Abstract
Due to the prevalence and impact of childhood undernutrition, the objective of the study was to investigate causes of malnutrition and evaluate the effectiveness of a Nutrition-Supplementation Program (NSP) in rural Dominican Republic with and without nutrition counseling. Causes of undernutrition were examined by qualitative interviews conducted with parents. Program effectiveness was measured by comparing children's pre- and post-percentage goal weight/age. The most prevalent contributors of malnutrition found were food insecurity, disease, poor maternal and child health policies, and lack of knowledge. Children who received only milk and vitamin supplementation did not improve % goal weight/age (MEAN pre=77.3; MEAN post=78.1; t=0.21; p<.83). Children who had both nutrition counseling and supplementation improved markedly (MEAN pre=67.2, MEAN post=78.2; t=3.01; p<.07). Because of the complexity of malnutrition, programs are most successful when multiple interventions including nutritioncounseling are provided. role of malnutrition in disease burden, this MDG cannot be achieved without steps to improve the nutritional status of young children. Undernutrition has major public health consequences including increased mortality and disease burden as well as decreased cognitive development and economic productivity. In a comprehensive analysis of global health burden, researchers found that malnutrition was responsible for 21% of worldwide deaths in children under 5.(4) Because of the integral role of nutrition in immune function, children with poor nutritional status are more likely to contract diarrhea, malaria and respiratory infection and more likely to suffer from these illnesses for a longer duration.(5) Additionally, malnourished children have reduced intellectual ability and years of schooling. Associations have been found between taller stature and higher cognitive performance which is thought to be due to better nutritional status during periods of brain development.(5) Furthermore, individuals that were malnourished as children lose more than 10% of lifetime earnings and countries lose at least 2-3% of their Gross National Product to undernutrition.(6) More recently, research has found a link between undernutrition and susceptibility to chronic diseases in later life. In a study of men and women born in the UK, the individuals who were undernourished as infants were found to have a greater prevalence and severity of obesity, hypertension, stroke and diabetes as adults.(7) It is evident that reducing undernutrition confers significant social and economic benefits in terms of better health outcomes, improved cognitive development, and higher earnings and health in adulthood. The cause of malnutrition is complex and multifactorial. UNICEF's strategy for improving nutrition of children is based on a conceptual framework that classifies causes of malnutrition into three levels: immediate, underlying and basic.(8) The immediate causes of malnutrition are inadequate dietary intake and disease. Inadequate intake may arise from lack of knowledge about infant feeding, food insecurity, poor appetite or eating impairments. Diseases such a HIV, infections and low birth weight or prematurity increase metabolic needs which contributes to malnutrition.
Highlights
More than 50-million children under the age of 5 years in the developing world are wasted, 27% of children are underweight and 32% are stunted.[1]
One of the Millennium Development Goals (MDG) to address global hardships calls for a two-thirds reduction in mortality of children less than 5 years of age by 2015.[3]. In light of the role of malnutrition in disease burden, this MDG cannot be achieved without steps to improve the nutritional status of young children
In a comprehensive analysis of global health burden, researchers found that malnutrition was responsible for 21% of worldwide deaths in children under 5.[4]. Because of the integral role of nutrition in immune function, children with poor nutritional status are more likely to contract diarrhea, malaria and respiratory infection and more likely to suffer from these illnesses for a longer duration.[5]
Summary
More than 50-million children under the age of 5 years in the developing world are wasted, 27% of children are underweight and 32% are stunted.[1]. One of the Millennium Development Goals (MDG) to address global hardships calls for a two-thirds reduction in mortality of children less than 5 years of age by 2015.[3] In light of the role of malnutrition in disease burden, this MDG cannot be achieved without steps to improve the nutritional status of young children. Associations have been found between taller stature and higher cognitive performance which is thought to be due to better nutritional status during periods of brain development.[5] individuals that were malnourished as children lose more than 10% of lifetime earnings and countries lose at least 2-3% of their Gross National Product to undernutrition.[6] More recently, research has found a link between undernutrition and susceptibility to chronic diseases in later life. It is evident that reducing undernutrition confers significant social and economic benefits in terms of better health outcomes, improved cognitive development, and higher earnings and health in adulthood
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