Deep-Rooted Causes, Far-Reaching Effects
“I was hungry and you formed a committee to investigate my hunger. I was homeless and you filed a report on my plight. I was sick and you held a seminar on the situation of the underprivileged. You investigated all aspects of my plight and yet I am still hungry, homeless and sick.”—Author unknown.
ALTHOUGH world agencies have made numerous efforts to stop malnutrition, achievements have fallen short of hopes. For example, in 1996 the World Food Summit of the Food and Agriculture Organization of the United Nations (FAO) set the goal of reducing the number of the world’s undernourished by half—some 400 million people—by the year 2015. *
Commendably, some progress has been made. But unfortunately, the FAO’s recent report, The State of Food Insecurity in the World 2001, acknowledges: “Clearly, there has been a slowdown in the reduction of undernourished in the world.” So the goal of the summit still seems out of reach. In fact, the report admits that “the number of undernourished has increased considerably in the majority of developing countries.”
Why is this enemy so hard to defeat? To find an answer, we might first define malnutrition and then examine its far-reaching effects and its deep-rooted causes.
What Causes Malnutrition?
Malnutrition is caused by a deficiency in the intake of nutrients by the cells of the body, and it is usually triggered by a combination of two factors: (1) an insufficient intake of proteins, calories, vitamins, and minerals and (2) frequent infections.
Such illnesses as diarrhea, measles, malaria, and respiratory diseases tax the body heavily and cause loss of nutrients. They reduce appetite and food intake, thus contributing to malnutrition. On the other hand, the undernourished child is more susceptible to infections. Thus forms a vicious circle that increases the mortality rates for protein-energy malnutrition (PEM).
Why are children at greater risk of suffering malnutrition? They are in a period of rapid growth that increases the demand for calories and proteins. For similar reasons, pregnant and nursing women are vulnerable to malnutrition.
Frequently, the baby’s problem begins even before birth. If a mother is undernourished or malnourished before and during pregnancy, the baby will have a low birth weight. Then, early weaning, poor feeding habits, and lack of hygiene can bring on malnutrition.
Lack of necessary nutrients causes the child to stop growing and developing properly. It cries a lot and is prone to sickness. As the condition worsens, weight loss becomes more pronounced, eyes and fontanel (the soft spot on top of the head) become sunken, skin and tissues lose elasticity, and the ability to maintain body temperature decreases.
Undernourishment can take other forms. These too can retard growth in children. For instance, an inadequate intake of minerals—mainly iron, iodine, and zinc—and of vitamins—particularly vitamin A—can have such an effect. The United Nations Children’s Fund (UNICEF) notes that a deficiency of vitamin A affects about 100 million small children in the world and causes blindness. It also weakens the immune system, reducing the child’s resistance to infections.
Malnutrition wreaks havoc on the body, particularly that of a child. Every organ and system—including the heart, kidneys, stomach, intestines, lungs, and brain—may be affected.
Various studies have shown that poor growth in a child is associated with impaired mental development and poor scholastic and intellectual performance. A report from the United Nations calls these effects the most serious long-term results of malnutrition.
For children who survive malnutrition, the aftermath can linger on into adulthood. That is why UNICEF lamented: “The depletion of human intelligence on such a scale—for reasons that are almost entirely preventable—is a profligate, even criminal, waste.” So the long-term consequences of malnutrition are of great concern. Recent research relates undernourishment in infancy to a tendency toward such chronic illnesses in adulthood as heart disease, diabetes, and high blood pressure.
However, serious malnutrition is not the most extensive problem, as UNICEF acknowledges: “More than three quarters of all [the] malnutrition-assisted deaths are linked not to severe malnutrition but to mild and moderate forms.” (Italics ours.) Children who suffer from mild or moderate malnutrition may face long-term health repercussions. It is therefore vital that symptoms of undernourishment in children be identified so that proper treatment can be provided.—See the box on page 7.
As noted before, the direct cause of malnutrition is a lack of food. But there are deeper social, economic, cultural, and environmental causes. Principal among them is poverty, which affects millions of people, particularly in developing countries. However, in addition to being a cause, poverty is also a consequence, as undernourishment weakens people’s productivity, thus intensifying poverty.
There are other contributing factors. Lack of knowledge breeds poor eating habits. Infections, as we have seen, play a role. There are also social and cultural causes, such as the unequal distribution of food and discrimination against women. Women often eat “last and least”—that is, after men and less than men. Women are also denied educational opportunities that would help them to care for their children better.
In addition, environmental factors cause a decrease in food production. Among these are natural disasters and wars. According to The State of Food Insecurity in the World 2001, from October 1999 to June 2001 alone, 22 countries were affected by drought, 17 by hurricanes or floods, 14 by civil war or strife, 3 by extremely cold winters, and 2 by earthquakes.
Treatment and Prevention
How can a child be treated for malnutrition? If the child suffers from serious undernourishment, hospitalization may be best for initial treatment. According to a manual for physicians published by the World Health Organization, the doctors will evaluate the child’s condition and treat any infections or dehydration. Feeding may begin gradually, often starting with a tube. This initial phase may take as long as a week.
A rehabilitation phase follows. The child is reintroduced to mother’s milk and is encouraged to eat as much as possible. Emotional and physical stimulation are important during this phase. Care and affection can do a surprising amount of good for the child’s development. This is when the mother may be given education on how to care for her child with a proper diet and hygiene, so as to avoid a relapse. Then the child is released from the hospital. It is important that the child be taken to the hospital or clinic for follow-up visits.
Clearly, however, prevention is the best course. That is why in many countries, government and private organizations have established food supplementation programs or programs to fortify foods for general consumption. Communities also contribute to the prevention of malnutrition in many ways, such as by providing nutritional education programs, protecting the drinking water supply, building latrines, keeping the surroundings clean, sponsoring vaccination campaigns, and watching over the growth and development of children.
But what can be done on an individual basis to prevent malnutrition? The box on page 8 has some helpful suggestions. Along with these, pediatric nutritionist Georgina Toussaint recommends that the mother return to her pediatrician or health clinic seven days after the birth of her child, when the baby is one month old, and each month after that. The mother should also seek professional health care if the baby shows symptoms of dehydration, severe diarrhea, or fever.
Although these recommendations are of help in improving the diet of children, it must be admitted that malnutrition is a big problem—so big that it is beyond human efforts to resolve. The Encyclopædia Britannica acknowledges: “The provision of an adequate food supply and nutritional education to all people, however, remains a crucial problem.” Therefore, is there hope that this “silent emergency” will ever end?
[Box on page 7]
IS YOUR CHILD MALNOURISHED?
How do health professionals evaluate the nutritional health of a child? They may analyze various signs and symptoms, ask questions about eating habits, and order a laboratory analysis to be made. However, they most commonly rely on fairly straightforward measurements. They measure the child’s body and compare the figures to reference standards. That helps them determine the type and seriousness of the malnutrition.
The most important measurements are weight, height, and the perimeter of the arm. Comparing weight and age reveals the degree of the undernourishment; if it is serious, the child is wasted and looks very thin. The illness is considered serious if the child’s weight is more than 40 percent below normal, moderate if it is 25 to 40 percent below, and mild if it is 10 to 25 percent below. A very low height-to-age ratio may reveal chronic undernourishment—the child is stunted.
The most serious forms of protein-energy malnutrition (PEM) are marasmus, kwashiorkor, and a combination of both. Marasmus (progressive wasting) appears in nursing babies between 6 and 18 months of age. It establishes itself slowly as a chronic deficiency of calories and nutrients and develops as a result of insufficient nursing or the use of very diluted substitutes for human milk. The baby shows a great loss in weight, the muscles are so thin that the skin sticks to the bones, and growth is retarded. The baby also has “an old person’s face,” is irritable, and cries a lot.
The term kwashiorkor, taken from an African dialect, means “deposed child.” It refers to a child’s being replaced at the mother’s breast by a newborn sibling. This condition appears after weaning, and while it includes caloric deficiency, it develops from an acute lack of proteins. It causes the body to retain fluids, making the child appear bloated in the extremities and the abdomen. Sometimes it affects the face too, making it resemble a full moon. Skin lesions and alterations in the color and texture of the hair appear. Children with this condition show swelling of the liver and are apathetic and sad. This was the case with Erik, mentioned previously, whose mother fed him breast milk for only the first month of his life; then she gave him very diluted cow’s milk. At three months he was given vegetable soups and sugar water and was left in the care of a neighbor.
The third type of PEM includes characteristics of both marasmus and kwashiorkor. All of these conditions can prove fatal if not treated in time.
[Box/Picture on page 8]
PROTECT YOUR CHILD FROM MALNUTRITION!
▪ It is essential to improve the diet of the mother. Pregnant and nursing women need to consume more calories and proteins. Proteins in particular help in the production of mother’s milk. So when there is little food, give preference to women of childbearing age and to little children.
▪ In almost all cases, the best possible food for a baby is its mother’s milk. This is especially so during the first days after birth because mother’s milk contains antibodies that protect the baby from infection. During the first four months or so, breast milk provides all the nutrients that the baby needs in order to grow and develop properly.
▪ Although mother’s milk continues to be the main food, between the fourth month and the sixth, the baby is ready to receive other foods. Gradually introduce fruits and vegetables in a mashed form. Let the baby try one new food at a time. Two or three days later, after it is familiar with that food, let it taste another. Of course, patience and many attempts are often needed before the baby accepts a new food. When preparing such food, remember that everything should be clean, clean, clean! Wash foods and utensils well!
▪ Between the fifth and ninth months of life, babies generally start to need more calories and proteins than milk provides. Continually and persistently introduce other foods. Cereal and vegetable baby food may come first, meat and dairy products later. Whereas the earliest foods are strained, from the baby’s sixth month on, they may be finely chopped. Adding salt or sugar is neither necessary nor recommended.
▪ After eight months, mother’s milk is no longer the basis of the baby’s diet but, rather, a complement. The baby begins to eat the food that the family eats. The food should be kept scrupulously clean, and it should be finely chopped so that it is easier to chew. The ideal diet includes fruits and vegetables, cereals and legumes, and meat and dairy products. * In particular, children need foods rich in vitamin A. Some examples are breast milk, dark-green leafy vegetables, and such orange or yellow fruits and vegetables as mangoes, carrots, and papayas. Children under three years of age need to eat five or six times a day.
▪ The greatest possible variety of foods in different combinations provides nutrients that protect your baby. The mother should focus on providing the child with good-quality food, neither forcing the child to eat after it is full nor withholding food from the child when it appears to want more.
Experts agree that mother’s milk is almost always the best food for a newborn
© Caroline Penn/Panos Pictures
[Picture on page 7]
Children eating bulgur and vegetables at a school in Bhutan
FAO photo/WFP Photo: F. Mattioli
[Picture on page 9]
You can take steps to improve the diet of your child