the interaction between undernutrition and health text adapted from the world food problem leathers...

The Interaction Between Undernutrition and Health

Text adapted from

The World Food Problem

Leathers & Foster, 2009

http://www.amazon.com/World-Food-Problem-Toward-Undernutrition/dp/1588266389

Health and Nutrition

• Poor nutrition leads to poor health

• AND

• Poor health leads to poor nutrition

• Vicious cycle

Girl with Marasmus in Darfur, Sudan

http://www.drfletcherinafrica.co.uk/marasmus4.jpg

http://www.usaid.gov/our_work/global_health/nut/images/malnutrition_chart.gif

Infections also cause Malnutrition

• Loss of appetite– Intolerance of food

• Cultural factors– Substitution of less

nutritious diet when sick

• Body loss of protein– Used to fight

infection

http://www.sikhspectrum.com/112006/images/u2.gif

Disease and dietary deficiencies

• Keratomalacia: Blindness – Vitamin A deficiency

• Scurvy: Soft gums– Vitamin C deficiency

• Beri-beri: Nerve inflamation– Vitamin B1 deficiency

• Pellagra: Skin disorder– Niacin deficiency

• Anemia: Blood disorder– Iron, B12 deficiency Pellagra

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18103.jpg

Diarrhea and Nutrition

• Diarrhea most common infection causing undernutrion– Kwashiorkor induced by

diarrhea

• Worst in children under 5

• Diarrhea reduces– Water– Salts

• Fatal if dehydration > 15%– 60-70% diarrhea deaths caused

by dehydration

http://www.ghi.com/WebMD/topics/diarrhea.jpg

Causes of Diarrhea

• Rotavirus

• Cholera

• Shigella

• Samonella

• Parasites

• Etc.

http://203.190.254.12/picture/HSB41_Ban_03.jpg

http://203.190.254.12/picture/HSB41_Ban_03.jpg

Rotavirus Diarrhea

http://www.brown.edu/Courses/Bio_160/Projects2004/rotavirus/Images/globaldistribution.jpg

Oral Rehydration Therapy

• Diarrheal salt loss cannot be corrected by drinking salt water– More fluid pulled from

body into intestine

• If add sugar to salt, – sugar crosses intestinal

lining

– pulls salt into bodySigns of dehydration

http://www.wikieducator.org/images/6/61/Signsdehydration.jpg

Oral Rehydration Therapy

• “The cheapest and most effective health intervention that can be implemented in the home to decrease childhood mortality”– UNICEF

Diluted salt water with sugar

http://ec.europa.eu/research/headlines/images2/cholera_rehydrate.jpg

http://cholera.designthatmatters.org/Site_Images/msf_moz_cholera_ort.jpg

Malnutrition Exacerbates Infection

• Philippine children with respiratory infection were 13x more likely to die– if malnourished

• Malnutrition aggravates– Intestinal diseases

– Worms

– ParasitesPhilippine Children

http://www.bbc.co.uk/birmingham/content/images/2007/05/15/main_riverside_children203_203x152.jpg

Malnutition Exacerbates Infection

• Malnutrition most common cause of immune system deficiencies– Decreases in

• white cell response• Interferon• skin integrity• Mucous membranes• Tissue replacement, repair

• Children with PEM– Atrophied thymus– poor T cell productionWhite blood cell surrounded

by red blood cells

http://www.sciencemuseum.org.uk/antenna/cancerkillers/images/cells.jpg

Malnutrition reduces Stamina

• Reduced capacity to cope with life

• Reduced job performance

• Reduced income for– Healthcare

– Transportation to clinics

– MedicinesUganda Health Clinic

http://www.doctorsforafrica.org/images/mulanda_health_centre.jpg

Director General of World Health Organization, 1989

• “ If we could increase the health spending in the developing countries by only $2 per head,

• we could immunize all their children,

• eradicate polio, and provide the drugs to cure all their causes of diarrheal disease,

• acute respiratory infection, tuberculosis, malaria, schistosomiasis

• and sexually transmitted diseases.”

http://www.who.sk/obr/nakajima.jpg

Hiroshi Nakajima

Policies promoting low cost health for the poor

• Good health promotes good nutrition

• Good nutrition promotes good health

• Cheaper to maintain good health– Than to try to cure sick people

• Low cost health for poor– Barefoot doctors in China– Nutrition huts in Philppines– Health huts in Haiti

Barefoot Doctors, Chinahttp://www.chinatoday.com.cn/English/20021/1960nian.htm

U.S. Public Health Policies

• 1840s: modern sewage systems

• 1900s: Drinking water

• 1923: Salt fortified – Iodine

• 1940: Flour fortified – Iron

– Thiamin

– Riboflavin

– Niacin

http://www.ames.lib.ia.us/farwell/publication/Pub6940.htm

Marston Water Tower, 1897

Subsidizing Maternal and Child Health Services

• 1974: less than 5% children in developing world immunized against– Measles– Tetanus– Diphtheria– Pertussis– Tuberculosis– Polio

• Today: 80% immunized due to government policies– Ex: World Health Organization

• 36 million infants/yr not immunized

http://maconareaonline.com/news.asp?id=14271

Maternal and Child Health Centers

• Immunization– Including hepatitis B, yellow fever

• Vitamin distribution– Vitamin A pills cost 5 cents to make

• Monitor Child Development

• Oral Rehydration Therapy

• Promote Breast Feeding

• Nutrition Education

• Family Planning

http://www.new-agri.co.uk/image/043/dev01b.jpg

Maternal Health Center, Malawi

Problems with Baby Formula

• Water supply contaminated with human excrement

• Household hygiene poor– Flies

– Feces

• No refrigerator

• Wood stove, little fuel

• No equipment to clean bottle

• Uneducated mother– No knowledge of germs

http://www.emag.uni-bremen.de/emag/2004/projects/wterprob/my%20home.html

Public Water Case Study

• Port-au-Prince, Haiti, 1976• 50% of municipal water

supply leaked out– Few shut off valves– Little incentive to conserve

• Direct service to 150,000 relatively wealthy

• 400,000 poor supposed to use 27 public stand pipeshttp://www.paho.org/English/DPI/100/100feature25_photos.htm

Public Water Pump, Port-au-Prince


• Extreme water scarcity solutions:– 40,000 people relied on

leaks in pipes

– 95,000 more wealthy people shared with neighbors

– 300,000 bought water through private vendors

Port-au-Prince

http://www.ehponline.org/docs/1994/102-12/focus1.html


• Private Water Market– Tanker trucks

• Filled up free at hydrants

– 2,000 connected households

• sold water to neighbors

– 14,000 people were mobile vendors

• Bought water from connected households

• Delivered to customers– 2 cents a bucket

http://www.wehaitians.com/haitian%20suffering.html

Port-au-Prince


• Private Water Market– Customers paid out $3.8

million/year– Municipal Water Authority

earned $650,000/yr

• Family of 5 would pay $4/month for 11 litres/day– 40% of families earned

$20/month or less– Poorest purchased water

only for drinking• Bathed in surface runoff

http://www.sciencemuseum.org.uk/exhibitions/geographical/fossez.asp

Port-au-Prince

Policies promoting low cost health for the poor

• Good health promotes good nutrition

• Good nutrition promotes good health

• Cheaper to maintain good health– Than to try to cure sick people

• Low cost health for poor– Barefoot doctors in China– Nutrition huts in Philppines– Health huts in Haiti

Barefoot Doctors, China

http://www.chinatoday.com.cn/English/20021/1960nian.htm