Thursday, March 23, 2017

Effects of Malnutrition

Text by Emily Rempel
Images as noted


Throughout March, Pop Wuj is spotlighting our Nutrition Program and its mission to create lifelong opportunities for Guatemalans via treatment of early childhood malnutrition.

¡Gracias por su apoyo! Thank you for your support!


If you were to ask one of our many doctors or medical students about the impacts of malnutrition, you would likely receive a flood of information about z-scores, development markers, and a whole slew of acronyms that, if you’re like me, you’d have to Google. I, obviously, am not a doctor, nor a medical student, nor have I even taken a single science class in the last four years. So consider the following a layperson’s explanation of the short-term and long-term impacts of malnutrition, with a bit of a human rights flair.

In 2015 the international community adopted a set of goals aimed at ending poverty, protecting the planet, and ensuring prosperity for all as part of a new sustainable development agenda. These goals are called the Sustainable Development Goals, or more colloquially, the Global Goals.
Image from UN News Centre

#2 of the Global Goals is: Zero Hunger. By 2030, we have committed to ending hunger, achieving food security and improved nutrition, and promoting sustainable agriculture.


Image from GlobalGoals.org

Why is this so important?

Globally, 1 in 9 people in the world today are undernourished.[i] Nearly half (45%) of deaths in children under 5 are due to poor nutrition.[ii] Guatemala has one of the highest rates of chronic malnutrition in the world (at 47%) and the highest rate of child stunting (low height for age) in the Americas, estimated at 47% at birth, 53% at three months of age, and 56% at six months.[iii] Those most severely affected by chronic malnutrition in Guatemala are indigenous women and children. Mary, our Environmental Projects Coordinator, talked about why these numbers are so high and why they affect whom they affect in her latest blog post. Now we’re going to talk about what these numbers and effects mean.

In the short-term:

Many of the short-term effects of malnutrition are obvious and visible; namely, stunting (low height for age), wasting (low weight for height), and children who are underweight (low weight for age).[iv] It has also been identified as a major cause of reduced head circumference.[v] One of the greatest immediate threats caused by malnutrition is its impact on the immune system. Malnourishment can greatly compromise a child's immune system, making them more susceptible to infectious diseases. This is particularly troubling in the communities in which we work, where there are often poor sanitary practices and increased exposure to animal feces, unclean water, and other forms of contamination. There is a reciprocal relationship between malnutrition and infections, which is compounded by poverty: malnutrition increases susceptibility to infections while, at the same time, infections worsen malnutrition by decreasing appetite and increasing demand for nutrients.[vi] For a child experiencing malnutrition, bouts of diarrhea or vomiting can quickly lead to dehydration and rapidly worsen their health.[vii] Additionally, malnutrition coupled with infections or parasites can interfere with the body's ability to absorb nutrients, thus further contributing to poor growth.[viii] In these situations, child mortality is a very real threat.



Conceptual framework on the relationship between malnutrition, infections and poverty. 


In the long term:

Malnutrition remains a significant barrier to sustainable development as it creates a trap from which people cannot easily escape. Its effects are cyclical and permeate through almost all aspects of a person's life. During the first 1000 days of a child’s life, while rapid development is occurring, malnutrition can mean poor outcomes in health, cognitive development, and educational and economic attainment later in life.[ix] Malnutrition has been shown to increase the likelihood of heart disease, diabetes, kidney damage, and anemia into adulthood.[x] Another related consequence of malnutrition, coupled with a weakened immune system, is a lowered capacity to work. Decreased economic productivity, compounded by existing barriers to dignified and fair work, perpetuates poverty. Child malnutrition during the vital years of brain development can cause permanent delays in motor, cognitive, and emotional development. It may also lead to conditions such as cerebral palsy, language and communications disorders, behavioural disorders like ADHD, autism spectrum disorder, learning disabilities and dyslexia.[xi] Of course, the negative impacts of delays in brain development are coupled with external barriers to education, leading to lower scholastic achievement and higher drop-out rates.

As mentioned several times throughout this blog post, it's vital to remember that barriers to health and education already exist for many indigenous communities, outside of the challenges associated to malnutrition. We see an urbanization of services, systemic discrimination, limited funding, and corruption. These barriers are compounded by malnutrition, and vice-versa. It's all cyclical. For example, research shows us that child malnutrition rates are higher for children whose parents have low education levels.[xii] Unsurprisingly, the correlation is even stronger with maternal education levels, given mothers are generally the ones responsible for feeding their children. Again, we usually see low education levels paired with high poverty levels, creating a virtually impermeable trap of malnutrition. Furthering the link between maternal health and child health, malnourished women are more likely to have low birth-weight babies, thus perpetuating the problem across generations.[xiii]

In our projects we see parents who were themselves malnourished as children, who did not receive an education, who are working in low-paying, labour-intensive jobs, who struggle with poverty every day. The next generation thus grows up in the same circumstances, with the same limits to opportunity, with likely the same outcomes. That's why at Pop Wuj we take a holistic approach in serving these communities. We provide nutritional support for children to aid in physical and mental development. Then later on in these children's lives, we provide scholarships to further support their education. Our medical clinics offer ongoing care, from childhood into adulthood, which may otherwise be inaccessible. In this way, we strive to help families break cycles of poverty and malnutrition.

A Nutrition Program participant checks out the goings-on at the project during her checkup in La Victoria
Photo by Emily Rempel

We have 17 Global Goals that we are attempting to reach by the year 2030 and we will not get there unless we take a holistic approach to development. Without action on health and nutrition, not only won’t we achieve goals 2 (Zero Hunger) and 3 (Good Health and Well-Being) but we also won’t meet many of the other Goals, from education and gender equality to environmental sustainability and peace and justice. Please, stand in solidarity with our grassroots efforts against child malnutrition. As Mary mentioned, though our organization may not be able to singlehandedly realize Zero Hunger in Guatemala, we can help make it a reality for some.

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Sources:
[i] UN.org, “Sustainable Development Goals,” http://www.un.org/sustainabledevelopment/hunger/
[ii] UN.org, “Sustainable Development Goals,” http://www.un.org/sustainabledevelopment/hunger/
[iii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of 
       Age. Plos ONE, 11(11), 9
[iv] Oruamabo, Raphael S. (2015). Child Malnutrition and the Millennium Development Goals: much haste but less speed?. Arch of Dis Child, 100, 19-22.
[v] Dhopeshwarker, Govind A. (1983). Effects of Malnutrition on Brain Development. Nutrition and Brain Develop. Springer, US: 49-83
[vi] Rytter, M. H., Kolte, L., Briend, A., Friis, H., & Christensen, V. B. (2014). The Immune System in Children with Malnutrition—A Systematic Review. Plos 
      ONE9(8), 1-19. doi:10.1371/journal.pone.0105017
[vii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of 
       Age. Plos ONE, 11(11), 9
[viii] Nelson, C. A., Bos, K., Gunnar, M. R., & Sonuga-Barke, E. S. (2011). V. THE NEUROBIOLOGICAL TOLL OF EARLY HUMAN 
       DEPRIVATION. Monographs Of The Society For Research In Child Development76(4), 127-146. doi:10.1111/j.1540-5834.2011.00630.x
[ix] Danaei, G., Andrews, K. G., Sudfeld, C. R., Fink, G., McCoy, D. C., Peet, E., & ... Fawzi, W. W. (2016). Risk Factors for Childhood Stunting in 137 
         Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. Plos Medicine, 13(10), 1-18.
[x] PBS.org, "Widespread Childhood Malnutrition is a Paradox in Agriculturally Rich Guatemala," http://www.pbs.org/newshour/bb/widespread-childhood-
       malnutrition-paradox-agriculturally-rich-guatemala/  
[xi] Cattopadhyay, N., Saumitra, M. (2016). Developmental Outcome in Children with Malnutrition. J Nepal Paediatr Soc, 36(2), 170-177.
[xii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years 
        of Age. Plos ONE, 11(11), 9
[xiii] The World Bank, “World Development Indicators – Guatemala,” http://databank.worldbank.org/data/reports.aspx?source=2&country=GTM

Images:

UN News Centre, http://www.un.org/apps/news/story.asp?NewsID=51809#.WNAgdWQrLL8 
GlobalGoals.org, http://www.globalgoals.org/global-goals/no-hunger/ 
 Rytter MJH, Kolte L, Briend A, Friis H, Christensen VB (2014) The Immune System in Children with Malnutrition—A Systematic Review. PLoS ONE 9(8): 
        e105017. doi:10.1371/journal.pone.0105017