends on following Mechanisms
 cost benefit analysis
 cost effective
 Constraints
 Replicable capacity
Stages of Nutrition Planning… Contn.
5. Decision making
 which methods will apply to eradicate malnutrition?
 How many method will be used?
 How many months/years should it be continued?
6. Implementation
 To bring selected agreed methods into reality
 To implement within allocated time frame
7. Evaluation
 Measuring actual performance by comparing between
baseline data and end line data.
 Informing the planners about the weakness of the plan
Stages of Nutrition Planning ….. cont.
Types of Evaluation
 Baseline
 Mid level evaluation for modification and adjustments.
 End line

Post- evaluation steps to be taken

 Actual performance revealed
 Weakness of the program revealed
 Achieved effectiveness
 Alteration for continuation
 Back to 1st step of planning
 Process Evaluation
and Adjustment
Assess

Prioritize

Analyze problem and

propose model to
address

Develop
Intervention
goals, objectives,
implementation
plan
Evaluate
outcomes
 ESSENTIAL NUTRITION ACTIONS (ENA) to Comba
Malnutrition

ENA consists of 7 affordable, evidence‐based nutr interventions delivered

at health facilities/comm to improve Nutr status of women and children.
1. Promotion of optimal breastfeeding during the first six months
2. Promotion of optimal complementary feeding starting at 6 months with
continued breastfeeding to 2 years of age and beyond
3. Promotion of optimal nutritional care of sick and severely malnourished
children
4. Prevention of vitamin A deficiency in women and children
5. Promotion of adequate intake of iron and folic acid and prevention and
control of anemia for women and children
6. Promotion of Adequate intake of iodine by all members of the household
7. Promotion of optimal nutrition for women
Community Nutrition Assessment:
 Anchors
program/intervention in the reality of the
community
 Essential part of ongoing process:
Needs assessment
Designing and implementing services
Evaluation
Improving programs and services
 Must includes Comm/ Stakeholders to achieve
 Full compliance & active participants
Community Nutrition Assessment:
 Based on assets more than deficits
 Helps to integrate nutrition programs into community-based
health programs and plans

Successful Community Assessment Includes:

Understanding current conditions of families and individuals
Evaluating local capacities for supporting health and nutrition needs
Building community support for implementing changes

Models and Protocols for Community Assessment

 Planned Approaches to Community Health (PATCH) – CDC
 Assessment Protocol for Excellence in Public Health (APEXPH) – NACHO
(National Association of County Health Officials)
 Moving to the Future: Developing Community Based Nutrition Services –
ASTPHND (Association of State and Territorial Public Health Nutrition Directors)
Strategic Planning for Initiatives to Address Local
Health Efforts
 Community Assessment
 Organize a community planning group
 Define community boundaries
 Gather information
 Statistical profile
 Qualitative data
 Community Resources

Agency for Health Care Policy and Research