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Nutritional Deficiencies Among Women & Children in Nicaragua Dr. Matthew Blondin & Audrey Blondin PUBH 5497 Food, Health & Politics Introduction • Nicaragua is the largest country in Central America and the second poorest country in Latin America, due to a history of dictatorship, civil war and natural disasters. 1 • The current population (2007) is approximately 5.6 million, including approximately 900,000 children under six years of age (about 22% of the population). 2 • More than half of these children (55%) live in poverty and 40% of the rural population can’t read or write. 1 • Approximately 50% of the adult population experiences either unemployment or underemployment with greatest unemployment found in the rural areas. 1 • Over 30% of children do not complete primary school. 1 • Almost 60% of children do not attend secondary school. 1 • Child mortality rate is six times worse than the child mortality rate in the United States, 11 per 100 children. 3 • Half of the rural population does not have access to adequate sanitation facilities, including potable water supplies. 1 Historical Perspective • Nicaragua’s economy was ravaged in the 1980’s by the Contra wars, which saw the destruction of much of the country’s infrastructure. The economy began expanding in 1991, and as of 2006, the service sector represented the largest component of GDP at 56.8%, followed by the industrial sector at 25.8% & agriculture at 17.3%. 29% of the Nicaraguan labor force is involved in agriculture. 4 • The economy remains primarily dependent on foreign assistance, primary from the United States, and remittances from Nicaraguans living abroad. • Nicaragua currently ranks 4 th in the world for coffee bean production, 17 th in the world for beans, 32 nd for sesame seed & sugar cane, 33 rd in pineapples and 41 st in cocoa beans. 4 • The volatile political environment in Nicaragua has hampered its stability and prosperity. Corruption within the government and a general lack of governmental control persist, fueling civilian unrest and political demonstrations. 4 • Staple foods of the Nicaraguan diet include maize, rice and beans. Fish is an important part of the diet, particularly in coastal areas. Vegetables include cassava, plantains, onions, potatoes and tomatoes. Fruits available include guavas, limes, mangoes, papayas, oranges and tamarinds. 2 • Despite steady economic development in Nicaragua since 1990, child nutritional status has not improved as much as might be expected. • Factors include low levels of education of the mother, lack of breastfeeding, distance from a public health center preventing regular child heath check-ups with growth monitoring, and the early introduction of food and other liquids that satiate hunger but do not nourish the body. 6 • Worldwide, 42 % of pregnant women and 47 % of preschool children are anemic, caused primarily by iron deficiency, but also by infectious diseases such as malaria, hookworm and HIV/AIDS. 8 Approximately 16% of reproductive-age women in Nicaragua and 35% of children under age 5 are anemic. The consequences of anemia include: • Increased maternal and perinatal mortality • Increased numbers of preterm births and/or low birth weight • Impaired cognitive development in children • Reduced adult work productivity WHO’s 2002 Global Burden of Disease Report identified iron deficiency as the 12 th most important risk factor for all mortality globally and the 9 th most important risk factor for the global burden of disease. 8 Conclusions and Implications • Three major Vitamin A deficiency control strategies exist to enhance a child’s chances of survival, help reduce the severity of childhood illness and contribute to the well-being of children, their families and their communities. These include high-dose Vitamin A Supplementation every 4-6 months for children between the ages of 6-59 months, food fortification including the introduction of Vitamin A into multiple food products such as sugar, oil, milk, flour and infant foods and formula, and dietary diversification to increase consumption of Vitamin A rich foods of animal origin, coupled with more fruits and vegetables. 7 • Interventions to reduce anemia of any severity among women and children have been shown to reduce the risk of death by about 20 % for each 1 g/dL increase in Hb. Additional interventions proven to be effective include supplementation of pregnant women’s diets with daily iron folic acid tablets, iron supplementation of commonly consumed food products such as milk and bread, malaria preventative insecticide treatment programs, including indoor residual spraying and insecticide treated bed nets, and control of hook worms as a routine part of preventative health care. 8 • Programs to address nutritional deficiencies among women and children need to be addressed in a coordinated way, including promotion of exclusive breastfeeding for infants under 6 months, identification of illness danger signs with early treatment and care for ill children and improved care and attention for pregnant mothers in the home and the community. More needs to be done to take advantage of partnerships with agencies and programs locally, nationally and internationally to implement relevant intervention programs and succeed in eradicating disease and deficiencies among women and children • In a 2006 Nicaraguan demographic and health survey, 20 % of children under age 5 exhibited stunted growth, 12 % were underweight and 2 % were considered wasted. 5 • 12 % of children are born with low birth weight. 5 • Less than 1/3 of children are breastfed for at least 6 months. 5 Food Consumption and Childhood Health Deficiencies •Ministry of Health (MINSA) is responsible for the administration of the governmental health care system. • There are 33 public hospitals in Nicaragua. Approximately half of the 5,256 hospital beds are located in Managua. •Private sector care is located primarily in Managua for the wealthy, who comprise less than 10 % of the population. 3 • The remaining 90 % are treated in the public health care system in Health Care Centers (“Centro de Saluds”) located Nicaraguan Health Care System throughout the countryside. These centers face both a lack of financial and human resources, resulting in a lack of adequate tools for diagnosis and treatment of disease and related consequences. • 40 % of Nicaraguans are excluded from the health care system due to the uneven providing of services. • Community health care workers, or “Briqadistas”, are an extension of the health care system within the community, and are involved primarily in preventive care, reporting of deaths and cases of disease within the community and vaccination campaigns. 3 Discussion • Approximately 31 % of all Nicaraguan children under age 5 suffer from vitamin A deficiency (VAD). Vitamin A is essential for eye health and proper functioning of the immune system. It’s found in foods such as milk, liver, eggs, red and orange fruits and leafy vegetables. Vitamin A deficiency is the leading cause of childhood blindness. 7 Anemia Vitamin A Deficiency References 1. Nicaragua. (Accessed August 27, 2008, at http://www.plan-uk.org/wherewework/centralamerica/nicara gua/.) 2. Excerpt taken www.worldinfozone.com. (Accessed September 5, 2008, at http://www.worldinfozone.com/country.php? country=Nicaragua.) 3. Nicaragua's Health System. (Accessed September 8, 2008, at http://www.access2insulin.org/html/nicaragua_s_health_sy stem.html.) 4. Wikipedia, the free encyclopedia. Economy of Nicaragua. (Accessed September 5, 2008, at http://en.wikipedia.org/wiki/Economy_of_Nicaragua.) 5. Unicef. At a glance: Nicaragua. (Accessed September 5, 2008, at http://www.unicef.org/infobycountry/nicaragua_statistics .html.) 6. Nutrition and consumer protection – Nicaragua. (Accessed July 10, 2008, at http://www.fao.org/ag/agn/nutrition/nic-e.stm.) 7. Statistics By Area/Child Nutrition. (Accessed September 5, 2008, at http://www.childinfo.org/vitamina.html.) 8. Maternal Anemia: A Preventable Killer. (Accessed September 5, 2008, at http://www.aed.org/Publications/upload/FANTAanemia2006.p df.) 9. Red Cross. Integrated Management of Childhood Illness – Nicaragua. (Accessed September 5, 2008 at

Nutritional Deficiencies Among Women & Children in Nicaragua Dr. Matthew Blondin & Audrey Blondin PUBH 5497 Food, Health & Politics Introduction Nicaragua

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Nutritional Deficiencies Among Women & Children in Nicaragua Dr. Matthew Blondin & Audrey Blondin

PUBH 5497 Food, Health & Politics

Introduction

• Nicaragua is the largest country in Central America and the second poorest country in Latin America, due to a history of dictatorship, civil war and natural disasters. 1

• The current population (2007) is approximately 5.6 million, including approximately 900,000 children under six years of age (about 22% of the population). 2

• More than half of these children (55%) live in poverty and 40% of the rural population can’t read or write. 1

• Approximately 50% of the adult population experiences either unemployment or underemployment with greatest unemployment found in the rural areas. 1

• Over 30% of children do not complete primary school. 1

• Almost 60% of children do not attend secondary school. 1

• Child mortality rate is six times worse than the child mortality rate in the United States, 11 per 100 children. 3

• Half of the rural population does not have access to adequate sanitation facilities, including potable water supplies. 1

Historical Perspective

• Nicaragua’s economy was ravaged in the 1980’s by the Contra wars, which saw the destruction of much of the country’s infrastructure. The economy began expanding in 1991, and as of 2006, the service sector represented the largest component of GDP at 56.8%, followed by the industrial sector at 25.8% & agriculture at 17.3%. 29% of the Nicaraguan labor force is involved in agriculture. 4

• The economy remains primarily dependent on foreign assistance, primary from the United States, and remittances from Nicaraguans living abroad. • Nicaragua currently ranks 4th in the world for coffee bean production, 17th in the world for beans, 32nd for sesame seed & sugar cane, 33rd in pineapples and 41st in cocoa beans. 4

• The volatile political environment in Nicaragua has hampered its stability and prosperity. Corruption within the government and a general lack of governmental control persist, fueling civilian unrest and political demonstrations. 4

• Staple foods of the Nicaraguan diet include maize, rice and beans. Fish is an important part of the diet, particularly in coastal areas. Vegetables include cassava, plantains, onions, potatoes and tomatoes. Fruits available include guavas, limes, mangoes, papayas, oranges and tamarinds. 2

• Despite steady economic development in Nicaragua since 1990, child nutritional status has not improved as much as might be expected. • Factors include low levels of education of the mother, lack of breastfeeding, distance from a public health center preventing regular child heath check-ups with growth monitoring, and the early introduction of food and other liquids that satiate hunger but do not nourish the body. 6

• Worldwide, 42 % of pregnant women and 47 % of preschool children are anemic, caused primarily by iron deficiency, but also by infectious diseases such as malaria, hookworm and HIV/AIDS. 8

Approximately 16% of reproductive-age women in Nicaragua and 35% of children under age 5 are anemic. The consequences of anemia include:

• Increased maternal and perinatal mortality• Increased numbers of preterm births and/or low birth weight• Impaired cognitive development in children• Reduced adult work productivity

WHO’s 2002 Global Burden of Disease Report identified iron deficiency as the 12th most important risk factor for all mortality globally and the 9th most important risk factor for the global burden of disease. 8

Conclusions and Implications

• Three major Vitamin A deficiency control strategies exist to enhance a child’s chances of survival, help reduce the severity of childhood illness and contribute to the well-being of children, their families and their communities. These include high-dose Vitamin A Supplementation every 4-6 months for children between the ages of 6-59 months, food fortification including the introduction of Vitamin A into multiple food products such as sugar, oil, milk, flour and infant foods and formula, and dietary diversification to increase consumption of Vitamin A rich foods of animal origin, coupled with more fruits and vegetables. 7

• Interventions to reduce anemia of any severity among women and children have been shown to reduce the risk of death by about 20 % for each 1 g/dL increase in Hb. Additional interventions proven to be effective include supplementation of pregnant women’s diets with daily iron folic acid tablets, iron supplementation of commonly consumed food products such as milk and bread, malaria preventative insecticide treatment programs, including indoor residual spraying and insecticide treated bed nets, and control of hook worms as a routine part of preventative health care. 8

• Programs to address nutritional deficiencies among women and children need to be addressed in a coordinated way, including promotion of exclusive breastfeeding for infants under 6 months, identification of illness danger signs with early treatment and care for ill children and improved care and attention for pregnant mothers in the home and the community. More needs to be done to take advantage of partnerships with agencies and programs locally, nationally and internationally to implement relevant intervention programs and succeed in eradicating disease and deficiencies among women and children within the Nicaraguan population. 9

• In a 2006 Nicaraguan demographic and health survey, 20 % of children under age 5 exhibited stunted growth, 12 % were underweight and 2 % were considered wasted. 5

• 12 % of children are born with low birth weight. 5

• Less than 1/3 of children are breastfed for at least 6 months. 5

Food Consumption and Childhood Health Deficiencies

•Ministry of Health (MINSA) is responsible for the administration of the governmental health care system.• There are 33 public hospitals in Nicaragua. Approximately half of the 5,256 hospital beds are located in Managua. •Private sector care is located primarily in Managua for the wealthy, who comprise less than 10 % of the population. 3

• The remaining 90 % are treated in the public health care system in Health Care Centers (“Centro de Saluds”) located

Nicaraguan Health Care System

throughout the countryside. These centers face both a lack of financial and human resources, resulting in a lack of adequate tools for diagnosis and treatment of disease and related consequences.• 40 % of Nicaraguans are excluded from the health care system due to the uneven providing of services.• Community health care workers, or “Briqadistas”, are an extension of the health care system within the community, and are involved primarily in preventive care, reporting of deaths and cases of disease within the community and vaccination campaigns. 3

Discussion

• Approximately 31 % of all Nicaraguan children under age 5 suffer from vitamin A deficiency (VAD). Vitamin A is essential for eye health and proper functioning of the immune system. It’s found in foods such as milk, liver, eggs, red and orange fruits and leafy vegetables. Vitamin A deficiency is the leading cause of childhood blindness. 7

Anemia

Vitamin A Deficiency

References1. Nicaragua. (Accessed August 27, 2008, at

http://www.plan-uk.org/wherewework/centralamerica/nicaragua/.)2. Excerpt taken www.worldinfozone.com. (Accessed September 5, 2008, at

http://www.worldinfozone.com/country.php?country=Nicaragua.)3. Nicaragua's Health System. (Accessed September 8, 2008, at

http://www.access2insulin.org/html/nicaragua_s_health_system.html.)4. Wikipedia, the free encyclopedia. Economy of Nicaragua. (Accessed

September 5, 2008, at http://en.wikipedia.org/wiki/Economy_of_Nicaragua.)5. Unicef. At a glance: Nicaragua. (Accessed September 5, 2008, at

http://www.unicef.org/infobycountry/nicaragua_statistics.html.)6. Nutrition and consumer protection – Nicaragua. (Accessed July 10, 2008, at

http://www.fao.org/ag/agn/nutrition/nic-e.stm.)7. Statistics By Area/Child Nutrition. (Accessed September 5, 2008, at

http://www.childinfo.org/vitamina.html.)8. Maternal Anemia: A Preventable Killer. (Accessed September 5, 2008, at

http://www.aed.org/Publications/upload/FANTAanemia2006.pdf.)9. Red Cross. Integrated Management of Childhood Illness – Nicaragua.

(Accessed September 5, 2008 at http://www.redcross.org/services/intl/imci/nicaragua.asp.)