Category: Malnutrition

Intended Outcomes of the Proposal Recommendations

It is expected that the proposal recommendations will help develop a comprehensive strategy for managing the process of hospitalized patients nutrition. As a result, the instances of undernourishment or any other malnutrition cases will hopefully be avoided. Furthermore, both patients and nurses will receive essential guidelines concerning proper nutrition.

Detailed instructions about the screening process will be provided to nurses. Moreover, patient education will require that nurses should engage the target population in the active acquisition of the relevant information about their disease or disorder and the dieting options that they have. Thus, patient independence can be promoted successfully.

Potential Unintended Outcomes/Consequences Resulting from Implementation of the Proposal Recommendations

The proposal recommendations will cause a rapid drop in the cases of malnutrition among inpatients. In addition, the level of proficiency in managing nutrition-related patients needs will rise exponentially among nurses. Finally, patients will also receive important information about the nutrition process and will develop the relevant skills.

Among the unintended consequences, the engagement in lifelong learning as the health management strategy may be observed among some of the patients. The identified outcome is quite unlikely, yet, with proper guidance provided by nurses, the target population may develop enthusiasm about gaining new information about health and health-related concern. Thus, a gradual improvement in the well-being of the community members can become a possibility. Furthermore, there is a chance that the patients will be able to determine malnutrition at its early stages and inform nurses about the problem. In addition, the enhancement of the communication process between nurses and patients may be triggered by the suggested changes to the nutrition strategy for hospital inpatients. As a result, a rise in the number of positive patient outcomes will possibly be observed.

Summary

Malnutrition is a medical term that is used in reference to under-nutrition and over-nutrition (Duggan & Watkins, 2008). Persons whose diets do not provide their bodies with enough proteins and calories for their development experience Under-nutrition issues. On the other hand, individuals whose diets provide their bodies with too many calories experience over-nutrition issues. Currently, the world produces adequate food to feed its inhabitants. As compared to the past century, the worlds food production rate has improved by 25%. Despite these improvements, it is estimated that in the world close to one billion people are suffering from undernutrition. Equally, it is estimated that more than one billion individuals are suffering from over-malnutrition and obesity cases. According to the UN reports, the worst-hit regions by malnutrition are developing countries in South Asia and Africa. In these regions, cases of malnutrition were reported to be rising in areas experiencing civil strife and draught.

Alternatively, adequate nutrition is achieved when an individual consumes sufficient, balanced diet food at the right time. Medical experts suggest that it is appropriate for every individual to maintain adequate nutrition. It is through this habit that individuals can maintain healthy lifestyles. According to medical experts, development in children is greatly affected by their feeding habits. It is for this reason that stunted growth, underweight, and obesity issues are associated with malnutrition. According to the UN reports, malnutrition and development issues in children do not only affect their survival but also affect the quality of their lives. Currently, sufficient knowledge on how to improve the development in children exists (Roth, 2011). As such, several measures have been implemented to treat and reduce incidences of malnutrition in children. Similarly, methods of how to achieve adequate nutrition in children have been developed and implemented. For instance, in the past century, several efforts were focused on the treatment of childhood malnutrition with the effort of enhancing their development (Shils & Olson, 2010). Despite these relentless efforts, malnutrition issues are still considered major health challenges in developing countries. Currently, it is noted that health experts have shifted their efforts of improving childrens development towards adequate nutrition initiatives (Cameron, 2009). In this regard, there is an urgent need to establish adequate facts on whether adequate nutrition or the absence of malnutrition reduces the risk of development.

Descriptive Questions

What are the benefits of enhancing childrens development through the treatment of childhood malnutrition? What are the benefits of enhancing childrens development through adequate nutrition initiatives? What are some of the components of malnutrition primary prevention programs that have been developed and tested over the last few years? What are some of the adequate nutrition programs developed and tested over the last few years? What are the determinants that influence the approach taken towards the enhancement of childrens development? What is the percentage of children whose developments have been affected by malnutrition-related cases?

Comparative Questions

Between adequate nutrition programs and malnutrition primary prevention programs, what approach is the most effective to enhance childrens development? As compared to malnutrition primary prevention programs, why are adequate nutrition programs preferred?

Correlation Questions

What are the similarities between adequate nutrition programs and malnutrition primary prevention programs? What are the dissimilarities between adequate nutrition programs and malnutrition primary prevention programs?

References

Cameron, N. (2009). Human growth and development. San Diego, Calif.: Academic Press.

Duggan, C., & Watkins, J. B. (2008). Nutrition in pediatrics basic science, clinical applications (4th ed.). Hamilton, Ontario: B.C. Decker.

Roth, R. A. (2011). Nutrition & diet therapy (10th ed.). Clifton Park, NY: Delmar Cengage Learning.

Shils, M. E., & Olson, J. A. (2010). Modern nutrition in health and disease (8th ed.). Philadelphia : Lea & Febiger.

Iron deficiency anemia (IDA) affects 2 billion people worldwide. It has been estimated that iron deficiency (ID), without anemia, is at least twice as frequent. In India alone, 600 million people are afflicted by this nutritional inadequacy. Current iron fortificants either suffer from poor bioavailability of negatively affect the sensory profile of foods. Additionally, the use of iron fortificants and supplements may also cause adverse effects in children, especially in malaria-epidemic areas. Tata-Cornell has, therefore, made it a top priority to address the rising issue of IDA in India.

Microalgae are gaining traction as a biofuel industry substrate. Even after lipid extraction, the leftover biomass (defatted) contains high amounts of proteins, omega-3 fatty acids and micronutrients. In cooperation with Cornell University’s Field of Food Science, TCI Scholar Rohil Bhatnagar is investigating the potential of defatted microalgae Nannochloropsis oceanica (DGM), a by-product of the biofuel industry, as a novel iron source.

To test the bioavailability of native iron present in this microalgae, a mouse study was conducted with diet-induced iron-deficient mice that were fed DGM-extracted iron (Fe-DGM, 39 mg Fe/kg) for 6 weeks. Previously, the mice were made iron-deficient through consumption of a rice-based control diet without supplemental iron (6 mg/kg Fe). Rice was chosen as a vehicle because over half of the world’s population considers rice as a staple. Mice fed the Fe-DGM diet had elevated hemoglobin and liver storage iron over the iron-deficient control. Iron-repletion through Fe-DGM diets positively affected the expression of iron metabolism pathway genes in the duodenum and liver. This was the first study to determine the effectiveness of DGM-extracted iron in improving mild anemia in iron-deficient mice.

Subsequently, we conducted a safety assessment study to determine any putative adverse effects from high doses of continuous DGM supplementation on liver health and other parenchyma. Toxic effects through DGM consumption has not been investigated previously. C57BL/6 mice were fed the control diet (0% DGM), or control + DGM (5 or 10%) for 4 weeks. Excess iron (called secondary iron overload), as evident through tissue iron accumulation, can cause many severe detrimental health effects, including microbial infections and cancer. Repeated oral challenge through high doses of dietary DGM did not induce any oxidative stress, iron bioaccumulation or visible inflammation.

To assess what foods hold most promise for fortification, fieldwork in rural communities in India was carried out. As wheat flour is widely consumed and available through the public distribution systems, it may serve as a suitable vehicle for iron delivery. To mask the color and flavor of DGM for use in wheat flour fortification, encapsulation of DGM in emulsions (o/w) using conventional homogenization methods was applied. The mean particle diameter of the microcapsules was …….. with a spherical shape when examined under a scanning electron microscope.

The addition of up to 35 mg Fe/kg of this encapsulated powder to wheat flour did not cause any stability changes for 45 days, as measured through lipid peroxidation, color change and moisture content. In fact, the encapsulation process prevented the oxidation of ferrous ions present in the DGM to ferric ions. We also conducted a sensory analysis (n = 110) with Indian baked bread (chapatis) made from wheat flour supplemented with encapsulated DGM at a 35 mg Fe/kg fortification rate, and concluded that there was significant differences between fortified or unfortified chapatis. The work presented in this dissertation provides a novel approach to combat global iron malnutrition, and exhibits the vast potential of DGM as an effective and safe iron source.

Nutrition is defined as a substance working in the body. A living life form is the result of nourishment. The individual requires in excess of 48 distinct supplements for its prosperity. Supplements are substance parts gotten from nourishment, which help support body capacities, body development, and protection of the organs of the body

Malnutrition signifies impedance of wellbeing emerging either from inadequacy or overabundance or irregularity of supplements in the body. It is a natural issue (Gopalan, C., 2002). It is the final product of different covering and collaborating factors – physical, natural, social and cultural environment, and financial.

Adolescence is a time of progress between childhood and adulthood happening somewhere in the range of 12 and 18 years old (Chilman and Nancy, 1994). In young ladies, immaturity development happens prior (i.e., amid 12-15 years) than in young men (i.e., amid 13-16 years). Achievement of menarche is a critical occasion in a young lady’s life. Adolescent girls shape an essential portion of the populace and comprise, figuratively speaking, the crucial ‘connect’ between the present age and the following. As of late, expanding worry for the nourishing status of young people is revealed by nutritionists, health care professionals, politicians, and administrators.

Malnutrition has an antagonistic effect on grimness and mortality. It influences physical development and improvement amid the development time frame and prompts summed up useful hindrance, incapacity, reduced efficiency, and failure to adapt to ecological dangers including protection from disease. The dietary status of an individual is basically controlled by the admission of a sufficient eating regimen and an individual’s defenselessness to contaminations which interfere with digestion and assimilation (Raman, 1992).

Ignorance of the basic principles of nutrition is a major cause of many diseases of malnutrition. Malnutrition is not due to lack of economic resources but to the poverty of knowledge and information needed for food needs. The society in which various diseases of malnutrition spread has low efficiency and ability of labor and production and cannot make progress of any kind, because the nutritional status of individuals directly affects society as a whole (Ayat Obaid,2001).

Malnutrition at its fundamental biological level is an insufficient supply of supplements to the cell. On an organic dimension, dietary lack issue might be named essential or optional, as indicated by the accessibility of the supplement. An essential insufficiency infection is an illness that outcomes specifically from the dietary absence of explicit basic supplements. An auxiliary inadequacy infection is a malady that outcomes from the powerlessness of the body to utilize a particular supplement legitimately (Akseer N, et al, 2017).

More than one-half of the 9.7 million child and adolescents deaths worldwide are caused by undernutrition. Malnutrition alone not only kills but also accelerates the burden of infectious diseases. World Health Organization in 2002 pointed out that more than 3.7 million deaths could be due to being underweight. As long as deaths from undernutrition occur among young children and adolescents, the loss of healthy life years is even more substantial (Lui JC, Nilsson O, Baron J, 2011).

Adolescence is a physiological and social process through which a child matures into an adult. The word is borrowed from the Latin adolēscentia, and its first known use was in the 15th century. The UN defines young people as those aged 10–24, early adolescents as those aged 10–14 years, and late adolescents as those aged 15– 19 years. The world is currently home to 1.8 billion young people; this is the largest generation in human history. Their number and population share continue to grow in many places, and nearly 90% of young people live in low- and middle-income countries (Rodriguez CA, et al, 2017).

Adolescence is a critical period in the process of growth and development. This phase is characterized by a rapid increase in height and weight and many changes in physiological and social. During adolescence, the prevalence of malnutrition and erratic food behavior leads to the spread of future diseases such as osteoporosis, obesity, increased fat levels, delayed puberty, final height at puberty, and nutritional deficiencies during this phase this age (Iman Al-Beloni, Mason Shteifi, 2003: 3).

Proper nutrition is defined as eating an individual’s food containing enough nutrients for his or her body. If a deficiency or increase in one or more nutrients in his or her daily food or inability to take advantage of nutrients is repeated, this leads to physiological disorders in the human body, known as malnutrition.

Malnutrition is a disease caused by shortness or excessive intakes of one or more nutrients, such as obesity, thinness, night sickness, scurvy, rickets, bone marrow, anemia, beriberi, and pellagra. Among the most common diseases of malnutrition among teenagers: Anemia and obesity.

The World Health Organization and the United Nations Children’s Fund have warned people of the dangers of malnutrition by saving children and adolescents from the risk of malnutrition (Laila A. Hossam El-Din, 2004).

Malnutrition does not stop at measuring the amount eaten or failing to eat. Medically, malnutrition is diagnosed by not eating adequate amounts of proteins, energy, and other nutrients and is also diagnosed with an infection or illness.

Ignoring the basic principles of nutrition is a major cause of many diseases of malnutrition. Malnutrition is not only due to lack of economic resources but to lack of knowledge and information needed for food (Ghai OP, 2006).

Therefore, the study recommended that food culture programs should be provided to all family members. It was found that there is a relationship between cardiovascular disease and eating fat in food, in terms of quantity and quality, for example, the level of cholesterol in the blood indicators of atherosclerosis in humans, has also proved that heart disease and blood circulation are linked to the amount and type of protein and is a vegetarian or animal? Therefore, preventive nutrition is the best treatment to avoid the most serious diseases caused by malnutrition in adolescents.

Healthy nutrition is essential; especially for the elderly because at this stage of their lives, they have a lower tolerance to hunger and a weaker immune system; which makes them more prone to suffer from diseases. Unchecked malnutrition and dehydration can lead to severe health complications and worse still, death. Therefore, the need to carefully monitor the eating pattern, fluid intake and overall wellbeing of the aged explains why most people move their elderly loved ones to nursing homes in the hopes that they are given better and adequate professional care; well fed and ‘bustling with good health.’

Alas! Research has shown that malnutrition and dehydration in nursing homes are real and in fact, one of the most concealed but leading causes of deaths in nursing homes in the United States! This is not surprising since most times, the crucial task of monitoring the nutrition of the elderly is sadly left to assistants who are overworked, overstressed and understaffed.

HOW TO IDENTIFY DEHYDRATION AND MALNUTRITION IN THE ELDERLY

Dehydration arises when the body utilizes more water than it gets; it means the body desperately needs water to function but simply lacks it. Malnutrition, on the other hand, occurs when the body lacks the necessary nutrients it needs; due to lack of proper, regular and healthy diet. The best way to identify dehydration and malnutrition in the elderly is to watch out for the signs.

SIGNS OF DEHYDRATION IN NURSING HOMES

Since dehydration deaths in nursing homes are very common but concealed, the burden lies on you to swiftly identify the signs to protect your loved ones and take the necessary steps to pursue a nursing home dehydration lawsuit.

• Dry mouth because of lack of fluid for saliva production
• Heart palpitation and rapid breathing because the blood contains less water
• Hollow/ sunken eyes
• Excessive thirst
• Lack of urination or orange colored urine
• Weakness and dizziness
• Confusion
• Dry eyes
• Dry skin

SIGNS OF MALNUTRITION IN NURSING HOMES

• Rapid weight loss
• Extreme fatigue
• Wounds heal slowly
• Frequent cold
• Trouble concentrating
• Lack of balance/ frequent falls

SHOULD YOU PURSUE A NURSING HOME DEHYDRATION LAWSUIT/ MALNUTRITION LAWSUIT?

While it has been established through careful investigation (based on research) that nursing homes neglect dehydration, treat malnutrition of the aged left in their care with levity and try (where possible) to conceal deaths from malnutrition and dehydration, stopping this terrible trend begins with you!

First of all, you should know that according to Federal policy, it is legally binding on all nursing homes to:

• Ensure that the elderly in their care receive adequate fluids to prevent dehydration as well as for their general well being.
• Ensure that they are given proper and appropriate nutrition.

Secondly, you should establish that:

• The damage suffered by your loved one was caused by the nursing home because of their neglect or carelessness.
• The damage suffered by your loved one is significant enough to warrant a lawsuit.

Regardless of how significant you feel the injury may be, you can save the life of your loved one and by extension, the entire population of vulnerable elderly people in nursing homes by reporting any sign you notice. This starts with constant random visits during meal times to observe and pay attention to the signs.

Do not hesitate to take appropriate legal steps if you notice that your loved one is suffering from malnutrition and dehydration in a nursing home due to neglect because silence may degenerate to something fatal− death.

Introduction

Crohn’s disease is an inflammatory idiopathic chronic disease. The disease mostly affects a part of the gastrointestinal tract beginning from the mouth to the anus. Crohn disease brings about complications in the digestive system of a human being. The disease is thought to be caused by bacteria that live in the intestines. The disease also could be associated with genes of particular people. The interaction between intestinal bacteria and the environment causes an immune response, which is not normal. The abnormal immune response causes alterations in the functions of the mucosal barrier and hence increasing the permeability of diet antigens (Fuhler et al., 2014). Crohn disease causes a person to lose appetite and hence bringing about malnutrition. This paper aims at reviewing past literature concerning malnutrition due to bowel inflammation. The paper analyzes the causes of the Crohn disease and also discusses how malnutrition as a result of this disease can be overcomed.

Malnutrition is one of the main complications that come with Crohn disease. According to Matarese (2013), the disease causes weight loss and low body mass index among patients who are affected by the disease. The malnutrition is caused by anorexia, inflammation as well as the increased loss of intestines. Data from past researches on the disease indicates that malnutrition affects more than 65% of patients who have Crohn disease. Among pediatric patients, malnutrition brings about retarded growth and could bring about intestinal symptoms. Lomer et al., (2017) indicates that patients who have Crohn Disease (CD) have low body fat composition, and their muscle mass is very low compared to healthy individuals. The disease is also associated with a low density of the minerals in the bones. The main reason why individuals with Crohn Disease experience malnutrition is because the intake of food through the mouth decreases (Smith & Harris, 2014). Patients with CD find it difficult to eat due to the symptoms associated with the disease. These symptoms include; pain in the abdomen, nausea, vomiting, and diarrhea. Once patients experience these symptoms, they significantly reduce the quantities of food that they consume and hence they lack proper nutrition. Restriction in terms of the diet consumed brings about malnutrition for CD patients. Due to the inflammatory nature of the disease, patients are advised not to consume particular types of foods, which could aggravate the disease. This may therefore, cause the patients to take diets which are low in some nutrient and hence causing malnutrition.

The Crohn infection has no cure, and its patient has to undergo surgery especially during the first ten years after diagnosis. Also, more than 75% of Crohn’s patients who have been operated through surgery requires further surgery at least once in their lifetime. These surgeries are very critical; the healthcare specialist considers and optimizes the nutritious status to minimize surgical risk and other modifiable factors. The doctor prioritizes on advising the Crohn’s patient on the current nutrition guidelines that are in accordance with the general surgery for the Crohn disease. The administration route is selected in accordance with the patient’s presentation and conditions.

Researchers indicate that mal-absorption occurs among patients with CD. This means that inflammatory cytokines release immune cells to the intestine. Loss of nutrients in the intestines also occurs and hence resulting in malnutrition. Changes in ionic transport in the body cause electrons to disperse in the body. This leads to the bowel getting ulcers and hence bringing about chronic loss of blood and proteins within the intestines. Data indicate that the energy requirements by CD patients are very high. Tests conducted using the Harris-Benedict formula indicated that there is a significant difference in energy usage between people who have a normal weight and those with below normal weight. He also indicates that there is a huge difference in the oxidation of carbohydrates and lipids between patients who have CD and people who are not affected by the disease. CD patients exhibit high lipid oxidation while carbohydrate oxidation is low.

Dietary advice is very critical for people who have CD. This is because patients with this disease need to take the right diet in order for them to fight malnutrition. Proper diet for people with CD disease helps in improving the absorption of nutrients in the body and hence improve the health of the individual. Fowler, Jones, Hull & Ghosh, (2015) recommends that a person who has the disease must eat meals on a regular basis. It is also advisable that a person eats between two to three snacks every day. This ensures that a person who is affected by the disease gets enough proteins, calories as well as minerals, which are critical in the proper functioning of the body. Research has also established that patients suffering from the disease often experience deficiency of iron and calcium in their bodies. They should, therefore, focus on taking dietary supplements that are rich in iron and calcium in order to strengthen their bones. Studies have also indicated that vitamin A deficiency is 90% among patients with Crohn disease. This is as a result of low BMI as well as low intake of foods rich in vitamin A. Lack of vitamin A is associated with night blindness as well as a problem in the healing of wounds.

Cheifetz (2013) indicates that foods which trigger Crohn symptoms differ from one patient to another. He however, notes that there are some foods that should generally be avoided by patients who have CD. These foods include; alcohol, carbonated drinks, coffee, butter and margarine, corn as well as dairy products (Porter et al., 2017). Others include raw fruits, spicy foods, whole grains as well as foods which produce gases. People who are affected by the disease should, therefore, avoid the above foods or find new ways of preparing the food in order to minimize the negative impact on their health.

Suskind et al., (2016) indicate that a low residue diet can be critical in the treatment of Crohn disease. A low residue diet is one that is low in specific foods which bring additional residue to the stool. This is important since most of the people who have Crohn disease have narrow small intestines. A diet that does not have a lot of fiber helps in reducing abdominal pain, cramps as well as diarrhea. It is also critical for a person with Crohn disease to keep a diary of the food that they consume on a day to day basis. Keeping track of the food that a person consumes helps in identifying foods that trigger stomach inflammation. This, therefore, helps in taming the symptoms which come with the Crohn disease and hence improving the nutrition of a particular person. Additionally, a daily diet plan enables a person to maintain a diet that is highly nutritious. This happens because a person is able to observe if they are consuming food, which is rich in nutrients important to the body.

Consumption of foods with a lot of liquids is critical in avoiding malnutrition among people with Crohn disease. Carlsson & Persson (2015) indicate that people with CD should consume a high-calorie liquid diet, especially at times when the disease is very active. The liquids help in making digestion easier and hence reducing the impact of the disease (Cope, 2015). This enables a person to eat healthier foods and hence minimizing malnutrition in a patient with the disease. Research has also established that dietary supplements such as omega-3 fatty acids help in minimizing the effects of the disease. Several studies conducted using fish oil as well as flaxseed oil indicate that the foods have an anti-inflammatory effect. The foods help in minimizing symptoms that are related to the disease. This supplement also improves the nutrition of a person who finds it difficult to consume food that is rich in other fats and oils. This, therefore, improves the nutrition of patients who have Crohn disease.

Total parenteral nutrition is another technique popularly used in controlling the Crohn disease. This is a type of therapy where individuals with this disease are advised to stay for a long duration without eating. This technique, however, has a risk of infection and may result in reduced integrity of the intestines. A study conducted among 51 patients with the disease indicated that remission occurred in 71% of the patients. This means that the strategy is highly effective in combating CD.

Conclusion

Crohn disease is an inflammatory bowel disease that has a profound effect on the health of patients. The disease causes malnutrition among patients due to several factors. The main reason why the disease causes malnutrition is because patients tend to avoid foods that bring about inflammation. This, therefore, means that a person may fail to consume diets that are rich in some nutrients and hence resulting in malnutrition. This paper has discussed the strategies which are used to reduce malnutrition among patients who suffer from CD. Patients suffering from the disease are advised to take dietary supplements that are recommended by their doctors. The patients are also advised to avoid foods that are likely to cause inflammation of the bowel. Foods that are rich in vitamins and which have enough liquids also help in managing the disease.

References

1. Carlsson, E., & Persson, E. (2015). Living With Intestinal Failure Caused by Crohn Disease. Gastroenterology Nursing, 38(1), 12-20.
2. Cope, G. (2015). Overview of dietary choices for ulcerative colitis and Crohn’s disease. Gastrointestinal Nursing, 13(1), 35-41.
3. Cheifetz, A. S. (2013). Management of active Crohn disease. Jama, 309(20), 2150-2158.
4. Fowler, S., Jones, J., Hull, P. R., & Ghosh, S. (2015). Extracorporeal photopheresis for the treatment of Crohn’s disease. Transfusion and Apheresis Science, 52(2), 183-186.
5. Fuhler, G. M., Parikh, K., van der Woude, C. J., & Peppelenbosch, M. P. (2015). Linkage between genotype and immunological phenotype in Crohn’s disease. Annals of translational medicine, 3(16).
6. Lomer, M. C., Hart, A. L., Verjee, A., Daly, A., Solomon, J., & Mclaughlin, J. (2017). What are the dietary treatment research priorities for inflammatory bowel disease? A short report based on a priority setting partnership with the James Lind Alliance. Journal of human nutrition and dietetics, 30(6), 709-713.
7. Matarese, L. E. (2013). Nutrition and fluid optimization for patients with short bowel syndrome. Journal of Parenteral and Enteral Nutrition, 37(2), 161-170.
8. Porter, C. K., Welsh, M., Riddle, M. S., Nieh, C., Boyko, E. J., Gackstetter, G., & Hooper, T. I. (2017). Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment‐related risk factors, and antecedent episodes of infectious gastroenteritis. Alimentary pharmacology & therapeutics, 45(8), 1115-1127.
9. Smith, C. J., & Harris, H. (2014). Crohn disease: Taking charge of a lifelong disorder. Nursing2018, 44(12), 36-42.
10. Suskind, D. L., Wahbeh, G., Gregory, N., Vendettuoli, H., & Christie, D. (2014). Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. Journal of pediatric gastroenterology and nutrition, 58(1), 87-91.
11. Yang, N., Sampathkumar, K., & Loo, S. C. J. (2017). Recent advances in complementary and replacement therapy with nutraceuticals in combating gastrointestinal illnesses. Clinical Nutrition, 36(4), 968-979.n

Abstract

This paper offers knowledge into the key concepts behind not only nutrition, but key points regarding malnutrition as well. It speaks on how important it is to understand that an individual must take care of their body the correct way to avoid any unforeseen illnesses, and stresses the importance of understanding how vital it is to understand what role the foods you eat play in your health. In addition, it speaks on macronutrient which refer to the three main sources of nutrients that do can meet your nutritional needs without help from others. It speaks on minerals which are simply inorganic substance that our bodies require to allow certain activities. This paper reflects on the different groups of people that may be liable to suffer from a form of malnutrition, and also gives a number of different resources that we can use to help identify people that may suffer from malnutrition as well. With that being said it also includes informative research about some of the main causes of malnutrition, and what could be done to possibly prevent it in some cases while also including the steps that can be taken to help ensure they know the cause before giving the patient a random solution. One of the last things that this paper does is give solutions to how to fix malnutrition as each solution is customized for that specific person to avoid any further harm. The final thing that this paper touches on is taking supplements as one’s nutrients through another form instead of eating certain things that may be hard for one to swallow especially if the person has a swallowing disorder of some kind to which it would be easier to swallow a small pill rather than a large item.

Introduction

In today’s society, it is common that when people are wanting to lose weight the vast majority of them start to go to the gym more, eat less, and some people even go so far as to not eat at all. However, what many fail to realize is that the lack of a proper diet that includes the proper nutrients will result in malnutrition. Malnutrition is when you do not have enough to eat, not eating enough of the right things, or your body is not taking any nutrients from the food that one is consuming. One of the main concepts that we have to learn as people malnutrition is a serious problem that we face especially in today’s generation where it has become normal to want to look like the individuals that we see on television, yet neglect to understand that how they reached that figure getting as well as maintaining their bodies more than likely was not naturally.

Many people fail to understand that by not getting the right nutrients their body will struggle with accomplishing their usual daily tasks. A nutrient is a substance that is used by our bodies to promote growth, maintenance, and repair. There are six main categories of nutrients which split into three major nutrients, and two minor nutrients. The major nutrients are carbohydrates which are your sugars, and starches. Lipids which are also known as neutral fats which are your meats, and dairy products. With the last major nutrient being protein which are your eggs, milk, and fish. The minor nutrients are vitamins which are organic substances and minerals which are inorganic substances. Each nutrient plays a different role than all of the others. Although, they may all play a different role all nutrients come together to assure that our bodies are functioning correctly.

The first macronutrient is carbohydrates which has a make-up of carbon, hydrogen, and oxygen. As mentioned before carbohydrates are sugars, starches, and fibers. Carbohydrates are the bodies main source of energy, and are known to be a quick energy source. The total carb intake should be between 45 and 65 percent of ones’ total calorie intake. We typically receive the sugars from fruits, sugar cane, and milk. However, we receive the starches from grains, legumes, and some root vegetables. Carbohydrates not only provide energy for the muscles it also provides fuel for the central nervous system as well. There are two types of carbohydrates which are simple carbohydrates, and complex carbohydrates which differ in their structure. Simple carbohydrates contain one to two sugars, and are mainly found in things such as candies. While complex carbohydrates contain three or more sugars, and can be found in foods such as potatoes and cereals. There are bad carbohydrates such as pastries, rice, as well as sodas which typically contain little to no nutritional value. Bad carbohydrates tend to be high in sodium, low in fiber, high in calories, and low in nutrients. However, there are good carbohydrates as well such as fruits, and vegetables. These carbohydrates tend to be high in nutrients, low in sodium, low in calories, and low in saturated fats. Carbohydrates have a variety of benefits such as they’re beneficial to your mental health, and can be vital in the weight loss process. However, like all things too much could be harmful.

The second macronutrient is lipids which by definition is a compound formed of carbon, hydrogen, and oxygen. Waxes, phospholipids, fats, and steroids are all considered lipids. A fat which is also referred to as a triglyceride is a molecule that contains two main parts a glycerol backbone, and three fatty acid tails. Fats contains double the amount of energy a carbohydrate contains, and is the most common form of a lipid. Fats come in the form of both saturated fats,and unsaturated fats. We obtain saturated fats through meat, dairy products, and some plants. Saturated fats have a single bond between carbons within the hydrocarbon chain. We obtain unsaturated fats through seeds, nuts, and some vegetable oils. Unlike saturated fats unsaturated fats have a double bond, and contain fewer hydrogens than saturated fats. Fats play a vital role in helping the body function properly, and are essential to the body as well. Fats serve the body as they provide a place of storage for energy for long periods of time, and provide insulation for the body as well. Like carbohydrates too many bad fats could cause a substantial increase in weight, and an increase in cholesterol. However, unlike fats that only contain two main components to function phospholipids contain four major components to function which are fatty acids, a glycerol component, a polar molecule, and a phosphate group. To which the polar molecule as well as the phosphate group would be hydrophilic, and the fatty acid tail would be hydrophobic.

Steroids are the most unique in structure when referring to lipids due to the fact that a steroid contains a carbon backbone with four connected rings. Sex hormones and cholesterol are both forms of steroids. Waxes like steroids are also very unique in structure as they are made up of a long chain of alcohol, and fatty acids with its main function being to help prevent water loss. The third macronutrient which is proteins which accounts for 50 percent of the organic matter in the body, and are complex nitrogenous substances: that are the main building material for cells. Protein helps to build, and repair tissues within the body. Protein is usually found in foods such as eggs, milk, meats which are complete proteins, and oats. However, foods such as beans that do not produce a high amount of protein are known to be nutritionally incomplete due to a low amount of essential amino acids. With essential amino acids being amino acids that the body cannot make that have to be obtained through our diet. Those eight amino acids are tryptophan, methionine, valine, threonine, phenylalanine, leucine, isoleucine, and lysine. All of which can be obtained through the daily diet of a person whom is not a vegetarian. Vegetarians have to take precautionary measures to make sure that they do not suffer from malnutrition due to lack of protein within their diet. The inclusion of protein within one’s diet comes with a variety of benefits. Some of those benefits being that protein makes up the majority of our hair and nails, and is the most important building block for bones, muscles, cartilage, skin, as well as the blood. There are two main types of proteins which are fibrous, globular which are based on the shape of the protein. Fibrous proteins are proteins that are strand like, and appear often in the body’s structure. These proteins are vital in that they provide strength in specific body tissues.

However, unlike fibrous proteins globular proteins are spherical with a tertiary structure that is typically compact. Some globular proteins help provide immunity, and others help regulate growth and development. With the inclusion of enzymes that are responsible for regulation of chemical reactions in the body.

Signs and Symptoms

When one is faced with suffering from malnutrition they develop a series of signs that indicate that they are not receiving the amount of nutrients that they require in order to maintain proper function of their body. Malnutrition could cause reduced immune function that makes it harderfor an individual to fight an infection as well as it increases their susceptibility as well. In addition, malnutrition may cause a loss of strength affecting one’s ability to function normally.

With that being said it also affects the wound healing process, because of the low amount of nutrients circulating. One of the most widely known affects that malnutrition has is on the function of the brain. It affects the brains ability to the point where we do not begin to think clearly, and begin to make irrational decision which could result in a state of depression. Those whom have a difficult time swallowing disorders are at risk of suffering from malnutrition.

People with low income are likely to have malnutrition due to the fact that they have enough income to supply themselves with enough food to meet their nutritional needs that they require to function correctly. People whom are single are also at risk of suffering from malnutrition as they are less likely to not cook, and “typically skip meals or rely on snacks” (Taylor, C.). Individuals that suffer from illnesses are among the highest groups likely to suffer from malnutrition as they suffer from a loss of appetite, have malabsorption of nutrients, suffer from nausea, and diarrhea.

Which includes individuals that have health issues as well as they struggle with eating due to the fact that they suffer from a loss on interest in food, and have no set eating pattern. There are afew questions that one may ask to help identify is an individual may be suffering from malnutrition. With the first question being when is the last time they have eaten this will help determine their eating pattern if one exist. The next most common question that would follow would be do they “rely more on snacks than meals” (Taylor, C.). This would help one indicate if they are getting the necessary nutrients they need in order to function correctly with certain tasks that may be presented to them, and could mean that they are only getting a certain amount if nutrients. The last question that could be asked is are the meals that the individual eating mostly soft foods which could indicate that there is a swallowing problem at hand.

Diagnosis and Treatment Options

There are a variety of solutions to helping someone that suffers from malnutrition. However, before one determines what is necessary to fix the problem it is important that one finds the root of the problem at hand. After the root of the problem has been identified it is vital that one try, and figure out a “solution that is specifically for the person” that they are trying to help (Taylor, C.). At this point in time one would have to determine needs a therapist of some sort to help them get over any personal issues, if the person needs to be on a medication that would not cause any side effects that would affect their appetite, or if the person needs to taken out of the home that they are current living in due forced starvation. The main solution however would be simply to increase the nutritional intake, and to rely more on meals if possible rather than snacks. One should make sure that they are meeting their required nutritional intake if they are wanting to snack they need to make sure that their snacks are high in nutrients which are snacks such as cheese, yogurt, and meats. Fortifying food is also another solution which is a technique that allows for every bite to count towards one nutritional intake. Eating soft foods would be the best solution for those that suffer with having a swallowing problem as it allows for a softer texture, and allow for a smoother swallowing process. If the patient is still not able to gain the correct amount of nutrition from their daily meals one might advise them to begin to take supplements.

These supplements will replace the nutrients that one might get from food, and instead gain it through a pill or some other oral injection.

Conclusion

In conclusion, the article that I read discussed that there are a variety of key components that play a part in making sure that one is receiving the necessary nutrients to maintain homeostasis and avoid malnutrition. The first step we would take to help avoid any form of malnutrition would be to make sure that an individual that we are attending to is actually suffering from malnutrition, and not suffering from another disorder we do this by asking them number of choices regarding their meal intake within the last 48 to 24 hours. under that there are certain nutrients that their body needs to be able to function at its normal level. The third step we would take would be to figure out what group of individuals are the most likely to suffer from malnutrition, and help them take the steps that they need to ensure that they will live a health life.

The fourth step that we would have taken in the avoiding malnutrition process would be to figure out the source of the problem at hand, and we do this by determining the best solution to help that certain individual take the necessary steps to reach their nutritional goals. The fourth step that we would take in the avoiding malnutrition process would be to figure out the needs of the person that were helping whether that be getting them to see a therapist of some kind, a doctor of some sort, or even simply if they need someone to talk to for clarity as well as guidance. The fifth step which is the final as well as the most important step in the malnutrition process would be the solution. This is the most important due to the fact that the solution is different for everyone, and no one approaches the problem the same as the other which makes this point in the process the most vital.

Bibliography

1. Taylor, C. (2018). Malnutrition: causes, consequences and solutions. Journal of Community Nursing, 32(6), 52–56. Retrieved from https://search-ebscohost- com.waylandbu.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=133718512&site=eds-live

INTRODUCTION

Background

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and or nutrients. This means a condition which result from eating a diet in which one or more nutrients are either not enough or are too much to causes health problems. It is frequently part of a vicious cycle that includes poverty and disease. It usually refers to a number of diseases, each with a specific cause related to one or more nutrients. Examples are protein, iodine, vitamin A or iron 1.

Malnutrition is the greatest cause of the child death in the country, it contributes to over one third of the child death every year. Apart from the disease burden, micronutrient deficiencies severely affect economic and human development leading to an annual loss of 2.65% of Tanzania GDP 2.

Globally the impacts of malnutrition which are developmental, economic, social and medical burden are lasting among the affected individuals, their families and countries3. Malnutrition is closely linked to the overall standard of living and whether a population can meet its basic needs, such as access to food, housing and health care 3.

The condition is prevalent in many contexts, and the priority can be adopted in different approach to tackle the condition. Children from families with low quality of life when affected have worse outcome than those from higher quality of life. Understanding characteristics of the condition helps us to know how to prevent and control the condition 4.

Growth assessment in malnutrition does not only serves as a means for evaluating the health and nutritional status of children but also provides an indirect measurement of the quality of life of an entire population. The WHO Global Database on Child Growth and malnutrition illustrates malnutrition’s enormous challenge and provides decision makers and health workers alike with the baseline information necessary to plan, implement and monitor and evaluate nutrition and public health intervention programs aimed at promoting healthy growth and development5.

The state of food security and nutrition in the world 2018 tracks the rise of hunger worldwide over the past three years at it revealed levels were returning to those compiled a decade ago. The report warns that more must be done and urgently if sustainable development goal (SDG) of Zero Hunger is to be achieved by 20306.

By these reasons there must be intentional effort directed to our local health care providing areas so as to observe how far we have gone on reducing the burden of malnutrition to the under-fives, including the trouble they face being it morbidity and mortality to this age group.

Literature Review

A study done in 2012,show that about 171 million children less than 5 years of age are stunted globally, whereby 167 million children found in developing countries. It was estimated that childhood stunting will decrease from the prevalence of 39.7% in 2010 to 21.8% or 142 million in 2020. However in Africa the prevalence of malnutrition has persistently been high since 1990 at about 40% and little improvement was expected, as compared to Asia where the prevalence of malnutrition in children as dramatic decreased from49% in 1990 to 28% in 2010, nearly halved the number of stunted children from 190 million to 100 million. The conclusion was made that though there would be overall decrease in developing countries stunting remains a major public health problem in many countries14.

According to blessing et al, in 2017 conducted cross sectional study on 32 countries on the child malnutrition in Sub-Saharan Africa. A cross-sectional data from most recent Demographic and Health Surveys (from 2006 to 2016) of 32 countries were used, in subgroups of West Africa, East Africa, Southern and Central Africa. Generally the prevalence of malnutrition was highest within countries of East and West Africa by 52% and 39.2% of stunting respectively. The appropriate nutrition interventions are needed in East and West African countries if Sub-Saharan-Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 202515.

According to Cyprian Ouma, there are inequalities in the trend of malnutrition in East African countries. The study which was conducted on the malnutrition profile in East Africa in 2012 showed that stunting was highest in Burundi by the prevalence of 59.1%, lowest in Kenya by 26%. Wasting was higher in Burundi again, lowest in Rwanda. Underweight was higher in Tanzania by 22.5%, followed by the fellow Uganda by 14%. Generally the findings of the study show that malnutrition was highest in Burundi. About 45% of all child deaths were associated with poor nutrition in East Africa.16

Maimuna M. Ahmed et al, conducted a cross sectional study on prevalence of under nutrition and risk factors associated with severe malnutrition among undernourished children aged 6-60 months admitted to Bugando Medical Centre (BMC) pediatric wards. Out of 720 screened children, 402 (55.8) were undernourished. Severe malnutrion was found in 24.7% children and among 54.5% had marasmus. Maimuna M.Ahmed then concluded that there is high prevalence of malnutrion in hospitalized children and majority ware marasmic17.

According to a study done by Omari Ali Juma et al, on the prevalence and assessment of malnutrition among children attending RCH at Bagamoyo district Hospital, Tanzania in 2016. A total of 63237 children under five were recruited and the prevalence of under nutrition was found to be 15.52%, stunting being 8.37%, underweight 5.74% and wasting 1.41%. In this study boys were more affected than girls. Also 50% of the under-five mortality rate were contributed by the underlying under nutrition18.

According to Tanzania National Nutritional Survey of 2014, under nutrition was found to be one of the world’s most serious but least addressed public health problem. Stunting has become an important target of nutrition and other development-related programs. Malnourished women or adolescent girls give birth to babies with low birth weight. If these children grow up in an environment of suboptimal feeding practices and a high burden of infectious diseases, these children do not experience much catch-up growth in subsequent years, leading to an intergenerational cycle of stunting. Stunting is a cumulative process that can begin in utero and continue until about 2 years after birth and it should be noted that environmental differences, rather than genetics, are the principal determinants of stunting because children from different settings worldwide are expected to grow similarly if they are brought up in healthy environments. Children who are stunted are more likely to get sick or die. If they survive they enter school late, do not learn well, and are less productive as adults. In later life, they are at an increased risk of chronic diseases. To illustrate, childhood stunting – even in its moderate form it increases mortality by 60%. It is related to a 2-3 year reduced school attendance and 22% lower income in adulthood. There is even evidence that poor nutritional status and childhood stunting may result in cognitive impairments which cannot be reversed in later life19, 20.

Problem Statement

Globally 1 in every 4 children was malnourished in 2017 making an estimation of 151 million children with malnutrition. The rates are still alarming and declining slowly. In Tanzania there is an estimation of Top of FormBottom of Form 43 % of children under 5 years old who were malnourished in 2016. Out of which 34% were stunted sign of chronic malnutrition, 5% were wasted i.e. too thin for their height which signify acute malnutrition and 4% are overweight or over nourished. In Dar es Salaam region (15%) of all under five children were malnourished, one in every sixth children is malnourished. All three nutritional status indicators are highest among children in the lowest wealth quintile and lowest in children in the highest wealth quintile7, 8.

Among the factors contributing to malnutrition in children in Tanzania were unbalanced diets eating, incomplete or lack of vaccination, children with single parent, low level of education in mother, early age of weaning before six month of age and interruption of breastfeeding before two years old of age. Stunting is attributed to a combination of factors, including maternal malnutrition, inadequate infant feeding practices, low quality of health care, and poor hygiene. Complementary feeding practices are inadequate, with only 10 percent of breastfed children 6–23 months receiving a minimum acceptable diet, which has a major impact on growth and development. The risk of stunting is 33 percent higher among first-born children of girls under 18 years in Sub-Saharan Africa, and as such, early motherhood is a key driver of malnutrition9.

The most consequence of malnutrition in children are vulnerability to illness, increased complications and in very extreme cases even death. About 50% of all childhood deaths are attributed to malnutrition. Their immune system have reduced ability to fight infection, have impaired wound healing, their kidneys have reduced ability to regulate salt and fluid which can lead to over hydration or dehydration. Children with malnutrition can develop apathy, depression, introversion, self-neglect and deterioration in social interaction. They have growth failure and stunting, delayed sexual development, impaired intellectual development and increased lifetime risk of osteoporosis. Consequences of specific nutrient deficient are many, such as anemia, skin rashes and inability to fight infection due to zinc deficiency, rickets and osteomalacia as deficiency of vitamin D and many more. Tanzania made significant progress in improving nutrition among children under 5 years of age. During 1992-2015 there was a significant reduction in number of underweight children and those suffering from chronic malnutrition10, 11, 12.

Tanzania is placing strong emphasis on decentralization to ensure that nutrition is on the agendas of those working closest to affected communities. There has been development of guidelines for planning and budgeting for inclusion in the council’s comprehensive plans, annual regional planning and budgeting sessions, and the training of the trainers on Mkoba wa siku 1000, influencing positive behaviors for better maternal and child nutrition13.

Rationale of the Study

Malnutrition is the global health problem by WHO, it affects mostly under five years children and in Tanzania there is the higher prevalence of stunting, wasting and a group of children who are overweighed. The findings from this study will be used to increase awareness and knowledge about malnutrition. Also the results will help to inform the policy makers how far we have reached concerning the problem, and simplify to know the way forward.

Study Area

The study is going to be conducted at Mwananyamala reginal referral hospital in the pediatric ward. It is located in a Mwananyamala administrative ward in the Kinondoni district in Dar es Salaam region in Tanzania. It is located between the latitude 6047’16’ and 6.78790 South of equator and longitude 39015’23 and 39.25630 to the east of Greenwich. Kinondoni District is a district in north west of Dar es Salaam’s central business district, Tanzania, others being Temeke (to the far Southeast) and Ilala (downtown Dar es Salaam). To the east is the Indian Ocean, to the north and west the Pwani Region of Tanzania. The 2002 Tanzanian National Census showed that the population of Kinondoni was 1,083,913. The area of Kinondoni is 531 km².the latest population census of 2012 showed that population of Kinondoni was 1,775,049: 914,247 female and 860,802 male. There are 446,504 households in Kinondoni with the average of 4 person per household. The hospital has 6 departments, pediatric and child health department, medical department, surgical department, obstetric and gynecological department, TB and leprosy department and CTC department. Pediatric and child health department has reproductive and child health clinic which operates from Monday to Friday where children are given vaccines, and are weighed. Pediatric ward has more than 25 beds, and has some malnutrition cases.

Ethical Consideration

Before commencing of the study, ethical clearance will be requested from ethical clearance committee of St. Joseph College of Health Sciences. Also the permission to conduct study and collecting data will be obtained from district medical officer of Kinondoni district and medical officer in charge of Mwananyamala referral hospital. More over all ethical principles will be considered to ensure that the study respect human dignity.

The research findings would generate important information on the prevalence of malnutrition in Kinondoni district. The copy of the study will be disseminated to MOHCDGEC as the key decision makers in the responsible authorities which deals with health issues, District Medical Officer(DMO) of Kinondoni district and lastly the research findings will be given to St Joseph College of Health Sciences library to help further in updating the existing problem.

REFERRENCES

1. WHO / What is malutritionen.
2. Ochieng, J., Afari-Sefa, V., Karanja, D., Rajendran, S., Silvest, S. and Kessy, R., 2016. Promoting consumption of traditional African vegetables and its effect on food and nutrition security in Tanzania (No. 310-2016-5388). Tanzania food and nutrition journal, Volume 13. 2013; 1: 1-2.
3. World Health Organization. Topic: malnutrition, 16th February 2018.
4. Alan Jackson. Nutrition Journal 2018. 17:84. Identifying children at risk of malnutrition.
5. WHO World Database on Child Growth and malnutrition, 2018.
6. Stefan Jung curt PHD. Content editor for agriculture, climate change and sustainable energy (Germany) 18th September 2018, UN report.
7. Chika Hayashi, Elaine Borghi, Espen Beer Prydz and Richard Kumapley. UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018, page 2.
8. Tanzania demographic and health survey and malaria indicators survey. Topic: child nutrition. 2016: chapter 32 page 119.
9. Tanzania nutrition profile journal by USAID, February 2018 edition, chapter 1, page
10. Kyunki-JeenaIssiKaNaam Hal. The Mother and Child Health and Education Trust. Article: Malnutrition, impact of malnutrition. 16 December, 2017.

Introduction

What is poverty you may ask? According to Google poverty is “the state of being extremely poor” in other words poverty is having an insufficient amount of money to fulfill the basic needs of life. Many Canadians today struggle with the ongoing conflicts of provision of resources due to their social status. Canada is not unaware of the Canadians who are facing poverty in this day and age however they have also neglected this part of the society in numerous ways. Many residents of this country are poor due to unemployment which restricts them from being able to access daily necessities such as food. A financial crisis makes Canadians unable to afford a meal a day which leads to malnutrition and other health complications. Poverty and malnutrition is the biggest problem facing Canadians today because of many aspects of Canadian geography itself.

Physical Geography

Poverty is an issue which is connected to physical geography as well since natural disasters can become a possible factor of poverty. Natural disasters such as droughts and wildfires can impact people drastically when it comes to their financial stability. Wildfires are caused by humans through the crisis of climate change which can and does destroy homes and buildings in which people reside . One example of this would be the 2016 Fort McMurray wildfire which destroyed 1600 homes and rose up till 10, 000 hectares due to which residents of the city were forced to evacuate (Post Media 2019). Droughts which are also a result of climate change and the increasing humidity have put the farmers through many losses and eventually poverty. Droughts have made farmers go through a lot of financial stress since their land becomes dry and barren causing all of their efforts to drown in despair . Farmers who live on the sole means of farming are left to starve in these conditions caused by droughts (Mercy Corps, 2019). This is a clear representation of how natural disasters can devastate one’s financial stability.

Changing Populations

Canadians are drastically impacted by poverty and healthcare since it has become an issue for them due to its expenses (Canada Without Poverty, (n.d.)). A few statistics of poverty are enough to justify that Canada may be developed however people are still left poor regardless of whether the country is classified as a part of the “West” (University Of Oxford, 2015). You’d be astonished to learn that 1 in 7 Canadians live in poverty, approximately 15% of Canadians living in poverty are disabled of which 59% are women, and 1 in 5 children live in poverty currently (Canada Without Poverty, (n.d.)). Poor people’s lack of accessibility of healthcare leads to malnutrition, other serious health complications, and if not treated at all eventually death which in children could cause child mortality (Citizens For Public Justice, 2015).

Livable Communities

People tend to not reside in areas in which poor people live and the government decides to neglect poor people due to which their communities are less developed and in other terms not living up to the standard of livable communities in today’s day and age. There is little to no development as they have small unattractive homes, less institutions such as schools in a vast area, inadequate accessibility to residential land due to urban sprawl, neglection of minorities (such as Indigenous peoples or immigrants), and an economically unstable and unsafe area (Jaffe, Jaffe, & CityLab, 2016). Poverty tends to be a pattern in localities for example Vancouver’s Downtown Eastside where the lowest median income was 13, 600 dollars (Skelton, 2010). That is because low income families have to settle for small homes to fulfill the basic needs of life. The society has implanted a small mentality in everyone which makes them believe their status is everything and anyone who is viewed as poor or financially unstable is disgusting and monstrous. In addition to that, the government doesn’t help the poor either since they always neglect the minorities. Those poor people have no say in what happens in their community and their needs aren’t met either. The government decides to racially segregate communities due to their ethnicity and the fact that they are a minority. In a community minorities are deprived rights of adequate funding and they face unemployment due to urban sprawl and the lack of jobs which leads to no money, no food hence malnutrition (Jaffe, Jaffe, & CityLab, 2016). Furthermore, studies show that areas with high proportions of low income households and high crime rates are linked (StatCan, 2015). Did you know that Indigenous children are twice as more likely to be poor than non-Indigenous children (Canadian Centre For Policy Alternatives, 2016). Another fact that minorities are neglected is that children of immigrants have a 32% child poverty rate (Canadian Centre For Policy Alternatives, 2016). This is evidence that poverty is an issue which is involved in a livable community as well.

Managing Resources

This can actually become a major cause for poverty because of the inaccessibility of energy and resources in addition to human interactions with the environment specifically oil spills. Inaccessibility to resources and energy such as food, water, and heat can be factors and indicators of poverty and malnutrition (Energising Development , (n.d.)). Poor people are unable to access these basic needs of life which deteriorates their living conditions and this signifies critical financial instability. Due to this they are unable to consume an adequate amount of food, in addition to having no heat in order to survive the harsh winters which leads to numerous illnesses. Human interactions with the environment in the form of oil spills are extremely negative for fishermen. Fishermen face losses and financial instability due to the human caused disaster of oil spills (Kidz World, 2018). The water becomes contaminated and poisons and deteriorates the health of the marine animals making them unwell/infected therefore, unsuitable for human consumption (US Department of Commerce & National Oceanic and Atmospheric Administration, 2010). Furthermore, the chemicals used in order to recover the oil spill are hazardous to humans in other words it isn’t good for our health. Therefore, managing resources can impact one’s life economically.

Conclusion

In conclusion I believe we need to acknowledge poverty for the significance it has in the lives of Canadians and in order to do so we need to speak up and raise awareness of this so, no child will ever face the dread of poverty again.

Introduction

Malnutrition is one of the major issues for child mortality in low and middle income nations (Kouam, 2014). Around 2 billion inhabitants globally suffering from a different point of malnutrition (Kamruzzaman, 2017). Malnutrition is a vital cause of death of almost yearly 45% children has died globally (WHO, 2018). It mostly occurs in the first five years of life (Aheto, 2015). Malnutrition in children is harmful. According to WHO (2018), malnutrition is defined as excesses of food, deficiency, imbalances in the intake of nutrients and energy. Moreover, deficiency in nutrients not only have bad impact on the health of children but also alleviate ability to work which leads to the worst outcome in adults life such as weaken the immune system, digestive problem, reducing the learning ability and in its worst it ends with even blindness (Kouam, 2014). Other social factors also affect such as abuse, poverty, gender bias, the pressure of population, and misleading family planning (Kamruzzaman, 2017). This report will discuss the major malnutrition issue in Bangladesh. Besides, how stockholders play their role by implanting policy like CMAM to overcome this health issue. Moreover, it will also elaborate on the six blocks of system thinking approach given by WHO, and describe the challenges and management to improve the health situation in Bangladesh.

Malnutrition

Malnutrition is the cause of around 3.1 billion deaths yearly in middle income and lower-income nations (Kouam, 2014). Malnutrition in children measured by anthropometric to describe the nutritional value: weight-for-height, height-for-age, weight-for-age. For any above indices, malnutrition explains as an a-z score below 2-0 (Kouam, 2014). Malnutrition can be classified as acute and severe malnutrition.it again divides into severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). However, the prevalence of global acute malnutrition is 13.5% which means 2.2 billion children, 10.1% MAM and 3.4% of SAM suffer someone time (Kouam, 2014).

Malnutrition in Bangladesh and the role of policyholders

In Bangladesh, about 34.7%of under-five children are under weigh and 48.6% inhibited (Kouam, 2014). Also in Dhaka has a high prevalence rate of malnutrition in Bangladesh (Kamruzzaman, 2017). Despite a significant number of nutrition interventions accomplished by non-government organizations (NGOs) in current years to address malnutrition in the nation (Kouam, 2014). Malnutrition is a pivotal issue, many projects closed due to intervention in malnutrition tackle by NGOs. To overcome this global issue policy, planning and decision were formulated by the ministry of health and welfare (MOHFW). The policy is implemented with the help of the four authorities: the director of general health services, director of family planning, nursing services, director of drug administration. In the public health sector, there are private and public health sectors in urban and rural areas, each particular level of the health system is mostly managed by the NGOs (Kouam, 2014).

WHO building blocks implementation

Importantly, WHO blocks of the health system are usually adapted to public health nutrition to evaluate the system of health to integrate community-based management of acute malnutrition (CMAM) (Delisle, 2014). Moreover, six themes classified into 16 criteria. Which leads to a stable result of different contexts.

Nutrition governance

Nutrition is a priority for the government of Bangladesh. The ministry of health and welfare (MOHFW) originate policy concerning this issue. The Bangladesh integrated nutrition program was the first universal nourishment project apply in the country, a goal to overcome the incident of the underweight birth and malnutrition in children. Moreover, the policy has been defiantly improved the status of nutrition in children (Kouam, 2014).

Nutrition finance

The major fund was provided by the World Bank, the United Kingdom department of international development, a united state agency, and UNICEF. 7% of the government budget was given to nutrition. Besides, Bangladesh health policy comes up with the free of charge primary health care for children, yearly supported by the MOHFW (kouam, 2014).

Service delivery

In research, the site had a total of 39 health centers, among them 4 delivered inpatient activity and outpatient activity. Nutritional data were taken monthly using weight-for-age to identify the malnutrition cases (Kouam, 2014). During services, the main issue has occurred which had been drastically incremented of diarrhea during the year. Moreover, screening and managing malnutrition were not part of the community health services.

Human resources

As a human resource team, they were not being able to manage malnutrition cases because of the absence of the training (Kouam, 2014). NGOs had not seems any lack of staff members. Even though, there was almost half the vacancy of the post in sub-district and family welfare clinics. At, nationally, policymakers and NGOs very well aware of the vacancy of the staff in the rural area and they agreed to employ more health care workers and volunteers to fulfill the shortage of the staff (Kouam, 2014).

Medicine technology

At the health care center has hospitalization, consultation and storage room facility, each complex has water, electricity and other services (Delisle, 2014). However, the kitchen area also provided by the government but unfortunately, it was not good and well equipped as per standard. Medically examine tools were available and have better working conditions but weighing machine and board for measurement was out of order. In, addition to that not even one center provide a basic meal as per national guideline for inpatient of SAM (Delisle, 2014).

Information

The health care worker supervised the sites on monthly and look out the delivery of services, health facility and supervisor had conversation with a health worker about their routine management quarries and gave them practical instruction to overcome it (Kouam, 2014).

Conclusion

A health system report demonstrated that the strategy for the short term would be more based on strengthening the leadership of the government in nutrition implementation. Moreover, they have to recognize the source of funding, improved the services and supply activity through the health centers. Moreover, the major challenge was tanning for health care workers would be improvised with the help of volunteers to manage the SAM and MAM. It needs to be also more focused on encouraging the health worker to provide medical services in rural areas. A long-term goal would be a commitment of funding which requires for productive integration of CAMA in the health system. Thus, stakeholders always play a key role to overcome the issue by applying the policy. Moreover, policy for nutrition analysis always tends to reduce the challenges in the impact of malnutrition in Bangladesh (Mohseni, 2019).

References

1. Aheto, J., Keegan, T., Taylor, B., & Diggle, P. (2015). Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana. Pediatric & Perinatal Epidemiology, 29(6), 552–561. https://doi.org/10.1111/ppe.12222
2. Kamruzzaman, Md & Hakim, Md. (2017). Food and Nutrition Counseling in Bangladesh: A NC4HD Approach in Health Statistics. 5. 1-5.
3. Kouam, C., Delisle, H., Ebbing, H., Israël, A., Salpéteur, C., Aïssa, M., & Ridde, V. (2014). Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh. Nutrition Journal, 13(1), 22. https://doi.org/10.1186/1475-2891-13-22
4. Mohseni, M., Aryankhesal, A., Kalantari, N., & Vellakkal, S. (2019). Prevention of malnutrition among children under 5 years old in Iran: A policy analysis. PLoS ONE, 14(3), e0213136. https://doi.org/10.1371/journal.pone.0213136
5. https://www.unicef.ca/en/malnutrition