The Effects of Malnutrition

I chose malnutrition as the topic of my research for this week. Malnutrition develops when the body is deprived of vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. I chose this topic because malnutrition is not only a major health concern in developing nations but here at home in the United States as well. In the US, malnutrition can be seen in the form of over nutrition (children become overweight) and under nutrition (children are underweight). An overweight child is more likely to develop diabetes, high cholesterol and high blood pressure. In comparison, in developing nations throughout the world, malnutrition is visible in the form of under nutrition. Statistics show that 1/3^rd of children in developing nations suffer from this form of malnutrition. Malnourishment during the early childhood period has serious long-term consequences. It impedes motor, sensory, cognitive, social and emotional development (UNICEF). Severe malnourishment can cause a child to become stunted (very short for their age) or wasted (a child being severely underweight for their age and height). It can also cause brain damage, make the likelihood of death due to a childhood disease higher or be the cause of diseases such as Marasmus and Kwashiorkor. (Berger, 2012). 

Malnutrition statistics from around the world (Save the Children, 2012):

·         -   Every hour of every day 300 children die of malnutrition

·         -   It is the underlying of cause of death of 2.6 million children each year

·         - I in 4 of the world’s children are stunted

·         - 80% of the world’s stunted children live in just 20 countries

·      -  Seven countries have been predicted to see an increase in stunted children by 2015 (In Nigeria -1.6 million, in Tanzania -450,000)

·         - Adults who were malnourished as children earn 20% less on average than those who weren’t.

India has the second highest rate of malnutrition in the developing world ahead of sub Saharan Africa. 1/3^rd of malnourished children in the world live in India where 46% of children under 3 are too small for their age, 47% are underweight and 16% are wasted. There are several contributing factors that are the cause in addition to poor access to adequate nutrition; lack of access to health services, lack of services for pregnant mothers and children and lack of good hygiene practices. Social factors also contribute to malnutrition in girls who are considered to be of a lower social status than males; they are the last to eat in the family.(UNICEF). The lack of knowledge about appropriate feeding practices is also a contributing factor (Mendelson, 2005).

According to one study conducted to examine effects of malnutrition on cognitive development among children in the United States, findings showed that obesity may affect cognitive development as does under nutrition (Averett, S. &  Stifel, D., 2006). Whether being undernourished or over nourished, it is clear that malnutrition during early childhood affects the healthy development of a child with effects lasting into adulthood. This information has given me an even clearer understanding of the link between good nutrition and healthy development. As an educator, I can use this information identify any nutritional concerns among my students and educate them and as well as parents about the importance of good nutrition and their long term health and development implications. 

References:

UNICEF (n.d.). Nutrition  Retrieved from: http://www.unicef.org/india/children_2356.htm

Save the Children (2012). A life free from hunger Retrieved from: http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.7980641/k.C98/Nutrition_Report_2012.htm

Averett, S. &  Stifel, D. (2006)   The Cognitive Effects of Childhood Malnutrition in the United States. Retrieved from: http://sites.lafayette.edu/stifeld/files/2010/05/averett_stifel_obesity_june_2007.pdf

Mendelson, S. (2005). Child malnutrition in India.  

Retrieved from:  http://www.cini.org.uk/childmalutrition.pdf

Birthing practices in Sri Lanka

I chose to research and learn more about birthing practices in Sri Lanka. As a child growing up in Sri Lanka, I was shielded from discussions surrounding topics such as sex, pregnancy and childbirth. This is probably the reason why I feel like I don’t know much about the birthing practices in the country and chose to research this topic further. To give a little background; Sri Lanka is a small island nation located off the southeast coast of India. It has a diverse population of many ethnicities, religions and languages. Religion plays a role in beliefs and practices surrounding pregnancy and childbirth. The population is also diverse in its socio-economic status. As a developing nation faced with conflict until recent years, the level of development throughout the country varies which affects access to facilities, quality of life etc.

Throughout the country, pregnancy is considered a very special time in a marriage. In the Buddhist faith, couples perform rituals and make vows at Buddhist temples to ensure healthy pregnancy and safe delivery. A pregnant woman is well cared for by her family and her community and lavished with attention. The elder women in the family and community advise her on various aspects of the pregnancy. They make sure the mother to be is well fed by preparing whatever food she mother craves. However, there are many beliefs surrounding which foods should be eaten and which should be avoided during the pregnancy. For example pineapple, specific types of fish are avoided in the belief that they produce excess body heat that might cause an early abortion. Certain types of food are believed to augment breast milk production and women are also encouraged increase their intake of these types of food. Regardless of economic status, pregnant women try as much as possible to consume a healthy diet in the hope of giving birth to a healthy baby. However, economic constraints often prevent pregnant mothers from receiving the nutrition they need. They also hold widespread beliefs surrounding pregnancy and the supernatural. For example women are asked to avoid sewing shut stuffed pillowcase, tightening knots, striking nails all in the belief that it would hurt the baby. Baby showers are considered bad luck and gifts are not given until after the birth of the child. When preparing clothes for the baby, the garments are not completed until the birth because it assumes the birth is a certainty. 

Every area has a Medical Officer of Health (MOH) and a Public Health Midwife (PHM). Pregnant women register with the PHM during the first trimester and receive prenatal care through health clinics as well as home visits. In urban areas, there is increasing access to private hospitals as well as more doctors. Many in these areas opt for private medical facilities versus government provided health care because of better facilities and easier access but it comes at a price. 

It was customary for the pregnant woman to return to her mother’s house for the birth. Although this practice has diminished with modernization, the mother or a female relative steps into provide assistance to the mother to be. During this time, in the Buddhist faith, monks are invited to chant and cast away any evil spirits that may harm the mother and the fetus. The majority of births are assisted by physicians and take place in government health institutions but there is an increase in the use of private hospital facilities. Most women give birth vaginally but c-sections are on the rise. The availability and use of drugs to assist in the labor varies depending on the area. Rural areas have lesser facilities whereas urban areas have access to far better facilities. 

My sister-in-law in Sri Lanka chose to give birth in a government hospital due to the high cost of private hospitals. When she entered the hospital when she went into labor, she barely had a bed to lie on because the maternity ward was overcrowded. Her family including her husband had no way of knowing the progress of her labor. When she was ready to deliver, she was transferred to a labor room where she gave birth on her own surrounded only by her doctor and hospital staff during the late evening after hospital visiting hours. Her husband was not able to see her and the baby until the next morning. After the birth, her health and the baby’s health were monitored and the nursing staff instructed her on how to care for herself postpartum and the newborn. For these reasons, women who are able to afford it, opt to give birth in a private hospital. 

I was very saddened to hear about this experience in comparison to my own. The lack of facilities made the process seem a very impersonal one. In contrast, my husband was by side throughout my labor and delivery. I was in a comfortable hospital room and felt supported throughout. I believe that the birth process in Sri Lanka may cause emotional stress to the mother which might affect the delivery, possibly even resulting in complications.  The mother and the infant don’t seem to receive the attention and support they need which can affect the mother’s emotional health which will affect her ability to care for her newborn. My sister-in-law dealt with some emotional issues postpartum but was able to overcome through support from family. There is also no opportunity to bond as a family which I believe has an impact on a child’s development. Although, there is much to be desired about the facilities available in the area of maternal care in Sri Lanka, support from family and the community to the mother and the infant allow them to both thrive during the prenatal period and in the weeks and months following the birth. Despite his mother’s birth experience, my little nephew is now a very happy 3 year old developing well in all areas.

My Personal Birth Experience

I chose to share my experience of giving birth to my daughter. In my native county Sri Lanka giving birth is a very private affair and so I have not participated in any birth experiences other than my own. After 7 years of marriage and many life experiences in between, my husband and I were very excited when we found out we were going to be parents. We immediately shared the news with our parents and siblings. It was decided as was the norm in Sri Lanka not to share the news with others until the end of the first trimester. I faced some emotional stresses during this time. Both my maternal grandparents who I had been very close to growing up passed away within three months of each other. My family tried to shield me from it as much as possible but I was devastated. It was difficult for me to deal with because I was half way around the world from them. My family kept telling me that I shouldn’t be upset because it would affect the baby. 

Regardless, I was blessed to have a relatively easy pregnancy without any complications. Morning sickness hit me towards the end of the first trimester. Unlike its name, I was sick every night for the next 6 weeks or so. My doctor offered me medication while both my mother and mother-in-law had many suggestions as to what I should eat and what I should avoid and other words of advice. Desperate to feel better I tried every suggestion.  Towards the end of my pregnancy we were advised to attend birthing classes as well as take a tour of the hospital. Some of my anxiety about the actual birth process was relieved through the hospital tour as a result of knowing what to expect once I was at there. I worked right up until 2 days before giving birth. I was a toddler teacher at the time. My daughter was born at 38 weeks, the day after we finished our final birthing class. My water broke in the early hours of the morning and I gave birth less than 9 hours later. I had made a birthing plan in advance, making it clear to my husband and doctors as to what I wanted. I had already decided I would opt for an epidural. At the final stages of the delivery, things weren’t going as planned and my doctor mentioned that I might have to go in for an emergency c-section. I was determined not to let it happen and fortunately was able to deliver my daughter vaginally before long. My mother had planned on being present for the birth and was flying in later that week. However, since I went into labor earlier than expected it was just me and my husband in the delivery room. As soon as the baby was born she was placed in my arms. It was the most amazing feeling! We were surprised at how tiny she was. The hospital scale weighed her at 4lbs 13 oz. My husband and I were worried. The doctors reassured us that despite her size she was otherwise healthy. Later that same day she weighed 5 lbs 9 oz. The hospital apologized that the scale in the labor room hadn’t been properly calibrated. I now realize that she could have been termed a Low Birth Weight infant based on the initial weight reading.

I had what I consider a relatively easy and uncomplicated pregnancy and birth experience. I look at my 2 ½ year old daughter and marvel as to what an amazing little girl she has developed into from the tiny little thing that was placed in my arms at the hospital several years ago. Looking back, I think the nature of my pregnancy and the birth process itself has had a positive influence in my daughter’s development. I had a lot of support throughout my pregnancy from my husband as well as my family although they were far away. We had the opportunity to bond immediately after birth. I was encouraged to breastfeed immediately and she was in our care throughout the time we spent in the hospital versus in a nursery. These factors among many others have helped us to form a close bond with each other. This I believe has had a positive influence in her current emotional development which has contributed to her overall development. I realize that things might have turned out differently if I were to have needed an emergency c-section. My daughter might have had to deal with complications resulting from it. I believe that the nature of the pregnancy and the birth process does have an effect on development. I feel blessed!