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Child Malnutrition

Malnutrition is central to many of the health issues in Bangladesh, as well as in many developing countries, for instance low birth weight, poor growth, slow cognitive development and susceptibility to infections.

But what is malnutrition?

"Malnutrition" is a condition that results from an inadequate or excessive intake of nutrients. Obesity caused by excessive intake of refined carbohydrates and fat, is also a form of malnutrition which is more common in industrialised countries, but recent studies have shown that this 'western' problem is now seeping into the developing nations leading to the situation of a "double burden" of under- and over-nutrition. [1]

There are 2 types of malnutrition:

• Primary malnutrition - occurs in parts of the world wherein most of its population is undernourished because of famine, poverty and limited crop production. This affects mostly children in underdeveloped countries.
• Secondary malnutrition is the result of an underlying disease which includes: eating disorder like anorexia or bulimia, cancer etc which can eventually cause malnutrition because of the inability to digest food or absorb the nutrients derived from food. People who have an alcohol or drug addiction may lose interest in food, which can lead to severe malnutrition.

From 2003 data the World undernourished situation is alarming, as evident from the map below [2]:

General Statistics [3]:

In March 2009, Unicef made their year long observation and stats public and stated that 10million more children around the globe face starvation because of the global financial meltdown, with 400,000 expected to die this year (2009). Unicef goes on to say that up to 2.7 million youngsters are acutely malnourished and nine times more likely to die in Africa. Whilst in South Asia, up to 4.7million are suffering.

• According to the Global Hunger Index, South Asia has the highest child malnutrition rate.
• The 2006 report mentioned that "the low status of women in South Asian countries and their lack of nutritional knowledge are important determinants of high prevalence of underweight children in the region" and was concerned that South Asia has "inadequate feeding and caring practices for young children".
• Half of children in India are underweight, one of the highest rates in the world and nearly double the rate of Sub-Saharan Africa.
• Bangladesh ranks 3rd in the countries with the highest number of undernourished people.
• One child dies every 5 seconds as a result of hunger - 700 every hour - 16 000 each day - 6 million each year - 60% of all child deaths. [4]

This problem is especially prevalent amongst children who are most vulnerable to diseases and adverse environmental conditions, with no assistance or guidance on how to maintain a well-balanced diet or even the guarantee of seeing their next source of sustenance: the street children.

• Street dwellers are often exposed to, and have easy access to non-prescriptive drugs, such as alcohol, tobacco, sniffing glue/petrol. Although alcohol has calories and provides energy it can also prevent the absorption of necessary vitamins and other nutrients. In general, a person taking substances can easily overlook the importance of good nutrition. Street children use substances to relieve hunger and this can lead to malnutrition. [5]
• And though some street children may get enough to eat, they do not have nutritious diets. Which inevitably leads to malnutrition, anaemia and vitamin deficiencies.
• Street children experience many common diseases such as tuberculosis, chest and respiratory infections, typhoid/cholera and dental problems largely due to the lack of personal hygiene and access to clean food and water. [6]

Below is a snapshot on the issue of malnourishment around the world, something that is still clearly the most important Millennium Development Goal that needs to be met.

Calcutta City, India: Results revealed that 69.4% of pavement-dwelling children are undernourished and that 16% of them suffer from severe malnutrition. Prevalence of severe grade malnutrition was noted to be 3 times higher in females. Moreover, children of illiterate parents and non-working mothers had a higher incidence of severe Protein Energy Malnutrition (PEM). [7]

Manila, Philippines: About 30% of Manila's 50,000-75,000 street children are estimated to be moderately or severely malnourished. According to international standards, both male and female respondents are seriously underweight and under-height. About half the street children reported regular drug use, primarily glue sniffing. [8]

Jakarta, Indonesia: Children scavenge food, i.e. at train stations, where some of them stroll through train cars looking for unfinished rice packs from travellers, and from little restaurants around the market, where the children watched for customers who had not finished their meals. Some owners of these food stalls call the children. However, most owners chased the children away. When the children purchased food, they usually buy their meals from the numerous food stalls along the roads or from food pedlars. The staple food of the children is, as everywhere in Indonesia, rice. This is usually consumed with different kinds of oily sauces and local vegetables. The consumption of fish and meat is normally rare, as it is expensive. "...more children were too small for their age ... 52% of the children suffered from stunting" caused by malnutrition at birth. [9]

Eldoret, Kenya: The malnutrition rates are high with 31.1% and 41.9% of the children being stunted and underweight, respectively. Abandoned children staying in shelters have the highest rate of malnutrition with 51.8% and 64.3% being stunted and underweight. Street children have a higher incidence of childhood diseases than their counterparts. [10]

Guatemala: As one might expects, street children suffer profoundly and face enormous economic, political and social challenges. In addition to economic poverty, which often leads to malnutrition and even starvation, these children are exploited and victimised by their own governments, usually by a police force. [11]

Dhaka, Bangladesh: About 73% of the street children in the Dhaka city suffer from chronic malnutrition while mortality and morbidity status among the street dwellers has reached an alarming level due to lack of basic healthcare services. This was revealed at a seminar organised in Dhaka by ICDDR,B [13] to release the findings of a study on 'Health Needs and Health Seeking Behaviours of Street Dwellers in Dhaka City'. [12] In Bangladesh 45% of newborn infants weigh less than 2500 grams; this proportion is the highest in the world. The high incidence of low birth weight is viewed as a major obstacle to improving child health and development. Because so many children are small, PEM is not recognised as abnormal. Similarly, healthcare providers do not recognise children as malnourished when they come for treatment of common illnesses. [14] In Dhaka, Bangladesh only few of the street dwellers are aware of the existence of government health facilities or Extended Programme on Immunization (EPI). The ICDDR,B study showed an alarmingly 69% of men taking drugs daily in addition to sharing syringes and needles among injecting drug users. [13]

Actions to be taken by governments and humanitarian organisations:

• Free and accessible health services should be made available for street children to help curb the incidence of common diseases.
• Introduction of 'static clinics' at identified locations reinforced by mobile outreach sites in evening hours in order to make the available health services accessible.
• Street children should be given free access to cleaning facilities (bathrooms and toilets) to reduce incidence of preventable diseases.
• Introducing nutrition programmes in existing health care services for street children. To inform the street dwellers about the existing health services, drug vendors can be explored as potential advocates to increase awareness among street dwellers.
• Improving child feeding including increasing rates of exclusive breastfeeding and appropriate and adequate complementary feeding.
• Provision of vocational training and micro-loans for street children to break the cycle of poverty.
• Provision of free psycho-social counselling and drug-rehabilitation services for street children.
• Rigorous lobbying of government to implement street children friendly health policies and to commit to allocating budgetary resources.

References:

1. Food-based approaches to combat the double burden among the poor: challenges in the Asian context. Asia Pac J Clin Nutr. 2008;17 Suppl 1:111-5.
2. Percentage population undernourished world map
3. 2008 Global Hunger Index Key Findings & Facts
4. Human Rights Council
5. WHO. Working With Street Children
6. WHO. Working With Street Children
7. Nutritional status of pavement dweller children of Calcutta City. Indian J Public Health. 1999 Jan-Mar;43(1):49-54
8. Social correlates of malnutrition among Filipino street children. Conn Med. 1993 Jun;57(6):373-6
9. Height and weight as a reflection of the nutritional situation of school-aged children working and living in the streets of Jakarta. Gross et al. 1996. Soc. Sci. Med. Vol. 43. No. 4, pp. 453-458
10. Health problems of street children in Eldoret, Kenya. East Afr Med J. 2001 Dec;78(12):624-9
11. Morales Case Focused International Attention on Plight, Rights of Street Children
12. 73pc street children face chronic malnutrition: study
13. ICDDR, B: Dissemination Seminar on: Health Needs and Health Seeking Behaviours of Street Dwellers in Dhaka City
14. ICDDR,B. Nutrition Research