Malnutrition a development issue

Focus

Malnutrition has direct link to maternal and childhood mortality in Papua New Guinea as outlined below by the HEALTH DEPARTMENT.

Recent studies done by Lancet, a leading scientific journal specialising in nutrition related research confirms that malnutrition is no longer the underlying causes of maternal and childhood mortality globally as previously thought by the scientific community.
Maternal and childhood malnutrition has direct linked to increased prevalence of maternal and infant mortality rates in developing countries.
Malnutrition in fact is a developmental issues and not merely a disease trend.
Many government economic and infrastructural development strategies, guidelines and policies fail to capture malnutrition as an agenda and are left unattended giving rise to the increasing trend of these preventable deaths.
PNG has one of the highest maternal mortality rate of 215 deaths /100 000 live births and infant mortality rate in 2018 of 36.3/1000 live births in 2018 in the Pacific region.
The increase in these mortalities is complemented with high prevalence of malnutrition rates for children under five years the Pacific.
Stunting is at 48.2 per cent (2010), underweight 27.2 per cent (2010), wasting 16.2 per cent (2010), overweight 5 per cent (2005) and low-birth weight 11 per cent (2005).
It is a known fact that every day approximately 830 women die from preventable causes related to pregnancy and childbirth.
Approximately 99 per cent of all maternal deaths occur in developing countries and maternal mortality is high in women living in rural areas and poor communities.
Infant die early in life from preventable deaths in the country. Statistics show that deaths in children are directly linked to malnutrition.
Studies shows that children with very weak immunity are susceptible to disease and are not able to fight infections.

The two extremities of malnutrition
Malnutrition in a nutshell has two extremities, those who suffer from not having enough to eat (undernutrition) and those who have excess food (over nutrition).
This situation is also known as double burden of malnutrition.
PNG consequently suffers from both extremities and our hospitals are now seeing increasing number of patients who suffer from disease related to over nutrition such as hypertension, coronary heart diseases, and different forms of cancers, diabetes and other metabolic disorders.
Children and mothers who suffer from undernutrition can be classified in low birth weight, underweight, wasting, stunting and micro-nutrient deficiencies.
Mothers and children who suffer from over nutrition are classified in overweight and obesity.
Over nutrition is a risk factor for chronic non-communicable diseases such as high blood pressure, obesity, coronary health diseases, stroke, hypertension, type 2 diabetes and degenerative diseases.
However, the key issues of discussion in this editorial are the “undernutrition status of both mother and child that leads to unnecessary death, an irreplaceable loss to the family unit and the country as a loss.
A study done by Frontier Economics shows that the economic loss from malnutrition is 8.45 per cent of GDP. That is US$1.5 billion (K5bil) per annum. The factors leading to undernutrition status of women and children and its consequences are not very understood by the many including the learned persons.
Malnutrition does not merely occur due to food security but also due to other environmental factors including water supply, sanitation and hygiene.

Under nutrition & its linkage to maternal and infant mortality
During pregnancy and lactation, mothers need higher energy and nutrition needs to support fetal development while maintaining their own energy and nutrient needs.
Lack of protein, energy and essential nutrients such as iron, iodine, zinc, folate and vitamin B12 during the first 1000 days affects the structural and functional development of the child. It is therefore very important that mother attend all four antenatal visits during pregnancy to receive iron supplementation and child receive vitamin A and deworming tablets.
Studies show that young children with protein-energy malnutrition show brain atrophy (shrinking of the brain cells due to lack of nutrients).
Tragically, the growth impairments that occur as a result of undernutrition are permanent and irreversible.
There is a very strong body of evidence to show that it is impossible to recover from these impairments despite improvement in nutrition after two years and the child is vulnerable to multiple infections and is susceptible to repeated infections due to low immunity.
Undernourished children are more susceptible to illness.
It threatens a child’s survival through weakening their immune system and increasing vulnerability to diseases such as diarrhoea, acute respiratory diseases, malaria, and measles.
Undernourished children are therefore more likely to have continuous attacks of illness.
An undernourished child is four times more likely to die than a well-nourished child. It is estimated that in PNG, approximately 33 per cent of all hospitals deaths of children under five years were either directly or indirectly related to malnutrition.
However, Frontier Economics estimates that it could be as high as 76 per cent of total deaths in the country.
The cyclical interaction between stunting and illness is potentially lethal.

Economic costs of malnutrition
Not only does undernutrition claim lives of unfortunate children, it poses a major barrier to economic development of PNG.
The economic impact of childhood stunting was brought to attention of global policy makers when World Bank estimated that stunting could decrease low-middle-income nations GDP by 2-3 per cent per year.
Some other studies published in the Lancet, a leading scientific journal specialising in nutrition related researches showed that stunting can result in losses as high as 11 per cent of the GDP.
Recent study in PNG conducted by Frontier Economic showed the effects of stunting of under 5 years children on the economy of PNG in three dimensions.

  • Loss of productivity in labour force due to increased childhood mortality 0.26 per cent of GDP or US$46 million (K155mil)
  • loss of potential income and productivity from poor physical status and reduced cognitive functions at 2.45 per cent of the GDP or US$459 million (K1,549mil); and,
  • Loss from increased healthcare expenditure in treating diseases associated with stunting at 0.02 per cent of the GDP or US$3 million (K10mil)

Malnutrition although is said to be disease of the poor but in PNG, malnutrition is seen in all the 4 quantiles of the society.
It shows that 55 per cent of the poorest suffer from undernutrition as well as 36 per cent of the richest quantile also suffer from undernutrition.

Solutions to reduce malnutrition related maternal and infant mortality
There is hope and solution.
Undernutrition can be prevented through better healthcare and improved nutrition in the first 1000 days of life from conception until aged two.
During pregnancy women need to consume a balanced diet to help ensure safe birth.
The infant should be feed early and exclusively up to 6 months and continue to breast feed with diversified complementary diet after 6 months to 2 years of life.
Children and mothers also need to live in clean environment with good latrines and drinking water.
To realise all of these, communities need support. Government to provide support to revitalise nutrition, water supply, sanitation, immunisation and antenatal care services in all health settings.
Health workers need to be properly trained in proper infant and young child feeding practices.
Pregnant mothers should at least attend four antenatal clinics to be provided with iron supplements.
Children under 5 years should have received all vaccinations including supplementation of vitamin A and de-worming tablets.
The government has a greater role in providing proper sanitation facilities and safe drinking water.
The potential benefits of such as programme is astonishing by reducing number of stunted children, we can increase economic growth.
Our forefather in their wisdom had placed integral human development through attainment of proper nutrition as a corner-stone and a pillar of our constitution.
The same is again been repeated in several high level government documents including the Vision 2050, National Health Plan 2011-20 and more recently the Medium Term Development Priority Three (MTDP 3) and the National Nutrition policy (NNP 2016-26.) Are these high level documents merely a requirement as a formality or key strategies aimed at improving the lives of children and the future leaders of PNG.

Conclusion
Undernutrition is a form malnutrition that occurs as consequences of repeated inadequate intake of optimal and balanced diet compounded with chronic tropical infections
and lack of adequate and safe
water supply and sanitation amenities.
It is of no surprise, PNG did very poorly in the last MDGs and the current SDGs won’t be a difference if no immediate action is taken by the government and its relevant stakeholders.
Undernutrition deprives the child of its future potentials in all facets of life and places the child in irreversible mental and physical developmental statues.
Malnutrition can occur as early at conception and its vicious cycle continuous intergenerational if no coordinated effort is made to break this cycle.
The crucial periods in a child’s life time is from conception to the second year of life.
This period also known as the 1000 days is proven by several studies as the window of opportunities.
It is this 1000 days that is very important days in a parents calendar if you are expecting or nursing an infant under two years of life.

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