ECOLOGY OF MALNUTRITION
Introduction
Definitions
Grading of ecological factors
Individual groups and underlying causes of malnutrition
Analysis of malnutrition.
Introduction
Human nutrition is an ecological problem resulting from multiple overlapping
and interacting factors in the community
That is physical, biological, cultural environmental factors must be examined on
their effect on malnutrition before elaborating an appropriate preventive
nutrition programme
Diagram showing the relationship between ecological factors
Definitions
Malnutrition is a pathological state resulting from a relative and absolute
deficiency or excess intake of one or more essential nutrients
Ecology of malnutrition is the description of ecological factors and their
relationship with malnutrition in a community
Grading of ecological factors
These factors are categorised into seven major groups as listed below.
Conditioning infections
Food consumption
Cultural influences
Educational services
Medical services
Socio economic factors
Food production
Conditioning infections
• include factors directly associated with malnutrition of a community.
• E.g. : diarrhoea, measles, whopping cough, malaria, tuberculosis and intestinal
parasites infestation.
• They predispose malnutrition by :
Increased loss of nutrients i.e. diarrhoea, worm infestation(round and tape
worms) ,vomiting ,dysentery
Increased requirement due to metabolic changes by both human and organism
i.e. measles , fever ,diarrhoea
Decreased intake due to poor apetite,illness like whooping cough, malaria
Poor utilisation of ingested food nutrients during diarrhoea and vomiting and
worm infestation.
Food consumption
• It is important to have detailed knowledge on the actual food eaten in a
community
• It helps to assess nutritional status and discover dietary factors that can be
corrected.
It covers type and quantity of food consumed
Frequency of consumption
Breastfeeding and bottle feeding practices
Weaning practices
Balanced diet
Timing of meals
Protein and calorie intake of a child
Family size determines how much is available
Diagrammatic representation of ecology and nutrition of a child
Cultural influences
• Culture normally defines what a community group consumes, why ,when and
how it is prepared.
• Culture is people’s way of doing things or behaviour.
• It can be traditional or religious based.
Religious culture
Consumption of food as per what is described as good for eating or bad based on
ones faith/beliefs e.g.
Muslims do not consume pork as a food taboo
Catholics do not eat red meat on Fridays during lent
Hindus do not eat beef
Seventh day Adventist do not eat white meat, grasshoppers and white ants.
Traditional beliefs:
This affects how food is perceived , preparation, what is eaten, by whom and why.
This information is normally passed on from elders to generations below and is
one distinct aspect of particular cultures co-exiting in the same population group.
It plays a very important role in nutritional status of the people as nutrient
availability in the body is dependant on attitude, preparation and what is eaten.
Its subdivide into food attitudes, disease causation, child rearing, food
production.
Food attitudes
What is considered food as per culture
Food given on basis of age group i.e. children ,and sex group i.e. women and
during pregnancy and lactation.
Celebrations i.e. turkey for thanks giving ,sweet beer from sorghum during
engagements in Malawi
Disease linked foods i.e. those restricted because they are believed to cause
infections like eggs and fish for intestinal worms in Malaya.
Cultural super foods which are the staples i.e. millet among acholi in Uganda
,sweet potatoes in basoga in uganda and rice in south east Asia.
Modern prestige foods normally considered prestigious and used to define socio-
economic status e.g. aerated bottle drinks, processed meat
Cooking practices
Meal patterns like times ,usual dishes ,family order of eating, special dishes for
children, way of food consumption ie use of cutlery or fingers
Disease causation ie local concepts on cure and prevention using certain foods
and herbs i.e. obwosi referring to kwashiokor has no connection to diet. The most
affected are the indigenous uneducated
Child rearing
Breast feeding i.e. nipple preparation, duration and mothers diet during the
process.
Artificial feeding i.e. Type ,quantity ,dilution ,feeding method(cup, spoon,
bottle)
Supplementary foods i.e age introduced, type, quantity, method of feeding.
Weaning i.e. age, abrupt or gradual, use of deterrent substances ,whether child
was sent away or not.
Food preparation for children ie special or part of family meals
Responsible person for feeding i.e. Mother, grand mother, house help or
older sibling
Educational services
• This will involve education of all members of the family
• Mothers educational level
• Parent teacher association
• Schooling of the children
• How many are in a particular class
• Nutrition education involvement in formal curriculum
• School meals
• School gardens
Medical services
It will focus on the following
Number of hospitals and health centres.
Distribution and facilities available in hospitals
Number of admissions ,age when it happened
Diagnosis and results of the treatment if given
Health education
Immunization status
Height and weight monitoring
Birth order
Socio-economic factors
Social factor:
Population of community i.e. number, age , sex distribution
Family details i.e. size ,relationship ,spacing of children.
education i.e. literacy of men and women, access to books and news papers,
children attending school, classes
Housing facilities i.e. type ,floor ,ventilation ,rooms ,number of housemates
Family type i.e. joint, nuclear, polygynous,patrilineal
Caste i.e. OC/ST/SC
Kitchen facilities ,location, type of fuel, drainage
Water supply i.e. source and distance from house, purity
Water facilities in India
• Economic factors.
Occupation e g farmer, seasonally employed
Family income e.g. wages, cash crop
Tangible wealth i.e. land, live stock, transport mode, electronic media
Family expenditure on food ,clothe, rent ,feul.education,recreations
Food prices: when the food prices go high, then the availability of
food decreases.
Diagram to illustrate relationship of economic status and nutrition of family
members
Food production.
Food production is considered an availability of production to family
If is dependent on preservation distribution marketing and economic
In India per capita availability of cultivable land and food production per hectare
is far that of developed countries
There is deficiency in production of cereals, pulses, vegetables ,milk.
It is said that their is a food gap in developing countries and not protein gap.
Diagram to explain how soil health affects quality of agric produce.
Assessment
Data collection on all the above is done through nutritional survey
,questionnaires ,rapid ecological visits, case study surveys.
There are a variety of organisations working tirelessly to eliminate the problem of
malnutrition together with the governments but the problem is still alarming
especially in developing countries.
In India for example, UNICEF, Charity,NFHS,ICDS, NRHM and many more are
currently existing and working to eliminate malnutrition.
Analysis of past and present situation
Richard mahapatra, October, 6, 2004, pointed out the ecological poverty which
he considered a silent killer in India.
In his paper, he stated that over thousands of children under the age of six died in
two months (July and September 20,2004) in districts of maharashtra,nandibar
and Orissa, malkangiri, nabrangpur districts.
In these districts which lie in the tribal belt, agriculture contributes less and
forests remain a major source of food security and with limited access to them,
arouse severe malnutrition.
In the same it was noted where a mother had to sell a four month baby to earn a
few rupees for food
.
Continuation of analysis.
The government however continued to deny the fact that all those children died
of malnutrition making the situation worse.
In India with a population of 1.2 billion has the largest number of children.
according to a report released on 10/01/2012 by the prime minister Dr
Manmohan Singh ,conducted by a group of non profit organisations, being the
largest study since 2004,
42%of the children under five were found to be underweight and nearly60%
were stunted.
Cont’d
Of the stunted ,half were severely stunted and the other half stunted or under
weight by the time they were two years. this was also attributed to infections from
communicable diseases during early life hindering the absorption and utilisation
of food nutrients for proper growth
Since 2004, the number of underweight had decreased from 53% to 42% in the
past seven years which is a positive change in child nutrition.
This was more prominent in 100 focused districts especially Bihar
,jharkhand,madhya Pradesh, Orissa ,Rajasthan and Uttar Pradesh states
Cont’d
Malnutrition was higher among children from low income families
Children from muslim or SC/ST house holds generally had worse nutriton
indicators
Birth weight was also pointed out as an important risk factor for malnutrition
with prevalence of 2.5kg and below born babies being 50% while those with 2.5kg
above is 34kg.
Maternal awareness about nutrition was found to be low where 92% mothers
had no idea of malnutrition
Maternal education was found to affect child nutritional status
cont’d
In the study in India, it was found that during the monsoon, communicable diseases like
cholera were prominent due the flooding that occurs during the process.
Malaria is still a threat due the poor drainage system, there is alot of water logging
which acts breeding sites for the disease causing mosquitoes. Malaria is a serious threat
to the children and mothers especially expectant ones.
Typhoid is also a serious problem since a big part of the population still has limited
access to safe drinking water especially during summer where in some areas, water
becomes very scarce.
Some areas are dependant on heavily polluted water containing alot of lead from
untreated waste
Cont’d
Diarrhoea is still common especially in slum areas where sanitation is still a big
problem. it has caused severe loss of lives especially children below the age of six.
This was attributed to still existing practice of open defecation which is done in
open drainages and on dry land. it was estimated to be over 665 million people to
still be practising such in India which is the major cause of these infections so
when rains come, all these are run off with surface water into the rivers, dug wells
and streams which supply water to the local people
In august/2012, a case of vibro-cholerae was reported in odisha states .
Three deaths were reported and suspected to be due to vibrio-cholerae bacteria
which is responsible for water-borne diseases. it is said to have the ability to
combat antimicrobial drug effect which is essential in the cure.
Some cases of the same were reported in kalahandi which suffered the most in
2008 of the same outbreak.
Government however was slow on response to vaccination in rayagadas which
witnessed a major out break in 2007.
Out break of chikungunya fever in 2005 on the islands of Indian ocean and later
spread to AP in February 2006 and Tamil nadu in April 2006,then Karnataka
and Kerala in may of the same year.
However the disease was first experienced in India in 1963-1964 in Karnataka
and 1965 in Chennai
Pneumonia plague in northern India was experienced in 2002 with 16 cases
reported who lived in hamlet in Himalayas.
One of the victims claimed to have gone hunting where he killed and skinned a
sick cat in shimla district which is suspected to have caused the disease.
Analysis cont’d
According to census of India 1991,88.2% of the households had access to
drinking water through tap
11.7 % through different sources like wells, hand pump/ tube wells, river canal
with 68.8% taps situated in the houses;3.6% depend on hand pumps, well as
6.3% well others tank and canals.
Today however the water resources are heavily constrained due the over grown
population causing a strain on heavily polluted water sources and during
summer, some states go completely dry with severe scarcity of water causing a
strain on the sanitation .
Women who had economic power were found to have their families well
nourished hence women empowerment remains a major task for the government
Joint families still strongly exists and some have enabled the excellence of some
families as all problems /burden is shared but in low income families ,there is
struggle for the constrained resources like food hence showing a high prevalence
of malnutrition
Unicefs’ latest report
• Child mothers:the report stated that 22% of the women in india between the age
of 20-24years gave birth to their first child before they turned 18.
45 among every thousands births are born to mothers in the 15-19 age bracket.
57% male adolescents(15-19yrs) and 53% female thought it is okay for husbands
were justified to beat their wives under certain circumstances.
35% male and 19% female adolescent had comprehensive knowledge on HIV.
conclusion
Ecology plays an important role nutrition status of a community hence alot
attention should be given to it
Sanitation is the major determinant of communicable diseases and if not
controlled, efforts to supply food will remain insignificant as malnutrition will
remain significant at all life styles.
Western culture were consumption of fast foods is considered prestigious is a
major cause of obesity and CVD ,diabetes etc
Nutrition education will lower the prevalence of malnutrition so should be
included in formal curriculum.
Child mothers should be avoided as it increases the risk of malnutrition among
children and mothers
some cultural values need to be revised
www.charitywater.org/blog/category/countries/countries_india/?guind=c1717rif
-LMcfu576woodf35AOQ
Ganges river at varanasi2008.jpeg available at en.wikipedia.org/wiki/file:ganges-
river-at-varanasi_2008.jpeg.,accessed on 23/11/2012.
Kounteya Sinha,TNN, March, 1.2012, hthe time of india,State of the world
childrens’ report.WHO,UNICEF available at www.indiatimes.com/2012-03-
01/india/31113013-1-child marriage-unicef-child-brides. accessed on22/11/2012
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