Category: Malnutrition

According to Esther M. et al. (2004) community dwelling elderly people are defined by their age (≥60 years of age) and by living independently. This group can suffer from a large variety of health care problems; from just getting older (not diseases specific) to suffering from multiple pathologies. Thus, we are going to discuss the prevalance, causes and consequences of four common nutritional problems that may happened among community-dwelling older adults.

1) Malnutrition

On July 2015 to May 2016, a cross-sectional study has been conducted in Kandy district, Sri Lanka to estimate the prevalance of malnutrition and its associated factors among community-dwelling older persons. Malnutrition causes adverse effects on health as well as the quality of life of older persons. Further, it presents high costs to health care systems [10, 11]. Hence, malnutrition has become an important component of geriatric care that warrants monitoring.

Results show the prevalance of 12.5% of the participants were malnourished, 52.4% were at risk malnutrition while 35.1% were well-nourished. From th findings, this may cause by low economic condition which related with the house hold food security for the older population. Further studies also showed that this malnoutrition due to the extended family support especially in nutritional care. The psychological changes of aging also affect body metabolism and those older adults with sarcopenia and osteoporosis might limit their mobility to prepare foods, grocery shopping and even consuming foods. Participants with hypertension contribute 70% to be malnourished. It also might because of oathophysiological efects of diseases which lead to loss of appetite, slowing digestion, absorption and metabolism.

Consequences of having malnutrition will contribute to progressive decline in health, reduced physical and cognitive functional status, increased utilization of health care services, premature institutionalization, and increased mortality.

2) Obesity

Obesity among older adults nowdays has become the most common nutritional disorder. Based on a study conducted in America, it indicates that older people range 65 to 74 years old, approximately 27% of women and 24% of men are considered obese. This study shows that older adults in America have higher rates of obesity. Obesity is commonly associated with insulin resistance, hypertension and lipid abnormalities (Schwartz, 1997).This association has highly increase the risk factor of being obese Being executed with family also give impact on elderly nutrition intake, most of them were had difficulties in preparing healthy foods thus they have to eat whatever food that easily prepared. A substantial body of evidence links overweight to hypertension, dyslipidemia, heart disease, insulin resistance and diabetes, cholelithiasis, respiratory impairment, gout, and osteoarthritis (Pi-Sunyer, 1993). However, there is also study shows that being overweight could protect them from hip fracture.

3) Depression

Depression is one of the common illness among elderly and it can be occurred with many factors such as socioeconomic factors (Mohammad Reza et al., 2010).

Based on a study conducted in 2017 among residents in FELDA scheme in Johor, Malaysia, the prevalence of depressive symptomps was 3.7%. Majority of them were married and have no chewing and vision problem. Findings show that depressive symptom found to have significant correlation with socio-demographic characteristics sucha as age, gender, education level and monthly income, Health related Characteristics such as chewing problem, vision problem and chronic diseases, Functional status characteristic, anthropometric parameters and lifestyle characteristics.

Depression will impact older people differently than younger people. In the elderly, depression often occurs with other medical illnesses and disabilities and lasts longer. Depression in the elderly is associated with an increased risk of cardiac diseases and an increased risk of death from illness. At the same time, depression reduces an elderly person’s ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack.

4) Sarcopenia

Sarcopenia was a term proposed by Rosenburg in 1989 referring to the age‐related decline in lean body mass. This nutritional problem has become a relatively well‐known condition among researchers and physicians. The prevalance of elderly with Sarcopenia based on study conducted in Japan in 2016 was ranged from 2.5 to 28.0% in Japanese men and 2.3 to 11.7% in Japanese women. From findings, it shows that BMI was the only factor associated with sarcopenia across all definitions within the Japanese population studied, and a predominant risk factor for sarcopenia in previous studies. Having sarcopenia will possible effects of sarcopenia include decreased muscle strength, problems with mobility, weak bones (osteoporosis), falls and fractures, decreased activity levels, diabetes, middle‐age weight gain and a loss of physical function and independence.

Although at times in certain individuals poor immunity is inherited by birth or some suffer from autoimmune disorders, for the majority of the population immunity can be improved by healthy nutritious food, maintaining standards of personal hygiene, and a sanitary environment. The strong relationship between malnutrition and infection was originally described by Scrimshaw et al. From this framework, many investigations were done in this area and there is a total agreement among authors that mortality is significantly more elevated in an undernourished child compared to healthy ones.

Bacterial Infection: A bacterial contamination is a proliferation of a harmful strain of bacteria on or within the body. One-third of the world’s population is infected with tuberculosis, the main agent that provokes death among infectious diseases, causing tuberculosis. This infection is particularly influenced by undernutrition and often co-exists with PEM. Gastroenteritis is another example of bacterial infection which causes high mortality among malnourished infants and preschool children causing inflammation of the stomach and persistent vomiting and diarrhea, and weanling diarrhea common among weaned malnourished infants can be cited to associate the relationship between nutritional status and incidence of infection. Pneumonia, meningitis, and food poisoning are also a few illnesses that can be resulting from dangerous bacteria. Noma is an opportunistic infection promoted by extreme poverty that evolves rapidly from a gingival inflammation to mutilating orofacial gangrene, as a result of very complex interactions among malnutrition, infection, and compromised immunity. Fusobacterium necrophorum and Prevotella intermedia are the bacterial pathogens causing noma. Bacterial infections increase the need for protein and other nutrients for a speedy recovery.

Viral Infection: Infection resulting from the presence of a pandemic in the body due to the virus. Depending on the state of health, numerous viruses can infect nearly any form of body tissue, from the brain to the skin. Examples include children with PEM who suffer from influenza and measles. Even though effective vaccines are licensed for measles, it continues to cause death and severe disease in children worldwide. Complications from this viral infection can occur in almost every organ or system.

Parasitic Infection: A parasitic ailment, referred to as parasitic diseases can have an effect on nearly all living organisms, with low immune stature. Malarial parasites cause hemolytic anemia and deplete protein reserves. Hookworm infestation causes blood loss leading to anemia. Ascariasis, small intestine infection is another example instigated by Ascaris lumbricoides, which is a species of roundworm prevalent in areas of poor sanitation and hygiene that interferes with the absorption of nutrients in children. The coexistence between undernutrition and nematode infection encompasses two connecting trails, malnutrition that augments susceptibility to infection and the infection itself that leads to a more accentuated undernutrition. Intestinal nematodes provoke malnutrition causing anorexia and a variety of pathophysiological disturbances in the gastrointestinal tract such as vomiting, diarrhea, and malabsorption. All these put together, affect the ability of the child to acquire sufficient nutrients from the diet. Parasites namely helminths, Giardia duodenalis, Entamoeba histolytica, coccidia, and Schistosoma sp. that affect the nutritional status of the children are mostly transmitted through soil.

Now, having a better understanding of ensuring food and nutrition security, it is very much important to understand the influence of the intergenerational cycle on the nutritional status of the community. We had been all the while stressing the importance of nutritional care to be given to pregnant women, but the bearing of it on the entire generation has not been discussed. This chain lays the foundation for a healthy community and claims to be an important intervention strategy to break the cycle of malnutrition.

Further, a life-course standpoint suggests that nutritional changes are most likely to be continued when they occur during times of developmental transition or milestones such as pregnancy or adolescence. Adolescence is an exclusive period, as the growth spurt is high and also in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women’s education. Hence, an intergenerational cycle is nothing but passing on the nutritional stature from one generation to another.

When a girl child is not provided with enough nourishment, at any stage of the life cycle, an inter-generational cycle of malnutrition may set in. The individual level and intergenerational cycles of under-nutrition and ill health together pose serious consequences.

A low-birth-weight baby-girl born for a malnourished mother becomes a stunted/malnourished girl child, à stunted/ malnourished adolescent, à malnourished woman; and in turn, gives birth to a second-generation low-birth-weight baby. This sequence depicts how poor in-utero nutrition from an under-nourished mother extends through the life cycle affecting nutritional status generation-by-generation. Teenage pregnancies where the adolescent girls have to bear the dual-burden of their own growth and that of the developing foetus leading to still poorer pregnancy outcomes that heighten the severity of the cycle. Also, closely spaced high parity pregnancies often intensify nutritional deficits which get passed on to their offspring too. Micro-nutrient (iron, zinc, folate, iodine & vitamin A) deficiencies in young girls can aggravate the intergenerational malnutrition cycle. All these magnitudes put together, an intergenerational malnutrition cycle leads to the impaired workforce with reduced work capacity .which will mask the nation’s development.

In the light of these adversaries, nutrition has become an integral component of all the maternal and child health programmes such as:

• Integrated Child Development Services (ICDS), launched on 2nd Oct 1975 has been universalized in the country. The target group comprises children (Reproductive, Maternal, Newborn, Child and Adolescent Health Programme (RMCH+A, launched in 2013) addresses the major causes of mortality among women, children & adolescents along with the reasons for delayed access/utilization of health care services. This strategic approach highlights the importance of a ‘continuum of care during various stages of life;
• Janani Shishu Suraksha Karyakaram (JSSK) – launched on 1st June 2011 aims to provide better women/child health services such as cost-free/cashless facilities for pregnant women (normal deliveries/cesarean section operations) and sick new-borns (• Pradhan Mantri Matritva Vandana Yojana (PMMVY) is a maternity benefit program implemented by Ministry of Women & Child Development, Government of India. It is a conditional cash transfer scheme for pregnant/nursing mothers (aged >19 years) for the first two live births to partially compensate the childbirth/childcare-linked wage loss. In addition, it provides adequate facilities for safe delivery and breastfeeding/infant feeding;
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aims to reduce maternal and infant mortality rates in the country through safe pregnancies and safe deliveries. It provides quality comprehensive antenatal care to pregnant women on a designated day – the 9th of every month;
• The Mother and Child Tracking System – Monitors the health care system to ensure all mothers & their children have easy access to various healthcare services like care during pregnancy/child-birth and complete maternal & child immunization;
• MAA (Mothers’ Absolute Affection) – an intensified flagship program of the MoHFW was launched in 2016. It aims to enhance optimal breastfeeding practices in the country through a set of comprehensive activities for protecting, promoting, and supporting breastfeeding/child feeding, both at the community & the facility level. The programme emphasises generating community awareness, strengthening inter-personal communication skills of the functionaries, and providing necessary support for breastfeeding at delivery points/public health facilities along with the need for adequate family support to the nursing mother;
• The recent amendment of the Maternity Benefit Act (April 2017) enshrines paid maternity leave for 26 weeks even in private sector; however, for the pregnant women already having 2 living children, it remains unchanged (12 weeks) and the same is for adoptive/commissioning mothers too. Crèche facility and the option for work from home are other features of this amended Act;
• India Newborn Action Plan (INAP), launched in September 2014, aims to end preventable new-born deaths and stillbirths so as to achieve single-digit neonatal mortality/stillbirth rates by 2030;
• Adolescent Reproductive and Sexual Health (ARSH) program comprises the package of preventive, promotive, curative, and counseling services for addressing their reproductive and sexual issues.

Other programs/schemes targeting adolescent girls include Kishori Shakti Yojana, Balika Samridhi Yojana, Scheme for Adolescent Girls (SABLA), Weekly Iron and Folic Acid Supplementation (WIFS) program, Menstrual Hygiene Scheme, and many more. These programs aim at empowering the adolescents with improved nutrition/health-related awareness as well as better nutritional status so that they enter matrimony and motherhood with better nutrient stores.

Under UIP, Mission Indradhanush is cost-free expanded immunization coverage for children against 7 vaccine-preventable diseases (Diphtheria, Pertussis, Tetanus, Childhood-Tuberculosis, Polio, Hepatitis B, and Measles) by 2020. Further, Swachh Bharat, ‘Beti Bachao Beti Padao’ Abhiyan, adolescent-friendly clinics also address critical nutrition-sensitive issues.

It is thus, possible that through concerted efforts, the intergenerational cycle of malnutrition can be turned virtuous and improvements in maternal nutritional status and pregnancy outcome can be achieved. Better diet quantity/quality, micronutrient supplementation and improved health services can be the catalytic strategies for bringing about the desired change. As per the continuum of care approach, focusing on girl child to women along the lifecycle is imperative for achieving the Sustainable Development Goals (SDGs) and overcoming poverty, malnutrition and ill-health.

Malnutrition essentially comes in various forms, which include undernutrition, inadequate vitamins or minerals, and overweight to mention a few, however, most people only see malnutrition from the aspect of undernutrition. Notwithstanding research has shown that not only does malnutrition involve inadequate food supply, but also can be present in people with enough food supply but who lack the appropriate nutrients.

To begin it would be interesting to note that:

• It is estimated half of anaemia cases are due to iron deficiency. Almost half of children in low and middle income countries 47% of under fives are affected by anaemia, impairing cognitive and physical development Iron is a key component of micronutrient blends which are used in large-scale and targeted fortification programs;
• Iodine deficiency is the greatest single cause of mental retardation and brain damage. It can easily be prevented by adding iodine to salt. Between 1990 and 2009, the number of households consuming iodized salt rose from 20% to 70%. Coincidently, the number of countries in which iodine-deficiency disorders were considered a public health concern reduced by 43% between 1993 and 2007;
• Vitamin A deficiency causes early childhood blindness and increases the severity of infections and anaemia. It affects an estimated 190 million pre-school aged children, and 19 million pregnant and breastfeeding women globally. Vitamin A can be added to cooking oil as well as wheat and maize flour. It is also included in micronutrient powders;
• Zinc deficiency affects children’s health and physical growth; it is also essential for mothers during pregnancy. It is estimated to cause 4% of deaths in pre-school aged children in lower-income countries. Zinc supplementation improves growth in stunted children and can be included in wheat flour, maize flour, or rice.

Notwithstanding the facts listed above, the main causes of malnutrition are not recognized. Therefore it is necessary to have a glimpse through the foundation of malnutrition in the human body.

In the early 1950s, the understanding of the immunity of the body system was undeveloped. However malnutrition can be dated back to the dark ages, where animals were deprived of certain nutrients essential for their daily living, this seemed like a step towards the acquisition of knowledge, Unfortunately, the animal models represented, at best, only moderately faithful simulations of the human situation. This was because animals were fed a defined diet deficient in the specific nutrients of interest, with everything else in sufficient amounts, because the diet was provided by a defined schedule, because the animals were maintained on a strict cycle of light and dark, and because they were generally protected from external infectious diseases. In each of these features, the animal models differed totally from the human situation. From the perspective of human nutrition, it was considered that protein-energy malnutrition or protein-calorie malnutrition as it was called was attributable principally to dietary deficiency and therefore it could be prevented or treated by dietary measures alone. There was also little or no contact between immunologists or infectious diseases specialists who studied host susceptibility to infection and those interested in nutrition. Without a doubt, the best immunology of the day was not being applied to nutritional diseases which explains the limited conclusion made by the individuals in that time concerning the outcome of malnutrition in humans at that time.

The awareness of Malnutrition

In the 16th century, various discoveries were made which described the link between malnutrition and infections, unique reviews were made on the American Journal of medical sciences article by Taylor and Gordon in 1959. The authors made the case that malnutrition resulted in increased susceptibility to infection and that infection caused deterioration of nutritional status, ushering in a cycle of malnutrition-infection that would ultimately lead to kwashiorkor, which is a major symptom of malnutrition and, if untreated, to death. The interactions were described as generally synergistic, occasionally antagonistic. Synergistic interactions, the most common, were those in which the combined effects of malnutrition and infection were more profound than the sum of the individual effects of either one alone. Antagonistic interactions were occasionally documented in which the presence of malnutrition lessened the impact of an infectious disease. This article explains the malnutrition cycle, which leads to infection, more nutritional deterioration, and finally more infections. The article implies that improving nutritional intake with exposure to infection isn’t necessarily the best way to reverse the cycle, rather more attention should be given to the infections in order to reduce death rates resulting from malnutrition. This was because infection itself caused a loss of critical body stores of protein, energy, minerals, and vitamins. The article explains common occurrences usually observed in children who were improving during the initial phase of nutritional treatment for acute kwashiorkor suddenly worsen when they developed an infection such as measles or bacterial pneumonia, often with a fatal termination, or to see children fail to respond to nutritional therapy until an in apparent ongoing infection, such as in the urinary tract, was detected and treated. Experiences such as these suggested that a dual attack on nutrition and infection was needed for an optimal response.

The finding recorded in the article made a significant impact on the study of malnutrition, which served as a stepping stone for research in the later years, such as that of William Beisel, who first suggested a role for leukocyte-derived mediators in initiating the catabolic changes and loss of nutrient stores characteristic of the infected host. These studies employed partially purified mixtures of the growth medium in which leukocytes were incubated and stimulated.As well as discoveries made within a ten-year period in the 20th century. The endogenous pyrogen derived from activated leukocytes and responsible for the febrile response during infection was cleansed, sequenced and the gene identified. With this information, this protein was renamed interleukin the first of a number of peptide mediators with different functions found to be clearly characterized. Identification of other interleukins soon followed, including tumor necrosis factor-alpha. These critical mediators of cell function and host response are now known as cytokines. When it was appreciated that many of these same cytokines were involved in the activation of the immune response, it became clear that the immune and metabolic responses to infection were intimately entwined, with common pathways of activation and regulation, suggesting that both responses had survival value and that attempts to manipulate the metabolic response to diminishing the deterioration of nutritional status during infection might have potential downsides. These discoveries began to draw the attention of immunologists to study the effects of nutrition on immune function, and the beginning of greater collaborations between experts in different fields, especially in nutrition and immunology. There was an increase in the number of studies conducted in humans during this period, as the approach towards malnutrition continued to improve and new methods to obtain relevant cell types from human blood and other tissues were developed. Some of this was ascribed to the full realization that malnutrition of a degree sufficient to impair immune function was not just confined to children in developing countries without access to nutritionally complete diets, but occurred in up to half of the adult patients hospitalized on medical or surgical services around the world.

Introduction

The term malnutrition describes as a deficiency excess or imbalanced of wide range of nutrients resulting adverse effects on body which leads to poor health which increase the risk of malnutrition. In most cases malnutrition is a treatable condition that can be managed by optimizing proper food diet or by using oral nutritional supplements to patients where necessary to help maintain an adequate nutritional state. Malnutrition can refer as individuals who are either under or over nourished.

Similarities

Lifestyle factors affecting on individuals as skipping their meals and get depended on snacks if they are less likely to prepare meals if eating alone can result in reduction of nutritional content probably may be the important etiological factor for Malnutrition. Lower income groups mostly prefer cheaper food having less content of necessary nutrients like protein, vitamins and minerals. There can be the mental health issues of individuals who may be facing problems like depression, self-neglect which can causes to loss of interest in food erratic eating pattern.

Differences

Due to health problems like injuries or illness there can be marked reduction in appetite because of modified secretion of cytokines, glucocorticoids, peptides and insulin like growth factors this problem is mainly caused in hospitals due to failure to provide regular nutritious meals or missed meals due to lack of help with feeding and clinical investigation when required. It was the thought that increased energy expenditure was responsible for disease related to malnutrition.

Effects of Malnutrition can reduce the immune function. It can affect the functions and recovery of every organ systems loss of muscle and bone power which affect the mobility, weight loss by depletion of fat and particularly muscles and lead to organ mass. Effects of malnutrition on body organs can face the problems like depression or apathy, reduce cardiac output, impaired liver function, reduced the strength and can even decrease the immune system. Bone mass decline with weight loss if intake of nutritional components is insufficient to the individual. Simple provision for nutritional risk is enough to address by checking regular meals or food with better nutritional contents. There is the assessment of diagnosis for malnutrition which includes examination and medical history. In medical history there is an overview of daily food intake, food intolerance and can be due to religious or allergies and other restrictions. Can be checked by if patient is able to eat, sallow, digest specific amount of food to meet their required level of nutrients needed. Weight loss is the patient can be more challenging to assess, there should be a recent history of weight which can be intentional or unintentional weight loss of more than 10% of normal body from last 3-6 months is significant malnutrition risk.

Patients records like are they getting particularly high requirement for certain nutrients. Or the patient has excessive nutrient loss, cause chronic pancreatitis can cause malabsorption without steatorrhea. There are many possible solution to malnutrition as we need to search the causes of it, so it get more easy to target the solutions which includes as : Any of the other medications causing side effects which can be the cause of reducing the nutritional intake, if the patient is old which makes them not able to chew the food this type of patients need to refer to a dentist if needed.

Conclusion

A ‘food first’ approached should be given to the person who is affected by disease malnutrition by malnutrition management or advising the individual to have a proper intake of nutritious food with vitamins, protein and/or minerals. There should be proper diet with the nutrients in it to avoid malnutrition. Old age people should take proper care of their diet.

References

1. Dera, M. and Woodham, D. (2019). Treating malnutrition in the community | British Journal of Community Nursing. [online] Magonlinelibrary.com Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2016.21.11.558 [Accessed 22 Oct. 2019].
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3. Taylor, C. (2018). Malnutrition: causes, consequences and solutions. [online] Jcn.co.uk. Available at: https://www.jcn.co.uk/files/downloads/articles/12—malnutrition-causes-consequences-and-solutions.pdf [Accessed 22 Oct.2019].
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Ageing is not a disease, but it is a process. Nonetheless, due to risky behaviors, genetic factors, social environment or personalities, ageing may be correlated with some worsening in senses and non-communicable diseases.1 Elderly people encountered physical and mental problems.1 The United Nations (UN) defines elderly by 60 years but World Health Organization (WHO) defines elderly, not by time (years), but by new roles, loss of previous roles, or inability to contribute effectively to society. In Myanmar, elderly means the people whose aged was 60 years and above.6

United Nations estimates the population above 60 years old will reach 1.2 billion globally by 2050 which is ascending from 901 million in 2015.17 The world’s ageing population is increasing18 but the current health system is poorly designed for the elderly to obtain information on the specific nutritional needs and the long term care needs.19 Malnutrition is a condition with an inadequate, abundant or imbalance of energy, protein or other nutrients. Hence, malnutrition means over-nutrition, under-nutrition and imbalanced diet.2,3 Most of the elderly people suffer malnutrition problem.5 Older adults are at the risk of developing malnutrition due to various causative factors such as co-morbidities and their complications such as polypharmacy, inflammation and pain;7 lifestyle factors;8 psychological problems;9 and age-related pathophysiology such as dysfunctions in swallowing, taste, smell, sight, appetite and gastric emptying.9

Several reports have revealed that malnutrition remains under-recognized in the elderly.10 In Myanmar study, the prevalence of malnutrition and at risk of malnutrition among the old by using MNA-SF (MNA-Short Form) screening tool was 7.2% and 38.6% respectively.19 Increasing trend of malnutrition indicates the crucial development of screening tools to detect early and treat effectively. 4 In this regard, several screening tools have been developed to identify malnutrition.11Among those, the Mini Nutritional Assessment (MNA) which is accepted globally12 and European Society for Clinical Nutrition and Metabolism (ESPEN) suggests it to be used for routine geriatric nutritional assessments.13

There were very few studies on factors influencing on malnutrition among the elderly and use of MNA for geriatric nutritional assessment in Myanmar. The previous study in Myanmar used MNA-SF (MNA-Short Form) instead of MNA. MNA has four parameter of assessment: anthropometric, general condition, dietary pattern and self-perceived health status. At that time, MNA-SF has two: anthropometric and general assessment. One of the Germany studies state that MNA was superior than MNA-SF in expecting mortality and distinguishing functional decline during 1 year of follow-up.20 Although MNA is simple, non-invasive, inexpensive and can be done easily, it is not well known in Myanmar.

Therefore, the objective of this study was to estimate the prevalence of malnutrition by using MNA and the factors influencing malnutrition among the elderly in Loikaw Township, Myanmar. This study was a community based, cross-sectional study to explore the malnutrition of the elderly. The study population was the 60 years of age or more of the old who reside in Loikaw Township. Very ill and mentally retarded persons were excluded from this study.

REFERENCES

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Introduction

In this essay, the focus is to examine food insecurity as the root cause of conflict in modern societies. In this context, it would be pertinent to use the term conflict analysis to mean the systematic study of the causes motivating actors and the dynamics of conflict. Dealing with any conflict would require that it would first be analyzed and understood. Before any intervention can be initiated in the context of conflict, conflict analysis is the most important step that needs to be carried out in order to gain a clear and deep understanding of the origin, nature and dynamics of the conflict in question. Conflict analysis therefore is not only collection of information and evidence about a particular conflict, but it also involves the interpretation and evaluation of the collection information about that particular conflict. Conflict analysis thus helps in the identification of the following: (i) type of the conflict, (ii) causes and consequences of the conflict, (iii) components and actors involved in the conflict and (iv) the levels in which the conflict takes place (Ohana, 2012).

Throughout the history of the human species, at its most elemental level, food has been a game against nature while politics emerged from divergent material interests facing scarcity – who gets to eat what, how often, and through what means of acquisition or entitlement? Over time the scale of polity has shifted phenomenally from local divisions of the grain pile, for example, in India’s archetypal Jajmani system, to an imagined international community in the Millennium Development Goals (MDGs) of the United Nations (UN). The first goal of the global vision of the UN was the elimination of poverty and hunger. It sought, by the year 2015, to halve the proportion of people who suffer from hunger – although this target remains elusive (Herring, 2015: 4). In terms of food politics, a wide range of actors will seek to influence outcomes, often conflicting with each other. While consumers would expect food prices to be low, farmers would want them to be high. Those representing farmers will vie amongst each other to whom the largest subsidies would go – for example, to producers of imported products versus exported products. In developing countries, subsidies are often granted to export-oriented farmers, however, on the other hand in develop or rich countries, farmers who compete with imports are favored (Paarlberg, 2010: 6).

The Politics of Food

Food in recent years has become one of the pervasive issues in political struggle. In terms of politics, the media often warns of a global food crisis due to rising prices in food and droughts which induce shortages in food, whilst the developed world faces an ever mounting health concern stemming from overeating and continued redirection of food grains towards biofuel production (Lavin, 2013: 1). At the same time, food has become increasingly entangled in controversies at the transnational level in terms of access to food. These controversies have placed food in the forefront of political debates both at the national and international levels. The phrase ‘Politics of Food’, just a few decades ago, would have drawn attention to a limited number of problems that might have fallen within the domain of the bureaucracy of the state. It would have denoted a set of issues such as food security, social inequality, nutrition policy and agricultural policy. At the micro level, food security could also mean the gendered inequality in terms of distribution of food and labor within the household. At the macro level (state), it could have been applied to the study of unfair trade, the dominance of multinational corporations and food as a human right. Most importantly the phrase ‘Politics of Food’, would have denoted access to food at different levels of scale and the problems associated with matching access to needs (Lien & Nirlich, 2004: 1).

Food Security and The Politics of Food Security

Human societies throughout time have struggled to ensure that people have access to adequate food in order to lead active and healthy lives. Events in the early 21st century have clearly demonstrated that despite global efforts, providing adequate food to all people remains an urgent problem situated at the nature, society and technology nexus. Rising food prices have motivated unrest in many parts of the world and an increase in the number of people who are undernourished is seen (Mcdonald, 2010: 1). The notion of food security has evolved over time and the First World Food Conference that was held in 1974 focused its attention on the availability of food both at the international and national levels. Food security was thus defined ‘as the availability at all times of adequate world food supplies of basic foodstuffs to sustain a steady expansion of food consumption and to offset fluctuations in production and prices’ (FAO, 2006: 1).

In this context it is worth noting that towards the late 1970s and the early 1980s, when the Green Revolution failed to bring substantial reduction in food insecurity despite increased availability of food, Amartya Sen brought out his most powerful critique of the food availability argument with his entitlements and depreciation thesis (Sen, 1981). It thus led to the addition of a demand-side perspective to redefine the concept of food security as ensuring that all people have access to basic food requirements both physically and economically at all times. In the mid 1990s, two more elements were added to the concept of food security: (i) not only was access to food important at all times its safety and nutritional value also were important; (ii) social and cultural acceptability of different types of food was also taken into consideration (Mukherjee, 2012: 1-3).

In the modern age of globalization, food politics remains situated at the national/local level. This is because most of the food that is produced in a country is consumed within that country. In most cases the food is consumed by the same subsistence farmer who produced it. Despite globalization, in Africa, only 15 percent of total cereals consumption is satisfied from imported supplies (Paarlberg, 2010: 4). Only six percent of wheat consumption and one percent of rice consumption is supplied through imports in south Asia (ibid: 3). These developing countries that are home to millions of poor and hungry people purchase very little from the world market as they cannot afford it. Typically, the heaviest users of world food products are rich countries and rich countries import from other rich countries . However, these rich countries place restriction on foreign supplies of food staples and national governments guard their authority over these products. In any case, the upper hand usually rests with the nation-state. The politically managed and non-globalized quality of most food systems is also visible through their nutritional outcomes which differ dramatically across the world. The developed countries are agriculturally productive and well-fed whereas the less wealthy countries are less productive and home to farmers who are not well nourished. 60 percent of all citizens in the sub-Saharan Africa are all farmers who are undernourished. In South Asia, there are about 400 million farmers who earn only about US$1 per day and approximately 25 percent are malnourished. The needs of these people remain unmet because both the colonialists and then their own national governments have invested too little in the development of the rural economy (Paarlberg, 2010: 4-5).

Hunger, Malnutrition and Conflict

In the context of hunger malnutrition and conflict, there can be two distinct ways of explanation that can be offered (i) conflicts leading to food insecurity and (ii) food insecurity leading to conflict. In general food security implies that all people at all times have physical access to sufficient, safe and nutritious food that meets dietary needs and food preferences for an active and healthy life (FAO 2006:1). This includes availability of sufficient quantity of food, access by individuals to nutritious food on a regular basis, among others, where problems with any of these dimensions can be termed as leading to food insecurity. Food insecurity has often been associated with outbreaks of social unrest or more severe forms of conflict (Bora, Ceccaci, Delgado and Townsend, 2010: 2) . On the other hand, conflict itself has been the in many instances the primary cause that interferes with one or more dimensions that provide for food security (ibid: 2). In May 2005, the Food and Agricultural Organization (FAO) reported that armed conflicts had become the leading cause of food insecurity. In 2005, forty-five countries and territories were suffering with food insecurity due to armed conflicts. These included twenty-two countries with active conflicts, nine receiving refugees from neighboring wars, and fourteen where conflict had ended. However, the effects of the conflicts continued to contribute to food insecurity. In the year 2017, there were about 124 million people across 51 countries who faced crisis levels that were termed acute food insecurity or worse that required urgent humanitarian assistance in order to safeguard their lives and preserve their livelihood. More than 76 percent of the total populations in 34 of these countries faced acute food insecurity and about 90 million people also faced climate shocks (FAO 2018: 57). The impact on food insecurity is more severe where conflicts and climate shocks occur together. In 2017, 14 out of 34 countries that faced food crisis experienced the double impact of both climate shock and conflict that increased the levels of food insecurity. Over 60 million people required immediate humanitarian assistance out of which 15.4 million people experienced extreme levels of food insecurity that require immediate life-saving assistance (ibid: 57-58). The UN Office for the Coordination of Humanitarian Affairs and other UN agencies reported that about fifty five million people were left in need of food due to these conflict with more than half of these people living in the sub-Saharan Africa (Messer & Cohen, 2007: 301).

The year 2014 served as a stark reminder that conflicts often worsen food and nutrition insecurity. The destruction of infrastructure coupled with disruptions to access to markets often makes goods and services extremely expensive or altogether unavailable. In addition to this, investors and tourists abandon conflict-affected areas and clashes between the conflicting parties force millions to flee either to safer places within their own countries or in neighboring countries which often results in contracting of economies, instability and insecurity spilling over borders, along with the rise in food insecurity. It is clear then why conflicts threaten seriously our efforts to achieve the ambitious development goals that the international community has been discussing since 2015, including the goal of eradicating hunger and malnutrition by the year 2025. Although countries like Bangladesh, Brazil, China and Vietnam have demonstrated that rapid reduction in hunger and chronic child malnutrition is possible, it is however, a general perception that reaching these goals may be difficult to achieve particularly where countries are affected by civil conflict and political instability (Breisinger, Ecker & Trinh Tan, 2015: 51).

Food insecurity leading to conflict

In January1994, just when the North American Free Trade Agreement came into force, the Zapatista rebellion (the Zapatista Army of National Liberalization (EZNL) an indigenous armed group declared war on the Mexican Government and demanded work, land, housing, food, health security, education, independence, liberty, peace, democracy and justice. For more on the Zapatista rebellion and demands please refer the article by Iker Reyes GodelMann: The Zapatista Movement: The Fight for Indigenous Rights) erupted in Mexico and into the world political-economic scene. While making their demands and communicating to the world through the internet, they demonstrated that food security, globalization and conflict are interconnected (Gilberth & Otero, 2001). However, it is still not clear whether lessons from this rebellion has been fully grasped by global policy makers – that globalization and free trade agreements will have winners and losers and in the absence of supportive public policies, these losers when organized and resourced, take up arms. Trade, agricultural and food policies should not look to eliminate commercial barriers but it should also include the rights to food access, land and water, livelihoods, healthcare and education.

The Millenium Development Goals (MDGs), the new Human Security Unit of the United Nations and the Food and Agriculture Organization’s (FAO) right to food initiatives all look to establish a more economically integrated politically peaceful world, based on the better implementation of rational, economic political and legal norms (Messer & Cohen, 2007: 298).

While exploring the links between food insecurity and conflict, it would be useful to place our focus on regions that are more vulnerable to food insecurity than others and where food insecurity has been a catalyst of conflict. These regions include the Middle East and North Africa (MENA) and the Sahel and the Horn of Africa. In the year 2011, several MENA countries were seriously affected by conflict and remained so in 2013. Most of these countries have been experiencing increases in food prices and when there is a rise in food prices, the impact on household spending is enormous and its effect is magnified politically and socially in two ways. Then is food insecurity a cause for conflict? The answer is yes. Food insecurity, when caused by rising food prices, heightens the risk of civil conflict, protest, rioting and communal conflict. Conflicts may appear in different forms: (i) communal conflict between two or more distinct communities that neither targets nor directly involves the state, (ii) civil conflict between the state and an opposition group and (iii) urban unrest. Food insecurity can motivate participation in armed civil conflict at the individual level, however, acute food insecurity may also diminish conflict because there are limited resources available for militants and thereby hinder active political participation and food denial is often a strategy used in counter insurgency operations (Hendrix & Brinkman, 2013: 4). Thus the causal link between food insecurity and conflict is both complex and ambiguous while the reciprocal relationship is well established.

In terms of communal conflicts, it tends to cluster around areas or regions where land, water and resources are scarce (for example the Sahel). Recurrent droughts have often undermined cooperative relationships between pastoralists and sedentary farmers as pastoral encroachments of land have increased in recent times like in Sudan. Because marginal lands are used in herding activities, these conflict often occur in the backdrop of chronic or frequent food insecurity and are increased by poverty and political exclusion.

Urban protests and riots have received attention following the food crisis in 2007-08 and during the Arab Spring. In connection with the food crisis of 2007-08, a study (Berezneva & Lee, 2011) reported that there were varying degrees of violent conflict and mostly urban protest occurred in fourteen out of fifty-three African countries (Helland & Sorbo 2014: 23). It concluded that food riots are more likely to occur in authoritarian states with few political freedoms and with a high incidence of economic and human poverty. Lagi et.al (2011: 2) formulate an interesting hypothesis to the effect that in food-importing countries with widespread poverty, political organizations may be perceived to have a critical role in food security. Failure to provide for food security undermines the very existence of the political system and once this occurs, protests emerge reflecting a wide range of dissatisfaction that broadens the scope of the protest. Thus increase in food prices is likely to lead to large-scale unrest in regimes where the government has actively intervened in food prices while taking into account past price controls and consumer subsidies. Hence Hendrix and Brinkman (2013: 8) argue that these interventions create expectations that will make consumers to look at their depend on their governments in terms of their ability to stabilize consumer prices.

Conclusion

As old as humanity, conflict is a salient feature of the human society (Florian, 2015). Even in a situation of non-availability of arms or tools of violence, Morgenthau states that men will fight even with their bare fists (Morgenthau, 1948). This presupposes that human beings will continue to fight as long as they possess emotions that has the potential to love or hate, happy or sad, pleased or angry. This also brings us to the conclusion that as long as humans have other humans around them, there is every possibility that there will be disagreements because their interests differ and their interests clash with each other. Conflict thus manifests itself in disagreements, hatred, destruction, killing and war which in most cases can be posited as those that arise due human beings’ needs and claims over certain resources.

Although the study of conflicts is so common, theorizing about conflicts emerged as an important field only after the end of the Second World War. In recent decades, many theories about conflict have emerged which explain that it is very much part of human life. Understanding conflict is determined by the way one thinks about the nature of the conflict. Definitions about conflict move backwards and forwards in which conflict is perceived as negative or positive process. While some present conflict as a natural phenomenon, others perceive it as an abnormal happening, there are yet others who consider conflict as a necessary condition for the development and growth of individuals and societies.

Economics is defined as the science of wealth, and wealth as the sum of things that have value, it would seem that the central theme of science would be value. However, economists use the term value depending upon scarcity; hence value would never exist without scarcity. Therefore, it would be good to assume that everything which is scarce has value. Thus with this qualification we can also assume that value and scarcity are always together and can never be separated. Scarcity therefore means insufficiency to satisfy wants. It must be noted that even though a thing is available in abundance, if there is not as much as is required then it is scarce, on the other hand if a thing is, even though rare, available more than wanted then it is not scarce. Thus, the fact of scarcity implies the existence of a lack of harmony or conflict between humanity and nature. This stage of disharmony between humanity and nature visible in the form of scarcity results in the disharmony between human being. When there is scarcity, we can assume that there will be two persons wanting the same thing and subsequently there will be antagonism of interests. This antagonism of interests between human beings will result in questions that would need to be settled – questions of right and wrong, of justice and injustice, and such questions would not arise in any other circumstance. On the other hand, when there is no conflicting interests between human beings we do not concern ourselves with it. However, when they are imperfect, we are compelled to concern ourselves with it even if we wish not to. Thus there is a profound belief in some that underneath all these disharmonies is a deep desire to fulfill human interests (Carver, 1908: 628-30).

In conclusion it can be agreed that civil conflict is rarely grounded in single grievance or simple causes – it represents the accumulation of a complex set of interrelated factors. While food insecurity and poverty may be the stimulants or root causes for political instability or conflict, neither hunger nor poverty can be seen in vacuum. Other aspects of the political social and economic factors affect the degree to which food insecurities and grievances more generally are expressed violently. Finally, in the context of hunger, it will be interesting to recall Rousseau – What is the purpose of political association? The security and prosperity of its associates (Rousseau, 1762 p.116). Paul Collier in 2008, stated that politicians and policymakers have the capacity to bring food prices down (Collier 2008). Thus, the state has a responsibility to provide for its citizens those things that are necessary for their decent living and sustainable growth.

Works cited

1. Berazneva, Julia & David R. Lee (2013) ‘ Explaining the African Food Riots 2007-2008: An Empirical Analysis’, Food Policy, 39 (c): 28-39.
2. Bora, Saswati, Iride Ceccacci, Christopher Delgado & Robert Townsend (2010) ‘Food Security and Conflict’, World Development Report 2011, Background Paper.
3. Breisinger, Clemens., Olivier Ecker, and Jean Francois Trinh Tan (2015) ‘Conflict and Food Security: How Do We Break the Links?’, in 2014–2015 Global Food Policy Report Washington: IFPRI Research.
4. Carver, T.N (1908) ‘The Basis of Social Conflict’, American Journal of Sociology, 13(5): 628-648.
5. Collier, Paul (2008) ‘The Politics of Hunger: How Illusion and Greed Fan the Food Crisis’, Foreign Affairs, 87(6), https://www.foreignaffairs.com/articles/2008-11-01/politics-hunger. (Accessed: 19.11.2018).
6. Elizabeth Lien, Marianne & Brigette Nerlich (eds.) (2004) ‘The Politics of Food: An Introduction’, in Marianne Elizabeth Lien & Brigette Nerlich, The Politics of Food, New York: Berg Publishers.
7. Folarin, Sheriff F (2015) ‘Types and Causes of Conflict’, Ota: Covenant University Press.
8. Food and Agriculture Organization (2006) ‘Food Security’, Policy Brief, June 2006, Issue: 2, www.fao.org/fileadmin/templates/faoitaly/documents/pdf_Food_Security_Cocept_Note.pdf. Accessed: 18.05.2019.
9. Food and Agriculture Organization (2018) ‘The State of Food Security and Nutrition: Building Climate Resilience for Food Security and Nutrition’, Rome: Food and Agriculture Organization of the United Nations. www.fao.org/3/i9553en/i9553.pdf. Accessed: 18.05.2019.
10. Gilberth, Chris & Gerardo Otero (2001) ‘Democratization in Mexico: The Zapatista Uprising and Civil Society’, Latin American Perspectives, 28(4): 7-29.
11. Godelmann, Iker Reyes (2014) ‘The Zapatista Movement: The Fight for Indigenous Rights in Mexico’, https://www.internationalaffairs.org.au/news-item/the-zapatista-movement-the-fight-for-indigenous-rights-in-mexico/. Accessed: 18.05.2019.
12. Headey, D and Shenggen Fan (2010) ‘Reflections on the Global Food Crisis. How Did It Happen? How Has It Hurt? And How Can We Prevent the Next One?’, Monograph 165, Washington: IFPRI Research Monograph 165, Washington 2010.
13. Helland, Johan & Gunnar M. Sorbo (2014) ‘Food Securities & Social Conflict’, Bergen: Christian Michelsen Institute.
14. Hendrix, Cullen S. and H-J. Brinkman (2013) ‘Food Insecurity and Conflict Dynamics: Causal Linkages and Complex Feedbacks’, Stability: International Journal of Security & Development, 2 (2): 26. pp.1-18.
15. Herring, Ronald J (2015) ‘How is Food Political? Market, State and Knowledge’, in Ronald J. Herring (ed) The Oxford Handbook of Food, Politics and Society, Oxford: Oxford University Press. pp. 3-42.
16. Jean-Jaccques Rousseau 1762 Translated by Betts, Christopher (1994) (trans.) ‘Discourse on Political Economy and The Social Contract’, Oxford: Oxford University Press.
17. Lagi, Marco, Karla Z. Bertrand and Yaneer Bar-Yam (2011) ‘The Food Crises and Political Instability in North Africa and the Middle East’, Cambridge: New England Complex Systems Institute.
18. Lavin, Chad (2013) ‘Eating Anxiety: The Perils of Food Politics’, Minneapolis: University of Minnesota Press.
19. McDonald, Byran (2010) ‘Food Security’, Cambridge: Polity Press.
20. Messer, Ellen & Marc J. Cohen (2007) ‘Conflict, Food Security and Globalization’, Food Culture and Society: An International Journal of Multidisciplinary Research, 10(2): 297-315.
21. Morgenthau, Hans J. (1948) ‘Power and Ideology in International Politics’, New York NY: Alfred A. Knopf.
22. Mukherjee, Amitava (2012) ‘Food Security in Asia’, New Delhi: Sage Publications.
23. Ohana, Yael & Nadine Lyamouri-Bajja (2012) ‘T-KIT: Youth Transforming Conflict’, Strasbourg: Council of Europe Publishing.
24. Paarlberg, Robert (2013) ‘Food Politics: What Everyone Needs to Know’, Oxford: Oxford University Press.
25. Sen, Amartya (1981) ‘Poverty and Famines: An Essay on Entitlements and Deprivation’, Oxford: Clarendon Press.
26. World Bank Data Team (2018) ‘New Country Classification by Income Level: 2018-2019’, https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2018-2019. Accessed: 18.05.2019.

WHO describes malnutrition as imbalance, deficiency or excesses in a person’s diet in context of nutrients and energy. The statement covers two wider groups, one being under-nutrition, which is caused due to insufficiency and or inadequacy in the food source resulting in stunting, underweight, deficiency diseases, wasting, etc. While the other one being dietary diseases like obesity, diabetes and cancers in the alimentary canal. Malnutrition affects people all around the globe hence we need to tackle it like a species. Around 1.9 billion adults worldwide are overweight. Even around 462 million are underweight. An estimated 41 million children under the age of 5 years are overweight or obese, while some 159 million are stunted and 50 million are wasted. Adding to this burden are the 528 million or 29% of women of reproductive age around the world affected by anemia.

Malnutrition is one of the major causes of health problems in Vietnam. The country is facing food scarcity due to lower quality crops and cheaper produce. Besides this, the lack of food security and standardized public distribution systems worsen the situation. Children under the age of five years are affected the worst. Severe deficiencies lead to stunting which increases the risk of mortality. Approximately 1.2 million children out of 7.6 million births are affected, that is 26% of the total children born per year. Several children show patterns of stunted growth, and about all of them are at risk of death. The post-natal factors are also responsible for stunted growth like improper infant and child feeding practices. Another major effect of malnutrition on the population is severe anemia amongst women in the reproductive age along with 1/3rd of children below the age of 65 months i.e. approx 5 years. It is caused by the deficiency of micronutrients like iron, vitamin A, etc. Micronutrient deficiency like that of iodine is a major causative of many health problems amongst the general population, but the most affected are the school going children due poor quality of food and lower standards of nutrition.

Vietnam has addressed these issues critically and the numbers had gone significantly down by the year 2014. Childhood malnutrition is especially important for Vietnam as the children between the ages of 5 and 65 months are also vulnerable to contracting infectious diseases, which if ignored can turn out to be fatal.

Loss of food productivity in Vietnam is highlighted when we consider crops like fruits and vegetables. The rate of post harvest loss is massive in the case of Vietnam. Such loss directly affects the economy as well as the grade of food that the citizens get to consume, a poorer economy resorts to consuming cheaper food that usually are not fortified and have very low nutritional value. Vietnam is has taken this matter into its site and is trying to find ways to improve fruit production both consumption and export. One example being FAO and Vietnamese government are cooperating to fight off pink mealybug which is a parasite on cassava plants.

Along with the post harvest losses Vietnam faces crop or product loss due to the increasing rates of air, land, and water pollution caused by several factors. One of the major factors is the over-use of chemical fertilizers. The trends have worsened over the last 20 years and the use of chemical fertilizers and plant protectors have increased almost five-fold. It has resulted in degradation of soil and contamination of water both currently resulting in poor yield and lower quality product.

Along with other products, Vietnam is also a big producer of freshwater fish and shrimp which are grown and captured in the Mekong Delta, with a net value worth of millions in USD. But this industry also is suffering product loss due to various factors. A fast extension of the zone being used for aquaculture has been hard to direct. The industry requires major changes in the infrastructure as the previously built canals, etc. do not match the requirements for the practice of aquaculture. There has been a decrease in coastal aquatic resources in latest years, resulting in enhanced pressure on the livelihood of millions of individuals dependent on natural aquatic resources, e.g. small-scale fishing operations. Despite the fast growth of industrial-scale shrimp cultivation that has made a significant contribution to complete aquaculture manufacturing from the fisheries industry, the large-scale disease outbreak is a severe problem for the future development of shrimp farming in Vietnam’s coastal regions.

Even though the country is having issues in maintain the rich fresh water reserves but Vietnam recognizes the threats like salt water intrusions etc. in the delta and is trying its best to deal with such perils caused due to industrialization.

Even though there are several programs running in the country to combat malnutrition and loss of produce but every plan needs certain amount of enrichment and outlook. Therefore, Vietnam would like to suggest the following recommendations.

• FAO should promote food diversification in different communities to cover a broader spectrum of nutrients
• FAO should help share the technological and biotechnological advancements in crop research across the globe
• FAO should expand its boundaries by maintain the collaboration between FAO and Epi-LABNET to fight against diseases caused post malnutrition across the globe
• FAO should join hands with GAIN and National Institute of Nutrition (NIN) to promote distribution of micronutrient powders to countries facing childhood malnutrition
• FAO should promote nutrition sensitive agriculture in order to prevent wastage

The above mentioned recommendations and the belief of Vietnam about the fact that the entire globe has to cooperate and work hand in hand to combat Malnutrition and Loss of food productivity. By developing efficient food resources and sustainable forms of agriculture we can defeat the curse of malnutrition that faces us. Hence Vietnam invites each of our fellow nations to contribute to make the world a better place for us and for the generations to come.

Nearly one in three persons globally suffers from at least one form of malnutrition: wasting, stunting, vitamin and mineral deficiency, overweight or obesity and diet-related Non-Communicable Diseases1. Malnutrition is widely known as under-nutrition until and unless it is not specified. It accounts for at least half of all childhood deaths worldwide. Malnutrition is considered as fundamental cause of morbidity and mortality among the children2,3. It also poses a risk to children’s physical and mental development, which results in poor academic achievement. Malnutrition affects the future health and socioeconomic development of children and the dynamic prospective of the society4,5.

In the last two decades, there has been a little reduction in the prevalence of child malnutrition in Pakistan compared to other developing countries. The prevalence of all types of malnutrition in Pakistan was found to be higher than the global threshold value. It was found that malnutrition starts at an early age and remains persistent at later stages6.

According to the National Nutrition Survey 2011, it has been reported that 13.4 million (43%) of children under the age of five in Pakistan are moderately or severely stunted, 9.9 million (32%) are moderately or severely underweight, and 4.8 million (15.1%) children under five years of age are wasted. 50 percent of the children were anemic, and 33% were anemic from iron deficiency7.

The contributing factors in childhood malnutrition are low birth weight, inadequate breast feeding and exclusive breastfeeding, inappropriate complementary feeding, maternal education, lack of proper knowledge of nutrition, micronutrient intake, parity, birth spacing, household socioeconomic status, food insecurity, poor sanitation, vaccination, and infectious diseases8.

Anemia among pregnant women has increased to 52 percent. Maternal anemia is associated with reduced birth weight and increased risk of maternal mortality. Anemia rates have been worsen over the past two decades. Children who are born with intrauterine growth restriction and low birth weight have a greater risk of morbidity and mortality. These children usually continued with slow growth rate resulted in stunting, slow mental growth and remained underweight9Comparison of National Nutrition Survey 2001, 2011 and PDHS 2017-18 showed that over the last 18 years there is slight improvement in few aspects of malnutrition but generally the malnutrition status among children and women is stalling or further deteriorated. • Iodine deficiency among women and children has decreased (improved).

• Anemia among children and Iron deficiency anemia among women have worsened.
• The chronic malnutrition indicators such as Wasting and stunting among children has worsened.
• Both women and children have showed many folds increase in the prevalence of Vitamin A deficiency.
• Still micro-nutrient deficiencies are highly prevalent among children and women

Malnutrition has a negative impact on cognitive development, school performance and productivity. Stunting and iodine and iron deficiencies, combined with inadequate cognitive stimulation, are leading risk factors contributing to the failure of children to attain their full development potential. Each 1% increase in adult height is associated with a 4% increase in agricultural wages and eliminating anaemia would lead to an increase of 5% to 17% in adult productivity10.

Food Security

Food security [is] a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life (defined by The Food and Agriculture Organization (FAO).

Despite Pakistan’s strong agricultural base, food insecurity is widespread. According to The State of Food Security in Pakistan, 44 percent of households consume less than 2,350 Kcal per adult equivalent per day11, the accepted normative standard set by Ministry of Planning Development & Reform. The food security situation showed no signs of improvement since the last food insecurity assessment conducted by the United Nations in Pakistan (WFP Report 2009), which revealed that 51% of the population was food insecure. The situation has, in fact, deteriorated further. This will have serious implications on the nutrition, growth and health of the Pakistani population12.

Despite growing levels of food production, economic access to food remains a major challenge in Pakistan. If available food is not accessible to the population, food security cannot be achieved. A household’s access to food is a measure of its income, food distribution and the market prices of food items. Official estimates consider 29.5 percent of Pakistan’s population ‘poor’ with reference to the revised national poverty line of PKR 3,030.3213. However, multidimensional poverty is estimated to affect 38.8 percent of the population when severe deprivations in education, health and living standards are considered. Poverty is most prevalent in eastern Sindh, western Balochistan and pockets of KP and Punjab14.

The Food Consumption Score (FCS ) a proxy indicator of food security is a composite score based on dietary frequency, food frequency and relative nutrition importance of different food groups consumed at the household’s level. The recent drought assessment in Sindh revealed that overall, around 18 percent of households have ‘acceptable food consumption’, 41 percent have ‘poor consumption’ and another 41 percent have ‘borderline consumption’15.

Key issues related to food insecurity in Pakistan:

• Access to food is a major challenge. Poverty is one of the biggest barrier to access to food. Additionally, high food cost and access to market of rural communities are major contributors.
• Most of the households spend half (49 percent) of their monthly expenditure on food, on average, a proportion which increases among the poor.
• Roughly half of Pakistan’s population is energy deficient, consuming fewer calories than those required for a healthy life.
• Dietary diversity is limited in Pakistan, especially among poor and marginalized groups who follow a fixed pattern of food intake and consume a narrow variety of nutrients. One of the resulted outcome is micro-nutrient deficiencies.
• Whether an individual consumes—or not—nutritious food is contingent upon a myriad of factors, ranging from the availability of certain foods, how convenient they can be turned into meals, or simply, if they meet consumers’ tastes. But above all, the high cost of food remains the most critical barrier to proper nutrition and affects the poor more than the rich. And in Pakistan, where malnutrition persists in multiple forms, the cost of nutritious food is prohibitive.
• The ready to use supplementary food are not available in the market and only available from limited sources on high cost.

Burden of Non-communicable diseases

Pakistan is facing double burden of Malnutrition as reported by National Nutrition Survey and latest data shared by Pakistan SUN Secretariat Report 2017-18, Ministry of Planning and Development. According to these reports adult overweight and obese person are 30%, mostly residing in urban locations. Among male adults obese and overweight are 27 percent and slightly more female adults 32% are obese and overweight. The major contributing factors are the dietary pattern and habits leading to inappropriate consumption of food including consumption of more energy dense foods rather than the nutrient-dense foods, and consumption of artificial foods. These malnutrition states lead to two major non-communicable diseases including Hypertension, cardiovascular diseases and Diabetes.

Solutions

Strategy for Prevention and Management of Malnutrition

It is established fact that a malnourished child will face poorer outcomes as an adult. In Pakistan, where malnutrition persists in multiple forms, improving nutrition in the early stages of life is critical to a child’s future development and health. The path toward better nutrition includes adequate maternal and child care, access to better sanitation facilities, health services, and naturally, nutritious foods.

A. Community based Primary Health Care interventions with special focus on Nutrition specific interventions for Children and Women such as:

The preventive measures must focus the children under five years of age, adolescent girls and women including pregnant and lactating mothers. The first 1,000 days from the start of a woman’s pregnancy to a child’s second birthday offer a window of opportunity for preventing under nutrition and its consequences. We should targets this period with support for breastfeeding, nutrition-rich foods for infants and micronutrient supplements for mother and children. These nutrition specific interventions may be effectively implemented through primary health care services by community based Marvi workers and supervisor LHVs for quality technical services. The effective strategic plan should be devised including

• Primary Health Care interventions (community based education of mothers, health and nutrition services for prevention of malnutrition by promoting preparation of diversified appropriate meal (age appropriate) at home)
• Manufacturing and Provision of Ready to Use Supplementary and Therapeutic Food — for acutely malnutrition children, pregnant and lactating women
• Manufacturing and Provision of Multiple Micro-nutrient supplement (including iron and folate) tablets for pregnant and lactating women and Multiple Micro-nutrient sachet for children (6 – 24 months)

Provision of antenatal care, counseling about balance diet and provision of iron-folate supplements to all pregnant women through services within villages

Referral strategy for safe institutional deliveries through linkages with Public sector health facilities

Promotion of breast feeding ensuring three Es including Early initiation inclusive of colostrum, Exclusive breast feeding and Extensive breast feeding for 2 years. Engage the communities in vigorous campaigns to promote breastfeeding at the local level.

Prevention of stunting and wasting through promotion of Infant and young child feeding as education of mother on appropriate diet preparation and feeding based on dietary diversity. Promote local dietary recipes through cooking demonstration. Use of Positive Deviation approaches for effective behavior change and correct practices by the mothers

Growth monitoring of all children under five years of age quarterly and marked on growth cards for learning of mothers for linear growth follow up of each child

Provision of multiple micro-nutrient (MNN) sachet for each child of 6-24 months of age

Identification of children with Severely Acute Malnutrition and Moderately Acute Malnutrition and their community based management by provision of Ready to Use Supplementary Food (RUSF — produced locally as Acha Mum packets by Ismail industries) and Ready to Use Therapeutic Food (RUTF — provided by Unicef) for period of at least 2 months. Additionally encouraging mothers to feed home-made meals to the children

B. Strategy for Improving Food security at Community and household level

The most energy-dense foods (cereals, oils and fats, sugars) generally had the most stable prices, showing the least inflation. These foods generally have a longer shelf life for storage and transportation. Food security and agriculture policies have emphasized energy-dense foods for the last several decade. The nutrient-dense foods such as legumes, lentils, animal source food, vegetables and fruits tend to be highly perishable, usually available on high cost, mostly not available in poor settings or unaffordable by the poor communities.

Strengthening of Regulation of Legislation on milk substitutes: There is a need to develop or where necessary strengthen legislative, regulatory and/or other effective measures to control the marketing of breast milk substitutes in order to ensure implementation of the International Code of Marketing of Breast-milk Substitutes and relevant resolutions adopted by the Health Assembly.

Food security assurance thru Food Points in rural areas. For food security, increased access to foods of good nutritional quality should be ensured in all local markets at an affordable price all year round, particularly through support to smallholder agriculture and women’s involvement. Food points /enterprises may be developed at villages levels, to ensure the availability of recommended food items at affordable cost. For establishing these food points or enterprises, a grant of 20000/- to community based health worker may be provided. These workers may be connected to UC level whole sale shop keeper or suppliers. The system should ensure the promotion and availability of micro-nutrient fortified food such as iodized salt, wheat flour with iron, and edible oil with vitamin A &D at affordable prices within communities.

In addition, to food enterprises, community cooking sites / spot may be established to prepare the nutrient-dense meals which would be available for malnourished children (at least one meal for a day) at an affordable cost. The recipes are already devised and suggested by the Unicef, Nutrition support program and HANDS PHC program. The major food items for these meals would be based on chick peas, lentils/ legumes, rice, porridge, dairy products, eggs, edible oil (enriched with Vit A & D), and iodized salt.

Food packaging and Supply system: The food packaging and supplier agency may be formed to establish and ensure the functional food supply chain system. This agency may also play a vital role in managing and controlling the market price of the nutrient-dense and energy-dense foods. The government or concern organizations may play vital role in developing food supply chain system to ensure the availability on affordable cost of nutrient-dense foods in addition to energy-dense foods in the poor settings.

Partnership with Food industry for Ready to Use food: Additionally, strategic partnership may be developed with the food products manufacturing industries. The high energy and nutrient-dense ready to use food items may be produced by these industries on affordable cost for the treatment of acute malnourished children, pregnant and lactating women. Currently cost of treating one malnourished child by giving these ready to use food is ranged from Rs. 5500 to Rs. 10000/=.

Following food products may be produced as per demand:

• Ready to Use Supplementary Food (RUSF) for Moderately Acute Malnutrition (MAM) Children
• Ready to Use Therapeutic Food (RUTF) for Severely Acute Malnutrition (SAM) Children
• Ready to Use Supplementary Food for pregnant and lactating women — Mamtaa
• Multiple Micro-nutrient supplement sachet for children
• Multiple Micro-nutrient supplement tablets for women

District Level Resource centers: These resource centers may be established to serve the purpose of addressing and improving the food security issues at large scale or district level. These centers should develop strategic partnerships with agriculture institutes for technical support and oversight. These centers may perform the following tasks:

• Support farmers by providing drought resistant and drought tolerant crops, inputs, and promotion of climate smart agriculture. Specifically, provide drought resistant seed of cereals, fodder, pulses, legumes, vegetables and shrubs plantation.
• Introduction and up scaling of bio-saline agriculture
• Capacity building of farmers through Farmers Field Schools (FFS), Junior Farmer Field Schools (JFFS), Farmers Business School (FBS) and Women Open Schools (WoS)
• Introduction of drought tolerant fruit, fodder and shrubs plantations
• Soil management through proper fertilization
• Helping communities in applying No-till/reduced tillage systems
• Facilitating farmers Usage of crop rotation/cropping systems
• Strip farming as required centers
• Establishment of community seed banks

C. Strategy for reducing the Burden of Obesity and non-communicable diseases

Information, Education and Communication material development: The information and education material may be used in large scale in printing form and by developing short video sessions based on healthy dietary habits and balance diet.

Halfway Healthy Spaces: The hospitals spaces such as waiting areas and OPD areas may be utilized for conducting these sessions. These may be promoted as halfway health spaces

References

1. Black, R.E.; Victora, C.G.; Walker, S.P.; Bhutta, Z.A.; Christian, P.; de Onis, M.; Ezzati, M.; Grantham-McGregor, S.; Katz, J.; Martorell, R.; et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013, 382, 427–451. [CrossRef]
2. Meshram, I.I.; Arlappa, N.; Balakrishna, N.; Rao, K.M.; Laxmaiah, A.; Brahmam, G.N.V. Trends in the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among under five-year tribal children in India. Asia Pac. J. Clin. Nutr. 2012, 21, 568–576. [PubMed]
3. World Health Organization. Children: Reducing Mortality. Available online: http://www.who.int/mediacentre/ factsheets/ fs178/ en / (accessed on 3 March 2018).
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6. Stevens, G.A.; Finucane, M.M.; Paciorek, C.J.; Flaxman, S.R.; White, R.A.; Donner, A.J.; Ezzati, M.; Nutrition Impact Model Study Group. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: A systematic analysis of population representative data. Lancet 2012, 380, 824–834. [CrossRef]
7. Planning Commission, Government of Pakistan, Pakistan Institute of Development Economics. National Nutrition Survey; Pakistan, 2011
8. Di Cesare, M.; Bhatti, Z.; Soofi, S.B.; Fortunato, L.; Ezzati, M.; Bhutta, Z.A. Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: An analysis of data from a nationally representative survey. Lancet Glob. Health 2015, 3, e229–e239. [CrossRef]
9. United Nations System Standing Committee on Nutrition. Progress in nutrition: Sixth report on the world nutrition situation. Geneva, United Nations System Standing Committee on Nutrition Secretariat, 2010.
10. WHO/NMH/NHD/14.1”Comprehensive Implementation plan on Maternal, Infant and Young Child Nutrition”, WHO 2014, www.who.int/nutrition
11. FAO, IFAD, UNICEF, WFP & WHO. 2017. The State of Food Security and Nutrition in the World 2017: Building resilience for peace and food security. Rome, Food and Agriculture Organization. Available at: http://www.fao.org/3/a-I7695e.pdf.
12. Planning Commission, Ministry of Planning, Development & Reform. 2016. Pakistan’s Revised Poverty Line. Islamabad, Government of Pakistan.
13. Ministry of National Food Security and Research, WFP, FAO & UNICEF, 2016.
14. UNDP, OPHI & Planning Commission. 2016. Multidimensional Poverty in Pakistan. Islamabad, UNDP/Ministry of Planning Development & Reform. Available at: http://www.ophi.org.uk/wp-content/uploads/Multidimensional-Poverty-in-Pakistan.pdf.
15. Unicef, FAO, Acted, HANDS, IOM, WFP, WHO, DFID, PDMA Sindh, “Sindh Drought Needs Assessment (SDNA) Report Jan 2019”.

Abstract

Political corruption influences various state welfare sectors, thereby impacting various socio-economic and public health areas, which affect millions of people around the globe. One of these focus areas is malnutrition among children, which this research design proposal investigates the relationship into. With support of existing literature in related fields and publicly available data, this work aims to answer the following question: to what extent does political corruption affect malnutrition in children? The research offers insight to the hypotheses through the literature review, research question, methodology, theoretical expectations, study populations, and conclusion.

Introduction

Over many centuries, political systems in numerous countries have moved away from hierarchal structures where one exclusive individual, or sometimes even a few elites, are prioritized over the rest of the people in that country. Societies have embraced change for systems where the welfare of communities are brought into the spotlight, in order to raise the overall global standard of living by allowing for better and more universal education as well as improving general public health. Included here are worldwide campaigns to eradicate preventable deaths and illnesses related nutrition and food security. However, unfortunately to this day, many people, and children in particular, remain heavily affected by diseases that could have and can be prevented, such as those relating to malnutrition (Weininger, 2018). A few examples of such illnesses include “cystic fibrosis, chronic obstructive pulmonary disease, chronic kidney failure, chronic heart failure, cancer, and inflammatory bowel disease” among others (What is disease-related malnutrition?, n.d.). However, while the circumstances of various countries are, inherently different (through factors like history, geography, or available resources to name a few) this paper explores whether countries that experience higher levels of corruption in their political system also see higher occurrences of malnutrition in children.

Literature Review

In a 2011 study, a team of researchers published an article titled “Corruption Kills: Estimating the Global Impact of Corruption on Children’s Deaths” in which they scrutinized the impact of political corruption on child mortality. Prior to the study, scholarly literature existed in support of the notion that corruption has a negative impact on the deaths of children, though the team wanted to gain further insight (Hanf et al., 2011). By using a multivariate model, they found that corruption lead to an estimated minimum of 140,000 deaths of children. A significant variable in the study was “the percentage of people with improved sanitation”. This may be interpreted as overall sanitation including hygiene practices in health services, but also relating to cleanliness around water resources leading to water-borne diseases. The authors of the study warn that “without paying regard to the anti-corruption mechanisms needed to ensure” improved sanitation practices, global trends could continue to result in more deaths of children around the globe, while also allowing for more corrupt government practices to occur (Hanf et al, 2011).

They elaborate by stating that, “in the developing world, 80 per cent of health problems can be linked back to inadequate water and sanitation” (Hanf et al., 2011). These staggering findings relate to my thesis of corruption impacting malnutrition in all persons (thus of course including children), which I wish to recreate with some changes in this research. (This is further elaborated in the Methodology section of this paper.)

In a similar study published in The Pan African Medical Journal in 2015, Florence Nguzi Uchendu and Thaddeus Olatunbosun Abolarin examine corruption and its impact on food security and life expectancy in developing countries. Based on their findings, they write, “improvement in government policies to discourage corrupt practices, promote good governance, primary healthcare, mechanized agriculture, household food security, availability of portable water, and nutrition education at [the] community level should be embraced to eradicate malnutrition in developing countries.” They attribute corruption as being a factor which influences “socio-political problems” in developing countries. Here, a consequence of these problems is the negative influence on overall food security and life expectancy (Uchendu & Abolarin, 2015). Like “Corruption Kills”, I wish to further investigate the socio-political element of nutrition as influenced by corruption on its impact on children’s deaths and will reference Uchendu & Abolarin’s work. Their findings offer indirect support for my hypothesis, which would be tested in my multivariate model (to which I write more about in the Methodology section of this paper).

Lastly, another significant study relating to the topic of my research is Rebekah Burroway’s “Democracy and child health in developing countries” published in the International Journal of Comparative Sociology in 2016. As measures of child health, Burroway scrutinizes diarrhea and malnutrition across 52 countries by conducting a multivariate analysis model with control variables including level of education, socio-economic factors, and household wealth in her regression model. The results of her study suggest that democracy does not have a significant effect on health; though GDP, water sanitation, and socio-economic factors do. Interestingly, her research findings contrast with existing literature, and instead “support a small but growing” collection of recent studies that closely reexamine the previously established relationship between democracy and health (Burroway, 2016).

Research Question

Given existing literature and interest for politics and public health, the fundamental research question of this work is: to what extent does political corruption impact malnutrition in children?

Before presenting the paper’s hypotheses, it is crucial to conceptualize terms that are central to this paper. These are specified below:

• Child: a human being below the age of five (5) years. (While the United Nations Convention on the Rights of the Child or UNCRC defines children as “human beings below 18 years of age” [United Nations, 1989], I limit the scope in my research paper on basis of willingness to investigate into the effect of political corruption on infants and young children exclusively.)
• Corruption: “The manipulation of policies, institutions and rules of procedure in the allocation of resources and financing by political decision makers, who abuse their position to sustain their power, status, and wealth” (Transparency International, n.d.).
• Malnutrition: “Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients” (World Health Organization, 2016). While malnutrition may refer to “undernutrition” or “overweight, obesity, and diet-related noncommunicable diseases”, only the former reference is meant throughout this paper when labeled as malnutrition. Unless otherwise specified, it includes stunting, wasting, underweight, and micronutrient deficiencies and insufficiencies (World Health Organization, 2016).

Methodology

Similar to the Hanf et al. and Uchendu & Abolarin publications, the research design for this project is a quantitative, population-based study with all necessary data available online and accessible for public use. More specifically, the study relies on the Borrow-A-Method research approach modeled in likes of the “Corruption Kills” publication. Here similarities include the style in which the multivariate regression is constructed in order to determine whether a significant correlation between the variables exists.

To measure the independent variable, corruption, Hanf et al. and Uchendu & Abolarin used Transparency International’s Corruption Perceptions Index or CPI. The index observes 180 countries around the world, ranking them on a scale of perceived corruption as determined by specialists and businesspeople (Transparency International e.V., 2018). Then a score between 0 and 100 is assigned to the country as its rank, where 0 indicates a country is highly corrupt while 100 indicates a country is very clean (Transparency International e.V., 2018).

To measure the dependent variable, malnutrition in children, this project draws time-pooled, country data from the World Bank databank.

Hanf et. al control for “socio-economic conditions, vaccination coverage, health service level, undernutrition, climate, war and natural disasters, and the interaction between political context and corruption in their estimation of child deaths affected by corruption” (Hanf et. al, 2011). In my study, I too would control for “health service level, [omission of undernutrition] climate, war and natural disasters, and the interaction between political context and corruption” as these variables could potentially confound the relationship between political corruption and malnutrition. This is because the lack of access to health services could worsen the impact of malnutrition, where as climate could affect the availability of staple foods in given areas thus potentially contributing to undernutrition. Similarly, times of war and natural disasters could hinder the access to food supplies or affect agriculture in given areas, while the interaction between political context and corruption could also be an influencing factor on corruption affecting malnutrition.

The empirical process performed by Hanf et al. used log transformations of the dependent variable, 2008 data of child deaths per 1000 births for 178 countries. The researchers then performed a Focused Principal Components Analysis to interpret the correlation between all quantitative variables (Hanf et al., 2011). They looked closer at the six variables that were most significant, those being: “the log of health expenditure per capita, the log of GDP per capita, the percentage of people with access to improved sanitation, the dependency ratio, the food supply, and the perceived corruption” (Hanf et al., 2011). They also looked at variables that correlated most with CPI, which were “the health expenditure per capita, the GDP per capita, civil liberties index, the food supply, the political rights index, and the percentage of rural people” (Hanf et al., 2011). Next they executed multivariate regressions, including significant variables in the model to determine their results, which they checked afterwards for measurement errors like homoscedasticity and multicollinearity.

Due to statistical shortcomings on my part, my research would include more basic models. Using the same strategy, I would recreate testing for significant variables impacting the dependent and independent variables, then using these in a multivariate regression to test for the correlation between malnutrition in children and political corruption. Finally, I would also examine whether the models include measurement errors. When reporting the results, it would then crucial to explain which variables were significant to have been included in the regression model and what their importance to the outcome is. Here it would also be essential to make note of variables that have been operationalized for the purpose of the study and to explain how and why this was done.

Theoretical Expectations

Based on existing literature pertaining to corruption and measures of public health, I would expect the regression model to confirm the existence of a positive correlation between higher levels of corruption (or lower CPI scores) and higher levels of malnutrition among children. I anticipate these results on basis that more corruption leads to less government investment in societal welfare initiatives such as education, healthcare service, and/or the sanitation sector (Burroway, 2016). Thus, this would thus allow for less food security in given areas, which could likely result in more malnutrition.

Another point to consider in relation to this topic is: where are the politics? Countries with higher levels of corruption, such as many African countries, are often former colonies that have “irresponsible and greedy leadership” and mismanage “state and public properties” (Alemazung, 2010). Many of these countries, such as Somalia, South Sudan, Sudan, and Libya ranked among the most corrupt countries according to the CPI in 2017. Not coincidentally, Somalia, South Sudan, and Sudan are also in urgent need of “access, funding, and security” for humanitarian relief according to a United Nations report describing the dire situation of children affected by cholera and diarrhea (United Nations, 2017). The report further elaborates that in South Sudan, a country of 12.5 million people, “1.1 million are malnourished” and “almost 290,000 children suffer from severe acute malnutrition”.

Other countries ranking at the bottom of the 2017 CPI list include Syria, Yemen, and Afghanistan and are not much different in their public health circumstances. On account of former Western involvement in these countries, the aftermath of political turmoil could perhaps be seen as other plausible explanatory factors to the public health issues experienced.

Study Population & Samples

The populations of interest to this study are the 10 highest-ranking countries of the 2017 CPI and the 10 lowest-ranking countries of the 2017 CPI. I chose these as study populations as they would likely show the greatest differences between political corruption and malnutrition among children, if a correlation is found.

In 2017, 10 highest-ranking countries on the Corruption Perceptions Index were New Zealand, Denmark, Finland, Norway, Switzerland, Singapore, Sweden, Canada, Luxembourg, and the Netherlands. The 10 lowest-ranking countries were Equatorial Guinea, Guinea-Bissau, North Korea, Libya, Sudan, Yemen, Afghanistan, Syria, South Sudan, and Somalia (Transparency International e.V., 2018).

Purpose of Study

The purpose of this study is to gain more insight on the relationship between corruption and its impact on one measure of public health. With a continuously growing global population, the importance of eradicating preventable diseases while establishing regional food security is progressively gaining international attention and is highlighted by this research.

As a first step in determining the magnitude of the relationship between the 10 most and least corrupt countries and the impact on malnutrition on children, this paper serves as a research design proposal for a potentially larger scale project in the future. While there is no international “easy fix” for the political corruption of any sovereign state, there exist countless ways to have indirect influence for improving dire situations. Thus, there is great potential for small positive outcomes that can develop into larger, longer-lasting effects. Therefore, I list points of interest if this project were to be expanded in the future. In that event, I would wish to explore: 1. What would this project look like on a larger scale? (Looking at the 50 most and least corrupt countries rather than 10.) 2. In countries with the highest levels of political corruption, are existing policies to eradicate malnutrition impeded by current government practices? 3. In those same countries, are present international organizations effective in providing humanitarian aid? Or is their work impeded by the politics of a country? 4. Given current trends, is the rate and severity of malnutrition increasing or decreasing? In the event of change, what is driving it?

Conclusion

In conclusion, the aim of this research design proposal is to look closer into the relationship between political corruption and malnutrition in children. Based on the results of the study, various theories could be proposed on what national and international actions could be taken to remedy the ailing concern.

It is also important to make notice of the shortcomings of this paper. These include, and are not limited to the brevity of this proposal affecting the operationalization explanation of variables, an absence of clear and defined causal inference, as well as the shortage of complete data for the dependent variable, and of course the lack of complete knowledge on statistics for regression model construction. Nevertheless, as this paper is a research proposal, it is a work in progress on a topic that continues to be relevant and of interest to me.

Finally, the politics of a country continue to play a huge role in the allocation of resources and welfare programs available to people. While much literature already exists on democracy and corruption affecting public health and various measures of it, I would hope to further investigate this topic in the future with a particular focus on child nutrition. Thus, for a future project, exploring the extent of corruption on malnutrition remains of vital interest to me. By using a Borrow-A-Method approach to model my regression, it would certainly be gain further insight on the hypotheses and study populations. Lastly, the outcome of this study can offer various recommendations into improved national policies or international access and distribution of humanitarian aid for what can be done to help thousands of children and people worldwide that are suffering from preventable deaths and illnesses pertaining to malnutrition.

References

1. What is disease-related malnutrition?. (n.d.). Retrieved from http://www.nutricia.ie/articles/what_is_disease-related_malnutrition#
2. Alemazung, J. A. (2010, January). Post-Colonial Colonialism: An Analysis of International Factors and Actors Marring African Socio-Economic and Political Development. Retrieved from https://www.researchgate.net/publication/228429413_Post-Colonial_Colonialism_An_Analysis_of_International_Factors_and_Actors_Marring_African_Socio-Economic_and_Political_Development
3. Burroway, R. (2016, November 30). Democracy and child health in developing countries. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0020715216676514
4. Hanf, M., Van-Melle, A., Fraisse, F., Roger, A., Carme, B., & Nacher, M. (2011, November 2). Corruption Kills: Estimating the Global Impact of Corruption on Children Deaths. Retrieved from https://journals.plos.org/plosone/s/journal-information
5. Transparency International e.V. (2018, February 21). Corruption Perceptions Index 2017. Retrieved from https://www.transparency.org/news/feature/corruption_perceptions_index_2017
6. Transparency International e.V. (n.d.). What is Corruption?. Retrieved from https://www.transparency.org/what-is-corruption#define
7. Uchendu, F. N., & Abolarin, T. O. (2016, February 6). Corrupt practices negatively influenced food security and live expectancy in developing countries. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458312/
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