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Sign/symptom Nutritional abnormality Pale: palms order indapamide without a prescription hypertension teaching for patients, conjunctiva generic indapamide 1.5 mg without prescription hypertension vs pulmonary hypertension, tongue Anaemia: may be due to the deficiency Gets tired easily; loss of appetite of iron discount indapamide 1.5 mg with amex blood pressure medication ear ringing, folic, vitamin B12, acid, copper, shortness of breath protein or vitamin B6 Bitot’s spots (whitish patchy triangular Vitamin A deficiency lesions on the side of the eye) Goitre (swelling on the front of the Iodine deficiency disorder neck) ■ Aster is a one-year-old girl who was brought to your health post by her mother, with a complaint of body swelling and poor appetite for one month. What is the nutritional problem Aster is suffering from and what are the indicators? You can ask what the family or the mother and the child have eaten over the past 24 hours and use this data to calculate the dietary diversity score. Dietary diversity is a measure of the number of food groups consumed over a reference period, usually 24 hours. These can be represented in the food guide pyramid which you read about in Study Session 2 and which is reproduced in Figure 5. You may recall from Study Session 2 the base or widest part of the pyramid indicates the need for higher quantities of consumption of carbohydrate source foods, while the tip is narrow, indicating the need for eating only small amounts of fats and sweet things. If a person consumes any examples of the food type from each of the six groups in 24 hours, we can say that their dietary diversity score is six. Dietary diversity score is an indicator of both the balance of nutrient consumption and the level of food security (or insecurity) in the household. The higher the dietary diversity score in a family, themorediversified and balanced the diet is and the more food-secure the household. Whichever measurements you are taking you should remember that it is important to follow procedures correctly and take accurate measurements that ensure the quality of data generated about the individuals you are responsible for in your community. Summary of Study Session 5 In Study Session 5 you have learned that: 1 Nutritional assessment is the interpretation of data to determine whether a person or groups of people are well nourished or malnourished (over nourished or under-nourished). Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of the Module. In Study Session 5 you learned how to assess the nutritional status of children and adults. You are now going to look at how to use the knowledge and skills you learnt in that study session to identify children and adults with nutritional problems. You will also learn about acute and chronic malnutrition in the community and something about their causes. The knowledge acquired will enable you to identify children with malnutrition in your community at the earliest possible stage and to consider strategies you can use to manage the situation effectively. Learning Outcomes for Study Session 6 When you have studied this session, you should be able to: 6. Wasting is usually the result of recent food insecurity, infection or acute illness such as diarrhoea. Measurement of wasting or thinness is often used to assess the severity of an emergency situation, with severe wasting being highly linked with the death of a child. It’s often associated with poor development during childhood and is one of the harmful effects of poverty. Stunting is commonly used as an indicator for development, as it is highly related with poverty. Forty seven percent of children under five years of age are considered to be stunted and this is the fourth highest percentage in Africa. Thirty eight percent of children under five years of age were underweight and 11% were severely underweight. Based 68 Study Session 6 Common Nutritional Problems in Ethiopia on mother’s subjective assessment of the size of the baby at birth, 21% of births were reported to be very small and 7% were reported as smaller than average. In the past, severe acute malnutrition was classified in the way described in Box 6. You need to know this, because you may come across people who still use these terms. Marasmus: Severe form of acute malnutrition that is characterised by wasting of body tissues.

The interactions may be audio recorded order indapamide 1.5mg heart attack one direction lyrics, or in some cases where analysis of nonverbal communication is important order generic indapamide online pulse pressure product, they may be recorded on video tape buy indapamide on line arrhythmia long term effects. The fundamental data produced are verbatim transcripts of the discussions which are subsequently analysed either through qualitative summary or through systematic coding and content analysis. The questions used are normally designed to extract a maximum range of relevant topics and as specific data as possible, to foster interaction that explores the participants feelings in some depth, and takes into account the personal context that participants use in generating their responses to the topic. The available information suggested that an increase in the use of heroin was occurring, although there was no significant evidence of large groups of new users. Focus groups were conducted among known heroin users and the discussions were directed at exploring changing patterns of use and hidden populations of new users. These discussions did identify some new groups of users, although they were limited. Many of these addicts were changing their route of administration from injecting to snorting heroine, which necessitates higher levels of consumption of the drug. Focus groups were extensively used in the qualitative field assessment of the cross culturally applicable “model” core questionnaire that is included in this guide. The research protocol and summary findings resulting from that assessment are included in Chapter 10 of this guide. Chapter 10 also includes the focus group protocol and guide questions used in the field assessment, together with the questionnaire which was the product of the assessment. Thus if only 4 variables are considered such as age (2 groups), sex (2 groups), use of substance (2 groups) caste (3 groups) are considered, 24 focus groups are required (2x2x2x3=24) for each research issue or area. These authors state that if more than one issue is included, the number of focus groups required multiplies accordingly. These methods do not replace the need for classical ethnographic or other qualitative data collection, but they enhance the possibility of confirming basic findings and make possible a more in depth analysis in a number of cultural dimensions. These methods provide techniques for the analyses of culturally defined cognitive systems, the development of cultural models of diseases, and exploration of cultural consensus on drug abuse related beliefs and issues. The methods for defining culturally constructed cognitive systems can be classified as developments that: i. In one form or another, the technique has been used by every ethnographer who discovered an important cultural concept or area of interest and wanted to explore the limits of that knowledge, belief or behaviour. The most basic format for this approach is to ask a set of cultural experts to list and describe all of the things that are part of a particular cultural domain. Other examples include asking individuals to tell us about the ways they try to beat urine screens using folk medical concepts, and exploring the labels for different types of sexual partners and how these labels affect risk taking behaviour, such as lack of condom use when people are high. Free listing can be used as a rapid scanning technique in groups, or can be used as an interview exercise, one-on-one. Free lists are important because they provide natural language information that can be used in questionnaire construction or in educational materials which are culturally appropriate for a specific group. It is useful to record unexpected responses in free listing exercises, words and phrases that we subsequently need to be described and discussed in greater ethnographic detail, since these labels provide a window into unknown behaviours or into previously unexplored elements of the culture. For this reason, information on demographic characteristics of the informants is collected, in conjunction with the free listing. This creates the opportunity to use the data to analyse relationships between drug use domains and other variables such as: cultural orientation; intra cultural variation; gender differences in knowledge; or economic and educational differences, since it would be expected that the answers to free listing questions might differ based on the sex, age, income, educational level and other culturally significant factors. Free listings can also be used to generate ethnographic questions and to suggest the wording for questions in quantitative survey instruments. Free listing was used in the qualitative field assessment of the cross culturally applicable “model” core questionnaire that is included in this guide. Chapter 10 includes the free listing protocol and questions used in the field assessment. Free listing was extremely useful in identifying the different drugs used (and their local street names) at each of the six sites. Some of the more sophisticated uses of free listing data treat these nominal or categorical data as variables which can be used in statistical procedures, to provide more extensive explorations of the relationships among informants or among the elements in a cultural domain.

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Once all adhesions have been divided discount 1.5 mg indapamide overnight delivery pulse pressure method, the second line of incision on the foreskin near the corona can be marked and the circumcision operation can proceed as usual purchase 1.5mg indapamide amex arteria thyroidea ima. In the forceps-guided or dorsal slit methods cheap indapamide 2.5mg line heart attack by demi lovato, the line of incision is marked on the outer aspect of the foreskin in the normal manner. However, with minor degrees of phimosis, it may be necessary to make a small dorsal slit to allow full retraction and cleaning under the foreskin before proceeding with the operation. The forceps-guided method should not be used if there is evidence of extensive scarring. Tight or scarred frenulum All males have a band of tissue (the frenulum) on the ventral side of the penis, just below the glans. During early sexual experiences, the frenulum may be stretched as the foreskin is retracted, and minor tears are a frequent problem. Such tears can heal, leaving inelastic scar tissue, which tightens and makes further tearing and scarring more likely. The problem can be seen when the foreskin is retracted during physical examination. Spread open the foreskin and retract it ventrally to put the frenular band under tension. Using dissection scissors, snip the band at its centre, taking care not to injure the urethra, which is just under the frenulum. Any bleeding from the frenular artery should be controlled by careful tying or under-running. In this case, however, do not suture the penile skin up to the edge of the foreskin defect, since this will cause increased tension on the ventral side. This tension may cause curvature of the penis or possibly make erection or Surgical procedures for adults and adolescents Chapter 5-33 Male circumcision under local anaesthesia Version 3. Instead, close the V-shaped defect by placing the frenular suture 1–2 cm (depending on age and penis size) back from the apex of the V, taking both sides of the defect (Fig. Four surgical techniques are described: • the dorsal slit method; • the Plastibell method; • the Mogen clamp method; • the Gomco clamp method. Four widely-used surgical techniques for paediatric circumcision are described in this chapter. The recommended techniques are shown in detail so that they can be referred to in the context of a training course. Surgeons should become expert in the technique most suited to the circumstances of their practice. It is not recommended that a nursing, clinical or medical officer learn all the techniques. Circumcision of infants and pre-pubertal boys is simpler than circumcision of older boys and adults, because the penis is relatively underdeveloped and the foreskin less vascular. Circumcision can be delayed to an older age, when the boy can understand the risks and benefits of circumcision and consent to the procedure himself. Programmes that promote circumcision of young children are likely to have lower morbidity rates and lower cost than programmes targeting adolescents and adults. If there is any doubt, surgery should be deferred or the client Infant and paediatric circumcision Chapter 6 - 1 Male circumcision under local anaesthesia Version 3. Neonatal circumcision (within the first 28 days of life) should be undertaken only if the birth was a full-term delivery and the baby has had no significant medical problems. Known haematological disorders and jaundice are contraindications to circumcision. Thus any baby with yellow sclera or purpuric skin lesions should not be accepted for clinic-based circumcision. Any congenital abnormality of the genitalia is a contraindication to circumcision. Only babies with a normal physical examination and an intact, completely normal appearing penis and foreskin should be considered for male circumcision. This is because the foreskin may be needed for plastic surgical repair of the abnormality. The parent or legal guardian should be fully informed about how the procedure will be done, what type of anaesthetic will be used, what complications are possible, and what type of postoperative care should be provided. The consent of the child should also be obtained, if he is able to give it (Chapter 3 addresses this issue in more detail).

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Comparing these different data will often be difficult and the reliability and validity variable cheap generic indapamide uk blood pressure medication bad for you. Many artefacts such as a push by police to arrest drug abusers order indapamide 2.5 mg with amex hypertension 5 year old, the closing of drug treatment facilities cheap indapamide online mastercard can blood pressure medication cause jaw pain, or the contamination of the existing drug supply, will have differential effects on the number and type of cases who appear in these data sets. Furthermore, even with the helpful interpretation of those close to the “drug scene” many unanswered questions will emerge upon review of the data, questions that can be answered through both qualitative and/or quantitative methods. The difference between these approaches is primarily related to techniques of sampling, data collection methodologies, and data analyses. Qualitative approaches can be used for exploratory purposes, either to examine issues for which no information is available or to “flesh out” information of a more quantitative nature that the researcher wishes to understand better. The quickest assessment is often obtained from interviews with "key informants" or "gatekeepers", those people who see large numbers of alcohol and drug users in their daily work. These are likely to include heads of specialised treatment agencies in countries with large, developed programs. If there are no such agencies it may be workers in health centres, emergency wards, psychiatric hospitals or primary care physicians. In some countries social or community workers in regular contact with drug abusers are the best choice. Police, prison officials, customs officers and magistrates may also have valuable information. It is worth remembering, however, that these informants have a limited view of the drug abuse world and can talk only about their part of it. Also, informants in different geographic regions may have different views if the drug abuse trends vary significantly across these regions. For example, in North America crack cocaine use first appeared in a few large cities and it was several years before it came to smaller cities and towns. Informants who know the “drug scene” or have privileged access to the places in which drug users gather, such as drug users themselves, can add or provide a different perspective to these studies and observations. More sophisticated and longer term anthropological participant observation can also be conducted with drug users. Examples of these include ethnographies of: street heroin users in the United States (Agar, 1973; Hansen et al. For some key informants it may be advantageous to conduct group discussions in the form of focus groups. In this group format it is possible to suggest a theme and have people closer to the issue exchange their experiences and views. Other qualitative methods that evoke open, less structured communications have been designed to assist certain subpopulations, such as children, or to assist in the discussion of certain topics that may be highly stigmatised or difficult to articulate. The two qualitative approaches most commonly used are key informant studies and focus group discussions. Because these approaches are usually open-ended, it is important to be well prepared with a guide or series of questions to prompt the collection of information. Also, careful attention should be paid to the specific characteristics of the population being approached as well as the special nature of the questions or issues being addressed and the appropriateness of the method selected. Key informants may be interviewed informally or with specially developed interview guides or questionnaires. In New-Delhi India, for example, key informant interviews were conducted with community leaders to identify geographical areas where the prevalence of drug use was high (Mohan, 1993). They may be interviewed informally in treatment centres or social agencies, or at the time when they are appear in court (Erikson, 1980), provided it is clear that there is no police involvement or influence on the study. It is increasingly common to involve drug users, or others with access to drug users, in the collection of data. This may involve drug users recommending other drug users through the “snow ball” sampling methods (Erikson et al. Focus groups are an excellent method to use to ascertain more qualitative information about a topic, particularly on a topic for which there is very little available information. For instance, focus groups are helpful in providing information on such things as street names of drugs and in reviewing the content or format of a standardised data collection instrument. However, the usefulness of information coming from focus group discussions depends greatly on the expertise of the person to create groups with appropriate characteristics and to stimulate, without influencing, open conversation among the group members focusing on a particular topic or topics. Although such groups appear to be simple and straight forward, it takes expertise in group processes and group dynamics to achieve the desired goal for having convened the focus group.