Lecture 1.1: Maternal and child undernutrition: the
UNICEF framework model
05/09/2022
Hunters-gatherers: plants, low fat wild animals, varied diet, few nutritional deficiencies, infectious
diseases.
Agriculture: cereals predominant, low fat intake, nutritional deficiencies emerge
Technological revolution: increase in fat intake, sugar etc. physical labor declines, obesity, chronic
diseases
Today’s modern society: varied diets, less fat, increased carbohydrates.
Facts:
Countries with the highest burden of malnutrition: Southeast Asia, Africa.
Global Hunger Index: Africa, South America, South Asia
Since Corona (2018-2019) , undernourishment is increasing again. But worldwide, it is becoming
better.
Number of undernourishment is higher in Southeast Asia, due to the higher number of people that
are living there.
1945: founding of United Nations
- UN Standing Committee on Nutrition created in 1977, working in consultation with other UN
agencies.
- Global Nutrition Targets for 2025 (WHA):
o Stunting, anaemia, low birth weight …..
- Sustainable development goals: almost every goal has something to do with nutrition…
Course activities
- Lectures (not mandatory)
o Discussion board per group
- Tutorials (mandatory)
- Group assignments (mandatory group work)
o Meeting your supervisor & presentations
- Excursion (mandatory)
- Exam (knowing, not applying)
Lecture 1.1 UNICEF framework (part of theme 1)
Stunting = too short for your age
Example: Aïsha (7) had a low birth weight. Her mother gave birth early to her, and didn’t feel well at
the time. From 3 months onward she did not receive any breastfeeding and she got solid food. She
grew up, and by the year of 2 she didn’t receive all the nutrients and she was stunting.
Now, she is working and looking after her siblings.
Malnutrition:
- Stunting
- Wasting: not enough … for your height
, - Underweight
- Protein-energy malnutrition
- Low birth-weight
- Vitamin A deficiency, iron, iodine, zinc, folic acid, calcium
- Overweight and obesity! (you can have overweight and a vitamin A deficiency)
Consequences
- Over 159 million children under 5 are stunted as a result of malnutrition
- 50 million children are too thin and require special treatment
- At the same time, 41 million children are overweight, some as a result of poverty, when
families are unable to afford a balanced, nutritious diet.
- 2 billion people are deficient in key vitamins & minerals.
- 2-3 billion people experience consequences: health, education, economic development (not
sure about this slide, 12)
Categories of causes of malnutrition
- Household food insecurity
- Disease
- Inadequate access to resources (land, education, employment, income, technology)
- Inadequate maternal & child care
- Inadequate capital (financial, human (not enough doctors), physical, social (social network
that can take care of your child))
- Inadequate health services and unhealthy environment (water and sanitation)
- Inadequate formal and non-formal education (anything outside of school: vocational
training)
- Inadequate food intake
- Political, economic and socio-cultural context
Giving not the right food to the child is an immediate cause, a government which didn’t import food
is a further cause, but still a cause.
,UNICEF framework
Immediate causes:
1. direct dietary intake
2. diseases
Could be the mother who wasn’t properly nourished when giving birth.
Underlying causes:
1. Household food insecurity
2. Inadequate care and feeding practices
3. Unhealthy household environment and inadequate health services
Basic causes:
1. Quantity and quality of resources
2. Inadequate financial, human, physical and social capital
3. Social cultural, economic and political context
a. For example, in some Asian countries the girl/mother always eats last. Then all the
meat is already gone.
Programs & paradigms
A good program always touches upon different targets, different causes
When are actions taken? Prerequisites for inclusion of nutrition in policy and planning
- Consensus on the problem
- Formulation of objectives which are consistent, realistic and acceptable
- The political will to achieve these objectives
- Means and capacity to influence the causes
- Understanding of the causes of the problem to be addressed
Paradigms in Applied Nutrition (don’t study these by hard)
- Ideas can be contradictive. Over the past 50 years, several paradigms were dominant.
- You have the theory and the practice.
, 1. Paradigms before 1950
- Hunger as inevitable part of daily life, in some cultures even glorified
- Discovery of vitamins let to the Vitamin Deficiency Paradigm: malnutrition is caused by lack
of certain vitamins in the diet
- In 1932 new disease in Ghana discovered: Kwashiorkor, caused by protein deficiency
2. New paradigm in 1974 (1950-1974) The Protein Deficiency Paradigm
- Scientific evidence
o Need for a regular intake of proteins (essential amino acids)
o Caused by low consumption of protein-rich foods
o Protein requirements were much higher than expected
- 1967: UN report: international action to avert the Impending Protein crises
- Criticism (the Great Protein Fiasco)
o In most countries where this happens, most diets are low in protein AND energy
protein is used as energy source
o Protein quality more important: consuming normal diet protein content and
quality often adequate
o Increased estimates for daily protein requirements too high
o Most malnourished children have infections, contributing to malnutrition
3. Multisectoral nutrition planning paradigm (1974-1980)
- From practice: delivery of protein-rich foods did not solve malnutrition asked for broader
multi-causal approach
- Isolated technical fixed should be avoided
- Use of systems theory of modelling: resulted in unbelievable complicated maps of the
nutritional problem (everything depended on everything else)
- Criticism
o Much more data required than could be provided
o Systems analyses far too complicated
o Nutrition no political priority (not interesting)
4. The national nutrition policy paradigm (1980-1990)
- Some fundamental principles stayed:
o Malnutrition is result of social, economic, political and cultural processes
o Efforts should address all levels of society
- No longer protein problem but food supply and access problem only solution is to reduce
poverty
- Interventions should be coordinated (not integrated)
- National nutrition strategies or policies (expatriates) and national nutrition surveillance
- Criticism:
o Government is not committed and dependant on donors. It should come from
countries themselves, because external people made policies, but then there was no
commitment to do something about it.
o Food-biased: HFS only one of requirement
o Surveillance data not used for action
o There should be more coördination
5. The community-based nutrition paradigm (1985-1995)
- From macro to micro level (community), from curative to prevention
