#$%&'$!()'$*+!,!(-.!//"0! -$12)!.3)4)5*'*1%5!('52%6*! -$12)!"! ! Nutrition and Global Health Chapter 8 The best student-centered learning experience in America -$12)!/! ! ! Topics Item 1 • The importance of nutrition Item2 • Determinants of nutritional status Item 3 • Gauging nutritional status Item 4 • Nutritional Requirements Throughout the Life Cycle Item 5 • Nutrition, health, and economic development Item 6 • Policy and program briefs Item 7 • Future nutrition challenges – Key nutritional needs ! -$12)!7! • WHO (2012) reports that 41.8% of pregnant women worldwide are anemic. At least half of this anemia burden is assumed to be due to iron deficiency, with the rest due to conditions such as folate, vitamin B12 or vitamin A deficiency, chronic inflammation, parasitic infections and inherited disorders. The importance of nutrition • Nutritional status has a profound impact on: • The health of pregnant women and of pregnancy outcomes • Birth-weight of children • Young children’s growth • Young children’s proper mental and physical development • Young children’s overall health in their adulthood ! • UNICEF reported that in lowand middle-income countries, 26% of children under 5 years were underweight in 2008. About 30 % of the children in these countries are stunted. • 35% of all child deaths (3 million children) each year are attributed to nutrition-related causes (WHO). ! "! • Nutrition status has a positive and direct impact on an individuals health status, and therefore it is intimately linked with whether or not children: • Enroll in school • Register effective performance in school • Register regular school attendance • Complete their schooling -$12)!8! • In view of its’ impact on individuals’ growth and development of mental and physical capacities, nutrition has a great influence on people’s labor productivity and prospects for earning income.! !! • Eating well promotes a better metabolism. Stronger metabolism causes your body to digest its food more completely. More completely digested food will provide the body more energy and ability to focus. It will also help distribute more vitamins and nutrients throughout the body. These vitamins and minerals will help the body fight off many of the ailments associated with chronic diseases. The importance of nutrition Cont’d • Poor nutrition is the leading risk factor for the loss of health among the poor, particularly in low- and middleincome countries • The seeds of suboptimal health are often sown in childhood, when many children and teens consume highly processed, fatty, salty, and sugary foods • Proper nutrition helps eliminate excess fat from the body. A diet low in fat and high in fiber and lean meats will cause fat to melt off the body. This is important as fat and obesity often contribute directly to chronic diseases ! • By their 20s, most people are not as healthy as they should be because they fail to get enough exercise or to eat diets rich in antioxidants or other nutrients. • By the time they’re in their 30s, prime time for devotion to family and career, they are often too busy for regular exercise and sufficient sleep. • By their 40s, due to stress, poor diets, and inactivity, they’re ! /! tense, undernourished, and overweight. • At about age 50, most diseases begin to manifest themselves. Many women, for instance, begin to show signs of osteoporosis, and many people of both sexes begin taking one medication or another. Large portions of the population begin to receive regular care for hypertension and high cholesterol.! !! -$12)!9! • Eating well promotes a better metabolism. Stronger metabolism causes your body to digest its food more completely. More completely digested food will provide the body more energy and ability to focus. It will also help distribute more vitamins and nutrients throughout the body. These vitamins and minerals will help the body fight off many of the ailments associated with chronic diseases. The determinants of nutritional status Socioeconomic context of child feeding • • Nutrient intake and the presence or absence of disease are the direct determinants of child survival, growth, and development Dietary intake and the incidence of illness are, in turn, influenced by the underlying factors of household food security, childcare practices and available health care services ! • By their 20s, most people are not as healthy as they should be because they fail to get enough exercise or to eat diets rich in antioxidants or other nutrients. • By the time they’re in their 30s, prime time for devotion to family and career, they are often too busy for regular exercise and sufficient sleep. • By their 40s, due to stress, poor diets, and inactivity, they’re tense, undernourished, and overweight. • At about age 50, most diseases begin to manifest themselves. Many women, for instance, ! 7! begin to show signs of osteoporosis, and many people of both sexes begin taking one medication or another. Large portions of the population begin to receive regular care for hypertension and high cholesterol.!! -$12)!:! • The Nigerian Food Consumption and Nutrition survey (NFCN 2001-2003) reported acute food shortage and substantial weight loss trends with 42 percent stunting, 25 percent underweight, and 9 percent wasting (Maziya-Dixon et al. 2004). Significant variations were reported across rural and urban regions, geopolitical, and agro-ecological zones. The 2003 NDHS showed that rural children (43 percent stunted) are disadvantaged compared to urban children (29 percent stunted) and children living in the North West geopolitical zone stand out as being particularly disadvantaged. Determinants of nutritional status ! • Among the three broad agroecological zones used in the NFCNS 2001-2003, the stunting rate was 58 percent in the dry savannah, about 46 percent in the moist savannah and lowest (27 percent) in the humid forest zone. Similar patterns were reported for underweight and wasting. • Consequences of the Low Status (autonomy) of Women: Autonomy of caregiver has many consequences for child health. The low status of women lowers their influence on resource ! 8! allocation and decision making within the household. They are less able to influence decisions on desired family size, health care-seeking behavior for children, the amounts and types of food fed to children, and the amount of time to spend on child-rearing. Moreover, the discrimination the women faced as girls affects the nutrition status of their children through their own smaller size as adults. Small women have a greater risk of having low birth weight children and—some would argue—of obstetric complications due to smaller pelvic size. The intergenerational patterns are particularly strong for girls. The low status of women leads to an undervaluation of their time and to underinvestment in their education. This in turn leads to wide gender differentials in wage rates for the same activity. There is strong evidence from India that this adult wage malefemale differential is partly responsible for the relative underinvestment in girls (Rosenzweig and Schultz 1982). Girl’s education is described by Ramalingaswami et al. (1997, 16) as the “key of keys” to reducing gender inequalities. • Economic theory suggests that families in which mothers work, especially outside the home, must tradeoff the advantages of greater income against the disadvantages of less time for home food production and supervision of children’s activities, and this tradeoff may result in positive, negative, or no impacts (Crepinsek and Burstein 2004). While several studies are ! 9! inconclusive on the effect of maternal employment on child nutritional status (Leslie 1986; Albee 1994), others have indicated negative impact of maternal labor supply on child nutrition in Africa by reducing time available for household activities related to child development (Glick and Sahn 2001; Genebo 2002). However, Penders, Staazt, and Tefft (1999) while recognizing the possible negative impact of maternal agricultural labor participation on child nutrition in Mali indicated the possibility of using raised incomes to offset the negative impacts. The importance of women’s involvement in productive activities is predicated by the notion that since nutritional problems have their origin in social and economic systems, one of the objectives of a sound nutrition program must be to bring about changes in these systems, particularly at the household level (Rogers and Youssef 1988). And since women have a central role in the health and nutrition of children, efforts to improve nutrition must support women’s capacity to generate and control income while adequate child care can be ensured through existing support systems, through flexibility in work schedule, through adequate alternate care giving, or through organized child-care services. Also when women work, it improves their social status and decisionmaking in the household which are associated with improved maternal and child health outcomes (Parvin, Ahsan, and Chowdhury 2004). ! :! ! -$12)!;! • Childcare practices are themselves determined in part by the ability of caregivers to gain access to economic, human and organizational resources that are necessary to provide adequate complementary foods and care. Determinants of nutritional ! • Socioeconomic status approach is the most dominant theme in the explanation of the association between maternal education and child health outcome. This approach assumes that maternal education is a proxy for socioeconomic status at the individual and household levels (Emina et al., 2011). • In general, the most educated women come from high socioeconomic strata of the society. They tend to have. • better work opportunities and high incomes compared to noneducated women. Educated women are also more likely to marry husbands with high education level, belonging to high socioeconomic class of the society (Emina et al., 2011). In addition, they tend to live in more economically developed areas such as urban areas with access to safe water, sanitation systems, and health facilities. In parallel, children from high socio-economic households with mothers working in formal sectors are well fed; less exposed to infectious diseases, and have access to health services (preventive and curative cares). Therefore, there is an inverse relationship between the mother’s education ! ;! and child under-nutrition (Emina et al., 2011).!! -$12)!*=;0 $# $" BMI rates in South Africa are particularly high especially among females. !# !" &'()* +'*)* ,)-(* ./00(* 12/3' 456(7* 8919 ! China and South Africa appear to be particularly vulnerable to nutrition transitions. This picture has become more complex as the relationship between socioeconomic status and chronic diseases is not a simple cause and effect equation. -$12)!/;! Urban areas in the developing world have higher rates of obesity as they are much further along in the nutrition transition than rural areas. That is not to say that individuals in rural areas are immune, especially women.!! ! Chronic diseases have multiple causes- some of which are deeply influenced by culture. Chronic diseases – truly biocultural • !"#$%&'#()*+,, -.(./'&0,#/,/)&, 0&#*)1. • 2#3+,'4)1.,)(3, '3.(&'&+5 !6)47$.8, 9)")1.:,;)%*'&)(') •
Purchase answer to see full attachment