Mother and Child Nutrition in the Tropics and Subt

  • View
    223

  • Download
    0

Embed Size (px)

Text of Mother and Child Nutrition in the Tropics and Subt

  • 8/11/2019 Mother and Child Nutrition in the Tropics and Subt

    1/16

    Mother and Child Nutrition in the Tropics and SubtropicsChapter 12 Public Health Nutrition

    391

    Chapter 12 Public Health Nutrition: Community Programmes for Better

    Nutrition

    Chapter 12 Public Health Nutrition: Community Programmes for Better Nutrition......................391THE NEED FOR A DISTRICT INVENTORY OF NUTRITION .............................................392

    INTERVENTIONS......................................................................................................................392

    COVERAGE, A KEY ISSUE......................................................................................................394

    ESTIMATING TARGET GROUPS............................................................................................394

    THE NEED FOR INTEGRATION .............................................................................................395

    INNOVATIVE APPROACHES..................................................................................................395

    THE THREE TIERS IN THE ICEBERG OF MALNUTRITION..............................................396

    A STRATEGY OF NUTRITION WITH THE PEOPLE ............................................................399

    URBAN AREAS..........................................................................................................................405

    FURTHER READING ................................................................................................................406

    Figure 12.1 Interventions at different stages of the food chain. .....................................................393

    Figure 12.2 The triple A cycle ........................................................................................................398

    Figure 12.3 Causes of malnutrition (UNICEF 1998)......................................................................398

    Figure 12.4 Integration of nutrition intervention with health surveillance services .......................400

    Figure 12.5 Developing a social network around MCH and nutrition services..............................402

    Figure 12.6 Collaboration within the health sector.........................................................................404

    Figure 12.7 Intersectoral collaboration...........................................................................................405

    Table 12.1 Selection of at-risk' mothers and children ...................................................................401

    391

  • 8/11/2019 Mother and Child Nutrition in the Tropics and Subt

    2/16

    Mother and Child Nutrition in the Tropics and SubtropicsChapter 12 Public Health Nutrition

    392

    In spite of major scientific advances in the subject of nutrition, the overall burden of malnutrition in

    the world has not changed much, and may have even become worse during the last decade. In Latin

    America and East Asia much progress has been made in reducing child malnutrition. But overall

    the absolute number of malnourished children worldwide has grown. Half of South Asias children

    are malnourished. In Africa one out of every three children is underweight. Malnutrition is

    continuing to be implicated in more than half of child deaths worldwide. Deaths of 6 millionchildren (55% of the total) are either directly or indirectly attributable to malnutrition. It has been

    often stressed that if only the available knowledge were to be uniformly applied, there would be

    very little malnutrition left. Thus the main constraint will appear to be our inability in creating

    viable national systems for delivering nutritional information and care to the majority of people,

    especially in the developing countries. Several years ago the world community became aware of the

    fact that in China, with a population equal to one-fifth of the total world population, there was very

    little malnutrition. This large nation, once described as "the sick man of Asia', and with only 20 per

    cent of its land surface arable, had at last succeeded in feeding her people. Since then several

    reports on China show that progress has been achieved in many directions. Agricultural productivity

    has improved, though still continuing to be labour-intensive; the general standard of health has

    improved remarkably and there is an efficient system of distribution with local self-sufficiency. Arethese experiences and achievements applicable to the rest of the developing world with different

    politico-social systems, diverse cultural and historical experiences and operating from differing

    planes of technological development?

    About the same time small-scale projects of health and integrated development came to be

    established in several countries. These projects have provided valuable records and experiences of

    setting up systems of care for hitherto unreached populations. Recently a study of ten such projects

    in different pads of the world has shown that a marked improvement in health and nutrition has

    occurred amongst the beneficiaries. In these experiences lies the hope of modifying existing

    systems of delivery of care in ways that would ensure improvement in the general nutritional status

    of the community. This chapter is addressed to the district health team in the average developing

    country who are likely to be confronted b many of the clinical problems described in the preceding

    chapters.

    THE NEED FOR A DISTRICT INVENTORY OF NUTRITION

    INTERVENTIONS

    In almost all countries there exist a variety of national programmes and strategies for the

    improvement of the general nutritional status of the population. These vary from food distribution

    schemes and feeding programmes (school meals, mid-day meals, on-the-spot or take-home feedingprogrammes) to the issuing of food supplements to vulnerable groups like pregnant and lactating

    women and children, ration cards, food subsidies and fair-price shops. More recently several

    countries have set up programmes for the promotion of breast feeding. It is necessary to prepare an

    inventory of all current nutrition programmes in the district or region or nation as the case may be,

    including an assessment of their effectiveness in reaching out to those in need. The purpose of such

    an inventory is to determine for each of the programmes the resources currently used, the intended

    beneficiaries, the geographic outreach, the key personnel and their training needs as well as the

    political and administrative support.

    In a given catchment area the nutrition activities and programmes are part of the nutrition system

    which is the channel through which nutrients pass from suppliers (local production and imports),through distributors and the processing media to the consumer. The effectiveness of this system in

    392

  • 8/11/2019 Mother and Child Nutrition in the Tropics and Subt

    3/16

    Mother and Child Nutrition in the Tropics and SubtropicsChapter 12 Public Health Nutrition

    393

    reaching families and communities at the periphery will determine the state of nutrition of the

    population in general and of the economically weaker sections in particular. In most developing

    countries the indigenous components of the nutrition system are insignificant. There are low yields

    in agricultural production, there is wastage in storage, there is inequity in distribution and there are

    problems of transportation. On the other hand, unemployment, lack of land resources and of

    technical know-how reduce the ability of large segments of the population to provide theirnutritional requirements. Nutrition projects, often funded by international aid agencies but now

    increasingly through national resources, are intended to help strengthen and buttress the nutrition

    system so as to improve the supply of nutrients for the target groups.

    In most countries the national health system provides the major outlets for a variety of nutritional

    intervention programmes. Thus, there are services for providing curative care for the severely

    malnourished, and health surveillance clinics like the antenatal and under-5s clinics where

    preventive measures can be applied for the promotion of adequate growth and nutrition as well as

    for protecting the undernourished from severe malnutrition. These services also provide the main

    framework for the promotion of breast feeding in the community. Thus the health centre and the

    satellite subcentres are useful springboards for monitoring the nutritional status of the vulnerablegroups. The outreach clinics and home visiting further extend the scope of the health services into

    the home and remote communities. The impact of such direct interventions targeted at the family is

    strengthened by indirect preventive action for increasing the production and availability of food,

    improving the distribution system and purchasing power through local development activities,

    nutrition education and improved environmental and health conditions (See Figure 12.1).

    Figure 12.1 Interventions at different stages of the food chain.

    393

  • 8/11/2019 Mother and Child Nutrition in the Tropics and Subt

    4/16

    Mother and Child Nutrition in the Tropics and SubtropicsChapter 12 Public Health Nutrition

    394

    Such a multi-pronged approach addresses itself to the observation that nutrition problems are not

    solved through hand-outs of food, but require consideration of basic development storage and

    transport; cre