Nutrition

(Note: This reading reflection paper was written in the second half of 2020 as part of an Introduction to Global Health course)

The readings this week show the importance of good nutrition especially for children between 0–2 years, “the window of opportunity,” because of the long term negative outcomes associated with undernutrition at these critical years of life. Undernutrition sets in a motion a cyclical and intergenerational chain that ends in morbidity and mortality. Undernourished women have an increased risk of dying from pregnancy related deaths or giving birth to children with low birth weight. Calcium deficiencies contribute to maternal deaths by preeclampsia. Undernourished children are susceptible to infections that make it difficult to absorb nutrients from food. Immunization helps prevent infections and increase the chances of survival of undernourished children. Poor nutrition also results in poor academic outcomes and low worker productivity. The ability to provide good nutrition for children is impacted by the health and education of the mother and influenced by other factors such as poverty, the health system, gender, economic factors, among others. Despite the complexity of this problem, long lasting effective solutions are those that address undernutrition working with mothers and using existing food sources within communities.

Poor or under nutrition manifests in a variety of ways: wasting (low weight-for-height), stunting (low height-for-age), underweight (low weight-for-age), and micro-nutrient deficiencies or excess. Under nutrition makes children more vulnerable to disease and death. 45% of deaths of under 5 children worldwide are associated with nutritional deficits. (WHO) Most of the damage done to their development, physical and mental, cannot be changed. Under nutrition also contributes to the risk of being overweight, obesity, and diseases such as heart disease, stroke, diabetes, and some cancers later in life. Obesity and being overweight are responsible for 44 percent of the burden of diabetes, 2 percent of the burden of ischemic heart disease, and 7 percent to 41 percent of the burden of certain cancers. (WHO)

The interventions for undernourishment can be categorized into three broad headings: nutrition specific interventions, nutrition sensitive interventions, and creating an enabling environment for nutrition. Nutrition specific interventions have a direct impact on nutrition and include the promotion of exclusive breastfeeding, micronutrient supplementation, and food fortification. Nutrition sensitive interventions address the underlying determinants of malnutrition and include vaccination programs, or nutrition programs to enable farmers increase the yields of the crops that they produce. An enabling environment for nutrition includes creating laws, policies, resources, and institutional issues that relate to the approach countries take to nutrition.

Jenniper Tapan (2017) in her book, “the riddle of malnutrition,” show how attempt to medicalize the treatment of undernourished kids was problematic and did not sufficiently meet the needs of the mothers and the communities. Also, mothers were instructed to add the powdered milk to a child’s food, but only fed the powdered milk to the child the way it was being done at the hospitals and sometimes overdiluted the milk. This led to supplementary bottle feeding which displaced breastfeeding and increased the prevalence of undernutrition or marasmus. There were barriers to providing protein-rich food to children because most of the meat, fish, and eggs were reserved for men. Also, soya milk being a cash crop was an economic barrier to its availability as food for children.

However, as mothers and communities were given the opportunity to be more involved and local food sources were created, the health of undernourished children began to improve and at a lower cost compared to the medical options. This new local food for children in Uganda, “Kitobero,” is described as “a testament to the power of this synthesis of the local and the biomedical in public health promotion.”

The readings did not address adequately the question of nutrition for mothers during pregnancy. I think the starting point of the conversation should be what mothers need to eat during pregnancy to prevent giving birth to children with low birth children, especially women who are themselves stunted. Also, the readings did not address what mothers who want to breastfeed their children, but inadequate quantity of breast milk can do. In Nigeria, lactating mothers are encouraged to eat more liquid food such as pap (fresh corn paste gurelle) and stew made from molokhia leaves.

Also, with regards to addressing obesity, labelling calories in food assume that people know the amount the calories they are expected to consume per day and that they would keep track. If the recommended consumption per day is 1,600–2,400 calories per day and a cookie has about 400, a banana about 200, It would take a lot of discipline to adhere to this daily limit. Recommendations to eat more vegetables and protein might be easier to understand and follow.

Question

· Although it has been “proven” to work and backed by the UNICEF, I am a little conflicted about the peanut butter campaign. Could giving children a highly fatty meal be problematic in the long run — lead to rapid weight gain, and the child is also sedentary because it is ill — and or should this be one of those cases where I just choose to trust that due diligence and research has been done about this. Also, why again are we trying to get mothers to use a packaged product that costs about costs $68 for 6 weeks and not prioritizing training mothers and grandmothers to use and maximize food sources available locally.

· Since stunted children that gain weight rapidly is associated with obesity and ischemic diseases later in life, is there a way to phase this recovery so they do not gain weight as quick? Is there a fear that if the children do not gain weight quickly, mothers may abandon the treatment? What else is going on there? Is it a case that either if the weight gain is rapid or not, it will still result in a higher risk of obesity and ischemic diseases later in life?