PZM En. Wan Mohd Nurussabah bin Hj Abd. Karim of KMDHO
The briefing about nutrition unit started at 9.00am provided by PZM En. Wan Mohd Nurussabah bin Hj Abd. Karim. (PZM- pegawai zat makanan). En Wan is a graduate of UKM after his 3 years studies in food science. We have been told that every district has only one nutritionist and he is the nutritionist in District Kuala Muda. Basically nutrition unit is covering all the matter which related to food.
The job scope of a nutritionist is the following:
- Give counseling to the patient who are malnutrition in the nutrition clinic.
- Received cases which are referred from Doctor in hospital or clinic especially like cases of diabetes mellitus or hypertension.
- Give advise to the antenatal mother who have gestational diabetes mellitus
- Give counseling to the antenatal mother whose body weight did not increased correspondent to her period of pregnancy and so on.
We have been told by En Wan that there are difference between nutritionist and dietitian. Dietitian is the one who usually worked in hospital. They treat uncontrolled cases while the patient is in the hospital. There is no followed up done by the dietitian. Meanwhile, Nutritionist worked in the district health office. They serve more on community, prevent people from getting sick and treat those who were discharged from hospital.
The patient will come to visit nutritionist every month. Details such as diet recall for 24 hours, the main meal time, quantity, quality and way of food processing have been asked by nutritionist. This has done in order to calculate the daily calorie of patient and make sure their food is good and suitable for them. Daily calorie for a healthy adult is 2000 to 2500 calorie while 1500 to 1800 calorie for child. According to their diet habit, advice and diet modification have been given to patient.
The main activities held by nutrition unit include:
- Survey IDD (iodine deficiency disorder)
- Program kekurangan zat makanan (KZM)
- Program Penyusuan susu ibu (PSI)
Survey IDD
It has been started for more than 20 years. This is a randomized survey which concentrated on school student. Sample of urine is taken to measure the value of iodine within the body. There was found in the survey that IDD was serious not only in the rural area which is far away from the sea such as Sabah and Sarawak, many cases of low iodine found in the student of Kuala Muda. Some steps have been taken by the government to control this problem such as provide the iodinated salt in the market and setting up the iodinator in the main pipe. Iodinator has been settled up in a few places which are far away from the sea such as Sik and Padang Serai.
Program Kekurangan Zat Makanan (KZM)
The program cover for children aged 6 months to 7 years old. It has been categorized into yellow and red color where yellow are child who lack of nutrition and red are the serious cases. Under the program, the family income per capita less than RM87 can apply for aid in the form of food basket.
Food basket contains:
- Carbohydrate: rice, noodle, biscuit, flour etc.
- Protein : Ikan bilis, bean
- Fat : full cream milk(1kg)
- Multivitamins
Each food basket contains of 180% of calorie. Food basket provided for a child at least 6 months dependent on their health condition. If it is necessary, the child will be received the aids until the age of 7 years old. So far, we have been told by En Wan that district Kuala Muda has 14 of such cases in year 2008. Staff from district will make the monthly visit to the house of those received food basket. Recipient is also obligate to join all the activities which are held by nutrition unit. Besides that, child with congenital problem can apply for the food basket.
Program Penyusuan Susu Ibu (PSI)
It is a program promoted by WHO and held in worldwide. It concentrates on exclusive breast feeding where only breast milk is feed to child until the age of 6 months. In order to enforce the program, baby friendly hospital initiative (BFHI) has been settled up. Under this policy:
- 80% of staff include the doctor and specialist are obligate to attend breast feeding
courses for 18 hours.
- No milk bottle or artificial nipple should be placed in the hospital.
- Staff should encourage and support postnatal mother to feed their child with breast milk.
- Postal and pamphlet related to breast feeding should provide to the mother.
- Talk about breast milk feeding is provided to antenatal mother.
- Staff nurse who made the 1st postnatal visit should educate and give practical to the mother about breast feeding.
- No advertisement for formulated milk is allowed in the hospital.
Besides this entire program, nutrition also held some program for obesity in adolescent and body weight management program. Activities such as jungle tracking, hiking were organized by them in order to promote healthy lifestyle among younger generation.
Reported by Helly Chai
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