Impact Of Community Development On Population Health And Wellbeing In Africa

MAN308 Community Development on Malnutrition

Literature Review

Millions of people living in Africa lack the basic human needs that can be attributed to poverty. The nation is generally ranked low, with regards to economic growth and development. The small task According to research studies, poverty, in addition to lack of infrastructure, gender inequality and AIDS create significant impacts on hunger in Africa. While there is plenty of food in some regions, lack of reliable pathways for delivering the food to the vulnerable and disadvantaged people contribute to hunger, and subsequent under-nutrition (Gohou and Soumaré 2012). Similarly, gender inequality plays an essential role because there is a tendency to deliver more food to women. AIDS also renders the community members of rural regions too sick to participate in agricultural activities, thereby resulting in their failure to acquire food (Justesen and Bjørnskov 2014). The assignment will illustrate several strategies and frameworks that have been formulated as a part of community development to address the severe issue of malnutrition in Africa.

Malnutrition can be defined as the condition that arises when an individual consumes diet that does not contain adequate proportion of the nutrients, needed by the body. Commonly encompassing overweight and under-nutrition, malnutrition is a global issue and presents a plethora of threats to health (Neis, Zielstra and Zipf 2013).

According to research reports, the continent is under serious nutrition related threats that stem from deficiency in nutrients in the diet. Despite an reduction in prevalence of stunting on a global scale, more than 60 million African children, under the age of 5 years demonstrate poor growth and development. Recent reports from the WHO indicate that the issue is still persistent in the region, which thereby contributes to an increase the number of undernourished children (Horton and Steckel 2013). The major factors that contribute to under-nutrition are population growth, limited resources for purchasing food and mounting food wastes. This lack of nutritious food items creates a significant impact on the infrastructure development and economic progress of the nation, in addition to human wellbeing. African nations are found to lag behind on attaining appropriate physical and mental capacities for the population due to under-nutrition. An increase in mortality rates, chronic illnesses, and loss of productivity contribute to this condition (Chan et al. 2012). Thus, it can be stated that improving the dietary intake and ending malnutrition in the nation will greatly help in reversing the problem. The African government and non-governmental organizations have adopted several strategies with the aim of formulating productive and sustainable measures that will counteract the issue of malnutrition and enhance the overall growth and wellbeing of all individuals.

Analysis of the Articles

According to statistical data, about 1 in 12 children living in the sub-Saharan regions of Africa suffer from malnutrition. The World Bank reports state that approximately 17.6 million children living in the region are affected with acute malnutrition (Bain et al. 2013). Furthermore, there was an increase in the number of stunted children, between the years 1990-2014, by approximately 20 million. Further reports from the WHO also suggest that Africa demonstrates the highest risk of a child dying before the first birthday (Grace et al. 2012). Research findings also illustrate the fact that more than 6.7 million people die each year in Africa due to hunger (de Sherbinin 2011). Health promotion is defined as the process that enables individuals to improve and increase their control over their health status. It focuses on a range of environmental and social interventions. Socio-economic differences directly influence the educational attainment, occupational status, and income. The social determinants of health are most often amenable to a range of political interventions and depend on political action (Ahnquist, Wamala and Lindstrom 2012). Health promotion strategies are governed by the politics of the nation because wellbeing and good health are the basic aspects of human rights and citizenship (Savedoff et al. 2012). Cultural aspects of a the residents also influence health promotion owing to the wide plethora of existing experience and knowledge, regarding health promotion and disease prevention that exists among the culturally diverse populations (Mackenbach 2012). Thus, it can be stated that these factors play a major role in the adoption of effective health promotion strategies.

The primary aim of PRISMA is to evaluate the interventions that have been applied in the context of research. It acts as an essential critical appraisal tool that facilitates the quality assessment of the selected literature, thereby assisting in gauging the reliability and effectiveness of the research findings (Stovold et al. 2014). Thus, the PRISMA acts as a broader effort for improving the reporting of various kinds of healthcare based research. The PRISMA flow diagram helps in depicting the flow of relevant information through a wide variety of stages that are imperative for a systematic review. The diagram assists in mapping out the records that have been identified, excluded or included in the search. The diagram also explains the probable reasons for exclusion of the articles. The major themes for the literature review include nutritional capacity assessment, nutritional feeding or therapeutic feeding programs, integrative protocol, and community management strategies.

Relevant research articles were extracted from PubMed databases by using specific key words such as, “child”, “children”, “malnutrition”, “under-nutrition”, “prevention”, “reduce”, “strategies”, “community development”, “framework”, “Africa”. Several boolean operators such as, AND, OR, and NOT were used to narrow down the search and exclude articles that were irrelevant to the topic of interest. Articles that were published in English, not prior to 2011, were selected for the analysis. Unpublished articles, abstracts and articles published before 2011 were excluded. Fourteen articles were enlisted (refer to appendix for PRISMA flow chart).

Table 1- Summary showing database search results

Theme 1: Nutritional capacity assessment

A framework developed by (Shrimpton et al. 2014) was based on building the nutritional capacity for addressing the needs of child and mother malnutrition. The methodology was appropriate due to the fact that capacity refers to the ability to conduct the predetermined objectives and the procedure by which groups, individuals or organisations are able to increase their problems solving ability. The researchers demonstrated an appropriate practice in building the concept on existing approaches. Furthermore, the research focused on the operational effects of system, organizational, workforce and community level on nutritional assessment of the community. The methodology acknowledged the importance of involving beneficiaries to improve nutrition. It also illustrated the role of population coverage, village organizational structure, community ownership and proper training to improve the nutritional needs. Issues were associated with  superficial conceptualizations of capacity development.

Theme 2: Nutrition feeding/therapeutic feeding

Another research study (Tomedi et al. 2012) was conducted with the aim of determining the effectiveness and feasibility of locally available food supplementation to prevent child malnutrition in Kenya. The research study was accurate in the way that it focused on the rural population that had higher rates of child under-nutrition. The methodology can be stated accurate due to the fact that food supplementation has been earlier proved to increase the amount to nutrients in the normal diet among people suffering from its deficit. Furthermore, the researchers focused on administering essential nutrients to the undernourished children. Thus, distribution of food ration on a monthly basis was a necessary step that facilitated consumption of essential proteins, vitamins and minerals, required by children in their growth years. Moreover, conducting educational sessions on appropriate food handling and hand washing techniques were also needed for preventing any adverse health effects.

The nutrition intervention programs that focused on malnutrition were assessed by another study (Iversen et al. 2012). This demonstrated a correct methodology due to the fact that the primary aim of these programs was related to alleviating malnutrition among the young population. The primary drawback of these intervention programs was the fact that they failed to address the nutritional needs of the blacks and other disadvantaged population. The research was accurate in analyzing the positive impacts of the community-based programme such as, the Integrated Nutrition Programme on the population. However, it was also successful in establishing failure of the programmes in increasing growth rates among the under-nourished children in Africa.  

Effectiveness of a mid-upper arm circumference related therapeutic feeding program on treating acute malnutrition in West Africa were determined by another study (Goossens et al. 2012). The research was conducted in Burkina Faso, a region in West Africa that is severely affected by high prevalence of children under-nutrition. Therefore, the research study was correctly able to identify the global issue related to malnutrition and focused on a community-based management to reduce the high burden of the disease. The methodology was correct in using a routine program for monitoring data from the nutritional program that was conducted in collaboration with the ministry. It was also accurate in identifying nutritional indicators for the reason that emphasized on high levels of wasting and stunting. The nutritional program was appropriately implemented following recommendations imposed by the national guidelines. The methodology focused on increasing accessibility of the nutrition programs to all people, regardless of their social standards. Accuracy can be demonstrated by the fact that children, who received their nutritional intervention recovered better, achieved the standards of weight gain, showed absence of pathological diseases, and had minimum duration of stay.

Another research article identified the effectiveness of community management strategies in reducing acute malnutrition in regions of the developing world, such as, Ethiopia (Park et al. 2012).The methodology was correctly able to focus on the fact that more than 52 million children under the age of 5 years suffered from protein energy malnutrition. It also speculated that addressing malnutrition properly would lead to reducing one third of the total rates of child mortality and morbidity. It illustrated the importance of the management strategies formulated by the WHO, in addressing under-nutrition. It also focused on effectiveness of gaining knowledge on the function of different proteins, and antioxidants that play a major role in pathogenesis of malnutrition. Necessary administration of mixture of oil, sugar and dried skimmed milk in diluted clean water, which is supplemented with additional magnesium and potassium, was elaborated. The article focused on the importance of readymade recovery diet that is widely available and easily accessible. Importance of providing adequate training to the staff, and increasing provisions of emergency interventions were also discussed.

The long term benefits of nutritional therapy among children suffering with moderate acute malnutrition (MAM) in rural regions of Malawi were determined by another study (Trehan et al. 2015). The methodology was correct in recruiting children aged 6 to 59 months suffering from MAM, due to the fact that this physiological condition creates a drastic reduction in weight of children. It was accurate in measuring year-long benefits of supplementary feeding among such children regardless of their anthropometry. It focused on administration of soy ready-to-use, whey ready-to-use, and blended supplementary foods. The researcher’s demonstrated accurate practice in providing training to the research nurses, responsible of implementing the nutritional program upon a child. Standard methodologies were set for the anthropogenic measurements. Effectiveness of the research lies in the fact that lower rates of malnutrition and a reduction in death rates, on supplementary feeding were observed.

Effectiveness of outpatient therapeutic feeding programs in improving recovery rates among children suffering from acute malnutrition in Kamba district was determined by another study (Shanka, Lemma and Abyu 2015). This research accurately reported that severe acute malnutrition resulted in maximum number of paediatric hospital admissions in poor countries of Africa. The researchers demonstrated a correct practice in recruiting children, suffering from this physiological disorder and were treated in outpatient services, through administration of feeding programs. The methodology was correct in focusing on semi-structured data collection procedure for determining the socio-demographic baseline characters, outcomes status and follow-up conditions. Effectiveness of the therapeutic program was shown by high recovery rates among children who received the treatment (67.7%). However, upon comparison with international standards, recovery rates were found to be lower, which indicates conduction of therapeutic programs on a more rigorous basis.  

Infants suffering from severe acute malnutrition were also treated in a study that was conducted in the Niger (Vygen et al. 2013). The methodology accurately recruited young infants, admitted to nutrition rehabilitation programs for curing under-nutrition. The researchers demonstrated an accurate practice in establishing importance of intensive antibiotic therapy, exclusive breastfeeding, and coaching mothers on infant feeding practices. These interventions showed significant improvements in rates of recovery (85%). Furthermore, effective implementation of the nutritional rehabilitation program reduced mortality, infection and default rates among the recruited infants.

Major ethical issues were associated with the existing debate on artificial nutrition and hydration techniques. Furthermore, a large proportion of the population most often refused therapeutic and nutritional feeding programs due to stereotypes and prejudices.

Theme 3: Integrative protocol

Another research also investigated the implications of an integrated protocol in managing severe and moderate malnutrition among people living in Sierra Leone (Maust et al. 2015). The research was correct in identifying global acute malnutrition as a major problem that contributes to high rates of mortality and morbidity among children and infants. It was also able to recognise the fact that humanitarian emergencies like war, and draught often escalate rates of malnutrition. Following recruitment of children with mid-upper arm circumference less than 12.5 cm, and inadequate appetite, the researchers implemented the treatment protocol, recommended by the government. Standard management protocol included proper administration of vaccines, food supplements, folic acids and vitamins. They also demonstrated an accurate practice in feeding the children with fortified blended flour that contained correct proportion of all essential nutrients. Effectiveness of this treatment protocol can be associated with greater recovery rates, and improved weight. The program also showed significant effects on reducing the number of clinical visits, fever, infections and diarrhoea.

Implications of sustainable nutrition research agenda in sub-Saharan African regions were also evaluated by a study that was correct in stating the fact that considerable economic growth in the country fails to improve under-nutrition rates, when compared to the world (Lachat et al. 2014). It was also correct in addressing the fact that diet related non-contagious diseases are a major public health issue in the continent. The research focused on community interventions for improving nutritional status among the members. It also established the importance of behavioural strategies and food security interventions for improving impression.  The findings were accurate in stating that better governance on research that addresses nutrition problems, aligning all nutrition related funding with priorities of the population, increasing the capacity of nutrition research competency, and enhancing the process of information sharing in nutrition research, are some of the major approaches that were considered essential by the primary stakeholders of the nation.

Lack of viable rural infrastructure that would enable a policy environment for eliminating malnutrition and hunger are the major issues related to this theme.

Theme 4: Community management strategies

A review focused on addressing the global concerns that were related to improvement of nutrition among undernourished children in Asia and sub Saharan Africa (Duggan 2014). The review was accurate in identifying the fact that undernourishment is often considered as a failure of the dietary energy intake of the community while meeting the requirements. It was correctly focused on the wide prevalence of undernourishment in sub-Saharan Africa, which deteriorates the overall health and well-being of children. It appropriately focused on certain anthropometric measurements for assessing presence of under-nutrition in children staying in such settings. It focused on adoption of welfare foods for improving this scenario. Furthermore, the review was also a successful in establishing correlation or links between improve child nutrition and economic development of the country. Findings suggest that economic growth of Africa directly resulted in a reduction in poverty, increased the availability of food and enhanced child and maternal health Services. This created positive implications on nutritional consequences. It was also appropriate in identifying the importance and effectiveness of nutrition sensitive programs, as the primary determinants of child nutrition. It established the fact that these programs are larger in scale and multidisciplinary. It also identified the need of implementing appropriate agriculture practices, health practices, water and sanitation, education and child development to reduce rates of child malnutrition. Furthermore, the methodology illustrated the success of nutrition specific preventive strategies, partnered by the national government and UN based non-governmental organisations. The efficiency of incorporating nutrition education in National policies was also defined by the review.

Another study considered views of African stakeholders in improving nutritionals status in sub-Saharan regions (Holdsworth et al. 2014). The researchers showed an appropriate methodology in setting the research priority on improving nutrition in Africa and shifting the status quo towards reducing malnutrition. Using multi-criteria mapping strategy, views of African stakeholders were correctly analysed, in the context of socio-demographic and environmental changes that might create an impact in malnutrition. Findings stated that community interventions were considered the major priority by stakeholders. Furthermore, the study also established the fact that a cost-effective and inexpensive community management strategy, related to behavioural nutrition would help in reducing acute malnutrition among infants.

A prospective interventions study was also conducted in Niger to prevent moderate and severe acute malnutrition among young children (Lagendorf et al. 2014). It was correct in stating the fact that good nutrition forms an essential aspect of health and survival, and increases the susceptibility to chronic elements and infectious diseases. On conducting the study in the villages, while focusing on cash and increased amount of family food ration, which was able to meet energy needs of all average household, the researchers found that combination of supplementary food distribution and cash transfer was effective in preventing acute malnutrition.

Impacts of community based agricultural interventions on nutrition and food security in South Africa were also determined by a study that was correct in identifying the country as one of the 36 high-burden nations, which contain undernourished children (Faber, Witten and Drimie 2011). The methodology focused on small scale and home-grown food production for the rural people, while focusing on technical and contextual factors. The researchers demonstrated an appropriate practice in teaching several models of home gardening that could address micronutrient deficiencies among the people. It also focused on sustainable home agricultural practices, and addressed gender distinctive issues. Findings suggested that such community based interventions acted as a critical component in reducing rates of malnutrition, and improving food and national security in all households (refer to appendix for summary table).

Conclusion

Thus, it can be stated that supplement feeding programs are an important intervention that can help in addressing and the nutrition. Such feeding programs focus on increasing the amount of ration for each child. They also emphasize on use of locally produced foods such as vegetables, beans and rice that will help in supplying essential macro and micronutrients to the diet. Consuming adequate number of blended cereals act as a major source of vitamins and minerals. Using dry food ration or premixed ration on a weekly basis can help in providing a dick with nutrients that are required by children. It will also improve weight. Dietary management of children, suffering from acute malnutrition should also focus on appropriate breast feeding practices that are inexpensive, when compared to infant formulas. Giving adequate milk to a child helps in reducing the energy deprivation, and deficiency of vitamins and minerals. Furthermore, it also adds essential proteins fats and nutrients to the diet. Immune factors present in the milk will also help in eliminating infectious diseases that occurred due to under-nutrition. Conducting appropriate training courses in hospital and outpatient facilities to manage severely malnourished children will also help in reducing rates of paediatric deaths. Such training programs will improve knowledge of the health workers on nutrition assessment, thereby filling the gap.

To conclude, it can be stated that, the community should focus on adopting effective management strategies for reducing rates of mortality morbidity and hospital admissions due to under-nutrition among children. Effective implementations of these community management practices will also help in weight gain, and overall survival of the children.

The research question was kept comprehensive and precise. It is mentioned below:

Have community management efforts and interventions been successful in reducing malnutrition rates in the African population?

References

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