Session 5 Causes of malnutrition & Health assessment.

Session 5

Causes of malnutrition &

Health assessment

Child malnutrition,death and disability

Outcomes

Inadequatedietaryintake

DiseaseImmediatecauses

Inadequatematernal & childcaring practices

Poor water/sanitation &inadequate

health services

Underlyingcauses athousehold/family level

Quantity and qualityof actual resources -

human, economicand organizational -

and the way they are controlled

Basiccauses insociety

Potential resourcesenvironment,

technology, people

Political, cultural, religious, economic andsocial systems, including status of women,limit the utilization of potential resources

Inadequate and/or inappropriate knowledge anddiscriminatory attitudes limit household access toactual resources

* Source: UNICEF, 1997.

Insufficientaccess to

Food

The conceptual framework for analysing the causes of malnutrition

2People Empowermwnt Advocacy & Communal Harmony (PEACH)

Immediate causes of malnutrition

The malnutrition infection cycle

The immediate cause of malnutrition is due to an imbalance between the amount of nutrients absorbed by the body and the amount of nutrients required by the body

This happens as a consequence of consuming too little food or having an infection which either increases the body’s requirements for nutrients or prevents the body from absorbing the food consumed

In practice, malnutrition and infection often occur at the same time because one can lead to another.

A malnourished child, whose resistance to illness is poor, falls ill and becomes more malnourished which reduces his capacity to fight against illness and so on

This is called the infection-malnutrition cycle and is illustrated in figure below


•Loss of appetite•Malabsorption•Increased nutritional requirements

Increased incidence, severity and duration of

disease

Inadequate diet

•Weight loss•Growth faltering•Lowered immunity

The infection-malnutrition cycle


Summary of interactions between malnutrition and the major killers in emergencies

Disease Impact of disease on malnutrition status of individual

Impact of infection on factors which tend to lead to malnutrition

Diarrhoea (e.g. shigellosis)

1. Increased duration

2. Increased severity

3. Increased mortality

•Malabsorption•Appetite loss•Loss of nutrients

Acute Respiratory Infection

(lower tract)



•Appetite loss•Metabolic effects resulting in muscle breakdown


Summary of interactions between malnutrition and the major killers in emergencies…

Disease Impact of disease on malnutrition status of individual

Impact of infection on factors which tend to lead to malnutrition

Measles 1. Increased duration



•Appetite loss

•Decreased levels of plasma Vitamin A

•Prolonged immune suppression resulting in increased incidence of ARI and diarrhoea

•Fever increasing requirements

•Metabolic effects resulting in muscle breakdown

Malaria 1. Some evidence of increased severity in deficiencies of Vitamin A and zinc

•Iron deficiency leading to anaemia

•Impaired foetal development, low birth weight and growth faltering


Underlying causes of malnutrition

1) Food

2) Carea) Caring for and supporting vulnerable groups

b) Child feeding behaviour

c) Health protection behaviour

d) Psycho-social behaviour

e) Caring for and supporting mothers

3) Health


Underlying causes of malnutrition…

1) Food Household food security (HFS)“Sustainable access to safe food of sufficient quality and quantity to

ensure adequate intake and a healthy life for all members of the family”

HFS depends on Access to food Food availability and utilisation by the body

HFS applies to foods available in a particular geographical area through local food production systems; agriculture, fisheries, livestock rearing and foods from hunting.

It also includes Food imported and exported into the region A consideration of seasonal variations in food availability

Food security does not stop short at the availability, it needs to include food access by different households with different livelihoods (means of making a living) and incomes.



1) Food… In emergencies the way people obtain food is often

disrupted(Especially if they have to leave their homes due to conflict or sudden flooding or an earthquake)

In disasters Food stocks are destroyed

(in the home, warehouses and where crops are grown i.e. land, water, forests and grazing ground)

Even abundant of food is available on the market, but families may not be able to afford to buy the food 9People Empowermwnt Advocacy & Communal

Harmony (PEACH)


2) Care Caring practices

“The way community members, including the vulnerable such as children, the elderly and the sick, are fed, take care of, taught and guided”

It is the responsibility of the entire family and the community

Caring practices can be determined by Cultural factors Resources, like income, time and knowledge Attitudes to modern health services, water supplies and

sanitation The values of the society strongly influence the priority

given to the care of children, women and the elderly10People Empowermwnt Advocacy & Communal

Harmony (PEACH)


2) Care…a) Caring for and supporting vulnerable groups Children, the disabled, the chronically ill, the elderly

and those in hospitals or prisons all deserve special care attention

Different cultural norms and economic situations tell-how these caring practices are carried out?

Both formal and informal systems of care exist through institutional care and family networks

In emergency situations these tend to be disrupted and may leave these groups more vulnerable to developing malnutrition



2) Care…b) Child feeding behaviour Alongwith breastfeeding children must be provided with

complementary foods at six months (to ensure optimal growth and protection from infection)

The foods first introduced Family’s financial situation and cultural norms

Changing the diets of infants from a diet based on milk to the family plate

Time consuming Requires extra care

(Around hygiene practices related to preparation and provision of food)

In emergency situations, normal child feeding practices may be disrupted and undermined if care takers are busy with meeting their daily family needs



2) Care…

c) Health protection behaviour In order for children to flourish, they require

essential health care, especially immunizations Cultural norms and quality of health information

and services available influence the way families seek appropriate and timely health care for their children

In emergencies, this is disrupted and carers may not know who to go to for support



2) Care…

d) Psycho-social behaviour

Emotional support and cognitive stimulation is required for optimal child development

In emergency situations It is essential to maintain high levels of

stimulation and interaction between carers and their children (to maximise recovery rates among the malnourished)



2) Care…

e) Caring for and supporting mothers The unequal division of labour and resources in families

and communities that favours men jeopardizes the well-being of both children and women

The elements of care most critical for women during pregnancy and breastfeeding include

Extra quantities of good-quality food Release from heavy labour Adequate time for rest.



3) Health

Health refers to “A range of factors linked to access to health care, safe

water and sanitation” An essential element of good health is access to

affordable, good quality health services and a healthy environment



3) Health… In emergency situations the health environment

often deteriorates rapidly Access to adequate clean water and sanitation

may be adversely affected Displacement may lead to people having to live

in camps and overcrowding, encouraging infectious diseases to spread



3) Health… Access to basic health services determines the extent to which

infection can be prevented or treated Effective treatment should reduce the duration and the severity of

infection Access to health services is determined by physical distance and

cost Costs can include transport costs, medical costs for treatment as

well as time costs for the family member having to attend the clinic and leave other tasks undone

In emergencies, there is frequently a complete disruption of health services so reducing access to medicines and qualified staff


Basic causes of malnutrition Basic causes are

Political Legal Cultural factors

These also include The degree to which the rights of women and girls are protected by

law and custom The political and economic system that determines how income and

assets are distributed The ideologies and policies that govern the social sectors

To address basic causes of malnutrition Greater and better-targeted resources and better collaboration are

needed between sections of national governments and between governments and all development partners, including donors, United Nations agencies, non-governmental organisations and investors. Above all, the poor themselves must be a major part of the process


The role of seasonality

All three clusters of underlying causes are subject to seasonal variation

For example Access to food typically reduces prior to the harvest when

workload is also high (for agricultural producers), or prior to the rains when workload finding water and pasture is high (for pastoralists)

The health environment changes according to the temperature and rainfall

The care environment changes as labour requirements alter according to the agricultural cycle. Often seasonal calendars are drawn to illustrate the seasonal variation of various factors affecting nutritional status


Conclusion

Identifying the causes of malnutrition is essential in emergencies to guide appropriate response

All nutrition assessments carried out during an emergency should include an assessment of causes

The conceptual framework continues to be used widely to help understand causes, how they relate to one another and the multi-causal nature of malnutrition


Exercise Q. Common consequences of malnutrition in emergency situations include a) Food allergiesb) Growth failurec) Micronutrient deficiencyd) Reduced ability to work (a)Q. Which of these is not made worse by malnutrition in an individual? a) Increased severity of diseaseb) Increased duration of diseasec) Increased resistance to diseased) Increased incidence of disease (c)Q. The main childhood killers include: a) Iron deficiency anaemiab) Acute lower respiratory tract infectionsc) Malariad) Measles (a)


Exercise…

Q. At which level do the underlying causes of malnutrition have their main effect?

a) individual levelb) household levelc) community leveld) society level (b&C)Q. True or false

Household food insecurity affects all members of the household in the same way (False)

Intra-household differences due to family composition and status affect individuals who have different needs. For example if there is a reduction in food available to the house it is likely to affect children, the elderly and the infirm more quickly than able-bodied adults. However, mothers often decide to forego food in order to be able to feed the rest of the family better, which may mean children are protected but in the long term the health of the mother is compromised which can lead to future children not developing fully during pregnancy, or the mother becoming ill and not being able to perform the many household tasks. Food insecurity affects household members differently at different times.


Exercise…

True or falseAdequate shelter serves to keep people safe, warm and with a sense of privacy that allows them to protect themselves from disease(True)

Q. True or falseThe values of the society strongly influence the priority given to the care of children, women and the elderly, but all societies prioritise the care of children above all else.

(False) Whilst child care is essential in all societies, cultural norms will protect different members of society through

formal and informal systems with different degrees of success. It is essential to understand the care practices to e able to identify the most vulnerable in emergencies who may not be receiving adequate care.

Q. The elements of care most critical for women during pregnancy and breastfeeding includea) Extra quantities of good-quality foodb) Extra rest timec) Extra health cared) Extra vaccinations(a, b, c)10. Which of these are seasonal factors to consider in nutrition emergencies? a) market price of foodsb) migration patterns of wild animalsc) tidesd) vaccination campaigns at health centres(all)


Key messages

1. Malnutrition has many inter-related causes which need to be identified in order to be effectively addressed during an emergency

2. The conceptual framework for malnutrition is a useful tool for understanding the causes of malnutrition. It describes three levels of causality: immediate, underlying and basic

3. The immediate causes of malnutrition in an individual are inadequate food intake and disease

4. The cycle of infection and malnutrition describes how infection leads to malnutrition. Most malnourished individuals also suffer from infections

5. There are three clusters of underlying causes that overlap: food, care and health Food insecurity is about the availability, access and utilisation of food Caring practices are the way community members, especially the vulnerable, are fed,

nurtured, taught and guided Health refers to a range of factors linked to access to health care, safe water and sanitation.

6. The basic causes of malnutrition are related to formal and informal institutions, infrastructure and physical, natural, social and economic resources, and the type of shock that leads to the emergency

7. All three clusters of underlying causes are subject to seasonal variation which can be magnified in an emergency


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Session 5 Causes of malnutrition & Health assessment.

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