A Tragedy of Great Magnitude

Erika is six months old. However, his weight and height are barely those of a one- or two-month-old baby. Despite being so underweight, his legs and stomach are swollen and his face is bloated and round. He is pale, his hair is brittle and dull, and he has lesions on his skin. He seems extremely irritable. As the doctor examines Erik’s eyes, he must be very careful, since the eye tissue could tear easily. Erik’s mental development has likely been hampered. Sadly, this child’s situation is far from unique.

“IT IS implicated in more than half of all child deaths worldwide​—a proportion unmatched by any infectious disease since the Black Death. Yet, it is not an infectious disease. Its ravages extend to the millions of survivors who are left crippled, chronically vulnerable to illness, and intellectually disabled. It imperils women, families and, ultimately, the viability of whole societies.”​—The State of the World’s Children, United Nations Children’s Fund.

What ailment do those words describe? Malnutrition​—in particular, protein-energy malnutrition (PEM), which the World Health Organization (WHO) has called “the silent emergency.” What is the magnitude of this tragedy? WHO declares that it “is an accomplice in at least half of the 10.4 million child deaths each year.”

Malnutrition covers a wide range of illnesses, from undernourishment due to a lack of one or more nutrients​—such as vitamin and mineral deficiencies—​to obesity and other diet-related chronic diseases. However, PEM “is by far the most lethal form of malnutrition,” states WHO. Its principal victims are children under five years of age.

Think for a moment about Erik, mentioned at the outset, and of the millions of children who suffer from malnutrition. They are not to blame for being in that condition, nor are they able to escape it. Pediatric nutritionist Georgina Toussaint told Awake!: “Those who suffer and pay are the least to blame yet the most vulnerable.”

Some might assume that the problem is inevitable​—that there is simply not enough food for all. Paradoxically, according to WHO, “we live today in a world of abundance.” There is enough food for all the humans on earth​—and more. Further, human malnutrition is the easiest illness to prevent and the cheapest to cure. Do not these facts make you feel indignant?

Who Is Affected?

Malnutrition is not limited to children. According to a WHO report of July 2001, “malnutrition casts long shadows, affecting close to 800 million people​—20% of all people in the developing world.” This means that 1 out of every 8 people in the world suffers from it.

While the largest number of undernourished people are found in Asia​—mainly in the southern and central zones—​the population with the highest percentage of undernourished people is in Africa. Some developing countries in Latin America and the Caribbean are next on the list.

Are developed countries free from malnutrition? No. According to The State of Food Insecurity in the World 2001, 11 million people who live in industrialized countries suffer from malnutrition. An additional 27 million undernourished people live in what are called transitional countries, especially ones in Eastern Europe and republics of the former Soviet Union.

Why has malnutrition become such a serious problem? Is there anything that can improve the condition of the undernourished right now? Will our planet ever be free from malnutrition? The following articles will address these questions.

[Footnote]

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COUNTRIES WITH POPULATIONS AT RISK OF INADEQUATE NUTRITION

HIGH RISK

MEDIUM RISK

LOW RISK

NO RISK OR INSUFFICIENT DATA

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Waiting for relief supplies in Sudan

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UN/DPI Photo by Eskinder Debebe

Deep-Rooted Causes, Far-Reaching Effects

“I was hungry and you formed a committee to investigate my hunger. I was homeless and you filed a report on my plight. I was sick and you held a seminar on the situation of the underprivileged. You investigated all aspects of my plight and yet I am still hungry, homeless and sick.”​—Author unknown.

ALTHOUGH world agencies have made numerous efforts to stop malnutrition, achievements have fallen short of hopes. For example, in 1996 the World Food Summit of the Food and Agriculture Organization of the United Nations (FAO) set the goal of reducing the number of the world’s undernourished by half​—some 400 million people—​by the year 2015.a

Commendably, some progress has been made. But unfortunately, the FAO’s recent report, The State of Food Insecurity in the World 2001, acknowledges: “Clearly, there has been a slowdown in the reduction of undernourished in the world.” So the goal of the summit still seems out of reach. In fact, the report admits that “the number of undernourished has increased considerably in the majority of developing countries.”

Why is this enemy so hard to defeat? To find an answer, we might first define malnutrition and then examine its far-reaching effects and its deep-rooted causes.

What Causes Malnutrition?

Malnutrition is caused by a deficiency in the intake of nutrients by the cells of the body, and it is usually triggered by a combination of two factors: (1) an insufficient intake of proteins, calories, vitamins, and minerals and (2) frequent infections.

Such illnesses as diarrhea, measles, malaria, and respiratory diseases tax the body heavily and cause loss of nutrients. They reduce appetite and food intake, thus contributing to malnutrition. On the other hand, the undernourished child is more susceptible to infections. Thus forms a vicious circle that increases the mortality rates for protein-energy malnutrition (PEM).

Why are children at greater risk of suffering malnutrition? They are in a period of rapid growth that increases the demand for calories and proteins. For similar reasons, pregnant and nursing women are vulnerable to malnutrition.

Frequently, the baby’s problem begins even before birth. If a mother is undernourished or malnourished before and during pregnancy, the baby will have a low birth weight. Then, early weaning, poor feeding habits, and lack of hygiene can bring on malnutrition.

Lack of necessary nutrients causes the child to stop growing and developing properly. It cries a lot and is prone to sickness. As the condition worsens, weight loss becomes more pronounced, eyes and fontanel (the soft spot on top of the head) become sunken, skin and tissues lose elasticity, and the ability to maintain body temperature decreases.

Undernourishment can take other forms. These too can retard growth in children. For instance, an inadequate intake of minerals​—mainly iron, iodine, and zinc—​and of vitamins​—particularly vitamin A—​can have such an effect. The United Nations Children’s Fund (UNICEF) notes that a deficiency of vitamin A affects about 100 million small children in the world and causes blindness. It also weakens the immune system, reducing the child’s resistance to infections.

Far-Reaching Effects

Malnutrition wreaks havoc on the body, particularly that of a child. Every organ and system​—including the heart, kidneys, stomach, intestines, lungs, and brain—​may be affected.

Various studies have shown that poor growth in a child is associated with impaired mental development and poor scholastic and intellectual performance. A report from the United Nations calls these effects the most serious long-term results of malnutrition.

For children who survive malnutrition, the aftermath can linger on into adulthood. That is why UNICEF lamented: “The depletion of human intelligence on such a scale​—for reasons that are almost entirely preventable—​is a profligate, even criminal, waste.” So the long-term consequences of malnutrition are of great concern. Recent research relates undernourishment in infancy to a tendency toward such chronic illnesses in adulthood as heart disease, diabetes, and high blood pressure.

However, serious malnutrition is not the most extensive problem, as UNICEF acknowledges: “More than three quarters of all [the] malnutrition-assisted deaths are linked not to severe malnutrition but to mild and moderate forms.” (Italics ours.) Children who suffer from mild or moderate malnutrition may face long-term health repercussions. It is therefore vital that symptoms of undernourishment in children be identified so that proper treatment can be provided.​—See the box on page 7.

Deep-Rooted Causes

As noted before, the direct cause of malnutrition is a lack of food. But there are deeper social, economic, cultural, and environmental causes. Principal among them is poverty, which affects millions of people, particularly in developing countries. However, in addition to being a cause, poverty is also a consequence, as undernourishment weakens people’s productivity, thus intensifying poverty.

There are other contributing factors. Lack of knowledge breeds poor eating habits. Infections, as we have seen, play a role. There are also social and cultural causes, such as the unequal distribution of food and discrimination against women. Women often eat “last and least”​—that is, after men and less than men. Women are also denied educational opportunities that would help them to care for their children better.

In addition, environmental factors cause a decrease in food production. Among these are natural disasters and wars. According to The State of Food Insecurity in the World 2001, from October 1999 to June 2001 alone, 22 countries were affected by drought, 17 by hurricanes or floods, 14 by civil war or strife, 3 by extremely cold winters, and 2 by earthquakes.

Treatment and Prevention

How can a child be treated for malnutrition? If the child suffers from serious undernourishment, hospitalization may be best for initial treatment. According to a manual for physicians published by the World Health Organization, the doctors will evaluate the child’s condition and treat any infections or dehydration. Feeding may begin gradually, often starting with a tube. This initial phase may take as long as a week.

A rehabilitation phase follows. The child is reintroduced to mother’s milk and is encouraged to eat as much as possible. Emotional and physical stimulation are important during this phase. Care and affection can do a surprising amount of good for the child’s development. This is when the mother may be given education on how to care for her child with a proper diet and hygiene, so as to avoid a relapse. Then the child is released from the hospital. It is important that the child be taken to the hospital or clinic for follow-up visits.

Clearly, however, prevention is the best course. That is why in many countries, government and private organizations have established food supplementation programs or programs to fortify foods for general consumption. Communities also contribute to the prevention of malnutrition in many ways, such as by providing nutritional education programs, protecting the drinking water supply, building latrines, keeping the surroundings clean, sponsoring vaccination campaigns, and watching over the growth and development of children.

But what can be done on an individual basis to prevent malnutrition? The box on page 8 has some helpful suggestions. Along with these, pediatric nutritionist Georgina Toussaint recommends that the mother return to her pediatrician or health clinic seven days after the birth of her child, when the baby is one month old, and each month after that. The mother should also seek professional health care if the baby shows symptoms of dehydration, severe diarrhea, or fever.

Although these recommendations are of help in improving the diet of children, it must be admitted that malnutrition is a big problem​—so big that it is beyond human efforts to resolve. The Encyclopædia Britannica acknowledges: “The provision of an adequate food supply and nutritional education to all people, however, remains a crucial problem.” Therefore, is there hope that this “silent emergency” will ever end?

[Footnote]

[Box on page 7]

IS YOUR CHILD MALNOURISHED?

How do health professionals evaluate the nutritional health of a child? They may analyze various signs and symptoms, ask questions about eating habits, and order a laboratory analysis to be made. However, they most commonly rely on fairly straightforward measurements. They measure the child’s body and compare the figures to reference standards. That helps them determine the type and seriousness of the malnutrition.

The most important measurements are weight, height, and the perimeter of the arm. Comparing weight and age reveals the degree of the undernourishment; if it is serious, the child is wasted and looks very thin. The illness is considered serious if the child’s weight is more than 40 percent below normal, moderate if it is 25 to 40 percent below, and mild if it is 10 to 25 percent below. A very low height-to-age ratio may reveal chronic undernourishment​—the child is stunted.

The most serious forms of protein-energy malnutrition (PEM) are marasmus, kwashiorkor, and a combination of both. Marasmus (progressive wasting) appears in nursing babies between 6 and 18 months of age. It establishes itself slowly as a chronic deficiency of calories and nutrients and develops as a result of insufficient nursing or the use of very diluted substitutes for human milk. The baby shows a great loss in weight, the muscles are so thin that the skin sticks to the bones, and growth is retarded. The baby also has “an old person’s face,” is irritable, and cries a lot.

The term kwashiorkor, taken from an African dialect, means “deposed child.” It refers to a child’s being replaced at the mother’s breast by a newborn sibling. This condition appears after weaning, and while it includes caloric deficiency, it develops from an acute lack of proteins. It causes the body to retain fluids, making the child appear bloated in the extremities and the abdomen. Sometimes it affects the face too, making it resemble a full moon. Skin lesions and alterations in the color and texture of the hair appear. Children with this condition show swelling of the liver and are apathetic and sad. This was the case with Erik, mentioned previously, whose mother fed him breast milk for only the first month of his life; then she gave him very diluted cow’s milk. At three months he was given vegetable soups and sugar water and was left in the care of a neighbor.

The third type of PEM includes characteristics of both marasmus and kwashiorkor. All of these conditions can prove fatal if not treated in time.

[Box/Picture on page 8]

PROTECT YOUR CHILD FROM MALNUTRITION!

◼ It is essential to improve the diet of the mother. Pregnant and nursing women need to consume more calories and proteins. Proteins in particular help in the production of mother’s milk. So when there is little food, give preference to women of childbearing age and to little children.

◼ In almost all cases, the best possible food for a baby is its mother’s milk. This is especially so during the first days after birth because mother’s milk contains antibodies that protect the baby from infection. During the first four months or so, breast milk provides all the nutrients that the baby needs in order to grow and develop properly.

◼ Although mother’s milk continues to be the main food, between the fourth month and the sixth, the baby is ready to receive other foods. Gradually introduce fruits and vegetables in a mashed form. Let the baby try one new food at a time. Two or three days later, after it is familiar with that food, let it taste another. Of course, patience and many attempts are often needed before the baby accepts a new food. When preparing such food, remember that everything should be clean, clean, clean! Wash foods and utensils well!

◼ Between the fifth and ninth months of life, babies generally start to need more calories and proteins than milk provides. Continually and persistently introduce other foods. Cereal and vegetable baby food may come first, meat and dairy products later. Whereas the earliest foods are strained, from the baby’s sixth month on, they may be finely chopped. Adding salt or sugar is neither necessary nor recommended.

◼ After eight months, mother’s milk is no longer the basis of the baby’s diet but, rather, a complement. The baby begins to eat the food that the family eats. The food should be kept scrupulously clean, and it should be finely chopped so that it is easier to chew. The ideal diet includes fruits and vegetables, cereals and legumes, and meat and dairy products.b In particular, children need foods rich in vitamin A. Some examples are breast milk, dark-green leafy vegetables, and such orange or yellow fruits and vegetables as mangoes, carrots, and papayas. Children under three years of age need to eat five or six times a day.

◼ The greatest possible variety of foods in different combinations provides nutrients that protect your baby. The mother should focus on providing the child with good-quality food, neither forcing the child to eat after it is full nor withholding food from the child when it appears to want more.

[Footnote]

“The Silent Emergency” Soon to End!

“COMPARED with the relatively recent past, we live today in a world of abundance. . . . There is more than enough food for all . . . theoretically.” So says a study by the World Health Organization (WHO). If that is the case, what is the real problem that causes malnutrition?

“The problem is that food is neither produced nor distributed equitably,” says WHO. “All too frequently, the poor in fertile developing countries stand by watching with empty hands​—and empty stomachs—​while ample harvests and bumper crops are exported for hard cash. Short-term profits for a few, long-term losses for many.” A recent study by the Food and Agriculture Organization of the United Nations (FAO) shows that ‘the richest fifth of the people’ on the planet ‘eat 45 percent of all the meat and fish; the poorest fifth get just 5 percent.’

On the other hand, “a lack of access to good education and correct information is also a cause of malnutrition,” says the United Nations Children’s Fund, adding: “Without information strategies and better and more accessible education programmes, the awareness, skills and behaviours needed to combat malnutrition cannot be developed.” But lack of food, in turn, diminishes a person’s health and ability to get a better education​—yet another vicious circle.

Justice and Unselfish Interest in Others

Despite such frustrating obstacles, some experts in this field are still optimistic. For instance, the director general of the FAO, Jacques Diouf, expressed this hope: “I have a vision of a world where every man, woman and child has enough nutritious and safe food, every single day. In my vision, the shocking extremes of wealth and poverty are reduced. I see tolerance and not discrimination; peace and not civil strife; sustainable habitats and not environmental degradation; general prosperity and not debilitating hopelessness.”

As we have seen, though, it will take more than increased production and distribution of food to realize such hopes. Widespread justice and unselfish interest in others are needed. But these noble traits are not typical of modern commercialism.

Is it possible to eliminate such huge obstacles as greed, poverty, strife, and selfishness and thus rid the earth of malnutrition? Or is this an impossible dream?

The Only Real Solution

According to the Bible, we should not be surprised at the underlying problems that lead to malnutrition. God’s Word states: “In the last days critical times hard to deal with will be here. For men will be lovers of themselves, lovers of money, . . . having no natural affection, not open to any agreement, . . . without love of goodness, . . . having a form of godly devotion but proving false to its power.”​—2 Timothy 3:1-5.

Can mankind eradicate such deeply ingrained attitudes without God’s help? It doesn’t seem likely, does it? Perhaps you have noted that sometimes people in authority have good intentions regarding the social problems of mankind, but selfishness, love of money, and imperfection on the part of others interfere with and paralyze even the most honest endeavors.​—Jeremiah 10:23.

Yet, the solution is not an impossible dream. The Bible promises that the Kingdom of God will put an end to the problem of injustice as well as to all other afflictions that plague mankind today.

Isaiah 9:6-7 offers us this magnificent hope: “There has been a child born to us, there has been a son given to us; and the princely rule will come to be upon his shoulder. And his name will be called Wonderful Counselor, Mighty God, Eternal Father, Prince of Peace. To the abundance of the princely rule and to peace there will be no end, upon the throne of David and upon his kingdom in order to establish it firmly and to sustain it by means of justice and by means of righteousness, from now on and to time indefinite. The very zeal of Jehovah of armies will do this.”

It is this same Kingdom that people pray for when they recite the Lord’s Prayer and say to God, “Let your kingdom come.” (Matthew 6:9, 10) Note that Isaiah mentions that “the very zeal of Jehovah of armies will do this.” Yes, Jehovah God has always been keenly interested in providing for the needs of humans. He has designed this earth to produce ample food for all.

Psalm 65:9-13 says of him: “You have turned your attention to the earth, that you may give it abundance; you enrich it very much. The stream from God is full of water. You prepare their grain, for that is the way you prepare the earth. There is a drenching of its furrows, a leveling off of its clods; with copious showers you soften it; you bless its very sprouts. . . . The pastures have become clothed with flocks, and the low plains themselves are enveloped with grain.”

Yes, the Creator, Jehovah, is the best provider for mankind. He is “the One giving food to all flesh: for his loving-kindness is to time indefinite.”​—Psalm 136:25.

We can be confident that God’s Kingdom under Christ will take care of all people. “There will come to be plenty of grain on the earth; on the top of the mountains there will be an overflow,” as the Bible says. But there will also be an equitable distribution, for “[Jesus Christ] will deliver the poor one crying for help, also the afflicted one and whoever has no helper. . . . The souls of the poor ones he will save.” (Psalm 72:12, 13, 16) So take courage! This “silent emergency” is about to be resolved once and for all.

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