Public Health

Nutrition
Module I
Introduction

Nutrition

Fundamental pillar of

human life, health and development across the

life-span,

Fetal development-Birth-Infancy-ChildhoodAdolescence-Adulthood-Old age

Proper food and good nutrition, essential for

Survival
Physical growth
Mental development
Performance and productivity

Definitions

Human Nutrition

A scientific discipline, concerned with the access

and utilization of food and nutrients for life, health,
growth, development and well-being.

Scope of human nutrition

Biological and metabolic nutrition,

Clinical nutrition,
Public health nutrition

Public health nutrition

Studies relationship between dietary intake and

disease,
Uses tools of nutritional epidemiology,
Knowledge applied for nutrition intervention,
National nutrition programs,
Global prevention, control and elimination of
nutritional disorders,

Dietetics

Application of nutritional knowledge tailored to

individual needs,

Mainly based in hospitals,

Use of diet in treatment and management of disease,

Nutrition education in the community

Aims of the module

Familiarize the student with the main issues

and approaches in public health nutrition,

Prepare student to further examine detailed

issues in subsequent modules,

Learning Objectives
After completion of this module, the student should be able to;

Explain the scale and dimensions of the problem

of malnutrition,

Discuss the multi-factorial causation of

malnutrition,

Describe the malnutrition-infection interaction

and identify nutritionally relevant infections,

Scale of the problem of

malnutrition

Over 50% of all child deaths worldwide,

Survivors

left crippled,
chronically vulnerable to illness,
Intellectually disabled

Malnutrition and child mortality

6 out of the 12 million (>55%) children under-five

annual death in developing countries, attributable
to malnutrition,

2.2 million children die from

Persistent diarrhea dehydration

Aggravated by malnutrition

Importance of malnutrition as an underlying

factor in under-five mortality in Ethiopian
Children.
Others

Perinatal
Complications

Diarrheal
Diseases

Malnutritio
n
58%

Malaria

Measles

Acute
Respiratory
Infections

WHO 98

Malnutrition is a silent emergency

Most child deaths related to mild-moderate

malnutrition,

Malnutrition and poverty

Malnutrition and infection

Malnutrition rates in developing world

Falling over the last few decades,

Markedly different pace,
Sub-Saharan Africa, exception

Increasing rates during 1990s

Following economic decline of 1980s

Government budget shrunk

Basic social (and health) services hit hard
Per capita income declined
Ability to purchase food declined

Dimensions of the malnutrition

problem

Beyond child survival, maternal mortality and

morbidity;

Life-time disabilities,
Weakened immune system,
Diminished learning capacity,

Young children, malnutrition

Dulls motivation and curiosity,

Reduces play and exploratory activities,
Reduces interaction to environment, & care-givers
Impaired mental and cognitive development

Expectant mother,

Iodine deficiency in mother

Severe iodine deficiency in utero

mental retardation in infant (varying degrees)

Cretinism (profound mental retardation)

Anemia (contributing factor, principal cause)

20-23% pf postpartum maternal deaths (Africa, Asia)

Infancy and early childhood

Iron deficiency anemia

Low birth-weight babies

delayed psychomotor development

Impaired cognitive function
Lower IQ (9 points)

Lower IQ (average of 5 points)

Non-breast-fed children

Lower IQ (average 8 points)

Pre-school children

Anemia

Loss of attention
Poor discrimination of visual stimuli

Primary school children and adolescents

Iron deficiency

Poor school attention

Adulthood

Lower physical and intellectual abilities,

Lower levels of productivity,
Higher levels of chronic illness and disability
Increased costs and pressure on families,
Overstretched social services,
Impact on national and global development

Nutritional problems of public

health importance

Multiple types of malnutrition

Protein-energy malnutrition,
Iodine deficiency disorders,
Vitamin A deficiency,
Iron deficiency anemia,
Varying combinations

Each type of malnutrition is the result of

complex interplay of factors;

Inadequate dietary intake and disease

Household access to food,

Child and maternal care,
Safe water and sanitation,
Access to basic health services

Causes of malnutrition

Malnutrition is not a simple problem with a

single, simple solution,

Multiple and interrelated determinants

involved,

Multifaceted, and multisectoral approaches

needed,

Malnutrition

Manifestations

(individual level)
Inadequate
Dietary Intake

Insufficient
Household
Food Security

Disease

Inadequate
Maternal &
Child Care

Insufficient
Health Services &
Unhealthy
Environment

Immediate
Causes

Underlying
Causes
(household/family level)

Inadequate Education

Resources and Control

Human, Economic &
Organization

Political and Ideological Superstructure

Economic Structure

Fig. 1. Causes of Malnutrition

Potential Resources

Basic
Causes
(societal level)

Conceptual framework on
causes of malnutrition

Guide in assessing and analyzing causes,

Help identifying appropriate interventions,

Used at national, district, local levels to plan

effective actions to improve nutrition.

Immediate causes
Weight loss
Growth faltering
Lowered immunity
Mucosal damage

Inadequate
dietary
intake

Disease:
incidence
severity
duration

Appetite loss
Nutrient loss
Malabsorption
Altered metabolism

Underlying causes

Inadequate access to food,

Inadequate care for children and women,
Insufficient health services and unhealthful
environment,

Household food security

Sustainable access to safe food,

Sufficient quality and quantity,

Energy, protein and micronutrients

Ensure adequate intake, and healthy life,

For all members of the family
Depends largely on access to food (availability +)
Women play special role in maintaining HFS;

Preparing, cooking, preserving, storing food,

Producing, purchasing food

Health services, safe water and

sanitation

Access to curative and preventive health

services,

Affordable, and good quality,

Environmental health,

Lack of access to safe water supply and proper

sanitation,
Unhygienic handling of food,

Diarrheal diseases, intestinal parasitosis malnutrition

Women and children are responsible for

Fetching water needed for domestic use

Time and energy draining task

Caring practices

Inadequate care for children and women,

Care,

Only recently recognized

The way a child is fed, nurtured, taught, guided,

Caring behaviors,

Feeding,
Protecting childrens health,
Support and cognitive stimulation for children,
Care and support for mothers,

Feeding

Good caring practices

Good information and knowledge,

Free from cultural bias and misconceptions

Withholding food and fluids during diarrhea,

Whether children are fed first or last,
Sex preference in child feeding and caring,

Knowledge about hygiene, disease transmission,

Hand washing,
Food preparation and storage,

Protecting childrens health

Sound health information,

Appropriate and timely health care seeking,
Essential health care to children,

Preventive, curative, etc.

Support and cognitive

stimulation

Emotional support and cognitive stimulation,

Recognizing and responding to actions and needs

of infants,
Breastfeeding,

Verbal stimulation by caregiver,

Best early occasion to provide support and stimulation,

Close emotional bond between mother and infant,
Important for linguistic development

Special attention to ill or malnourished children,

Encourage to feed, to renew interest in surrounding,

Optimal cognitive development;

Education of parents and other caregivers

Improved nutrient intake (+)

Stimulation, regular interaction

Enhanced caring behavior

Policy makers should recognize significance

of such measures and actions

Care and support for

mothers

Unequal division of labor and resources,

Women put twice the hours of men into family and

household activities,

Discrimination in education and employment,

Critical elements of care for women during

pregnancy and lactation,

Extra quantities of good quality food,

Reduced burden of work,
Adequate time for rest,
Pre- and post-natal health care from trained
provider,

Cultural norms and misconceptions,

Fish, meat, eggs, and fat excluded from diet

Fear of too large baby and difficult labor,

Better maternal diet improves birth weight of

newborns without causing significant
increase in head circumference,

Improving womens status in society

Building skills and capacities,

Equal partnership with men,
Ensuring womens access to family and
community resources,

Credits, education, information, etc.

Preventing early marriage in girls

Involvement in major personal decisions,

When to marry, Birth spacing,

Adolescent pregnancy and child birth

Major risk factor for both mother and child,

Low birth weight,

Toxemia,
Hemorrhage,
Anemia,
Infection,
Obstructed labor,
Perinatal mortality

Basic causes of malnutrition

Poverty

Principal cause of child malnutrition,

Many poor families receive adequate nutrition,
Malnutrition is found in many better-off families,
Fuller understanding of different types of
resources necessary for good nutrition,
Factors that affect families ability to access and
control resources,

Often efforts to fulfill one precondition for

good nutrition compete for the same
resources required to fulfill another condition,

Household food security through spending

excessive time in producing food,
Provision of adequate care, compromised

Political, legal and cultural factors at national

and regional levels may defeat the best
efforts of households to attain good nutrition
for all members.

Degree to which rights of women and girls are

protected by law and custom,
Political and economic system that determined
how income and assets are distributed,
Ideologies and policies that govern the social
sector,