Discuss about the Nutrition and Malnutrition Issues.
Food nutrition is an important health issue globally and malnutrition remaining a health concern. Malawi as a country also faces the food malnutrition problem with some regions such as Zomba district being areas of concern. Vitamins and minerals deficiency is the key components of malnutrition that are used to estimate the food insecurity in most part of the country. Public health concern focuses on the number of children that are experiencing malnutrition in the District. The following paper explores various aspects of nutrition issues such as anthropometric assessment, micronutrient deficiency and food security from an international perspective.
In order to assess the Anthropometric assessment body mass index (BMI) becomes the basic assessment where body weight and height are used to determine BMI. The ratio between the body weight and height clearly reveal the nutritional condition of the child. The steps involved in measuring the BMI are measuring weight using scale while height is measured using tape. The ratio of weight to height is then calculated. This is used to determine underweight in children as a sign of malnutrition.
Indices that are calculated in anthropometric measurements include weight to height, weight to age and height to age. Firstly, weight to height is used to determine acute malnutrition that indicates body wasting. Secondly, height-for-age is an index for determining malnutrition problem of chronic malnutrition that implies the child is stunting. Thirdly, weight-for-age is another index for measuring the malnutrition problem of any protein-energy malnutrition as a reflection of underweight (Ko et al, 2001).
Some of the indicators that are used in anthropometric are stunting, wasting, and underweight. Firstly, stunting is where the height of children is lesser than their age and is measured in the ratio of height for age. The stunting is due to chronic malnutrition normally protein-energy malnutrition or frequent illness. Secondly, wasting is another indicator for anthropometric and is usually measured in terms of weight for height that reflects low weight as compared to their height. Wasting can be due to starvation or severe disease that causes wasting of the body proteins. Thirdly, underweight is an indicator that shows the child has low weight when compared to their height measured in weight for age ratio. Weight can reduce by time indicating the acute malnutrition status of the child. The scoring system that is used is Z score that measures the distance from median as the proportion of standard deviation. Therefore the cutoff point is -2 Z-score which is 2 standard deviations below international reference median values. In addition, the cutoff compared the difference between well-nourished children from those malnourished (Bhutta et al, 2013).
Prevalence of the anthropometric indicators is used to show health problem in a population. The cutoff that is normally used is ?-2 and ?+2 Z-score that give the prevalence reporting. According to WHO (2011), when using -2 Z-score as the cutoff, various indices are scored giving 2.3% of the population as malnourished. Therefore, 2.3% becomes the baseline for reporting the prevalence of malnutrition as the health problem within the population. For instance, the standard deviation of ?-2 is considered low weight for age ratio and show moderate to severe undernutrition while ?-3 is severe undernutrition. This implies that the overweight in children when using weight for height index is scored at ?+2standard deviation (WHO, 2015).
The two micronutrients deficiencies that will be assessed are vitamins and minerals. The two most important micronutrients deficiencies in the protein-energy malnutrition (PEM) and are known to cause a problem in children in developing countries. In the society with malnutrition, deficiencies of vitamins and mineral cause various diseases or conditions. For instance, Iron deficiency as mineral causes anemia while Vitamin A is also known for serious malnutrition problems in children (Rohner et al, 2014).
Vitamins that are assessed include Vitamins A, B, C and D while minerals are Calcium Folate, Iodine, Iron, and Zinc. The two most important indicators for micronutrient are vitamin A and Iron. Indicator for assessing vitamin A deficiency is blindness and the measurement, for instance, is serum vitamin A level. The mineral deficiency, for instance, iron deficiency indicator is anemia measured by color testing of the blood to determine the hemoglobin estimation. Vitamin A deficiency indicator xerophthalmia and is measured with the cutoff of serum retinol < 0.70 μmol/L (Pee & Dary, 2002).
Micronutrients deficiencies indicators show micronutrient status of the child. The cutoff for Iron deficiency is hemoglobin < 0.70 g/L among preschool children is considered with anemia. According to WHO (2000), 100-109 g/L is considered mild anemia, hemoglobin 70-99 g/L is moderate anemia while lower than hemoglobin 70 g/L is severe anemia. Vitamin A is a crucial vitamin that causes the morbidity and mortality of children have the cutoff of serum retinol < 0.70 μmol/L. while the extreme end serum retinol of ?1.5 μmol/L is considered high (Bailey et al, 2015).
Inflammatory corrected iron deficiency shows the prevalence within the population indicated with < 15 μg/L as a public health problem in general. Prevalence of anemia has been considered to be 11.6±1.0% in public health problem index. In the preschool children < 12 μg/L shows the prevalence and is a public health problem. Vitamin A deficiencies among the population indicate that 2-9% shows mild, 10-19% moderate while over 20% shows severe when assessed in the public health (Black et al, 2013).
The two main food security indicators in Malawi are availability of food per household, food consumption per household, Receipts of Food Aid (cereals). According Onis et al (2006), receipt of food aid can be defined as the amount food especially cereals that are designated as aid from other donors to Malawi. This implies that receipt of food donated to Zomba District from international donors can be used to indicate the food security situation within the Zomba. Secondly, household food availability is used to show the food security status of each household in the district. The household food availability is critical for assessing the food security situation especially in malnutrition situation in places such as Zomba. Thirdly, food consumption per household is another food security indicator that shows the amount of food that each household can consume. The amount of food that can be consumed show the amount of food the family can afford per day. This is translated to the food consumption status of people living in Zomba District (Suchdev et al, 2016).
For the food security indicators, the level where data can be collected depend on the food security indicator. Household food availability and household food consumption are collected at household level while receipt of food aid is collected at the district level. Firstly, household food consumption and household food availability all reflect the food security status of the household and require data collected at the household level. Secondly, receipt for food aid reflects the amount of food that is donated to Zomba District from international donors and the data is available at the district level (Khan & Khoi 2008).
The two selected food security indicators are household food consumption and receipt for food aids. Firstly, receipt for food aid in Zomba District can be collected using qualitative data analysis approaches where the data on food aids donated to the district are collected from the district office from secondary sources such as records, books, computer data bases and electronic sources kept by the district office. Secondly, data on household food consumption on the other hand can be collected by qualitative approaches were sampled households are visited, interview on their food consumption and the data recorded. This may be in form of survey that is conducted per sampled house to determine the amount of food consumed per day (Deitchler, Swindale & Coates).
Food security indicators have both advantages and limitations that are used to determine the food security status. Firstly, using receipt for food aid has advantages such as directly reflect the amount of food donated. Amount of food donated as revealed by receipt of food aid shows the food deficit within the District and can be used for planning food security improvement. The limitation of this food security indicator is that receipt of food aid can be misused by donors as the data is mostly compiled by the donor or the World Food Programme (WFP).
Secondly, advantages of household food consumption as food security indicator are the overall data recorded show the food status of each household. The data collected from the house directly reflect the food security at the house level and reveal the true picture of food security within that location. The data can also be used to estimate the household food consumption within the country as it gives the real per capita food consumption of the country. The limitation of household food consumption is time-consuming to collect the data and analyze. The food security indicator requires household sampling and interview to collect data that is time-consuming.
Conclusion
In conclusion, malnutrition is one of the disasters that affects most children in developing countries leading to mortality. Malawi especially Zomba District being one of the least developed localities within the countries is facing malnutrition challenges with limited food availability and accessibility. The two most common micronutrients indicators are anemia and xerophthalmia that shows the deficiency for Iron and Vitamin A respectively. Some of the food security indicators are household food availability, receipt of food aid and household food consumption.
References
Bailey, R.L, et al (2015), The epidemiology of global micronutrient deficiencies. Ann Nutr Metab.66 Suppl 2:22-33.
Bhutta Z.A., et al. (2013), Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet.; 382 (9890):452-77.
Black R.E., et al. (2013), Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 382(9890):427-51.
Deitchler, M.B., T. Swindale, & Coates, J. (2011), Introducing a Simple Measure of Household Hunger for Cross-Cultural Use. In: Food and Nutrition Technical Assistance II Project A, editor. Washington, D.C.
Khan N.C. & Khoi H.H. (2008), the Double burden of malnutrition: the Vietnamese perspective. Asia Pacific Journal of Clinical Nutrition 17(Suppl 1):116–118
Ko GT, et al. (2001), Body mass index profile in Hong Kong Chinese adults. Ann Acad Med Singapore.;30:393–396.
Onis, M. et al (2006), Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes. Public Health Nutr.;9:942–947.
Pee S, & Dary O. (2002), Biochemical indicators of vitamin A deficiency: serum retinol and serum retinol binding protein. J Nutr.132:2895S–2901S.
Rohner, F. et al. (2014), Biomarkers of nutrition for development–iodine review. The Journal of nutrition, 144(8):1322s-42s.
Suchdev, P.S., et al. (2016), Overview of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. Adv Nutr.7(2):349-56.
WHO. (2011), Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. World Health Organization
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