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Global Health
Micheline Beaudry,
Université Laval
Learning Objectives
At the end of this lecture you will
Be aware of the key role played by
undernutrition in the lives of people
& societies around the world
Realize that food, though essential,
is not equivalent to nutrition
Know that there are affordable
solutions & wish to find out more
about them
At the end of this lecture you will be
able to (performance objectives)

List the 4 major nutrition problems in

the world, their major manifestations,
consequences & global distribution
List the major causes of these
problems and solutions proposed
Convince a friend of the opportunities
provided to improve people’s lives
The major nutrition problems
in the world are:
Protein-energy malnutrition (PEM)
Iron deficiency
Vitamin A deficiency or
hypovitaminosis A (VAD)
Iodine deficiency disorders (IDD)
Nutrition-related chronic diseases
Protein-energy malnutrition (PEM)
 insufficient height gain relative to age;
 implies long-term malnutrition and poor health

 insufficient weight gain relative to height/losing weight
 implies recent/acute malnutrition

 insufficient weight gain relative to age or losing weight
 implies various combinations of stunting and wasting
Proportion (%) of underweight
children by region, 1985-1995


40 South Asia

SubSaharan Africa
Sout-East Asia

10 Lat.Amer.&Caribb
1985 1990 1995
PEM and young child mortality
Malnutrition potentiates the effect of
disease on child mortality
The effect is for both mild-to-
moderate as well as severe
malnutrition; it is not only due to
confounding by socioeconomic
factors or intercurrent illness
The effect of malnutrition and
infection on child mortality is
multiplicative rather than additive as
was implicitly assumed
Other consequences of PEM
Impaired cognitive &
behavioral development
Low educability
Reduced productivity &
Poor reproductive health
Causes of malnutrition
Manifestations Growth, survival and
Immediate Diet intake Disease
Underlying Access to CARE practices HEALTH
Causes FOOD for mothers&ch serv & environ.
Ressources & Control
Human, Economic &
Basic Organizational
Political, Ideological
&Economic structure
To ensure adequate growth &
nutrition, it is necessary to facilitate
The ability of households to provide
CARE for mothers & young children
(e.g. breast-feeding, complementary
feeding, love...)
Access by households to sufficient
FOOD to lead an active & healthy life
Access to adequate HEALTH services
(e.g. immunization) & a healthy
environment (e.g. clean water)
Iron deficiency
Over 2 billion people suffer from some
form of iron deficiency
Not all causes of anaemia are
nutritional in origin; yet anaemia linked
to iron and/or folic acid deficiency is
among the world’s major nutritional
Africa & South Asia have the highest
overall incidence of anaemia, followed
by Latin America & East Asia
Consequences of iron deficiency
Reduces work capacity, thus
productivity, earnings & ability to care
for children
Associated with 50% of maternal
deaths & wholly blamed for up to 20%
Retards fetal growth, causes low birth
weight (LBW) & increases infant
Impairs ability to resist disease; in
childhood, reduces learning
Improving Iron status

Iron tablets (daily vs. weekly)

Iron fortification of basic
Increased consumption of
iron rich foods & factors
which enhance absorption
Control of parasitic infections
Vitamin A deficiency (VAD)
Subclinical, severe & moderate
251 million children 0-4 years old
Clinical (xerophtalmia)
2.8 million children 0-4 years old
Blindness, total or partial
atleast half a million children a
about half die within a few
Consequences of VAD
Onset of childhood diseases
Partial or total childhood
Child mortality increases at least
May increase maternal mortality
May increase HIV transmission
Improving vitamin A status
Increased intake of vitamin A rich
foods e.g. eggs, butter, whole milk,
liver, red palm oil, dark green,
yellow & red fruits & vegetables
Fortification of basic foods with vit.
Supplements e.g. 2 capsules per
year to young children
Iodine deficiency disorders (IDD)
In1990: 1.6 billion people
worldwide at risk of IDD
At least 655 million with goitre
43 million with some degree of
mental impairment
11 million with cretinism
Other consequences of IDD
Moderate Iodine deficiency:
associated with average reduction of
over 13 IQ points
Adequate intake of Iodine: can
prevent all IDD, make milder forms of
goiter disappear & improve
development of older children mildly
Severe forms of IDD such as cretinism,
cannot be reversed; can only be
prevented by adequate intake of I
during pregnancy
Progress in iodizing salt
60% of all edible salt in the world is
now iodized in 1997
Before 1990, some 40 million
children were born each year at
some risk of mental impairment
due to I deficiency in their
mother’s diets. By 1997 is closer to
28 million
Improving nutrition
can lead future
progress in health
and development
around the world