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Lecture 5 & 6- Public health

All of the following are health complications of worm infestations in a child, EXCEPT

Anemia

poor nutrient absorption

impaired cognitive development

Obesity or weight gain

T/F: worm infestations in children peak at the age of 1 to 3

True

False

T/F: It is recommended to do exclusive breast-feeding for the first 4 months , then introduce solid foods at the fifth month and continue on-demand breast feeding and contin

True

False

Complementary foods can be introduced After 6 months of exclusive breast-feeding, in combination with frequent or on-demand breast-feeding.

True

False

Breast-feeding is common in well-developed countries as urbanization has led to a positive impact on defying cultural norms

True

False

Breast milk is considered a complete food that supplies all nutrients for babies from birth until they are months old

True

False

What are the requirements for safe formula feeding?

Access to safe water & electricity

Sufficient money to buy formula and utensils needed in preparation

Providing training for the mother regarding the Preparation method, use, and handling of powdered infant formula to minimize health hazards

All of the above

More than half of deaths in children under 5 years are attributed to undernutrition

True

False

Fill in the blank: At birth, the head circumference is 35 cm and it increase by ............ Cm during the first year in the baby's life

2 cm

5 cm

12 cm

7 cm

The breast milk can cause a risk of illness due to contamination

True

False

From month (0-4), the baby gains 200g per week, then from month (4-8) he gains 500g per month, then in the last 4 months of the first year the weight gain is only 40 g per week , so it can be said that the total approximate weight gain after 4 months is 2-4 kg and when the baby completes 1 year, the average weight gain is 7 kg

True

False

In the first year of a toddler life, it is expected that the he gains 7 kg totat

True

False

As the head circumference of the baby increase, the brain size increase as well

True

False

The higher proportion of brain growth and the total development of human brain occurs POST-NATALLY

True

False

What are the consequences of undernutrition in infants and young children?

a. Improved immunity

B. Stunted growth

C. Increased risk of adult chronic disease

D. Both b and c

In which region do we find the highest number of child deaths due to undernutrition?

North America

Europe

Sub-Saharan Africa and South Asia

Australia

How can the growth and development of infants and young children be assessed?

A. Through blood tests

By assessing weight and length/height

Through neurological exams

D. Both a and b

What is the average length at birth for boys? a. 45 to

A. 45 to 53 cm

B. 46 to 55 cm

53 to 60 cm

D. 40 to 48 cm

At what age does the brain reach 50% of its adult weight?

1 year

2 years

3 years

4 years

When do infants maximize energy intake and minimize energy expenditure?

A. 0-3 months

B. 3-6 months

C. 6-9 months

D. 9-12 months

At birth, the brain of the baby represents 25% of its adult weight

True

False

What are the short-term effects of early Healthy nutrition in children & infants?

Improved immunity

Growth and muscle mass

Both a and b

None of the above

What are the risks associated with low birth weight and preterm birth?

Increased perinatal mortality

Delayed psychomotor development

Pulmonary morbidity

All of the above

What is childhood stunting?

Rapid linear growth

Retardation in linear growth

Increased height-for-age ratio

None of the above

What is considered underweight in relation to weight-for-age chart in children?

Weight-for-age below -1 SD

Weight-for-age below -2 SD

C. Weight-for-age below -3 SD

Weight-for-age below -4 SD

What are the long-term benefits of breastfeeding on the infant when he grows up in adulthood

Lower blood pressure

Lower prevalence of obesity and type 2 diabetes

Higher intelligence scores

All of the above

Powdered infant formula milk is sterile and it has no risk of contamination, thus it wouldn't cause an infection to the baby

True

False

In the first week after birth, preterm infants tend to grow very fast as they adjust to extra uterine nutrition

True

False

What is childhood obesity diagnosed based on?

A. Weight-for-age

B. Height-for-age

C. Weight-for-height

D. BMI-for-age chart

What is the expected growth pattern of preterm infants during the first year in terms of the weight curve chart?

The preterm infant's weight curve is expected to cross the percentile lines during the first few months and by the end of the first year, the length of the average preterm infant is usually around the 15thpercentile

The preterm infant's weight curve is expected to cross the percentile lines during the first few months and by the end of 6 months, the length of the average preterm infant is usually around the 50th percentile

Which of the following are common nutritional issues in young children < 5 years

A. Vitamin A, Vitamin D, iron, iodine, zinc deficiency

B. Undernutrition

C. Measles

D. Only a & b

E. All of the above

All of the following are the factors that affects the child survival negatively, EXCEPT

Nutrient deficiency including protein and micronutrient deficiencies

The presence of environmental hazards

Injuries

Setting personal prevention measures to control personal illness

Infants become double their birth length once they reach year one

True

False

Researches have found direct proportional relationship between breast-fed infants and their tendency to develop obesity later on in their adulthood

True

False

Breast-fed babies are less likely to develop childhood obesity later on

True

Fales

Most of growth faltering begins in utero or soon after birth

True

False

Dietary assessment analysis to check the adequacy of feeding of the infant include investigating?

The type of the feeding used (whether it is breast-feeding or formula)

The use of vitamins/minerals supplements by infants

The quantity and frequency of feeding

Solid food intake

Feeding behaviour of the baby

The cleanliness of the Feeding environment

Whether the family of the infant is avoiding certain foods/ food groups and follow alternative dietary practices

If the baby suffers from food allergies

All of the above

Which of the following is used in assessing the physiological growth in infancy

The Egyptian weight-for-age percentiles chart

The WHO weight-for-age charts using growth curves

The BMI-for age charts

The weigh-for-height percentiles chart

The body mass index-for age percentiles is used for young children aging from 2-20 years

True

False

What is ideal time to intervene with a nutritional counselling to prevent child stunting

In the preschool age from 3-5 years old

When the child is under the age of 24 months

Once the child reaches the age of 3

Non of the above

Macronutrient malnutrition such as malnutrition caused by protein-deficiency is also known as the ''silent or hidden hunger'' because it can be asymptomatic

True

False

Choose the correct statements about the recommended nutrient intake (RNIs) in infants

They can be considered an alternative to Recommended dietary allowance (RDAs_

In case the infant is > 6 months old, this value will be based on the amount of nutrient provided by the breast milk or breast milk substituents and the complementary solid food

In case the infant is <6 months old, and he is exclusively breast-fed, this value will be based on the amount of nutrient provided by the mother's milk only

This value should be regularly assessed to ensure optimal intake as a part of nutritional counselling to support the infant growth

All of the above statements are true

All of the following are considered effective and appropriate nutritional interventions for infants and young children EXCEPT

Increase the awareness of caregivers on growth monitoring children and encourage the mothers on interacting with caregivers to promote their child growth

Educating the new mothers about the principles of complementary feeding when the child is > 6 months old

Giving the lactating mothers additional food supplements in food-insecure populations such as those going through a crisis of war

Treating severely malnourished pre-schooler kids by supplementation with various micro and macro nutrients

Giving the new mothers formula milk fortified with essential micronutrients rather than breast-feeding since it has higher iron content

All of the following are appropriate feeding practices for a pre-school child EXCEPT

A) Giving him 2 child-sized servings of fruits and veggies as snacks since they're rich in iron, vit.C, vit.A

B) Force the child to eat at least 3 times per day to ensure a satisfactory nutrient intake

C) Encourage the child to eat variety of foods

D)In each meal preparation, the child should be served 3 tablespoons of food for each year of age

E) both options b & d are incorrect statements

Children of late pre school age appear to be less responsive to external cues than to their instinctive ability to self-regulate their nutrient intake

True

False

All of the following are benefits of breast-feeding for mothers EXCEPT

Decreasing high-density lipoprotein cholesterol levels

Enhances fat loss in the early post-partum weeks

Increasing bonding with baby.

Reduces the risk of post-partum hemorrhage

Frequent breast-feeding helps to delay the return of fertility of the mother and thus helps to space children

True

False

The following are barriers to breast-feeding, EXCEPT

Insufficient information from the healthcare provider

Positive emotions about breast feeding

Workplaces are not supportive of breast feeding because the maternity leave is insufficient

Embarrassment about breast-feeding in public.

What should be done as a part of the ABCD approach for assessing nutritional status of lactating mothers?

Conducting anthropometric measurements

Checking vit.D, calcium and iron levels

Investigating if there are any signs of vitamin deficiencies, general signs of malnutrition and fluid retention

All of the above

The skinfold thickness & calf-circumferences are reliable anthropometric measurements for assessing nutritional status in pregnant women

True

False

Match each anthropometric measurement with what it would reflect in case of a pregnant women

Mid-upper-arm-circumference (MAUC)

Reflects Severe wasting

Very low pre-pregnancy BMI

Reflects higher risk of IUGR

Women with very low height (140-150cm)

Reflects past and current nutritional status

The abdomen circumference of a pregnant women acts as a proxy indicator for her skeletal pelvic structure

True

False

The hight of pregnant women can be used to predict the risk of cephalopelvic disproportion and obstructed labor

True

False

Women of short stature (height is 140-150cm) are at high risk of which complications?

Having low birth babies

Preterm delivery

Both a & b

Non of the above

The accepted range of gestational weight gain for all pregnant women is 7-10 kg

True

False

M.S. Is a pregnant women coming to your clinic to monitor her gestational weight gain, on week 25 her weight was 46, today she is at her week 38 and her weight was 50 kg, height is: 160 cm, Based on the following chart, is M.S gestational weight gain considered normal?

No, she is severely underweight

Yes, her BMI is normal

No, she is moderately overweight

Can not decide due to lack of information

M.K is a pregnant women coming to your clinic to monitor her gestational weight gain, she had a normal BMI pre-pregnancy, and she gained a total of 6 kg in the period from week 25 gestation to week 39 gestation, based on these values and according to the given figure

Her Weight-for-gestational age is at -2 SD indicated suboptimal weight gain

She has a normal healthy weight gain

Her weight for gestational age is at +1SD indicating that she gained more weight than she should

Can not decide due to lack of information

All of the following are biochemical methods used in the assessment of nutritional status of a pregnant women EXCEPT

CBC and hemoglobin

Fasting blood glucose

Urine analysis including looking for signs of glucosuria or proteinurea

Collecting medical history and investigating clinical symptoms

Dietary intake assessment to reflect a pregnant women nutritional status includes

Food frequency questionnaire

24- dietary recall method

Writing a food diary for 24 hours

Conducting medical history collection to identify nutrition-related problems or risks

All of the above

Low pre-pregnancy weight is a predictor of intrauterine growth restriction (IUGR)

True

False

Maternal health (the mother's health) in periods of inadequate nutritional intake is more compromised than fetal growth

True

False

The baby is considered low birth weight when his weight at birth is

Less than 3.5 kg

Less than 2.5 kg

Less than 3 kg

Between 2.7-3 kg

The following are all complications of Intrauterine Growth Restriction (IUGR) EXCEPT

Sudden infant death syndrome

High risk of pre-natal death

Neurological issues

Normal psychomotor development

Decreased cognitive abilities

Which of the following is considered a risk factor that can lead to Intrauterine Growth Restriction (IUGR)

Cigar smoking

Low height 140-150 cm

Pre-eclampsia that is not treated

Low nutrient intake that leads to low and suboptimal gestational weight gain

Low BMI prior conception

All of the above

Which of the following can lead to the delivery of premature baby?

Low pre-conceptional BMI

Suboptimal conceptional weight gain in pregnancy

Multiple subsequent pregnancies with little spacing time between births

Comorbidities during pregnancy like anaemia, placental insufficiency, hypertention

All of the above

Deficiency in which vitamins can lead to micro nutrient malnutrition in maternity and negatively influence the fatal growth

Vitamin A, C, D

Iron and zinc

Folic acid

All of the above

Which vitamin is recommended as soon as the women gets pregnant because inadequate availability of it in 21-37 conception days could lead to neural tube defects

Folic acid

Iron

Vit. B12

Vitamin A

What is the recommended daily amount of elemental iron in pregnancy to avoid nutritional deficiency?

60 mg

120 mg

325 mg

30mg

What is the recommended daily amount of calcium for a pregnant women to reduce the risk of hypertension and pre-eclampsia (hypertension in pregnancy)

1000-2000 mg

400-600 mg

3 grams

Non of the above

When is the period of time that is considered the most critical window for applying nutritional interventions in pregnant ladies

In the second trimester of pregnancy

From the beginning of pregnancy and up to the age of 2 years

During first trimester only

In the first 3 months post-partum

The BMI cut-off point of 18.5 can be used as a valid assessment tool for maternal body weight in pregnant women

True

False

The BMI cut-off point of 18.5 can be used as a valid assessment tool for maternal body weight in lactating women

True

False

Skinfold thickness and maternal calf circumferences are valid anthropometric measurements in the nutritional assessment of lactating mothers?

True

False

Fill in the blank: According to RDA for energy during lactation, a lactating mother needs additional................. Kcal in the first 6 months after giving a birth, and extra .................. Kcal for the second 6 months

230 kcal, 300 kcal

330 kcal , 400 kcal

260 kcal , 500 kcal

She doesn't need extra energy

Overweight women need to add additional 350 kcal to her total energy need if they are performing exclusive breast feeding

True

False

Extensive insufficient protein/nutrient intake for long periods in lactating women can lead to failure of breast feeding due to decreased the volume of milk production

True

False

Prolonged exclusive breast-feeding feeding beyond 6 months can cause maternal folate deficiency which leads to megaloblastic anemia

True

False

All of the following are baby-friendly practices , EXCEPT

A) Showering the baby within 1 hour of birth

B) Giving the baby a pacifier to promote latching

C) help the mother to breast fed within 1 hour of birth

D) promote skin-to-skin contact as soon as the delivery occurs

E) options a & b

E) allow the mother and her baby to stay in the same room

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