MY NEAR HOMECOMING

Dear Profossor,
I would like to express my feeling about what I learnt from you on "E-Communication".
I can tell you that I was very impreesd in leraning new tools to search on line through meta search engines and mainly how to create blog and share information woldwide.
When I go back home, I will help other people to learn "E-Communication" in order for them to reinforce their skills and abilities in their domains. That will be a great satisfaction for me thanks to your inestimable contribution.
May Gog Bless yoy and your Family.

REPUBLIC OF GUINEA

Republic of Guinea covers 245,857 square kilometres of West Africa. The population of Guinea is estimated at 10.2 million with 24 ethnic groups: The most prominent groups are the "Fula, Mandinka and Susu". Conakry, the capital and largest city, is the hub of Guinea's economy, commerce, education, and culture. Guinea is divided into four natural regions with distinct human, geographic, and climatic characteristics:

* Maritime Guinea (La Guinée Maritime) covers 18% of the country
* Mid-Guinea (La Moyenne-Guinée) covers 20% of the country
* Upper-Guinea (La Haute-Guinée) covers 38% of the country
* Forested Guinea (Guinée Forestière) covers 23% of the country, and is both forested and mountainous. It is also is divided into 8 administrative regions: Boké, Conakry, Kindia, Mamou, Labé, Franah, Kankan and N'Zérékoré. To learn more about Guinea, clic here

ABOUT MALNUTRITION

According to WHO, we can define malnutition as a condition resulting from deficiency or excess, relative or absolute, one or more essential nutrients, this condition is clinically apparent or can be detected by biochemical, physiological or anthropometric analysis.

Malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause. Lack of access to highly nutritious foods, especially in the present context of rising food prices, is a common cause of malnutrition. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition. Infection – particularly frequent or persistent diarrhoea, pneumonia, measles and malaria – also undermines a child's nutritional status.

A recently developed home-based treatment for severe acute malnutrition is improving the lives of hundreds of thousands of children a year. Ready-to-use Therapeutic Food (RUTF) has revolutionized the treatment of severe malnutrition – providing foods that are safe to use at home and ensure rapid weight gain in severely malnourished children. Read more

EPIDEMIOLOGY OF MALNUTRITION

Malnutrition is and remains a public health problem. Globally, it is estimated that nearly 20 million children suffer from Severe Acute Malnutrition (SAM), most of them live in Asia (9%) and Sub Saharan Africa (32%).

In Guinea, one in ten children suffers from acute malnutrition and one in three is chronically malnourished. According to the Demographic Health Surveys (DHS) II and III, chronic malnutrition has increased sharply from 26% in 1999 to 34.8% in 2005 while acute malnutrition has increased significantly from 9% to 9.4 % with rates above 10% considered the threshold.
A 2007 survey by the SPHERE Project in Guinea showed a prevalence of 13% of severe acute malnutrition in the administrative region of Faranah, 12% in the region of Labe, 11% in the region of N'Zérékoré and 10% in Kankan region.

CLINICAL FORMS OF MALNUTRITION

We have three clinical forms of Malnutrition:
1. Kwashiorkor: It is characterized by
- Oedema, deficiency thrive, behavior modification
- Rash made of red spots on pressure points
- Skin Fragility: cracks folds, erosions, ulcerations,
- Red hair, partial alopecia, angular stomatitis
- Sulcus Harrison, digestive disorders (anorexia, chronic diarrhea with malabsorption and bloating), hepatomegaly, fatty liver, secondary infections (pyogenic, candida).

2. Marasmus: characterized by
- Extreme underweight, old facies
- Irritability, apathy, active behavior, preserved appetite, starving children,
- Alopecia, elongated cilia
- Diarrhea hunger (small stools and greenish)
- Neither edema, or rash, or disorders of pigmentation,
- The skin has the feeling of touch of flour,
- The sclera is blue,
- Swelling in the chondro-costal junction,
- Dislocation costo-sternal cartilage called string of scurvy,
- Depression of the bases of the thorax (Harrison's sulcus)
- Osteoporosis and rarely fractures.

3. Mixed Form: Kwashiorkor and Marasmus together

CLASSIFICATION OF MALNUTRITION

We have three types of malnutritions:
1. Acute Malnutrition (Weight Loss): Measured by the weight / height, reflects the losses or gains weight regardless of age. It is reversible. It includes two types:
- Moderate acute malnutrition: Determined by an index weight / height <80% of median weight for the reference height of National Center for Heath Statistic (NCHS) or W / H = 70-80% in children from 6 months to 18 years or the Mid Upper Arm Circumference (MUAC) <125 mm in children from 6 to 59 months. In adults (except pregnant and lactating women) is determined by a BMI <18.5 kg/m2. There are no signs or clinical forms.
- Severe Acute Malnutrition : Determined by an index W / H <70% of median weight for NCHS in children from 6 months to 18 years or MUAC <110 mm in children aged from 6 to 59 months and / or the presence of bilateral oedema. In adults (except pregnant and lactating women) is determined by a BMI <16 kg/m2. It may be with or without complications.
2. Chronic Malnutrition (stunting): Measured by the the ratio (height/age) and reflects the growth. It is difficult to reverse.
3. Underweight: Measured by the ratio Weight / Age, reflects in the same time the ratio W / H: we speak about "dénutrition."

FACTORS LEADING TO MALNUTRITION

We have many factors leading to malnutrition in our countries:

1.Factors related to the health of mother and child:

- Close Pregnancy : the frequent pregnancies exacerbate the nutritional status of the mother, they lead to early and total stop of breastfeeding and expose the child to malnutrition.
- Numerous and repeated pregnancies, the risk is almost twice higher among children born in families with four children than those with one to three.
- Prematurity: It increases calorie needs while the child is more difficult to feed. It plays a supporting role of malnutrition.
- Infections: Any infection in children causes a loss of appetite that restricts food intake and leads to a vicious circle.
- Poor health and vaccine coverage
2. Socio-cultural factors:

- Bad practice of breastfeeding: Breaks with tradition increases the frequency of these passages in artificial feeding. But breastfeeding has benefits for the child than the mother: breast milk is the best food for infants, it contains nutrients in appropriate proportions and antibodies such as IgG struggling against microbial attacks, it is the cheapest. Lactation is relatively contraceptive.
- Advertising on certain dietary abuse: That encourages mothers to abandon breastfeeding in favor of these products.
- Unschooling or disregard of the needs of the child, mothers have no information about the nutritional values of foods for their children, which explains in part the non-food diversification.

3.Factors related to food security, availability and accessibility: The main cause of malnutrition in children is the difference between needs and actual food intake.

4.Psycho-affectif Factors

PREVENTION OF MALNUTRITION

As we know that prevention is better than cure, so investing in prevention is critical. Preventive interventions can include: improving access to high-quality foods and to health care; improving nutrition and health knowledge and practices; effectively promoting exclusive breastfeeding for the first six months of a child’s life where appropriate; promoting improved complementary feeding practices for all children aged 6–24 months — with a focus on ensuring access to age-appropriate complementary foods (where possible using locally available foods); and improving water and sanitation systems and hygiene practices to protect children
against communicable diseases.To read more, clic here.

COMMUNITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION

Severe acute malnutrition remains a major killer of children under five years of age.
Until recently, treatment has been restricted to facility-based approaches, greatly
limiting its coverage and impact. New evidence suggests, however, that large
numbers of children with severe acute malnutrition can be treated in their communities
without being admitted to a health facility or a therapeutic feeding centre.
The community-based approach involves timely detection of severe acute malnutrition
in the community and provision of treatment for those without medical complications
with ready-to-use therapeutic foods or other nutrient-dense foods at home. If properly
combined with a facility-based approach for those malnourished children with medical
complications and implemented on a large scale, community-based management of
severe acute malnutrition could prevent the deaths of hundreds of thousands of children. To learn more, go to

SYSTEMATIC MANAGEMENT OF MALNUTRITION

In case of severe acute malnutrition, we refer to the medication:
1.Antibiotic: amoxicillin (syrup preferably) for 7 days without signs of infection:
- <5 kg: 125 mg × 2/day
- 5-10 kg: 250 mg × 2/day
- 10-20 kg: 500 mg × 2/day
- 20-35 kg: 700 mg × 2/day
-> 35 kg: 1000 mg x 2/day
2.Folic acid: 5 mg once during the 1st visit
3.Vitamin A at the 4th visit (6-11 months: 100,000 IU,> = 12 months: 200,000 IU)
4.Anti-Measles Vaccination at the 4th visit for all children older than 9 months (not vaccinated or had no immunization card)
5.Deworming: Mebendazole 500 mg dose at the 2nd visit for all children from 12 months.

POSSIBLE COMPLICATIONS OF MALNUTRITION

Without treatment, malnutrition could lead to following diseases:
a. Dehydration
b. Heart Failure
v. Septic shock
d. Hypoglycemia
e. Respiratory Distress
f. Hypothermia
g. Hyperthermia
h. Severe anemia
i. Pneumonia

INSTITUTIONS ACTING AGAINST MALNUTRITION IN GUINEA

At the first level, we have the Ministry of Public Health as a national institution. Beside the Ministry, we have some international institutions such as UNICEF, SAVE CHILDREN, PLAN GUINEE,WHO, WORLD BANK, WFP, NGOs, etc.

These institutions and NGOs are assisting the country by:
- Mobilizing resources to support implementation
of these recommendations.
- Facilitating the local production or procurement of RUTF for countries with a high prevalence of severe acute malnutrition in communities where access to utrient-dense foods is limited.
- Supporting the development and evaluation of nutrition rehabilitation protocols based on local foods in countries where poor families have access to nutrient-dense foods.
- Working with governments and the private sector, including non-governmental
organizations, to rapidly disseminate these recommendations and build capacity for their implementation.
- Conducting operations research to refine protocols of community-based management of
severe acute malnutrition.
- Jointly implementing expanded communitybased programmes to combat severe acute
malnutrition in major humanitarian emergency situations.