Malnutrition concern in PNG

Malnutrition is a serious problem in Papua New Guinea. It can result in irreparable physical and
cognitive damage. It is not uncommon to see children suffering from kwashiorkor – an extreme symptom of malnutrition, Russ Stephenson, Shirlynna Lowagipo write:

THE 2005 PNG National Nutrition Survey in 2005 found that 43.2 per cent of children between six and 59 months were stunted (impaired growth and development indicated by low height for age), 5.5 per cent were wasted (low weight for height), and 18.1 per cent were underweight (low weight for age).
Malnutrition is higher in rural than in urban areas.
Data on child growth rates can guide early nutritional and health interventions before clinical symptoms of malnutrition appear.
In 2018, we conducted a malnutrition survey of children in villages in the disadvantaged Strickland Bosavi region of Western and Hela.
This happened three years after a serious drought and 10 months after a devastating earthquake affected the region.
The survey provided baseline data for a Rotary-sponsored project to alleviate malnutrition, based on Food Plant Solutions philosophies.
We measured the weight and height of 341 children (174 boys and 167 girls) under five years of age at the Bedamuni and Edolo villages of Mougulu, Adumari and Huiya.
Mid-upper arm circumference (MUAC), which indicates wasting, was measured at Huiya and surrounding villages.
Many of the children were from families who had been displaced from their villages by the magnitude 7.5 earthquake of February 2018.
Guidelines based on PNG child growth data were developed for PNG’s national nutrition survey in 1982/83.
zBut we used the more readily available World Health Organisation (WHO)/World Vision International guidelines to estimate wasting, stunting and underweight for each child.
A child was considered to be malnourished if any one of these values is less than the critical levels from the WHO standard child growth tables. International standards overestimate stunting and underweight, but not wasting, compared to the PNG standards.
Each of these indicators covers a different aspect of malnutrition.
So together, they provide a more complete insight into a child’s nutritional status.
The table (above) shows that slightly over 40 per cent of the children showed at least one criterion of malnutrition (stunting, wasting, underweight or MUAC).
The incidence of malnutrition varied with location.
Stunting was the most common expression of malnutrition, particularly among children who had sought refuge at Huiya and those who resided at Adumari.
Children from these locations also showed the highest overall incidence of malnutrition (at least one criterion).
Wasting was much higher for children from villages associated with Mougulu.
Underweight was also high at these villages, though it was even higher at the refugee villages associated with Huiya.
For refugee children at Huiya, overall malnutrition and stunting were higher in children under three than in those who were older (60.8 vs 39.7 per cent for overall malnutrition, and 43.1 vs 34.5 per cent for stunting).
For children from Huiya, these figures were 47.7 vs 33.3 per cent for overall malnutrition, and 27.3 vs 25 per cent for stunting.
At Adumari, where stunting was also pronounced, there was little difference between the two age groups.
At Huiya, this age group difference was most pronounced among children who had been displaced by the earthquake.
The villages of all these children were seriously affected, with many gardens destroyed in landslides.
While this may have exacerbated malnutrition.
The drought of 2015/16 likely had more influence.
Stunting is a chronic condition that arises from malnutrition experienced during the first 1,000 days of a child’s life (conception to two years of age).
Eighty of the 341 children surveyed (23.5 per cent) were severely malnourished.
Lingering effects of the drought could be implicated.
For refugee children at Huiya, the February earthquake could have exacerbated expressions of malnutrition.
Boys were heavier (mean 12.2 kg) and taller (mean 86 cm) than girls (11.0 kg, 81.4 cm).
But with the exception of wasting, measures of malnutrition were similar for both.
Only 20.6 per cent of children had received three or more vaccinations (for Hepatitis B, measles and triple antigen, which provides protection against diphtheria, tetanus and whooping cough or pertussis).
A further 42.3 per cent had received either one or two, and 31.1 per cent of children had not had any vaccinations.
Malnutrition was reduced slightly with increased level of immunisation: 50.4, 40.8 and 39 per cent respectively, for zero, one or two, and three vaccinations.
While this may illustrate a positive influence of national vaccination programmes, the capacity of health services to address malnutrition remains limited in the Strickland Bosavi region.
The high levels of overall and severe malnutrition suggest an urgent need for remedial action in this region.
The situation at and near Huiya and Adumari appears particularly bad, with high levels of stunting.
Many villages near these focal communities have no on-site medical support.
Follow-up work is needed to identify malnourished children and to guide provision of a regular, well-balanced, nutritious diet and, as needed, treatment.
For children up to five years old, a balanced, nutritious diet is essential for unimpeded body and brain growth and development.
Children need about half the amount of nutrients required by adults, but their stomachs are small so it is difficult for them to consume sufficient low-energy foods to supply their daily requirements.
Children need some additional high-energy and protein-rich foods in their diet, for example, corn porridge, boiled mashed bean seeds, or coconut milk mixed with staple foods for babies, and seeds and nuts for children older than 12 months.
The project to alleviate malnutrition in Western has raised awareness on the importance of good nutrition by about 2000 families – thanks to the team of volunteer instructors who conducted 41 village nutrition workshops in the region.
The next phase of the project, with support from the Cross Sector Partnership Initiative (XSPI) collaborators and funding bodies, will focus on sustainable adoption of better diets for children.
Whether or not people in Western experience hunger is not the issue and Bourke disputes this claim anyway – that its children do not consume a well-balanced and nutritious daily diet is indisputable.

Disclosure: This survey was undertaken with support from the Rotary Foundation and Rotary Clubs and in collaboration with the Care International Earthquake Recovery Team. The views are those of the authors only.

This article appeared first on Devpolicy Blog (devpolicy.org), from the Development Policy Centre at The Australian National University.

Russ Stephenson is an agricultural scientist, and was a senior lecturer in agriculture at the University of Papua New Guinea from 1975 to 1979. He is a Rotarian, and leads the Rotary Alleviation of Malnutrition Project in PNG’s Western.

Shirlynna Lowagipo is a trained

nurse. She was the nutritionist on the Care International Earthquake Recovery Team after the 2018 earthquake in PNG, and supervised collection of survey data.