Case Study on Issue Related to Nutrition and Its Solution

Question

Task: This assessment is a case study on a nutrition problem in a specified population and includes analysis and discussion of the scale, consequence and cause of the nutrition problem and an analysis of a successful program that aims to address the nutrition problem.

Chose a population that you are interested in. This could be a country or a region in a country or a specific population (e.g. pregnant mothers, school-aged children) in a country or region. The population must be large enough that there is health and nutrition data available for the specific population and that there is a program that has been evaluated and has been shown to successfully address the nutrition problem.

For your population;

• Outline the nutrition situation and identify the major nutrition issues in the population indicating which groups are most vulnerable and why.
• What are the consequences of the nutrition problem. Consider health, social and economic consequences.
• Discuss and identify the causes of malnutrition (over or under) and state the level at which they act. Use the UNICEF Framework for Under-nutrition to map the cause of malnutrition.
• Consider how the various factors impacting on the nutrition situation are connected and how they are influenced by one another.
• Considering evidence-based interventions what are the priorities for action to address the identified nutrition problem?
• Identify and discuss a successful nutrition program in your population.
• Considering the UNICEF framework at what level does this program intervene?
• What are the key components that make this program successful and why?
• How does your program link with other programs in your population that aim to address the identified nutrition problem?
• What recommendations would you make to improve the program?

Note:

• Include health and nutrition data to support your case study.
• Your chosen program does not have to address the whole problem but can be a component of a broader mutli-sectoral approach
• Chose a program that has been evaluated so you can demonstrate impact of the program on the nutrition situation.

Answer

Introduction
Nutrition plays an important factor in identifying, the extent by which diseases and conditions can be prevented with the inclusion of a healthy diet. Healthy nutrition also assist in the identification of certain diseases which can be due to the deficiency of certain dietary factors, poor diet, intolerance of certain types of food and food allergies. It has been observed that an increase in the malnutrition has lead to closely linked diseases and disability thereby resulting in death. There were also several situations where due to malnutrition of the pregnant women results in prenatal and infectious disease in addition to the chronic diseases. Vitamin A deficiency is been seen in large numbers amongst women. According to WHO which is referred in this case study for nutrition, around 9.8 million pregnant mothers are found to be suffering from the night blindness in addition to diseases like anaemia, weakened immunity and increased risk of morbidity and mortality.

Outline of nutrition situation
The level of malnutrition is multifaceted in Somalia. The effect of malnutrition has been found to affect the pregnant mothers, infants, adolescent girls and young children. This results in the restriction of the development and prosperity of the nation (Farah, Hasan and Gichuki 2019). The situation of the women and children reflects a violation of the rights of the children for the survival and proper development of the health. Although with the recent five years UNICEF has been reporting an improvement of the condition, however, the pregnant women are found to still suffer from the multiple nutritional deprivations. According to the CARE organisation, work may for the improvement of the condition of the expecting mother in Somalia through donations providing assistance to lactating and pregnant mothers in the drought-stricken areas of Africa. It was observed that around 12 million people required humanitarian assistance in the areas which included Ethiopia, Kenya, Djibouti and Somalia. It was estimated that around 3, 60,000 pregnant women and one in every five young girls in their reproductive age are suffering from acute malnutrition. Compromising of the mother’s health have resulted in the malnourished children and children whose total body weight is less than the total birth weight of the children.

During pregnancy, if the mother suffers from malnutrition and during the first two years of the life of the child, it results in the negative impact on the future and development of the child. The children are found to be deprived of essential nutrition which has resulted in the stunted growth, proper cognitive development and lower levels of immunity for the diseases (Kinyoki et al. 2018). When in the prenatal years and in the first 100 days of the life of the children they do not receive adequate food, it results in the damage of mental and physical condition of the body and also prevents in the future potential of growth of those individuals. In many areas of Somalia, malnutrition existed as a chronic condition which got exacerbated during the drought seasons of the summers. In Somalia, there were 86000 pregnant women who were found to malnourished due to the drought, but it is essential for them to have adequate nutrition so that they can increase the nutritional stores in their body. This will results in the proper nourishment of the infants especially when the infants are born and depend only on the breast milk as observed in this case study for nutrition. The breast milk for the infants was found to be highly nutritional and protect the infant from disease and malnutrition.

Effect of the nutritional problem (Health, Social and Economic consequences)
Malnutrition has been found to affect the micro and macro level in society. Due to the increase in the unemployment and lower wages in addition to the lack in knowledge of the individual in Somalia have resulted in the insecurity of the household food, lack of care, lack of a healthy environment in the household and lack in the health services. The amount of nutritional food required in a household could not be accessed by most of the families in Somalia because of poverty. This has resulted in an increase in diseases and morbidity, a disability which has contributed to the health care cost which the people could not afford (Kinyoki et al. 2016). The advent of the malnutrition at the very early stage o the women in Somalia have been found to have a spiralling effect which has deepened the influences caused by poverty. Poverty in the individuals of Somalia has completely entrapped the individual as well as society. With the decrease in the investment and decline in the life condition, the individual cannot escape from the situation which continues to the adult stage of the individual. For example, if the pregnant mother faces a lower level of nutrition followed by lack of adequate nutrition to the foetus and their growth within the first two years, as a whole will completely jeopardize the health of the adults.

Lack of nutrition has also found to have affected the economic growth which has also perpetuated through poverty. With the increase in mortality and morbidity, there was a loss of human capital and a decrease in the productivity that has affected the economy. At the level of the macro-economy, it was calculated that with the loss of 1% in the adult height due to the malnutrition of the children resulting in the stunted growth have found to show 1.4% decrease in productivity (Grijalva-Eternod et al. 2018). The country also suffered from indirect effects like a decrease in the cognitive function of the individuals which resulted in the lesser number of individual taking school education. Due to the lack of adequate education, people lack skills and fail to join the workforce. These again further add to poverty and malnutrition.

Discussion and identification for the reason behind malnutrition (UNICEF framework)
Malnutrition is a condition which has increased its seriousness in Somalia, especially amongst pregnant mothers. This is caused to the availability of the adequate nutrients which is essential in order to meet the requirement of her body (Izudi et al. 2017). Lack of adequate nutrition has found to seriously affect the vital organs and affect the proper functioning of the body of the affected women. The cause of nutritional deficiency in pregnant mothers can be because of various reasons. It can occur due to the low nutritional diet as the family has a lower income in society. Sometimes due to the malnutrition, there are painful teeth or mouth may appear which will prevent the individual to consume food. The expectant mother can suffer from several chronic infections as well as depression which have led to the malnourishment of the mother as well as their children. Inadequate intake of food and lack of adequate calories in order to meet the demands of the pregnancy can also lead to malnutrition of the expecting mothers.

Maternal malnutrition has been found to create a risk for the gestational anaemia. In addition, other diseases which include hypertension, pre-term delivery, miscarriages and maternal mortality have also found to affect the expecting mothers. Further, the infants who are born from the malnourished mothers were found to have lower birth weight. Also, retardation in the intrauterine growth of the foetus has a lifelong consequence on the health and the quality of life lead by the child (Goudet et al. 2017). According to the framework of the under-nutrition and malnutrition by the UNICEF, the condition has been explaining occurs due to the lack of proper intake proper diet and leading an unsatisfactory diet. The conceptual framework highlights the various factors in respect to the human and environmental conditions, social, economic conditions and also certain ideological factors that affect nutritional level amongst the pregnant mothers in Somalia. The framework relates the structure with the different social and organisation levels in the country (Krishnamurthy, Lewis and Choularton 2014). These are the factor which affects the individuals, related families, community as well as the nation. The conceptual framework created by the Food Security and Malnutrition emphasizes the economic and biological approach in order to achieve an inter-disciplinary condition which will ensure the security of food and nutrition to the women and the children.

Figure1: Conceptual framework by UNICEF for under-nutrition of pregnant mothers

Interconnection of the various factors impacting on the nutrition and the intensity at which they influence each other
There are several factors that affect the nutritional status of an individual. Food accessibility, health, availability of drinkable water, sanitation and proper hygiene practices are some of them. In most of the families in Somalia, the primary caregiver was the woman of the family. Hence women play a very important role in maintaining the nutritional status of the family (Gee, Vargas and Foster 2019). The various factors and their interrelation in between them which lead to the malnutrition is:

• Care includes an adequate amount of time and attention provided to expecting mothers. They play an import role in maintaining the nutritional status of the expecting women In addition adequate care also includes various household works like cooking, presence of adequate nutritional food and requirement of the adequate consideration of the importance of the health in pregnant women is essential. Additionally, complementary healthcare for the expecting mothers, breastfeeding mothers, hygienic preparation food, and development both psychological and social is necessary for the development of a healthy child.
• Food production and its availability not only can assist in protecting the women and the children form under-nutrition and death but also have the ability to generate the economy. Agriculture can help in retrieving the home consumption and also increase the income of the family.
• Health, water, sanitation in addition to hygiene is important to maintain the proper health of the expecting mother. It has been observed that the poor health of the individual leads to a lack of the ability to absorb nutrition (Mohamed et al. 2018). The household of an individual is usually determined with the level of nutritional deficiency in the individual.
• Dietary needs for every individual are not the same and differ from person to person. The circumstances of an individual are capable of driving the total energy in addition to the nutritional requirement. Improvement in the dietary condition of the individual can be categorized into labour and physical exertion with issues related to sanitation and environment.

Figure 2: Income versus the dietary energy of the individual in African countries
(Source: Mohamed et al. 2018)

The priorities for addressing nutrition issue (Evidence-Based Intervention)
With the increase in the number of years, there is an increase in the number of deaths caused due to malnutrition in Somalia. There are in between three to five million deaths due to under-nutrition in Somalia every year. Insufficient diet is a part of the daily situation for the pregnant women and children of Somalia. Also, under-weight women carrying babies were observed where the child later conceived chronic disease after its birth (Ma’alin et al. 2016). Thus insufficiency of diet and under-nutrition creates a medical emergency. Increase in the Malnutrition amongst the pregnant women have weakened their immunity and have caused the death of children bore by them and at the time also results in the death of the pregnant mothers. Some of these diseases are like pneumonia, diarrhoea, measles, AID, malaria which till now have cause death of more than 1, 50,000 children and women in between the year 2006 to 2007.

The current approaches which are understood by the different organisation to work against the malnutrition amongst the Somalia pregnant women and children are found to have severe limitations. In spite of their contributions against child mortality and maintaining of the long term health of the individual in addition to the treatment and prevention for the malnutrition, highly nutritious food were not available for a larger mass of the people (Abera, Dejene, and Laelago 2017). It is essential for the organisation to take initiative in educating the people so that a change in the behaviour amongst the people of Somali can be observed. This will help them to take proper choices related to the food, essentiality of breastfeeding of the infants and proper nutritional intake by the pregnant mothers.

Identification and discussion of the nutrition program of the selected population
The main purpose of the nutritional program as discussed in this case study for nutrition will be undertaken will aim at increasing the adequate nutritional intake by the mother and the weight management. If the mother gets adequate nutrition, then the infant will also be able to get enough dietary protein and nutrients from the breast milk of the mother (Chinjekure et al. 2018). The program will be a community based nutritional program. Distribution of highly nutritious foods which are ready to use also known as RUFs is done to the pregnant mothers and the children. This will help in the affecting intervention of nutrition. Several therapeutic treatments should be given to the expected mothers in Somalia so that they can be supervised properly before they are giving birth so that the mortality rate of the individual are decreased.

Further, as a part of the community-based program, it is also essential for the pregnant mothers to be educated about the safety and hygiene conditions which are essential to decrease the mortality of the fetus (Russo et al. 2008). Most of the condition, it has been observed that pregnant mothers in Somalia prefer giving birth at home rather than affording the expense of the hospital. However, educating the mother in the program will also add to protecting the mother of conceiving various diseases due to malnutrition. Also, they will be aware that an increase in the intake of the proper nutrient will be able to provide adequate nutrition to their child through breast milk and allow healthier growth of the infants.

The level at which the program may intervene with the UNICEF framework
The program on proper implementation will be able to affect the immediate cause and manifestation levels of the conceptual framework of the malnutrition. The immediate cause of the malnutrition is inadequate dietary supplements which lead to an increase in the disease and weakness in the expecting mother. Here providing RUFs to the expecting mother will be able to provide the required nutrition. Adequate nutrition to the expecting mother will reduce diseases in the child and hence will be able to affect the manifestation by reducing malnutrition.

The key components for making the program successful
The key points which the program will succeed in implementing are a healthier nutrient level for the expecting mothers, increase the knowledge of the pregnant mothers on breastfeeding so that they breastfeed infants in between 0-6 months. In addition, complementary feeding of healthier food to the children in between 6-35 months will be essential for the future development and growth of these infants. Providing proper nutrition to the expecting mothers will be able to control certain deficiencies like iodine deficiency, iodine deficiency and Vitamin A deficiency.

The extent at which the program, when linked with another program, is successful
The nutritional program when linked with discussion with the expecting mother to increase the knowledge of the essentiality of proper nutrition will not only help the mother and the child against the issues related to maternal nutrition but also will able to take precautionary actions to prevent further spread of malnutrition. In such case, mothers will be aware of the importance of dietary factors and will bring their children and themselves for weekly checks for the weight, a sign of fever, upper-arm circumference (Mawa and Lawoko 2018). The integration of the lessons with nutrition will be able to prevent malnutrition.

Recommendation for the improvement of the program
Development of a proper budget in order to provide nutrition containing dietary factors to expecting mothers in Somalia:

• It is recommended in this case study for nutrition Integration of the nutrient-specific programs with the primary health program so that the mothers are aware of the diseases caused due to the deficiency of nutrition.
• It is recommended in this case study for nutrition Linking of the malnutrition with other interventions which includes social protection, water and sanitation and agriculture.

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Reference List
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Chinjekure, A., Shams, M.Q., Qureshi, A.B., Safi, S. and Noor, N.R., 2018. Screening for maternal and child malnutrition using sentinel-based national nutrition surveillance in Afghanistan. Field Exchange 58, p.79.

Farah, M.A., Hasan, M.A. and Gichuki, J., 2019. Developing a Common Results Framework for nutrition in Somalia. Nutrition Exchange 11, p.20.

Gee, S., Vargas, J. and Foster, A.M., 2019. “The more children you have, the more praise you get from the community”: exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya. Conflict and Health, 13(1), p.11.

Goudet, S.M., Kimani-Murage, E.W., Wekesah, F., Wanjohi, M., Griffiths, P.L., Bogin, B. and Madise, N.J., 2017. How does poverty affect children’s nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition. Public health nutrition, 20(4), pp.608-619.

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Ma’alin, A., Birhanu, D., Melaku, S., Tolossa, D., Mohammed, Y. and Gebremicheal, K., 2016. Magnitude and factors associated with malnutrition in children 6–59 months of age in Shinille Woreda, Ethiopian Somali regional state: a cross-sectional study. BMC Nutrition, 2(1), p.44.

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Mohamed, A.A., Mohamud, S.A., Mohamud, F.Y., Ali, K.A., Abdulle, F.A. and Hussein, A.A., 2018. Prevalence and Associated Factors of Exclusive Breastfeeding Practices Among Mothers of Infants Less Than Six Months in Galkayo, Somalia: A Community Based Cross-Sectional Study. Science, 6(5), pp.133-139.

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