DOUBLE BURDENS
In a world of issues the one of diseases cannot be unseen. Nowadays there is a great existence of chronic diseases in the world (World Health Organization, 2015a). As predictions tell they will be accounting for almost three-quarters of deaths worldwide.
Several of these chronic diseases are obesity, diabetes, cardiovascular diseases, cancer, osteoporosis and dental diseases. These diseases are increasing worldwide. Often is thought that developed countries have the greatest existence of them, but less is true. They are rapidly finding their way in developing countries as well (World Health Organization, 2015a).
The prediction mentioned befeore even tells that by the year 2025 the number of people in developing countries with diabetes will have been increased by more than 2.5 times compared to this number in 1995. This leads up to the point where in the future as much as 60% of the burden of chronic diseases will occur in developing countries.
These changes are happening in such a high rapidity that there will often also be a double burden of disease (World Health Organization, 2015a). This means that both chronic non-communicable diseases and communicable diseases, such as malaria and tuberculosis exist at the same time (Agyei-Mensah & Aikins, 2010). Communicable diseases have not yet been combated enough while simultaneously non-communicable diseases take their rise.
One of these non-communicable diseases, obesity, is becoming a serious problem in Asia, Latin America and parts of Africa, despite the simultaneous existence of undernutrition (World Health Organization, 2015a).
Being underweight, as a result from undernutrition, and obesity are both in the top ten of risk factors for the global burden of disease (Kennedy, Nantel, & Shetty, 2006).
A key role in the occurrence of chronic diseases can be ascribed to diet (World Health Organization, 2015a).
Not only is diet important in the chronic diseases mentioned before, but also a great contributor to underweight. Malnutrition is on base of this. According to Zello (2012) malnutrition is “a diet containing insufficient quantities of nutrients or a diet in which one or more essential nutrients is missing or is present in the wrong proportions”.
Malnutrition, as well as hunger, is a huge problem in especially poor countries and has a great effect on their health. Even globally 30% of the world population is suffering from malnutrition in some sort of way (World Health Organization, 2015a).
This is shown in the currently existence of a double burden of malnutrition, which includes both undernutrition and overweight (World Health Organization, 2015b). It refers to a situation in which both things happen within the same population (Kennedy, Nantel, & Shetty, 2006). Shrimpton and Rokx (2012) also add the aspect of these things happening across the life course. Which means that undernutrition in early life contributes to a higher probability of over-nutrition in later life.
Furthermore, that undernutrition in early life has a lot of influence on health in later life such as brain growth which in turn makes children less able to finish school and achieve economic success (Shrimpton & Rokx, 2012). Even incomplete diet of the mother while pregnant can affect the unborn child and can influence the chance of the child becoming overweight or obese or getting diabetes in later life.
ERNST EN PREVALENTIE VAN BOUBLE BURDEN IN GUATEMALA
http://apps.who.int/nutrition/landscape/report.aspx?iso=gtm
One of the low-income countries which highly suffers from malnutrition and the double burden of it is Guatemala (World Food Programme, 2015; World Bank, 2011). This country has the fourth highest rate of chronic malnutrition in the world which is as much as 49,8% (World Food Programme, 2015).
This is shown in different effects of malnutrition on physical development. The most common ones in Guatemala are stunting, underweight, overweight and obesity, a high susceptibility to infectious diseases and an increased mortality rate (Zello, 2012). From these effects, stunting is the most visible one in child malnutrition. Stunting can be defined as being unable to reach your growth potential due to inadequate nutrition (Skolnik, 2012). This is also one of the main problems appearing in children under five years of age. Unicef (2010) states that 43.4% of the children under five in Guatemala are chronically malnourished in measurements of stunting. The World Bank (2011) shows that this high percentage results in Guatemala having the highest prevalence of stunting in the world. Additionally, a lot of children are born with low birth weight (12,5%) due to malnutrition of the mother.
On the other hand, malnutrition is also cause for overweight and obesity. A great part of the Guatemalan population is too heavy for their height. As much as 67% of the Guatemalans older than fifteen are overweight and 29% of them is obese.
These problems clearly show the existence of the double burden of malnutrition, while they are both present within the same population.
OORZAKEN DOUBLE BURDEN IN GUATEMALA IK DOE NU MEER MALNUTRITION. IS DAT ERG?!
Various factors account for the origination of these double burdens in Guatemala (Zello, 2012).
There is a reason for malnutrition, which is more than simple ‘bad food’. It appears that many mothers or pregnant women in Guatemala are uneducated or do not have sufficient information about how to feed their children. They lack the information about the right nutrients or practices to raise their children and do not understand the role they play in the growth of their child. Yet even if they would have been educated better, the access to nutritious food is scarce. Food availability is in general low in Guatemala. The main underlying factor for this is poverty.
The government is playing an important role in this, but seems to be ineffective.
It has failed to rebuild the country after a long civil war and several natural disasters, in terms of education and living conditions, leaving the inhabitants with poor nutrient-rich food access and often bad water conditions. Main result is Guatemala having one of the most unequal economies in the world. Resources are not equally available for everyone, meaning that the few rich end up having the majority of the resources needed for a healthy life, while the many poor do not have access. Zello: the richest 20 percent of the population possess 60 percent of the country’s income
Fifty-three percent of the population lives in poverty, and 13 percent in extreme poverty (World Food Programme, 2015).
These conditions are a great contributor to the spreading of infections (Mac Arthur, 2015). Increased prices of food, particularly protein –rich foods, also contribute to decreased access to sufficient nutrients (SPOON foundation, 2015). The poor are unable to afford this thus and up buying less nutritious but affordable food.
These combinations of factors all lead to a poor diet and thus to malnutrition.
UITLEG INHOUD DIEET IN GUATEMALA
As explained before, poverty and lack of education lead to malnutrition in Guatemala.The poor diet which is on base of that malnutrition will be explained further on.
More than half of the inhabitants of Guatemala are descendants of indigenous Mayan people, which has strongly influenced the Guatemalan diet to what it is nowadays. The basis of their diet consists of corn and beans and at this time also rice (SPOON foundation, 2015). This is combined with squash, tomatoes, chilies, fruit, cocoa and wild game. Commonly drunken beverages are highly sweetened coffee, hot chocolate and fruit flavoured cold drinks. Guatemalans who live in urban areas are, in general, able to eat a wide variety of food. However the diet of most poor Guatemalan people consists of mainly tortillas and little extra (Zello, 2012). Corn and beans are eaten with every meal and the variety of their diet is less than that of the rich (SPOON foundation, 2015). If snacks are eaten, they mostly consist of a heavenly sweetened drink with a pastry. Beans, eggs, meat and dairy products are often too expensive to afford (Zello, 2012).
The quality of the diet of most Guatemalans is poor as well as their eating habits (Mac Arthur, 2015). The diet which consists of mainly maize tortillas and rice is high in calories from the sugar, carbohydrates and fats and oils (Mac Arthur, 2015; Zello, 2012).
EFFECTEN MALNUTRITION OP ….. (EERST ALGEMEEN DAARNA IN GUATEMALA)
It is clear that the diet of the Guatemalan poor is not fulfilling all nutritious needs. Variety is poor and this may be the reason for several deficiencies occurring (SPOON foundation, 2015). The SPOON foundation (2015) listed the main possible nutritious deficiencies. These are lack of folate, iron, vitamin A, vitamin B12 and Zinc. The importance and main effects due to the specific functions of the nutrients missing, will be explained below.
Folate is a supplement needed for creating DNA in new cells and is of great importance for the development of spinal cord and the brain of an unborn child (SPOON foundation, 2015).
Iron can be found in fish, meat and poultry (Skolnik, 2012). The iron found in those animal products is the one which is easily absorbable, but there is also iron which is less absorbable. This type of iron can be found in fruits, grains, vegetables, nuts, and dried beans.
Iron is also important for cell growth and is especially needed for the delivering of oxygen to the cells (SPOON foundation, 2012). When iron has been lacking for a longer time it can eventually result in anemia, fatigue, poor work performance, slow cognitive and social development in children, and decreased immunity.
Vitamin A can be found mostly in green leafy vegetables, carrots and yellow and orange fruits which are not citrus fruits (Skolnik, 2012). Some animal products also contain vitamin A, such as liver, milk and eggs.
Vitamin A has a critical role in the ability to see well, in the growth and development of a child and in the functioning of the immune system (SPOON foundation, 2015). A deficiency in vitamin A can cause blindness, low growth rate, slow bone development and it can make you more vulnerable to infections. On top of that, vitamin A also helps to mobilize stored iron. This means that when you lack vitamin A, there is a big chance your body will also be less able to use the iron your body has stored, which makes it look like you have an iron deficiency even though you do not. (Although the symptoms are the same).
Vitamin B12 is important for energy production as well as changing the inactive form of folate into its active form (SPOON foundation, 2015). As is the case by vitamin A and iron, vitamin B12 can cause symptoms of folate deficiency although you have enough folate but lack the vitamin to make it active.
Zinc is mainly found in red and white meat and in shellfish (Skolnik, 2012). It is involved in many important processes in the body (SPOON foundation, 2015). Deficiency of zinc is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction (Skolnik, 2012). Zinc deficiency also increases susceptibility to infection.
Also lack of protein, due to the unaffordability of beans or meat for poor Guatemalans, has negative health effects. Meat and dairy products are essential to the development of a child (Zello, 2012). However, the average Guatemalan child has a diet in which 80 percent consists of carbohydrates, which leaves insufficient room for right amounts of good fats and protein.
Additionally, Zello (2012) explains that some necessary nutrients which pregnant women need for the development of their child when still inside the womb, are simply not available. These nutrients are for example protein, omega 3, folic acid and vitamin B. These kinds of nutrients are found in fruit and vegetables, fish and whole grains.
Not all of the above possible effects of nutrient deficiency are directly visible. However, it can be easy to notice if a child is malnourished. They often appear to have a bloated stomach and their bones could be clearly visible (Zello, 2012). It is possible that they look overweight or normal weight because of their bellies holding liquid, which is a sign of failing of organs, while they actually are not overweight or even underweight. They can look weak and seeming to lack the strength to do simple things like carrying or picking up stuff. Moreover, hair loss or change of hair colour from black to blonde is not uncommon. Also colour changes in the skin can appear, like turning darker or showing the veins in their legs. Their skin might even peel.
GEVOLGEN VOOR KINDEREN EN DAT ZWANGERE VROUWEN OOK VEEL INVLOED HEBBEN
Sufficient nutrition is fundamental to the growth of young children, their development and the health they will achieve in adulthood (Skolnik, 2012). The deficiencies due to their diet mainly have effects on development, growth and immune system and susceptibility to infections.
The Guatemalan diet can cause several severe health conditions in general. However the deficiencies seem to have the most impact on children and pregnant women (Skolnik, 2012).
Child nutrition begins in the mother’s womb where is it already building on the child’s health (Zello, 2012). An important part of the biological development of a child takes place between the moment of conception and two years of age (Mac Arthrur, 2015; Skolnik, 2012). Nutrition is especially important in that time period both for the woman as for the unborn.
When the pregnant women is malnourished, she won’t be able to provide her unborn with sufficient nutrients. In the pregnant phase women do need additional calories and protein, but is often unable to change her diet. As said before, lack of nutrients in the diet has a great effect on the development and growth of the child. Malnourished pregnant women are therefor very likely to give birth to a low-birthweight baby.
Iron deficiency in pregnant women for example can result in giving birth to a premature or low birthweight baby or in haemorrhaging by the mother or even dying when giving birth (Skolnik, 2012).
In Guatemala, 38% of children under-five years of age suffer from anemia, as well as 22% of pregnant women (World Bank, 2011). This is mainly a result of iron deficiency.
When surviving but being born underweight, the chance of becoming a healthy adult decreases substantially. Getting problems with health later in life is very likely in that case. For example, low-birth weight infants may be at greater risk of obesity and chronic diseases (World Bank, 2011). This is also the case for stunted children. Moreover, if the mother did not receive sufficient nutrients while pregnant, her child is ten times more likely to die during adulthood (Zello, 2012).
As said that some nutrients are important in the physical development and growth of a child, it is no surprise that Guatemala has high stunting rates. Guatemala is one of the 36 countries which account for 90% of all stunting in the world (World Food Programme, 2015). Half of all the children under 5 years of age in Guatemala are suffering from anemia and stunting (Mac Arthur, 2015). The final adult height which children will reach is already determined by age two (Shrimpton & Rokx, 2012). The first two years of life are most important ones in development and height of adults reflects the nutrition quality of that early life period.
The failure in linear growth is defined in early life and is caused by inadequate diet and frequent infections (Victora et al., 2008).
Malnourished children are more susceptible to infectious diseases because their immune system doesn’t function as good anymore. They are important determinants of stunting (Robert et al., 2008). Diarrhoea is one of these influential infectious diseases. When suffering from it, nutrients cannot be absorbed that well anymore which causes undernutrition.
When becoming stunted as a child, the chance of catching up growth in later life is very low. Done damage to the body due to malnutrition earlier, is in most cases unchangeable (Skolnik, 2012).
Vitamin A deficiency is present in 16% of preschool aged children and causes around 1500 deaths each year. EN WAAR IS DE BRON?!
The Guatemalan diet is not only insufficient in nutrients but often also high in calories and unhealthy fats. Diets which have high proportions of refined carbohydrates, saturated fats and sugars are major contributors to the increase of overweight and chronic diseases (World Bank, 2011). The diet rich in carbohydrates and fats is cause for stunted children as well as for overweight adults (Zello, 2012). When sticking to the same diet, the likelihood of becoming overweight when older will increase for children who were malnourished, due to that diet, as a child. Mac Arthur (2015) tells that overweight or obesity due to poor diet and eating habits appears in half of Guatemalan women of reproductive age.
DISCUSSION/CONCLUSION
As explained, diet is one of the greatest, as if not the greatest, contributor to healthy development of children.
– Natuurlijk niet alleen belangrijk hoe zon kind er dan uit ziet maar kan ook daadwerkelijk minder doen (basic directe dingen)