Vitamin D Deficiency in Children: Development of a Community Health Program

This report discusses the development of a community health program for Vitamin D Deficiency in Children in Canada. It includes the goals and objectives of the program, health promotion approaches, comparison of strengths and limitations of two approaches, and the role of community health nurses. The report also highlights the importance of dealing with Vitamin D Deficiency among children in Canada.

Vitamin D Deficiency in Children: Development of a Community Health Program

Contents
Introduction......................................................................................................................................2
Outline for the Health Promotional Program...................................................................................2
Goals and Objectives...................................................................................................................3
Rationale......................................................................................................................................4
Health Promotion Approaches.........................................................................................................4
Comparison..................................................................................................................................4
Role of Community health nurses...................................................................................................7
In relation to the two identified approaches.................................................................................7
In relation to the planned health promotion program..................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10
Appendix........................................................................................................................................13
1

Introduction
The Community Health Programs are generally locally based education and treatment programs
available typically to poor individuals or the ones who do not have any sort of insurance
coverage. These programs are usually not-profit and most of the funds are arranged through
various health department programs or through donations or government grants. The following
report is written to develop a community health program for Vitamin D Deficiency in Children.
A part of the report is dedicated for the discussion of the goals and objectives of the program and
another part of the report talks about various health promotion approaches and comparison of
their strengths and limitations (Lhamo, Chugh, & Gautam, 2017). Lastly, there will be a
discussion of the role of the Community Health Nurse in relation to the identified approaches
and to the planned health promotion program.
Outline for the Health Promotional Program
Vitamin D deficiency is more common among urban Canadian children as compared to the rural
children. The researchers have found that one third of the toddlers had less than the
recommended levels of Vitamin D. As a result of deficiency of Vitamin D, the Urban Toddlers
are at a greater risk of a number of medical problems including Rickets, Type 1 Diabetes,
Multiple Sclerosis and certain types of Cancer (Gold & Nebres, 2009).
For the prevention and treatment of the Vitamin D Deficiency among children of Canada,
various Health Organizations and Societies in Canada can come forward to fund a viable Health
Promotional Program for treatment and prevention of Deficiency of Vitamin D among Canadian
2

Children. These organizations might include Canadian Society of Epidemiology and Biostatistics
(CSEB), Canadian Child Care Federation (CCCF), Child Care Human Resources Sector Council,
Canadian Pediatric Society, YMCA Canada, etc.
Goals and Objectives
Vitamin D Deficiency has been a long-standing public health issue among children. A severe
vitamin D deficiency leads to impairment in the mineralization of bones tissues, which further
leads to Osteomalacia and even the impairment of the growth plates, which leads to Rickets. In
order to deal with both of these cases, our projected Health Promotional Program will have
following goals and objectives:
Goals:
 To improve the food intake habits of the urban children of Canada and to respond to the
underlying determinants of the deficiency among them. Intake of naturally containing
Vitamin D can be increased.
 To encourage children for joining various weight loss programs as it may mobilize
vitamin D and its metabolites from the adipose tissue (Ladhani & Ward, 2015).
Objectives:
 The prime objective of this program is to identify the urban children showing deficiency
of Vitamin D in the urban areas of Canada.
3

 The children-sensitive approaches will be designed in such a manner that the community
empowerment will be facilitated together with action for health promotion, self-care and
health protection throughout the life course in cooperation with the relevant national and
international partners (Ward & Gaboury, 2017).
Rationale
The purpose of these goals and objectives is to minimize the effect of deficiency of Vitamin D
among children of Canada residing in the urban areas of the country. The objectives will even
identify that whether the children and their parents have acquired the skills and knowledge about
the ongoing conditions and body changes related to deficiency of Vitamin D and whether the
community health nurses have been able to identify their roles and responsibilities in developing
and implementing. The realistic goals and objectives of the health promotion plan will be
achieved within the given time frame and in the given environment (Canadian Government,
2015).
Health Promotion Approaches
Two crucial Health Promotion Approaches will be followed in this program. Each one of the
approach has its own Strengths and Limitations.
Comparison and Contrast of Strengths and Limitations of two health promotion
approaches
4

Approach 1: Take the help of the local health practitioners and nurses to recommend vitamin D
intake to the parents of the children suffering from deficiency of Vitamin D. In this approach,
special care will be taken to choose the dietary reference intake for Vitamin D. It will be chosen
with a margin of safety and “overshoot” that targeted serum values to ensure that the specified
levels of intake achieved the desired levels in all the children being treated (Atkinson, 2018).
For this approach:
 Financial aid and other resources will be acquired from the various organizations and
agencies mentioned above.
 Human resource in the form of health practitioners, nurses and a number of young
volunteers is also required to achieve the target in a given timeframe.
Approach 2: In order to determine the Vitamin D status in the infants and children, the maternal
vitamin D status can be determined. Although it will take a lot of trouble to reach out for all the
pregnant women of the country and ask them to undergo a test during their pregnancy, yet it is
the most promising approach to find out the exact number of children that might suffer from the
deficiency. All pregnant women could have their 25(OH) D levels checked especially during the
first trimester (Pilz & Marz, 2018).
For this approach:
 Various camps are to be arranged and volunteers will be needed to go door to door for
spreading awareness among the pregnant women and their family members.
 The source of financial and monetary aid would be the same as used in the first approach
and there will also be a similar need of the health practitioners, specially pediatrics and
gynecologists.
5

Strengths
There are various individual strengths of the above approaches. For the first approach, the dietary
intake concept is easily understood to the people who are not much familiar with the concept of
Vitamin D Deficiency. In addition, to increase the awareness among the patients and their family
members about improving their lifestyle and food intake habits, not much effort is to be applied.
There will be no need of good infrastructure and skill requirement for this approach. So overall it
is quite cost-effective. Similarly in the case of the second approach if the deficiency or the exact
level of Vitamin D in the body of the infant is determined before his/her birth through the level
of Vitamin D in the mother then it will be quite easy for the doctors and other health practitioners
to determine the exact amount of doses of the Vitamin that could be given to the new born. Also,
it would be evaluate any other ailment or disease that could be present in the child and then the
doses can be increased or decreased accordingly (Qari, 2013).
Limitations
Apart from the strengths, there will be a number of limitations of both the approaches. Like in
the case of the of the first approach there will be a number of side effects for the direct intake of
the Vitamin D supplements and sometimes it is quite hard to convince a person for such
supplements, especially in the case of children. In addition, spreading awareness among the
children and their parents about the obesity and eating habits is a tiresome process, which will
require a lot of resources as well as time. Likewise, in the case of the second approach there are a
number of risks associated with the Vitamin D deficiency and level determination tests during
6

the pregnancy period of the women and that too in the first trimester. So convincing mothers and
their family members is yet another limitation approach. In addition, this approach will require
ample of data so the entire process will consume a lot of time (Pachoe & McLaughlin, 2018).
Role of Community health nurses
The community health nurses have been working hard to improve the health of the population in
Canada. They will have a crucial role in both the cases of the identified approaches and the
health promotion program. Their specific roles have been discussed below:
In relation to the two identified approaches
In relation to the two identified approaches, the role of the community health nurses will be:
 Managing and providing care across the chosen group and identifying the impact of the
deficiency of Vitamin D on the children.
 Their role in community is like a caregiver and thus they often form close bonds within
the communities they serve and even form long lasting relationships. They also have a
capability to become area experts on health and the wellness (Ansari, 2018).
 The role of the nurses in these approaches will also be to integrate evidence-based
research with the community health needs so that the care and treatment is provided to
the children based on science and evidence.
 For the effective implementation of the approaches, it is the duty of the community
nurses to establish a good relationship between the community being targeted and the
health team, which will be providing services to the community. A smooth relationship
7

between them will help the nurses to impart their duties well and even suggest best
solutions to ongoing and upcoming problems (Underwood & Mowat, 2009).
In relation to the planned health promotion program
In relation to the health promotion program, the role of the community nurses will be:
 The prime role of the community nurses will be providing services to the children and
their families without any discrimination. The prime target of this program is the urban
children of Canada, but there will be a lot of variety of such children based on social
classes and income status of the family. In such a case, the community nurses have a
responsibility to ensure that everyone is treated equally and should be given the best
treatment.
 They will communicate the exact elements and precise benefits of the program to the
children and their family members and will even make the people aware of the
consequences of ignoring this deficiency.
 They will actively participate in the overall development of the health plan for the
community and even provide quality nursing services to the participants of the program
(Community Health Nurses of Canada, 2011).
 They will even have a role in conducting research related to the cases of deficiency of
Vitamin D in the children of Canada in the past and even evaluate the exact statistics and
numbers of the children that are likely to develop such deficiency in the coming future.
 Apart from spreading awareness and educating the community about the deficiency of
Vitamin D among children, the community nurses also have a role of using the available
resources in a judicious manner so that there is no issues and chaos at the time of crisis
(Canadian Public Health Association, 2010).
8

9

Conclusion
From the above discussion, it can be concluded that the Canadian children, especially those
residing in the urban areas, are suffering with deficiency of Vitamin D and in order to deal with
this a proper health development program is to be created. The patients could either directly be
given Vitamin D through food supplements or they can be evaluated for the level of Vitamin D
in their birth by examining the levels in the body of the mother while she is pregnant with her
first trimester. Both the approaches have their strengths and limitation, and the best one can be
chosen by evaluating them in a critical manner.
10

References
Ansari, A. (2018). Role of nursing in community health. Retrieved from
https://www.pulsus.com/scholarly-articles/prole-of-nursing-in-community-healthp-
4136.html
Atkinson, S. (2018). Vitamin D: Who is really at risk of deficiency? Retrieved from
https://osteoporosis.ca/wp-content/uploads/2018-03-13_atkinson_slides.pdf
Canadian Government. (2015). Health at a Glance: Vitamin D blood levels of Canadians.
Retrieved from www150.statcan.gc.ca:
https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11727-eng.htm
Canadian Public Health Association. (2010, May 27). Public Health ~Community HealthNursing
Practicein Canada: Roles and Activities. Retrieved from
https://www.cpha.ca/sites/default/files/assets/pubs/3-1bk04214.pdf
Community Health Nurses of Canada. (2011). A blueprint for action for community health
nursing in canada. Retrieved from http://neltoolkit.rnao.ca/sites/default/files/A
%20Blueprint%20for%20Action%20for%20Community%20Health%20Nursing%20in
%20Canada%20March%202011.pdf
Gold, S., & Nebres , M. (2009). Canadian kids don't get enough Vitamin D. Retrieved from
www.sickkids.ca:
http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2009/canadian-children-
vitamin-d.html
11

Gupta, R., & Saheen, A. (2014). Role of Vitamin D in Children. 27(4), pp. 1-3. Retrieved from
http://medind.nic.in/jav/t14/i4/javt14i4p229.pdf
Ladhani, M., & Ward, L. (2015). Vitamin D deficiency rickets. Retrieved from
https://www.cpsp.cps.ca/uploads/surveys/vitamin-d-deficiency-rickets-survey-results.pdf
Lhamo, Y., Chugh, P., & Gautam, S. (2017). Epidemic of Vitamin D Deficiency and Its
Management: Awareness among Indian Medical Undergraduates. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394390/
Pachoe, M., & McLaughlin, J. (2018). Vitamin D Supplementation and Screening for the
Prevention of Rickets and Osteomalacia in Alaska. 20(4), pp. 1-12. Retrieved from
http://www.epi.alaska.gov/bulletins/docs/rr2018_04.pdf
Pilz, S., & Marz, W. (2018). Rationale and Plan for Vitamin D Food Fortification: A Review and
Guidance Paper. Retrieved from
https://www.frontiersin.org/articles/10.3389/fendo.2018.00373/full
Qari, F. (2013). Practical Approach for the Prevention and Management of Vitamin D
Deficiency in Adults. 2(4), pp. 315–318. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339455/
Schwalfenberg, G., & Hiltz, M. (2010). Addressing vitamin D deficiency in Canada: A public
healthinnovation whose time has come. pp. 1-10. Retrieved from
http://www.vitamindsociety.org/pdf/Schwalfenberg%202010%20-%20Addressing
%20vitamin%20D%20deficiency%20in%20Canada.pdf
12

Underwood, J., & Mowat, D. (2009, September). Building Community and Public Health
Nursing Capacity:A Synthesis Report of the National Community Health Nursing Study.
Retrieved from
https://pdfs.semanticscholar.org/d11d/e28e5d8d8b170637088ba83d808f6f2c470a.pdf
Ward, L., & Gaboury, I. (2017). Vitamin D–deficiency rickets among children in Canada.
177(2), pp. 161–166. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913133/
13

Appendix
Approach 1:
 It is assumed that there are no contributions to serum 25(OH) D levels from sun exposure
and recommendations are applicable to people with dark skin or negligible sun exposure.
 However, to keep the serum levels of 25(OH)D >30 ng/dL which is considered to be the
optimal level, the US Endocrine committee has suggested the intake of 400-1000 IU/day
under 1 year of age and 600-1000 IU/day from 1 to 18 years.
 Children at risk (on anticonvulsants, glucocorticoids, antifungal and medications for
AIDS) need 2 to 3 times the requirement for their age.
 The upper limit of vitamin D intake as maintenance therapy which is not to be exceeded
without medical supervision is as follows : 1000 IU/ day for infants from 6 months-1 yr;
1500 IU/day for 1-3 years; 2500 IU/day for 4-8 years, 3000 IU/day for >8 years - 4000
IU/day (Kruger, 2004).
14

Approach 2:
 Though practically difficult, all pregnant women should have their 25(OH) D levels
checked during the first trimester of pregnancy. If they are deficient they should be
treated with 3000-5000 IU until 25(OH) D is more than >20 ng/dL followed by 400 IU
/daily.
 Routine vitamin D supplementation to all the pregnant women is controversial [39].
Administration of high dose of vitamin D (400-6400 IU) daily to breast feeding mothers
increases the anti-rachitic activity of breast-milk [40,41] without causing
hypervitaminosis in the mother.
 Supplementation in newborn period: For infants who are exclusively breastfed a
minimum daily intake of 400 IU/day should be initiated within a few days after birth.
Since most of the infant formulas contain 400 IU/L, infants who are on formula feeds
also need supplementation unless they consume more than 1000 mL of formula per day.
 Toddlers and adolescents: Children who are dark skinned, veiled, exposed to reduced sun
light or who have underlying medical condition should receive 400 IU daily to prevent
vitamin D deficiency (Nordstrom, 2015).
15