The dual-burden of nutrition is essentially described as a state of co-existence of stunting or undernourishment (malnutrition) or obesity due to over nutrition (Varela-Silva et al., 2012). The coexistence is found to be present in the same group of people and the same population sample i.e. belonging to a particular location, ethnicity, or population (Varela-Silva et al., 2012). Further, the coexistence may occur in the same individual, family, or household (Varela-Silva et al., 2012). The phenomenon described above has been termed ‘dual-burden malnutrition’ and has been noticed predominantly in the developing, underdeveloped, and low or middle-income nations or continents (Varela-Silva et al., 2012). The problems associated with malnutrition and the nutritional dual-burden have been examined in research in the more recent times (Varela-Silva et al., 2012). The dual-burden of malnutrition have been observed in households of the low and middle-income and developing nations (Varela-Silva et al., 2012). The most commonly noticed issues related to malnutrition include underdevelopment of height and appropriate values of weight (Varela-Silva et al., 2012). Obesity in infants is commonly mistaken for optimal nourishment which leads to increased difficulty in the management of the nutritional dual-burden concern (Varela-Silva et al., 2012). Research has observed that the occurrence of underdevelopment of height and being overweight are contradictory to the biological nature of human development (Varela-Silva et al., 2012). These occurrences have not been predicted in the conventional food systems or nutritional bases (Varela-Silva et al., 2012).
Dual-burden of nutrition is a relatively recent pandemic that has been affecting people across the world (Popkin et al., 2012). The pandemic of obesity has fast evolved in the recent times in both the developed and the underdeveloped or developing world (Popkin et al., 2012).The primary reason for the evolution of the dual-burden obesity and malnutrition pandemic is the considerable alteration in the lifestyle, dietary, and exercise patterns in the world (Popkin et al., 2012). With the advent of westernization in dietary and lifestyle habits, the pandemic of obesity has gained immense growth in the recent times (Popkin et al., 2012). The amount of physical activity is greatly decreased in the Western as well as the rest of the world. The phenomenon of modified dietary patterns is known as ‘nutrition transition’. The transition in dietary patterns as compared to the conventional food intake systems of the region, leads to altered health patterns and ultimately causes obesity or dual-burden malnutrition (Popkin et al., 2012). Research has found that the statistical ratios of the sociodemographic data in terms of age, race, ethnicity, and region in specific and subspecific sections of the studied population has resulted in obesity in children and adults (Popkin et al., 2012). The increase in the intake of processed food which is has low nutritional index, but high amounts of fat, is one of the primary reasons for the occurrence of this pandemic (Popkin et al., 2012).
The World Health Organisation (WHO) stresses the need for food security across the globe (Guyomard et al., 2012). The concept of food security is described as the achievement of access of food which is adequate, nutritious, and safe for consumption by an individual, family, or household (Guyomard et al., 2012). The WHO emphasises that upon ensuring food security in a nation, the economic and social status of the nation is largely improved (Guyomard et al., 2012).
The WHO has found that the status of food security is low across the globe (Guyomard et al., 2012). Similar to obesity and the problem of being overweight, undernourishment and malnutrition are of equal importance (De Onis & Blossner, 2006). The management of the dual-burden of nutrition is primarily based on the contradictory presence of undernourishment and obesity within particular households or populations (De Onis & Blossner, 2006). Due to the contradictory nature of these pandemics, the management of the problem becomes increasingly difficult (De Onis & Blossner, 2006). However, in the recent times, the advent of health systems that lay emphasis on both under and overnutrition has begun (De Onis & Blossner, 2006). Research has identified that the presence of dual-burden households is a social health concern and needs to be addressed effectively (Doak et al., 2005). Studies have reflected upon the connection between the dual-burden households and residence in urban areas or the level of income in households (Doak et al., 2005). Scientists deduce that undernourishment may be a side-effect of overnutrition prevention programmes in individuals of normal weight ranges (Doak et al., 2005). Literature points out that there is statistically significant level of positive association between stunting and obesity with the age, lack of physical activity, and the skipping of breakfast or the first meal in the day (El-Kassas & Ziade, 2017). Therefore, some of the most prominent strategies for intervention in the cases of dual-burden households entails the assessment of the dietary and lifestyle habits. These interventions focus on improved dietary habits with the intake of nutritional food, increased physical activity, and reduced screen time or sedentary habits (El-Kassas & Ziade, 2017). Every nation or region in today’s times, faces challenges with respect to undernutrition, obesity, and dual-burden malnutrition (Gillespie & Bold, 2017). Therefore, research considers malnutrition as a multi-layered and multi-sectoral public health concern that leads to a complex interaction between each household and the agricultural and food production systems of the nation, decision-making concerns of the individual and the household, the systems of environmental and health policies practiced in the nation (Gillespie & Bold, 2017).
The current article discusses the occurrence of dual-burden malnutrition in Sub-Saharan Africa along with providing an analysis of the nutrition, food production, and dietary patterns of the region. Additionally, it provides a suitable intervention for tackling the dual-burden of malnutrition in the region by addressing the concerns of the nutrition transition and retainment of traditional food systems.
National dietary patterns and food production statistics for Sub-Saharan Africa:
Malnutrition is generally characterised by various forms of nutritional problems including undernutrition, obesity, prevalence of hunger, deficiencies of micronutrients, and overnutrition (Fanzo, 2012). The term malnutrition is a broad concept and includes the individuals subject to malnutrition and lack of dietary supplements. The calories and protein that is required for normal health status are primary indicators of health and nutrition in children and women (Fanzo, 2012). The lack or deficiency of essential nutrients such as minerals and vitamins results in hidden hunger or deficiency of micronutrients that lead to the development of malnutrition and hunger in most individuals (Fanzo, 2012).
The primary disorder that results in the development of malnutrition include the origin of undernourishment in most children. There is the presence of a global pandemic of acute malnutrition that is termed “wasting” (Fanzo, 2012). Wasting is described as the occurrence of a low weight in individuals of a particular height (Fanzo, 2012). The ratio of height to weight is grossly disturbed in most of these cases (Fanzo, 2012). In cases of wasting, there is an additional occurrence of oedema in most individuals.
In Africa, the ratios of wasting in children have remained high and malnutrition has not seen significant improvement in the recent years (Lartey, 2008). The global hunger index (GHI) has shown some degree of improvement in Africa since 2010; however, the overall Sub-Saharan African continent does not indicate a considerable degree of improvement (Lartey, 2008).
Statistically, in the Sub-Saharan African region, the number of undernourished or cases of malnutrition have been: 100 million approx. in 1990-92; 150 million approx. in 1995-97; 200 million approx. in 2000-02, 2005-07, and 2008 respectively. It has increased in 2009 reaching approximately 250 million, and slightly reduced in 2010 to 210 million approximately (Lartey, 2008). The percentage of undernourished population is the highest in the Sub-Saharan African region: 34% approx. in 1990-92; 32% approx. in 1995-97; 30% in 2000-02; 28% approx. in 2005-07; 26% approx. in 2008; 31% in 2009; and 30% in 2010 approximately (Lartey, 2008).
The current scenario in the Sub-Saharan African region indicates the absence of effective nutritional and food production strategies. The lack of nutrition in children and maternal nutritional deficits has led to the development of malnutrition pandemics a=in the continent. The primary aim in order to eradicate the malnutrition and dual-burden nutrition problem is to provide sufficient micronutrients and to ensure minimum calorific intake in individuals according to age, height, gender, ethnicity, and region (Lartey, 2008).
The population that includes women who are bearing children such as the pregnant women and those feeding their babies, children and infants, and older adults (Lartey, 2008).Therefore, women, children, and the elderly comprise the most vulnerable population that is at the risk of nutritional disorders (Lartey, 2008). These individuals have a nutritional vulnerability that originates from requirements that have higher extent of physiological nutrient levels (Lartey, 2008). More often than not, their nutritional requirements are not fulfilled in these individuals (Lartey, 2008). Due to the lack of interventions in most countries for the dual-burden nutrition, the concern for the public health problem is often not addressed adequately (Lartey, 2008). Women, especially those lactating and those pregnant, makes them additionally vulnerable to nutritional concerns (Lartey, 2008). In infants as well, there is a high demand of nutrition as they are at the peak age for growth and development (Lartey, 2008).
Research in the Sub-Saharan African population has observed that there is a greater vulnerability to malnutrition amongst the women and children of these regions due to the climatic and environmental factors of the region (Lartey, 2008). The children and the women of these regions, there are several economic challenges that result in deficient statuses of nutrition (Lartey, 2008). Literature has several studies that indicate the connection between the economic and financial statuses of households (Gillespie & Bold, 2017). The interplay of social, economic, and urban lifestyle factors with the presence of dual-burden households is an important indicator of the national nutritional status (Lartey, 2008).
Research indicates that the Sub-Saharan African region is prone to the highest number of cases of malnutrition, primarily due to poverty, deficient food systems, and lack of resources (Fanzo, 2012). Limitations in resources and the absence of essential infrastructure additionally pose the risk of several diseases and epidemics. The people of these regions lack adequate access to efficient health care centres (Fanzo, 2012).
Africa, despite these challenges in nutrition and resource-availability, has managed to make remarkable progress in the management of the pandemic of malnutrition. The interventions that are most essential in these regions, few of which are being practiced include the promotion of health and nutrition by focusing on consumption of traditional food systems and practices in the region (Fanzo, 2012).
The primary focus of the intervention for malnutrition in the Sub-Saharan African region is to spread awareness about the importance of nutrition and the development and growth in the human system (Fanzo, 2012). The physiological basis of nutrition as a critical factor for growth and development has to be promoted. The intervention has an additional and important focus on the preservation of conventional food practices of the African population. The intervention further aims to promote hygiene and optimal practices for child feeding (Fanzo, 2012).
An essential goal of the intervention is to lay emphasis on the agricultural and food production systems of the nation (Fanzo, 2012). One of the most crucial reasons for the presence of dual-burden is the nutrition transition that has occurred in most nations (Fanzo, 2012). The advent of the Western habits of food intake have led to the concerns of nutrition transition due to which the production of food in the regional locations has greatly altered owing to the modified demands (Fanzo, 2012). In the Sub-Saharan region, poverty and lack of micronutrients for children and food for adults is identified as a major factor for the occurrence of malnutritional pandemics (Fanzo, 2012).
Therefore, the intervention primarily addresses the nutrition transition and absence of conventional food systems in this region. The promotion of the supply of micronutrients to infants stems from the improvement of agricultural and food production patterns (Fanzo, 2012). Stunting and malnutrition are greatly connected to the lack of hygiene, health awareness, supply of micronutrients for feeding mothers and children, food fortification techniques, and acute absence of feeding in therapeutic interventions, according to the Lancet series on undernutrition in 2008(Fanzo, 2012).
The food industry greatly contributes to the success of the interventions that target the eradication of malnutrition in the Sub-Saharan regions. The core interventions that need to be practiced in these regions are required to be based on the evidence collected in these regions (Fanzo, 2012). The recommendations made by Lancet studies in 2008 additionally emphasise an approach that is multi-sectoral and the incorporation of interventions that are sensitive to nutritional demands (Fanzo, 2012). The various sectors that comprise the interventional approach include the agriculture sector, social and health sector, education, agriculture, and the industry of food production (Fanzo, 2012).The industry of food is a critical sector for the adequate addressing of nutritional pandemics (Fanzo, 2012).
The intervention must essentially include the following strategies:
- Integration of farming techniques and systems that exploit the combination of aquamarine culture, horticulture, and rearing of poultry and livestock – all of which constitute consumable nutritional systems. These systems need to combine and incorporate techniques of reducing wastage and cost-cutting strategies for inputs in the agriculture industry in order to enhance the diversity of products in the food industry (Fanzo, 2012).
- The communication systems that constitute the spreading of awareness and education about the various aspects of nutrition and marketing strategies for food products. These marketing interventions need to focus on strengthening the systems of local food production and the promotion of the extent of consumption and cultivation of foods that are rich in local micronutrients (Fanzo, 2012).
- The improvement of the techniques for the management of improved techniques for products obtained after harvest. These strategies incorporate the storage, food handling, transformation and production, and processing of food products. These strategies contribute to the decrease in the loss of nutrients and the quality of the products and their content that focus on the protection of the safety of products (Fanzo, 2012).
- The interventions for the development of economic and business in order to enhance employment opportunities for women that help eradicate poverty or lack of resources
- Improvement in the financial and health statuses of women in order to help children as well
- Easy access to various health services, antenatal care, reduction of workload for pregnant women and new mothers, nutritional services etc
- Improved facilities for maternal nutrition, education, immunizations and vaccinations, general health services, and financial secutrity
- Safe food and water for consumption and improved hygiene and health in the general communities
The afore-mentioned interventions primarily aim to eradicate the reasons that are identified for the dual-burden malnutrition pandemic.
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