Last week we looked at Sickle Cell Anaemia, and how a placement in the developing world would give you firsthand experience of the disease progression and how it is treated in other countries - something you would only get to read about in text books at home. This week we are focussing on a sickness some might not have considered to play such a big role in their city placements overseas - malnutrition.
Everybody will undoubtedly know what a problem it is - the adverts surrounding Comic Relief and a barrage of other charities show just how badly some people suffer - but it may surprise you to find that it is not just restricted to the poorer rural areas of Africa. As the largest single contributor to disease (according to the UN's Standing Committee on Nutrition), it is one of the world's major health problems and is very apparent in everyday life on placement. Many departments even have their own malnutrition wards to cope with the problems.
“I have only read about “Kwashioko” (malnourishment) in text books until now, I had never seen it in the UK. But due to economic constraints over here I suppose it is no surprise that it is common here on the children’s ward". Ellie, Ghana
The World Food Programme defines a malnourished person as one that "finds that their body has difficulty doing normal things such as growing and resisting disease. Physical work becomes problematic and even learning abilities can be diminished. For women, pregnancy becomes risky and they cannot be sure of producing nourishing breast milk".
Part of the problem is that even if people get enough to eat, they will become malnourished if the food they eat does not provide the proper amounts of micronutrients - vitamins and minerals - to meet daily nutritional requirements. When they suffer from malnutrition their systems are not able to fight off bouts of diarrohea, sickness and malaria. It also means that it can be quite hard to tell that someone is suffering - the Oxfam adverts show clearly hollowed ribs and drawn faces, but malnutrition works on a sliding scale and you can still be susceptible to disease even if you look fine.
In Tanzania 44% of the country’s population is classified as undernourished, and this particularly effects children. The country is ranked 10th in the world for the worst affected countries for chronically undernourished children, and over the past decade over 600,000 children aged below 5 years are estimated to have died as a result. In Nepal the story is much the same, with as many as 4 in 10 under 5's classed as underweight and nearly half suffering from stunted growth. In Sri Lanka 14% of under 5's suffer from acute malnutrition and 29% are underweight. Ghana has similar statistics with 26% underweight and 11% acutely malnourished.
Malnutrition isn’t really an issue back home either but it is very prevalent here. Having that opportunity to work with patents suffering from those illnesses has been an eye opening experience. Learning the disease process and treatment options first hand is invaluable to me and could never be replaced by reading about them in a textbook” Candace, Arusha
Treatment for malnutrition tends to fall into two areas - stabilisation and rehabilitation - depending on how severe it is. Stabilisation involves treating infections and other medical problems as well as providing sufficient energy and nutrients to stop further loss of muscle and fat. Children are then provided with extra energy and nutrients for rapid weight gain and catch up growth. Plumpy nut seems to be the food substitute of choice and children are given packs to eat with milk.
Susie, Operations Manager for Tanzania, recently travelled over to Mwanza and talked about the malnutrition ward in the large Government hospital: "I think what students find most surprising is how so many patients admitted with malaria, tuberculosis or other illnesses are also malnourished, and that this was the primary problem leading onto the secondary disease. Either the malnourishment caused the problem, like in the case of one girl who had anaemia because she was vitamin deficient, or an overall weakened immune system contributed to them catching diseases that they then can't fight".
With hunger posing the world's biggest health risk - more so than HIV or malaria combined - and undernutrition contributing to five million deaths of children under five each year in developing countries, learning more about the problems firsthand is an excellent introduction to global health issues.