international nutrition

Question 1

1. Name the first 4 of the 8 Millennium Development Goals (MDG) and current “prognosis” for achieving them.

Answer 1

1. Eradicate extreme poverty & hunger
   (“Halve the proportion of people who suffer from hunger”: on track- 15% by 2015) 2. achieve universal primary education (enrollment = 90% in all but 2 regions) 3. promote gender equality and empower women (gender parity in primary school = 95% in 6/10 regions) 4. Reduce under 5 child mortality by 2/3. (overall decreased by 28%, from 12.5M to 8.8M due to malaria, HIV control and measles immunization)1. Eradicate extreme poverty & hunger
   (“Halve the proportion of people who suffer from hunger”: on track- 15% by 2015) 2. achieve universal primary education (enrollment = 90% in all but 2 regions) 3. promote gender equality and empower women (gender parity in primary school = 95% in 6/10 regions) 4. Reduce under 5 child mortality by 2/3. (overall decreased by 28%, from 12.5M to 8.8M due to malaria, HIV control and measles immunization)

Question 2

What is the largest group of under 5 child mortality

Answer 2

neonates- 41% of under 5 deaths. Progress is slow

Question 3

What percentage of world population is “hungry”

Answer 3

13.10%

Question 4

1. Name the last 4 of the 8 Millennium Development Goals (MDG) and current “prognosis” for achieving them.

Answer 4

5. improve maternal health (50% of births attended by skilled birth attendants, esp rural & low SES). 6. Combat HIV/AIDs, malaria, other dz (10-fold increase in antiretroviral Rx; 42% of those in need of treatment). 7. ensure environmental sustainability (deforestation slowed). 8. Global partnership for development

Question 5

What are the causes of hunger

Answer 5

poverty is principal cause. Underlying cause of poverty is economic and political systems. Also conflict is cause of hunger for refugees

Question 6

Who is at risk for malnutrition

Answer 6

women of childbeearing age, infants, children under 5

Question 7

2. Describe the framework for the contextual factors that contribute to malnutrition.

Answer 7

social, economic and political context > lack of capital (financial, human, etc) > income poverty > household food insecurity, inadequate care and/or unhealthy household environment/ lack of health services > inadequate dietary intake and/or disease > maternal and child undernutrition > short and long term consequences

Question 8

List basic causes of malnutrition

Answer 8

basic: Poor roads and lack of electricity lead to isolation. Limits markets and access to resources. This is in social, political, economic context and due to lack of capital.

Question 9

list underlying causes of malnutrition

Answer 9

Underlying causes: income poverty (no electricity or running water, indoor air pollution, food insecurity), inadequate health care,

Question 10

list immediate causes of malnutrtion

Answer 10

inadequate intake, monotonous diet, food insecurity, disease and illness

Question 11

Short term consequences of under nutrition

Answer 11

morbidity, mortality, disability

Question 12

Long term consequences of under nutrition

Answer 12

Stunted growth, limited intellectual capacity, economic productivity, reproductive performance, chronic diseases (metabolic and cardio)

Question 13

Describe nutrition problems related to mothers

Answer 13

10-19% of women have BMI <18.5%. Being underweight and short stature are independent risk factors for poor reproductive outcomes. Undernutrition increases risk of death during childbirth by 20%

Question 14

Stunting and undernutrition

Answer 14

stunting in infants correlates with stunting in mothers

Question 15

What is the critical window for height and weight

Answer 15

The first 1000 days

Question 16

What causes stunting

Answer 16

chronic malnutrition (NOT energy deficity). Micronutrient deficiencies such as zinc, iodine, iron, etc. Inflammation and recurrent infection. More common in rural vs urban, and in males vs females

Question 17

Describe the triple burden

Answer 17

diarrhea, stunting and chronic disease

Question 18

3. State and describe three major nutrition problems in developing countries, including growth, dietary, and reproductive outcomes.

Answer 18

1. protein energy malnutrition (stunting&raquo_space; wasting). 2. mineral deficiencies (hidden hunger). 3. Enteropathy

Question 19

4. Describe the implications of the “3 myths” about global malnutrition.

Answer 19

myth 1: Malnutrition is primarily a matter of inadequate food intake- Can also be due to inappropriate feed and care, poor sanitation and disease. Myth 2: Improved nutrition can only come as by-product of poverty reduction - education, using resources avaible, positive deviance and water/sanitation can all improve nutrition. Myth 3: Broad based action to improve nutrition not feasible- fortification programs (ie. iodized salt), promoting breastfeeding, Vit A supplements, Zn supplements for diarrhea and good management of common illnesses can improve nutrition

Question 20

Single most important factor in prevention of deaths in <5 yr old kids

Answer 20

exclusive breastfeeding- an infant not BF is 23X more likely to die of diarrhea. This is the least expensive and most cost effective method.

Question 21

Second most potent strategy to prevent child deaths

Answer 21

Improved complementary feeding with breast feeding. Traditional complementary feeding is low in Zn, Vit A and iron, so supplements and fortifications can aid in this.

Question 22

Describe maternal interventions to improve nutritional status

Answer 22

1. Peri-conceptional folate supplementation, Iodine fortification. 2. Balanced energy-protein supplement. 3. Calcium supplement. 4. Multiple micronutrient supplementation in PG

Question 23

Describe infant interventions to improve nutritional status

Answer 23

1. Promotion of breastfeeding . 2. Appropriate complementary feeding. 3. Vitamin A supplementation. 4. Preventive Zn supplementation. 5. Management severe & moderate acute malnutrition (SAM & MAM)

Question 24

Discuss plant breeding as intervention

Answer 24

Increase bioavailability of phytate reduced maize.

Question 25

Discuss biofortification as intervention

Answer 25

Plant breeding to increase micronutrients. NOT GMO.

Question 26

Discuss education strategies for interventions

Answer 26

1. behavior chang communication- negotiate priorities through health centers or directly with families. 2. positive deviance- who in community is successful and why?