Major Health Problem Of Undernutrition Health And Social Care Essay

Undernutrition is defined as bad nourishment and is clinically characterized by inadequate intake of protein, energy and other nutrients like vitamins. (WHO, 2010) The most basic kind is called protein energy undernutrition. It results from a diet lacking in energy and protein because of a deficit in all major macronutrients, such as carbohydrates, fats and proteins.(WFP, 2010) Undernutrition increases the risk of diseases and even death. Each year in the developing countries protein -energy undernutrition plays a role in almost half of all deaths of children ages 5 and below. (World Bank, 2010)

Although poor nutrition and hunger affects all ages, the long-term development and welfare implications are especially important for young children because most undernutrition happens in the womb or in the first two years of life. Much of this early damages both physical growth and brain development is irreversible. (World Bank 2006) There is an impact on educational achievement, work productivity and increase risk of proness to adult disorder.

Undernutrition is strongly associated with starvation, marasmus, cardiovascular disease, kwashiorkor, anemia, beriberi, scurvy, rickets, hypertension, resistance to infection and low intelligence these cause death and thus eradicating child undernutrition is of high priority. (FAO, 1997)

In Nigeria, undernutrition is wide spread with over 43% of all children less than 5 years of age being stunted, 9% wasted and 25% underweight. 60% of all child related deaths are due to malnutrition in Nigeria. (Uthman, 2009)

Figure 1: The Burden of Undernutrition through the Life Cycle and across Generations around the world

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Source: World bank 2006

Figure 2: The UNICEF Conceptual Framework of the Determinants of Nutritional Status

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Source: World Bank 2006

Policy context

Factors that influence child undernutrition

The Nigerian Politics

The federal government of Nigeria has the judicial, legislative and executive arm and 36 state levels. Each state has an execute governor (elected), an executive council and a house of assembly with power to make law. Each state has a local government area which is administered by an executive chairman and elected council and members.

The federal government has substantial autonomy and exercise considerable authority over allocation and utilization of recourses. This constrains the leverage that the state and local government has over state and local governments getting them to invest in health (IWRAW, 1997). Other political determinants include:

-Insufficient and inadequate resource and planning for the management, control and eradication of childhood malnutrition.

-Ethnic and religious crises that is not properly managed by the country's government

Conflict aggravates poverty and poor governance. Thus the government have been unable to provide basic public services, this result in a lack of access to food, care, health services, and a healthy environment.

-Inadequate collaboration between the federal and state government as well as the various arms of government e.g. various ministries.

- Inadequate policy stating the role of each party in the control and management of childhood malnutrition.

- Inadequate and uneven distribution of food and health resources.

- Unsustainable management of natural resources.

The Nigerian Economy

Nigeria's economy has been built on its huge high and quality oil reserves with over 90% of its foreign exchange from oil exports and from its non oil sector which grew from 2.9% in 2001 to 9% in 2006. The income however has not been used to benefit the population. Much of the revenue yielded has been taken by the political elite and high ranking government employee, thus leading to unequal distribution of resources and health resources. (Oshikoya, 2008) Resources are concentrated in urban areas. Inequitable trade policies and the negative impacts of globalization. Subsidies in developed countries, unsustainable world market prices, and international dumping in developing markets hinder opportunities for Nigerian farmers to get out of debt or generate profits.(Atinmo et al, 2009) This had lead to inflation making it impossible for poor citizens to purchase food.

The Nigerian Culture

- Inadequate knowledge and awareness both on the individual and community level about the complications of childhood malnutrition and the importance of a healthy diet. Undernourished children are more prevalent in rural areas than in urban centers. Although food is produced on farms in rural areas, this does not mean that rural children are better nourished. Equally important, safe water and adequate sanitation, health services, and the information needed by mothers or other caregivers to provide children with effective care are relatively less accessible in rural areas. (Benson and Shekaar, 2006)

-Household level food security: In certain parts of Nigeria where childhood malnutrition exists, within each household decision are made as to the quantity and quality of food that is to be allocated to each member of the household. This factors includes income gender as well as the health status of the individual

-Gender discrimination is wide spread. Despite various studies that demonstrate the correlation between women's development and household well being, women in many parts of Nigeria still don't have access to education, inheritance rights, and essential resources such as land and investment inputs. (Atinmo et al, 2009)

- In rural Nigeria where childhood malnutrition is rampant, women are often married early. An underweight mother burdened with pregnancy in her teens, inadequate spacing between issues, excessive work and inadequate nutrition and care leads to the birth of a child with low birth weight. This child often being exposed to poor health, hygiene and nutrition practise and thus develops into an underweight or stunted adolescents leading to a vicious cycle of undernutrition.

- Lack of breastfeeding especially in the rural areas, leads to undernutrition in infants and children. They do not know how to get their baby to latch on properly, or suffer hurt and discomfort (Nordqvist, 2010)

- Staple diets that are often of low energy density usually bulky and unpalatable, low in protein and fat content and not fed frequently enough to children. (FAO, 1997)

Poverty and Unemployment in Nigeria

Despite the high income from crude oil sales, there is still high incidence of poverty. Economic growth has not improved the welfare of the majority of people. Poverty is severe in the rural areas 80% of the population live on less than 1dollar a day.

Inadequate nutrition and poor health increase vulnerability to HIV and other infections causing people to fall ill sooner and thus lose weight. Family spending increases while ability to generate income is reduced. (Atinmo et al, 2009)

Policy agenda setting and stakeholder analysis

Although child undernutrition has been seen as a major public health issue in Nigeria, extra measures has to be taken to get the policy into the agenda. This can be done by subverting the contending stakeholders and strengthening the encouraging stakeholders. According to Kingdon's model, 1984, of taking advantage of agenda setting, the policy has several policy windows to be included in the government's formal agenda setting (Buse et al, 2005):

- The stream of Politics.

The establishment of democracy in Nigeria is advocating major public

changes. The government is also committed to improving the health status of

Nigerians

- The stream of Policy:

Non communicable diseases are the major cause of deaths around the world. UNICEF and many international organizations are paying more attention to epidemiological, social and economic burden of non communicable diseases and their risk factors including child undernutrition.

- The stream of Problem:

High child undernutrition rate.

A proposed issue would not get a response if it is not feasible, legitimate or if it doesn't have public support. (Buse et al, 2005)

Child undernutrition is a very legitimate issue because its impact on health has evidence based reports. Its high prevalence and related diseases in Nigeria makes it a serious public health issue prompting quick action to be taken by the government and Nigerians.

Also knowledge availability (causes and management of undernutrition), skilled staff (doctors, dieticians, public health workers, etc) and existence of the infrastructures will allow programme feasibility (Buse et al, 2005). Cost would be minimized by the use and building up of existing resources and manpower.

Agenda setting also has to get the support of the public; this can be done by organizing national campaigns to make the public aware of the policy objectives and possible outcomes and also through the media.

Having done this, the policy makers and stakeholders are to be convinced that successful and affordable solutions are available to eradicate child undernutrition and that it should be implemented.

Stake holder analysis

This will allow the understanding of the behaviour, intentions and interests: and to assess the influence and resources they bring to bear on decision-making or implementation. (Walt al, 2008)

Smith (2000) describes the stages of stakeholder analysis. These include

Identifying the project stakeholders

Outlining stakeholders roles

Assessing stakeholders importance and influence

Identifying stakeholders, interest, impact level

Defining stakeholders' participation.

Table 1: Stakeholder analysis

Stakeholders

Roles

Importance and influence

Interest and impact level

Participation

Children and parents

Take part in policy formation, implementation and evaluation

Low

Active

Supportive

Schools

Implementing education programme

Medium

Active

Supportive

Health professionals

Management of malnutrition by promoting healthy lifestyle and disease diagnosis

Medium

Active

Neutral

Legislators and other politicians

Discuss policy alternatives and decide whether to approve proposal

High

Active

Not supportive

Ministry of health

Policy formation, implementation, monitoring and evaluation

High

Active

Supportive

Ministry of education

Promote healthy lifestyle in schools

Medium

Active

Supportive

Ministry of information

Health promotion and campaign through the media

High

Active

Neutral

Ministry of finance

Provision of funds

High

Active

Not supportive

Ministry of agriculture

Provision of crops

High

Active

Supportive

WHO

Provide guidelines for malnutrition, provision of funds

High

Active

Supportive

World bank

Funds

High

Active

Supportive

UNICEF

Provision of resources and funds

High

Active

Supportive

Policy content

Policy formulation

Although some form of malnutrition control and prevention is already on ground in Nigeria, undernutrition still persists and remains a serious problem. A mixed scanning approach will be suitable to make public health policy changes. This will use a rational approach to formulate policies, which will be passed through the Ministry of health through which it will be introduced to the whole country

The policy that is being proposed is the National childhood undernutrition eradication policy. This policy will be prepared by the ministry of health but the programmes of the policy should be done as a result of the collaboration of all partners and stakeholders.

Aim

To reduce morbidity and mortality caused by childhood malnutrition

Objectives

Process

To provide Nigerians with adequate knowledge and skills required for the prevention, control, and eradication of child undernutrition

To strengthen the capacity of medical professionals to detect and manage childhood malnutrition

To break the inter-generational cycle of undernutrition

To promote healthy food eating

To improve agricultural services

To reduce food and health inequalities

To eradicate poverty

To make healthy food available and affordable

To stop childhood marriage

Outcomes

To reduce mortality caused by child undernutrition and its related diseases.

To reduce the incidence and prevalence of child undernutrition

To improve the overall health status of Nigerians

Programs

Mother and child health nutrition programmes. Establishment of therapeutic and nutritional feeding ant teaching centers that provide nutritious food for women in their last trimester of pregnancy as well as the therapeutic food for children under 2years of age as well as teaching parents how to improve nutrition using the family budget.

Health training for health professionals in relation to undernutrition

Provision of funds for mass campaigns that emphasizes healthy eating and awareness of the complication associated with undernutrition

The creation of school based programmes- provision of lunch in all schools for students as well health promotion programmes priority should be given to children ages 5years and below.

Subsidizing food prices

The creation of local employment / micro enterprise with the development of small and medium food businesses thus addressing the issue of poverty. The creation of improved rural credit schemes and empowerment programs that encourages agricultural development through the access to appropriate food processing technologies that enables inexpensive processing of locally available fruits, vegetables, grains and legumes. This process will allow both the preparation of food for immediate use and inexpensive preservation for food for consumption later.

Giving of food supplies to poor rural farmers

The formulation of laws that bans child marriages

Policy process

Policy Implementation

This policy would be implemented at different phases using the bottom-top approach. The policy must be based on acceptable, available, accessible and dynamic methods. (Brynard, 2005)

This would be done by partnering with local, national and international bodies, involving all the stake holders, thus utilizing scarce resources, focusing on achieving behavioural goals with specific people and tackling access to inequality and health resources. Laws and legislations to establish laws on the provision of lunch in all schools and the ban of child marriages done. The implementation process depends on a variety of factors like

Availability of hospitals and hospital facilities for the management, teaching and training of staff.

Availability of human resources for example doctors, nurses, epidemiologist, etc.

Collaboration between various sectors like the public and private sectors.

Interest of politicians, professional and the community and Political will is essential for policy implementation.

Ability to empower individuals and communities through knowledge and awareness of child undernutrition

Economic support: By the government and private sectors of the economy will ensure that funds are available for the policy.

All this would ensure its success.

Policy monitoring and evaluation

Policy evaluation should start as soon as policy problems are identified. Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate. It is a practical, non-prescriptive tool, designed to summarize and organize the essential elements of program evaluation. The framework comprises steps in evaluation practice and standards for effective evaluation. The framework is composed of six steps that must be taken in any evaluation. . (Milstein et al, 1999) They include:

Figure 3: framework of evaluation

Sources: CDC, 1999

Donabedian's framework for evaluating policies looks at three dimensions: input, process and outcomes.

Table 2: Evaluation

Implementation Evaluation

Input

Process

Output

Outcomes

Impact

Therapeutic feeding ands teaching health clinics

Availability of cordial accessible centers

Service quality

-early and proper detection

-distribution of food

- teaching

- proper management

-staff training

Capacity building for health professionals

Behaviour and attitudes

-Improved diet

- Improved awareness

Healthy mother and child

- increased capability of staff to manage malnutrition

-adopting healthy lifestyle

-decrease in the number of hospital admission with regards to malnutrition and its related diseases and complications

-establishment of legislations that encourages food distribution in schools, subsidized food prices and childhood marriage ban

-Providing healthy environment at home, schools and neighbourhood

-Establishment of a childhood surveillance system

- awareness of child undernutrition by the whole community including children

Reduction in the incidence of child undernutrition

-reduction in the prevalence of child undernutrition

- reduction in the incidence and prevalence of child undernutrition related diseases and its complications

-improved quality of life for Nigerian children and Nigerians

-reduced from morbidity and mortality from undernutrition and its related diseases and complication.

-poverty eradication

-reduction in maternal mortality

- economic development

Media, data and information systems

Advertisement and articles on child undernutrition

Media campaign targeting the specific group mainly affected

Community knowledge and awareness of disease and complication

Community relationship

Sensitization of community leaders on the awareness of child undernutrition

-Surveillance systems

-quality and quantity of data collection

-Quality of follow up of cases

-Agricultural development

-Participation in decision making

Access

-Establishment and distribution of undernutrition centers in health centers

-Availability of healthy food at affordable prices

Advocacy and policy

Laws and legislations

- Advocating for policy reforms on socio-cultural and economic issues child undernutrition

Increased awareness by stake holders on child undernutrition.

Political awareness

Funding management

Provision of funds and resources needed

- Proper use of available resources with the available budget.

Improved quality of resources and services

School based program

Training of school teachers

Review and update curriculum including health promotion programs

-Provision of healthy lunch for students focusing on the under fives.

-Capacity building for staff

-Equity

-Availability of services to all children regardless of socio-economic status, gender and geographical location

Information drawn from studies (RCT or Cohort for quality of intervention) (cross sectional for prevalence) surveys, interviews (individuals and groups), malnutrition clinic sheets, newspaper, questionnaires, hospital admission records, school evaluation reports and growth charts.

Conclusion

Child undernutrition is a serious public health problem and it has a huge impact on the world economy. Child undernutrition has been recognised as public health problem in Nigeria. Immediate actions should be considered to eradicate it completely. This proposal is an outline for child undernutrition eradication policy. It contains the proposed programmes and approaches. Each program has its objectives.

There is no right method of getting the policy on the agenda, approved and implemented. Guidelines are helpful. The above process is not always simple and can change and so should be adjusted to match the system Legislators are usually influenced by interest groups within and outside the government. All stakeholders, media, research and direct contact would be used to influence the approval of the policy. They control the future of the policy

The childhood policy should be tested by running small identical programs of the big picture in different settings and if successful should be done on a nationally. All available resources are necessary for proper implementation. This policy would health improve the health status of Nigerian children and the country as a whole thus enhancing economic development.