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Malnutrition, a global health concern

Published : Tuesday, 14 January, 2020 at 12:00 AM  Count : 227
Md Zillur Rahaman

Md Zillur Rahaman

Md Zillur Rahaman

Millions of people are suffering from different forms of malnutrition across the world. In fact, globally 1.9 billion adults are overweight or obese while 462 million are underweight. Among children, 52 million under fives are suffering from wasting, where they have a low weight for height.

Around one in ten children are born with a low birth weight, and in South Asia, it is one in four, and about 45 per cent of deaths among children under-five are linked to under nutrition. These deaths often occur in low and middle income countries where childhood obesity levels are rising at the same time.

Globally malnutrition affects 2 billion people in the world, 45 per cent of deaths of children under five years of age are attributable to under-nutrition. Malnutrition is an underlying cause of death of 2.6 million children each year - one third of child deaths globally. Around 160 million children under five years of age worldwide are affected by stunting. Vitamin A deficiency causes 157,000 child deaths a year, and zinc deficiency 116,000 child deaths.

Basically malnutrition is a condition that results from eating a diet in which one or more nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrition is called under nutrition or undernourishment while too much is called 'over nutrition'. Malnutrition is often used to specifically refer to under nutrition where an individual is not getting enough calories, protein, or micronutrients.

If under nutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.

A study of USAID found that rates of malnutrition in Bangladesh are among the highest in the world. More than 54 per cent of preschool-age children, equivalent to more than 9.5 million children, are stunted, 56 per cent are underweight and more than 17 per cent are wasted. Although all administrative divisions were affected by child malnutrition, there were important differences in the prevalence of the three anthropometric indicators. The prevalence of underweight ranged from 49.8 per cent in Khulna to 64.0 per cent in Sylhet which also showed the highest prevalence of stunting (61.4 per cent) and wasting (20.9 per cent). Despite the high levels, rates of stunting have declined steadily over the past 10 years.

Bangladeshi children also suffer from high rates of micronutrient deficiencies, particularly vitamin A, iron, iodine and zinc deficiency. Bangladesh should be commended for making significant progress in reducing vitamin A deficiency (VAD) among preschool children over the past 15 years; however, consumption of vitamin A rich foods is still low, suggesting that the underlying causes of VAD require further attention and support. Anaemia is also highly prevalent among children in Bangladesh and few programs have been initiated to improve their iron status.

Malnutrition among women is also extremely prevalent in Bangladesh. More than 50 percent of women suffer from chronic energy deficiency and studies suggest that there has been little improvement in women's nutritional status over the past 20 years. As observed for children there were important differences in the prevalence of women malnutrition among administrative divisions. The prevalence of women with a BMI<18.5 kg/m2 ranged from 47.6 per cent in Khulna to 59.6 per cent in Sylhet. Clinical VAD is common among women of reproductive age and during pregnancy. Sub-clinical VAD and anaemia are also highly prevalent among pregnant and lactating women. Programs in Bangladesh also need to begin to incorporate components for adolescents and school-age children who will also benefit from improvements in nutrition.

Undernourishment is most often due to not enough high-quality food being available to eat. This is often related to high food prices and poverty. A lack of breast feeding may contribute, as many a number of infectious diseases such as: gastroenteritis, pneumonia, malaria, and measles, which increase nutrient requirements. There are two main types of under nutrition: protein-energy malnutrition and dietary deficiencies. Common micronutrient deficiencies include: a lack of iron, iodine, and vitamin A. During pregnancy, due to the body's increased need, deficiencies may become more common. In some developing countries, over nutrition in the form of obesity is beginning to present within the same communities as under nutrition. Other causes of malnutrition include anorexia nervosa and bariatric surgery.

According to the Global Hunger Index (GHI) data in 2019 showed that the hunger situation in Bangladesh continues to remain "serious", with one in every seven persons suffering from undernourishment.

The report said Bangladesh has made strides in fighting hunger and undernourishment since 2000 due to steady economic growth. The country scored 25.8 on a 100-point scale -- where 0 reflects no hunger -- in the 2019 GHI, down from a score of 36 in 2000, which was considered alarming.

This year, the GHI ranked Bangladesh 88th out of 117 countries. The country falls behind Sri Lanka and Nepal in fighting hunger but stays well above Pakistan, India and Afghanistan in South Asia. The report also said Bangladesh has made significant advances in child nutrition and stunted growth dropped from 58.5 per cent in 1997 to 40.2 per cent in 2011 which was 36.2 per cent in 2018.

It has been found that significant progress has been made in cereal production in Bangladesh over the past decades. However, the rapid population growth and resulting high and growing food requirements pose a difficult challenge given the limited availability of cultivable land in Bangladesh. Re-occurring disasters further complicate the stability of food production. Recently the government of Bangladesh and interested organisations have started to encourage non-cereal food production and consumption along with food self-sufficiency.

Greater attention is being given to supportive policies for agriculture input, research on non-cereal crops, and commercial and homestead promotion of poultry and fruits/vegetables are receiving greater attention. There is a clear need to diversify food sources both in terms of land/environmental sustainability, development of the rural economy and increased consumption to achieve improvements in the nutritional status of the people of Bangladesh.
Improving nutrition can have a significant impact on survival as well as physical and cognitive development and productivity. Good nutrition, comprising adequate quality and quantity of food intake and reduction of illness is also a basic human right and is an essential input for economic development. However, Bangladesh was able to make notable improvement in reducing hunger during the last two decades by successfully reducing the prevalence of stunted growth by nearly half and child mortality rate by nearly three times.

The 2019 GHI said Bangladeshis consume a diet that centres on rice, from which they receive about two-thirds of their calories. It said besides rice, vegetables and fish are important components of the diet for some people, yet for many others, dietary diversity is low and micronutrient deficiencies are widespread.
Since malnutrition is the main cause of many death and disease in the world and the developmental, economic, social and medical impacts of malnutrition are serious and lasting, so every government should focus on it not only for health development, but also socio-economic development.

The writer is banker









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