Health System Under Strain: Malnutrition’s Ground Effect

Malnutrition.

Malnutrition is a condition in which children are deprived of essential nutrition, resulting in incomplete mental and physical development. Consequently, they may face additional health issues such as tuberculosis, typhoid, and malaria.

There are several methods to assess malnutrition. These include measuring a child’s weight, height, and the circumference of the head or arm, and then comparing these with the average measurements of healthy children of the same age.

At primary health centers, the mid-upper arm circumference (MUAC) is used to assess malnutrition. UNICEF and WHO have donated medical supplies and tools, including MUAC tapes, to all government health centers. However, this method is applicable only for children aged six months to five years.

Based on MUAC measurements, there are three possible outcomes:

1. Normal – MUAC greater than 12.5 cm

2. Moderate Acute Malnutrition (MAM) – MUAC between 11.5 cm and 12.5 cm

3. Severe Acute Malnutrition (SAM) – MUAC less than 11.5 cm

Now let’s discuss the treatment for children with the last two types of malnutrition at basic and rural health centers:

For Moderate Acute Malnutrition (MAM): Children are given multi-mineral sachets (image attached). These sachets are rich in essential minerals and vitamins, which not only help address the nutritional deficiency but also increase appetite. Each box contains 30 sachets, to be mixed daily with milk, Cerelac, or similar food. These children typically show improvement within one month and return to normal MUAC levels within three months.

For Severe Acute Malnutrition (SAM): In addition to the multi-mineral sachets, these children receive a unique, peanut butter-like paste called Plumpy’Nut or Ready-to-Use Therapeutic Food (RUTF) (image attached). This paste is imported from France and made from peanuts, vegetable fat, milk, and soy. Children suffering from SAM enjoy eating it. With regular use, they gain significant weight, and I have personally observed noticeable improvements in their MUAC measurements.

We have both systems and resources in place, yet implementation is lacking. For instance, the government and NGOs are providing valuable resources, but most people are unaware of them due to poor execution and lack of awareness. As a result, rightful beneficiaries are deprived of their rights. It's also true that the government has not provided adequate attention or resources to crucial sectors like health and education. Even the resources that are available often fall victim to mismanagement and corruption. This is the unfortunate state of most government departments, where those in power control the resources, and the public is left with nothing.

Mastering the History Quest: A Key to Clinical Success

For a doctor, taking detailed history from patient is extremely important. It has multiple benefits: 

1. Gains patients' confidence 

2. Patient's trust building on doctor

 3. Real insight into the disease process 

4. Communication gap between doctor and patient is remarkably reduced. This way, patient shows up on follow up almost always.

 5. Narrows down clinical examination and laboratory or other testing options. Cuts short on patient expenses.

 6.Narrows down treatment options, a good doctor advises the least medicine. Detailed history can ultimately lead to caculated moves and various treatment strategies can be discussed openly.

 7. History taking can be challenging. A to the point as well as detailed history taking in real time is a test of your own knowledge of the disease process and its treatment options. 

At the same time, a patient has to remember following important points:

 1. He/She must be truthful. His interest will depend on his belief. Belief is the root of success. In order to get thorough or successful treatment, he needs to believe in his physician. This belief will lead to openness and truth. 

2. He must discuss his reservations with his doctor openly regarding any testing or treatment option. 

3. He must show on followup at least once. A doctor always has one or two options regarding treatment. Sometimes, one option works and at other time, the other. Giving it into doctors' knowledge will not only increase doctor's trust, but also lead to effective treatment, especially saving the hassle of going to a different doctor and repeating the process all over again. 

4. Compensate your doctor aptly. A good doctor patient relationship once built, will lead to prosperity in health.