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  • Describe nutrition problems around the world: their extent, causes, and manifestations
  • Identify the signs and symptoms of micronutrient deficiencies and understand approaches to addressing these deficiencies
  • Describe key interventions for malnutrition in various settings: in developing countries, during complex humanitarian emergencies, and in the context of HIV/AIDS and tuberculosis
  • Identify some tools for measuring malnutrition and distinguish between growth monitoring and rapid emergency assessment
  • Describe how national and international policies can shape nutrition strategies and approaches. Give examples of potential beneficial and adverse effects of such policies

During the past few decades we have become increasingly aware of the central role that nutrition plays in all aspects of population health. We have recognized that access to adequate nutrition is a human right since the promulgation of the Universal Declaration of Human Rights in 1948, as stated in Article 25: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food ”[emphasis added]. Although it may seem intuitively obvious that such access is also a basic human need, there is value in reviewing the biologic factors that inform our understanding of this. We will come back to a more detailed discussion of these concepts later in this chapter, but keep these two fundamental truths in mind while reading the following pages. In addition, we wish to introduce another concept for you to consider while reading this chapter; all of the major causes of death of the people of this globe, be they living in high-income, middle-income, or low-income countries, are inextricably linked to the nutritional environment in which they find themselves.


In a century characterized by modern approaches to identifying and solving global health problems, undernutrition prevails in the world’s children, contributing to a third of all deaths in children under 5 years of age.1 An estimated 195 million children under 5 years in developing countries are stunted in growth (height-for-age), and some 120 million are wasted (weight-for-height).2 Overall, 80% of the world’s undernourished children live in just 20 countries around the world, according to the World Health Organization (WHO).3 In addition, a third of the developing world suffers from micronutrient deficiencies—deficiencies that accompany poor nutrition and are silent until their effects are advanced and, in some instances, irreversible. In these settings, infections, such as human immunodeficiency virus (HIV), tuberculosis (TB), and parasites, intensify the impact of undernutrition, and vice versa.

We can define direct causes of undernutrition as primary undernutrition, caused by inadequate food intake, or secondary undernutrition, caused by underlying diseases such as TB or HIV/AIDS. In addition, there are many indirect causes of undernutrition: poverty, the low status of women, unsanitary health conditions, wars and conflict, low national income growth, as well as poor governance and corruption. Factors underlying poor health services are human, economic, and organizational resources and their control. This is one reason that ...

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