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Recently, Nube and Sonneveld16 showed distinct patterns in the distribution of underweight in Africa, which compelled them to suggest that it would be essential to tackle nutrition issues in Africa according to regional distributions of the problem. The present study goes even further to suggest that within a small
and presumably homogeneous country such as Malawi, there is a need to recognise the unique heterogeneity of agro-ecological zones, and how each of them can potentially have an impact on nutrition interventions.
Wobst et al.5 observed that the three ADDs of Blantyre, Lilongwe and Mzuzu are highly heterogeneous. For example, Blantyre ADD has the highest land constraints compared with Lilongwe and Mzuzu ADDs. Hence, it would be logical to suggest that there are diversities in livelihoods (such as access to farming land, food, sanitation, and socio-economic services) of inhabitants of these areas, which ultimately has a substantial impact on nutritional wellbeing.
The basic, underlying and immediate causes of
malnutrition are well known and have been summarised by UNICEF through the conceptual framework of the causes of malnutrition.15 In the present study we did not investigate the different determinants of malnutrition in each of these areas. However, synergistically the causes of malnutrition are likely to have varying degrees of impact on the magnitude of malnutrition from one area to another depending on an array of potentiating factors. We recommend that unlike the current practice where blanket national recommendations are made for implementation in Malawi as a whole, the ongoing decentralisation programme should be an opportunity for nutrition managers in various areas to start identifying priority interventions that are likely to address the most important causes of malnutrition in their agro- ecological zones. Such a process should start with the assessment and prioritisation of the determinants of malnutrition in each area. Because the agro-ecological zones are unique in many social and economic aspects, we avoid making specific recommendations on
interventions at this stage as that will defeat the very purpose of developing area-specific strategies.
The Surveillance of Micronutrient Programmes in Malawi receives financial support from UNICEF Malawi.
1. National Statistical Office. 2004 Malawi Demographic and Health Survey. Zomba, Malawi: National Statistical Office, 2005: 163-184. http://www.nso.malawi.net (accessed 7 December 2006).
2. UN SCN (United Nations Standing Committee on Nutrition). Fifth Report on the World
Fig. 2. Distribution of height-for-age z-scores of children from Blantyre, Lilongwe and Mzuzu ADDs compared with the NCHS/WHO reference population.
Fig. 1. Prevalence of stunting, underweight and wasting in preschool children from Mzuzu, Blantyre and Lilongwe ADDs. Using Pearson χ2, both stunting and underweight were significantly lower in Mzuzu than Lilongwe ADD (χ2 = 8.61, p = 0.003; and χ2 = 11.72, p = 0.0006, respectively). χ2 analysis was not possible for wasting because of inadequate count in some cells.
Fig. 4. Distribution of weight-for-height z-scores of children from Blantyre, Lilongwe and Mzuzu ADDs compared with the NCHS/WHO reference population.
Fig. 3. Distribution of weight-for-age z-scores of children from Blantyre, Lilongwe and Mzuzu ADDs compared with the NCHS/WHO reference population.
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Nutrition Situation. Nutrition for Improved Development Outcomes. Geneva: UN SCN, 2004: 7-19.
3. National Statistical Office. Malawi Demographic and Health Survey 1992. Zomba, Malawi: National Statistical Office, 1994: 105.
4. Pelletier DL, Frongillo EA jun, Schroeder DG, Habicht J-P. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 1995; 73: 443-448.
5. Wobst P, Balint B, Mduma JK, Seebens H, Tchale H. Policy Analysis for Sustainable Agricultural Development in Central and Eastern Europe and Southern Africa: Final Report. Bonn, Germany: PASAD, 2005: 12. http://www.pasad.uni-bonn.de/final_report.
pdf (accessed 7 December 2006).
6. Gibson RS. Nutritional Assessment: a Laboratory Manual. New York: Oxford University Press, 1993: 44-55.
7. World Health Organization. Physical status: the use and interpretation of
anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995; No. 854, 29-32.
8. Gibson RS. Principles of Nutrition Assessment. 2nd ed. New York: Oxford University Press, 2005: 337.
9. Chilima DM, Kalimbira AA, Mtimuni BM, Mvula N. Surveillance of Micronutrient
Programmes in Malawi: Summary of Findings. Lilongwe, Malawi: Likuni Press and Publishing Company, 2003: 17-18.
10. Caulfield LE, de Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2004; 80: 193-198.
11. Chandra RK. Effect of post-natal protein energy malnutrition and intrauterine growth retardation on the immunity and risk of infection. In: Calder PC, Field CJ, Gill HS, eds.
Nutrition and Immune Function. New York: CABI Publishing, 2002: 41-56.
12. National Statistical Office. Malawi Demographic and Health Survey 2000. Zomba, Malawi: National Statistical Office, 2001: 138.
13. National Statistical Office, International Food Policy Research Institute. Malawi – an Atlas of Social Statistics. Zomba, Malawi: National Statistical Office, 2002: 11-13.
14. National Statistical Office. Integrated Household Survey 2004-2005. Vol. 1. Zomba, Malawi: National Statistical Office, 2005: 37-47.
15. United Nations Children’s Fund. The State of the World’s Children Report 1998. New York: UNICEF, 1998: 24.
16. Nube M, Sonneveld BG. The geographical distribution of underweight children in Africa. Bull World Health Organ 2005; 83: 764-770.
Williams' Essentials of Nutrition &
Diet Therapy, 9th edition
By Eleanor Schlenker and Sara Long
ISBN 032303764X / 9780323037648 Ä Paperback Ä 832 Pages Ä 358 Illustrations
Mosby Ä Published November 2006
Health & Medical Publishing Group
Private Bag X1, Pinelands, 7430 Tel: 021 – 6578200 - Fax: 021- 6834509
e-mail: [email protected] / [email protected]
A favorite for more than three decades among nursing and allied health instructors and students, Williams� Essentials of Nutrition & Diet Therapy provides focused nutrition coverage in an easy-to-read style presented in an attractive and colorful layout. Formerly known as Essentials of Nutrition & Diet Therapy, the ninth edition strives to both improve and enhance the book� s reputation for solid core nutrition content, ensuring that the most up-to-date information and topics in this ever-changing field are addressed throughout. Wellness and health promotion are stressed, as are global nutrition issues and the ever-increasing recognition of the vital roles that culture and religion play in everyday dietary patterns, practices, and overall health.
Features
Content follows a logical progression of nutrition, separated into chapters organized by the basic principles of human nutrition, community nutrition throughout the life cycle,and an introduction to clinical nutrition related to a number of common disease states.
Solid, up-to-date content is presented in an easy-to-read style.
Hot topics in nutrition and diet are addressed including the low-
carbohydrate/high-protein diet, the glycemic index and diabetes, food processing and labeling, genetics, and more.
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