LEARNING OBJECTIVE 1

1.

Describe malnutrition (in defect) in developing countries: epidemiology, direct and indirect causes, and short and long term consequences for the affected individuals and the community.

DEFINITIONS Hunger: subjective feeling of discomfort that follows a period without eating. Undernourishment defines insufficient food intaketo continuously meet dietary energy requirements (FAO 2003). Undernutrition goes beyond calories and signifies deficiencies in any or all of the following: - Energy - Protein - Essential vitamins and minerals. Undernutrition is the result of: Inadequate intake of foodin terms of either quantity or quality Poor utilization of nutrients due to infections or other illnesses Combination of these factors, which are in turn caused by: Household food insecurity Inadequate maternal health or child care practices Inadequate access to health services, safe water, and sanitation

Food insecurity relates to the condition that exists when people do not have physical and economic access to sufficient, safe, nutritious, and culturally acceptable food to meet their dietary needs and lead an active and healthy life (FAO 1996). There is a distinction between chronic and acute food insecurity: Chronic food insecurity occurs when people are unable to access sufficient, safe, and nutritious food over long periods, such that it becomes their normal condition. Acute food insecurity exists when the lack of access to adequate food is more short-term, usually caused by shocks such as drought or war.

Nutrition deals with the way the body absorbs and uses food. Malnutrition leads to health problems, growth retardation, poor cognitive development, and in the worst cases death. It may result from deficiencies, excesses, or imbalances in energy, protein, and other nutrients (FAO 2003). It is also caused by numerous factors ranging from the inadequate care received by a newborn baby, through the lack of essential micronutrients (vitamins and minerals) in the food consumed, to the diseases and conditions that prevent the body from properly absorbing and using nutrients (FAO 2003).

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MALNUTRITION:
It is a suboptimal nutritional health state in which there is a deficiency of energy, proteins +/micronutrients, that causes adverse effects in the composition and functioning of the tissues or in the whole organism. Its an imbalance between food intake and nutritional demands.

Degrees of malnutrition: -mild IMC 17-185

-moderate IMC 16-169 -severe IMC <16 -LETAL: Man < 13; Woman <11.

Classification:
Primary malnutrition There is the absence in the diet of one or more components. Occurs mainly in developing countries under conditions of war, famine and political unrest. Secondary malnutrition occurs mainly in industrialized countries. Persons with adequate food supplies can become malnourished as a result of acute or chronic diseases that alter nutrient intake or metabolism, particularly diseases that cause acute or chronic inflammation. patients hospitalized in general Medical and surgical wards are affected by PEM (consistent finding that nutritional status influences patient prognosis underscores the importance of preventing, detecting, and treating malnutrition).

Causes of malnutrition:
Poor diet Illness Access to food Maternal care take practices Socioeconomic and political condition *Theory of 6Ps as a causes of malnutrition: Production (season and climate conditions) = poor diet. Preservation of the food (poor diet). Population: density, cultural and religious food customs, breastfeeding habits and level of education and sanitation. Poverty economic situation (misery, crop failure, droughts) Political situation (war, corruption). Pathology infections (diarrhoea)

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Epidemiology of malnutrition:
1 of every 6 people in the world suffers malnutrition, that means that there are aprox. 1000 million people suffering that. The majority are in the rural areas of developing countries. Asia + Pacific Sub-saharian Africa. Latin America If we look at countries, the place where there are more undernourished people is India (237 million). Then, it goes China (130 million) and Bangladesh (41.7 millions) In Africa, the country which more malnutrition is the Democratic Republic of Congo (41.9 millions), followed by Ethiopia (31.5 millions) and Tanzania (13.7 millions) (Information of 2005)

Consequences of malnutrition:
Mortality: malnutrition is directly responsible for 300000 deaths per year in children younger than 5 years in developing countries. Strong association between malnutrition and infections. Infectious diseases: a malnourished children tends to suffer more days of infections and disease. This is because immune System is depressed with a reduction in the response and in lymphocytes number. 1. Main causes of child death in developing countries: Diarrhoea (19%) E.Coli Acute respiratory infections (19%)

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Perinatal deaths (18%) deaths between 28 week of pregnancy and 7th day post-birth. The two mainly factors for this are: malnourished women because they are in more risk of giving birth to low birth weight infants and poor conditions. Measles (7%) Other infections like malaria, TBC and tetanus. Functional outcomes: children who are chronically malnourished exhibit: 1. Behavioural changes: Irritability and anxiety Apathy and attention deficits Decreased social responsiveness. 2. Brain damage: Delayed intellectual development. Impaired cognitive function means a child can have a diminished capacity to learn, leading to lower educational performance and ultimately, lower economic productivity. This in turn can hinder a nations economic development. The degree of delay and deficit depends on the: Severity of malnutrition. Duration of malnutrition Age in which malnutrition occurs (younger ages = worse outcomes). Poor growth Loss of proportion between height and weight. The different kinds of growth problems are related with the different types of deficiencies and malnutrition.

Determinants of hunger
Poverty, war, natural disasters, disease epidemics, political and economic shocksall affect: Determinants of hunger (physical, technological,economic, political, social, and cultural) Underlying determinants (household food security, care, and health environment).

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DETERMINANTS Poverty Extreme poverty accounts for close to half the variability in overall malnutrition rates. Relationship between GDP per capita growth and changes in underweight prevalence People living on less than $1 a day is correlated with the percentage of the population underweight. Level of parents education, especially mothers level of education, has significant impacts on child malnutrition. If the mother attended primary school, the child is less likely to be underweight. The correlation is even stronger if the mother also received secondary education. The reduction in child malnutrition due to womens education may be due in part to the fact that education and skills training better equip women to participate in activities that can improve their overall economic and social status within the household and the community. Educating girls can delay their marriage age, reduce their future family size, increase their earning power, and improve the nutritional status of their future children. Agricultural productivity increases dramatically when women receive the same inputs as men, including education Improved food availability = reduction of malnutrition. Food production in developing countries tripled over the past 30 years = The number of rural poor fell by half. The real prices of the main cereal crops fell by 76 percent. The impact of an increase in food availability on malnutrition depends on the present level of availability and access to food. Inverse relationship between food shortages and underweight children: there are more underweight children in cereal-surplus countries than in cereal-deficit ones. Productivity growth in agriculture is not the most effective measure for reducing malnutrition. Instead, the key is to ensure that improvements in productivity are shared across a broad spectrum of resource-poor farming households. This requires equitable access to productive assets, especially land, and to improved technologies. In Africa, however, soil nutrient depletion and unreliable water supply are extreme. Depleted soils cannot provide sufficient mineral nutrients (nitrogen, phosphorus) for crops to grow. This translates into low food productivity and supply. Therefore, for most African countries, the initial entry point to increasing food production and access may revolve around investments in soil health and water management to improve agricultural productivity. Inadequate sanitation, poor health facilities, and unsafe water sources contribute significantly to malnutrition by increasing the burden of illness for both children and adults. More than 1 billion people, one-sixth of the worlds population, lack access to safe drinking water (FAO 2001a). Households dependent on well or surface water for drinking are more likely to have increased prevalence of underweight children because the water is more likely to be contaminated. And children living in households with no toilets are more likely to be underweight. Of the nearly 12 million children under age five who died in 1995, about 70 percent were

Education

Food production and access -

Sanitation, health facilities, and water -

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affected by one or more of just five conditions: malaria, measles, acute respiratory infections, undernutrition, and diarrhoea. And the death rate from disease among undernourished children is much higher than among those better nourished (FAO) Socioeconomic and political access and inequalities The biggest challenge throughout the developing world is to reduce the differences in access to food across geographical areas and social strata. Access to food is also limited by inefficient markets that are unable to supply sufficient quantities of seasonal food in response to demand throughout the year. These market failures exacerbate fluctuations in the price of food and affordability of food for the poor Sociopolitical conditions affect malnutrition through inequality and exclusionary practices that disempower groups such as women, children and ethnic minorities in many countries. Social exclusion results in deprivation not just in food but in a wide range of basic services, including education and health. These and other factors have led to a vicious circle of poverty, deforestation, land degradation, and malnutrition. Rural families have had to develop coping strategies, which in many cases have allowed them to overcome food insecurity. Environmental, economic, and other forces are undermining these strategies, particularly in areas susceptible to drought, floods, and, recently, armed conflict. Discrimination in food intake between boys and girls, it is largely in favor of boys The inequalities in food intake reflect cultural values and the different wages commanded by male and female adults in the labour market. This type of gender-specific exclusion from food consumption. Forms of social and political exclusion in the region can have similarly negative impacts on food security and nutritional status.

LEARNING OBJECTIVE 1 WHAT CAUSES MALNUTRITION?

LEARNING OBJECTIVE 1
FOOD SECURITY