1. Community and Public Health
Nutrition
10-Nutrition in Developing
Countries
Prepared by;
Dr. Siham M.O. Gritly
1Dr Siham Gritly

2. Glossary
• Poverty; The state of being extremely poor. The state of
being inferior in quality or insufficient in amount or
the state or condition of having little or no money, goods,
or means of support; condition of being poor.
• hunger; a craving or urgent need for food or a specific
nutrient or an uneasy sensation occasioned by the lack of
food
• Or hunger: consequence of food insecurity that,
because of prolonged, involuntary lack of food, results in
discomfort, illness, weakness, or pain that goes beyond
the usual uneasy sensation
2Dr Siham Gritly

3. • food poverty: hunger resulting from inadequate access to
available food for various reasons, including inadequate
resources, political obstacles, social disruptions, poor weather
conditions, and lack of transportation
• famine: widespread and extreme scarcity of food in an area
that causes starvation and death in a large portion of the
population.
• oral rehydration therapy (ORT): the administration of a
simple solution of sugar, salt, and water, taken by mouth, to
treat dehydration caused by diarrhea. A simple
• ORT recipe:
• • ½ L boiling water
• • 4 tsp sugar
• • ½ tsp salt Dr Siham Gritly 3

4. • Sustainable development is the development that
"meets the needs of the present without
compromising the ability of future generations to
meet their own needs."
• food security: access to enough food to sustain
a healthy and active life.
• food insecurity: limited or uncertain access to
foods of sufficient quality or quantity to sustain a
healthy and active life.
• food insufficiency: an inadequate amount of
food due to a lack of resources.
Dr Siham Gritly 4

5. Developed vs. developing countries
• Developed countries mainly depend on
industries while Developing countries should
struggle for integrated rural development with
the sustainable agricultural development
and the promotion of economic activities.
• sustainable agriculture: ability to produce
food indefinitely, with little or no harm to the
environment.
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6. • Kramer, (2003) pointed out that disparities
between developed and developing countries
highlighted by;
• maternal mortality,
• infant mortality,
• stillbirth
• and low birth weight
Dr Siham Gritly 6

7. The double burden of diseases in the
developing world
• WHO indicated that;
• Hunger and malnutrition remain among the most
devastating problems facing the majority of the
world’s poor and needy people
• The root causes of malnutrition include;
• poverty and inequity.
• Eliminating these causes requires political and social
action
Dr Siham Gritly 7

8. Poverty is main characteristic of developing
countries
What is poverty
• Poverty refers to the condition of not having
the means to afford basic human needs such as
• Clean water
• Balance nutrition (quantity and quality)
• Health care
• clothing and shelter.
Dr Siham Gritly 8

9. poverty is derived in collective terms at three
dimensions:
• incidence of poverty (percent of individuals
out of the total sample whose incomes are
insufficient to attain the minimum energy
level),
• depth (intensity) of poverty (meaning how
far is the poor group from reaching the
minimum energy level),
• and the severity of poverty (energy inequality
within the poor group).
Dr Siham Gritly 9

10. • Each of these dimensions might require a
different policy action
• the most widely used poverty measure is
poverty incidence; also known as headcount
ratio.
Dr Siham Gritly 10

11. Poverty line
• Poverty line is defined as expenditure required
for daily Calorie intake of 2.400 per person in
rural areas and 2000 Calories in urban areas
• Poverty is the main cause of;
• Low expectancy
• Low birth weight
• High maternal mortality
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12. • Under five years of age mortality
• Handicap and disability
• Stress and mental illness
• Suicide
• Family disintegration
• Drug use and crime
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13. Human Development Index (HPI).
• HDI Defined as; a composite (complex) index
combining indicators representing three dimensions;
• 1-longevity (the expectancy at birth) long life
• 2-knowledge (adult literacy rate and mean year of
schooling) knowledgeable
• 3-income (real GDP Gross Domestic Product per
capita in purchasing power parity in US dollars) high
standard of life
• GDP is gross income generated within the country
excluded net income received from abroad
Dr Siham Gritly 13

14. • The human development index provides a
more comprehensive picture of human life
than income does
• The HDI ranges between 0-1
• The HDI value for a countries shows the
distance that it has already travelled to words
maximum possible value to 1 and allows
comparisons
Dr Siham Gritly 14

15. • To construct the index, maximum and
minimum values have been established for
each of the indicators
• 1-life expectancy at birth- 25 and 85 years
• 2- adult literacy rate- 0 percent and 100
percent
• 3-GDP per capita; $ 100 and $ 40.000
Dr Siham Gritly 15

16. Human Poverty Index (HPI).
• 1997 another term Human Poverty Index was
introduced
• The HPI assesses levels and progress using a concept
of development much broader than that allowed by
income alone (Human Development Report 2010).
• The human Poverty Index measures deprivation in
human development needs (health, education and
income)
• 1-longevity
• 2-knowledge
• 3-income
Dr Siham Gritly 16

17. Nutrition in developing countries
• UNFPA reported that there are some factors
contributing to the poor health status among
African population.
• These factors include
• malnutrition,
• lack of sanitation especially drinking water, and
absence of health care during pregnancy,
• uncontrolled fertility,
• illegal abortion
• and low education.
Dr Siham Gritly 17

18. Food production and food security
• Food production can influenced by factors such
as;
• pests,
• Climatic variations,
• prices,
• availability of agricultural inputs and farmers'
ability to obtain them,
• political stability and
• peace
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19. • Most food in the world comes from;
• cereals.
• The second largest amount of food comes from
root crops,
• followed by legumes or pulses.
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20. Food availability; the role of agriculture
sector in developing countries
• The main objectives of agricultural sectors is to;
• provide balance and adequate diet for all the member of
the community Expanding agricultural efforts to increase
and improve food production
• to have to understand the needs of human and how to
overcome the problems of malnutrition,
• job opportunities for huge number of the society,
increase the income of rural families through greater
production of cash crops so agriculture is very related to
human nutrition.
Dr Siham Gritly 20

21. To improve nutrition, agricultural planners
should aim to;
• expand the production of staple cereals and
legumes
• should promote consumption of fruits,
vegetables, oilseeds and
• livestock products or those of small animal
husbandry.
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22. Access to food (food demand)
• Access to food, or food demand, is influenced
by;
• economic issue,
• physical infrastructure and
• consumer preferences.
Dr Siham Gritly 22

23. food security
• Food security defined as; "access by all
people at all times to enough food (quality
and quantity) required for an active and
healthy life"
• the under nutrition in developing countries is
due to inadequate intake of both protein and
energy and that it is often associated with
infectious diseases.
Dr Siham Gritly 23

24. • Achieving food security includes ensuring:
• a nutritionally adequate and safe food
supply at both the national and household
levels;
• stability in the supply of food during the
year and in all years;
• access by each household to sufficient food
to meet the needs of all
Dr Siham Gritly 24

25. Food security categories:
• High food security: no indications of food
access problems or limitations
• Marginal food security: one or two
indications of food-access problems but with
little or no change in food intake
Dr Siham Gritly 25

26. Food insecurity categories:
• Low food security: reduced quality of life
with little or no indication of reduced food
intake; formerly known as food insecurity
without hunger
• Very low food security: multiple indications
of disrupted eating patterns and reduced food
intake; formerly known as food insecurity with
hunger
Dr Siham Gritly 26

27. Social and cultural factors
• Social factors and cultural practices in most
countries have a very great influence on;
• what people eat,
• how they prepare food,
• their feeding practices and
• the foods they prefer
Dr Siham Gritly 27

28. • many practices are specifically designed;
• to protect and promote health;
• providing women with rich, energy-dense
foods during the first months of pregnancy
• Some researcher suggested that traditional
food practices and taboos constitute an
important cause of malnutrition in some areas
of Africa
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29. • Nutritionists need to have a knowledge of the
food habits and practices of the communities
in which they work so that they can help to
support the positive habits
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30. Food habits
• habit is an accustomed way of doing things.
Habits accumulated through generations emerge
as customs, and customs in turn create habits.
• All people have their likes and dislikes and their
beliefs about food,
• They tend to like what their mothers cooked for
them when they were young,
• the foods that are served on festive occasions or
those eaten with friends and family away from
home during their childhood.
Dr Siham Gritly 30

31. Nutritional advantages of traditional food
habits
• The traditional diets of most societies in
developing countries are good.
• Eating certain protein-rich foods such as
insects, snakes, baboons, mongooses, dogs,
cats, unusual seafoods and snails is beneficial.
• Another habit that is good nutritionally is the
consumption of animal blood.
• Blood is a rich food, and mixed with milk it is
highly nutritious.
Dr Siham Gritly 31

32. Food taboos
• *Food taboos defined as a set of rules about which foods or
combinations of foods may not be eaten
• The origin of these prohibitions is varied. In some cases,
these taboos are a result of health considerations or other
practical reasons.
• A taboo may be followed by a whole national group or tribe,
by part of a tribe or by certain groups in the society.
• Within the society, different food customs may be practiced
only by women or children, or by pregnant women or
female children
Dr Siham Gritly 32

33. • There are two main types of food prohibitions;
permanent and transitory.
• *permanent; maintained by specific cultural and
religious groups. Consumption of these foods is
part of what distinguishes each culture from other.
• *transitory, is applied to individuals within a
cultural setting due to specific phase states, such
as illness, pregnancy, postpartum, lactation and so
on.
Dr Siham Gritly 33

34. Nutrition and development
famine, hunger and starvation
.
34Dr Siham Gritly
The malnutrition consequences include;
death, disability, stunted mental and physical
growth, and as a result, retarded national
socioeconomic development.

35. Stages in the Development of a Nutrient
Deficiency
• 1-Primary deficiency caused by inadequate diet
or Secondary deficiency caused by problem inside
the body------assessment methods;-Diet history
and Health history
• 2-Declining nutrient stores (subclinical) and
Abnormal functions inside the body assessment
methods;-Laboratory tests
• 3-Physical signs and symptoms, assessment
methods; -Physical examination and
anthropometric measures
Dr Siham Gritly 35

36. malnutrition: any condition caused by excess or
deficient food energy or nutrient intake or by an
imbalance of nutrients.
Dr Siham Gritly 36
The severe wasting
characteristic of
marasmus
The edema characteristic of
kwashiorkor is apparent
in this child’s swollen belly.
Malnourished children commonly
have an enlarged abdomen from
parasites as well.

37. some factors as suggested by researchers that
contribute to nutritional problems among
underdeveloped communities; drought, flood, and
pests additional to political causes created by people
Dr Siham Gritly 37
Political Turbulence (disorder); A sudden
increase in food prices, a drop in
workers’ incomes, or a change in
government policy can quickly leave
millions hungry
Armed Conflicts; dominant cause of
famine worldwide.
Natural Disasters; Natural disasters and
other poor weather conditions create
food shortages
Without water, croplands
become deserts

38. Nutrition, infection and national development
• the effects of nutritional status on infections
and of infections on malnutrition a very
important relationship.
• The majority of children in most developing
countries suffer from malnutrition at some
time in their first five years of life.
• control of infectious diseases and
• improvements in the children's food intake and
health care. Are main factors that reduce
children mortality
Dr Siham Gritly 38

39. • Many of the children who suffer from
malnutrition and a series of infections;
• They are often;
• retarded in their physical,
• psychological or behavioural development,
• And a shortened life expectation.
Dr Siham Gritly 39

40. the most common serious nutritional
problems in almost all developing
countries
• Protein-energy malnutrition (PEM),
• vitamin A deficiency,
• iodine deficiency disorders (IDD)
• and nutritional anaemia - mainly resulting from
iron deficiency
Dr Siham Gritly 40

41. Principle problems of nutrition in
developing countries
• Maternal malnutrition
• Poor nutrition in preconception period and
pregnancy
• Maternal depletion, poor pregnancy weight
gain, and depletion of nutrient stores (fat and
muscle mass, iron, calcium, zinc, vitamin A,
etc.)
• Maternal anemia, or protein energy
malnutrition
Dr Siham Gritly 41

42. • Infant feeding
• Exclusive breast feeding (EBF) for first 4-6
months
• Those not EBF have double the infant
mortality rate as breast fed infants in
developing countries
Why
What are the benefit of breast milk
Dr Siham Gritly 42

43. • Weaning
• Continue breast feeding until 2 years child
• energy-dense food with high-quality complete
protein, essential vitamins and minerals
What are the main weaning food used in
Sudan
Dr Siham Gritly 43

44. • Micronutrient deficiencies
• Iron deficiency
– Anemia
– Impaired cognitive function
– Decreased physical activity
– Decreased work capacity in older children and
adults
– Decreased appetite
– Impaired cellular immune function
• Dr Siham Gritly 44

45. • Vitamin A
–Irreversible blindness
–Increased morbidity and mortality from
infection, especially pneumonia and
diarrhea
–Loss of structure and function of epithelial
linings of the body
–Impaired cellular immune function
Dr Siham Gritly 45

46. • Iodine deficiency
Impaired intellectual capacity, decreased
productivity,
Significant cause of poor pregnancy outcome,
severely retarded infants, children, and
adults
Dr Siham Gritly 46

47. • Others such as;
• Zinc deficiency
• Vitamin B12 deficiency
• Folic acid
• Calcium
• Vitamin D
Dr Siham Gritly 47

48. Poverty in Sudan
The UN Millennium Development Goals in Sudan
• The incidence of poverty in Northern Sudan
stood at 46.5%.
• This means that almost one out of two
Northern Sudanese does not have the
necessary means to purchase the value of a
minimum food and non-food bundle.
• Poverty levels vary greatly by state.
Dr Siham Gritly 48

49. • The incidence of poverty ranges from a quarter
of the population in the capital to more than
two thirds of the population in Northern
Darfur.
• That is the percentage of individuals whose
incomes are insufficient to achieve the
minimum energy level ,
Dr Siham Gritly 49

50. the growth strategy needs to focus on two
areas:
• (i) support for the agricultural sector,
including livestock, forestry and fisheries, to
promote growth and productivity change;
and
(ii) support for private sector development,
with policies, institutions, incentives and
infrastructural services to promote
investments, innovation, productivity growth
and employment creation in all sectors of the
economy.
Dr Siham Gritly 50

51. The key roles for the government in the
strategy includes
• (i) the maintenance of macroeconomic stability
that reduces macroeconomic risks,
• improves the confidence of the business sector in
the management of the economy,
• helps to maintain the competitiveness of
Sudanese firms;
(ii) adopt policy and institutional framework that
supports the strategic objectives of growth and
poverty reduction;
Dr Siham Gritly 51

52. • (iii) pursue human development efforts that
builds a skilled labor force consistent with the
demands of the labor markets to foster
innovation and productivity; and
(iv) economic services including infrastructure,
and for agriculture, knowledge related
services (research, extension and capacity
building).
Dr Siham Gritly 52

53. • the MDGs assessments in Sudan indicate to
positive and encouraging progress on;
• Goal 2 (access to education particularly at
primary level),
• Goal 3 (Gender Equality and Empowerment of
Women) and
• Goal 6 (HIV/AIDS).
Dr Siham Gritly 53

54. • Goal 1, Goal 4, Goal 5 and Goal 7 of the MDGs
may not be achieved unless current efforts are
scale up on all fronts (resources both human
and financial) to reverse current trends.
Dr Siham Gritly 54

55. Discussion
• What are the main causes of
poverty in Sudan
Dr Siham Gritly 55

56. Hunger-Relief Organizations
Ref Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.
2011, 2008 Wadsworth, Cengage Learning
Organization Mission Statement
Action without
Borders
www.idealist.org
International organization seeking to connect
people, organizations, and resources to help build
a worldwhere all people can live free and dignifi ed
lives.
Bread for the World
www.bread.org
Non-partisan, Christian citizens’ movement seeking to
influence reform in policies, programs, and conditions that
allow hunger and poverty to persist globally.
Community Food
Security Coalition
www.foodsecurity.org
North American coalition of diverse people and olevels to
build community food securityrganizations working from the
local to the international
Congressional
Hunger Center
www.hungercente
r.org.
Bipartisan organization training and inspiring
leaders with the intent to end hunger, and
advocatingpublic policies to create a food-secure
world Dr Siham Gritly 56

57. Hunger-Relief Organizations
Organization Mission Statement
Food and Agriculture
Organization
(FAO) of the United
Nations
www.fao.org
International organization leading efforts to
defeat hunger by helping to develop and
modernizecountries’ agriculture, forestry, and fi
shery practices
Oxfam
www.oxfamamerica.org
America International relief and development
organization aiming to create lasting solutions to
poverty, hunger, and injustice.
Pan American Health
Organization
www.paho.org
International public health agency aiming to
strengthen national and local health systems with
thepurpose of improving the quality of, and
lengthening, the lives of peoples in the Americas.
The Hunger Project
www.
thp.org
International relief organization emphasizing
sustainable solutions such as rural development
and selfreliance to facilitate food security
Dr Siham Gritly 57

58. Hunger-Relief Organizations
Organization Mission Statement
United Nations
Children’s Fund
(UNICEF)
www.unicef.org
International organization advocating for the protection of
children’s rights, to help meet their basic needs and to expand
their opportunities to reach their full potentials.
World Food Program
www.wfp.org
Food aid branch of the United Nations aiming to prepare for,
protect during, and provide assistance after, emergencies, as
well as reducing hunger and undernutrition
World Health
Organization (WHO)
www.who.int
United Nations agency acting as the authority on international
public health by infl uencing policy, setting research agendas,
establishing standards, and providing technical support to
monitor and assess
health trends
World Hunger Year
(WHY)
www.whyhunger.org
Domestic organization supporting and funding community-
based organizations intent on empoweringindividuals and
building self-reliance to provide long-term solutions to hunger
and poverty.
Dr Siham Gritly 58

59. references
• The world health report 2002: reducing risks, promoting healthy life.
Geneva, World Health Organization, 2002.
• Diet, physical activity and health. Geneva, World Health Organization,
2002 (documents A55/16 and A55/16 Corr.1).
• . Popkin BM. The shift in stages of the nutritional transition in the
developing world differs from past experiences! Public Health
Nutrition, 2002, 5:205-214.
• The world health report 1998. Life in the 21st century: a vision for all.
Geneva, World Health Organization, 1998
• Nutrition and development: a global assessment. Rome, Food and
Agriculture Organization of the United Nations and Geneva, World
Health Organization, 1992.
• Promoting appropriate diets and healthy lifestyles. In: Major issues
for nutrition strategies. Rome, Food and Agriculture Organization of
the United Nations and Geneva, World Health Organization, 1992:17-
20.
59Dr Siham Gritly

60. • Ref Ellie Whitney and Sharon Rady Rolfes; Under
standing Nutrition, Twelfth Edition. 2011, 2008
Wadsworth, Cengage Learning
• Drewnowski A, Popkin BM. The nutrition
transition: new trends in the global diet. Nutrition
Reviews, 1997, 55:31-43.
• World agriculture: towards 2015/2030. Summary
report. Rome, Food and Agriculture Organization of
the United Nations, 2002.
• Bruinsma J, ed. World agriculture: towards 2015/2030. An
FAO perspective. Rome, Food and Agriculture Organization of
the United Nations/London, Earthscan, 2003
60Dr Siham Gritly

61. Questions to Identify Food Insecurity
in Household
• 1. Did you worry whether food would run out before
you got money to buy more?
• 2. Did you find that the food you bought just didn’t last
and you didn’t have money to buy more?
• 3. Were you unable to afford to eat balanced meals?
• 4. Did you or other adults in your household ever cut
the size of your meals or skip meals because there
wasn’t enough food?
• 5. Did this happen in three or more months during the
previous year?
• 6. Did you ever eat less than you felt you should
because there wasn’t enough money for food?
Dr Siham Gritly 61

62. • Were you ever hungry but didn’t eat because
you couldn’t afford enough food?
• 8. Did you ever lose weight because you didn’t
have enough money to buy food?
• 9. Did you or other adults in your household
ever not eat for a whole day because you were
running out of money to buy food?
Dr Siham Gritly 62

63. • 10. Did this happen in three or more months
during the previous year?
• 11. Did you rely on only a few kinds of low-
cost food to feed your children because you
were running out of money to buy food?
• 12. Were you unable to feed your children a
balanced meal because you couldn’t afford it?
• 13. Were your children not eating enough
because you just couldn’t afford enough food?
Dr Siham Gritly 63

64. • 14. Did you ever cut the size of your children’s
meals because there wasn’t enough money for
food?
• 15. Were your children ever hungry but you just
couldn’t afford enough food?
• 16. Did your children ever skip a meal because
there wasn’t enough money for food?
• 17. Did this happen in three or more months
during the previous year?
• 18. Did your children ever not eat for a whole day
because there wasn’t enough money for food?
Dr Siham Gritly 64