ll.5.6. Causes of
malnutrition
According to the United Nations Children's Fund (UNICEF),
framework of causes of malnutrition, it is recognized that there are two
immediate causes of malnutrition, which are inadequate dietary intake and
infections (Pelletier et al., 1995). The cause of individual nutritional status
depends on the interaction between food that is eaten, the overall state of
health but also the physical environment. Malnutrition is both a medical and a
social disorder, often rooted in poverty. Combined with poverty, malnutrition
contributes to a downward spiral that is fuelled by an increased burden of
disease, stunted development and reduced ability to work (Pelletier et al.,
1995).
The poverty lead to many factors such as unhealthy
environment, insufficient household food security, insufficient supply of
protein, insufficient child maternal care, little education of women and
malfunctioning of society such as war and natural disaster. All of these
factors are direct or indirect causes of malnutrition (middle, moderate,
severe: Marasmus-Kwashiorkor, micronutrients deficiencies) as shown in figure
1.
Figure 1: Direct and
indirect causes of malnutrition.
Poverty is the main underlying cause of malnutrition and its
determinants. Adapted from (Müller and Krawinkel, 2005).
ll.5.7. Malnutrition in
Rwanda
The nutritional situation in Rwanda remains persistently poor.
For the last two decades, under nutrition remained a significant public health
problem contributing to the high infant, child and maternal mortality.
In Rwanda a combination of poor knowledge on appropriate
feeding, poverty and the traditional monotonous food consumption practices
based mainly on traditional grains, roots and tubers led to a persistent
problem of malnutrition among the most vulnerable populations.
In addition, a child mortality rate higher than 70 per 1000 is
considered an indicator of Vitamin A deficiency, and in Rwanda this rate is 103
per 1000 (RIDHS, 2007/2008). The 1996 National Nutrition Survey reported
prevalence rates of 25% and 21% for sub-clinical Vitamin A deficiency (serum
retinol < 20 ìg/dl) for infants under 6 months of age and between 6
and 12 months of age, respectively. This may be an indication of inappropriate
feeding practices in early childhood (Government of Rwanda, 2009).
II.5.7.1. Under nutrition in Rwandan
Children
According to the Rwanda Demographic and Health Survey (RDHS,
2005) and the 2009 Rwanda Comprehensive Food Security and Vulnerability
Assessment & Nutrition Survey (CSVA&N), rates of malnutrition remain
consistently high in Rwanda. For example, between the two surveys there were
no significant changes in stunting (51% to 52%), underweight (19.8% to 15.8%)
and wasting (5% to 4.6%). Furthermore, in May 2009, a nationwide screening
using Mid-Upper Circumference (MUAC) found 8.7% of all children under five
years of age to be suffering from wasting or acute malnutrition, (MUAC<12.5
cm). Although MUAC and W/H always give different figures of prevalence for
wasting, the recent screening (2009) confirms a persistence of acute
malnutrition in the country. There was also no significant improvement in
malnutrition among women of reproductive age between the 2005 RDHS and the 2009
CSVA&N (9.9% to 7%) (Government of Rwanda, 2009).
The 2005 RHDS founds that the problem of malnutrition was more
pronounced in rural than urban areas. This generally alarming situation is
partly due to recurring food crises and chronic food deficits at the household
level. The situation requires an effective and immediate response system
concomitant with concerted long-term actions to improve nutrition and food
security. The 2003 Annual Report of the Ministry of Health ranked severe
protein-energy malnutrition amongst the ten leading causes of morbidity in
health centers for children less than 59 months of age, and in hospitals, it
was ranked the fourth leading cause of mortality for children less than 5 to 12
months of age and second leading cause of mortality for children between one
and 14 years of age (Government of Rwanda, 2009).
ll.5.7.1.1 Lack of energy, proteins, vitamins, and
minerals in Rwandese children diet
According to the Rwanda Interim Demographic and Health Survey
(RIDHS) of 2007-2008, anaemia, which is a common manifestation of iron
deficiency, affects 47.5% in children under five years in Rwanda and is most
pronounced (65.5%) in children from six to 23 months of age. Children,
particularly infants and those under five years of age are also at an increased
risk for malnutrition due to a greater need for energy and nutrients during
periods of rapid growth and development.
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