Kuala Muda District - Food Unit & Health Education

Kuala Muda DHO Posting
Ninth Day (15th July 2009)

First Session
Venue : Consultation Room 9 (Klinik Kesihatan Bakar Arang)
Time : 9.00 am
Topic : Counselling Session with Nutritionist
Persons in charge : PZM En Wan

The counselling sessions that we observed covered few patients with nutritional disorders such as undernourished children, obesity in children, patients with diabetes, and anemia during pregnancy. Basically there are 2 types of counselling:
- Individual counselling
- group counselling

Individual counselling is of course more effective but looking at the ratio of the number of patients who had come to see the nutritionist, it is just not feasible. Therefore, two or more patients with the same disease are called at the same time and were given counselling together.

In children with nutritional disorders, the diagnosis of an undernourished/obese child is done base on the parent’s copy of the child’s growth chart. These growth charts are plotted monthly by nurses in the maternal child health clinic. Any deviation from the normal white zone of the graph into the red or yellow zone will be referred to the district’s nutritionist for further consultation.

The nutritionist started the conversation by building rapport with the child and parents. He then enquires the full diet timetable from the parents. The diet timetable includes the frequency of meals and the type of food taken from the moment the child wakes up till the moment he/she sleeps. He then studies the growth charts and explains to the parents its importance and how the measurements on the chart are made. Base on the growth chart, either nutritional deficiency or obesity, he advices the parents of the child accordingly. These include:
- type of food
- time of feed
- frequency of feeding.

He then explains the complications that may arise if no intervention is taken to improve the child’s diet (i.e. obese children have a higher risk of developing juvenile diabetes and undernourished children may perform poorly in school and are more prone to infections).

Mothers with nutritional deficiency babies are advise on proper timing of breastfeeding and usage of formula feeds if necessary, correctly.

Following that, he also had counselling sessions with diabetic patients where he stressed on their daily food intake and having a healthy lifestyle. The aim here is to make sure the patients are aware of the disease and its complications if their blood glucose is not controlled.

In a counselling session with an anemic pregnant mother, he advised on the proper diet she should be on and the importance of being compliant to the hematinics that are give to her.

The approach to the patient is very important as it may influence their initiation in making a change in their daily diet and leading a healthy lifestyle as advised by the professionals. It is worth noting that when a patient comes to see a nutritionist, he or she will not be prescribed with any medications instead, just advices on nutrition. Therefore it is of paramount important that a nutritionist should be able to get the information across to the patient effectively so that patient will not go back ‘empty handed’.

Second Session
Venue : Consultation Room 9 (Klinik Kesihatan Bakar Arang)
Time : 11.30 am
Topic : Briefing on Food Unit (Unit Pemakanan)
Persons in charge : PZM En Wan

Once the counselling session was over, we were brought to the meeting room for further discussion. We were briefed on the organization chart and the hierarchy of the nutritional department within the Ministry of Health. He also highlighted on the differences between a dietician and a nutritionist.

Dietician
• Deals with hospitalized patients.
• Works in a hospital.
• Falls under the Hospital hierarchy.
• More 'established' in Malaysia.
Nutritionist
• Deals with patients referred from Klinik Kesihatan (Health Clinic)
• Falls under the Public Health Department hierarchy.


Programs organized under the nutritional department:

1. Baby Friendly Hospital Initiatives (BFHI):
- to instil awareness to mothers on the benefits and proper techniques of breastfeeding
- Ensure that the health personnel especially the staff in Pediatrics and Obstetric & Gynecology department undergo sufficient training to educate the mothers.

There are a few policies that need to be adhered to in order for a hospital to be recognized as a Baby Friendly Hospital. These include:
- written policies on breastfeeding to mothers and health personnel
- adequate training to the health staffs
- education to mothers on exclusive breastfeeding
- providing a comfortable breastfeeding room
- not advertising any forms of formulated milk and pacifiers.

2. Breastfeeding week (1st to 8th August) annually done at the district level.

3. Weight Management Program
- providing gym facilities
- organizing physical activity such as aerobics.

4. National Plan & Action of Nutrition of Malaysia

5. Rancangan Makanan Tambahan (RMT) carried out in schools for students who fit certain criteria.

6. Iodine Deficiency Disorder Program – Iodinated salts for pregnant mothers, compulsory iodinated salts being commercialized in iodine deficient areas, e.g: Sabah.

7. Program Kanak-kanak Kurang Zat Makanan (Undernourished Children Programme) – Food Basket Programme. For a child to be eligible for this programme, the criteria are as follows:
- growth chart that falls below the normal percentile( yellow zone for 3 consecutive times or into the red zone for at least once)
- Per capita income of RM100 and below
- Congenital problems which may require financial aid.

Food Basket which is given monthly is worth around RM150 and contains different types of food such as:
- rice
- cooking oil
- rice noodles
- butter
- anchovies
- eggs
- multivitamins
- full cream milk

Third Session
Venue : Gym (Health Education Unit)
Time : 2.30 pm
Topic : Briefing Health Education Unit
Persons in charge : Health Education Officer Puan Norejan Nordin

Heath Education Department is managed by 3 staff:
- 1 Health Education Officer
- 1 Audio Visual Technician
- 1 Public Health Assistant (PKA)

The department works in collaboration with all the units in the district health office (i.e. Vector unit, Maternal Child Health clinic, etc). They organize many campaigns and health programs with the help of all the personnel from other departments.
Yearly ‘targeted’ programs are done in the forms of health campaigns, exhibitions, public talks, banner presentations, pamphlet distributions. The department also involves in public preventative announcement, for example in collaboration with the vector unit, announcement of preventative measure will be made to various localities at risk of vector-borne infections. Apart from these, the department also reaches the community via health camps and advertisements through prime mass media.
Most of the materials used in these health campaigns are provided directly from the Health Education Unit of Ministry of Health and the rest are produced by the department locally.

The dedicated health programs managed by this department include:

1. Kempen Cara Hidup Sihat (Healthy Lifestyle Campaign)
- 6 components
o Cara Hidup Sihat (Healthy lifestlye)
o Makan Cara Sihat (Healthy eating)
 5 Ms
• Mengurangkan Gula
• Mengurangkan Lemak
• Mengurangkan Garam
• Melebihkan Sayur-sayuran
• Melebihkan Buah-buahan
o Aktiviti Fizikal (Physical activity)
o Tidak Merokok (Quit smoking)
 TAK NAK campaign (stop smoking campaign): one of the largest campaigns ever launched by the Ministry of Health.
 Stop smoking clinic (only offer counseling to smokers to help quit the habit)
o Menangani Stress (Stress management)
 DASS questionnaires (evaluation of level of stress)
o Bebas Alkohol (Free from alcohol)

2. PROSTAR (Program Sihat untuk Remaja – Tanpa HIV/AIDS)
- Done with cooperation with the schools through PROSTAR club
- Includes the recruitment of pembimbing rakan sebaya (peer councilor) at school
- Also include campaign ‘remaja harapan’ for problematic students
- Law enforcement officers are also invited to give speech and talk to students on laws and consequences of breaking them
- Establishment of PROSTAR service centres to serve as a place for members and interested public to engage in extra curricular activities
 Example of past activity was ‘merdeka’ rally
- PROSTAR convention is held every 2 years (gathering of PROSTAR members at district, state and national level)

3. Program Doktor Muda (Young Doctor Program)
- Started first in 1989 in Sekolah Kebangsaan Seri Biram, Pekan.
- Expanded to schools in the East Coast of Peninsular of Malaysia.
- Currently, the program has been gazette by the Ministry of Health and Ministry of Education. Therefore the program has a national level coverage.
- The program has been incorporated into the school co-curricular program
- In a school, only 30 top students from standard 4, 5 and 6 can join as members and 2 teachers are selected to be trained to handle the program.
- The program contains 10 modules
1. Who is ‘doktor muda’?
2. Personal hygiene
3. Environmental Cleanliness
4. Oral hygiene
5. Good Mental health
6. Prevention of common disease
7. Health promotion and injury prevention
8. Healthy diet
9. Healthy lifestyle
10. Healthy teenager

- Currently there are 28 schools involve with this program
- Convocations are held every year to mark completion of the program (Certificates of participations are signed by Minister of Health)
- Conventions are held every 2 years (activities include story-telling competitions, plays, scrapbook competition and the awarding of ‘tokoh doctor muda’ award)
- Health education department is responsible in the surveillance of the program and also the contribution of education assistance tool.