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Traditional grammar and vocabulary instruction



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Traditional grammar and vocabulary instruction
Traditionally grammar and vocabularyare presented separately in textbooks and grammar is taught before the student learns particular vocabulary. Subsequently, there is a theme text for reading and ultimately the student is supposed to handle with exercises for listening comprehension. In other words, the traditional form of learning a foreign language imposes a form a primary importance. In addition, students are traditionally divided in the eyes of teachers to students who are "good at grammar" but "have a limited vocabulary" or vice versa. Teachers even traditionally test the two components separately. Language textbooks and foreign language courses are organized primarily by the grammatical structures with a certain bulk of vocabulary that supports the lesson topic. Widdowson (1990) notes, however, that teaching, which imposes a form a primary importance and uses words only as a means of exemplification, in fact, denies the nature of grammar as a structure that conveys meaning. Widdowson suggests that more effective and more natural would be exactly the opposite instruction approach that would start with the lexical units showing how they are to be grammatically modified to be communicatively effective.
Vocabulary instruction in ESP
According to Michael Lewis fluency in the linguisticdiscourse does not depend so much on the exact set of grammatical rules as Chomsky claims, and on a separate lexis, which provides quick access to comprehensive lexical units (chunks), such as phrasal verbs (e.g. look after, look forward, look for etc.), in which verbs have totally different meanings thanks to the combination with different preposition.Or the English idioms whose meanings are often not identifiable in spite of the knowledge of the meaning of the words that form it up (e.g. kick the bucket, an apple of my eyes, etc). There are also collocations, where it is necessary to learn how to join two parts of speech to the proper meaning, since non-native speakers tend to use words from their native language (e.g. heavy smoker, heavy rain, etc.). Lexical differences between English and Slovak are first dealt in the works by Mathesius and Vachech (in Repka, R., Gavora, P., 1987), who first outlined why it is necessary to learn lexical units coherently. The fact is that each linguistic community has a different denomination for some expressions of extra-linguistic reality and in case they are similar the difference may lie in the scope of their meaning (e.g. English “foot” and ”leg” = Slovak “noha”). Scrivener differentiates between a person’s vocabulary and lexis, and he states that whilst vocabulary means “single words”, lexis is a database of two- or three-word fixed combinations = “lexical items”. Acquisition of these lexical items allows students to create new phrases and sentences that are fitted in the speaker's mind without deep thinking about the grammatical form (Scrivener, 2011). ESP teachers are to support the use of the English monolingual dictionaries, since there are examples of a typical use, examples of occurrence in a sentence, pronunciation, relations with other lexical units, etc. It is also useful to include the final papers (essays, reports, summaries, research articles, etc.) related to the​​study field and interest of students, which generally includes a glossary, that is a list of technical terms from a specific text on the subject, containing an explanation of lexical units in English as well as the meaning in their native language. In this way, the teacher encourages students to work independently with dictionaries, what is a time consuming job during the semester in seminars with thenumber of students in one group.

Such a teacher's attitude towards the acquisition of vocabulary begins in a receptive way, i.e. by the perception of presence and understanding of the importance of lexical units in a written or spoken text. Then the productive acquisition practiced in the extent that it is becoming a part of student’s daily use follows. In doing so, we must not forget about the fact that in learning the vocabulary of the English language it is vital to aim at the acquisition of the correct pronunciation. The teacher has to keep to accurate transcription of the pronunciation so that students were skilled at using dictionaries. Beneš states: "practicing phonological system shall be situated at the very beginning of language teaching/instruction and its learning must necessarily precede all other components, the graphics system, lexical and grammatical structure."The teacher who is satisfied with their own pronunciation of a foreign language and compiling new words according to grammatical rules, thus deprives students with opportunities to learn the language as a means of communication. Practicing correct pronunciation before lexis and grammar are taught to the student helps them to identify the shapes that would otherwise remain misunderstood both at listening as well as an active oral communication process” (Beneš, E., 1970).

Lewis (1993) argues that lexisshould be at the heart of foreign language teaching, because language consists of ‘grammaticalised lexis, not lexicalised grammar '. Lexis is seen as essential for communication. If students do not understand the importance of keywordsthey will not be able to participate in the conversation, even if they know the morphology and syntax. On the other hand, however, it is not appropriate to confuselexis teaching for grammar teaching and Lewis himself explains that 'language consists not of traditional grammar and lexis, but often of the multi-word prefabricated chunks "(Lewis, 1997).

Lexis is essential for the creation of meaning and grammar plays a minor role. Lexical mistakes are generally more significant for understanding than grammatical mistakes. The teacher should spend more time helping students expand their stock of comprehensive lexical items and phrases, both in the receptive and productive way. Receptive vocabulary practice includes reading, repetition, translation, guessing the meaning of words from the context, using the lexical items in different texts, grouping of words according to certain criteria. Under the active productive practicing we understand the word completion in a context, forming up phrases according to a certain pattern, grouping of words according to related topics, answering the questions formulated so that the student had to use a proper word or phrase and translating the words and phrases to a foreign language. Today in the book market there is a range of publications aimed at practicing academic vocabulary, e.g. Academic Vocabulary in Use (McCarthy and O'Dell, 2008), regardless of the specific field of science/study. Academic English has in fact become an international language and general terminology that is used both in professional texts or oral presentations at international conferences is understandable for all users of the English language.This book is suitable for all students who want to be successful in the use of academic English because after mastering such a book it is just about acquiring the technical terminology of a particular study field. Another important moment in this lexical approach is that the large stock of lexical units is a prerequisite for the ability of literacy in reading and listening.

According to Gairns and Redman (1986), when teaching vocabulary, several aspects shall be taken into account:

- The boundary between conceptual significance = not only knowing the meaning of particular words but also the border that separates it from words with similar meaning (e.g. cup, mug, bowl),

- Polysemy = recognition between the different meanings of one word, which has one form, but many closely related meanings (e.g. head of a person / of a pin / of an organization),

- Homonymy = recognition between the different meanings of one word having one form, but multiple meanings that are not closely related (e.g. file: used to put papers in or a tool),

- Homophones = distinction of words that have the same pronunciation, but different spelling and meaning (e.g. flour, flower),

- Synonyms = distinction between different shades of meanings of the words that are synonymous (e.g. extend, increase, expand),

- Affective significance = distinction between factors of attitude and emotion (denotation and connotation), which depend on the attitude of the speaker or the situation,

- Socio - cultural association of lexical items = different meanings for the same word in British or American English,

- Style, register, dialect = ability to distinguish between different levels of formality, the influence of different contexts and themes, as well as differences in the geographical variations,

- Translation = ability to be aware of certain differences and similarities between the native language and a foreign language (i.e. ability to distinguish the so called ‘false cognates’ = "false relatives" and false friends = "false buddies"). False cognates are words in one or in different languages, which are similar in form and meaning but have different roots. False friends are words that have the same roots, but distinguish themselves with their meanings. Simply put, while false cognates mean roughly the same thing in two languages, false friends have different, sometimes opposite meanings.

- Lexical chunks=multiple word formations, idioms, collocations, lexical phrases,

- Grammar of the vocabulary = learning rules that allow students to create various forms of words, or even a variety of words from one word (e.g. slept, sleeping; able, unable, disability)



- Pronunciation = ability to recognize and reproduce lexical units in speech.
Grammar instruction in ESP
It is evident that students of foreign languages ​​taught by the traditional method of grammar separated from the vocabulary instruction and not at once have difficulty understanding written and spoken texts. While the syntax may help them understand the overall meaning of the text, vocabulary is the fundamental stumbling block when interpreting the meaning of any text. No one can ignore the importance of grammar in teaching a foreign language, but grammar is no longer in an isolated position as it interacts with the discourse, meaning and social function (Murcia, 1991). Traditionally, grammar used to be understood, and at lower levels of education, where English is taught in a deductive way (presentation of rules with examples) is still understood as a set of rules made up of syntactic and morphological components (Moras, 2001). Students learn them without any deeper analysis and design of written or oral discourse. In ESP teaching, where the rule of inductive teaching of grammar (grammatical rule derived from examples presented) is applied, however, we shall take into account the semantic components of speech, which constitutepart of teaching of grammatical forms.Nunan states that if teaching focuses mainly on precision, students acquire knowledge of the rules of the language without being able to use them in a spoken or written text fluently. It is more of the teacher-centred instruction, i.e. the rules and explanations are provided by the teacher to students (Nunan, 2003). In such a traditional instruction teachers believe that learning a foreign language is about mastering the linguistic system and if students can use grammatical rules they will be able to communicate in that language. Another phenomenon that highly occurs in this method of teaching is a common correction of students in their speech, which can lead to demotivation, to decreased self-esteem, and thus to smaller learning outcomes. Students need opportunities to familiarize themselves and at the same time create structures, which have been providedto them by the explicit form through the teaching of grammar or implicitly through many examples of their use.
Lexical minimum
Repka and Gavora state that grammar is abstract in nature (result of a process of abstraction) and grammatical structures have an independent status and exist only within the lexical materials. Grammar is understood not as a sum of structures, paradigms and rules, but as a system of grammatical phenomena. This means that their number is limited, the grammatical structures are linked together and are not mutually exclusive. The aim of grammar instruction is a largely automated control of grammatical structures and the meanings signalled by them as one of the preconditions for obtainingcommunicative competence. Blending grammar and vocabularyis also reflected in the composition of lexical units. In addition to the large number of words of meaning, each language has a relatively small number of words expressing relations between concepts expressed by the so-called functional words (Beneš, 1970). Regarding vocabulary when teaching a foreign language, ESP instruction included, it is neither possible nor advisable to adopt the lexis entirely, because even native speakers do not have this ability. It is important to meet the need of theso called lexical minimum, meaning purposefully selected set of lexical units needed to achieve the desired goal of adoption. Depending on the degree of training, the elementary lexical minimum, which corresponds to around 800 - 1000 words, is needed for trivial communication situations. Furthermore, thereis an essential lexical minimum ranging from 1100 - 2000 words, which is sufficient for common situations and reading of easy texts. Complete lexical minimum (5000 - 6000 words) is required for the communication of relevant professional topics and reading of fiction, newspapers and scientific articles. Finally, specialized lexical minimum, which includes the specialized vocabulary needed to read literature from any scientific field and has a range of about 2,300 words (Beneš, 1970).

The most important, when considering teaching of ESP vocabulary, is to expand the complete and specialized lexical minimum, even after the due instruction in college. During the lessons students should be guided to contextual guessing of the meaning of words and the use of dictionaries. In this way students reach the process of semantic processing that helps learning and remembering.

If the student has a skill in creating new words (word formation) and he/she does not have a trouble identifying prefixes or suffixes, the meaning is estimated more easily. Depending on a specific field,the ESP teacher must consider whether the objective is to active speaking, which includes the ability for the receptive understanding of spoken language or if the objective is receptive reading, the lexical minimum must include the amount of lexical itemsthat would enable the student reading of original texts without any difficulties. The fact is that receptive reading minimum forms a reservoir for the active speaking minimum and the phenomena mastered in a receptive way can be progressively activated. This applies to writing too. TheESP teacher is responsible for creating the syllabus and selection or editing course materials.Considering the selection of vocabulary they shall take into account the following aspects: statistic (frequency/occurrence of lexical units in the study field), thematic (relatedness to a certain topic), lexicological (stylistic neutrality or significance), syntagmatic (ability to combine with other words, polysemy, word formation opportunities, etc.), comparative (similarity to the mother tongue) and a didactic aspect (word patterns, the importance for the learning process). At the end of the semester, the ESP teacher shall assess the appropriateness of the choice of textbooks based on the receptive minimum and they shall determine the extent to which selected vocabulary ensures their understanding.

It was Comenius who first emphasized learning of lexical units in a particular context, the vocabulary acquisition is facilitated if we divide vocabulary into semantic groups according to the situations or by themes. As Repka and Gavora put it, setting up the sequence of grammar phenomenais governed by the needs of topics, which requires knowledge of certain lexical units modelled by grammatical rules (Repka, R., P. Gavora, 1987).



It is appropriate to point out the fact that study field requires a specific needs analysis in ESP, and in doing so, the ESP teacher needs to decide for the study materials and lexical units due to particular situations and study fields. When teaching English for psychology, e.g., it is important to deal with the accuracy of terminology, exact grammar and a mastery of academic writing, whereas in the students of nursery it is more important to deal with role-plays in particular situations that might happen in the treatment with a patient. Here lexical items are taught and practiced mainly in oral exercises (discussions, communicative activities, role-plays, simulated situations, etc.). Students of psychology, on the other hand, need to master their lexical capabilities in specialized texts, and new publications in English, aiming at the composition too so that they were able to write papers, theses, essays, etc.and make oral presentations.
Grammatical minimum
English as an analytic language working on a set of certain patterns. Their acquisition in learning grammar and vocabulary makes the English language student´s better English language users. Grammar is traditionally defined as the study of syntax and morphology. Thornbury (2004) defines grammar as the study of linguistic connections / links and gaps, or the study of the method of linking words in a specific order and also what kinds of words can fill the empty space respectively. Currently, at all levels of education, the communicative teaching of English grammar is pointed out, as its learning out of context leads to misunderstanding. Same as with the lexis, each level of language knowledge of grammar requires a certain minimum. Elementary grammatical minimum is necessary in the trivial communication situations, basic grammatical minimum aims at the ability to handle common situations in everyday life and easy written texts. Comprehensive grammatical minimum is necessary to master the foreign language in speaking and writing and alsoto not have difficultiesreading scientific texts and fiction. For scientists, researchers and ESP students it is required to possess the knowledge of specialized reading grammatical minimum, that is related to the mastery of the reading of scientific literature.
Conclusion
Once a student is mastering certain vocabulary and grammatical patterns and can properly combine them in a due course according to the rules of syntax in sentences, a discourse is being created, that is, an oral or written presentation. Although primarily we think of the words that follow the patterns of grammatical rules, then the sentences that have their peculiar grammatical rules, we must not forget the fact that the discourse has its own rules too. These determine the order in which they are to be arranged, as well as what may be left out of the sentence, and what is to be included in the expression. The essence of a linguistic discourse is the fact that the elements that constitute it have to be the bearers of a message. Combination of words, phrases and final discourse thus results in the expression of many meanings. It is said that words do not mean, people mean. Language is a living entity, and as the language is constantly changing, thus the society is changing and people using academic English shall follow its rules to be understood properly by the other specialists who might follow the results of their research papers.
Bibliography:
BENEŠ, E. 1970. Metodika cizích jazyků. Státní pedagogické nakladatelství
BEREŠOVÁ, J. 2013. English Language Teaching.Trnava: Trnavskáuniverzita
GAIRNS, R. REDMAN, S. 1986. Working with words. CUP
GAVORA, P., REPKA, R. 1979.Gramatikavovyučovanícudzíchjazykov. Bratislava: SPN
HUTCHINSON T., LEWIS, A.1987.English for Specific Purposes. CUP
LEWIS, M. (1993).The Lexical Approach. Hove: LTP
LEWIS, M. (1997) Implementing the lexical approach.LTP

McCARTHY, M., O’DELL, F. 2008.Academic Vocabulary in Use. CUP


MORAS, S. 2001. Teaching Vocabulary to Advanced Students: A Lexical Approach
MURCIA, M. C. 1991. Grammar Pedagogy in Second and Foreign Language Teaching,

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MUSUMECI, D. 1997. The role of grammar in communicative language teaching: A historical perspective. University of Illinois, Urbana-Champaign : The McGraw-Hill
NUNAN, D. 2003. Practical English Language Teaching: Grammar. New York: McGraw Hill
REPKA, R., GAVORA, P. 1987. Didaktikaangličtiny. Bratislava: SPN

Scrivener, J. 2011.Learning Teaching. The Essential Guide to English language Teaching. Oxford. Macmillan Education


THORNBURY, S. 2004. How to Teach Grammar. Harlow: Pearson Education Limited
WIDDOWSON, H.G. 1990. Aspects of Language Teaching.Oxford: OUP

MANAGEMENT OF ACUTE MALNUTRITION: RESULTS OF NUTRITION CARE FOR CHILDREN AGED UNDER FIVE IN THREE CENTRES IN KWALE COUNTY IN KENYA
ZUZANA KRÁĽOVÁ, DENISA JAKUBCOVÁ

Slovakia, Trnava University, Faculty of Health Sciences and Social Work, Department of Social Work, Department of Public Health



E-Mail: zuzana.kralova@truni.sk; denisa.jakubcova@tvu.sk


Abstract

Background: Faculty of Health Science and Social Work, in cooperation with Kwale District Hospital established three nutrition centres in Kwale region – Kwale, Mkongani and Tiwi, to provide medical, social and counselling services for malnourished children (0-5 year old). The aim of this study was to get overview of management of acute malnutrition by analysing anthropometric data of children clients from all three centres for first four weeks of their admission into nutrition programme.

Methods: Study group consisted of children examined in nutrition centres localized in Kwale District Hospital, Mkongani Model Health Centre and Provincial Rural Health Training Centre Tiwi in time period from June 2014 to September 2015. We used methods of descriptive statistic to gain basic overview of examined children. We compared differences in anthropometric indicators after first four weeks of children being in nutrition programme by using Wilcox test for medians and t.test for means in software R with the level of significance p<0.05.

Results:Total of 153 children from three nutrition centres aged 5 – 103 months were admitted and monitored for this study during first four weeks of their treatment process (2014 – 2015).

In Kwale nutrition centre proportion of children suffering from severe acute malnutrition reduced from 41% to 21%. In Mkongani nutrition centre proportion of children suffering from moderated acute malnutrition reduced from 74% to 55% and there were 2% of well-nourished children after 4 weeks in nutrition programme compared to 0% in admission week.In Tiwi nutrition centre were 23% well-nourished children after 4 weeks in nutrition programme compared to 7% at admission.

Conclusion: The significant difference in averages of MUAC score indicates a growth in two of three centres and proportion of children suffering from moderated acute malnutrition and severe acute malnutrition reduced after 4 weeks in nutrition programme compared to admission week.


Keywords:

Severe and moderate acutemalnutrition. MUAC score. Grow proportion and monitor. Well nourished. Kwale.



Introduction
Malnutrition is one of the leading causes of the morbidity and mortality under five years old (Ayaya, 2004). The level of under-five mortality in Kenya is 52 deaths per 1 000 births (Kenya Demographic and Health Survey, 2014). Malnutrition defines a state when the body does not have enough of the required nutrients (under-nutrition) or has excess of required nutrients (over-nutrition). Therefore is very important to identify malnutrition and to start appropriate care in nutrition centre.

Kwale County, where malnutrition remains a serious public health problem, should worry for 2 main reasons - malnutrition is closely linked with child mortality and malnutrition has long-term adverse effects (cognitive function, school achievement, mental health, work capacity).Established three nutrition centres, by Faculty of Health Science and Social Work in cooperation with Kwale District Hospital, provide services for malnourished children and their families in Kwale region. The aim is, through the diagnostic and treatment of malnutrition, provision of adequate complementary food (porridge, vitamin supplements, beans) as well as education of mothers on child care and their health (infectious diseases, HIV / AIDS, other health and social problems) contribute to improving quality of life of their families and communities as a whole. Local educated community health workers, by nutritional care for children and their mothers or caretakers, assist to reduce malnutrition among children.

Outpatient therapeutic care or community-based management of acute malnutrition is known as community-based approach, which is most appropriate approach to treating children with acute malnutrition (Henretty et al., 2013). Community health workers identify children who are malnourished with anthropometric measurements (e.g. MUAC) or where oedema is evident (National Guideline for IMAM, 2008). Children found to have uncomplicated SAM(Severe Acute Malnutrition) or uncomplicatedMAM(Moderate Acute Malnutrition) can be treated in the same outpatient program but with a slightly different protocol for provision of medication and RUTF. Children classified as SAM are treated through a “therapeutic feeding” protocol, while MAM children are treated through a “supplementary feeding” protocol (Henretty et al., 2013).Part of nutrition centre´s services is data collection by an online database using tablets by community health workers, which is a prerequisite for improving the documentation of child clients. It offers us instant access to data and creates space for regular evaluation of nutrition data, which contributes not only to covering other needs of community but also to further research activities. The child´s anthropometric measurements are checked regularly once a week by Outpatient therapeutic program and every two weeks by Supplementary feeding program.
Anthropometric Measurements and Data Collection
Two structured online questionnaires were used to collect demographic, socioeconomic and anthropometric data by using tablet. The children, aged under five years, were measured in the centres by trained staff using equipment to take weight and height measurements.
Results
The percentage of girls was higher in Kwale and Mkongani than in Tiwi, where boys were worse. Majority of children were included in nutrition programme SFP (Supplementary feeding program) -Kwale and Mkongani compared to Tiwi, where 63% were in OTP (Outpatient therapeutic program) programme. The proportion of HIV reactive children was quite low (Kwale 0%, Tiwi 2%, Mkongani 7%). All children from three nutrition centres had normal birthweight, only in Tiwi the difference between normal (56%) and low (44%) birthweight was almost the same.

In Kwale, average weight was not significantly higher after four weeks (from 7.25 kg at admission to 8.38 kg in week 4) and also there were no significant growth in medians of weight. Difference in average of height (from 70.95 cm to 73.12 cm) was not significant.

There was significant difference (p<0.05) in average MUAC score (from 11.45 cm to 12.08 cm). Proportion of children suffering from severe acute malnutrition reduced from 41% to 21%. Average weight of children in nutrition programme in Mkongani was not significantly higher (7.20 kg compared to 7.37 kg after 4 weeks). The difference in averages of MUAC score indicates a growth from 11.71 cm to 12.06 cm. The difference was statistically significant with p<0.05. Proportion of children suffering from moderated acute malnutrition reduced from 74% to 55% and there were 2% of well-nourished children after 4 weeks in nutrition programme compared to 0% in admission week. Weight of children grew after 4 weeks examined in nutrition centre in Tiwi facility (6.32 kg compared to 6.55 kg, p=NS). Thedifference in MUAC score was significant after (average from 11.8 cm to 12.06 cm; median from 12 cm to 12.3 cm) with p<0.05. There were 23% well-nourished children after 4 weeks in nutrition programme compared to 7% at admission.

Differences in children´s health conditions were not significant in all three centres. The average of temperature was highest in Kwale (37.2 °C compared to 37.4 °C), average of cough in Tiwi 0.40 days at admission compared to 0.17 days at admission in Mkongani. Diarrhoea was appeared in the centres Tiwi and Mkongani (average 0.04 days at admission compared to 0.05 days after 4 weeks in programme).

Proportion of the RUTF appetite test, through which was evaluated the child´s appetite, was highest in Tiwi centre (97% good after 4 weeks in nutrition care compared to 57% at admission). RUTF appetite test was not conducted in 90% after 4 weeks in programme compared to 16% at admission in Mkongani centre, and in 63% after 4 weeks in programme compared to 59% at admission in Kwale centre.

Proportion of the RUTF (Ready-To-Use Therapeutic food) used in nutrition treatment for children with SAM reduced from average of 9.68 sachets at admission to 8.10 sachets after 4 weeks in Kwale, grew from average of 4.19 sachets at admission to 4.33 sachets after 4 weeks in Mkongani, and grew also from average of 9.84 sachets at admission to 11 sachets after 4 weeks in Tiwi. Proportion of the Supplementary feeding used in nutrition treatment for children with MAM significantly reduced from average of 10.2 sachets at admission to 4.17 sachets after 4 weeks in Mkongani.

95% of children in nutrition programme were still in current care after 4 weeks in Kwale (91% at admission), compared to 87% in Tiwi (73% at admission) and 79% in Mkongani (100% at admission). 16% of children in nutrition treatment were cured after 4 weeks in programme in Mkongani centre compared to 5% in Kwale centre and 0% in Tiwi centre. Defaulter´s proportion among three centres was different by 13% in Tiwi after 4 weeks, 5% in Mkongani and 0% in Kwale.
Discussion
This study evaluated the anthropometric data of 153 malnourished children from three nutrition centres in Kwale region and presents the results of appropriate treatment care during first four weeks from their admission into nutrition programme. A child admitted with SAM or MAM should recovering after four months in treatment according to published guidelines for malnutrition. The study involved local authorities and community health workers who collected anthropometric data filling online questionnaires. This study seeks to identify the change ofnutritional status of children admitted to the nutrition centre and determine appropriate treatment to cure a child.

MID – UPPER ARM CIRCUMFERENCE (MUAC)is a transparent and simple measure of acute malnutrition (Henretty et al., 2013), which we used for our study as a diagnostic tool for identifying cases of SAM and MAM.WHO standards for MUAC show that there are very few children aged 6-59 months with a MUAC<115 mm in a well-nourished population. Children with MUAC less than 115 mm are in a high mortality risk and are diagnosed with severe acute malnutrition (WHO, UNICEF, 2009; National Guideline for IMAM, 2008). Children with MUAC ≥115 and <125 are diagnosed with moderate acute malnutrition. MUAC is less prone to mistakes than other nutrition measurements. It´s cheap and can be effectively used by community-based workers or volunteers. In our study, after first ¼ of treatment process, the difference in averages of MUAC score indicates a growth from 11.45 cm to 12.08 cm in Kwale, from 11.71 cm to 12.06 cm in Mkongani and from 11.8 cm to 12.06 cm in Tiwi. The most significant progress of average MUAC score was in Kwale centre.

Results present the proportion of children suffering from severe acute malnutrition reduced in all three nutrition centres, the most significant it is in Kwale centre from 41% to 21%. Proportion of children suffering from moderate acute malnutrition reduced only in two centres (Mkongani from 74% to 55%, Tiwi from 35% to 2%) compared to Kwale centre where MAM increased from 50% to 58%. The most significant improvement of well-nourished children was in Tiwi centre from 7% to 23%, compared with Kwale centre where are worse results of well-nourished children after four weeks of treatment (from 9% to 5%), what could be connected with increased number of children with MAM.

According to the survey from 2009 in Kwale region, children aged 20-23 months were found to be most vulnerable to malnutrition. In our study was this age group in average 13.4 months in Tiwi, 15.3 months in Mkongani and 17.8 months in Kwale centre. Girls had worse nutritional status in two centres (Kwale 78%, Mkongani 55%) than boys in Tiwi centre (57%). Survey from Kwale region from 2009 showed opposite results in sex predictor of nutritional status.

Child´s appetite evaluation by RUTF Appetite test should be an ordinary method in treatment process of malnourished child. WHO, UN World Food Programme, UNICEF and etc. endorse the Appetite test must be carried out at each child´s visit treated in the nutrition programme SAM and every 2 weeks with MAM (National Guideline for IMAM, 2008). Appetite test means to do trial a feeding, which is first step to determine a failure to respond to treatment. The findings of this study show that RUTF Appetite test was not conducted in two centres during first four weeks of treatment by more than 50% of admitted children. Only Tiwi nutrition centre included appetite test into treatment process.

Our study also compared discharge criteria in all three centres after first four weeks of the nutrition programme. The highest proportion of Defaulters released in Tiwi centre by 13% compared to Mkongani by 5%. Kwale centre hadn’t any defaulter after four weeks in the programme. Defaulter is a child who miss three consecutive visits (Henretty et al., 2013; National Guideline for IMAM, 2008; WHO, UNICEF, 2009). An important factor under this issue could be distance to the nutrition centre, lack of money for the transport to the centre and back home, weather conditions by heavy rain season is a cause related to defaulter´s issue, and unwilling of mother or family to care for a child because they are overwhelmed with other work or their responsibilities. To help the child stay in the programme until he is cured, we could advice increased number of home visits to determine the reason for defaulting.

Our further study work, included the whole four months treatment process, could create comprehensive overview of management of acute malnutrition and determine appropriate and adequate treatment for malnourished children aged under five years.


Conclusions
Our study reveals the pervasiveness of child acute malnutrition in Kwale region. Study also confirms appropriate treatment of malnourished children in all three nutrition centres during first four weeks, based on follow guides using by community health workers identify malnutrition and adequate care.

The significant difference in averages of MUAC score indicates a growth in two of three centres and proportion of children suffering from moderated acute malnutrition and severe acute malnutrition reduced after 4 weeks in nutrition programme compared to admission week.

Regular evaluation of nutritional data allows better identify the causes and factors of child malnutrition in Kwale region and determine the needs and the effectiveness of the chosen treatment and social assistance and to prevent defaulter´s discharge cause.
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HENRETTY, M., STOBAUGH, H. 2013. A comprehensive guide to: Treating acute malnutrition with RUFT: A Community Outpatient Approach. Edesia, Inc. March, 2013. 48 p.

National Guideline for Integrated Management of Acute Malnutrition. Republic of Kenya, Ministry of Health. October 2008. [accessed September, 2015]. Available from: http://www.cmamforum.org/pool/resources/kenya-moh-imam-guideline-june-2009.pdf
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WHO Guideline: updates on the management of severe acute malnutrition in infants and children. 2013. ISBN 978 92 4 150632 8[accessed September, 2015]. Available from: http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf
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http://apps.who.int/iris/bitstream/10665/44129/1/9789241598163_eng.pdf?ua=1

HUMANIZATION OF life of older people with respect for human rights
MONIKA MAČKINOVÁ, JANA KEKETIOVÁ

Slovakia, Faculty of Social Sciencies University of st. Cyril and Methodius in Trnava,

Department of social services and counseling

E-Mail: monika.mackinova@gmail.com

Slovakia, Trnava University in Trnava, Faculty of Health Sciences and Social Work,



Department of Social Work

E-Mail: jana.keketiová@gmail.com


Abstract

Each human being is a unique individual and respect for and observance of human rights should be as moral as ethical responsibility of all of us. The mission of social work is humanization of life and help to create realistic and dignified environment with no matter in what kind of social status the individual, family, group is situated. Therefore it is very important and necessary to encourage even greater the way of humanization by influencing nor only the public, lay people and various employers' organizations in favor of proper conditions for respect and protection of human rights in justified and necessary process of personal integrity of human.
Key words:

Humanization. Older People. Respect. Live.

Humanization of life of older people living in residential care with respect for human rights and human dignity calls for expending greater efforts to provide quality care and quality social services and protection of the rights granted to them (Matyšák, 2015). Trying to meet their needs as well as promoting justifiable demands requires to propose also solutions, that address the main problems with independence and immobility especially in work with severely disabled and socially disadvantaged people. This could lead to improvement of the quality of their way of life and to achieve their integration into society, which has considerable importance for themselves.

Compliance with the rules, laws, moral and ethical standards of human society (international declarations and conventions governing human rights and fundamental freedoms) are the highlight of the natural / moral action of people. The natural moral law, which is given to humane in its nature and through parents, respectively by the society is regarded as the criterion of ethics and humanity.

The basis for humanization of the human - rights aspects considered "Universal Declaration of Human Rights", which was adopted in 1948 in New York by the UN General Assembly, which brought new understanding of rights of individual. It is an essential document in the field of human rights at European and International level, which states: "Everyone has the right to live in freedom and personal security" and the right can not to be deprived from anyone, not even by the person himself.

Palovičová, (2009) writes: recognition of the inherent dignity by equal and inviolable rights of all people is the foundation of freedom, justice and peace in the world.. Natural human dignity of an human in practical terms and its respect means: "Everyone has the right to live life on their own terms and this applies equally to the rights of others". The limiting and damaging of the rights of other members of the society can not occur at the expense of one against another.

Not only basic human rights are not forgettable for their justice and dignity and are from no small measure important and essential for the authenticity of a human being.

Also the importance of social work is based on the important principle of humanization, empathy and respect for human rights and human dignity. Therefore, humanization of life of people of all ages concerns all of us, the whole society, but especially in the system of institutional care, where it is necessary to emphasize the rights of ill people and to preserve human dignity and respect for their unconditional right.

It is therefore very important, that the humanization in the provision of social care in social care institutions was implemented by planned and systematic procedures for the satisfaction of those, who the care needs urgently. Implementation of social work should be based not only on the principles of humanity, justice and human dignity, but also with respect for the rights to all the people.
The human - Legal aspects of life of older people with respect for human dignity and human rights in older age
Welfare Europe is based on human rights and solidarity. There is no doubt, that human rights include the right to a decent life for the entire population, including long-term care for older people, and that solidarity is a means to ensure this right. Hrozenská (2008, p. 111). At present time, human rights are defined as: authorization granted to an individual, enabling him{her to make full use of his/her skills, intelligence, talent and knowledge to meet the spiritual and other objectives and aspirations. For authenticity and dignity of the human being it is also essential that they should be respected by every country. (Slovak Constitution).

The existence of humane has various human - legal aspects, whether dealing with social life, religious life, moral life, or story of person. We need to know, what the meaning of our lives is and know the way of understanding of the world as well as how our world exists, what we expect from him and what to expect from the people in the concrete society. With that that to the person is given the natural human dignity, respect and observance of human rights should become for him/her ethical and moral responsibility. There could be said that social work is a work based on humanity and empathy and the foundation of the principles of human rights and social justice and the social sphere is the focus given on humanization and respect for human rights. Social services for persons dependent on social assistance carried out by qualified personnel, strive to promote and protect not only the physical, mental but also emotional and spiritual integrity of each individual.



Increasing of legal awareness of older people within the performance of social work is unforgettable and the social workers are expected to deal with an older person as with a human being. They will highlight not only the strengths and seek adequate solutions to the problems, but are making great efforts and support to their decisions by providing quality and accurate information and expert assistance and would seek for the understanding of all aspects of life and respect the right to decent conduct. Human rights by different ways affect people's lives. Respect for human rights and social justice are important for social work and in many ways fundamental. Therefore, with respect for the dignity are appealing to humanity and human dignity. Masaryk (2014) notes that within the provision of comprehensive care is therefore necessary from a human point of view to proceed calmly and to demonstrate the seriousness and respect as well as the human attitude to individual's.

For humanistic approach can be considered such approach or theory, which is considering as the highest value the human dignity and it is therefore necessary that the human dignity is respected and protected even against interference from political and economic power. On the principles of public good, solidarity and social justice is realized humanity and the value of universal human, individual, group and social concerns the most basic relationships between citizens. The protection of human rights and fundamental freedoms need to be developed and supported in the implementation of such measures, programs and practices, that would lead to improvement of the health status of older people to support their active lives, and to create conditions for maintaining of their physical and mental abilities within their possibilities and to respect their uniqueness, human dignity and rights they are entitled to with respect and humility, without elements of discrimination and humiliation. The aim is to make efforts on advancing of human, so, that the people and their lives acquired dignity they are due.

The human person is an essential source of understanding, love, respect, autonomy and sovereignty, hypostatic whole, is imperishable. He/she is not a means and therefore with an individual can never be treated as with a means or with as an inanimate being. The purpose of the real Community is to support every human being at every stage of his/her development and, if necessary, provide him/her with care and assistance. (Maturkanič, 2010).
The elimination of the risk of human rights violations and their prevention
Each person has been given the inherent dignity and human rights in many ways touch people's lives and are one of the primary mission of the Council of Europe, where are the main instruments the European Convention on Human Rights and Fundamental Freedoms and the European Social Charter. These are documents, which are very important in carrying out of the professional social work, which is gradually formulating quality standards. Their main criterion is to show respect for the rights, with respect of the uniqueness and esteem to individual, with the knowledge of preserving human dignity for each person. (Palovičová, 2009).

Although in the Slovak Constitution are enshrined basic human rights and freedoms, which are based on the Charter of Fundamental Rights and Freedoms, which was incorporated right into the Constitution of the Slovak Republic. These human rights and the rights of individuals are used to protect people against discrimination and are also seen as a right for justice and freedom.

Discrimination is unfair treatment of people on the basis of arguments without consideration and assessment of a fair and rational judgment, that is the opposite of fundamental human rights. The right to self-determination is a fundamental principle of social work and this right, which belongs to fundamental human rights is an essential element of any relationship that recognizes the rights and needs of older people, who are dependent on social services.

To aging individual is allowed to build a relationship and to find own answers to problems and in order to decide on his/her future and live, is created support for him/her. A holistic approach is in the work with an aging person a very important element, which means that the professional is with each and every human being as with holistic being and is interested in the whole person within the family, the social environment and is trying to understand all aspects of human life, if its his/her value system, customs, national or cultural affiliation or his/her skills, realities and spirituality. In carrying out of social work and its individual activities applies
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