Etiology and Epidemiology
Introduction
The double burden of nutrition can be defined as the characteristics of a country where there is a co-existence of under nutrition along with the disorders of overweight and obesity or also other diet-related non communicable diseases not only in the personal level within individuals but also among households, population and across he life courses (Ramachandran, 2016).. It has been found from a statistical analysis conducted by WHO (World Health Organization) that in the year 2014, approximately 1.9 million adults were found above the age of 18 an older who were overweight. At the same time, it was also found that 462 million people were found underweight. . Again, 600 million people were found to be obese. It has been found that poor nutrition continues to cause death in children out of which half the population of children are under the age of 5. Low and middle income countries are facing such these consequences for about 30% faster than the high income countries and therefore, it has become one of the primary concerns of the nations about how to handle the condition strategically to reduce the double burden of malnutrition and give a proper quality life (Shankar et al., 2017).
Etiology and epidemiology
India is one of the south east countries which are facing the consequences of double burden of malnutrition in spite of a huge number of initiative been taken at a national level as well as an international level. However, there is a requirement to discuss the entire scenario that had contributed to the occurrence of such a situation in India. After the independence of India, policy makers and politicians have identified the importance of India as a developing country to recognize the importance of planned growth as well as economy emphasis on the on human resource development (Kosaka & Umezaki, 2017). However India has not yet been successful in overcoming the problems of poverty, communicable diseases as well as under nutrition. Besides, it is also facing additional challenges which remain related to the affluence of industrialization, urbanization an economic betterment. Last two decades have seen the rate of obesity and overweight to increase along with prevalence of diabetes and cardiovascular issues in the urban areas (Mastorci et al., 2017). These disorders vary between urban and rural areas as well as in the different states and socio-economic strata. Case fatality rates are reported to be higher in the poor as well as rural population mainly because of the poor health care and delayed diagnosis and treatment or disorders in such classes.
Determinants in this scenario
The population of India has been seen to increase from 934 million in the year 1996 to that of 1264 million in 2016 although there has been no effective strategies to tackle the population increase effectively. This is leading to failure of the strategies as the strategies are not being able to provide intervention at the similar case of exponential increase in population. Moreover, the technological advantage and increases access to healthcare have caused reduction in crude birth rate from 24.10 to 21.41. Crude death rate from 8.99 to 7.48 as well as natural growth rate from 1.51 to 1.39 percent, infant mortality rate from 63 to 38 per 1000 live birth for males and 64 to 39 for females. All these had resulted in steady growth of population but managing resources to provide food, education and helter to these increase number of population had not been conducted properly which had contributed to poor quality living, lack of access to quality food, proper education for maintaining lifestyles and maintain a steady health and well being (Bohman, 2015). Moreover population is also growing because the present generation has the highest number of the reproductive age groups, high fertility due to lack of contraception. Due to the vast increase in population number, government is facing he issues to tackle the situation as financial development of the nation though developing steadily but is not sufficient for providing good food and lifestyle resources to this huge population increase. As a result while the urban areas are getting cases of obesity and the rural areas are facing underweight issues. Lack of financial power in rural areas leads to compromised women health and sequentially to their babies, that result in compromised health and poor nutritional status. Moreover lack of education, developing healthcare services (incapable for treating huge number of patients) have also resulted in poor condition of rural areas. All these lead to child mortality and even though they survive, they carry on the trend in a generation wise manner affecting the health of the nation.
Determinants in this scenario
Statistical analysis and researches conducted in India by eminent researchers have helped us to look deeper in the issue and has helped in pointing out some of the main determinants that had resulted in the present condition. India has been facing huge number of deaths in the under five children cohort. The main cause of malnutrition as well as death in the children has been contributed to three important reasons (Thow et al., 2016). The intergenerational perpetuation of malnutrition is first because often underweight pregnant women increases the likelihood of giving birth to low weight babies which in turn becomes a strong predictor of the underweight in infancy as well as in early childhood. Secondly, malnutrition in the different lactating mothers raises the incidence of the children receiving reduce micro-nutrient consumption during feeding on breast milk. This again affects infant growth. The third reason is that malnourished women are always sick and weaker and therefore they are less able to care for their children, effectively. These children often grow up on minimum nutrients which result them in stunted growth, wasting and poor quality lives. The low socioeconomic people also cannot afford privatized healthcare due to its high financial demands and the governmental hospitals remain overcrowded and effective treatment is delayed (Florentino 2014). The governmental healthcare although trust to provide the best care but lack of resources in order to meet the huge demands cut off their best attempts to give good lives to people (Ramirez et al. 2014). Low socioeconomic people also cannot afford education and financial stability required for maintenance of lifestyles and therefore they are not being able to afford proper quality food which becomes an addition indicator to poor nutritional status in addition to their low birth weight conditions (Shankar et al., 2017). However in the middle and higher classes, digitalized life and high tech life have affected in bad health in urban areas where huge pressures of work in office given people less scope for exercises and make people indulge in high calorigenic fast food which results in obesity. Static lifestyles, unhealthy diets, excessive pleasure in using gazettes, little sleep, little exercises and indulgence in luxurious lives all result in individuals being overweight. Lack of knowledge about health maintenance and better financial stability are the determinants of obesity in India (Thow et al., 2016). One of the another important findings of the researchers working on this topic in India have found out that the healthcare systems in India has lack of preventive health care assistant and is more based on curative. Hence making people educated about their health, making them aware of the wrong practices and the consequences are not promoted at a higher rate than it should have been. However, the present government has recently taken the issue of maternal nutrition strategies and missing the voices reach to rural areas as well. More rapid and evidence based strategies are require on an urgent basis to handle the dual burden of malnutrition effectively (Victoria & Rivera, 2014).
Food production statistics of the area
Food production statistics of that area
India having a population of above 1.2 billion has seen huge growth in last two decades where the gross domestic product has increased 4.5 times two times per capita consumption had increased thrice (Shankar et al., 2017). Food production in India has also increases about two times but in spite of producing sufficient amount of food to feed it population. India is unable to provide access to food to a larger section of people with the women and children being in the forefront of the danger. The FAO estimates have shown in the “The State of Food Insecurity in the World, 2015” , 194.6 million people are undernourished in the nation with 48% of women being underweight and 44% of the children under 5 being underweight. India is also ranked at 97 out of 118 countries in the world in the Global Hunger index of 2016 and showed three important indicators (Thow et al., 2016). This are prevalence of wasting and stunting children under 5 years, under 5 child mortality rate and proportion of undernourished children in population. Researchers have found out that one third of the food produced in the nation gets wasted or just gets lost due to corrupt stakeholders in management. about 40% of the fruits and the vegetable and 30% of the cereals which are produced by the farmers of the nation are lost due to inefficient supply chain management and do not reach the consumer markets. The farmers are forced to sell their harvests in lesser amounts to the stakeholders who often exploit their efforts and pay them less even when the government is paying a good amount to farmers. It is the middle men who undertake corruptions. A significant level of food losses are seen to occur upstream, during harvest and also during post harvest handling. A lot of food is lost or wasted even during distribution and consumption stages. Some of the food also gets wasted in the shelves and in warehouses of food business either due to excess production, introduction of new products, labeling errors and also due to shorter remaining life cycle (Tzioumis et al., 2016). The food which can be easily salvaged by timely withdrawal from the networks of distribution, proper aggregation of the food and then redirecting it to people of need get wasted due to inefficient workforce, inefficient knowledge of proper management, present of absenteeism, corruption and not being responsible with the duties of management workers. Therefore although green revolution had made India greener, the poorer class ha still been the sufferers (Mastorci et al., 2017). The middle and high income people are wasting food at a higher level and no proper strategies of renewal of food sources are present.
National dietary patterns
Source: (Mastorci et al., 2017)
Source: (Thow et al., 2016)
Source: (Thow et al., 2016)
Source: (Tzioumis et al., 2016)
National dietary pattern of Indian food habits
The Indian dietary pattern is very high on carbohydrates which cause their predisposition to different insulin resistances and diabetes, blood derangement and weight gain. Milled rice, pulses, table sugar, milk products and others all lead to heavy carb diet. Moreover as most the diet is vegetarian therefore it lacks certain important nutrients like B12, long chain omega 3 fatty acids, vitamin A and Iron. Indians have less protein in their diets due to their dietary patterns more curbs increases their chance to develop obesity and weight gain (Tzioumis et al., 2016). They have cereals and oilseeds dominate diet, which does not provide them enough protein but lots of calories. Moreover static lifestyle in the upper socio-economic classes is mostly affected. Due to les financial stability, low socioeconomic classes cannot afford food two meals a day even and even if they can afford of they are carb rich rather than proteins. Meat and fish are higher in cost and therefore cannot be afford by people on a daily basis which is very important for children during their growing years. All these had lead to the dual burden of malnutrition in India.
Strategies
The action plan is the framework or strategies that are implemented for building the strategic directions for creating or enabling the environment to provide nutrition to the individuals. However, some basic strategies are used for mapping the associations between the policy actions, the global form of nutrition, the relevant form of the indicators and the actions for making the various policies to improve the conditions of the health and the nutrition levels of the population. Therefore, some of the strategic plans are discussed in the section below
Strategy A: The improvement of the governance by enhancing the political form of commitment informed evidences and the context that are specific to the policies of the sectors
The good form of the governance can be unexpected phenomenon upon a very strong form of leadership, the will of setting the administration and the commitment towards the government. However, nutrition, in today’s world has become the most prioritized as the most important factor for developing the agenda of the country (Thow et al., 2016). It should be ensured that the healthcare system of the nation incorporates the maternal and the child health. The nutrition is an essential and primary package of the healthcare. With the increasing rate of malnutrition that are reflecting the poor condition of health of the population, the country’s healthcare have implemented various effectual packaging interventions to reduce the rates of interventions. The establishments of the high levels of coordination of the mechanisms are due to the nutritional actions that are needed in the multisectors (Mastorci et al., 2017). The government should also ensure the policy that provides the adequate form of financing for providing proper nutrition to the population.
Intervention strategies
Strategy B: Developing and adopting the guidelines that are relevant and regulatory that can help in the implementation of the interventions that are based on the evidences
The development of guidelines, regulatory form of the frameworks and the legislations are very much essential for the instruments that are essential for doubling the burden of the malnutrition. The guidelines that are evidence based are always available at the globalized level and should be adopted by the countries that are based on the context to the country.
The national guidelines for the dietary that are generally food based often helps to promote the nutritious form of the diet that emphasizes on the diversities of the high form of intake of the fibres and low sugar, salt and fat (Ramachandran, 2016). The national policies have limited the intake of the fatty acids and they tend to virtually eliminate the partial form of the hydrogenated vegetable oils in the supply of the food. The promotions of the fiscal policies are being practiced to overcome the unhealthy form of diets and enhancing the access of the healthy form of food. This phenomenon ensures that the guidelines are practiced all over the country for the supplementation of the macronutrient and for the fortifications of the products that are suitable for the population of the country (Shankar et al., 2017). However, it is very essential to review and develop the better form of national guidelines for the prevention and the treatments to provide care for managing the common form of diseases.
Strategy C: For addressing the double burden of malnutrition the there must be a development to strengthen the health systems by adding sufficient resources, strengthening the capacity and monitoring the community.
To achieve proper nutrition it is important to maintain the availability of the nutrition services so that it can be afforded easily. It is essential to arrange an evidence based development process that will incorporate latest technology, research and learning tools. For the primary healthcare some packages has been developed which ensure that a proper system is incorporated for nutrition of mother and child (Haddad, Cameron & Barnett 2014). To follow this policy an essential package of nutrition was developed by the health care system, which can reflect the double burden of malnutrition. Adequate resources were funded to fulfill the requirements for proper nutrition. Some qualified professionals are appointed to access and evaluate the nutrition programs implemented to reduce the double burden of malnutrition. Healthcare facilities were promoted that offer nutrition services in clinical condition to prevent and provide proper treatment for serious acute malnutrition problems. Food laboratories are being upgraded to ensure the safety of food and for supporting the implementation for healthy diet of mother and child (Shrimpton et al. 2016). Safe management of water was also established and access of the proper sanitation facility at different communities. Some actions were initiated for the development of nutrition and identification of the indicators to inform, evaluate and monitor the actions that are suitable for tracking the double burden of malnutrition.
Strategy D: For promoting healthy diets and formation of strategic alliances the communities must empower and strengthen the knowledge of nutrition.
The promotion of community empowerment depends on the development of the policies that are established to reduce the double burden of malnutrition. It is also important to form partnership with the food sector for promoting healthy diets which can help to reduce the double burden of malnutrition. Some action groups have been formed by the civil society organizations which helps to promote physical activity and healthy diets used to support the promotion of education campaigns of nutrition (Tebekaw, Teller & Colón-Ramos, 2014). Engagement of academic institutions is maintained for monitoring the evaluation of research to reduce the double burden of malnutrition. Advocating the resources for nutrition, support the partnerships policies and coordinating the mechanisms of health and various sectors for promoting healthy diets and safe nutrition. Supporting the targets to develop the National policies, action plans as well as the strategies which to reduce the double burden of malnutrition (Tzioumis et al., 2016). Community advocacy plan were developed and implemented for providing healthy diet. These plans execute the strategies of social marketing and also help in teacher training to improve the nutrition education in schools. The society must engage with the private sectors for the reduction of obsesogenic environment to reduce overweight obesity and dietary risks. On the other hand healthy lifestyles were also created in communities to reduce different forms of malnutrition. Healthy diets and lifestyle is also being promoted at workplaces to reduce the overweight and encourages in proper nutrition of the workers.
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