Underlying Causes of Malnutrition
Poverty
Poverty is far from being eradicated.
During the last two decades, the number of people effected by extreme
poverty in sub-Saharan Africa has nearly doubled, from 164 million in
1982 to some 313 million as of 2002. Poverty alone does not lead to
malnutrition, but it seriously effects the availability of adequate
amounts of nutritious food for the most vulnerable populations. Over 90
percent of malnourished people live in developing countries.
Lack of access to food
Most major food and nutrition crises
do not occur because of a lack of food, but rather because people are
too poor to obtain enough food. Non-availability of food in markets,
difficult access to markets due to lack of transportation, and
insufficient financial resources are all factors contributing to the
food insecurity of the most vulnerable populations. People are
increasingly dependent on international markets for all or part of their
food supply, particularly between harvest periods. Many people are
increasingly vulnerable due to fluctuations in the prices, as was
recently illustrated during the global food crisis.
Disease
Certain illnesses and infections, such
as tuberculosis, measles, and diarrhoea are directly linked to acute
malnutrition. A combination of disease and malnutrition weakens the
metabolism creating a vicious cycle of infection and undernourishment,
leading to vulnerability to illness. HIV and AIDS have become a leading
cause of acute malnutrition in developing countries. A child infected
with HIV is more vulnerable to acute malnutrition than a healthy child.
Anti-retroviral drugs are more effective when combined with adequate,
regular food intake. So ensuring a healthy diet is an important aspect
of HIV control and treatment.
If the HIV-infected child becomes acutely malnourished, her/his diminished nutritional state will increase the likelihood of infections, and may lower the effectiveness of medications — either anti-retroviral treatment or for other illnesses and infections. When severely malnourished, an individual may not be able to tolerate medications at all. The combination of acute malnutrition and HIV and AIDS thus considerably increases the chances of morbidity, placing the child at a higher risk of death.
Conflicts
Conflicts have a direct impact on food
security, drastically compromising access to food. Often forced to flee
as violence escalates, people uprooted by conflict lose access to their
farms and businesses, or other means of local food production and
markets. Abandoned fields and farms no longer provide food to broader
distribution circuits. As a result, food suppies to distributors may be
cut off, and the many populations dependent on them may be unable to
obtain sufficient food.
Climate change
In 30 years, the number of natural disasters — droughts, cyclones, floods, etc. — linked
to climate change has increased substantially. The effects of climate
change are often dramatic, devastating areas which are already
vulnerable. Infrastructure is damaged or destroyed; diseases spread
quickly; people can no longer grow crops or raise livestock.
According to UN studies in over 40
developing countries, the decline in agricultural production caused
either directly or indirectly by climate change could dramatically
increase the number of people suffering from hunger in the coming years.
Lack of safe drinking water
Water is synonymous with life. Lack of
potable water, poor sanitation, and dangerous hygiene practices increase
vulnerability to infectious and water-borne diseases, which are direct
causes of acute malnutrition.
SOLUTIONS TO MALNUTRITION
Action Against Hunger’s assessment,
treatment and prevention activities are designed and carried out
together with communities and health services. Until recently, children
suffering from severe acute malnutrition (SAM) were treated in
intensive-care inpatient facilities known as ‘Therapeutic Feeding
Centres.’ These hospital-like centres required children and their
parents or caregivers to remain in residence during their month-long
treatment.
The recent development of innovative
food products for treating severe acute malnutrition, known as
Ready-to-Use Therapeutic Foods (RUTF), now permits treatment to take
place in the community at any time and place, resulting in a shift
towards new outpatient treatment programmes. Such programmes, known as
Community-Based Management of Acute Malnutrition, offer severely
malnourished children the opportunity to be treated at home, rather than
in a centre, with family and community support for recovery. Health
professionals assist communities to diagnose nutritional problems, and
oversee community-level activities.
Ready-to-use therapeutic foods
Ready-to-Use Therapeutic Foods have been
developed in the form of peanut-butter based pastes and biscuits that
are nutrient-rich and packed with high concentrations of protein and
energy. RUTFs reduce exposure to water-borne bacteria as they contain no
water. They require no refrigeration and are ready to serve, ensuring
that essential nutrients are not lost by the time the products are
consumed. With no water, heating or preparation required, RUTFs avoid
all of the major inconveniences of therapeutic milk-based products,
which are the standard treatment in inpatient care of severe acute
malnutrition.
CMAM and RUTF have resulted in revolutionary changes in the fight to overcome acute malnutrition by enabling:
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A massive scaling-up of treatment programmes to cover many more malnourished children
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Increased coverage, with broader access to treatment
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A reduction in social costs associated with SAM treatment, as parents and caregivers are able to treat severely malnourished children without medical complications at home, without leaving the rest of the family or foregoing income-generating activities
- Community Outreach
- Outpatient Care: home treatment
- Inpatient Care: hospital or health facility treatment
Community outreach
To reach as many acutely malnourished
children as possible and achieve maximum programme coverage, CMAM
depends on community involvement in all aspects of the programme. Known
as Community Outreach, this aspect of CMAM includes community assessment
of nutritional status, community mobilisation, active case-finding of
acutely malnourished children, and referral and case follow-up.
Community volunteers work directly with malnourished children and their
families. Alongside local health professionals and volunteers, Action
Against Hunger's teams assess the nutritional status of childen and
identify new cases of malnutrition as early as possible, so that timely
interventions can prevent further deterioration. By working in
partnership with local health services, Action Against Hunger aims to
integrate the assessment, treatment, and prevention of acute
malnutrition into national, regional and local healthcare systems.
Children diagnosed with moderate acute
malnutrition are provided with care and support, which may include food
and micronutrient supplements, medical treatment, if needed, and
nutrition advice/education for parents and caregivers. Nutrition
education can include information on optimal infant and child feeding
and care practices, advice on hygiene and sanitation, and the prevention
of illness, and psycho-social support. The weight and height of
children with moderate acute malnutrition are monitored regularly in
order to prevent deterioration into severe acute malnutrition.
Outpatient care: home treatment
Children treated through community-based
Outpatient care represent 80 percent of all cases of severe acute
malnutrition. Those who are clinically stable, have no medical
complications, and still have an appetite, are directly admitted to a
programme of home treatment that is supported by weekly visits to
“stabilisation centres “ (either hospitals or health centres) for
medical supervision. Weekly visits allow health professionals to
evaluate the children’s progress and provide them with a weekly supply
of RUTF for home treatment. The visits also allow acutely malnourished
children to receive preventative measures and treatment for infections,
illnesses, and micronutrient deficiencies (such as antibiotics, vitamin
A, de-worming tablets, immunisations, etc). Follow–up visits can
continue for up to two months, depending on the child's progress and
recovery.
Inpatient care: hospital or health facility treatment
A child who does not have an appetite,
does not gain weight, and/or exhibits serious medical complications is
admitted to a specialised hospital, clinic, or other inpatient health
facility where s/he is treated using therapeutic milk products. Such
children represent about 20 percent of cases of severe acute
malnutrition. When a child with severe acute malnutrition and medical
complications has regained his/her appetite and medical problems have
been successfully treated, s/he is transferred to outpatient care. A
child may remain in inpatient care for four to seven days, depending on
his/her recovery.
