IT IS well established that young children in poor living communities are at risk for undernutrition and malnutrition due to lack of resources, neglect, abuse, and inappropriate care by parents and caregivers, who are often under physical and emotional stress. In Jamaica, approximately one in every four children under the age of four lives in poverty. That is approximately 70,000 children. (www.jsjCanada.org)
Poor nutrition and underdevelopment of children in developing countries, including Jamaica, led to heads of governments in November 1989 adopting the Convention on the Rights of the Child (CRC). The basic human rights for children under age 18 are delineated therein to include the right to survival, to develop to the fullest, and to protection from harmful influences, abuse, and exploitation.
The World Health Organization, in its Global Database on Child Growth and Malnutrition, indicated that at 2007, malnutrition prevalence - height for age - percentage of children under five in Jamaica was 5.70. Over a 29-year period, its highest prevalence value was 16.60 in 1978; its lowest value was 4.50 in 2004.
The risks for malnutrition are high, especially in poor families and among children who are being weaned, with stunting at 2.2 per cent compared to 3.4 per cent in 1990, and wasting at 4.3 per cent, compared to 3.6 per cent in 1990. Data in 1995 indicated an improvement in underweight, stunting, and wasting (Survey of Living Conditions 1996).
Between 1990 and 1995, the prevalence in overweight remained constant, but showed an increase in 2000. There is a synergistic relationship between the nine per cent increase in the number of meals eaten outside the home between 1992 and 1999 and weight gain. The diet in fast foods increases total fat intake, leading to overweight and obesity in children, teens, and adults. In the absence of national surveys on food consumption in Jamaica, the Survey of Living Conditions indicates that the consumption of meals outside the home had increased, with more children eating fatty foods.
The provision of rights for adequate health and nutrition resources as outlined in Articles one to 14 in the CRC has raised standards in the development of children, moving from deadly communicable diseases like tuberculosis and typhoid to lifestyle diseases like diabetes, hyper-tension, and obesity. Interestingly, children born in Jamaica after 2009 have a more than 97 per cent chance of surviving beyond five years and an almost 100 per cent chance of enrolling in school.
Some gains in the right to health care have been eroded, however. These include a decline in exclusive breastfeeding, with only 15 per cent of children being breastfed at six months. The 2005 Multiple Indicators Cluster Survey stated that less than half of lactating mothers exclusively breastfed at six weeks.
Immunisation rates have been lagging behind the national goal of 95 per cent average coverage, according to the End-of-Decade Assessment of the World Summit for Children 2002 Goals. In 2007, average coverage was at 83.8 per cent, according to the Ministry of Health's annual report, with the decline attributed to limited staff resources, including community health aides.
The nutritional status of children has been compromised with the spread of HIV/AIDS. In UNICEF's State of the World's Children 2002 report, it was stressed that every effort should be made to keep all children healthy and in caring environments, especially since children were so vulnerable to the AIDS virus.
Millennium Development Goals
Another critical assessment protocol for assessing nutritional status are the Millennium Development Goals (MDGs), which were established to monitor eight goals aimed at improving the quality of life for all, including children. An assessment of Jamaica's status at a glance indicates that Jamaica, in the eradication of poverty and undernutrition, is on track at halving, between 1990 and 2015, the proportion of persons whose income is less than one dollar a day (National Report of Jamaica on the MDGs 2009).
In assessing the progress of the MDGs in the eradication of poverty and hunger, there was a decline in the prevalence of underweight children to 2.2 per cent in 2007, from 8.4 per cent in 1990. The proportion of the population below minimum level of dietary-energy consumption - the food poor - decreased from 8.3 per cent in 1990 to 2.9 per cent in 2007 (Planning Institute of Jamaica).
Access to Food
Access to food continues to be critical, with 19 per cent of the population living below the poverty line and in rural communities with limited infrastructure and poor water supply, which contributes to poor nutritional status (www.fao.org). Child growth in rural Jamaica has been influenced by factors like diarrhoea and respiratory infections, which may influence body weight. Findings from a semi-longitudinal study (Miall, et al: 1969) of factors influencing child growth in a rural community in Jamaica revealed that while respiratory infections and diarrhoea both peaked between the ages of six and 24 months when children are at highest risk of malnutrition, there was no influence on body weight in the long term. The findings suggested that many of the diarrhoea cases seen in this rural community of children may have been secondary to undernutrition, rather than the cause of it.
The incidence of protein-energy malnutrition in severely malnourished children has declined significantly through supplementation and school-feeding interventions. Better nutrition is an essential component of providing basic needs for poorer individuals, especially the young. In Jamaica, vast numbers of school-age children face major nutrition and health problems that adversely limit their ability to take advantage of educational opportunities available to them.
Many children have a history of malnutrition and nutritional deficiencies exacerbated by parasitic infection, which is highly prevalent among school-age children. It has been demonstrated that when children are given a meal at school, they are better able to reap the benefits of classroom instruction. Providing breakfast to mildly undernourished students at school improves verbal fluency and speed and memory in cognitive tests (Grantham-McGregor S., Chang S., Walker S. Evaluation of School-Feeding Programs: Some Jamaican Examples. American Journal of Clinical Nutrition 1998; 67(4))
Food-consumption patterns have changed to match population demographics, particularly those of age, sex, and rural and urban living. There has been a dramatic shift in urbanisation, with a shift from 37.6 per cent in 1965, to 56.1 per cent in 2000, with a projected rise to 70.3 per cent in 2030 (UN, 2002). This has increased the dietary-energy supply requirement with slight increases in protein intake. Domestic food supply increased between 1990 and 1995, with more people moving to the cities instead of staying in rural townships. The 1999 SLC indicates that the inequity in food-consumption patterns is not changing, with the wealthiest one-fifth of the population responsible for 45.9 per cent of total consumption and the poorest one-fifth responsible for only six per cent of total consumption (fao.org./ag/agri/nutrition).
The Food and Agriculture Organization Nutrition Country Profile 2003 shows that food availability continues to be good, especially for fruits, vegetables and starch roots, meat and offal, except for 1989-91, as a result of the effects of Hurricane Gilbert in 1988. The same is true for nuts, pulses, and seeds, with sweeteners taking up a significant portion in the group providing energy. Major food imports indicated that cereals made up the country's major food imports. Food imports accounted for 94.7 per cent of dietary-energy supply.
The Way Forward
With Vision 2030 goals set for Jamaica, how can the quality of health care be improved for our people, and in particular, for our children? Here are some recommendations:
Continue home-based early-childhood and day-care programmes for poor children from birth to three years. This offers the hope of breaking the cycle of poverty especially when mothers are unemployed (Dr Kerida McDonald).
Expand the Malnourished Children's Programme, established in 1994 by The Tropical Metabolism Research Unit at the University Hospital of the West Indies, to address early-childhood deficiencies in children hospitalised for malnutrition. The intervention strategy provides follow-up home visits to monitor the child to prevent readmission to hospital. Outreach programmes are conducted in poor communities in Kingston, where there are pockets of malnutrition. Psychosocial stimulation is given to children three years old and younger and is enhanced by a toy-lending mobile library. (Elements of Quality in Early Childhood Home Visiting Programmes in Jamaica, Dr. Kerida McDonald, 2000).
Implement and monitor strategies to meet the MDGs' number-one goal of reducing poverty and eradicating hunger.
Provide access to basic education as there are now more school-age children in developing countries than ever before, due to population growth and the success of child-survival programmes.
Improve school-feeding programmes to provide one hot meal for every school-age child to reduce the risk of poor health and nutrition. This should be supported by regular nutrition education, along with policies for safe water and sanitation (www.freshschools.org).
Provide nutritional supplementation and psychosocial stimulation, to improve the mental development of stunted children.
Expand school health programmes to include immunisation, personal hygiene, and environmental improvement.
Heather Little-White PhD is a food & nutrition consultant in Kingston.