The Interaction Between Undernutrition and Health
Text adapted from
The World Food Problem
Leathers & Foster, 2009
http://www.amazon.com/World-Food-Problem-Toward-Undernutrition/dp/1588266389
Health and Nutrition
• Poor nutrition leads to poor health
• AND
• Poor health leads to poor nutrition
• Vicious cycle
Girl with Marasmus in Darfur, Sudan
http://www.drfletcherinafrica.co.uk/marasmus4.jpg
http://www.usaid.gov/our_work/global_health/nut/images/malnutrition_chart.gif
Infections also cause Malnutrition
• Loss of appetite– Intolerance of food
• Cultural factors– Substitution of less
nutritious diet when sick
• Body loss of protein– Used to fight
infection
http://www.sikhspectrum.com/112006/images/u2.gif
Disease and dietary deficiencies
• Keratomalacia: Blindness – Vitamin A deficiency
• Scurvy: Soft gums– Vitamin C deficiency
• Beri-beri: Nerve inflamation– Vitamin B1 deficiency
• Pellagra: Skin disorder– Niacin deficiency
• Anemia: Blood disorder– Iron, B12 deficiency Pellagra
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18103.jpg
Diarrhea and Nutrition
• Diarrhea most common infection causing undernutrion– Kwashiorkor induced by
diarrhea
• Worst in children under 5
• Diarrhea reduces– Water– Salts
• Fatal if dehydration > 15%– 60-70% diarrhea deaths caused
by dehydration
http://www.ghi.com/WebMD/topics/diarrhea.jpg
Causes of Diarrhea
• Rotavirus
• Cholera
• Shigella
• Samonella
• Parasites
• Etc.
http://203.190.254.12/picture/HSB41_Ban_03.jpg
http://203.190.254.12/picture/HSB41_Ban_03.jpg
Rotavirus Diarrhea
http://www.brown.edu/Courses/Bio_160/Projects2004/rotavirus/Images/globaldistribution.jpg
Oral Rehydration Therapy
• Diarrheal salt loss cannot be corrected by drinking salt water– More fluid pulled from
body into intestine
• If add sugar to salt, – sugar crosses intestinal
lining
– pulls salt into bodySigns of dehydration
http://www.wikieducator.org/images/6/61/Signsdehydration.jpg
Oral Rehydration Therapy
• “The cheapest and most effective health intervention that can be implemented in the home to decrease childhood mortality”– UNICEF
Diluted salt water with sugar
http://ec.europa.eu/research/headlines/images2/cholera_rehydrate.jpg
Malnutrition Exacerbates Infection
• Philippine children with respiratory infection were 13x more likely to die– if malnourished
• Malnutrition aggravates– Intestinal diseases
– Worms
– ParasitesPhilippine Children
http://www.bbc.co.uk/birmingham/content/images/2007/05/15/main_riverside_children203_203x152.jpg
Malnutition Exacerbates Infection
• Malnutrition most common cause of immune system deficiencies– Decreases in
• white cell response• Interferon• skin integrity• Mucous membranes• Tissue replacement, repair
• Children with PEM– Atrophied thymus– poor T cell productionWhite blood cell surrounded
by red blood cells
http://www.sciencemuseum.org.uk/antenna/cancerkillers/images/cells.jpg
Malnutrition reduces Stamina
• Reduced capacity to cope with life
• Reduced job performance
• Reduced income for– Healthcare
– Transportation to clinics
– MedicinesUganda Health Clinic
http://www.doctorsforafrica.org/images/mulanda_health_centre.jpg
Director General of World Health Organization, 1989
• “ If we could increase the health spending in the developing countries by only $2 per head,
• we could immunize all their children,
• eradicate polio, and provide the drugs to cure all their causes of diarrheal disease,
• acute respiratory infection, tuberculosis, malaria, schistosomiasis
• and sexually transmitted diseases.”
http://www.who.sk/obr/nakajima.jpg
Hiroshi Nakajima
Policies promoting low cost health for the poor
• Good health promotes good nutrition
• Good nutrition promotes good health
• Cheaper to maintain good health– Than to try to cure sick people
• Low cost health for poor– Barefoot doctors in China– Nutrition huts in Philppines– Health huts in Haiti
Barefoot Doctors, Chinahttp://www.chinatoday.com.cn/English/20021/1960nian.htm
U.S. Public Health Policies
• 1840s: modern sewage systems
• 1900s: Drinking water
• 1923: Salt fortified – Iodine
• 1940: Flour fortified – Iron
– Thiamin
– Riboflavin
– Niacin
http://www.ames.lib.ia.us/farwell/publication/Pub6940.htm
Marston Water Tower, 1897
Subsidizing Maternal and Child Health Services
• 1974: less than 5% children in developing world immunized against– Measles– Tetanus– Diphtheria– Pertussis– Tuberculosis– Polio
• Today: 80% immunized due to government policies– Ex: World Health Organization
• 36 million infants/yr not immunized
http://maconareaonline.com/news.asp?id=14271
Maternal and Child Health Centers
• Immunization– Including hepatitis B, yellow fever
• Vitamin distribution– Vitamin A pills cost 5 cents to make
• Monitor Child Development
• Oral Rehydration Therapy
• Promote Breast Feeding
• Nutrition Education
• Family Planning
http://www.new-agri.co.uk/image/043/dev01b.jpg
Maternal Health Center, Malawi
Problems with Baby Formula
• Water supply contaminated with human excrement
• Household hygiene poor– Flies
– Feces
• No refrigerator
• Wood stove, little fuel
• No equipment to clean bottle
• Uneducated mother– No knowledge of germs
http://www.emag.uni-bremen.de/emag/2004/projects/wterprob/my%20home.html
Public Water Case Study
• Port-au-Prince, Haiti, 1976• 50% of municipal water
supply leaked out– Few shut off valves– Little incentive to conserve
• Direct service to 150,000 relatively wealthy
• 400,000 poor supposed to use 27 public stand pipeshttp://www.paho.org/English/DPI/100/100feature25_photos.htm
Public Water Pump, Port-au-Prince
Public Water Case Study
• Extreme water scarcity solutions:– 40,000 people relied on
leaks in pipes
– 95,000 more wealthy people shared with neighbors
– 300,000 bought water through private vendors
Port-au-Prince
http://www.ehponline.org/docs/1994/102-12/focus1.html
Public Water Case Study
• Private Water Market– Tanker trucks
• Filled up free at hydrants
– 2,000 connected households
• sold water to neighbors
– 14,000 people were mobile vendors
• Bought water from connected households
• Delivered to customers– 2 cents a bucket
http://www.wehaitians.com/haitian%20suffering.html
Port-au-Prince
Public Water Case Study
• Private Water Market– Customers paid out $3.8
million/year– Municipal Water Authority
earned $650,000/yr
• Family of 5 would pay $4/month for 11 litres/day– 40% of families earned
$20/month or less– Poorest purchased water
only for drinking• Bathed in surface runoff
http://www.sciencemuseum.org.uk/exhibitions/geographical/fossez.asp
Port-au-Prince
Policies promoting low cost health for the poor
• Good health promotes good nutrition
• Good nutrition promotes good health
• Cheaper to maintain good health– Than to try to cure sick people
• Low cost health for poor– Barefoot doctors in China– Nutrition huts in Philppines– Health huts in Haiti
Barefoot Doctors, China
http://www.chinatoday.com.cn/English/20021/1960nian.htm
Director General of World Health Organization, 1989
• “ If we could increase the health spending in the developing countries by only $2 per head,
• we could immunize all their children,
• eradicate polio, and provide the drugs to cure all their causes of diarrheal disease,
• acute respiratory infection, tuberculosis, malaria, schistosomiasis
• and sexually transmitted diseases.”
http://www.who.sk/obr/nakajima.jpg
Hiroshi Nakajima
U.S. Public Health Policies
• 1840s: modern sewage systems
• 1900s: Drinking water
• 1923: Salt fortified – Iodine
• 1940: Flour fortified – Iron
– Thiamin
– Riboflavin
– Niacin
http://www.ames.lib.ia.us/farwell/publication/Pub6940.htm
Marston Water Tower, 1897
Subsidizing Maternal and Child Health Services
• 1974: less than 5% children in developing world immunized against– Measles– Tetanus– Diphtheria– Pertussis– Tuberculosis– Polio
• Today: 80% immunized due to government policies– Ex: World Health Organization
• 36 million infants/yr not immunized
http://maconareaonline.com/news.asp?id=14271
Maternal and Child Health Centers
• Immunization– Including hepatitis B, yellow fever
• Vitamin distribution– Vitamin A pills cost 5 cents to make
• Monitor Child Development
• Oral Rehydration Therapy
• Promote Breast Feeding
• Nutrition Education
• Family Planning
http://www.new-agri.co.uk/image/043/dev01b.jpg
Maternal Health Center, Malawi
Problems with Baby Formula
• Water supply contaminated with human excrement
• Household hygiene poor– Flies
– Feces
• No refrigerator
• Wood stove, little fuel
• No equipment to clean bottle
• Uneducated mother– No knowledge of germs
http://www.emag.uni-bremen.de/emag/2004/projects/wterprob/my%20home.html
Public Water Case Study
• Port-au-Prince, Haiti, 1976• 50% of municipal water
supply leaked out– Few shut off valves– Little incentive to conserve
• Direct service to 150,000 relatively wealthy
• 400,000 poor supposed to use 27 public stand pipeshttp://www.paho.org/English/DPI/100/100feature25_photos.htm
Public Water Pump, Port-au-Prince
Public Water Case Study
• Extreme water scarcity solutions:– 40,000 people relied on
leaks in pipes
– 95,000 more wealthy people shared with neighbors
– 300,000 bought water through private vendors
Port-au-Prince
http://www.ehponline.org/docs/1994/102-12/focus1.html
Public Water Case Study
• Private Water Market– Tanker trucks
• Filled up free at hydrants
– 2,000 connected households
• sold water to neighbors
– 14,000 people were mobile vendors
• Bought water from connected households
• Delivered to customers– 2 cents a bucket
http://www.wehaitians.com/haitian%20suffering.html
Port-au-Prince
Public Water Case Study
• Private Water Market– Customers paid out $3.8
million/year– Municipal Water Authority
earned $650,000/yr
• Family of 5 would pay $4/month for 11 litres/day– 40% of families earned
$20/month or less– Poorest purchased water
only for drinking• Bathed in surface runoff
http://www.sciencemuseum.org.uk/exhibitions/geographical/fossez.asp
Port-au-Prince