Improper feeding and its health implications among under five (5) years children

Introduction

Improper feeding (bad feeding habit) is a situation in which an individual neglect the proper feeding habit or it is a condition of adequately consumption of food nutrient that can enhance the normal body functioning system.

In other words, it is a pre disposing factor responsible for malnutrition. From ancient time, improper feeding or inadequate food consumption has been a predisposing factor of malnutrition. The issue predisposing factor of malnutrition has become a concern to health practitioners’ worldwide.

Malnutrition remains a factor in 60% of 11 million deaths of children under the age of 5 years old globally each year. Improper feeding is the most important risk factor for the burden of diseases in developing countries, which causes long term detrimental consequences, such as impairment and poor academic performance in children along side with other nutritional disorder.

Recently, there has been an increase in the prevalence of malnutrition as a result of improper feeding in Africa, which means that the glob set to reduce the level of under nutrition by 50% between 1990 to 2016 may not be met. The number of underweight children in Africa increased from 26,000,000.00 in 1990 to 32,000,000.00 in 200 in which prediction has been made that it will increase from 24.0% to 26.8% by 2016 (Blessner, 2005).

According to Appah and Krekling (2005), malnutrition is an important global public health problem and it is important to understand the factors that determine the translation of child health and nutrition into appropriate action to develop more effective invention against malnutrition. This may be as a result of war, food, taboo, socio-cultural factors and poverty, unequal distribution of food or lack of nutritional knowledge and so on.

Conceptual framework

Grantham (1984) stated that in developing countries, million of young children suffer from nutritional deficiencies and frequent infection. There is now a large and increasing body of evidence to indicate that nutrition and health affect children cognitive motor and behavioural development, as well as the severity and duration of the insult. However, because nutrition deficiencies and infections frequency occur together, the problem resulting from any one insult may be exacerbated by the presence of another and the effect can be cumulative. He further pointed out those children who suffer from those complication on nutrition as deficiencies and infections are usually from poor socio-cultural environment and suffer from a myriad of deprivation and disadvantages that could themselves be detrimental to intellectual and behavioural development also include poor physical resources such as overcrowded homes with poor sanitation and water supply, few household possession and low income. He added that limited education of parent may have to do with the nutrition disorders of children.

UNICEF (1998) has pointed out that 44% of children in developing countries are exclusively breast feed from 0 to 3 Months, 45% are breast feed while receiving complementary food at 20 to 23 Months range from 2% in Nigeria to 10% in Rwanda whereas values for breast feeding at later ages are much more consistent across countries. These data suggest that cultural country specify variable may influence it exclusively but not the basic practice of breastfeeding.

It is estimated that 19% of children under five years old in south Asia and 10% of children in sub-Sahara Africa are severely underweight children in estimated to have declined globally from 38% in 1980 to 34% in 1990 to 30% in 1997. Not all countries have shown this decline. Although the term protein energy malnutrition is used to classify Kwashiorkor, along with marasmus and other forms of malnutrition, it is recognized that many nutrient deficiencies are present in protein energy malnutrition. There have been proposition to replace the term “ protein energy malnutrition” with energy nutrient malnutrients malnutrition. However, protein energy malnutrition is still the standard term used.

Water low and Rutishanser suggested that protein energy malnutrition can be classified by the degree of washing and stunting. Washing (weight expressed as a percentages of the expected weight for height), indicates current or recent nutritional condition whereas stunting (height for age) indicates nutritional experience over longer period of time it is probable that the duration of malnutrition is more highly related to children’s mental development than short – term severity.

Meek and Gradner (1997) stated that a few studies have been undertaking assessing the behaviour of mildly to moderately under-weight infant or school aged children who were also stunting to some degree.

Factors that influence improper feeding in growing children

According to Children Centre for Digestive Health Care (2010), many factors combine together to effect feeding in growing children. Common problems affecting feeding, especially in growing children may include:

  1. Reflux
  2. Prematurity or milk protein allergy more severe problems are particularly common with children
  3. Developmental delay
  4. Sensory disorders
  5. Autism  however, multiple other reasons may result in feeding disorders including, anatomical or structural problems (e.g cleft palate), medical conditions,
  6. Swallowing disorders
  7. Oral – sensory disorders
  8. Food allergy
  1. Reflux

Webberley (2015) stated that acid reflux is when some of the acid content of the stomach flows up into the oesophagus, into the gullet which moves food down from the mouth. The stomach contains a strong acid, hydrochloric acid, to help with the efficient digestion of food and to protect against undesirable microbes such as bacteria.

The living of the stomach is specially adapted to produce this acid, and also to protect the digestive organ against its own corrosive secretion, but the higher gut is not protected from this acid a ring of muscle. The gastroesophageal sphincter normally protects the oesophagus form the contents of the stomach by acting as a valve that lets food into the stomach but not back up into the oesophagus. When this valve fails and stomach contents are regurgitated into the oesophagus, the symptoms of acid reflux are felt, such as heartburn. This is also known as pyrosis or acid indigestion.

What causes acid reflux

We all may experiences acid reflux occasionally, often associated with certain food and drink recurrent acid reflux that leads to disease has other causes and risk factors and is termed gastoresophageal reflux disease (GERD or GORD) other risk factors are more easily controlled and often directly linked to modified lifestyle or dietary issues including:

  • Obesity
  • High intake of table salt
  • Low dietary fibre intake
  • Low levels of physical exercise.
  • Medications, including drugs for asthma, calcium – channel blockers, antihis-tamins, painkillers, sedatives, and antidepressants.

Signs and symptoms of acid reflux

Acid reflux whether it is a harmless, isolated episode of the sort we all experiences at some point or the persistent problem of gastroesophageal reflux disease, usually produces the same main symptoms which include:

  • Heartburn
  • Nausea
  • Vomiting
  • Wheezing
  • Dry persistent cough
  • Bad breath
  • Chest or upper abdominal pain.
  1. Prematurity or milk protein allergy

Marshall (2011) stated that if your premature infant or growing child was born before the gestational age of 32 to 34 weeks, he or she cannot feed mouth. This is because of:

  • Poor coordination (or lack) of sucking, swallowing, and gag reflux
  • Weakness of both the oral and stomach muscles
  • Small stomach

Until your infant becomes stronger and more mature, tube feeding into the stomach for children whose gastrointestinal tract cannot yet digest properly or is affected by necrotizing enterocolitis intravenous (parentaral) feeding are given through a tube into the umbilical site (umbilical catheter) or into a vein. Archana (2011), stated that milk protein allergy occurs when the immune system mistaking sees the milk protein as something the body should fight off. This starts an allergic reaction, which can cause a growing child of ages (1-5) fussy and irritable and cause an upset stomach and other symptoms. Most kids who are allergic to cow’s milk also react to goat’s milk and sheep milk, and some of them are also allergic to the protein say milk. A milk allergy is not the same thing as lactose intolerance the inabilities to digest the sugar lactose, which is rare in infants and more common among older kids.

Signs and symptoms

The slower onset reaction is more common symptoms may include loose of stools (possibly containing blood), vomiting, gagging, refusing food, irritability or colic, and skin rashes, like eczema.

In some cases, a potentially severe allergic reaction (anaphylaxis) can occur and affect the baby skin, stomach breathing and blood pressure.

  1. Development delay

According to Kyla (2010) development delay is when your child dose not reach their development milestones at the expected times. It is an ongoing major or minor decay in the process of development if your child is temporality lagging behind, that is not called development delay. Delay can occur in one or many areas for example, gross or fine motor languages social or thinking skills.

Causes of developmental delay

Developmental delay can be many different causes such as genetic causes (like down syndrome), or complications of pregnancy and birth (like prematurity or infections). Often, however the specific cause is not known other causes may also include:

Cerebral palsy, mental retardation, failure to thrive, Hookworm infections, hydrocephalus, cystic fibresis, etc.

  1. Sensory disorder

Zimmer and Desch (2012). Stated that sensory disorder is a condition that exists when multi sensory integration is not adequately processed in order to provide appropriate responses to the demands of the environment.

The sense provide information from various modalities – vision, audition tactile, olfactory taste, proprioception, and vestibular system, that humans need to function. Sensory processing disorder is characterized by significant problems to organize sensation coming from the body and the environment and manifested by difficulties in the performance in one or more of the main areas of life; productivity, leisure and play or activities of daily living. Different people experience a wide range of difficulties when processing input coming from a variety of senses.

Signs and symptoms

  • Children may appear unreactive and slow
  • Child might be difficult being toilet trained, unaware of being wet or solid
  • Appear implusive
  • Have poor posture
  • Appear slow and uncoordinated
  • Children might be delayed in crawling standing, walking or running
  • Difficulty dressing and eating
  • Poor motor coordination
  1. Autism

According to Alexander (2009), Autism is a complex neurobehavioral disorder that includes impairments in social interaction and developmental language and communication skills combined with rigid repetitive behaviours. This disorder covers a large spectrum of symptoms skills, and levels of impairment. It ranges in severity from a handicap that somewhat limits an otherwise normal life to a devastating disability that may require institutional care.

Children with autism have trouble communicating, they have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions an touch. Child who are autistic may have repetitive, stereotyped body movements such as rocking, pacing, or hand flapping. They may have unusual responses to people, resistance to change in their routines, or aggressive or self – injurious behaviours.

Symptoms of autism

Typically, symptoms may appear during the first three years of life some children show signs from birth. Others seem to develop normally at first only to slip suddenly into symptoms when they are 18 to 36 months old autism is four times more common in boys than in girls it knows no racial, ethnic or social boundaries. Family income, lifestyle or educational levels do not affect a child shank of being autistic.

  1. Swallowing disorder

Brady (2008) stated that dysphasia (swallowing disorder) is a sensation that suggest difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of pharyngeal sensation, of a various other inadequacies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing and globus which is the sensation of a lump in the throat.

Signs and symptoms

Some patients have limited awareness of their dysphasia, so lack of the symptom does not exclude an underlying disease. When dysphasia goes undiagnosed or untreated, patient are at high risk of pulmonary aspiration and subsequent aspiration pneumonia. Secondary to foods solids or liquids going the wrong way into the lungs. Other signs and symptoms may also include dehydration, malnutrition, renal regurgitation, difficulty initiating a swallow, coughing, choking and difficulty controlling food in the mouth

  1. Oral sensory disorders

According to Michael and Fox (2010), Oral sensory disorder is a condition in which the brain has terrible receiving and responding to information that comes in through the sense. The condition used to be called sensory integration dysfunction

Some people with oral sensory disorder are oversensitive to things in their environment. Common sounds may be painful or overwhelming. The touch of a shirt may chafe the skin

Others with sensory processing disorder may:

  • Be uncoordinated
  • Bump into things
  • E unable to tell where their limbs are in space
  • Be hard to engage in conversation or play
  1. Food allergy

Sicher (2012) stated that food allergy is an abnormal immune response to food. The signs and symptoms may range from mild to severe. They may include itching, swelling of the tongue, vomiting, diarrhoea, hives, trouble breathing or low blood pressure. This typically occurs within minutes to several hours of exposure when the symptoms are severe, it is known as anaphylaxis. Food intolerance and food poisoning are separate conditions. The common allergies in a region vary depending on the country. Risk factors include a family history of allergies vitamin D deficiency, obesity, and high levels of cleanliness. Allergies occurs when immunoglobin E, part of the body’s immune system, binds to food molecules. It is usually a protein in the food that is the problem. This triggers the release of inflammatory chemicals such as histamine.

Signs and Symptoms

Food allergies usually have a fast onset (from seconds to one hour) and may include:

  • Rash
  • Hives
  • Itching of mouth, lips , tongue, throat, eyes, skin, or other areas
  • Sweating (angioedema) of lips, tongue, eyelids of=r the whole face
  • Difficulty swallowing
  • Wheezing and/or shortness of breath
  • Nausea
  • Vomiting
  • Fainting

Symptoms of improper feeding in growing children

Hara (2013) stated improper feeding can occur for many reasons from lack of availability of healthy food, to limited knowledge of nutritional requirements and what foods are healthy or a simple tendency to eat the wrong type of food due to personal preferences. Whilst a few bad choices won’t make much of difference if you eat a nutritious balanced diet is followed on a daily basis, there can be serious repercussions for our health

What is good nutrition?

Good nutrition does not mean that you need to take supplement and eat only organic super foods. A healthy balanced diet can be achieved easily by eating a wide variety of foods, where possible fresh, that have undergone as little processing as possible variety is very important to get all the nutrients that the body needs to perform its daily functions correctly as different foods contains different vitamins and minerals

Improper feeding can have serious health consequences for all types of people; however, symptoms may not always be obvious.

It should be noted however that a person can be overweight and still be considered malnourished if they are eating on unhealthy diet, as though they are meeting their requirements for calories, they may not be getting all the nutrients they need

Signs of improper feeding

  1. Weight changes

Changes in weight, be in gain or loss, are not always a symptoms of improper feeding. It is perfectly possible to gain or lose weight whilst eating a healthy balanced and notorious diet. However, often a rapid weight change may indicate changing eating patterns and be an early sign of improper feeding.

Weight loss particularly to levels that are considered unhealthy may occur due to decreased intake, which leaves the risk of not enough food being consumed to meet requirements. On the other hand, weight gain may due to excessive intake of high calories, low nutrient foods which do not provide the necessary nutrition.

  1. Fragile immune system

Improper feeding can cause deficiencies in certain micronutrients that help boost your child’s immunity and insufficient intake of macronutrients and energy. Such nutrient deficiency can turn off immune system; you are more likely to develop infection and illness, which together can aggravate states of malnutrition by decreasing nutrient, absorption, encouraging nutrient loss and changing the metabolism of your body.

  1. Tiredness and lack of concentration

Although these may not even seem as serious as a full blown disease or condition, feeling laethargic, tired and unable to concentrate can make everyday activities a lot more difficult and can impact your life in a big way from how you perform at work to having enough energy to do exercise

Tiredness can be related to a huge number of nutrients deficiencies, although the most common are things like iron, particularly in women and athletes B12 and water. Skipping meals can also lead to lethargy as the body is not receiving the energy it requires to function.

  1. Physical symptoms

Sometimes it is possible to see physical effects of improper feeding these could be things like flaky, dry skin lifeless, thin hair, cracked nails, diarrhoea or constipation poor oral health and poor wound healing.

Developing proper feeding habits

Centre of Children Health Home (2013) stated that by teaching your child proper feeding habits, and modelling these behaviours in yourself, you can help your children maintain a healthy weight and normal growth. Also, the eating habits your children pick up when they are young will help them maintain a healthy lifestyle when they are adults.

Some of the most important aspects of proper feeding are portion control and cutting down on how much fat your child eats. Simple ways to reduce fat intake in your child’s diet and promote a healthy weight include serving:

  • Low-fat or non fat dairy products
  • Poultry without skin
  • Lean cuts of meats
  • Whole grain bread and cereals
  • Healthy snacks such as fruits and veggies
  • Also, reduce the amount of sugar sweetened drinks and salt in your child’s diet.
  • If you are unsure about how to select and prepare a variety of foods for your child and family, consult a registered dietitian for nutrition counselling.
  • It is important that you do not place your overweight children on restrictive diet. Children should never be placed on a restrictive diet to lose weight unless a doctor supervises one for medical reasons.

Other approaches parents can take to develop proper feeding habits of their growing children include:

  • Encourage your children to eat slowing. A child can detect hunger and fullness better when they eat slowing. Before offering a second helping or serving, ask your child to wait least 15 minute to see if they are truly skill hungry. This will give the brain time to register fullness. Also that second helping should be much smaller than the first.
  • Encourage your children to drink more water: over consumption of sweetened drinks and sodas has been linked drinks and sodas has been linked to increased rates of obesity in children.
  • Try not to use food to punish or reward your children: withholding food as a punishment may lead children to worry that they wont get enough food. For example, sending children to bed without dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable that other foods. For example, telling children that they will get desert if they eat all of the vegetables sends, the wrong message about vegetables.
  • Pay attention to portion size and ingredients read food labels and limit foods with trans fat. Also, make sure you serve the appropriate portion as indicated on the label.
  • Discourages eating meals or snacks while watching TV: try to eat only in s=designated areas of your home, such as the dinning room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to over eating

Benefits of proper feeding

Serena (2013) summed up the benefits of proper feeding which include;

  1. Weight control: to prevent weight gain, you must eat no more calories than you burn each day for weight loss, you must eat fewer calories than your body burns dairy. Healthy and nutrient-dense foods such as fruits, vegetables, whole grains and lean proteins, typically contain fewer calories than sodas, sweets and fast food meals. Shedding excess pounds reduces your risk of obesity related problems/conditions such as type-2 diabetes, clogged arteries and thyroid dysfunction.
  2. Brain health: proper feeling increases blood flow t your brain, protecting brain cells and helping to prevent Alzheimer’s disease. For a brain healthy diet, avoid fried foods and favour baked, steamed and grilled foods. Also, eat dark fruits and vegetables such as kale, spinach, broccoli, prunes, raisins, blueberries, raspberries, plums and cherries. Almonds, walnuts, pecans and other nuts great sources of vitamin E, which along with other nutrients, also helps fight Alzheimer’s disease.
  3. Bone and teeth strength: A diet rich in calcium keeps your bones and teeth strong and helps prevent bone loss associated with Osteoporosis. Low-fat dairy products, such as milk cheese and yoghurt, dark green vegetables such as bok chay and broccoli, and fortified foods such as say products, fruit juices and cereals are good sources of calcium. The centre for Disease Control and Prevention recommends 1,000 milligrams of calcium dairy for average adult ages 19 to 50 vitamin D helps your body absorb calcium choose products fortified with vitamin D to balance your nutrition
  4. Energy: Though many benefits of good nutrition today way not be realized until later in life, one benefit we can see dairy is in our energy level. Foods that are excessively sugary or high in fats can minimize our energy levels from day to day. Fats are slow to digest and thus don’t provide our body within steady source of energy. Sugary foods can create fluctuations in blood sugar levels causing us to feel tired very shortly after eating. By eating a healthy diet we maintain our energy levels at a consent throughout the day and the result is simply freckling better.
  5. Self confidence: Whether or not you are at your optimum weight or not, the benefits of good nutrition can be felt. Americans have been educated enough over the years to kwon that junk foods are not the health test choice yet many of its continue to indulge in them for emotional reasons. When we make the conscious choice to eat better and health, we begin to feel better about weight comes off. Its also true that the occasional sweet treat taste better when its consumed quite free because we eat healthier on a daily basis. When you examine all the benefits of good nutrition, you quickly realise that eating healthy and making healthy food choices results in a much better lifestyle. Anyone can start enjoying the benefits of proper feeding by changing one eating habit a week cut down on foods high in fat and begin replacing them with whole grain foods, low fat foods and fresh fruit and vegetables. You’ll be reaping the benefits of proper nutrition before you know it.

Dangers of improper feeding

According to Centres for National Health Services Directory (2011), improper feeding can impair our daily health and well being and reduce our ability to lead an enjoyable and active life. In short term, poor nutrition can contribute to stress, tiredness and our capacity to work and our time, it can contribute to the risk of developing some illness and other health problems such as;

  • Tooth decay
  • Being overweight or dose
  • High cholesterol
  • Heart disease and stroke
  • Type – 2 diabetes
  • Osteoporosis
  • Eating disorders
  • High blood pressure
  • Depression

Barriers to proper feeding

Ahrens and Bamman (2010) stated some barriers to proper feeding as including so many factors like; Not enough time for cooking, lack of money, limited motivation, little time available to spend with the children (to control what they are eating), grandparents breaking food rules, and the wide availability of energy-dense, nutrient poor foods, etc, these factors can hamper children eating healthy, low income families are likely to have diets that are less healthy, where shopping is more influenced by prize and taste preference of the children and food choice rules are less strict. Generally, there is lack of nutrition education/knowledge and eating fruit at school is not facilitated

Tearing down the barriers to improper feeding

According to Haerens (2014) parents most often perceive school as an important facilitator for healthy diet and lifestyle. This is due to the facts that children spend a significant amount of daytime at school. Nutrition education should thus be influenced since children from all socio economic classes could be reached this way. It is also necessary to have a well elaborated and consistent school food policy that is endorsed by the parent. This is important as parents need to become more aware of their responsibility for improving their children’s diet and lifestyle

Meaning of malnutrition

According to Facts of Life (2010), malnutrition can be defined as faulty nutrition due to inadequate or unbalanced intake of nutrients or their impaired assimilation or utilization. Malnutrition can also be defined as insufficient, excessive or imbalanced consumption of nutrient (Young, 2012). Several different nutrition disorders may develop, depending on which nutrient are lacking or consumed in excess

According to World Health Organization (2011), malnutrition is the gravest single threat to global public health, also, it is estimated that around three million people in the UK are affected by malnutrition. According to the Food and Agricultural Organization (2010), the number of people globally who were malnourished stood at 923 million in 2007, an increase of over 80million since the 1990-92 base period.

Causes of malnutrition

Fotso and Kuate (2005) stated that there are several major causes of malnutrition which include:

  1. Lack of food; this is common among the low income group as well as those who are homeless
  2. Those having difficulty eating due to painful teeth or other painful lesion of the mouth, those with dysphasia or swallowing disorder are also at risk of malnutrition. This could be due to a blockage in the throat or mouth or due to sores in the mouth
  3. Those with a limited knowledge about nutrition tend to follow an unhealthy diet with not enough nutrients, vitamins, and minerals and are at risk of malnutrition.
  4. Those with diarrhea or persistent nausea or vomiting
  5. Some medications tends to alter the body’s ability to absorb and breakdown nutrient and taking these may lead to malnutrition
  6. Among children lack of knowledge of adequate feeding among parents is the leading cause of malnutrition worldwide
  7. Loss of appetite: common causes of loss of appetite include cancers, tumours, depressive illness and other mental illness, liver or kidney disease, chronic infections etc
  8. Neglected children, orphans and those living in care homes are at high risk of malnutrition

Effects of malnutrition

Walter et al., (1998) stated that malnourished children experience developmental delay, weight-loss and illness as a result of inadequate intake of protein, calories and other nutrients because orphaned and institutionalized children may experience one or several macronutrient deficiencies, they are at risk of short term effect and complications.

  • Short term implication

Because so much development occurs in the first few years of life, nutrient deficiencies can have major short term implications in growing children

Immune implications

Malnourishment can greatly comprise a child’s immune system making them more susceptible to infectious disease. Particularly in the institutions where there are poor sanitary practices, children are vulnerable to infections from other children or caregivers. In particular, Zinc, iron and vitamin A are commonly associated with weakened immune functions.

Growth implications

Nutrient deficiencies and gastrointestinal infections commonly co occur in orphans. A child may contract an infection due in part to poor nutritional status. In turn, a gastrointestinal infection places the child at even greater risk for nutrient deficiencies because nutrients are unable to be absorbed properly. Consequently, nutrient deficiency combined with infection can cause growth retardation.

Additionally, a deficiency in one nutrient may lead to a deficiency in another nutrient. For example, deficiencies in iron, magnesium and zinc can cause anorexia and thereby result in reduced intake of other important nutrients such as protein. Low lipid intake can also affect the absorption of important fat soluble vitamins such as vitamin A and D. Zinc and protein deficiency can retards bone growth and development, putting a child at risk for long term complications.

The short term implications of malnutrition eventually give way to long term complications, such as growth and  cognitive delays

Growth implications

Malnutrition not only impact growth in the short term, but can also limit total bone growth. Additionally, children classified as low height for age (stunted) may never be able to regain lost growth potential if they continue to live in a nutritionally deprived situation

Cognitive implications

Malnutrition negatively affects brain development causing delays in motor and cognitive development such as

  • Attention deficit disorder
  • Impaired school performance
  • Decreased IQ scores
  • Memory deficiency
  • Learning disabilities
  • Reduced social skills
  • Reduced language development
  • Reduced problem solving abilities

Solutions to malnutrition

Arathi (2013) stated possible solutions to malnutrition. These solutions include the following

  1. Devote funding to nutrition programs: The economic toll of malnutrition, on individual and even countries, is astonishing. Malnutrition can rob individual of up to 10 percent of their annual earning and cost African countries up to 11 percent of their annual GPD. The good news is malnutrition solution offers so8und investment for counties futures. However, many national nutrition plans are only 20 percent funded. Countries must start prioritising nutrition programs wilting their national budgets
  2. Sustain global commitment: Progress towards reducing malnutrition will require a steadfast commitment from the international community USAID recently pledged over $10 billion for global nutrition programs for 2012 to 2014 and other countries have similar stepped up their commitments moving forward, donor will need to show patience in awaiting outcomes of nutrition programs as results cannot be clearly measured until a child’s second birthday. We also need to hold policy makers accountable to their commitment to nutrition programs and progress and harness the global momentum on nutrition to produce more effective programs.
  3. Align other sectors with nutrition goals: It seems common sense that agriculture, social safety nets and other important sectors could also play a role in advancing nutrition progress. Yet until this point, these programs have often not been designed, implemented or evaluated with improved nutrition outcomes in mind. Going forward, countries should take the opportunity to better integrate nutrition goals into these sectors. Donors should also support rigorous impact evaluations and studies to build a richer evidence base safety nets and other sectors
  4. Expand rich through community health workers: Community health workers programs offers a prime opportunity t9o increase already successful nutrition programs, coverage and provide services to populations who presently lack access several countries, including Ethiopia, have already started investing in community health worker programs to promote maternal and child health nutrition with great success. Community health workers hold great promise to bring nutrition services to those most vulnerable to malnutrition, and their capacity to carry out this work should therefore be strengthened
  5. Bring girls health into focus: More than one in four children born in low and middle income countries are underweight for their age. In addition, most pregnant women living in these countries cannot access nutrition services until the fifth or sixth lives already malnourished. If we prioritize the health of women and girls, we can boost general nutrition, reduce pregnancy complication and boost fatal growth and development.

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