Child Malnutrition In Developing Countries - Case Study, Victoria University, Australia

HMG7130 Nutrition For Global Health

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Introduction: The nutritional problem across the globe is primarily related to poverty, excessive dependence on nutrients from plant sources, lack of education, and the severe rate of infections. Some of the common complications associated with a lack of nutrition include nutritional animals, protein-energy malnutrition, vitamin A deficiency, and iodine deficiency (Das, Salam, and Bhutta, 2016). The major population segment vulnerable to be at higher nutrition-related risk include pregnant women and children. The present report outlined the population segment of children from Ethiopia that suffers from nutrition deficiency and requires strong intervention to control its adverse effect.

Question 1. Outline the nutrition situation and identify the major nutrition issues in the population indicating which groups are most vulnerable and why.

Answer: The chosen case study for this report is the lack of adequate nutrition among youngsters of Ethiopia. Children malnutrition still remains to be one of the major public health problems in developing nations like Ethiopia. Malnutrition is considered as one of the prominent causes of childhood illness and mortality in the country (Berbada, Haidar, and Gebremichael 2017). Malnutrition has been recognized as the underlying reason for approximately 3/5thof child death within the country. Suffering from malnutrition at an initial age of lifecycle increases the probability of illness, infection, and mortality, along with reduced cognitive and mental growth. The methodology imposed to measure the rate of malnutrition in the specified country is literature sources, survey report, and telephonic interviews. According to a demographic and health survey conducted in 2014, for a population of age group between 0 to 59 months residing in the rural areas of Ethiopia, 42% of children are stunted and 27% of children are underweight (De Valença, Bake, and Brouwer 2017). Children from rural areas are facing critical situation as compared to the urban location. The level of stunting (chronic malnutrition) and wasting (chronic malnutrition) among below-five children is found to be highest globally in Ethiopia. According to a recent report, more than 30% of Ethiopian children are underdeveloped, facing consequence of weak immune system and reduced cognitive capacity. It is also noticed that every 1/10thEthiopian children is wasted, leading to infant mortality. Wasting among children is commonly the outcome of immediate food unavailability or suffering from an acute illness likediarrhoea or cholera. The measurement of thinness (wasting) among children acts as a measure to determine the severity of the situation. However, stunting in children is caused due to their poor development from birth, which is associated with poverty. The nation is recorded to have the second positionin the malnutrition rate within sub-Saharan Africa (Mulu, Hamza, and Alemseged, 2016).

In particular, there exists four forms of malnutrition among the children community, viz., acute and chronic malnutrition, iodine deficiency disorder (IDD), vitamin A deficiency (VAD), and iron deficiency anaemia (IDA). According to the demographic health survey (DHR) report, due to malnutrition, Ethiopia is on the highest position in the world for low birth weight (LBW) (Berbada et al. 2017). The acute malnutrition is further categorized as severe acute malnutrition and moderate acute malnutrition. The classification severe acute malnutrition includes, protein-energy malnutrition (deficient intake or utilization of requisite food), marasmus (children become extremely thin), kwashiorkor (bilateral oedema along with weight to height ratio greater than or equal to -2 SD), and marasmic kwashiorkor (bilateral oedemaalong with weight to height ratio less than - 2 SD) (Kennedy, Tessema, and Hailu 2015). The reason behind this is the poor nutritional content among all men before and during their pregnancy. Also lack of education and cultural stereotype is also responsible for this concerned problem.

Question 2. What are the consequences of the nutrition problem. Consider health, social and economic consequences.

Answer: The deleterious consequences of malnutrition in Ethiopia often remains hidden and thus are not appreciated by external agencies. The reason is lack visible signs, victims remain silent and lack of educational awareness. However, based on the DHS report, the malnutrition for most of the kidsthose who have developgradually more malnourished starts after two years of their lives. By the end of 24 months, malnutrition has caused considerable damage to the overall development of the child, which is less likely to be recovered again (Massa, Woldemichael, and Tsehayneh 2016).

The nutritional problem thus has multi-dimensional consequences in terms of health, social, and economic aspects. Considering the health consequences, malnutrition leads to an increased risk of severe disorder and mortality. Nutritional problems such as malnutrition associated with vitamin A deficiency, suboptimal infant feeding practices consequently reduce the resistance of small children to infection. This, in turn, increases the risk of illness and death. Considering the statistics of past 10 years,36% of child mortality is because of acute malnutrition. Moreover, malnutrition among new mothers lowers the production of breast-milk, which also increases the risk of malnutrition among the infants. In simpler words, this is ancycle intergenerational occurrence of malnutrition, where a malnourished mother gives birth to a malnourished child having low birth weight (Madise, 2017).

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Malnutrition among children also results in the form of social consequences such as poor school performance or cognitive capabilities. It is evident that proper nutrition and diet help the overall growth of physical and mental development and school performance (Endris, Asefa, and Dube, 2017). However, malnutrition leads to the reduction of a child's learning ability, which is reflected in the school performance. A malnourished child often gets infected with diseases and is unable to attend school on a regular basis, resulting in poor school attendance. In Ethiopia, it has been identified that the deficiency of iodine has the thinking ability of children, which makes them less productive and creative in the later stages of life. Likewise, supplement of nutrients including vitamins and other minerals are essential for an optimal growth of the brain of the foetus at the time of pregnancy.

Malnutrition also affects economically through low productivity among individuals and poverty perpetuation. Stunting adversely affects children, and these children grow up as less productive. According to different studies, it is concluded that with increasing malnutrition the labour productivity declines, which in turn affects the worldwide GDP of the nation (Das et al 2016). As discussed above, a malnourished child has reduced mental and physical development which in turn affects the overall development of the nation. These factors will ultimately lead to the decline of the economic status of the local people.

Question 3. Discuss and identify the causes of malnutrition (over or under) and state the level at which they act. Use the UNICEF Framework for Under-nutrition to map the cause of malnutrition.

Answer: Based on the UNICEF framework, there are four major causes of malnutrition that are linked with economic, human and organizational levels of society.

Political factors - Some of the common political factors include the economic situation and policy decision taken on the basis of inflation or war, which ultimately lead to undernutrition. For instance, anextreme level of malnutrition is experienced among Ethiopian peoplein the time period of the Ethiopia Eritrean war.

Environmental factors - These factors are basically based on natural disaster such as floods, drought, and earthquake that can highly impact the society and lead to malnutrition. One such example is the terrible consequences of drought in 1977 experienced by Ethiopia (Kennedy et al 2015).

Cultural factors - The local health belief has aided to the spread of malnutrition in the community. It is hard for the government to make people realize that theirviews are causing a damaging impact on the health of children (De Valença et al 2017). For instance, Ethiopians have a belief that children suffering from diarrhoea or measles are not given any food, children are practiced with abrupt weaning due to the mother getting pregnant again. These cultural practices resulted in a reduction of nutrition from the body.

Social factors - Poverty is one of the prime social factors in the rural areas of Ethiopia, due to which the families are unable to buy basic food (Saldanha, Buback, White and2009). The man of the family often moves in search of a job, leaving behind their family and children. The family survives in poverty having minimum access to money, land, food and other physical assets.

Question 4. Consider how the various factors impacting on the nutrition situation are connected and how they are influenced by one another.

Answer: It is evident that a child suffers from malnutrition due to immediate causes like poor diet and diseases (Endris et al. 2017). However, these factors are due to some underlying causes, which differ according to varying communities and family background. Lack of educational knowledge related to basic health improvements leads to the birth of too many children in a family. Hence, the family is not able to feed sufficient food to each child (Massa et al 2016). Moreover, the existence of several families in a single arearesults in excessivecultivation. This further creates family food shortages. Therealso exists several other reasons behind food shortages such as low income or unnecessary spending on non-essential items such as alcohol and cigarettes.

As a matter of fact, inadequate nutrition and health care of children also leads to malnutrition. The reason behind this is the lack of basic educational knowledge among the woman of the house. Finally, the lack of education within the family deprives them of getting a job and ultimately they are forced to live in poverty (Massa e al 2016). Consequently, poverty heads to an unhealthy environment with poor health services such as low immunization coverage.

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Question 5. Considering evidence-based interventions what are the priorities for action to address the identified nutrition problem?

Answer: Based on the evidence-based interventions, the following actions should be implemented towards the issue of malnutrition among children in Ethiopia (Kennedy et al 2015):

Basic education - It is the primary intervention that is needed at community level, in order to improve the child nutrition and development. The advocacy must be provided for promoting equal chances of education with concept of gender equality. Likewise, parents must be aware of the benefits associated with health knowledge.

Healthy environment - This refers to the availability of safe and drinkable water, hygiene, cooking, and cleanliness. Management of waste in the locality as well as in the household must also be considered relevant in this scope.

Public health measures - The maternity health must be considered with priority, especially for the prevention and treatment of infection during pregnancy. Immunization for modifiable health risk must be made available and emphasis should be given on promoting health activities.

Maternal and child care - Antenatal care, prevention of early stage pregnancy, awareness of breastfeeding practices, and routine health check-up are the critical aspects that must be considered to effectively manage the public health measures.

Proper agriculture - Diversification for planning of plants with the help of seeds can make the option open for food availability. As a result the household provision can be managed and the nutritional requirement for pregnant mothers and below-five child can be managed.

Promoting a healthy family life - Health promotional events must ensure that community members are involved for the gain and betterment of health. As a result, they can be made aware of the fatal consequence and benefits associated with proper health management.

Question 6. Identify and discuss a successful nutrition program in your population.

Answer: One of the most active and successful nutrition programs is the Sustainable Undernutrition Reduction in Ethiopia (SURE!). It is a government run multiple sector program that aims at improving nutrition content in each individual, especially children (Moss, Bekele, and Salasibew 2018). In order to achieve this, the program mainly focuses on the health sectors and agricultural sectors. The program was initiated with an objective to minimize stunting by 26% till the end of 2020 in four most affected rural destinations of Ethiopia, that is Amhara, Tigray, Oromia, and Southern Nations, Nationalities, and People's Region. In this context, the SURE interventions are planned to implement in 150 districts of these four agrarian regions that would cover around 1.5 million stunted children (Berbada et al 2017).

Question 7. Considering the UNICEF framework at what level does this program intervene?

Answer: According to the UNICEF framework, there are three immediate causes that result in child stunting, inadequate food intake, reduced birth weight, and childhood disease (Moss et al 2018). These causes are interlinked with each other, as discussed in the report by Berbada et al (2017). Poor health burden causes low food intake, which again increases the risk of vulnerability to diseases. The primary root associated with each of these proximate causes lies at the household level. These include low income, large family size, inappropriate feeding during pregnancy, and lack of healthcare to the infant. Thus, SURE aims to intervene to modify the behaviour of family members with respect to feeding practices, reproductive choices, and hygiene practices (Berbada et al 2017). In this regard, the program is involved in improving the educational system, healthcare system, water, and sanitation system, and providing financial support. It also provides training allergic to nutrition intake, dietary, and agricultural practices.

Question 8. What are the key components that make this program successful and why?

Answer: The key components involved in the SURE Program developed by government in conjunction to other non-governmental agencies includes:

• Enhancement of nutrition in local community which addresses insufficientbalance ofeating as well as domesticnutritional diversity (Moss et al 2018). This is achieved by providing counseling new-born and adolescentserving and information regarding nutrition-sensitive agriculture.

• Thereinforcementof systems is another component that aims at combining health and agriculture extension platform, by developing an information system, human resource capabilities, and data management.

• The final component is the development of a justifiable multiple divisionmanagement tool in order to give dietaryassistances that are responsive to societies and administration leadership (Moss et al 2018).

Question 9. How does your program link with other programs in your population that aim to address the identified nutrition problem?

Answer: The SURE program works in coordination with other relatable programs working in Ethiopia towards mitigating the issue of malnutrition. The chosen program has been identified to work with the National Nutrition Program (NNP) towards addressing the determinants of undernutrition (Karim, Flora, and Akhter 2011). Both of the program aims to accomplish the commongoal of lowering the rate of stunting among children below the age of 5 years in specifically selected areas. The prevalence of stunting has been proposed to reduce by 26% between the years 2015 to 2020 (Moss et al 2018). According to the latest report, positive changes have been noticed with children from the age of 6 months are introduced to nutritional food along with continued breastfeeding (Karim et al 2011).

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Question 10. What recommendations would you make to improve the program?

Answer: There is no doubt that with the implementation of the SURE program, there has been noticeable and positive changes in the health of children in Ethiopia. However, there are still some improvements required to manage the intervention strategy effectively.

Promote collaboration - the collaboration between the development team (manages market facilitation and humanitarian) and the emergency team (manages relief intervention) to distribute the workload.

Supportive organizational culture - prior to the implementation of the strategy, the particular nutritional problem and its root cause should be identified (Wirth, Matji, and Woodruff 2017). This would help the program developers to design effective strategies.

Clear communication - clear and friendly communication with local people during the training sessions we help them to understand and accept the required change in behavioral practices.

Frequent funding - as SURE is a government operated the program, thus the Ethiopian government should provide multi-year funding along with budget flexibility for a better intervention strategy (Wirth et al 2017).

Visits and promotion of health in locality - Highest priority must be given to this issue, which in turn will help in attaining healthier habits among the community members. Correspondingly, the burden of undernutrition and diseased state within the community can be managed.

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