Framework of undernutrition
Malnutrition is an extremely complex problem. Some of the complexities arise from the fact that nutrition is not a sector in and of itself. Also, the field of nutritional science has many facets and encompasses medicine, biology, sociology, agriculture, economics and education, to name a few. As a result, many different views exist on the problem of undernutrition and what to do about it. In the 1990s, UNICEF developed a conceptual framework for undernutrition, providing a clear depiction of the various factors associated with undernutrition and the distinct levels at which these factors act. This framework has become very popular and still represents at present—with minor changes—the major view on the causes of undernutrition.
Immediate causes
The immediate causes of an individual’s nutritional status are inadequate dietary intake and disease, and the interaction between both. Dietary adequacy in terms of energy and essential nutrients is critical for normal growth and development of children. Infection increases the body’s requirement for nutrients, reducing appetite and lowering the absorption of nutrients from the intestine. Undernutrition and infection often occur at the same time: undernutrition can increase the risk of infection, while infection can cause undernutrition. The period when children are weaned off breastmilk and complementary foods are gradually introduced is a time of high risk of infection. This is due to the increased exploratory behavior of children, bringing them in contact with contaminated materials.
Underlying factors
Underlying factors affecting dietary intake and health status operating at household and community levels consist of 1) household food security, 2) care for women and children, and 3) health services.
1) Household food security refers to the ability of households to ensure sufficient, safe, nutritious and culturally acceptable foods to fulfill the needs of its members to have an active and healthy life. The four pillars of food security are: food availability and food access (referring to physical availability of foods in the households, from home-based production but also from purchases, exchanges or gifts); food stability (reflecting the ability to react to shocks such as environmental disasters); and food utilization (referring to how food is used, prepared and distributed within the households).
2) Care refers to care and health-seeking practices of parents. The care practices determine to what extent proper food hygiene is applied in the household and how sanitation, hygiene, and health services are used. It also includes the time parents have available to play with and stimulate their children in early life, an important factor in their mental development. These practices are dependent on resources such as income and time, as well as cultural factors and attitudes towards food and health. Economic constraints also impact the frequency of feeding and the variety of foods given to the children. The use of good quality sanitation and clean drinking water is crucial to reduce illnesses.
3) Health services refers to the availability of clean drinking water and proper sanitation. Inadequate sanitation and hygiene increases exposure to pathogens and consequent risk of diseases. Health services also encompasses living conditions which include the quality of shelter, exposure to high levels of indoor smoke, and living in proximity of contaminated areas (such as garbage dumps). Access to affordable, good quality health services is an essential prerequisite for good health. Access is often compromised because of long distances to these services, as well as consultation and treatment costs which may deter people from seeking treatment.
Comments