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  • PMSA EDITORIAL TEAM 2020

Double Burden of Malnutrition in the Pacific

Author: Macquin Anduwan


Malnutrition is a global burden presenting in various forms [1]. Generally, excess and deficiency in nutrition are the two polarities of malnutrition [1]. In 2018, 2.01 billion adults were overweight and obese globally, while, on the other hand, 150.8 million children were stunted and 50.5 and 38.3 million children were underweight and overweight, respectively [1]. Often times an overlap in burdens of undernutrition and overnutrition presents – commonly referred to as double burden of malnutrition (DBM) – as seen regularly in developing low and middle income countries globally [1].


The Asia-Pacific region, has been identified as a key region where DBM issues should be prioritized due to having most of the global burden of stunting, overweight and obesity prevalence, and highest obesity prevalence in the world [1].


Reports have stated that the Pacific region faces high levels of diseases, premature disability and death linked to unhealthy diets and lifestyles [2]. This is marked by the food security situation where, despite increasing availability and demand of protein-rich and resource-demanding food, such as meat and dairy, imports of processed foods low in nutrient value has also increased [2]. While it is generally accepted that most people in the region eat enough, the issue stems from the lack of proper nutrient intake [2]. This has led to micronutrient deficiency, especially in children, which developmentally leaves young people developmentally stunted [2].


UNICEF has reported that almost 2 of every 3 children in the Pacific between six months and two years of age are not receiving proper nutritional foods that would support their rapidly growing bodies and brains [3]. This gives rise to future developmental problems like weak learning outcomes, low immunity, increased infections, and in many cases, death [3].


The report further described a triple burden of malnutrition in which undernutrition, hidden hunger caused by a lack of essential nutrients, and overweight was described among children of several Pacific Island Countries (PICs) [3]. These countries had a high prevalence of stunting in children under 5 years, including Nauru, the Republic of the Marshall Islands, Solomon Islands, Tuvalu, and Vanuatu [3]. Additionally noted was that most of the PICs also have high rates of overweight and obesity among children and adolescents, including in the Cook Islands, Kiribati, Niue, Federated States of Micronesia, Fiji, Nauru, Palau, Republic of Marshall Islands, Samoa, Solomon Islands, Tonga, and Tuvalu [3]. Moreover, there was also high rates of anaemia among children under 5 years and among 15-49 year old women in every country in the Pacific [3].

As mentioned above, the double burden of malnutrition commonly occurs in low- and middle-income countries [4]. It is the simultaneous presentation of both under- and over-nutrition which consists of wasting, stunting, low birth weight and micronutrient-deficiencies on the one hand, and overweight, obesity and diet-related non-communicable diseases (NCDs) on the other [4].

In the Pacific region, researchers have noted that overnutrition is rising faster that undernutrition is decreasing [4]. In an article released by the World Bank Group, it stated that several countries belonging to the East Asia Pacific (EAP) region had under-five year olds stunting prevalence rates that were among the highest in the world, of which Papua New Guinea had a 50% rate [4]. Obesity was rising in EAP and the Pacific Island Countries and Territories (PICTs) had the highest rates of adult obesity in the world [4]. The article concluded stating that most EAP countries have a double burden of malnutrition problem [4].


Another article in 2019 aimed at determining the prevalence of under- and overnutrition as major DMB components and to investigate whether there had been a shift from under- to overnutrition in the Asia-Pacific region [1]. Of a total of 33 studies from 2008 to 2018, data analysis showed that DBM was generally present among the countries in the Asia-Pacific region except in high-income countries. In the low- middle-income countries where DBM was present, it was significantly high and sloped toward overnutrition [1]. The researchers suggested that future interventions and policy targeting to maintain a healthy weight should focus on both directions [1].


Research into the causes of DBM have indicated multiple factors stretched across the life course, with early nutrition a risk factor for overnutrition later on in life [4]. Inadequate diet, infectious diseases among mother and young children are direct causes of stunting in children [4]. Other related underlying factors include inadequate caring practices and poor status of women, low quality and accessibility of health care services, food insecurity and low food access, and unhygienic household environments [4]. The majority of PICT populations also lack access to proper sanitation facilities while no major improvement has been seen in the last decade [4].


If the double burden of malnutrition is to be confronted, adequate provisions of nutrients is imperative [5]. The first six months of a child’s life must be spent exclusively breast fed [5]. This is crucial in the child’s physical, mental, and long-term development [5]. Significant benefits can also be achieved by focused efforts during the first two years of life, while at the same time maintaining a life-course approach for good nutrition at any age [5].


Researchers have summarised it into 10 actions that simultaneously reduce the risk for undernutrition, obesity and diet-related non-communicable diseases:

· Scale up new WHO recommendations for antenatal care [6];

· Scale up programs to promote , protect and support breastfeeding [6];

· Redesign complementary feeding practice guidelines [6];

· Redesign current growth monitoring programs [6];

· Prevent unnecessary harm from micronutrient-fortified and energy-dense foods and ready-to-use supplements [6];

· Redesign food and cash transfers, vouchers and subsidies [6];

· Redesign school feeding programs and create new nutritional guidelines for food in and around education institutions [6];

· Scale up nutrition-focused agriculture programs [6];

· Design new food and agricultural system policies to promote healthy diets [6]; and

· Implement policies to improve food environments and prevent all forms of malnutrition [6].


Presently, many governments’ ability to effectively plan, prioritise and implement nutrition initiatives are compromised due to limited nutrition capacity [7]. Many of the PICTs still do not have nutrition policies and plans and not specifically mainstreamed into their food security and agriculture policies, although efforts are being made to ensure it as part of current policy development [7].


Another challenging factor is limited knowledge and awareness about good nutrition and healthy diets, in addition to insufficient nutrition education [7]. Since many Pacific Island countries face a double burden of malnutrition, there is an immediate need to develop nutrition plans and include it in the agriculture and food security policies and programmes to effectively utilize resources and direct activities to work toward global targets [7].


Despite all these challenges, once they’ve been met, a cooperative effort between government policy makers, non-government organisations, and individual effort should achieve a positive result, limiting the double burden of malnutrition in the South Pacific, and ultimately reducing global statistics.



References


[1]

W. Peng, Y. Mu, Y. Hu, B. Li, J. Raman and Z. Sui, "Double Burden of Malnutrition in the Asia-Pacific Region—A Systematic Review andMeta-analysis," Journal of Epidemiology and Global Health, vol. 10, no. 1, pp. 16-27, 2020.

[2]

P. Hanasz, "An appetite for risk? Food security in the South Pacific," theinterpreter, 26 June 2017. [Online]. Available: https://www.lowyinstitute.org/the-interpreter/appetite-risk-food-security-south-pacific. [Accessed 13 March 2021].

[3]

"Poor diets damaging children’s health in the Pacific, warns UNICEF," UNICEF, 15 October 2019. [Online]. Available: https://www.unicef.org/pacificislands/press-releases/poor-diets-damaging-childrens-health-pacific-warns-unicef. [Accessed 13 March 2021].

[4]

R. Shrimpton, N. V. Mbuya and A. M. Provo, "The Double Burden of Malnutrition in East Asia and the Pacific : Evidence and Lessons for a Multisectoral Response," World Bank Group, 2016. [Online]. Available: https://openknowledge.worldbank.org/handle/10986/26102. [Accessed 13 March 2021].

[5]

"Malnutrition in the Western Pacific," World Health Organization, [Online]. Available: https://www.who.int/westernpacific/health-topics/malnutrition#:~:text=Malnutrition%20in%20the%20Western%20Pacific&text=The%20double%20burden%20of%20malnutrition,(NCDs)%20on%20the%20other.. [Accessed 14 March 2021].

[6]

E. N. Dreisbach, "‘Double burden’ of malnutrition grows in low- and middleincome," Healio, 17 December 2019. [Online]. Available: https://www.healio.com/news/pediatrics/20191217/double-burden-of-malnutrition-grows-in-low-and-middleincome-countries#:~:text=Nearly%202.3%20billion%20adults%20and,%E2%80%9Cdouble%20burden%E2%80%9D%20of%20malnutrition.. [Accessed 14 March 2021].

[7]

"FAO Regional Conference for Asia and the Pacific," FAO, 2014. [Online]. Available: http://www.fao.org/3/mi701e/mi701e.pdf. [Accessed 13 March 2021].




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