Curriculum Rough Draft (Research Only) Table of Contents / Outline A. Issues that can be treated with diet 1. 2. 3. 4. 5.

Vitamin A Deficiency Vitamin B2 (Riboflavin) Deficiency Vitamin C Deficiency Vitamin D Deficiency Anemia [Pages 1 21] [Pages 1 4] [Pages 4 8] [Pages 8 12] [Pages 12 16] [Pages 16 21] [Page 22 34] [Pages 22 26] [Pages 26 29] [Pages 29 31] [Pages 31 34]

B. Issues that can be prevented or treated with natural methods 6. 7. 8. 9. Diarrhea Constipation Menaishnis Malnutrition

C. Issues that can be prevented/reduced with education but must be treated medically [Pages 34 40] 10. Malaria 11. Tuberculosis 12. HIV/AIDS D. Hygiene practices and Sexual practice 13. Food Preparation 14. Personal Hygiene 15. Safe-Sex Practices [Pages 34 36] [Pages 36 37] [Pages 38 40] [Pages 40 44] [Pages 40 41] [Pages 42 44] [Pages 44 44]

E. Other helpful resources, acknowledgements, conclusion and references [Pages 44 55] 16. Helpful Resources 17. Acknowledgements 18. Conclusion 19. References A. Issues that can be treated with diet 1. Vitamin A Deficiency Description/Symptoms [Pages 44 44] [Pages 45 45] [Pages 45 45] [Pages 45 55]

Vitamin A is an essential micronutrient for the normal functioning of the visual system, growth and development, maintenance of epithelial cellular integrity, immune function, and reproduction. (Bertini, 2004, p.104) Vitamin A Deficiency (VAD) is described as a state of inadequate vitamin nutrition. This is when there is a low storage in the liver of serum retinol. A doctor would need to be consulted to accurately diagnose a deficiency (Bertini, 2004, p.104). Symptoms include xerophthalmia, anaemia, growth retardation, increased infectious morbidity and mortality (Bertini, 2004, p.104). Definitions: Xerophthalmia: The main symptom of this is night blindness, which is described as Impaired vision in dim light and in the dark, due to impaired function of specific vision cells, such as the rods in the retina (Medicine Net, 2011). Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. Persons with anemia may feel tired and fatigue easily, appear pale, develop palpitations and become unusually short of breath. Children with chronic anemia are prone to infections and learning problems (Medterms.com, 2011). Growth Retardation: When a developing child does not reach the expected growth milestones in the designated time frame. Causes Malabsorption: Malabsorption occurs when nutrients are not properly extracted and absorbed from food during the digestive process (Bettermedicine.com, 2011). Inadequate diet: Not having access to or selecting the correct portion and variety of food for balanced nutritional eating. Malnutrition: Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. (Medical-dictionary.com, 2011) Diet Treatment/Natural Treatment The best form of natural treatment is diet intake. If this is not possible or is not sufficient enough to correct the deficiency, than supplementation or other prescribed intake methods are available. You should consult with a doctor if diet alteration is not a sufficient method. Fruits and Vegetables with 20% or more of daily-recommended vitamin a per serving

Apricots Cabbage Cantaloupe Carrot Chili Pepper, Hot Collard Greens Grapefruit Lettuce, Leaf Lettuce, Romaine Mango Pepper, Le Rouge Royale Spinach Sweet Potato Tomato Watermelon (Fruitsandveggiesmorematters.org, 2011) Meat and animal products with Vitamin A (On a rating system of medium to high meaning medium amounts of Vitamin A (10% - 20%) to High Amounts of Vitamin A (20% or more)) Eggs (high) Butter (High) Goat / Cows Milk (Medium) Oysters (Medium) Cod or Salmon (Medium) Livers and Kidneys from any animal (Highest) (Walqvist, 2007) If these foods are hard to come by, then likely you will need to treat Vitamin A deficiency with a sort of supplementation likely through pill form. If this is the case, then a doctor will need to be consulted to identify the level of deficiency and how much supplementation will need to be used. Daily Recommended for Men, Women and Children (International Units) 10,000 IU/day (plant-derived) for adult males. (Ages 25 50) 8,000 IU/day for adult females - 12,000 if lactating (Ages 25 50) 4,000 IU/day for children ages 1-3 5,000 IU/day for children ages 4-6 7,000 IU/day for children ages 7-10 (Decuypere, 2011) Conversion of IU (International Units) to Mcg/g (Micrograms)

1 IU = 0.3 Mcg/g of Retinol 1 IU = 0.6 Mcg/g of Beta-Carotene Retinol 3,000 Mcg/g a day (plant-derived) for adult males. (Ages 18 100) 2,400 Mcg/g a day for adult females 3,600 Mcg/g a day if lactating (Ages 18 100) 1,200 Mcg/g a day for children ages 1-3 1,500 Mcg/g a day for children ages 4-6 2,100 Mcg/g a day for children ages 7-10 Beta-Carotene 6,000 Mcg/g a day (plant-derived) for adult males. 4,800 Mcg/g a day for adult females 7,200 Mcg/g a day if lactating 2,400 Mcg/g a day for children ages 1-3 3,000 Mcg/g a day for children ages 4-6 4,200 Mcg/g a day for children ages 7-10 (Forbes, 2008) 2. Vitamin B2 Deficiency (Riboflavin) Description/Symptoms Riboflavin deficiency is associated with the increased oxidative stress that can be caused by free radicals. Symptoms of deficiency include sore throat; redness/swelling of the mouth, throat, tongue, lips, and skin; decreased red blood cell count; and blood vessel growth over the eyes. (Vitaminsdeficiency, 2009) Many of the early-stage deficiency symptoms for riboflavin involve eye-related problems. These problems include excessive sensitivity to light, tearing, burning and itching in and around the eyes, and loss of clear vision. Soreness around the lips, mouth, and tongue, and cracking of the skin at the corners of the mouth are symptoms that can also be characteristic of riboflavin deficiency. Peeling of the skin in different areas of the body can also be a symptom of the deficiency. (whfoods.com, 2011) Definitions: Ariboflavinosis: Deficiency of riboflavin (vitamin B2) characterized by swollen, cracked, bright red lips (cheilosis), an enlarged, tender, magenta-red tongue (glossitis), cracking at the corners of

the mouth (angular stomatitis), congestion of the blood vessels of the conjunctiva, and a characteristic dermatitis with filiform (wire-like) excrescences. (Answers.com, 2011) Angular Cheilitis: Angular cheilitis is inflammation and fissuring radiating from the commissures (angles) of the mouth secondary to predisposing factors such as nutritional deficiencies. (Medterms.com, 2011) Photophobia: Sensitivity to light is the inability to tolerate light, medically known as photophobia. In someone who is light sensitive, any type of light source (sunlight, fluorescent light, incandescent light) can cause discomfort. Photophobia typically causes a need to squint or close the eyes, and headache, nausea, or other symptoms may be associated with photophobia. People with light-colored eyes are more likely to have sensitivity to bright light than those with darker-pigmented eyes. Sensitivity to light is caused by a number of conditions that affect the eye as well as conditions that affect the entire body. (Medicinenet.com, 2011) Dermatitis: (Seborrheic dermatitis) can occur on many different body areas. Typically it forms where the skin is oily or greasy. Commonly affected areas include the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in the external ear, and along skin folds on the middle of the body (genitals). Symptoms

Skin lesions Plaques over large area Greasy, oily areas of skin Skin scales -- white and flaking, or yellowish, oily, and adherent -- "dandruff" Itching -- may become more itchy if infected Mild redness Hair loss

(Berman, 2007) Causes The most common cause of riboflavin deficiency is dietary inadequacy, which occurs in those who do not consume rich dietary sources of the vitamin, such as organ meats, eggs, milk, cheese, yogurt, leafy green vegetables and whole grains. Riboflavin deficiency is usually due to dietary inadequacy but can occur most frequently in people with long-standing infections, liver disease, and alcoholism.

(Vitamins-supplements.org, 2006) Diet Treatment/Natural Treatment The best form of natural treatment is diet intake. If this is not possible or is not sufficient enough to correct the deficiency, than supplementation or other prescribed intake methods are available. You should consult with a doctor if diet alteration is not a sufficient method. Fruits and Vegetables Fruit Avocado Banana Cherimoya Dates Grapes Lychee Mango Mulberries Passion Fruit Pomegranate Prickly Pear Vegetables Amaranth Leaves Artichoke Asparagus Bok Choy Brussels Sprouts Chinese Broccoli French Beans Lima Beans Mushrooms Soy Beans Soy Milk Peas Pumpkin Spirulina Squash - winter Sweet Potato Swiss Chard Meat/Poultry/Fish and Animal Products

Beef Cheddar Cheese Cottage Cheese Chicken (dark meat) Eggs Caviar Herring Pollock Salmon Sardines Tuna Goat Milk Goat Cheese Lamb Pork Turkey Breast Turkey Bacon Veal Yogurt Sour Cream Turkey Leg Lowfat Yogurt Roast Duck Hamburger Beef Sausage Ground Turkey Ground Chicken Nuts and Grains Almonds Buckwheat Chestnuts Oats Quinoa Rye Wheat - Durum Wheat - Hard Red Wheat - Hard White (Decuypere, 2011) If these foods are hard to come by, then likely you will need to treat Vitamin B2 deficiency with a sort of supplementation likely through pill form. If this is the case, then a doctor will need to be consulted to identify the level of deficiency and how much supplementation will need to be used.

Daily Recommended for Men, Women and Children (Milligrams) Children: *(Age) (4 6) need 1.1mg a day (7 10) need 1.2mg a day Males: *(Age) (15 18) need 1.8mg a day (19 - 24) need 1.7/1.8mg a day (25 50) need 1.6/1.7mg a day (50+) need 1.5/1.4mg a day Females: *(Age) (15 18) need 1.4/1.3mg a day (19 24) need 1.4/1.3mg a day (25 50) need 1.2/1.3mg a day (50+) need 1.1/1.2mg a day (Meyer, 2011) Conversion of IU (International Units) to Mcg/g (Micrograms) There is no conversion needed for Riboflavin (Vitamin B2) 3. Vitamin C Deficiency (Ascorbic Acid) Description/Symptoms Scurvy/Vitamin C Deficiency: [Characterized by] swollen and bleeding gums, looseness of the teeth, rupture of small blood vessels, and small bruises on the skin. Later symptoms may include anemia, extreme weakness, soreness of upper and lower limbs, tachycardia, and dyspnea Symptoms Include: Full-blown symptoms of the vitamin C deficiency disease called scurvy - including bleeding gums and skin discoloration due to ruptured blood vessels. Weak immune function, including susceptibility to colds and other infections, can also be a telltale sign of vitamin C deficiency. Since the lining of our respiratory tract also depends heavily on vitamin C for protection, respiratory infection and other lung-related conditions can also be symptomatic of vitamin C deficiency. (Whfoods.com, 2011) Definitions:

Scurvy: [Characterized by] swollen and bleeding gums, looseness of the teeth, rupture of small blood vessels, and small bruises on the skin. Later symptoms may include anemia, extreme weakness, soreness of upper and lower limbs, tachycardia, and dyspnea. (Medical-dictionary.com, 2011) Tachycardia: A rapid heart rate, usually defined as greater than 100 beats per minute. If symptom persists, should seek medical attention. (Medterms.com, 2011) Dyspnea: Difficult or labored breathing; shortness of breath. Can be a serious sign of respiratory complications and should be examined by a doctor if symptom persists. (Medterms.com, 2011) Anemia: The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. Persons with anemia may feel tired and fatigue easily, appear pale, develop palpitations and become unusually short of breath. Children with chronic anemia are prone to infections and learning problems. (Medterms, 2011) Weak Immune System: Weak, tired and lack of propensity to fight off infection. Upper Respiratory Infection: An upper respiratory infection (URI) is a viral or bacterial infection that affects the nose, throat (pharynx), sinuses, and voice box (larynx). These are the most common of all illnesses. The most familiar upper respiratory infections include the common cold (rhinopharyngitis), infection of the throat (pharyngitis), tonsils (tonsillitis), the maxillary sinuses behind the nose (sinusitis), and the larynx (laryngitis). Ear infections (acute otitis media) are another manifestation of URI. More serious upper respiratory infections include epiglottitis, an inflammation of the upper portion of the larynx and supraglottic area. (Mdguidelines.com, 2010) Lower Respiratory Infection: Includes pneumonia, bronchitis, and tracheobronchitis. These infections are often found in the elderly, but can happen at any age. (Binder, Kruse, & Mehr, 2003) Causes Vitamin deficiency anemia occurs when your body doesn't have enough of the vitamins needed to produce adequate numbers of healthy red blood cells. Red blood cells carry oxygen from your lungs throughout your body. If your diet is lacking in certain vitamins, vitamin deficiency

anemia can develop. Or vitamin deficiency anemia may develop because your body can't properly absorb the nutrients from the foods you eat. (Mayoclinic, 2011) Diet Treatment/Natural Treatment The best form of natural treatment is diet intake. If this is not possible or is not sufficient enough to correct the deficiency, than supplementation or other prescribed intake methods are available. You should consult with a doctor if diet alteration is not a sufficient method. Fruits and Vegetables High in Vitamin C Fruits and vegetables that contain 12 mg or more vitamin C per reference amount (20% of the Daily Value per reference amount) qualify to carry the label high in vitamin C. Apricots Beans, Yellow Snap Bell Pepper Blackberries Broccoli Brussels Sprouts Cabbage, Green Cabbage, Pe-Tsai Cabbage, Red Cantaloupe Carambola Cauliflower Cauliflower, Green Collard Greens Chili Pepper, Hot Gooseberries Grapefruit Guavas Kiwifruit Lemon Lime Melon, Honeydew Okra Onion Orange Papaya Pepper, Le Rouge Royale Pineapple

Potato Prickly Pears Pummelo Radishes Raspberries Rutabagas Spinach Squash, summer Strawberries Sweet Potato Tangerines Tomato Watermelon Good Source of Vitamin C Fruits and vegetables that contain 6 mg to less than 12 mg vitamin C per reference amount (1019% of the Daily Value per reference amount) qualify to carry the label good source of vitamin C. Artichoke Asparagus Banana Blueberries Carrot Celery Cherries, Sweet Corn Cucumber Green Beans Mango Nectarines Peaches Pear Plums (Fruitsandveggiesmorematters.org, 2011) Meat/Poultry Fish and Animal Products Cod Perch Goat Milk Soy Beans Lowfat Yogurt

Nuts and Grains Chestnuts (Decuypere, 2011) If these foods are hard to come by, then likely you will need to treat Vitamin C deficiency with a sort of supplementation likely through pill form. If this is the case, then a doctor will need to be consulted to identify the level of deficiency and how much supplementation will need to be used. Daily Recommended for Men, Women and Children (Milligrams) Children: *(Age) (4 6) Need 40 45mg a day (7 10) Need 40 -45mg a day Males: *(Age) (15 18) Need 45 60mg a day (19 24) Need 45 60mg a day (25 50 Need 45 60mg a day (50+) Need 45 60mg a day Females: *(Age) (15 18) Need 45 60mg a day (19 24) Need 45 60mg a day (25 50 Need 45 60mg a day (50+) Need 45 60mg a day (Meyer, 2011) Conversion of IU (International Units) to Mcg/g (Micrograms) There is no conversion needed for Ascorbic Acid (Vitamin C) 4. Vitamin D Deficiency Description/Symptoms A vitamin D deficiency can occur when usual intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert 25(OH)D to its active form, or absorption of vitamin D from the digestive tract is inadequate. Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, ovo-vegetarianism, and veganism (Ods.gov, 2011) Symptoms:

Rickets, osteoporosis, depression, hyperparathyroidism, fatigue, obesity, diabetes, and hypertension. Definitions: Rickets: Decreased calcium absorption from the intestine and abnormalities in formation and mineralization of skeletal bone, resulting in defective bone growth and deformity. (Thefreedictionary.com, 2011) Osteoporosis: A bone disease characterized by decrease in bone mass and density, resulting in a predisposition to fractures and bone deformities such as the collapse of one or more vertebrae (Thefreedictionary.com, 2011) Depression: A mood disorder characterized by an inability to experience pleasure, difficulty in concentrating, disturbance of sleep and appetite, and feelings of sadness, guilt, and helplessness. (Thefreedictionary.com, 2011) Hyperparathyroidism: Excessive secretion of parathyroid hormone resulting in abnormally high levels of calcium in the blood; can affect many systems of the body (especially causing bone resorption and osteoporosis). (Thefreedictionary.com, 2011) Fatigue: A feeling or sensation of tiredness, weariness, exhaustion, weakness or low energy. Fatigue is a symptom of a wide variety of mild to serious diseases, disorders and conditions including infection, inflammation, trauma, malignancy, chronic diseases, autoimmune diseases, and mental illnesses. (Bettermedicine.com, 2011) Obesity/Overweight: Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. (CDC.gov, 2010) Diabetes: A polygenic disease characterized by abnormally high glucose levels in the blood; any of several metabolic disorders marked by excessive urination and persistent thirst. (Thefreedictionary.com, 2011) Hypertension: Abnormally high blood pressure, especially in the arteries.

(Thefreedictionary.com, 2011) Causes Vitamin D deficiency can be caused by lack of vitamin d consumption through diet, limited exposure to sunlight, the level of melanin in the skin is reducing proper absorption, obesity or kidneys and digestive tracks do not convert vitamin d properly in the body. (Webmd, 2011) Diet Treatment/Natural Treatment The best form of natural treatment is diet intake, and in this case, increased sunlight exposure. If this is not possible or is not sufficient enough to correct the deficiency, than supplementation or other prescribed intake methods are available. You should consult with a doctor if diet alteration is not a sufficient method. Fruits and Vegetables Mushrooms Meat/Poultry Fish and Animal Products Beef Cheddar Cheese Cream Cheese Chicken Breast Cows Milk Whipping Cream Eggs Anchovies Caviar Cod Herring Sardines Goat Cheese Turkey Bacon Yogurt Sour Cream Hamburger Bacon Pork Sausage Beef Sausage Ground Turkey Nuts and Grains

None If these foods are hard to come by, then likely you will need to treat Vitamin D deficiency with a sort of supplementation likely through pill form. If this is the case, then a doctor will need to be consulted to identify the level of deficiency and how much supplementation will need to be used. Daily Recommended for Men, Women and Children (International Units) Children: *(Age) (4 6) Need 200(IU) a day (7 10) Need 200(IU) a day Males: *(Age) (15 18) Need 400(IU) a day (19 24) Need 200(IU) a day (25 50) Need 200(IU) a day (50 70) Need 400(IU) a day (70+) Need 600(IU) a day Females: *(Age) (15 18) Need 400(IU) a day (19 24) Need 200(IU) a day (25 50) Need 200(IU) a day (50 70) Need 400(IU) a day (70+) Need 600(IU) a day (Decuypere, 2011) Conversion of IU (International Units) to Mcg/g (Micrograms) Children: *(Age) (4 6) Need 200(IU) a day or 5 Mcg/g (7 10) Need 200(IU) a day or 5 Mcg/g Males: *(Age) (15 18) Need 400(IU) a day or 10 Mcg/g (19 24) Need 200(IU) a day or 5 Mcg/g (25 50) Need 200(IU) a day or 5 Mcg/g (50 70) Need 400(IU) a day or 10 Mcg/g (70+) Need 600(IU) a day or 15 Mcg/g Females: *(Age) (15 18) Need 400(IU) a day or 10 Mcg/g (19 24) Need 200(IU) a day or 5 Mcg/g (25 50) Need 200(IU) a day or 5 Mcg/g

(50 70) Need 400(IU) a day or 10 Mcg/g (70+) Need 600(IU) a day or 15 Mcg/g (Forbes, 2008) *Note: There are two types of Vitamin D. Vitamin D2 and Vitamin D3 (ergocalciferol and cholecalciferol); both sources come through the meat and animal products listed above. If an individual is a vegetarian, they might only want to use Vitamin D2 (mostly plant based), but if so, due to scarcity of Vitamin D2 in vegetables, the individual would need high doses of supplementation. If the individual expresses an interest in this, please advise they speak to a physician about this. (Summers, 2010) 5. Anemia Description/Symptoms Definition: Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. (Zieve, 2011) Common Symptoms: Symptoms common to many types of anemia include the following: Easy fatigue and loss of energy Unusually rapid heart beat, particularly with exercise Shortness of breath and headache, particularly with exercise Difficulty concentrating Dizziness Pale skin Leg cramps Insomnia

Anemia caused by iron deficiency: Hunger for strange substances such as paper, ice, or dirt (a condition called pica). Upward curvature of the nails referred to as koilonychias. Soreness of the mouth with cracks at the corners.

Anemia caused by vitamin B-12 deficiency: A tingling, "pins and needles" sensation in the hands or feet. Lost sense of touch.

A wobbly gait and difficulty walking. Clumsiness and stiffness of the arms and legs. Dementia Hallucinations, paranoia, and schizophrenia.

Anemia caused by chronic red blood cell destruction: Jaundice (yellow skin and eyes) Brown or red urine Leg ulcers Failure to thrive in infancy Symptoms of gallstones

Sickle cell anemia: Fatigue Susceptibility to infection Delayed growth and development in children Episodes of sever pain, especially in the joints, abdomen, and limbs

Anemia caused by sudden red blood cell destruction: Abdominal pain Brown or red urine Jaundice (yellow skin) Small bruises under the skin Seizures Symptoms

(Webmd.com, 2011) Definitions: Insomnia: Chronic inability to fall asleep or remain asleep for an adequate length of time. (Thefreedictionary.com, 2011) Fatigue: A feeling or sensation of tiredness, weariness, exhaustion, weakness or low energy. Fatigue is a symptom of a wide variety of mild to serious diseases, disorders and conditions including infection, inflammation, trauma, malignancy, chronic diseases, autoimmune diseases, and mental illnesses. (Betternedicine.com, 2011) Pica: An abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay.

(Thefreedictionary.com, 2011) Poor Circulation: An inadequacy of blood flow. Inadequate blood flow to a particular area of the body can result in too little oxygen being delivered to [said] area. (Medterms, 2011) Abdominal Pain: Abdominal pain is pain and discomfort that occurs in your abdomen. Abdominal pain can be mild or severe, and it may be continuous or come and go. Abdominal pain can be short-lived (acute) or occur over weeks and months (chronic). Many causes aren't serious, such as gas pains or a pulled muscle. If you have abdominal pain so severe that you can't move without causing more pain or you can't sit still or find a comfortable position, it is likely a more serious cause. Also seek immediate medical help if other worrisome signs and symptoms, such as bloody diarrhea or chest pain, accompany pain. (Mayoclinic, 2010) Constipation: Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel. (Camilleri, 2007) Jaundice: Yellowish discoloration of the whites of the eyes, skin, or mucous membranes caused by the deposition of bile salts in these tissues, occurring as a sign of disorders that interfere with normal metabolism or transport of bile. Liver diseases such as hepatitis commonly cause jaundice. (Thefreedictionary.com, 2011) Seizure: A sudden episode of transient neurologic symptoms such as involuntary muscle movements, sensory disturbances and altered consciousness. A seizure is caused by abnormal electrical activity in the brain. (Thefreedictionary.com, 2011) Causes There are more than 400 types of anemia, which are divided into three groups: Anemia caused by blood loss Anemia caused by decreased or faulty red blood cell production Anemia caused by destruction of red blood cells

Anemia Caused by Blood Loss

Red blood cells can be lost through bleeding, which can occur slowly over a long period of time, and can often go undetected. This kind of chronic bleeding commonly results from the following: Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the stomach), and cancer. Use of non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin or Motrin. Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies.

*Note: Consult a doctor immediately if you experience or observe these symptoms in yourself or in others. Anemia Caused by Decreased or Faulty Red Blood Cell Production The body may produce too few blood cells or the blood cells may not function correctly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or the a lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following: Sickle cell anemia Iron deficiency anemia Vitamin deficiency Bone marrow and stem cell problems Other health conditions

*Note: Iron deficiency and Vitamin deficiency can be treated with supplements in pill form or through change in diet. One should consult a doctor if change in diet does not improve symptoms. If diet is not enough, consult doctor regarding pill supplements or for more serious symptoms listed in the above category, please seek immediate help. Anemia Caused by Destruction of Red Blood Cells When red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing hemolytic anemia. Hemolytic anemia can be present at birth or develop later. Sometimes there is no known cause (spontaneous). Known causes of hemolytic anemia may include: Inherited conditions, such as sickle cell anemia and thalassemia Stressors such as infections, drugs, snake or spider venom, or certain foods Toxins from advanced liver or kidney disease Inappropriate attack by the immune system (called hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman) Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders

In rare cases, an enlarged spleen can trap red blood cells and destroy them before their circulating time is up

*Note: Consult a doctor immediately if you experience or observe these symptoms in yourself or in others. (Webmd.com, 2011) Diet Treatment/Natural Treatment Ones body can absorb 40% of the Iron in most meat: Meat Type Veal Liver Beef Lamb Ham Chicken Bologna Serving Size 1 oz 3 oz 4 oz 20 oz 3 oz 4 oz 3 oz 4 oz Iron (mg) 4mg 5mg 4mg 5mg 4mg 5mg 1.5mg 2mg 1.5mg 2mg 1.5mg 2mg

Ones body can absorb only 10% of the Iron in most fruits, grains and vegetables: Fruit, Grain, and Vegetable Type Raisins Prunes, dried Pease, cooked Beans, cooked Figs Spinach Barley Oatmeal Beans, green Rice Potato (O'donnell, & Thompson, 2009) If anemia is resulting from a Vitamin B12 deficiency, one should look to these foods for proper diet intake of Vitamin B12: Note* (No fruit, vegetable, nut or grain contains a significant amount of Vitamin B12) Beef (3 6 g per 3 oz serving) Cheddar Cheese (.23 g per serving/slice) Cottage Cheese (1.3 g per serving/cup) Serving Size 0.5 Cup 1 Cup 0.5 Cups 0.5 Cups 3 medium (figs) 1 Cup 0.5 Cups 1 Cup 1 Cup 1 Cup 1 medium (Potato) Iron (mg) 4mg 5mg 4mg 5mg 2mg 4mg 2mg 4mg 2mg 4mg 1mg 6mg 1.5mg 2mg 1.5mg 2mg 1.5mg 2mg 0.7mg 1.4mg 0.7mg 1.4mg

Cows Milk (1.12 g per serving/cup) Eggs (0.66 g per 1 serving/large grade AA egg) Catfish (3.55 g per serving/filet) Caviar (3.2 g per serving/tablespoon [black or red caviar]) Cod (2.1 g per serving/filet) Herring (25.15 g per serving/filet) Perch (0.64 g per serving/filet) Pollock (06.16 g per serving/half-filet) Salmon (3.18 g per serving/half-filet) Sardines (8.94 g per serving/can) Tuna (1.17 g per serving/can [white water-packed tuna]) Lamb (2.17 g per 3 oz serving) Pork (1.18 g per 100 grams serving) Veal (1.33 g per 3 oz serving) Yogurt (0.84 g per 8 oz serving) Chicken (0.34 g per 100 gram serving) (Decuypere, 2011) If these foods are hard to come by, then likely you will need to treat Anemia with a sort of supplementation likely through pill form. If this is the case, then a doctor will need to be consulted to identify the level of deficiency and how much supplementation will need to be used. Daily Recommended for Men, Women and Children (Micrograms) Children: *(Age) (4 6) Need 1.0 1.5 Mcg/g a day (7 10) Need 1.4 2.0 Mcg/g a day Males: *(Age) (15 18) Need 2.0 3.0 Mcg/g a day (19 24) Need 2.0 3.0 Mcg/g a day (25 50) Need 2.0 3.0 Mcg/g a day (50 70) Need 2.0 3.0 Mcg/g a day Females: *(Age) (15 18) Need 2.0 3.0 Mcg/g a day (19 24) Need 2.0 3.0 Mcg/g a day (25 50) Need 2.0 3.0 Mcg/g a day (50 70) Need 2.0 3.0 Mcg/g a day (Meyer, 2011) Conversion of IU (International Units) to Mcg/g (Micrograms) There is no conversion needed for Vitamin B12

B. Issues that can be prevented or treated with natural methods 6. Diarrhea Definition: Diarrhea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking water, or from person to person as a result of poor hygiene. Severe diarrhea leads to fluid loss, and may be life threatening, particularly in young children and people who are malnourished or have impaired immunity. (Who.int, 2011) Causes: The most common causes of diarrhea include the following:

Bacterial infections. Several types of bacteria consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli). Viral infections. Many viruses cause diarrhea, including rotavirus, norovirus, cytomegalovirus, herpes simplex virus, and viral hepatitis. Infection with the rotavirus is the most common cause of acute diarrhea in children. Rotavirus diarrhea usually resolves in 3 to 7 days but can cause problems digesting lactose for up to a month or longer. Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium. Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome. Intestinal diseases. Inflammatory bowel disease, ulcerative colitis, Crohns disease, and celiac disease often lead to diarrhea.

Symptoms / Accompanying Sickness Dehydration Diarrhea can cause dehydration. Loss of electrolytes through dehydration affects the amount of water in the body, muscle activity, and other important functions. Dehydration is particularly dangerous in children, older adults, and people with weakened immune systems. Dehydration must be treated promptly to avoid serious health problems, such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. Signs of dehydration in adults include

Thirst

Less frequent urination than usual Dark-colored urine Dry skin Fatigue Dizziness Light-headedness

Diarrhea Prevention / Treatment (Diet/Nutrition) In most cases of diarrhea, the only treatment necessary is replacing lost fluids and electrolytes to prevent dehydration. (Donowitz, & Fordtran, 2011) Examples of High Liquid Foods It is estimated that 20% of our water needs come from our food. Examples of high liquid foods are: Fruits Watermelon Citrus fruits Grapes Apples Papaya Strawberries Apricots Cherries Vegetables Carrots Bell peppers Lettuce Tomato Cucumber Squash Celery Broccoli Cauliflower Spinach The daily recommended fluid intake is 10 - 15 glasses (8oz/glass) depending on your age and sex. Females and younger people are at the lower end of the range while males are at the upper

end of the range. Foods contribute 20% of the fluids so actual fluid recommendations are 8 13 (8 oz/237ml) glasses daily. Focus on fruits and have variety in vegetables to meet these standards whenever possible, and increase water intake if you happen to be involved in physical activity. Thirst is not an accurate indicator of your body needing water or not. Again, this is a recommended goal, there may not be access to this amount of clean drinking water or resources in the area, therefore, you can only drink as much as reasonably acquirable a day. (Litchfield, 2011) Until diarrhea subsides, avoiding caffeine and foods that are greasy, high in fiber, or sweet may lessen symptoms. These foods can aggravate diarrhea. Some people also have problems digesting lactose during or after a bout of diarrhea. Yogurt, which has less lactose than milk, is often better tolerated. Yogurt with active, live bacterial cultures may even help people recover from diarrhea more quickly. As symptoms improve, soft, bland foods can be added to the diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. (Donowitz, & Fordtran, 2011) Water Treatment Options Because so much water is needed to maintain a healthy amount of fluid in the body at all times, we will review some water treatment methods. Clorin This liquid point-of-use disinfectant developed by the Pan American Health Organization (PAHO) and the Centers for Disease Control and Prevention (CDC) is a 0.05% sodium hypochlorite solution produced through electrolysis. Previous studies have suggested that Clorin, along with an improved water vessel and instructions on proper use, could reduce diarrhea prevalence by 15-48% (Quick et al 1999). (Baba, Burnham, Hansen, Majeed, & Myers, 2010) A bottle of Clorin is expected to treat enough drinking water for a household of six for one month (Baba, Burnham, Hansen, Majeed, & Myers, 2010). Boil The most efficient and cheapest way to purify water if Clorin or purified/bottled water is unavailable is to boil water. Heat up the water until it is at a rolling boil for 1 minute. Store at least a 3-day supply of water whenever possible. A gallon per person should be purified and stored in the household whenever possible. (Department of Health, 2009)

Oral Rehydration Solution Simplified (BRAC Method) For half a liter of water, use a pinch of salt and a handful of gur (unrefined brown sugar) / or regular sugar. (Mustafa, 2011) Specific (Rehydrate.org) - 6 teaspoons of sugar - ! teaspoon of salt for every 1 liter of clean drinking water (bottled / purified / pre-boiled) - Serve cold Feed after every loose motion. Adults and large children should drink at least 3 quarts or liters of ORS a day until they are well. Each Feeding:

For a child under the age of two Between a quarter and a half of a large cup For older children Between a half and a whole large cup

For Severe Dehydration: Drink sips of the ORS (or give the ORS solution to the conscious dehydrated person) every 5 minutes until urination becomes normal. (It's normal to urinate four or five times a day.) (Rehydrate.org, 2011) Education Hygiene Education Hygiene plays an important role in diarrheal disease transmission, with numerous studies demonstrating the association between poor hygiene practices and increased risk of diarrhea (Baba, Burnham, Hansen, Majeed, & Myers, 2010). These are general hygiene practices that are supported by the USAID and PSI: 1. Use protected drinking water

2. Improve environmental sanitation; use and maintain latrines 3. Improve personal hygiene, especially hand washing practices 4. Protect food from contamination 5. Use oral rehydration therapy (ORT) for diarrhea. *(Some of these practices will be discussed in further detail in the proceeding sections) (Baba, Burnham, Hansen, Majeed, & Myers, 2010) 7. Constipation Definitions: Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel. (Camilleri, 2007) Causes: Common causes of constipation include: Inadequate water intake. Inadequate fiber in the diet. A disruption of regular diet or routine. Inadequate activity or exercise or immobility. Stress. Resisting the urge to have a bowel movement, which is sometimes the result of pain from hemorrhoids. Hypothyroidism. Depression. Eating disorders. Irritable bowel syndrome. Pregnancy. Colon cancer. (Webmd.com, 2011) Symptoms / Accompanying Sickness: Symptoms: Symptoms of constipation can include: Infrequent bowel movements and/or difficulty having bowel movements. Swollen abdomen or abdominal pain. Pain. Vomiting. (Webmd.com, 2011) Prevention / Treatment:

Diet: Limiting the intake of dairy is important in keeping healthy soft, full stools. This combined with the adequate intake of 20 to 35 grams of fiber a day will ensure that this does not happen. If it is not reasonable to acquire this much fiber in a day, then as much as possible with a healthy amount of water should still ensure healthy digestion. (Camilleri, 2007) Foods with high-fiber: HIGH FIBER FOODS LIST with TOTAL FIBER GRAMS (g) Fresh & Dried Fruit Serving Size Apples with skin 1 medium Apricot 3 medium Apricots, dried 4 pieces Banana 1 medium Blueberries 1 cup Cantaloupe, cubes 1 cup Figs, dried 2 medium Grapefruit 1/2 medium Orange, navel 1 medium Peach 1 medium Peaches, dried 3 pieces Pear 1 medium Plum 1 medium Raisins 1.5 oz box Raspberries 1 cup Strawberries 1 cup Grains, Beans, Nuts & Seeds Almonds Black beans, cooked Bran cereal Bread, whole wheat Brown rice, dry Cashews Flax seeds Garbanzo beans, cooked Kidney beans, cooked Lentils, red cooked Lima beans, cooked Serving Size 1 oz 1 cup 1 cup 1 slice 1 cup 1 oz 3 Tbsp. 1 cup 1 cup 1 cup 1 cup Fiber (g) 5.0 1.0 2.9 3.9 4.2 1.3 3.7 3.1 3.4 2.0 3.2 5.1 1.1 1.6 6.4 4.4 Fiber (g) 4.2 13.9 19.9 2.0 7.9 1.0 6.9 5.8 11.6 13.6 8.6

Oats, rolled dry Quinoa (seeds) dry Quinoa, cooked Pasta, whole wheat Peanuts Pistachio nuts Pumpkin seeds Soybeans, cooked Sunflower seeds Walnuts Vegetables Avocado (fruit) Beets, cooked Beet greens Bok choy, cooked Broccoli, cooked Brussels sprouts, cooked Cabbage, cooked Carrot Carrot, cooked Cauliflower, cooked Cole slaw Collard greens, cooked Corn, sweet Green beans Celery Kale, cooked Onions, raw Peas, cooked Peppers, sweet Pop corn, air-popped Potato, baked w/ skin Spinach, cooked Summer squash, cooked Sweet potato, cooked Swiss chard, cooked Tomato Winter squash, cooked

1 cup 1/4 cup 1 cup 1 cup 1 oz 1 oz 1/4 cup 1 cup 1/4 cup 1 oz Serving Size 1 medium 1 cup 1 cup 1 cup 1 cup 1 cup 1 cup 1 medium 1 cup 1 cup 1 cup 1 cup 1 cup 1 cup 1 stalk 1 cup 1 cup 1 cup 1 cup 3 cups 1 medium 1 cup 1 cup 1 medium 1 cup 1 medium 1 cup

12.0 6.2 8.4 6.3 2.3 3.1 4.1 8.6 3.0 3.1 Fiber (g) 11.8 2.8 4.2 2.8 4.5 3.6 4.2 2.6 5.2 3.4 4.0 2.6 4.6 4.0 1.1 7.2 2.9 8.8 2.6 3.6 4.8 4.3 2.5 4.9 3.7 1.0 6.2

Zucchini, cooked (Commonsensehealth.com, 2011)

1 cup

2.6

Lifestyle Changes: Staying physically active, drinking lots of water, and eating a healthy highfiber diet is the best lifestyle to lead for healthy digestion. Laxatives: There are many forms of medication that can relieve constipation, such as fleet enemas, stool softeners, fiber supplements, suppositories, stimulants, and oral osmotics. If the above lifestyle changes, including water, fiber-rich foods and exercise do not relieve constipation; consult with a physician about taking either prescription laxatives or over the counter laxatives. (Mayoclinic.com, 2011) There are also natural laxatives that can be taken if medication is unavailable or unaffordable. Examples: Prunes (Prune Juice for pregnant women) (Natural-laxatives.org, 2011) Senna (Herb) Cascara Sagrada (Bark / Herb) Rhubarb (Vegetable / [Fruit in USA] (Specialtyproduce.com, 2011) Education: In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation: ! Eat a well-balanced, high-fiber diet that includes beans, bran, whole grains, fresh fruits, and vegetables. ! Drink plenty of liquids. ! Exercise regularly. ! Set aside time after breakfast or dinner for undisturbed visits to the toilet. ! Do not ignore the urge to have a bowel movement. ! Understand that normal bowel habits vary. ! Whenever a significant or prolonged change in bowel habits occurs, check with a doctor. (Camilleri, 2007) 8. Leishmanaisis Definitions: Cutaneous Leishmaniasis: A dermatologic disease caused by the parasite Leishmania tropica, transmitted to humans by the bite of the sand fly. This form of leishmaniasis, characterized by ulcerative lesions, occurs primarily in Africa, Asia, and some Mediterranean countries.

(Medical-dictionary.com, 2011) Visceral Leishmanias: A chronic, systemic disease characterized by fever, (hepato) splenomegaly lymphadenopathy, pancytopenia, weight loss, weakness and, if left untreated, death. (Fiekert, Lenglet, Leslie, Mahboob, & Mayan, et al., 2006) Causes: Leishmaniasis is caused by parasitic protozoa of the genus Leishmania. Humans are infected via the bite of phlebotomine sandflies, which breed in forest areas, caves, or the burrows of small rodents. (Who.int, 2011) Symptoms / Accompanying Sickness: Cutaneous Leishmaniasis: People who have cutaneous leishmaniasis have one or more sores on their skin. The sores can change in size and appearance over time. They often end up looking somewhat like a volcano, with a raised edge and central crater. Some sores are covered by a scab. The sores can be painless or painful. Some people have swollen glands near the sores (for example, under the arm if the sores are on the arm or hand). (Medicinenet.com, 2011) Visceral Leishmaniasis: Visible signs in people with visceral leishmaniasis usually have fever, weight loss, and sometimes enlarged glands (as discussed above). Upon testing performed in a medical clinic, such as an x-ray or sonogram of sorts, a physician might see an enlarged spleen and liver. Another sign of visceral leishmaniasis within the body may also be found through blood tests. Certain blood tests are abnormal. For example, patients usually have low blood counts, including a low red blood cell count (anemia), low white blood cell count, and low platelet count. (Medicinenet.com, 2011) Prevention / Treatment: Prevention: Strategies to prevent and control visceral leishmaniasis are aimed at reducing exposure to the sandfly vector. This can be achieved by improving housing, using insecticide treated bednets or curtains, [and] spraying houses indoors with residual insecticides. (Leishmaniasis in Afghanistan PDF) Treatment:

Cutaneous Leishmaniasis: Can heal at times on its own. Good hygiene practices will ensure the recovery process goes uninterrupted. Visceral Leishmaniasis: Visceral Leishmaniasis must be treated by a medical professional with access to specific pharmaceuticals. There is only a selection of treatment medications available at this point. 1. Pentavalent antimonials (Sbv) are the first-line treatment options worldwide. 2. Amphotericin B Deoxycholate is another option. This is very popular in India based on economics, but it is not the most effective of treatments. 3. Liposomal Amphotericin B is the most effective discovered treatment, however it is not always available or affordable. (Rai, & Sunder, 2005) Education: 1. Avoid outdoor activities, especially from dusk to dawn, when sand flies are the most active. 2. If there is access to insecticides, spray them appropriately on the skin, clothing and in the home. Do not ingest insecticide and do not spray on food or cooking utensils/materials. 9. Malnutrition (Undernutrition) Definitions: Malnutrition (Undernutrition)People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition) (Unicef.org, 2006) Micronutrient and/or Protein Deficiency: This is shown in a very large group of malnourished people. They either do not receive adequate amounts of vitamins and minerals (micronutrients), or the correct proportion of protein in their diets. (Malnutrition.org, 2011) Causes: Lack of nutrition through low calorie and protein intake. Some illnesses such as Celiac Disease and Cystic Fibrosis can interfere with absorption of nutrients. Alcoholism can also poorly effect nutrition distribution in the body. Celiac Disease: Celiac (SEE-lee-ak) disease is a digestive condition triggered by consumption of the protein gluten, which is primarily found in bread, pasta, cookies, pizza crust and many other foods containing wheat, barley or rye. People with celiac disease who eat foods containing gluten

experience an immune reaction in their small intestines, causing damage to the inner surface of the small intestine and an inability to absorb certain nutrients. Celiac disease can cause abdominal pain and diarrhea. Eventually, the decreased absorption of nutrients (malabsorption) that occurs with celiac disease can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment. (Mayoclinic.com, 2011) Cystic Fibrosis: Cystic fibrosis is a life-threatening disorder that causes severe lung damage and nutritional deficiencies. An inherited condition, cystic fibrosis affects the cells that produce mucus, sweat and digestive juices. Normally, these secretions are thin and slippery, but in cystic fibrosis, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the pancreas and lungs. This illness is not common to those outside of inheritors of Northern European lineage (Mayoclinic.com, 2011) Alcohol and Nutrition Discussion: Once ingested, food must be digested (broken down into small components) so it is available for energy and maintenance of body structure and function. Digestion begins in the mouth and continues in the stomach and intestines, with help from the pancreas. The nutrients from digested food are absorbed from the intestines into the blood and carried to the liver. The liver prepares nutrients either for immediate use or for storage and future use. Alcohol inhibits the breakdown of nutrients into usable molecules by decreasing secretion of digestive enzymes from the pancreas (2). Alcohol impairs nutrient absorption by damaging the cells lining the stomach and intestines and disabling transport of some nutrients into the blood (3). In addition, nutritional deficiencies themselves may lead to further absorption problems. For example, folate deficiency alters the cells lining the small intestine, which in turn impairs absorption of water and nutrients including glucose, sodium, and additional folate (3). Even if nutrients are digested and absorbed, alcohol can prevent them from being fully utilized by altering their transport, storage, and excretion (4). Decreased liver stores of vitamins such as vitamin A (5), and increased excretion of nutrients such as fat, indicate impaired utilization of nutrients by alcoholics (3). (Gordis, 1993) Symptoms / Accompanying Sickness: Marasmus: A condition of extreme malnutrition and emaciation, occurring chiefly in young children. It is characterized by progressive wasting of subcutaneous tissue and muscle. Marasmus results from a lack of adequate calories and proteins and is seen in children with

failure to thrive and in individuals in a state of starvation. Less commonly it results from an inability to assimilate or use protein because of a defect in metabolism. Care of the marasmic child involves the reestablishment of fluid and electrolyte balance, followed by the slow and gradual addition of foods as they are tolerated. (Medical-dictionary.com, 2011)!
!

Kwashiorkor: A malnutrition disease, primarily of children, caused by severe protein deficiency that usually occurs when the child is weaned from the breast. The child does not lose weight as dramatically and does not look as sick as a marasmic child, who lacks both protein and calories. Some now believe kwashiorkor may relate to bacterial grain contamination and occur when the newly weaned child begins to ingest grain products. Eventually the following symptoms occur: retarded growth, changes in skin and hair pigmentation, diarrhea, loss of appetite, nervous irritability, lethargy, edema, anemia, fatty degeneration of the liver, necrosis, dermatoses, and fibrosis, often accompanied by infection and multivitamin deficiencies. Because dietary fats are poorly tolerated in kwashiorkor, its treatment includes a skimmed milk formula in initial feedings, followed by additional foods until a full, well-balanced diet is achieved. (Medical-dictionary.com, 2011) Treatment: To properly treat someone with symptoms of malnutrition, a doctor must be consulted. When first seen, the child must be examined, a history taken and a decision made on the treatment to be given. Treatment should be started as soon as these tasks have been completed; details of the history and examination should be recorded later. Very sick children respond badly to frequent handling; they should not be taken for X-rays initially and should remain in bed while clinical specimens are taken. The individual who is malnourished should see a physician and when doing so, bring with them a family member or someone who knows there medical history well to help them give the doctors adequate information of their health history. This is necessary because doctors must be made aware of weight and health changes over time to assess rate of nutrition loss and how to adequately improve nutrition at the appropriate rate. (Golden, & Waterlow, 1999) Prevention and Education: There is no single way to treat malnutrition. There are many initiatives being implemented in partnership with CDC, World Food Programme, UNICEF and other organizations to target new strategies, often specific to geographical regions based on infrastructure, resources, etc. Check in with the World Health Organization, embassy or appropriate medical experts in the region.

Of course a healthy diet focusing on high protein intake in combination with exercise and adequate water intake will keep the body functioning optimally and avoid malnutrition. Here is a chart of adequate calorie intake by gender and age:

(Webmd.com, 2011) C. Issues that can be prevented/reduced with education/community action but must be treated medically 10. Malaria Definition: An infectious disease of tropical areas caused by the parasitic infection of red blood cells by a protozoan of the genus Plasmodium, which is transmitted by the bite of an infected female mosquito. Malaria is characterized by recurrent episodes of chills, fever, sweating, and anemia. (Thefreedictionary.com, 2011) Prevention: Preventing Mosquito Bites:

Limit your outdoor activity between dusk and dawn. Stay in screened or air-conditioned rooms. Wear protective clothing (long pants and long-sleeved shirts).

Use insect repellent with DEET (N,N diethylmetatoluamide). The repellent is available in varying strengths up to 100%. In young children, use a preparation containing less than 24% strength, because too much of the chemical can be absorbed through the skin. Use bed nets (mosquito netting) sprayed with or soaked in an insecticide such as permethrin or deltamethrin. Use flying-insect spray indoors around sleeping areas. Avoid areas where malaria and mosquitoes are present if you are at higher risk (for example, if you are pregnant, very young, or very old).

Education: Community Health Workers (CHWs) should be trained on how to distribute Chloroquine as a first-line treatment of malaria ((Hanif, & Waldman, 2002), p.15) in areas where someone experiencing symptoms of malaria is not able to get to a hospital in less than 6 hours (Olumese, 2010, p.46). Most malaria in Afghanistan is due to chloroquine-sensitive P. vivax infection. ((Hanif & Waldman, 2002), p.15). Treatment: Because P. Vivax Infection is predominantly the infection-type, this chart will show proper dosage and administration of Chloroquine. *Note: The chart below is not to be used unless there is a Community Health Worker in the area or a Community Health System set up or in case of an emergency, in all other cases, please refer all malaria cases to a physician.

(Kakkilaya, 2006) 11. Tuberculosis Definition: An infectious disease caused by the bacterium Mycobacterium tuberculosis that is transmitted through inhalation and is characterized by cough, fever, shortness of breath, weight loss, and the appearance of inflammatory substances and tubercles in the lungs. Tuberculosis is highly contagious and can spread to other parts of the body, especially in people with weakened immune systems. Although the incidence of the disease has declined since the introduction of antibiotic treatment in the 1950's, it is still a major public-health problem throughout the world. (Thefreedictionary.com, 2011) Prevention: Proper ventilation in ones home and in the classroom will make sure that air goes through proper cycling in and out of the room, thus not letting air become stale, thus breeding specific bacteria and trapping them in the room. (Mayoclinic, 2011) In those parts of the world where the disease is common, the World Health Organization recommends that infants receive a vaccine called BCG (Bacille Calmette-Gurin) made from a live weakened bacterium related to Mtb. BCG vaccine prevents Mtb from spreading within the body, thus preventing TB from developing. (Niaid.nih.gov, 2010) Education: Tuberculosis is transferred from one person to another through the air. ("Get the facts", 2005, p.4) Therefore, if someone has Tuberculosis, instruct them to wear a mask or stay at home away from others in a well-ventilated room in order to not infect others. (Mayoclinic.com, 2011) Treatment: Latent tuberculosis infection (LTBI): A condition in which a person is infected with Mycobacterium tuberculosis, but does not currently have active tuberculosis disease. (El-Amin W., Hauck, F.R., Neese, B.H. and Panchal, A.S., 2009, p.1)

Treatment: The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). INH for 9 months is the preferred regimen. INH kills the TB bacteria that are in the body. Children and people with HIV infection may need to take INH for a longer time. (CDC.gov, 2010) Tuberculosis: An infectious disease caused by the bacterium Mycobacterium tuberculosis that is transmitted through inhalation and is characterized by cough, fever, shortness of breath, weight loss, and the appearance of inflammatory substances and tubercles in the lungs. Tuberculosis is highly contagious and can spread to other parts of the body, especially in people with weakened immune systems. Although the incidence of the disease has declined since the introduction of antibiotic treatment in the 1950's, it is still a major public-health problem throughout the world. (Thefreedictionary.com, 2011) Treatment: The four most commonly chosen medicines are: Isoniazid. Rifampin (Rifadin, Rimactane). Pyrazinamide. Ethambutol (Myambutol). *Note This illness in both forms needs to be treated by a physician at a proper medical facility or in an approved Community Health Center or by a Community Health Worker who is trained and certified to treat Tuberculosis and has available and appropriate medications. 12. HIV/AIDS Definition: HIV: A retrovirus that causes AIDS by infecting helper T cells of the immune system. The most common serotype, HIV-1, is distributed worldwide, while HIV-2 is primarily confined to West Africa. (Thefreedictionary.com, 2011) AIDS: Short for acquired immune deficiency syndrome. An infectious disease of the immune system caused by a human immunodeficiency virus (HIV). AIDS is characterized by a decrease in the number of helper T cells, which causes a severe immunodeficiency that leaves the body susceptible to a variety of potentially fatal infections. The virus is transmitted in infected bodily fluids such as semen and blood, as through sexual intercourse, the use of contaminated hypodermic syringes, and placental transfer between mother and fetus. Although a cure or vaccine is not yet available, a number of antiviral drugs can decrease the viral load and subsequent infections in patients with AIDS. (Thefreedictionary.com, 2011)

Learn more about the differences between HIV-1 and HIV-2 at the link below. Again, HIV-1 is what is prevalent in Afghanistan. (Birden, 2001) HIV infection in Afghanistan is mostly climbing from injecting drug users. [It is less in relation to water sanitation issues, mother-to-child transaction or unsafe sexual practices.] (Claeson, Friedman, Rasoul, Rehman, & Sayed, et. al, 2007, p.2167) HIV-1 is the primary HIV infection type in Afghanistan as there is not substantial evidence of HIV-2 outside of Africa. (Carter, 2011) Prevention/Education: Sexual Transmission: This will be touched on again specifically in Section D, however it is worth mentioning again. Someone can eliminate or reduce their risk of becoming infected with HIV during sex by choosing to: Abstain from sex or delay first sex Be faithful to one partner or have fewer partners Condomise, which means using male condoms or female condoms consistently and correctly (Avert.org, 2011) Through Drug Injection: Stopping the injection of drugs all together would be ideal. However, methods such as needleexchange programs and community campaigns/counselor and drug prevention programs are helpful in encouraging safe behaviors. (Avert.org, 2011) Mother-to-Child Transmission: Again, safe-sex practices will greatly reduce the risk of HIV infection in the mother. If a woman were planning to become pregnant, it would be wise to get tested for HIV before becoming pregnant. Some other prevention methods are:

! ! !

A course of antiretroviral drugs given to her during pregnancy and labor as well as to her newborn baby can greatly reduce the chances of the child becoming infected. A caesarean section is an operation to deliver a baby through its mothers abdominal wall, which reduces the babys exposure to its mothers body fluids. The World Health Organisation advises mothers with HIV not to breastfeed whenever the use of replacements is acceptable, feasible, affordable, sustainable and safe.

(Avert.org, 2011) Treatment: Below is a list of the different types of Antiretroviral Drugs:

*Note HIV=1 and HIV-2 needs to be treated by a physician at a proper medical facility or in an approved Community Health Center or by a Community Health Worker who is trained and certified to treat HIV-1/HIV-2 and has available and appropriate Antiretroviral Medications. D. Hygiene practices and Sexual practices 13. Food/Water Preparation Purifying Water:

The most efficient and cheapest way to purify water if Clorin or purified/bottled water is unavailable is to boil water. Heat up the water until it is at a rolling boil for 1 minute. Store at least a 3-day supply of water whenever possible. A gallon per person should be purified and stored in the household whenever possible. (Department of Health, 2009) Purifying Instruments: Instruments used for skin piercing, tattoos, tooth extraction, circumcision, etc need to be boiled for at least 30 minutes. (Fountain, Gorske, & Hesterman, 2009, p.13) Five Keys to Safe Food: 1. Body Hygiene and Area Cleaning -Wash your hands before handling food and often during food preparation -Wash your hands after going to the toilet -Wash and sanitize all surfaces and equipment used for food preparation -Protect kitchen areas and food from insects, pests and other animals -Cloths and sponges used for cleaning dishes should be replaced daily. They should be cleaned in hot water and hung out in the sun to dry 2. Separate Raw and Cooked Foods -Separate raw meat, poultry and seafood from other foods -Use separate equipment and utensils such as knives and cutting boards for handling raw foods do not use the same cutting boards for fruits, vegetables and breads as you do for raw meats poultry and seafood. -Store food in containers to avoid contact between raw and prepared foods (Fountain, Gorske, & Hesterman, 2009, p.17) 3. Cook Properly -Cook food thoroughly, especially meat, poultry, eggs and seafood -Bring foods like soups and stews to boiling to make sure that they have reached 70C. For meat and poultry, make sure that juices are clear, not pink (Ideally, use a thermometer if one is available). -Reheat cooked food thoroughly. 4. Keep Food at Safe Temperatures -Do not leave cooked food at room temperature for more than 2 hours

-Refrigerate promptly all cooked and perishable food (preferably below 5C) -Keep cooked food piping hot (more than 60C) prior to serving -Do not store food too long even in the refrigerator -Do not thaw frozen food at room temperature 5. Use Safe Water and Raw Materials -Use safe water or treat it to make it safe -Select fresh and wholesome foods -Choose foods processed for safety, such as pasteurized and powdered milk -Wash fruits and vegetables, especially if eaten raw -Do not use food beyond its expiry date. Do not eat food from cans that are swollen or that squirt when opened. (Fountain, Gorske, & Hesterman, 2009, p.18) 14. Personal Hygiene General Hand-washing Method 1. Use hot water to wet hands 2. Use soap on both hands and scrub thoroughly up to above the wrists 3. Rinse off soap with hot water 4. Repeat process a second time 5. Dry hands well Hand-washing Considerations 1. It is important to clean under the fingernails 2. Do not wash in water that someone else has used. That can transfer their germs to us. 3. The washing area should have good drainage so that the water does not sit and become contaminated with bacteria or become a breeding area for mosquitoes and other insects. 4. The drying towels should be washed regularly and hung out in the sun to dry. (Fountain, Gorske, & Hesterman, 2009, p.14) When is Hand-Washing Appropriate? Wash after using the toilet. Wash after coughing, sneezing, blowing your nose. Wash after using tobacco, eating or drinking. Wash after handling dirty equipment, dishes or utensils. Wash immediately before handling food, equipment, utensils, dishes or single service items. Wash during food preparation as often as necessary to prevent cross-contamination. Wash when switching between raw and ready-to-eat foods. Wash after any activity that contaminates hands.

(Madison County Health Department, 2011, p.1) Disposal of Excrement The use of properly built latrines is one of the most important ways a community can immediately begin to prevent deaths from worm and bacterial infections. There are a few types of Latrines: 1. Simple Pit Latrine 2. Permanent Ventilated Latrine (VIP) Specific latrine building instructions can be found in the water and sanitation section of the World Health Organization website (www.who.int) When there is no latrine, individuals must go far away from where people bathe or get drinking water or grow vegetables. The individual must dig a hole and cover the excrement with dirt. (Fountain, Gorske, & Hesterman, 2009, p.15) Bathing / Washing Clothes If you are unsure of whether the water you are using is clean or whether or not it has been contaminated by latrines upstream, boil water to purify it and use this water for brushing your teeth, washing your body or washing your clothes. (Fountain, Gorske, & Hesterman, 2009, p.30) Oral Health Here are some general things to avoid putting in ones mouth to maintain good oral health: 1. Tobacco Increases chances of contracting gum disease, cancer, fungal infection in the throat, heart disease, stroke and many other diseases. 2. Limit Alcohol Heavy use of alcohol also is a factor in oral and throat cancers, especially in conjunction with tobacco. 3. Avoiding sugar and starches can help maintain healthy gums and teeth. 4. Drink purified water, and if it is not boiled, make sure it has fluoride in it. 5. Brush twice a day and floss at least once. Brush after breakfast and before bed and floss at least once (usually before bed). (Fountain, Gorske, & Hesterman, 2009, p.30) How to Brush and Floss Brushing: Place your toothbrush at a 45-degree angle against the gums. Move the brush back

and forth gently in short strokes. Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of the teeth. Brush your tongue to remove bacteria and freshen your breath. Flossing: Wind about 18 inches of floss around middle fingers of each hand. Pinch floss between thumbs and index fingers, leaving a 1"- 2" length in between. Keep this taut between your fingers. Use thumbs to direct floss between upper teeth. Use index fingers to guide floss between the lower teeth. Gently guide floss between the teeth by using a back and forth motion. Do not snap the floss into the gums. Curve it into a C shape against one tooth. Slide floss up and down against the tooth surface and under the gum line. Rinse: Always rinse your mouth and Swish between the teeth with safe water after brushing or flossing, and also after eating snacks or whenever you are unable to brush and floss. (Fountain, Gorske, & Hesterman, 2009, p.30) 15. Safe-Sex Practices The simplest and most effective safe-sex practices can be very simply summarized in what is called the ABC program. A Abstinence until marriage B Being faithful to one partner C Condoms (these should be used by those who dont practice A and B. Can be male or female condoms) (Fountain, Gorske, & Hesterman, 2009, p.11) Make sure to be tested for HIV/AIDS or have your partner tested if you have injected drugs, had more than one partner or want to be sexually active but are not sure of your status. It is also recommended to not have sex with prostitutes or individuals who have injected drugs. (Fountain, Gorske, & Hesterman, 2009, p.12) *NOTE Specific instructions that go further in detail about the ABC program can be found at http://www.pepfarwatch.org E. Other helpful resources, acknowledgements, conclusion and references 16. Helpful Resources Here is a list of helpful websites:
Government Websites Humanitarian Websites Medical Websites Nutrition Websites

www.ahrq.gov www.cdc.gov http://digestive.niddk.nih.gov www.doh.wa.gov www.ncbi.nlm.nih.gov www.niaid.nih.gov http://pubs.niaaa.nih.gov

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Fantastic curriculum example to follow with this presented research document can be found here: www.hepfdc.info 17. Acknowledgements I want to thank Massoud Modarres, Hengameh Kazemi and Robin Phillips for their involvement with my internship experience at the Child Foundation, specifically in their assistance with the restaurant fundraiser that was put on as well as with the grant proposals written. I of course wish to acknowledge all of the rest of the staff in the Child Foundation USA and their overseas branches. I also wish to thank Portland State University and the Public Administration program through the Hatfield School of Government for helping me set up this opportunity to work with the fabulous organization of the Child Foundation in an internship capacity. Thank you to Linda Golaszewski for meeting with Massoud, Hengameh and I for the initial meeting that set up this opportunity and for also being a mentor to me as I travelled through the MPA journey. I also want to thank Matthew Jones for being an excellent professor and encouraging mentor, Michael Wells for teaching me excellent grant writing skills and to Paul Ventura for helping me understand NGOs and international organizations and collaborations to a fuller extent. Lastly, I want to thank Kevin Matheny for helping me learn more about fundraising and social media techniques for nonprofits. Thank you all. 18. Conclusion This research was based on previous investigation of the most important medical issues in Afghanistan, then methods of treatment for prevailing issues were compared and the most economic and feasible for the region are presented in this research. The document that I have prepared for Child Foundation is a combination of research and methods for treatment and management involving health, illnesses, hygiene and water/food preparation. However it is now up to the Child Foundation USA staff to partner with its staff in Afghanistan to translate this research that has been completed to aid in the Afghanistan Computer Training & Employment Preparation for Youth (CTEPY) program as well as future projects dealing with education and community assistance and development programs, into a curriculum for said programs. I would strongly encourage using the hepfdc curriculum

(mentioned in the helpful resources section) as a guide to help construct an appropriate curriculum for the CTEPY program. The hepfdc curriculum is in accordance with World Health Organization evidence-based practices and theory and is meant to be used as an assisting tool for organizations like Child Foundation to either use or base their curriculum for programs from. 19. References Abdominal pain (2010). Mayoclinic.com. Retrieved July 1, 2011, from http://www.mayoclinic.com/health/abdominal-pain/MY00390 AIDS (2011). Thefreedictionary.com. Retrieved July 1, 2011, from http://www.thefreedictionary.com/AIDS Ariboflavinosis (2011). Answers.com. Retrieved July 1, 2011, from http://www.answers.com/topic/ariboflavinosis Birden, H. (2001). Syllabus for AUCT 140, Epidemics and Aids. Retrieved July 1, 2011, from http://uhavax.hartford.edu/bugl/hiv.htm Berman, K. (2007, July 18). Suborrheic dermatitis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001959/ Bertini, C. (2004). Fifth report on the world nutrition situation: nutrition for improved development outcomes. SCN Report, 5. Retrieved from http://www.unscn.org/en/publications/rwns/ Best of vitamin a (2011), Fruitsandveggiesmorematters.org. Retrieved July 1, 2011, from http://www.fruitsandveggiesmorematters.org/?page_id=135 Best of vitamin c (2011), Fruitsandveggiesmorematters.org, Retrieved July 1, 2011, from http://www.fruitsandveggiesmorematters.org/?page_id=132 Binder, Dr., Kruse, E.F., & Mehr, R.L. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2003). Nursing home residents with lower

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