Feeds:
Posts
Comments

I was reading an article recently and it brought to light an interesting point: “According to the WHO, malnutrition is the gravest single threat to global public health.” I think we all agree with this statement due the great effects malnutrition has on other areas of health and development in general. If people are starving, they are going to suffer from more infectious disease. If people are sick and starving they are not going to be able to live a productively and bring an income to their family, so they can buy and make food. The list can go on and it is easy to get depressed about the subject and feel overwhelmed. Where on earth do we start if we want to try to provide a successful intervention for malnutrition? I do not think there are any easy answers. This is a question that world leaders and development workers continually ask themselves. I do not think there is a shortage of good intentions in this world. For the most part, people do not like the idea of millions of people suffering from malnutrition and hunger. Who wants to hear about almost 16,000 children dying every day from hunger-related causes? It is just difficult to transfer these good intentions into actions that truly aid those suffering with sustainable development.

This book has some very good ideas about development that can be applied to interventions for malnutrition.

I want to talk about some ideas from a book I read last year for one of my classes. Don’t be fooled by the title. You can find most of it online here if you are interested in reading more. I want to point out the subtitle, which sums up the point of the book in one sentence: Why the West’s efforts to aid the Rest have done so much ill and so little good. Check out this article about the book for a summary and basic analysis. By using statistics, facts, and pointing out some hard truths, William Easterly discusses development work, including malnutrition intervention, in the past and how it is so often ineffective. If the world has the abundance of wealth that is does today, why are so many children still dying from nutrition related states? He argues that in order to truly aid those suffering in poverty and poor health,  we need to take on a “searchers” mentality. Searchers take into consideration the local customs, traditions, and needs and find ways to provide interventions that are appropriate and effective. We need to realize that it may not happen with fireworks and glory all at once, but that piece by piece, real improvement can be done. This approach is compared to that of “planners” which consists of coming up with a way to solve the problem in the West, and imposing it on people despite differences in culture, society, and knowledge. It almost always fails, and yet no one is held accountable for this failure of expended funds. The novel The Poisonwood Bible by Barbara Kingsolver highlights this idea of planners in the Congo. For instance, searchers would try to come up with an intervention for malnutrition by addressing a specific situation in a village by asking questions like why are people hunger? who is suffering from malnutrition? what cultural factors are affecting the reasons people are malnourishes? what can be done to change these reasons that will be culturally understood and accepted? what are the little things that can be done that will make a big difference? how can we increase food production? etc etc etc. One of the largest ironies about development and interventions is that lots of money has been spent in the past few decades and still there are millions of people suffering. Easterly calls for more accountability and a grass-roots smaller scale approach to development. We may not be able to stop malnutrition completely, but there are ways, that are not that complicated, to improve and decrease the negative effects of malnutrition. Malnutrition holds a key place in global health. Improvement in nutrition is an automatic improvement in overall health and productivity. These basic needs must be met before other issues can be addressed with development.

I hope you have learned a few things about malnutrition from this blog and that it has made you think. There are no easy answers. Luckily, the world has the most resources it has ever had and now is the time to join the millions of others that are taking action. If you are concerned or care about this subject, learn more! Research, get involved with one of the hundreds of organizations that are out there trying to make a difference, educate others, and don’t give up. We will make a difference in the world whether we try to or not, let’s make sure that difference is for the better. Thanks for reading!

Intervention

So far we have discussed the basics of malnutrition, the importance of prevention, and the global effort against hunger and poverty in the form of the MDGs. These next two posts will try to focus on interventions for malnutrition and hunger. There is a wide scale variety of possible interventions for this issue. Though there are inherent distinctions between different interventions, they all seem to have their place. They range from spreading awareness and signing online petitions, like in the 1billionhungry project, to strategies to build bottom-up interventions on the ground in developing countries, like in The Hunger Project. As we compare these two extremes, try to think about which one actually helps more and feel free to voice your opinion. Both take very different approaches  Part of creating new ideas and providing a successful intervention requires critiquing and learning from what has and is being done.

A recent article posted on the FAO website caught my attention this morning. It’s title is “Over 3 million people urge government to act on hunger: ‘The 1billionhungry project’ petition is presented to world governments.” It is a petition and campaign to allow people’s voices against hunger to be heard and to bring the topic to the forefront of governments’ and leaders’ agendas. Recently, for the first time in world history, there are roughly 1 billion people in the world who suffer from chronic hunger. This is just a small step away from chronic malnutrition. The world also has the resources and technology at this time to pull together and do something about it. The project has famous actors and athletes as well as world leaders speaking out against hunger and encouraging individuals to sign and get involved through social media. This is a way for individuals like us who feel strongly about this issue have our voices be heard. Watch this video to get more of an idea about their approach to the situation:

This project aims more at the raising awareness and getting numbers to try to let world leaders and governments take action against hunger. This is a good goal and I think a lot of good can come from this, but at the same time I think it leaves a lot wanting. Are the governments of these countries able to makes the necessary changes? Is a top-down approach effective? Do the leaders know what the people need or is there too much corruption or conflict? Will having millions of people sign a petition actually be effective at influencing world leaders? Maybe, maybe not. I am interested to see how this campaign pans out. I think this is a good step and is a good example of how we can use technology and social media to make a difference. Check out the 1billionhungry website to find out more about the project, what they do, and how you can get involved.

On the other end of the spectrum, there are organizations like The Hunger Project that focus on a more grass-roots approach to malnutrition and hunger intervention. Instead of trying to influence the government and leaders, they focus on empowering the individuals that are hungry to make decisions and actions to get themselves out of poverty and hunger. They realize that sustainable change does not always come from the top with handouts but can come from mobilizing people to reach a state of self-reliance. Volunteers from around the world work together at the village level in 13 countries. In Africa they use the epicenter approach and have projects that include increasing access to health care, education and  ways to provide income. In India they help women gain influence to improve issues of health, education, and sanitation. In Bangladesh they are training volunteers to initiate projects on issues of early marriage, nutrition, water and sanitation, women’s rights, and income generating activities. As we discussed before, to address malnutrition, many other issues need to be considered. This program, unlike the 1billionhungry project, focuses on the people who are suffering and empowering them to change that rather than waiting for governments and leaders to do something. I think both efforts are necessary though if we truly want to cover all our bases covered and intervene in global malnutrition. Individuals need to be empowered to make better health decisions, but they can only do so much with out the help from their government. We need both of these types of projects, but I think there would be problems if we only had one or the other. What do you think? Is one approach better than the other?

The Worldwide Campaign to End Extreme Poverty by 2015

Most of us have heard about the Millennium Development Goals, often called the MDG’s, but a few of us may not know exactly what they are. This is what the Millennium Campaign website has to say about the goals:

“End poverty by 2015. This is the historic promise 189 world leaders made at the United Nations Millennium Summit in 2000 when they signed onto the Millennium Declaration and agreed to meet the Millennium Development Goals (MDGs). The MDGs are an eight-point road map with measurable targets and clear deadlines for improving the lives of the world’s poorest people. World leaders have agreed to achieve the MDGs by 2015.”

The MDG’s address issues in these eight areas: End Hunger, Universal Education, Gender Equality, Child Health, Maternal Health,  Combat HIV/AIDS, Environmental Sustainability, and Global Partnership. Though the main goal is to end poverty, many of the goals deal with issues of health. Ending hunger and issues with malnutrition are address in the first area.

I am not sure about you, but I always get more things done when I write out specific goals and have a time limit set to meet them. I think it is great that the world realizes this and has made specific goals with a time limit to address issues like poverty and global health. This is a good step, but it still leaves a lot of questions. Are these goals what the people of the world need? Says who? Are the goals even reachable? If we stress about meeting these goals will other important aspects of good development be overlooked? Are there important areas the goals do not address? If the goals are not met, who is held accountable? Is there any accountability? What do you think? Are the MDG’s a good thing, or is there something better?

I attended the America Public Health Association Annual Conference a few weeks ago in Denver and was able to attend a lot of sessions on the MDG’s and find out what is happening around the world today. A lot of progress has been made but there is still a long ways to go. There are no easy answers but not all is lost. People are standing up and letting their leaders know they will not no for an answer. Check out the video about the MDG’s on the video page. Many experts feel the goals are the best thing we have going for us and there is a need to spread awareness and call for action. At the conference I was introduced to Midego, Inc which is an organization that helps get people involved and calls for action now to meet the MDGs. Sometimes this line of work is overwhelming because there just seems like too many people are going to bed hungry each night and suffering the effects of acute malnutrition for one person to make a difference. Midego realizes the power of many individuals with good intentions that take action. And the time to take action is now. A big part of addressing global malnutrition is spreading the word about the need and letting people know about these important issues. This is something we all can do. Decide to do something today and take a stand against hunger and malnutrition. Thanks for reading!

Prevention

I think by now, we all have a good idea of what malnutrition is, the effects it can have on individual’s lives and the global burden of malnutrition. I now want to shift focus and address what is being done about this situation, and what can we do about it as educated young citizens in a developed country with many resources. In this post, I want to focus on prevention. Treatment and what is being done to help those already suffering from malnutrition will be discussed in a later post. Fatima, is 15 months old girl and lives in the urban slums outside of a city in Sub-Saharan Africa. This is a chart of her clinical course towards malnutrition and is classic for other children all around the world facing this issue. When portrayed like this, it is easy to see how many different things affect malnutrition.

I wanted to use this chart to illustrate the need for an integrative approach necessary for prevention efforts. Many things are at play here and in order to truly have a lasting effect on preventing malnutrition, all of them must be addressed. I don’t want this to be overwhelming. I often ask myself how can all of this issues, from political, to national infrastructure, to economical, to education, to access to health care, to climate, and the list goes on and on, be fixed? I don’t believe there is a shortage of good intentions in this world, we just have to be effective with our efforts, which is much more easily said than done. The same report on Marasmus where I retrieved this chart said this about prevention, and I think it sums up nicely the point I am trying to make:

“Inappropriate development, poverty, armed conflict, mishandling of funds, lack of education (particularly women’s illiteracy), as well as limited access to medical care represent the primary underlying causes of malnutrition. The best preventive strategies should address these underlying problems.”

Who would have thought that something that seems simple on the surface, like malnutrition, can be so complex and caused by so many underlying problems. Giving people food is not the answer. I know this sounds redundant, but if we want to stop malnutrition and its effects, we must prevent it from occurring in the first place. We must realize that stopping malnutrition is not going to happen all at once; it is going to take a long time and a lot of hard work. Just because it seems overwhelming and that there is so much to be done, doesn’t mean that efforts to try to fix one small thing aren’t worth it. They are. An education program to help women learn how to read and manage funds isn’t going to solve the whole problem, but it will help. Providing better access to medical care isn’t the only solution, but it will surely help. And we have good news. The world is working together to address these issues, along with others that will improve overall global health. Expect a blog post on this coming soon! Great progress has been made all over the world in alleviating poverty and improving quality of life in the past few years. People are working together to make a difference. Check out this article to see what Brazil is doing to fight hunger and prevent the effects of malnutrition. They are having success and the article is really worth looking at. Another point I want to stress with prevention is that programs need to be culturally aware and address the needs of the specific population they are designed for. Something that works great in Southeast Asia might not work at all in Africa or Haiti. One of my health professors today discussed the need for community based participatory research, or CBPP. In order for prevention, or intervention for that matter, to be successful, the native culture and the native individuals themselves must be involved. If westerners come into a situation of poverty and try to impose what they think should be done, they will be met with little success. We must utilize the local knowledge and expertise and involve them in participatory learning and action methods. As if we needed something else to make this situation more complicated! Though difficult, I know the rewards will be that much more sweet if prevention and development is done in such a way. I still hope this post has made you think, and not get too depressed about the hard things we must deal with if we want to do something about this issue. Don’t be afraid to learn more, get involved, and educate others about what is going on in the world. Thanks for reading!

Before we discuss different interventions and what we can do to help in the global malnutrition situation, I just want to finish covering the basics of what effects malnutrition has on the body. These syndromes are due to specific nutrient deficiencies and their manifestations vary greatly. There are many of them, but I will highlight the most common and devastating ones in this post. Protein deficiency or Kwaskiokor and general calorie deficiency or Marasmus were discussed in the last post. Check out this webpage about Nutritional Deficiency Symptoms for a further overview about specific nutrients. Click on the syndrome to find out more about that specific disease. The world regions page has more information about places in the world that often suffer from these specific disease and others.

Iron-deficiency anemia: This is the most common mineral deficiency and includes symptoms of extreme fatigue, pale skin, weakness, headache, dizziness or lightheadedness, cold hands and feet, irritability, inflammation or soreness of your tongue, increased likelihood of infections, brittle nails, irregular heartbeat (arrhythmia) and poor appetite, especially in infants and children. Foods that have a high level of iron in them are meat, eggs, dairy products or iron-fortified foods. For proper growth and development, infants and children need iron from their diet. If there is chronically not enough iron in a person’s diet, they can experience growth and heart problems.

Endemic goiter: this syndrome comes from dietary iodine deficiency. Without iodine, an individual’s thyroid gland will swell, and can become quite large and hindering. Symptoms that may occur include a visible swelling at the base of your neck, a tight feeling in your throat, coughing, hoarseness, difficulty swallowing and difficulty breathing. The Mayo Clinic page on goiters says “In the developing world, people who live inland or at high elevations are often iodine-deficient and can develop goiter when the thyroid enlarges in an effort to obtain more iodine.” There are a variety of medications and surgical treatments are available, though not often in developing countries.

Beriberi: disease associated with thiamine deficiency, or vitamin B1 deficiency.  There are two types: Dry Beriberi affects the nervous system and Wet Beriberi affects the cardiovascular system. Symptoms include loss of feeling and muscle control, confusion, pain, shortness of breath, and increased heart rate. If untreated with supplemental thiamine, death often occurs. There can be congestive heart damage and nervous tissue damage.

Pellagra: this disease occurs with niacin (vitamin B3) and/or tryptophan deficiency, which is an amino acid. It is common in parts of the world where people have a lot of corn in their diets. Symptoms include delusions, diarrhea, inflamed mucous membranes, mental confusion, and scaly skin sores.

Scurvy: associated disease with vitamin C deficiency. Vitamin C is used to maintain healthy connective tissue in the body. Symptoms of scurvy often include general weakness, anemia, gingivitis or gum disease, and skin hemorrhages such as widespread bruising from broken blood vessels. This was associated with sailors during the 1700’s and can be cured by eating citrus fruits and other sources of vitamin C.

Rickets: disease from prolong vitamin D deficiency that results in the weakening and malformation of bones. Vitamin D is necessary for calcium and phosphorus to be used to build bone in the body and with out it, it can cause delayed growth, pain and muscle weakness. Skeletal deformities such as bowed legs, abnormally curved spine, and breastplate projection can also result. Vitamin D comes from fish oils and eggs, along with fortified milk. Our bodies also make Vitamin D in the sun. Deformities are irreversible and prevention should be stressed.

As mentioned previously, malnutrition can lead to a poor immune status and encourage other disease states and vice versa. For instance, diarrheal diseases can keep individuals from absorbing nutritions from their food and can lead to malnourishment. However, this post is going to be about what diseases are a result from malnutrition, usually in the form of a nutrient deficiency. Some are more common than others, some are easier to prevent  and others can be completely treated by simply adding the missing nutrient to a person’s diet. The two syndromes associated with chronic malnutrition in general are Kwashiokor and Marasmus. There has been a lot of research on both of these conditions and their effect on quality of life. They are both form of serious protein-energy malnutrition, or PEM. According to the WHO, 49% of the 10.4 million deaths occurring in children younger than 5 years in developing countries are associated with PEM. There are numerous other conditions associated with particular vitamin or mineral deficiencies and will be discussed in a later post. Click on the name of the disease for more information about that syndrome in particular.

Kwashiorkor: a disease of dietary protein deficiency. This disease is common in poor countries where diets, especially in children, do not have adequate amounts of protein. The most common symptom is a protruding stomach caused by edema or swelling from the imbalance of nutrients in the body. Other symptoms include decreased muscle mass, failure to gain weight, fatigue and diarrhea. It can also lead to increased infection due to a damage immune system. Treatment includes increased calories and protein and depends on the severity of the disease. Treatment earlier on generally has shown better success. If a child goes without treatment, it can be life threatening and there can be permanent mental and physical damage.

Marasmus: chronic undernutrition and protein and/or calorie malnutrition. Marasmus is characterized by the

general wasting of the body and shrunken appearance. The syndrome is always associated with a negative energy balance that can be cause by a number of reasons and is the adaptation of the body faced with insufficient energy. Symptoms include lethargy, decreased basal metabolism,
slowing of growth or stunting and weight loss. Once again, these conditions are oftenassociated with numerous infections and a compromised immune state. Prognosis is generally positive if there is proper treatment and follow-up care. Treatment usually includes in-patient care with complete nutrition intervention methods. Especially if severe deficiency occurs in early infancy, there can be permanent developmental disability.

Both of these conditions and PEM go hand in hand with malnutrition and its effects on a global basis. A comprehensive paper on eMedicine about Marasmus and PEM said this about the subject: “PEM results in not only high mortality (even for hospitalized children), without any improvement over the last 2 decades, and also results in morbidity, stunted linear growth, and compromised neurological development. The social and economic implications of PEM and its complications are incalculable.” This is just a little taste of what negative effects malnutrition can have on the human body. Real medical interventions are necessary along with social interventions to prevent the reasons for malnutrition in the first place. This is no easy task but one that requires the world’s attention.

Protracted Crisis

The burden of malnutrition is not equal around the world. Some areas are particularly more affected than others, even within developing countries. I found an article this week that pointed our 22 countries that have recently been defined  as being in a protracted food crisis. It can be found here, please check it out. If you are like me, you don’t know what a protracted crisis is. As defined in the article, protracted food crises are usually characterized by chronic hunger and food insecurity caused by a number of different factors, such as natural disasters, prolonged conflict, and weak governing institutions. This is the first times these countries have been characterized and defined. This is a good step because now interventions and aid efforts can be tailored to address the countries’ specific issues and better long term success should result.  The 22 counties in protracted crisis as defined by the Food and Agriculture Organization of the United Nations are as follows:

Afghanistan
Angola
Burundi
Central African Republic
Chad
Congo
Côte d’Ivoire
Democratic People’s Republic of Korea
Democratic Republic of the Congo
Eritrea
Ethiopia
Guinea
Haiti
Iraq
Kenya
Liberia
Sierra Leone
Somalia
Sudan
Tajikistan
Uganda
Zimbabwe

Source: State of Food Insecurity in the World 2010, p.13

Approximately 20% of the world’s undernourished people live in these countries. That is around 166 million people, which is about half of the United State’s population of 310 million. That is a lot of people. The situations in their countries make it difficult to rectify the many problems, there is a vicious cycle. Organizations called for a reevaluation of how aid is given to countries in protracted crisis. The article said, “Official assistance needs to refocus attention on longer-term solutions by aiming to achieve sustained improvements in the productive capacity of vulnerable countries and strengthening their resilience to shocks, whilst continuing to support life saving and livelihoods protection activities.” Last year, I took a class on international development. The main idea of the course was that successful and sustainable development requires the collaboration of many different specialties, including political science, engineering, health, biology, anthropology, sociology, food science, and international relations to name only a few. Because the nature of these problems are so encompassing, efforts to alleviate them require a holistic approach from multiple areas of specialty.   Hopefully, with more organized and efficient efforts, something can be done for the millions of people suffering from undernourishment.