Nutritional problems

Nutritional problems in developing countries can be deficiencies, imbalances or excesses.

Nutritional deficiencies

• Energy and/or protein deficiency

It is particularly important when its affects pregnant women, lactating mothers, and especially young children.
Even a mild deficiency will affect growth (from the foetal period on, with as a consequence a low birth weight), infant development, resistance to infections. It also increases mortality in under-fives.
A more severe deficiency is the cause of clinical malnutrition and high mortality.
This type of nutritional deficiency is very common in emergency situations (refugee camps, natural disasters), and it can sometimes be spectacular. Yet it is generally less known by the public that chronic malnutrition is considerably more common: more than 190 million children are estimated to be malnourished. It is the “silent urgency” denounced by UNICEF in 1997.

• Vitamins and minerals deficiency

The World Health Organisation recognises three main deficiencies in this category, with global significance:

• Iron deficiency reduces resistance to infections and is a cause of anaemia. It is estimated that more than 2 billion persons suffer from anaemia in the world.
• Iodine deficiency is well known for its most visible consequence: goitre. An estimated 225 million persons are iodine deficient, 20 million suffer from various degree of mental development retardation, including 6 million cretins. It is estimated that a billion persons are at risk.
• Vitamin A deficiency affects the eyes : night blindness, eye dryness (xerosis of the cornea and the conjunctiva), and blindness through destruction of the eye in the most severe cases. The population at risk is estimated to reach 190 million of which 40 million would actually be deficient, including 14 million with eye lesions. Three to four million of the latter would become blind. It should also be noted that even a mild vitamin A deficiency increases child mortality because of a loss of immunity.
• Other deficiencies. There are many other deficiencies that can have serious health implications, if they are localised: vitamin D (rickets); vitamin B1 (beri beri); zinc (stunting); niacin (pellagra); etc.

Nutritional imbalances

They can be due to a combination of deficiencies or to the combination of one or more deficiencies with the excess intake of one or more nutrients. Field situations are therefore extremely diverse.

Excesses

It is mainly the excess of energy intake which, particularly in the absence of sufficient physical exercise, is a cause of obesity. Obesity in turn is a disease that favours diabetes, blood cholesterol, coronary heart disease, arterial hypertension, vascular brain damage (thrombosis or haemorrhage), and lastly some cancers (particularly breast and colon cancers).

This group of conditions sometimes called “the disease of affluence” is, taken together, the first cause of death in industrialised countries. It is however much less known by the general public that this group of diseases increases at a fast rate in developing countries. There are a variety of reasons for this: urbanisation, reduction of physical exercise, monotonous diet poor in vegetables and fruits, etc. But – and this is important – it is rising mainly among the poor: it is no longer the disease of the rich.

The consequences for the poor countries are extremely damaging:
- rising cost of care and of disability;
- danger of bankruptcy of the health system and/or appearance of a duality in health care: express train for the rich, suburban transport for the poor;
- increased inequality when facing illness or death.

Solutions exist, but they are difficult to put into practice. There is a need therefore to conduct applied research, adapted to each situation.