According to the World Food Programme, malnutrition is the top health risk worldwide. Malnutrition can lead to impaired physical and mental development, which can sometimes be irreversible. It can also lead to death. Worldwide, about one-third of children who die before the age of five have malnutrition. One major outcome of malnutrition is stunting – low height for a child's age, which affects almost half of children in Latin America. One in five stunting cases is due to poor growth in utero, which is a highly impactful time for good maternal nutrition.
Overnutrition is also a form of malnutrition and is increasing in many countries, including in Latin America and the Caribbean. This article and accompanying illustrations focus on malnutrition caused by undernutrition.
Causes of Malnutrition
In developing areas of Central America, pregnant and breastfeeding women, as well as their children may have limited access to adequate quantities and types of food. Lack of access to nutritious food combined with the high energy demands of the mother's daily physical labor, and nutrition needs of frequent pregnancies and breastfeeding put expectant and new mothers, along with their children, at risk of malnutrition.
Mothers who give birth to infants who are small for their gestational age, live in poverty, have limited education or are in poor health are at a greater risk for being unable to provide adequate nutrition in the form of breast milk and complementary food to her infant, putting the child at risk for malnutrition.
Outcomes of Malnutrition
Health-related outcomes of malnutrition depend on which nutrients are missing from the diet. Macronutrient malnutrition can lead to stunting, wasting and being underweight. Severe protein-energy malnutrition can lead to marasmus, a form of starvation, marked by extreme wasting. Kwashiorkor is a form of protein-energy malnutrition which commonly occurs in young children subsisting on mainly carbohydrates and includes a variety of clinical symptoms, mostly notably edema.
Micronutrient malnutrition is typically less visible but can be just as detrimental. According to the World Health Organization, iron, vitamin A and zinc deficiencies are among the top 10 leading causes of death in developing countries. According to the Academy of Nutrition and Dietetics' position paper on nutrition security in developing nations, folate and iodine also are deficiencies of concern.
Malnutrition and its Effect in Central American Communities
Wasting and underweight are commonly seen in impoverished urban communities and in rural areas of Central America. In Guatemala and Nicaragua, the poorest children are six times more likely to be underweight when compared to their wealthy peers. In El Salvador and Peru, children are 13 to 16 times as likely to be underweight. Children affected by malnutrition and stunting are at a greater risk for poor school performance, disease and death. Malnourished children are more likely to drop out of school, which can lead to social and economic stress.
Knowledge gaps of the necessity of a balanced, varied diet including protein and ample feedings during the day contribute to childhood stunting and malnutrition in developing areas of Central America. Delayed introduction of solid foods is an example of inadequate feeding practices which should be assessed and discussed with mothers and caregivers. When many children in a community are stunted it may be considered a community norm unless parents are educated and healthy standards are discussed.
Half of the nutrition-related issues in Central America occur in communities exposed to environmental risks such as natural disasters. Earthquakes, droughts and floods may directly affect food sources and impair a community's access to food. Malnourished individuals also commonly live in households without adequate safe drinking water and proper water sanitation. This increases the risk of developing diarrhea-related diseases which can compound malnutrition.
According to the Food and Agriculture Organization of the United Nations, diets of many people living in Central America are low in total fat, protein and micronutrients, particularly in El Salvador and Guatemala. Some families that grow and produce protein-rich foods may sell them to purchase other foods or household items. Health educators should gather information on local food availability and economics and emphasize the importance of nutrition and appropriate allocation of scarce financial resources.
Combating Malnutrition in Central America
The World Food Programme declares "the first 1,000 days," the time from conception to age two, as the most important time for tackling malnutrition.
Educating mothers on maternal health and nutrition is a key strategy to preventing malnutrition in Central America. Pregnant women should consume a balanced diet of protein-rich foods, grains and starchy foods, fruits and vegetables. Adequate calories and protein are also essential for proper growth of the infant. Nutrients of concern during pregnancy depend on demographic, sociologic and ecologic factors and may include folic acid, iodine and iron.
Educating all women of child-bearing age in a community can further reduce the odds of malnutrition as preconception nutrition can significantly affect pregnancy outcomes. Exclusive breastfeeding for the first six months followed by the proper introduction of complementary foods in addition to continued breastfeeding is a key strategy for ensuring adequate child growth and development.
Community programs that weigh all children on a regular basis and compare their growth to expected norms can help mothers identify and seek remedies for poor growth. These programs generally include simple education for mothers who bring their children for weigh-ins. Health professionals can support and enhance these education sessions, which are often run by lay educators or volunteers. Similar programs may be available for monitoring weight gain in pregnant women and can provide a great forum for providing educational programs with visuals and demonstrations.
Ensuring children have access to safe drinking water along with proper sanitation is essential for disease prevention, management and treatment. Children who have access to clean water are more likely to experience expected gains in height compared to children without access to clean water.
What to Include when Conducting Malnutrition Education
Including lessons on the importance of maternal health, breastfeeding, infant and young child nutrition, as well as water safety and sanitation, will help minimize the risk of malnutrition in Central American communities. Health educators should include lessons on accessible nutrient-dense foods to eat during pregnancy and breastfeeding, as well as complementary foods to be introduced when infants are six months of age.
- Food and Agriculture Organization of the United Nations. Nutrition Country Profiles. Agriculture and Consumer Protection Department. Accessed December 18, 2015.
- Pan American Health Organization. Malnutrition in Infants and Young Children in Latin America and the Caribbean: Achieving the Millennium Development Goals. 2008. Accessed May 23, 2016.
- Save the Children. Nutrition within the First 1,000 Days: State of the World's Mothers 2012. 2012. Accessed March 10, 2016.
- Sight and Life. Prevention of Stunting in Latin America. Maternal Health Nutrition. 2013. Accessed March 10, 2016.
- The World Bank. Toolkit on How to Protect and Promote the Nutrition of Mothers and Children. 2013. Accessed May 23, 2016.
- Trehan I, Manary M. Management of severe acute malnutrition in low-income and middle-income countries. Arch Dis Child. 2015;100(3):283-7.
- World Food Programme. 11 Myths about Malnutrition in Latin America. 2014. Accessed March 10, 2016.