Category: Malnutrition

The people in India do not have the money or funds needed to buy food for themselves and their family, causing the worldwide issue of malnutrition. In particular, TLQ “It is estimated 23.6% of Indian population, or about 276 million people, lived below $1.25 per day on purchasing power parity”(action). About a quarter of the population currently living in India today, struggles with financial tasks to get them through their day, meaning surviving. All of those 276 million individuals, including adults and children, suffer in society with no upbringings available except for their very low wage job. Without money ready available, the poverty stricken social class in India fails to provide nutrients for their body as well as their children’s.

These people living in poverty are not able to buy the food that they need to sustain their hunger. Generally, the markets provided in the towns of India are difficult to access due to a lack of transportation. The bus fares can consume and erode away at one’s pocket money, and individuals living in the streets or small, run down houses would be very lucky if they owned a car. Another cause is the inadequate funds to provide for the purchases of food at markets(action). TLQ Single mothers and their children are identified as the most probable to end up in poverty. Predominantly, women who work, make less money than men which results in a reverberation of penury. Without a husband, or second parent in the picture, single parent families are forced to have a life full of burdens rather than a family would have with two supporters. India is one of the prime examples of a good amount of the society living in extreme poverty which dwells into the malnutrition of most of the population and young children especially(poverty).

India’s population increases every day. With more people coming into the world, food becomes scarce among the families who live in the streets. TLQ India emerges as a growing example of malnutrition and hunger. The leaders of this subcontinent parade and flourish over their impressive economic boom but take no necessary actions in helping the victims of starvation as they continue to eat less and less to the point of death. They are failing to provide basic needs to their population of around 1.2 billion.(India).

Furthermore, TLQ “India adds about 18 million people annually to its population, and is projected to overtake China by 2040”(India). With eighteen million people coming in each year, it also means eighteen million more mouths to feed each day. The growing population in India will only worsen the malnutrition rates. These children and infants coming into the world, grow up struggling to survive and face the brutal realities of starvation. When India overtakes the mass population of China, starvation rates will have no choice but to heighten unless necessary action is taken.

Abstract

This paper examines the relationship between climate change and malnutrition in Africa, specifically through the scope of rice production. Although Africa depends heavily on rice for sustenance to feed its growing population, this paper explores alternative options to rice due to rice’s nutrient depletion over time. The paper first delves into the history of rice in Africa and compares African rice to the rice currently grown in Africa. Climate change is then discussed, specifically focusing on the effect of greenhouse gases on food (rice) production. The differences between C3 and C4 plants is used to further illustrate climate change’s effects on produce, such as rice, as well as introduce the proposal of replacing rice crops with C4 crops, such as teff and fonio. These plants are not affected by climate change in the way C3 plants are and, therefore, retain nutritional value. Further, these plants are native to Africa and are therefore better equipped to thrive in African climates and environments.

Introduction

When envisioning food that provides sustenance, rice is likely not the first thing that comes to the mind of an American, yet to citizens of other countries rice may be the only food which comes to mind. Globally, rice is a staple food as it is responsible for feeding over half the world’s population (Nguyen, n.d.); as a populous, developing continent, African countries are no exception. However, due to the effects of global warming rice crops have suffered, both in production and in quality. The prominent increase of greenhouse gases in the atmosphere, specifically the increase in CO2, has caused plants to lose nutritional value. Because of the nutrient deficiencies in plants, reliance on rice could actually be aiding in malnutrition in Africa. This paper will explore the history of rice in Africa, climate change’s effect on rice consumption, and possible alternatives to improve the current status of malnutrition.

Malnutrition In Africa

Malnutrition refers to an improper intake of “energy and/or nutrients” (WHO, 2016, para.1), usually of protein and/or micronutrients. Malnutrition can result in physical and cognitive impairments as well as diarrhea and death (Berkhout, Malan, & Kram, 2019). Unfortunately, a disproportionate amount of malnutrition occurs in African countries. In 2004 half of Africa’s population lived below the international poverty line, and in 2018 that statistic remained unchanged (Beasley, 2009; Oluwatayo & Ojo, 2018). Poverty in Africa aids malnutrition as many African citizens are unable to afford a proper meal; it is estimated that the average citizen in Sub-Saharan Africa lives on “less than $1 USD/day” (Beasley, 2009, P.134). Additionally, the rate of population growth in Africa is one of the fastest in the world; there are currently over 1 billion people in Africa, which is double what its population was in the 1980’s (Wentling, 2016). The continent’s rapid growth rate makes it extremely difficult for the country to sustain itself. Further, the population’s average age is 19 years old which means that the average person is old enough to reproduce but young enough to be unemployed (Wentling, 2016). These rising numbers put pressure on the land and soil, which cannot compete with the growing need for food. Perhaps the ever-increasing demand for food is what motivates the majority of Africans to pursue a career in agriculture (Beasley, 2009).

Rice

Rice is a staple crop in Africa; in 2017, over 30 million tonnes of rice was produced in Africa (Food and Agricultural Organization, 2018). Over the past few decades the United Nation’s Food and Agricultural Organization (FAO) has noticed that the demand for rice far outweighs its supply, as its demand “is growing faster than that of any other major staple” (FAO, 2016, para. 9). However, it is important to note that the rice which is currently being grown is not native to Africa.

A Brief History Of Rice In Africa

The history of rice in Africa is complex, mainly because its origins have been highly disputed. Originally rice crops in African were credited to European settlers in Africa in the 1800s; however, evidence was uncovered that rice had been grown in Africa prior to Portuguese exploration of Africa in the fifteenth century (Carney, 2001). Credit for rice crops was given to Portuguese settlers instead of Africans; in both cases other nations prejudices prevented rightful attribution of rice crops to Africans because settlers refused to recognize that a. Africa had a robust and complex rice growing system b. that Africa had their own species of rice. Yet despite efforts to ignore African rice culture, an abundance of historic Muslim documents uncovered that African rice crops dated prior to the tenth century (Carney, 2001).

African rice, also known as O. glaberrima, was originally grown by African farmers as it was suited for the difficult African climate, namely “nutrient deficiencies, acidity, salinity, and flooding” (Carney, 2001, p.143) which were typical in African climates. Because glaberrima was impervious to these weather and soil conditions it grew quickly; however, African rice also shattered during milling. Thus O. sativa- Asian rice- was introduced to farmers (as it did not shatter); however, Asian rice was not native to Africa and therefore could not withstand its weather and soil. Despite its promise of producing higher yields, Asian rice did not grow well under African conditions (Fields-Black, 2008). Starting in the 1970’s onwards Africa experienced terrible droughts and unstable weather conditions. Due to these weather conditions, Africa’s food production was severely decreased from the 1970’s until the new millennium (Beasley, 2009). As an already struggling region, this decrease in production alarmed other nations of the world. After many international summits, a hybrid of African and Asian rice was developed in 2002 to combat rice shortages from drought. The project was a collaboration between the West African Rice Development Association and the United Nations (Chonghaile, 2002). Unfortunately, this hybrid rice did not save the rice industry as it could not compete with the effects of climate change. As temperatures continued to increase soil became dryer and weeds and other pests become abundant (Nhamo, Rodenburg, Zenna, Makombe, & Luzi-Kihupi, 2014). Despite the genetically modified attempt, rice production continued to suffer.

Impacts Of Climate Change

Climate change has a strong relationship with food and water supplies. Climate change creates erratic weather systems, which can be atypical for the given climate, that will negatively impact produce and water quality; this, by default, impacts levels of agricultural production and malnutrition.

Water

Water supply is an important casualty of climate change. Weather irregularities can cause changes in water quantity, such as flooding and drought, both of which can lead to contamination of water and/or pest “breeding sites” (Moreno, 2006, p.159). Africa’s water supply is a victim of climate change as much of its water supply is unsafe to drink as it carries disease. The lack of clean water has attributed to a rise in anemia; further, as water is not usable Africa’s already struggling agriculture suffers further (Wentling, 2016).

CO2 And Produce

Another impact of climate change relates to the greehnouse effect, the burning of greenhouse gases into the atmosphere, which has been a key element in atmospheric changes. Carbon dioxide (CO2), is a prominently studied greenhouse gas, as it is both produced and absorbed by living things. An area of particular importance relating to CO2 is that it is “broken down by photosynthesis in plants” (Dutta & Radner, 2006, p.253). CO2 will impact some plants more than others, namely C3 plants. C3 plants are characterized based on their method of photosynthesis, the Calvin cycle (Myer et al., 2014). Due to their method of photosynthesis C3 plants are more susceptible to disruption from the effects of climate change, namely the increase of CO2. Unfortunately, around “85% of plant species are C3 plants” (Georgia State University, n.d., para.3), rice being no exception. However, increased CO2 has additional consequences on plant development. Myer et al.’s (2014) meta-analysis of grain micronutrients found that the high concentrations of CO2 have resulted in C3 produce with lower protein and micronutrient contents. For example, protein in rice plants decreased by 7.8%, a more dramatic decrease than found in wheat plants (Myers et al., 2014). Further, zinc and iron had also significantly decreased in rice plants. In many countries, such as Africa, that depend on C3 plants like rice for their protein and micronutrient intake, this poses a serious concern for elevated levels of malnutrition.

In contrast to the protein and micronutrient deficiencies in C3 plants, C4 plants, which have different methods of photosynthesis, do not exhibit these deficiencies amidst increased CO2 levels. C4 plants “concentrate CO2 internally” (Myers et al., 2014, p.140) and are therefore are not impacted by an increase in CO2; further, they are able to grow in harsher conditions, such as the weather conditions produced by climate change.

The Future Of Rice

It is predicted that regardless of attempts to decrease CO2, “global CO2 in the atmosphere” (Myers et al., 2014, p.140) will continue to rise for at least the next 40 years. CO2 rise, along with other climate aggravates will continue to destabilize weather and erode soil. As the environment continues to suffer our agriculture will also be significantly impacted; it is estimated that within the next 30 years “world grain production per capita will likely decline by at least 14%” (Cheng, 2018, para. 1). This will not only impact Africa’s nutrition, but its economy as agriculture remains the top occupation. Rice, like many other C3 plants, cannot grow under very hot or cold temperatures, making it a poor choice of crop during erratic climate conditions. Additionally, genetically manipulated plants, such as the hybrid rice being used, are also sensitive to cold temperatures and become “more susceptible to pathogen infections” (Cheng, 2018, para.10). Finally, genetic manipulation of plants also further reduces biodiversity which contributes to soil erosion. It is clear that continuing to rely on the current agricultural system will only prove harmful for the future of produce, both in quantity and quality.

To solve the agricultural dilemma, some have proposed bioengineering C3 plants to mimic the systems of a C4 plant; a solution which is eerily similar to the decision to hybridize rice. However, there are several problems with this idea, the first being that this project will take a lot of time and money. The second problem is that C4 plants have a far more complex system than C3 plants, making it extremely difficult to superimpose into the C3 plants. C4 plants have “less dense topology, higher robustness, better modularity, and higher CO2 and radiation use efficiency” (Wang, Guo, Li, & Wang, 2012, p.1), further differentiating core aspects of its physiology from C3 plants.

Proposal

Based on the literature presented, an appropriate intervention would be to replace rice crops with C4 plants which are indigenous to the area and, due to their class of plant, aren’t impacted by the greenhouse effect. Some C4 plants are also ancient grains, which is an umbrella term for plants that have not changed or been changed over time (either through plant breeding or natural plant evolution) (Strausfogel, 2018). They are more nutrient (protein) dense, which means one can maintain nutritional value while eating less. Malnutrition isn’t solved by eating more food, it’s solved by eating more nutrient dense foods.

C4 plants not only help with current malnutrition by correcting protein deficiencies caused by nutrient deficient rice, they can also prevent future malnutrition by helping Africa’s economy. Ancient grains have become a valuable food source in today’s climate, as other countries seek to find a solution to the quandary of the decreasing nutrient value in plants. C4 plants do not lose nutritional value; therefore, they are not only valuable to Africans, who need nourishment, but other countries around the world whose agriculture also suffers from malnutrition.

Although there are many kinds of ancient grains, the two that are best suited for this intervention are teff and fonio. Teff and fonio, which are also C4 plants, are perennial plants (not seasonal) that are native to Africa. These plants can be ground or milled to make various doughs, formulas, and starches to substitute that of rice (National Research Council, 1996). These plants prevent the soil wind/water erosion and run-off. These grains also don’t need pesticides, are immune to pathogens, and are made to withstand severe weather (National Research Council, 1996). Native perennials have very high protein contents, some with “roughly twice that of today’s main cultivated cereals” (National Research Council, 1996, p.257). Additionally, because these plants can grow year-round, farmers would save time and energy from not having to replant crops seasonally.

Teff has high fiber levels, is gluten free, and has a low glycemic index (FAO, 2018). Low glycemic index (GI) foods generally allow for even toned metabolism or more consistent energy expenditure needs; additionally, low GI diets have been shown to prevent diabetes, cardiovascular disease, and some cancers (Omoregie, Osagie, 2008). Further, Teff can be stored for long periods of time without damage and is a highly valuable and profitable crop. Teff also has exceptional levels of iron and calcium (National Research Council, 1996).

Fonio, a cereal grain, has developed the nickname hungry rice by European settlers who loved fonio’s exceptional taste and “reserved it particularly for chiefs, royalty, and special occasions” (National Research Council, 1996, p.59). Fonio is rich in amino acids, is an extremely fast-growing crop, and is not affected by poor quality soil. “Fonio protein contains almost twice as much methionine as egg protein contains” (National Research Council, 1996, p.64); methionine is a critical amino acid involved in protein synthesis.

Conclusion

Reincorporation of native C4 plants, such as teff and fonio would help combat malnutrition levels in Africa by providing a more successful yield than rice crops, as well as providing higher nutritional value. Teff and fonio, being native to Africa, would not be affected by soil erosion as they are designed to grow in difficult climates. Further, they would help sustain biodiversity. As ancient grains, teff and fonio are perennial grains and would therefore prevent soil degradation as opposed to seasonal grains. Finally, introduction of such crops would save farmers energy, as year-round crops, and may aid Africa’s agricultural economy by offering crops which offer a solution to the effects of climate change.

References

1. Nguyen, N.V. (n.d.). Global climate changes and rice food security. Retrieved from: http://www.fao.org/forestry/15526-03ecb62366f779d1ed45287e698a44d2e.pdf
2. World Health Organization (2016). What is malnutrition? Retrieved from: https://www.who.int/features/qa/malnutrition/en/
3. Berkhout, E. D., Malan, M., & Kram, T. (2019). Better soils for healthier lives? An econometric assessment of the link between soil nutrients and malnutrition in Sub-Saharan Africa. PLoS ONE, 14(1), 1–26. https://doi.org/10.1371/journal.pone.0210642
4. Beasley, T. W. (2009). Poverty in Africa. New York: Nova Science Publishers, Inc. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=nlebk&AN=333687&site=ehost-live
5. Oluwatayo, I. B., & Ojo, A. O. (2018). Walking through a Tightrope: The Challenge of Economic Growth and Poverty in Africa. Journal of Developing Areas, 52(1), 59–69. https://doi.org/10.1353/jda.2018.0004
6. Wentling, M. (2016). Africa’s Great Hunger Handicap. American Diplomacy, 27–31. Retrieved from http://proxy.lib.wayne.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=poh&AN=119252200&site=ehost-live&scope=site
7. Food and Agricultural Organization of the United Nations (2018). Rice Market Monitor. Rice Market Monitor (RMM), XXI (1). Retrieved from: http://www.fao.org/3/I9243EN/i9243en.pdf
8. Food and Agricultural Organization of the United Nations (2016). Africa’s rice revolution takes off. Retrieved from: http://www.fao.org/africa/news/detail-news/en/c/431762/
9. Carney, J. A. (2001). Black Rice. Cambridge, Mass: Harvard University Press. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=nlebk&AN=281966&site=ehost-live
10. Fields-Black, E. L. (2008). Deep Roots : Rice Farmers in West Africa and the African Diaspora. Bloomington: Indiana University Press. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=nlebk&AN=283582&site=ehost-live
11. Chonghaile, C. N. (2002). Africa looks to new breed of rice to combat food shortages. Lancet (London, England), 359(9314), 1320. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=cmedm&AN=11965287&site=ehost-live
12. Nhamo, N., Rodenburg, J., Zenna, N., Makombe, G., & Luzi-Kihupi, A. (2014). Narrowing the rice yield gap in East and Southern Africa: Using and adapting existing technologies. Agricultural Systems, 131, 45–55. Retrieved from https://doi.org/10.1016/j.agsy.2014.08.003
13. Moreno. A. (2006). Climate change and human health in Latin America: drivers, effects, and policies. Regional Environmental Change, 6,157–164. doi10.1007/s10113-006-0015-z. Retrieved from http://www.bvsde.paho.org/bvsacd/cd68/ARMoreno.pdf
14. Dutta, P., & Radner, R. (2006). Population growth and technological change in a global warming model. Economic Theory, 29(2), 251–270. https://doi.org/10.1007/s00199-005-0056-4
15. Georgia State University (n.d.). C3 photosynthesis. Retrieved form: http://hyperphysics.phy-astr.gsu.edu/hbase/Biology/phoc.html
16. [bookmark: _Hlk536302690]Myers, S. S., Zanobetti, A., Kloog, I., Huybers, P., Leakey, A. D. B., Bloom, A. J., … Usui, Y. (2014). Increasing CO2 threatens human nutrition. Nature, 510(7503), 139–142. https://doi.org/10.1038/nature13179
17. Cheng, A. (2018). Review: Shaping a sustainable food future by rediscovering long-forgotten ancient grains. Plant Science: An International Journal Of Experimental Plant Biology, 269, 136–142. https://doi.org/10.1016/j.plantsci.2018.01.018
18. Wang, C., Guo, L., Li, Y., & Wang, Z. (2012). Systematic Comparison of C3 and C4 Plants Based on Metabolic Network Analysis. BMC Systems Biology, 6(Suppl 2), 1–14. https://doi.org/10.1186/1752-0509-6-S2-S9
19. National Research Council (U.S.). (1996). Lost Crops of Africa : Volume I: Grains. Washington, D.C.: National Academies Press. doi: 10.17226/2305. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=nlebk&AN=925&site=ehost-live
20. Food and Agriculture Organization of the United Nations (2018). Traditonal crops. Retrieved from: http://www.fao.org/traditional-crops/teff/en/.
21. Strausfogel, S. (2018). Go with the Ancient Grains. Better Nutrition, 80(10), 44–48. Retrieved from http://search.ebscohost.com.lb-proxy9.touro.edu/login.aspx?direct=true&db=rzh&AN=131552153&site=ehost-live
22. [bookmark: _Hlk536389644]Omoregie E.S., Osagie A.U. (2008). Glycemic indices and glycemic load of some Nigerian Foods. Pakistan Journal of Nutrition 7(5). DOI: 10.3923/pjn.2008.710.716. Retrieved from: https://www.researchgate.net/publication/26563798_Glycemic_Indices_and_Glycemic_Load_of_Some_Nigerian_Foods

When you take a trip to China, you mainly take a trip to the bigger cities such as Beijing, Shanghai, or Guangzhou, very popular tourist areas. However, rarely any outsiders visit the countryside, an area so scenic, yet suffering. In the countryside, hundreds of people are starving or eat imbalanced diets. The reasons include less money, overpopulation, and sometimes bad weather, and as a result, many of the young and old perish. It is estimated that around 12.7 million kids are stunted in growth, which is roughly equivalent to the population of Tokyo (13), a gargantuan magnitude. This must be stopped. We must stop the suffering of a group that large, that, around 19.6% of the population of the country with the most people in the world are rotting away (6), and make the area a better place.

China is the 3rd largest country in the world, with the largest population in the world, which has a population of 1.396 billion people (5). The government is a communist government, in which people elect a president. The current president is Xi Jinping. Major crops include wheat, rice, soybean, tuber, and corn (10). The climate often changes. In the Northwest is the Gobi desert, a dry, rocky desert that is hot during the day and freezing at night. In the Southwest is the Himalayas and the Tibetan area, a giant plateau. In central China are plains, and in the East are areas that are more like forests. The average farm size is 0.6 hectares, which is 1.48263 acres (1), which is way smaller than that in the United States, 434 acres (2). 56.22% of land has been cultivated, as of 2015 (3). These diverse environments have created a variety of different lifestyles, but some elements are similar all throughout the country.

In the country, what’s an average family like? The average family has 3.17 people (4), because of attempted birth control. The average apartment size is about 60 square meters. A typical diet consists of noodles, rice, meat, tofu, eggs, poultry, and many vegetables including soybean and onion. Urban families get food from a supermarket, and rural families grow their own food. Food is usually steamed or fried. There are a variety of jobs ranging from farmer to doctor and the average wage is 21,586.95 yuan, which is about 12,000 dollars (8). Families in urban areas do have access to healthcare and education (9), and it is relatively affordable. In rural areas it is not. In an urban area, the access to some services is low, but things like electricity and toilets, if it can be afforded, then you can access it, but it is higher than the rural areas. Barriers to access include overpopulation and overworking of land. Even though areas of the countries are very unique, they sometimes share common lifestyles, and common problems.

A huge problem of China is malnutrition. Although this problem is rare in urban life, and people are actually getting a bit obese now, it devastates rural China (10). Due to difficult access to many food resources such as markets, people have no choice but to grow their own food, so when the weather turns bad, or a blight comes, people starve, which causes a massive loss of life. Malnutrition is a severe problem in China because the amount of people in the country is steadily increasing, but food supply is not, causing many other problems such as disease.

Even now, trends are worsening. The population of China is still increasing, even with attempts at birth control. The growing population contributes to this because the higher the population plus less food makes widespread starvation and disease. Rural people are hit the hardest, and many children die from starvation and other forms of malnutrition. In urban areas, people are beginning to get obese due to eating unhealthy foods and not having a healthy, balanced diet. Statistics taken in the rural areas show that more women are affected by men. Elderly and children are hit first due to their weaker states and they they are less immune to disease. It affects more of the minority population because they live in the more remote countryside areas that help cannot even reach. The land may be overworked for more food, and this can ruin the land and cause habitat loss. Droughts, blights, and natural disasters can also take a hard toll on crops. This may be concerning not just for China, but to the world. China is best known for their large export of crops and cheaper goods, but if there are no workers in the countryside, urban populations would notice an obvious decrease in available food, and the world may find less food as well. An important concern has been found that not many notice, yet once in full effect, could potentially lead to a disaster.

To counter this problem, there are many possible solutions. I think the best possible solution is to join a few together and implement them at the same time to have joint results. Solutions I think should be joined together are moving some people populating the urban areas such as Beijing to Japan, slowly ship a small portion of food to the country each year, and donating money for “SmartFarms” and insect farms for food. Obviously, any solution would cost much money, so getting other richer countries such as the US to lend a hand is a big help to the project. Although people in the US, especially the congressmen, may not be too happy about this idea, it is a big help to the world. After getting the funding, the stages of the plan can begin.

There are two stages to the plan. The first one is to start moving the population to other countries. As of 2019, Japan’s population is steadily decreasing, and moving some Chinese over to Japan could kill two birds with one stone. To support this even more, culture shock is not a big issue due to the similarities between Chinese and Japanese cultures. Urban populations go to the Japanese cities first, and rural populations can grow and move to the urban areas for a better life with easier access to food sources.

The second stage is the most important one; this one is about the solution of producing more foods so the population cannot starve. I think the introduction of insect farms and “SmartFarms” would help. Insects are a very good source of protein, and the crops from the farms would give vitamins and water. SmartFarms, in my perspective, are similar to self-sustaining farms. It would be a system of terraced farms surrounded by a transparent dome, in which computer monitors measure parameters required for plant growth such as humidity, sunlight, richness of the soil, and pests. The computer system must also be able to adjust the parameters for optimal growth. With many of these built and in effect, larger amounts of food could also be the food issue may not be existent after some time.

The plan cannot be a plan unless people are willing to execute it. I think governments of more rich, advanced countries. Countries such as the US, UK, and Japan should consider funding the projects, since these countries depend on China for some imports. China, considering that this is an issue for their country, should provide workers to monitor the SmartFarms and insect farms, and they also have the responsibility to distribute the food to the population and markets. Housing should be done in more compact grounds, e.g. apartments and condos, to give room for farms. The executive seeing should be done by the United Nations and civic organizations, and the voluntary workers from several nonprofit food organizations should be chosen due to their dedication and their desire to improve the quality of life for so many people. Scientists who truly desire to be in this project would design the hardware and software of this computer, as well as construct and monitor the sensors and the facility.

Even with all of this, there are still issues with the plans. Some countries may not be willing to donate. The construction of the SmartFarms and the insect farms can cost millions, if not billions of dollars, and without funding, the project cannot get off the ground. Furthermore, due to complicated, rough history, the Chinese and the Japanese may not have a nice relationship with each other. In 1937, Japan invaded China. They forcefully took control of the then-capital city, Nanking, and slaughtered and mistreated many of the civilians living in the city. Since then, Chinese have felt some resentment towards the Japanese. Because of this, some Chinese, especially older generations that lived during World War Two, may not want to emigrate to Japan, and some Japanese may not like a large population of bitter Chinese arriving in their country. Quarrels and riots could soon ensue. Additionally, the Japanese would have to produce or buy more food due to the rising population, which may tip off some government officials.

However, once the plan is in full effect, there would be some major changes to the world. The USA may start buying more from China, since, due to their new SmartFarm systems, the nation could produce more and a wider variety of crops. This could significantly boost the economy, and people would no longer have to fear the horrors of poverty and malnutrition. Once the plan is in effect, boys and girls in the country side do not have to worry about growing food for their families; instead, they can go to school and get an education. Once the plan is in effect, people can move to the cities for more access to food, water, communication, sewage, etc. Once the plan is in effect, the welfare of 1.3 billion people would be changed forever, for the better.

Anyone can help. By donating money to an organization that attempts to tackle these kinds of issues, such as the 4-H and the World Food Prize. Posters, advertisements, billboards, papers, and websites can be put up to advocate the end of malnutrition and call for action. Petitions can also be drawn demanding the end of malnutrition in China. Tell any government office and present your arguments, and, if enough effort is put into this, if enough hope is put into this, malnutrition in China would be gone forever.

In conclusion, in China, people are starving due to causes such as poverty, overpopulation, and natural disasters. As a result, many of the young and old perish. This must be stopped. Solutions include donating money to construct SmartFarms and insect farms, and moving some of the population to other countries that the immigrants can easily adapt to, such as Japan.

Works Cited

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13. WFP/China. “UN World Food Programme.” WFP | United Nations World Food Programme – Fighting Hunger Worldwide, 30 June 2016, www.wfp.org/stories/10-facts-about-nutrition-china.

In 2017, I was privileged to study, for a short period, in Kyungpook National University. Three other students and I, were given a task of reviewing latest studies, which showed the relationship between malnutrition and gut microbiome, and to think of an appropriate solution to malnutrition based on gut microbiota. This is what I will briefly share with you. Under-nutrition is caused by a lot of factors, the immediate causes being inadequate diet and diseases.

However, research has shown that the gut microbiota also plays a role in causing or worsening acute malnutrition. A study done on Malawian twin pairs, studied the gut microbiota of several twin pairs for 3 years since their birth. Twins are common in Malawi, yet it was not understood why Kwashiorkor (severe acute malnutrition) would occur in one twin and not the other, yet they lived in the same house (same environmental condition) and fed on similar foods.

This, therefore, prompted the study to be done. The study showed that the composition of gastrointestinal microbiota was different for the healthy babies compared to those of their co-twins with kwashiorkor. The gut flora of the kwashiorkor co-twins had not matured enough since birth, unlike that of the healthy co-twins. The composition of microorganisms were also different. On treatment with Ready-to-use Therapeutic food (RUTF), the co-twins with kwashiorkor gained weight but later relapsed after the treatment. The gut microbiome from both the healthy babies and the malnourished babies were transferred to mice through fecal transplant. The mice transplanted with the gut microbiota from the babies with Kwashiorkor lost weight significantly after sometime. They were then transplanted with the gut microbiota from the healthy babies and they gained weight, as a result.

Therefore, this and other similar studies have shown that indeed the gut microbiome influences nutrition status. My group members and I, at Kyungpook National University, suggested possible solutions to acute malnutrition, based on these studies. They include;

• Fecal transplant (as also suggested by other studies)
• Taking probiotics with the right composition of healthy gut microbiota. Our professor, however, noted that the process of digestion may possibly interfere with the composition. Therefore, the need for more research to be done.
• RUTF should be infused with the healthy gut microbiome. Research also needs to be done to see if this is feasible.

In conclusion, fecal transplant has already proven to be effective in animal studies in treating malnutrition, and has also been used in humans to treat gastrointestinal conditions. Therefore, it could be a potential breakthrough in the management of acute malnutrition.

Malnutrition is a significant public health issue facing the world today. It is seen in every country. Worldwide, nearly 2 billion people are overweight and nearly half a million are underweight (WHO, 2016). Generally defined as “deficiencies, excesses or imbalances in energy intake or nutrients” (WHO, 2016). If malnutrition occurs during pregnancy or pre-two years of age – negative physical and mental development patterns can become permanent (Burchi et al, 2011).

Malnutrition exists in two main groups – undernutrition: historically associated by stunted growth, wasting, and micronutrient deficiencies and insufficiencies. Many diseases arise from undernutrition such as Kwashiorkor (severe protein deficiency) and Marasmus (significantly low body weight for age bracket). The other is overweight, obesity and diet-related noncommunicable diseases such as heart disease, diabetes, and cancer. In the UK, 26% of adults are classified as obese, up from 15% in 1993 (NHS,2016).

Personal choice and willpower can have the strongest influence on what we consume but others do exist – conditions such as dementia can result in people forgetting to eat or have forgotten that they have already eaten. Sounding paradoxical, malnutrition can occur even when large amounts of food are consumed – especially when the foods have little or nutritional value. It is not uncommon to find both conditions in the same area. It is possible to be both overweight and micronutrient deficient. Symptoms of malnutrition depend on what nutrient is lacking, for instance, a lack of iron includes lethargy. Malnutrition and Social Issues Stating that malnutrition only arises due to insufficiency or too much intake is an oversimplification. Social situations such as living alone, social isolation, lack of knowledge about nutrition, impaired mobility, pressure on teenagers, low income/poverty all increase malnutrition.

Many factors can contribute to this; for instance, magazine covers show images of the “ideal women” thus increasing pressure on teenage girls which can result in them developing eating conditions such as anorexia or bulimia. Quick population growth resulting in insufficient food supply – as seen in WW2 with rations. It is a commonly held belief that obesity runs in the family – but what also runs in the family is diet. If a child grows up with poor nutritional practices, then they will be more likely to carry these on into adult life and possibly to their children. Malnutrition and Economical problems Malnutrition is seen in all nations, not just developed. Poor socio-economic positions result in malnutrition. Increasing food costs coupled with the lack of food availability results in many families being “priced out” of access to enough nutritious food such as meat and milk. Whilst the food high in sugar and salt become cheaper and more readily available resulting in the rapid rise of numbers of overweight and obese children and adults. However, this is a misnomer as generally fruits and vegetables when brought in wholesale tend to be cheaper than some high fat/sugar items. Nations which obtain their nutrition from a single source, such as rice can result in malnutrition.

Multiple reasons exist for this – ie: lack of education or only having access to a single food source. Malnutrition and food choice Certain people choose to be vegetarians or vegans. This choice can result in deficiencies of certain vitamins such as Vitamin B12. How to reduce Malnutrition Short-term solution – multivitamin tablets Long term solution – improving farming practices, increasing education Prevention is the best cure when it comes to malnutrition and the best way to ensure you get all the correct amounts of nutrients is to eat a healthy, balanced diet. The underlying cause of malnutrition was always be identified first, then individual treatment can be given. Effects of childhood undernutrition on later life Prenatal nutrition is important. Early life growth patterns alter metabolism and physiological patterns have lifelong effects on the risk of developing cardiovascular disease (Victora, 2008). Undernutrition in the early stages of life cause a multitude of issues in later life; those who are undernourished before the age of two and then gain weight quickly later in childhood/adolescence at a higher risk to developing chronic diseases related to nutrition (Victoria, 2008).

Also, a relationship between educational achievement and economic status was identified. If not treated quickly, those who suffer from stunted growth will remain stunted for the rest of their lives (Walker et al, 2008). A multi-generational effect was noted by Victoria et al (2008). They discovered that girls who were undernourished and grow into stunted growth adults tend to have smaller children. Conclusion The double burden of malnutrition is a complex issue which many factors. However, it is a preventable issue. Education is going to be one of the ways in which pressure from this issue can be released. Informing practitioners, educators, parents, and policymakers on all levels of the educational chain to pass on the correct information on to future generations is of paramount importance.

The definition of double burden of malnutrition is coexistence of undernutrition along with overweight and obesity, or diet-related non-communicable diseases across the life course. There are multiple forms of malnutrition including: stunting, wasting, micronutrient deficiencies (vitamins and minerals), overweight or obesity, and non-communicable diseases (NCDs). Double burden of malnutrition is more evident in lower and especially middle income countries who experienced an economical growth leading to nutritional, epidemiological and demographic transitions which resulted in the coexistence of both under and overnutrition within the population.

Nutritional transitions include the shift in patterns of diet, and energy consumption and expenditure that are associated with economic growth, globalization, and urbanization. Epidemiological transitions is the alteration in the disease patterns among the population that is associated with the economic growth (e.g. increase in NCDs), while demographic transitions describe the increase in life span and the concurrent increase in the NCDs (WHO, 2017a) The double burden of malnutrition is the result of exposure to multiple factors including biological, lifestyle, socioeconomic and environmental factors through different stages in life starting from conception and pregnancy and continue to adulthood and later stages of life. evidence suggesting chronic NCDs has developmental origins in which maternal nutrition, fat deposition, and stress hormones factors are affecting the developing fetus during pregnancy and results in increased risk for developing chronic NCDs particularly diabetes type 2, and cardiovascular disease (Hales and Barker, 1992).

This is more evident when the fetal development and adulthood are different in terms of nutrition e.g. undernutrition during fetal development with resulting in both extremes of birth weight and followed by overnutrition and diet rich food in adulthood which will predispose for increased risk of chronic especially in developing countries who experienced economic changes (Bruce and Hanson, 2010). Other study showed protein restriction in maternal diet will lead to alteration in adipocyte gene expression and changes can persist and continue into adulthood might contribute to metabolic diseases (Bol et al., 2009). Other findings of maternal obesity and high fat diet during early development is associated with adults suffering from impaired glucose tolerance, hypertension, and hyperlipidemia. It is believed that high fat diet result in stretching of metabolic plasticity beyond its capacity leading to development disruption (Elahi et al., 2009).

Epigenetic modifications can lead to permanent changes through programming mechanisms via signaling pathways which can be represented in adulthood as non communicable diseases (Pujadas and Feinberg, 2012, Bruce and Hanson, 2010). Maternal nutrition play an important role for optimal fetal development through control of maternal obesity and preventing further low / high birth weight with its associated complications in future. Several studies showed an inverse relationship between birth weight and development of heart disease later in life with 10-20% decrease in risk if IHD with every 1 Kg increase in birth weight, this is may be related to maternal undernutrition during pregnancy and subsequent gene alteration that might lead the newborn more prone to chronic illnesses (Owen et al., 2007) The first 2 years of life is very crucial for the development as the body undergo a rapid maturation of all organs especially brain. Inappropriate diet during this period may lead to long lasting effects. Exclusive breastfeeding is highly recommended especially during the first 6 months and it is associated with decreased incidence of obesity, and type 1 and type 2 diabetes (Schanler, 2014).

Infants and children are more prone for protein energy malnutrition and micronutrient deficiencies especially iron, zinc, folate, iodine, and poly unsaturated fatty acids that will result in irreversible damage to cognitive and neurodevelopment leading to stunting, decreased learning outcomes, and later in life obesity and NCDs (Perng and Oken, 2017). On the other hand, over nutrition in infancy is associated with changes in dietary habits and development of life long obesity and type 2 diabetes (Singhal et al., 2010) Iron deficiency anemia usually happen in young children after weaning from breastmilk and iron fortified formula and shifting to solid food that is not rich in iron. Iron deficiency anemia can result in long term intellectual and behavioral problems and this can be prevented by providing iron rich foot to young children and toddlers such as lean meats, fish, poultry, eggs, legumes, and iron-enriched whole-grain breads and cereals (Kazal, 2002). Nutritional needs increased with growing up, and the tendency toward eating selective diet is high among toddlers and school age children and this is influenced by the family environment, social factors, and the media. Advertisements have an impact on children eating attitudes and attracts them towards sugary products, fatty fast-foods, excess calories, refined ingredients, and sodium which will predispose to obesity later in life (Zimmerman and Snow, 2012).

A special attention shall be paid to children of vegetarians and vegans in which the diet has to fulfill all the nutritional needs of the children. In case the children eating animal products then they can meet the nutritional needs for protein and other micronutrients required for development. Otherwise, the parents shall provide alternatives that can compensate for protein and micronutrients including iron, calcium, vitamin B12, and vitamin D. Legumes and nuts can be eaten in place of meat, soy milk fortified with calcium and vitamins D and B12 can replace cow’s milk (Zimmerman and Snow, 2012) During the last 50 years, food quality and quantity changed in terms of processed food quality and portion size. This promotes overeating which will have a negative impact on health and nutritional status of population with subsequent development of obesity later on. Processed food and meals with high energy content offered in restaurants now are larger, cheaper, and more accessible by all population (Livingstone and Pourshahidi, 2014). This is more evident in poor neighborhoods who can’t afford to buy fresh food and obliged to buy unhealthy food mainly grains, added sugars and fats. (Drewnowski, 2012). There are certain practices and beliefs running in certain society related to food and health. These include food taboos and proscriptions. Food taboos are of permanent nature e.g. religious taboos including pork meat among Muslims and beef meat among Hindu populations (Briones Alonso, 2015).

Food taboos can be gender specific in certain communities. In Africa for example, permanent taboos against females starts from infancy, in which females receive low nutrient diets and earlier weaning compared to males infants. In later stages of life females are deprived from high protein food such as eggs, animal meat, fish, and milk. Females and especially pregnant and lactating mothers will be suffering from iron and protein deficiencies which will have an impact on mother and child health later in life with high association of maternal and infant mortality rates and low life expectancy (UN-OHCHR, 1995). The double burden of malnutrition is a global public health challenge with serious and negative impacts on population. It is seen as a dual nutrition challenge to simultaneously overcome the burden of both undernutrition (including stunting, wasting and micronutrient deficiencies) and overweight, obesity, and NCDs. This needs an integrated complex approach involving multiple levels and actors to have interventions, policies, and programs fighting malnutrition through different stages of life (WHO, 2017a) Different approaches and interventions can be done through different life stages as listed below (WHO, 2017b):

• Maternal nutrition and antenatal care: Paying attention to maternal nutrition during period of pregnancy play an important role to ensure pregnant woman receive optimum nutrition especially iron and folic acid which both are crucial for the development of the fetus. Gestational weight during pregnancy shall be monitored as both extremes of weight might pose a risk on the mother and fetus with higher probability of NCDs in future.
• Exclusive breast feeding: Encouraging exclusive breast feeding for the first six month of infant life will provide essential nutrition required for development and reduce risk of obesity later in life a. In addition, breast milk has various benefits to mother including controlling weight during postpartum period and protecting against obesity and NCDs (WHO, 2004).
• Early and complimentary infant feeding: To ensure the infant receive the proper nutrition especially micronutrients with continuation of breast feeding up to 2 years of life.
• Children and school age: Careful monitoring of this age group with proper guidance and advice to have proper diet and nutrition. School specific nutrition programs that might help in controlling obesity among children. Awareness and education for the families regarding unhealthy food and its adverse impact on health of an individual and especially children. Physical activity also an important factor in controlling obesity.
• Regulations on food advertisement and marketing: This might change children food preference and shift the desire towards healthier habits. – Increase awareness regarding harmful beliefs in certain communities including food taboos, son preference, and deprivation of females from proper nutrition.

Finally, among all listed possible interventions above, optimal nutrition in the first 1000 days of life including pregnancy and up to 2 years of life is crucial for the health of both the mother and fetus, and regarded as a base for future “healthy” development later in life.

Australia’s indigenous health status of the people continues to be worst compared to other sub groups. According to a research study that there is little improvement over the past decades about Aboriginal and Torres Strait Islander’s health status. Their adult life expectancy is decreased by 15-20 years, twice mortality rates from cardiovascular diseases, death rate was 17 times higher due to diabetes and 10 times more due to pneumonia compared to non-indigenous Australians.

Even with the improvements in perinatal, they still remain to signify a major death cause, with up to 2.5 times higher of infant deaths than the general population.

Last 2012-2013 report, it shows that Aboriginal and Torres Strait Islander from 15 years old above were overweight (66%) and (30%) were average in weight and underweight were (4%). Occurrence in unhealthy pregnancy outcomes and malnutrition are still high in all areas. Cases of low birthweight and poor growth of children are still major concerns in most many Aboriginal and Torres Strait Islander communities. Providing good nutrition to children have failed that lead to health problems like pneumonia and other infectious diseases. Poor diet to children is an ongoing health issue contributing to obesity, heart diseases, malnutrition and tooth decay as well.

Determinants of Poor Nutrition in Children

Historical, socioeconomic, environmental and geographic are factors that contribute to the current poor health diet, nutrition and food security experienced by Aboriginal and Torres Strait Islander people.

A.) Historical Factor

Traditional Torres Strait Islander diets varied from island to island. They used to hunt animal and plant food. They always have fish and other seafoods in their meal. Gardening was very important to them for ceremonies or trades. They planted different crops such as taro, yams, coconut and bananas. But when European settlers came, there were shortage of traditional foods and many of the aboriginal people were forced to use the “introduced” food like flour, sugar, tobacco, eat, tinned meat and other foods which were high in fat and sugar. During their settlements and mission Aborigines had to share dining rooms, it seems to be their only choice to get some food. Because there was lack in distribution of the traditional food, it contributed to insufficiency of knowledge in preparing nutritious food, lack of food management, and poor feeding of their children. During these times, the Aboriginal people were eating food that lack of Vitamins, calcium, iron, fruits and vegetables.

B.) Socio-economic factor

a.) Housing– 7% are homeless and others lived all in one congested house.

b.) Lack of Income and Unemployment- Recent social survey last 2014-2015 showed that the unemployment rate for Aboriginal and Torres Strait Islander was 20.6% aged 15 years and above, while Australians in general unemployment rate was only 12.7%. Aboriginal and Torres Strait Islanders who have no jobs who were unemployed have greater risk of getting sick because of the decreased amount of fruit and vegetable consumption.

Food cost in remote areas are higher than in urban areas which low income families could not afford to buy healthy foods. The Food cost is 50% more expensive prices in remote Aboriginal and Torres Strait Islander communities than in urban areas.

c.) Lack of education- Because they lived in an isolated and remote place, the source of education and employment opportunities are limited only.

d.) Food cultural values -The effect of their previous policies and practices and how their diet was being introduced reflected their poor health status.

Environmental Factors

The Aboriginal and Torres Strait Islanders physical environment where they live has a great impact for their nutritional status. According to the report by the Australian Institute of Health and Welfare last 2012-2013, there were only 6% of the Aboriginal people that have all things functioning and present in their house like proper kitchen, cupboards, stove and sink, proper bath or shower and toilet and 13% have overcrowded households . It is very important to remove overcrowding and provide a proper and appropriate houses , well maintained and constructed houses are vital for the safe preparation, storage and consumption of food. The proper garbage disposal and having a safe sewage are very important for maintaining good health as well.

Geographic factors

There is a large number of Aboriginal and Torres Strait Islander people that live in remote and very remote places compare to urban and regional areas. 40% of Aboriginal and Torres Strait Islander Australians who are staying in remote areas experience health gap. Nutritious food items are only limited in remote stores especially having fresh fruit and vegetables supply, lean meat, dairy products that are low in fat, and whole grain cereals. People in remote communities also experience without food for an extended period due to road or weather conditions.

The maternal and perinatal result of Aboriginal and Torres Strait Islander mothers and babies shows consistency to be poorer than those non-indigenous Australian mothers. Risk factors are giving birth at young age, living in remote area and socio-economic difficulties.

The first national survey for dietary intake of children was conducted last 2012-2013 by the National Aboriginal and Torres Strait Islander nutrition and physical activity survey. It monitors the Aboriginal and Torres Strait Islander children dietary intake .According to the study that children in the communities described to have low intakes of fruit and vegetables because of the barriers like children disliking fruit and vegetables (33%), (4.1%) affordability, (7.4%) accessibility and (3.2%) lack of availability.

Conclusion

Therefore, food security is very important in human right. Food security happens only when all people have safe and sufficient access to healthy foods, physically and economically in order to meet dietary needs for active and a healthy life. The right to adequate food is understand by people, the opportunity to feed themselves and their families. Having such a low income, unemployment, lack of opportunities for education, lack of knowledge and skills, overcrowding, inadequate housing, pricey food, mothers giving birth at young age, are considered to be the major risk factors of underweight and malnutrition of Aboriginal and Torres Strait Islander children.

Malnutrition in children’s is becoming a key worldwide health challenge given the widespread nature of the population it affects. Children can also encounter various types of malnutrition: 3.62% of children under the age of five are both stunted and wasted, while 1.87% of children under the age of five are both stunted and overweight worldwide (6). It is related to the under nourishment or over nourishment of nutrients in an individual. The under nourishment section involves stunting, wasting, micro-nutrient deficiency while the over nourishment involves obesity, higher chances of developing non communicable diseases 1. Malnutrition affects almost every part of the world impacting the health outcomes of individuals reducing their productivity. There are number of factors that is associated with the under nourishment in children which may include poverty, high food prices, lower prevalence of breastfeeding. About 45% of mortality among children under the age of 5 are linked to malnutrition. These mostly occur in countries with low and middle incomes. At the same time, rates of childhood obesity and obesity are increasing in those same countries (5)

Child malnutrition in Bangladesh

Despite the years of progress made after the independence, under nourishment of children’s is still creating difficulties in making children’s realize their potential. Under nourishment has poor impact on child’s health, education, and economic outcomes. Over half of the population is suffering from malnutrition. 450,000 children are affected by severe acute malnutrition; while close to 2 million children have moderate acute malnutrition. 52 percent of children under five years of age are affected by anemia (4). Over thousands of child deaths a year in Bangladesh are caused by chronic malnutrition (stunting) and acute malnutrition (wasting) Children in rural Bangladesh are more at risk of stunting than in urban areas. Child under-nutrition in Bangladesh remains one of the key causes for childhood disease and mortality. Though Bangladesh has made substantial progress in reducing the mortality rate of infants and adolescents, the country has not achieved the same level of success in tackling child nutrition 2. Bangladesh’s malnutrition levels are among the highest in the world. Over 54% of pre-school children, or more than 9.5 million children, are stunted, 56% are underweight, and more than 17% are wasted (3).

Major factors

Role of poverty

Bangladesh is an under developed country with majority of its population living below the poverty line as a result they have less resources for disposal. As a result majority of population is unable to meet the nutritional need which is required by the children’s during there early years of development which results into mass wasting and stunting among the children’s. Lack of economic resources has a direct relation to the health outcomes of a country. In the wealthiest families, the prevalence of stunting, wasting and underweight was less than in the poorest households. The wealth index’s exposure to child hunger has risen over time and the wealth index has explained the biggest contribution to pro-poor inequality (Islam, 2020). Given the prevalent poverty and the scarcity of resources, people will invest less in healthcare of the children. The standard of living is poor and also poor access to healthy food is there. They are not able to afford things which will keep them healthy. Children from the poorest families have suffered more from the burden of malnutrition than those from the richest households. The level of inequality among rural children has also increased, though it has remained stagnant among urban children (Pulok and Enemark, 2016). All these have resulted into the increased child mortality in Bangladesh.

Food insecurity

A quarter of Bangladesh population suffers from food shortage making them food insecure. Food protection, which is related to health and nutrition, is a complex development problem. Hunger and hunger are closely correlated with food insecurity and are viewed as a major public health issue with long-term detrimental effects on the health of children. Food insufficiency in urban slums of Bangladesh is associated with stunting and underweight, but not with waste. The essence of food insecurity in households tends to be the product of a number of risk factors, as well as the inability to handle those risks due to constraints on income and resources. Moreover, one of the common scenarios in the study area is a reduction in food intake during the Monga era. Marginal effects and elasticity after probit regression reveal that household income; the per capita share of medical expenditure, the involvement of safety net and the area of residence appear to be the main factors significantly affecting seasonal food insecurity during the Monga period (Ahamad, 2013)

Limited access to sanitation facilities

Diarrheal diseases among children often results into malnourishment among the children’s.

Significant risk factors for diarrhea are inadequate supply of clean water and proper sanitation practices. In comparison with others, the practice of washing hands and the use of heated drinkable water was poor among lower socio-economic families. A higher risk was correlated with lack of hand hygiene before feeding their kids, and hand cleaning without soap. Water transport methods and inadequate water treatment at the household scale, the concentration of polluted water in the street, storage, processing, and disposal of wastewater, quality of domestic water reservoirs, and the development of vectors predispose children under five to diarrhea. All of these together increase child malnutrition rates among children due to diarrhea

Health care access and quality

The access to primary health care services and also the quality of healthcare which is provided plays a pivotal role in aggravating the cases of child malnutrition in Bangladesh. People living in rural areas have poor access to primary and secondary health care services. Lack of hospitals, medical staff, and the poor quality of health services that are tendered has resulted in increased mortality among children due to malnutrition. The major section of the population still lacks health insurance which makes them vulnerable as they cannot afford the basic medication. Lack of properly trained health care professionals and poor counseling also adds to the problem.

Low rate of breastfeeding

Breastfeeding provides the essential nutrients in proper proportion which is required for the overall development of the children. One of the major reasons attributable to the rising children’s mortality due to child malnutrition is the low maternal literacy backed by low breastfeeding. Infants who have been breastfed for less than two years are also found to be at a higher risk of malnutrition relative to those who have been breastfed for some more than two years. A structural and institutional analysis found that failure to breastfeed culminated in increased mortality risk from malnutrition relative to exclusive breastfeeding among infants aged five months. The analysis showed that there were an increasing proportion of teenage mothers. Much of the mothers belonged to lower socioeconomic backgrounds of nuclear families. Children corresponding to low socioeconomic status had a higher incidence of stunting and wasting than the better socioeconomic community. The mother’s education level showed a strong association with the health result of children.

Health education

Despite having adequate availability of fish and vegetables basic health knowledge is lacking among the common people of Bangladesh. Most of them fail to understand the importance of diversity of food which is required to obtain the nutrition. There are many traditional beliefs which are prevalent which considers vegetables as not a good food option for children’s (7). In Bangladesh, there is poor access to quality education in rural and semi-urban areas which is being reflected in the health outcomes of a country. People with a poor educational background will lack the basic understanding of the importance of healthcare in children, the nutritional needs of children, importance of exclusive breastfeeding, their basic medical needs, and precautions to be taken. All these have resulted in making malnutrition a serious threat in Bangladesh. The level of education has a direct correlation with health outcomes. Higher education will lead to increased expenditure on children’s health. As educated parents will take the health of the children more seriously and will look after its growth. In comparison with those of mothers with higher education, the prevalence of malnutrition, while decreasing, was consistently high among children of mothers with lower education. Children of mothers with secondary or higher education were at lower risk of childhood stunting, wasting, in adapted models integrating time effects, compared to children of mothers with no education (Hasan, 2016)

Role of gender

Girls were more impacted by wasting and stunting than boys among the respondents in the study. Girl children had a significantly higher incidence of acute malnourishment than boys. In this area, this may point to a potential cultural impact by which the health of female children is overlooked, limiting their access to quality health care. Patriarchy is highly prevalent in society which can also be seen in the wide range of disparity between the health outcomes of both genders. The health care of girl children is often neglected to make them more vulnerable to malnutrition given the lack of access to proper healthy food and hygiene.

Sustainable development goals success

With minimal resources, Bangladesh has seen one of the highest declines in poverty anywhere in the world in the last 15 years. Three years ahead of schedule, the country has met the target of reducing the proportion of population below the national poverty line. It has met the targets of reducing the rate of infant mortality from 92 per 1,000 live births in 1990 to 46 now; and reducing the prevalence of underweight children less than five years of age from 66 percent in 1990 to 32.6 percent now. The country has reached almost 100 percent enrollments in primary schools in terms of education, and has achieved gender parity with more girls than boys in primary and secondary schools. The goals for reducing malarial deaths and increasing the share of people using an enhanced source of drinking water have also been reached. In terms of achieving the Sustainable Development Goals, as one of the best performing nations (social watch, 2020)

Challenges

Disorganized urbanization has faced many massive issues due to the lack of planned growth, particularly large and fast-growing slum areas that lack essential services (particularly people without access to adequate sanitation, safe water and energy independence) and solid waste is being produced at a quicker speed, posing a serious threat to administration and the ecosystem. The solid waste management is a daunting challenge as the population grows and the form of waste varies. Waste disposal activities need to be concerned not only with the growth of their generation, but also with their ineffective practice. Socio-economic factors, demography, weather conditions, lack of knowledge and poor management practice influence waste generation. In addition, more than half of the population may not have access to electricity, and those connected to the grid frequently encounter extremely intermittent service. For cooking, inhabitants of rural communities use unsustainable and unsafe indoor stoves (13). Due to the proximity with the coastline Bangladesh is prone to extreme climate events in the forms of cyclone which negatively impacts the economy of Bangladesh and makes it difficult to manage its economic resources. It also negatively affects the food security of Bangladesh as sea water enters the field which affects the productivity.

Suggestions

For basic infrastructure such as highways, rail and ports, power stations, water and sanitation, as well as for sectors such as agriculture and rural development, climate change mitigation and adaptation, health and education, a nation such as Bangladesh would require enormous investment. Bangladesh government can actively work with the private sector players in order to diversify its finances which will be required in meeting the sustainable development goals. It can also work with multilateral institutions in order to get finances.

Way forwards

Providing food security

Providing food security to the people of Bangladesh should remain the top priority of the government. Increased food security will result into improving the health outcomes of the people of Bangladesh who are suffering from mass wasting and stunting. Government should focus on importing food grains from the neighboring countries in order to give food security to its people. Further, more focus should be given on the technological portion to increase the productivity. More land should be brought under the agricultural ambit so that the production level increases. Government can run subsidized food for children in schools in order to raise their nutritional status.

Taking help of Ngo’s and civil society

Help of Ngo’s and civil societies can also be taken to reach out to children who are undernourished. They will help the government in collecting the proper data regarding the prevalence of wasting and stunting among children. They can also be used for the proper implementation of programs and policies of the government regarding the child nourishment as they have deep rooted connections and people feel comfortable in dealing with them. Specific programs can be made solely for reducing wasting and stunting among children by taking the help of Ngo’s who works in the area of child development

Reducing poverty

Steps needs to be taken for reduce the level of poverty prevalent in the society by generating economic opportunities. More focus needs to be there to generate employment in the economy. If the per capita income of the people increases than it will have positive result in health outcomes. The people will start to invest more on the health and nutrition of child ultimately leading to reducing the child mortality among children. The government should focus on creating special economic zones which will radiate economic prosperity. Attention also needs to be taken to increase the export of the country. These steps will add to the per capita income of Bangladesh making it enhance its fight against child under nourishment.

Improving health care services

There is need to enhance primary and secondary healthcare services so that the child mortality relating to the under nourishment of the child can be reduced. Food fortification can also be done in order to provide essential nutrients to the malnourished children. Availability of doctors in the rural areas can be improved where there is more number of under nourished children and also monthly checkups can also be arranged. Door to door campaign can be launched where trained health professionals can be given the task to distribute iron and zinc tablets among the beneficiaries. The healthcare budget of the country needs to be expanded and more allocation of funds needs to be given to the areas which lag behind in the health and nutritional parameters of children. Healthcare infrastructure should be expanded in remote and rural areas which shares the major burden in child wasting and stunting.

Improving the sanitation and hygiene level

The implementation of systematic programs led by government to increase the supply of clean drinking water to the majority of the population specially those who live below poverty line. It is also important to increase the number of access to clean drinking water at a suitable distance from houses to decrease the number of individuals that share one washroom. Improved sanitation and hygiene has a positive correlation with the health outcomes and will ultimately lead towards reducing the mortality and morbidity that is associated with children’s due to malnourishment caused by diarrhea.

Government interventions

Higher maternal education, improved socio-economic conditions in households and extended birth intervals alone are not sufficient to bring about a major reduction in the prevalence of child malnutrition in Bangladesh. In addition to enhancing maternal education and other socio-demographic factors, tailored strategies should be planned to minimize the prevalence of low birth weight (Rahman, 2016). Steps also need to be taken to provide primary and secondary health care services to the rural population. Proper counseling sessions need to be carried out to enhance the people’s knowledge about the preventive steps that are available to deal with under nourishment in children where they should be educated about the importance of breastfeeding, the role of sanitation and hygiene, importance of diversity of food, child’s nutritional needs. At last proper programs and policies should be carried out which will be oriented towards the elimination of wasting and stunting in children as they are the future of the country.

Conclusion

Sharing the huge burden of children suffering from mass under nourishment due to the mass poverty, lack of food security, poor health facilities, and steps needs to be taken to address this growing challenge which is hindering the growth and development of children in Bangladesh. Further decline is possible through multi-pronged regional-specific approaches that can resolve area-specific covariates to break the cycle of undernutrition, such as strengthening economic and educational status, highlighting the role of fathers in enhancing their expertise in various aspects such as family planning, fertility reduction and improving the health of mothers. All these steps are necessarily needed in order to achieve the sustainable development goal by 2030.

Caring for every patient’s nutritional status is crucial when it comes to the role of a nurse. This is crucial for the nurse and their patient because the patient’s life could be in danger if they do not have a healthy diet or they are not provided with instructions on how to maintain a healthy diet. Every patient needs a different diet, and nurses need to be educated on what each of their patients need nutritionally to enhance their health and how to educate their patient on nutrition in a professional manner. Having a healthy nutrition status throughout our daily lives is very beneficial to our bodies. Healthy nutritional status promotes your growth status, your weight, avoiding any diseases, and in general just helps you maintain a healthy well-being. “Maintaining a healthy diet is essential for the prevention of obesity and noncommunicable diseases” (Patience, 2016, pg.1).

Background

As a nurse in this situation trying to maintain a healthy diet for their patient that is struggling with their weight involves critical thinking, and they have to put their critical thinking skills into use. It is the nurse’s responsibility to make sure they are promoting their patient’s health and preventing their patient from becoming ill or potentially causing damage to their bodies. All patients need to maintain a healthy diet based on their health status because of certain illnesses. “Current UK population-level advice is to eat starchy high fiber foods, at least five portions of vegetables or fruit a day, some protein-rich foods, dairy, unsaturated fats and oils, and drink six to eight glasses of fluid a day” (Patience, 2016, pg.1). Nurses need to ensure that their patients are meeting these standards when intaking foods and fluids. Maintaining a patient’s diet in the hospital or any healthcare setting is very important in promoting recovery. “Most patients fail to meet minimum dietary requirements and up to fifty percent of patients are malnourished in hospitals” (Roberts et al, 2020, pg.1). This is why it is important for the nurse to be educated on proper nutrition and know how to relay the knowledge they know to each of their patients.

Malnutrition Patient’s

Malnutrition is a major problem within hospitals, and it is affecting twenty to fifty percent of patients throughout the entire nation (Roberts et al, 2020). Malnutrition is when the patient does not have enough intake of nutrients to maintain a healthy body weight and lifestyle. Patients that are malnourished are at a higher risk of infections, fall risks, longer stays in the hospital, and pressure injuries. Patients that have wound injuries and are malnourished risk making their healing process longer and can make their wound worse than what it is. Within hospitals there is a wide range of different patients and in that case it is sometimes hard for nurses to keep up on all their patients nutritional status. This is why it is important for nurses to communicate with nutritionists, and doctors about their patients health status and their nutrition.

Patients that are dealing with malnourishment can experience a lot of different symptoms. Some may experience a loss of appetite, tiredness, weakness, and some even experience a drop in temperature. “Organisational factors such as the hospital food service, mealtime environment and the way hospitals and staff provide nutrition care also impact patients’ nutrition” (Roberts et al, 2020, pg.2). These factor changes can be hard for a malnourished patient that was admitted to the hospital. It is important for the nurse to ensure their patient is comfortable in these new settings, and provide an appropriate mealtime environment.

Educating the Patient

When it comes to the nurse educating their patient on nutrition it is beneficial to have their patient participate in this education and promote participation. Nurses that have their patients participate in promoting their health can lead to major changes in their nutritional status, and will help them improve. “Preliminary research has shown that patient participation in nutrition care is a feasible and effective strategy for improving dietary intake in hospitals” (Roberts et al, 2020, pg.2). If the patient does not show any signs of wanting to improve their health or interest in wanting to participate then the nurse needs to find other ways to help the patient improve.

Nurses who set goals for their patients plays a key role in promoting their patients well-being. When nurses set goals for their patients it makes them feel more in charge and feel they have something to work towards. Setting goals for their patients can make them more motivated and increase their nutritional health. “Setting goals and objectives appropriately optimizes the learning intervention” (Seyedin et al, 2015, pg.4). Learning a new diet can be hard on a lot of patients which can lead to discouragement and intimidation. This is why it is important for nurses to ensure their patients stay positive throughout the learning process and be supportive.

Communication within this role of a nurse being an educator to their patients plays a big role within the health field. “Nurses in all settings have an opportunity to make every contact count, by giving patients the right information regarding a healthy diet” (Patience, 2016, pg.1). Nurses need to make it a priority to make each patient interaction beneficial by giving them the right information they need, and that means communicating in a professional manner. Communication is also very important between the nurse, nutrionist, and doctors. For example, if the nurse, nutrionist, and the doctor do not communicate, then the patient could be receiving different information from each health care provider.

The Nursing Process

When it comes to patient education within nutrition nurses need to use the nursing process to promote their patient’s health status. The nursing process involves five important steps that are assessment, diagnosis, planning, implementation, and evaluation. “Patient education aims to provide adequate and relevant clinical information, with the goal of increasing understanding of illness condition and health promoting behavior; it is considered as the most significant roles of hospitals that will lead to better patient outcome”(Seyedin et al, 2015, pg.1). The nursing process helps nurses provide the proper care to their patients in an organized order and a professional manner.

Assessment Phase

“The first step is assessing the patient’s learning needs, learning style, and readiness to learn” (Seyedin et al, 2015, pg.2). This is important because every patient has a different learning style, and nurses need to know how to teach their patients in a way that they will understand the information being given. The nurses patient needs to show a readiness to learn too, or the information that is being given to them will not be beneficial or be used correctly. The assessment phase is when the nurse collects information from their patient, whether it is subjective data or objective data. For example, a nurse that is meeting with their patient for their nutritional health at this point they would ask their patient about the food they eat, and document any nutritional physical findings. The nurse during her assessment with her malnutrition patient can also look for edema, weight history, look at the patients skin integrity, and look for any electrolyte embalances.

Diagnosis Phase

The diagnosis phase is the second step the nurse performs in the nursing process. The diagnosis phase is when the nurse would diagnos a malnutrition patient with anorexia. In order for the nurse to make a diagnosis for their patient they have to use critical thinking. Anorexia would be related to not having enough nutritional intake to maintain a healthy weight.

Planning Phase

The planning phase is the third step in the nursing process, and this is where the nurse is coming up with a plan for their patient to improve their nutritional status. This can be long term or short term goals for their patients. At this point of the nursing process the nurse needs to come up with a plan to help a malnutrition patient. An example of a plan for a malnutrition patient would be the nurse coming up with long term and short term goals, and planning a diet for their patient. “A successful patient education program is dependent on a well-designed plan comprising of the goals and objectives of the educational process” (Seyedin et al, 2015, pg.2). The nurse can also include in the planning phase for their patient is to administer parenteral and enteral nutrition.

Implementation Phase

Implementation is the the fourth step the nurse puts into action when performing the nursing process. The implementation phase is crucial to the malnourished patient because this is where the nurse and her team will put the treatment they have come up with into action. Malnourished patients sometimes have a hard time with their body image, so it is important for the nurse to be supportive and promote their patients self esteem. The mind can play games on a malnourished patient’s brain, and this is why it is important for the nurse to implement therapy. Nurses should implement a daily food intake screening for their patients to keep track of what they are eating. Another implementation the nurse can make for their malnourished patient is weigh their patient daily. It is crucial to also weigh anorexic patients backwards with them not facing the number on the scale because it will intimidate the patient if they are gaining weight.

Malnutrition has become one of the leading contributor to the global burden of non communicable diseases. Malnutrition does not only refers to undernutrition associated with deficiency states, but also refers as overnutrition, excesses or imbalances in intake of energy, protein and/or other important nutrient and is associated with overweight or obesity. (1)In Middle East and North Africa have a high prevalence of overweight/obese population and has reported that by 2020 over 60% of non-communicable disease burden results from obesity as a consequence of changes in dietary habits, physical activity patterns and westernization which occurred in the Arab countries during the past three decades.(2)

Changes in the dietary habits in Arab countries are mainly characterized by an increase of calorific intake and the replacement of the traditional diet with high intake of fast food and processed food and a low intake of milk, fruits, and vegetables.Data from regional STEPS surveys measured the change in dietary intake behavior and showed that 79–96% of adults in Egypt, Jordan, Iraq, Kuwait, Saudi Arabia, Qatar, and Syria reported over intake of diet rich in fat and salt, and inadequate intake of fruit and vegetable and to be less than the recommended five servings per day.(3) This dietary behavior does not only restricted to the adult population, but also shows a health concern in children and adolescence as data from the National Health and Nutrition Examination Survey (NHANES), the Pediatric Nutrition Surveillance System (PedNSS), and the National Center for Health Statistics (NSCH) reported high overweight and obesity rates in young children (ages studied ranged from 1 to 5 years), school-aged children (aged 6–11 years), and adolescents (age range 10–19 years).

This will eventually generate a significant proportion of pediatric obesity to continue into adulthood obesity with broad range of adverse health effects such as hypertension, type 2 diabetes, and insulin resistance in early ages.(3) In Syria, overweight/obesity prevalence is high specially in urban and rural areas than suburban areas and the highest regional prevalence of overweight in the Syrian Arab Republic was in Halab 31.5% and Al-Raka 47.8% and particularly in women and this is likely rooted in the social norms and gender roles of traditional Arab societies, whereby women are mainly looked at as childbearers/child-rearers. Confined to their homes, either because of societal traditions or their pressing household duties, women may have little chance for recreational or sport activities (4) Obesity is a known risk factor for Cardiovascular disease (CVD) increasing its risk by 50%. In the Syrian public relation, the CVD mortality accounting for almost 45% of all deaths of adults between 45 to 74 years of age. In comparison to other neighboring countries, the mortality rates count about 25% of all deaths.(4)

A paradox is likely rooted in Arab societies when a high socioeconomic status is associated with decreased probability of CVD risk factor, however in Syria population this was not applicable. It was noticed that people with low education had the worst CVD risk profile mostly because of obesity and hypertension. Fruits and vegetables can be widely affordable in Syria, however their beneficial effects on the quality of health status , particularly on cardiovascular health is not widespread in the society (4). A study focuses on analysis of dietary habits and food consumption among adolescents’ students and revealed that dietary behavior is influenced by cultural norms, socioeconomic factors, lifestyle and nutrition education. The average consumption of fruit and vegetable was lower than the actual recommendation and this was associated with the low knowledge of its health benefits or other healthy eating behaviors. The study revealed that sources of nutrition education of students revealed that 33.1% of nutrition information was from family members,6.4% from schools,5.1% from social media.(5)

In 2011,A massive revolution have displaced a civilian war in Syria and has devastated the country’s population which had a detrimental impact on the lives of over 11 million Syrians and millions of citizens in host countries. The massive displacement of Syrians has not only as a result of the enormous political war but also due to the impact of the crises on the national economy, destruction of security, damage to infrastructure and collapses of services and social consequences including education (6). As the conflict continues, Syria now considered s one of the most food-insecure regions in the Arab world. The World Food Programme addressed that 2·5 million Syrians are suffering from hunger reported from inaccessibility of food due to financial crisis in the country or due to the unmet food needs, nonfood assistance or health in refugees shelter(7). These people who are suffering from humanitarian crisis are associated with higher risk for a major public health malnutrition and its comorbidities due to the lack access to healthy food and health services.(8)

To tackle the complex nature and multi-faceted aspect of malnutrition that is burdening the region several actions are needed to reorient services related nutrition behavior. One of them is implementation and development of culturally sensitive nutrition programs and policies that reaches families and the community at large since few studies revealed that families might have an important role in nutrition sources.(9) Nutrition programs seek to promote healthy dietary behavior, improving eating habits by delivering health nutrition educations and this can be achieved through a solid practice and framework of public health nutrition to effectively address, through both prevention and treatment. Nutritionists/Dietitians considered one of the most important roles in public health nutrition for better assessment nutrition related health problems and better for developing and implementing evidence-based nutrition programs at reducing the burden of malnutrition. A curios query to answer about the number capacity of nutrition education programs in Syria and the role of these programs on the Syrian society. Thus, the aim of this paper to examine and review nutrition-affiliated programs that is offered in colleges and universities in Syria.