LOCAL FEATURE: Interventions needed against malnutrition

Dar es Salaam. Acute malnutrition is a devastating public health problem of epidemic proportions that needs quick intervention to avoid death, poor cognitive development as well as poor school performance of children.

Muhimbili National Hospital paedetrician, Dr Edna Majaliwa, says that close to 40 children suffering from acute malnutrition are admitted annually at the hospital.  “About half of the number of the children admitted at our hospital with acute malnutrition die before treatment is completed,” she says.

Basic causes of malnutrition are related to political and socio-cultural factors where the former’s commitment is important to move the technical reality on what needs to be done to alleviate the problem.

Immediate causes of malnutrition include inadequate diet through low intake of food with insufficient balance of nutrients. Other causes also include infectious diseases that cause either increased loss of nutrients as the body fights infections and related fevers in cases such as malaria and measles infections.

Others are reduced appetite due to illness thus leading to low intake of food or loss of nutrients from the body, for example through diarrhea and vomiting.

Underlying causes are related to inadequacies in household food security resulting from low-capacity by homes to produce their own food, preserve and have it available the whole year round, including in off-season periods. There is also inadequate purchasing power and lack of social mechanisms by which community members provide food assistance to those with a shortage.

Inadequacies in these services could lead to an unhealthy living environment, resulting in outbreak of diseases, low immunity and behavior change towards better nutrition status.

Tanzania Food and Nutrition Centre (TFNC) director for community health and nutrition, Dr Sabas Kimboka, says severe acute malnutrition (SAM) is rampant in Tanzania, noting that without proper plans and strategies the problem will continue to hit most people.

He said they have come up with strategies to fight malnutrition through food fortification in flour and cooking oil.

“Maize flour and cooking oil are among priority foods in fortification because it has been discovered that if nutrients are added in them it helps to fight malnutrition,” he said.

He said they have directed millers to add 10 nutrients in food fortification, in flour and in cooking oil. He said this was because cooking oil produced from sunflower was lacking nutrients.

Dr Kimboka mentioned four major forms of malnutrition as protein-energy malnutrition (PEM), anaemia and iodine deficiency disorders (IDD) and vitamin A deficiency (VAD), common among children.

Worldwide, some 55 million children under the age of five suffer from acute malnutrition whereby 19 million of these are  from the most serious type – severe acute malnutrition. Every year, 3.5 million children die of malnutrition-related causes.

The human body needs energy and nutrients to function. If food intake is inadequate, the body begins to break down fat and muscle, the metabolism begins to slow down, thermal regulation is disrupted, the immune system is weakened and kidney function is impaired.

Nutrition Partnership manager for Panita in association with Save the Children International Joseph Mugyabuso said food rich regions have high rates of malnutrition due to lack of awareness. However, considering the complexity of causes of malnutrition, its underlying causes are grouped into Food, Care and Health or generally basic services factors.

Therefore, improvement in food availability or even broader food security - considering physical, financial and social accessibility to food - is not sufficient to prevent malnutrition.

According to him, one of the important steps in regions which produce a  surplus of staple food - including Rukwa, Mbeya and Iringa - would be to ensure that their agriculture is nutrition-friendly.

He said the high production of staples would need to be coupled with homestead food production of fruits and vegetables as well as keeping small animals including chickens and rabbits to improve availability of protein, mineral and vitamin food sources at household level.

“Sometimes agriculture is more engaging to women... therefore, they miss time to provide the necessary care to their young children, thus resulting in malnutrition… Involvement of men in all reproductive and child care initiatives is paramount,” he said.

According to him, the government’s recent strategy to join the global movement to scale up nutrition which stresses on its increased prioritisation in development plans at all levels is crucial.  It is also engaged in mobilising a diversity of stakeholders for a collective action to invest in nutrition-specific and nutrition-sensitive interventions. The formation and participation of the Partnership for Nutrition (Panita) in pushing the agenda to invest in nutrition  is an indication of political commitment to address the problem of malnutrition.

“The better the country’s economic situation, the higher the probability that enough resources would be committed to improving nutrition from the community to the national level,” said Mr Mgyabuso.

The status of these factors in the society determines the level and nature of leadership commitment. Taboos and cultural beliefs that could result in denying some groups eating nutritious foods could aggravate the problem of malnutrition

Mr Mgyabuso explains that the best interventions against these causes of malnutrition include service delivery in addressing immediate causes of the problem by providing food support and treating diseases.

Others are capacity-building in improving  the ability of households and communities to address underlying factors and inadequacies in food security, care of the vulnerable groups and basic services.

Empowerment of  long-term solutions to addressing malnutrition, for example, mainstreaming nutrition-specific and nutrition-sensitive interventions in district level plans for key sectors like health, agriculture, livestock  development and fisheries, water and sanitation, community development, education as well as planning and financing can also help.

  “If these key sectors collaborate, they can do a lot to reduce malnutrition in Tanzania,” he says.