Topological vertex for Higgsed 5d T N theories

The framework in Figure 4.2, a modified version of the framework employed by UNICEF, describes three main underlying preconditions to adequate nutrition:

Food ... Health ... Care

Food.... The food-related underlying cause is inadequate household food security (access to food).

Health.... The health-related underlying cause refers to household access to adequate health services and the adequacy of environmental health conditions.

Care.... Care relates to the social and care environment within the household and local community and its impact upon nutrition, particularly with regard to women and children.

For an individual to be adequately nourished, all three of these preconditions need to coexist. In any assessment of the causes of malnutrition, the relative roles of food, health and care must be examined.

These three underlying causes are not discrete but instead interact in important ways, as depicted by the overlapping circles in the framework. Likewise, a successful strategy to treat malnutrition is

SEVERE OR FATAL INFECTION

SEVERE UNDERWEIGHT MODERATE

UNDERWEIGHT MILD

UNDERWEIGHT NORMAL

WEIGHT

WORSE INFECTION WORSE

INFECTION INFECTION

TIME BETTER NUTRITION

Figure 4.3 Malnutrition-infection Complex

Mason (1996)

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almost never based solely on a food security intervention. If food based approaches are linked to interventions aimed at the health and care-related factors, then the overall effectiveness of the combined actions is likely to be significantly enhanced.

Precondition 1: household food security

In simple terms, food security is concerned with people's access to food. It can be defined as:

Access by all people at all times to the food needed for an active and healthy life.

For a household this means the ability to secure adequate food to meet the dietary needs of all members, either through their own food production or food purchases. Food production depends on a wide range of factors, including access to fertile land, availability of labour, appropriate seeds and tools, and climatic conditions. Factors affecting food purchases include household income and assets as well as food availability and price in local markets. In emergencies, other factors - such as physical security and mobility in war-affected regions, the integrity of markets, etc. - may come into play.

Precondition 2: health and environment

An individual or household's degree of access to good quality health services, safe water supplies, adequate sanitation and good housing are preconditions for adequate nutrition. The health environment influences exposure to, and therefore incidence of, infectious disease,.

Important health issues are: the existing primary health infrastructure, the types of services performed at these facilities, their accessibility and affordability to vulnerable populations and, of course, the quality of these services. Inadequate or delayed treatment of disease places a child at increased risk by prolonging the disease and possibly increasing its severity.

Key environmental issues include the degree of access to adequate quantities of safe drinking water, adequate sanitation systems, and adequate housing.

Precondition 3: the social and care environment

Malnutrition can occur even when access to food and healthcare is sufficient and the environment is reasonably healthy. The social context and care environment within the household and local community can also directly influence nutrition.

Appropriate childcare, which includes sound feeding practices, is an essential element of good nutrition and health.

The major childcare activities and behaviours that influence nutrition are:

• Feeding behaviours, including breastfeeding and complementary feeding.

• Hygiene behaviours related to food, individuals, and home.

• Psychosocial behaviours, including responsiveness, warmth, involvement and opportunities for learning.

• Health behaviours, such as service utilisation, oral rehydration therapy and home care.

Cultural factors and resources - like income, time and knowledge - condition caring practices. The values of the society strongly influence the priority given to the care of children, women and the elderly. Attitudes to modern health services, water supplies and sanitation also affect caring practices.

Finally, the care of children is particularly linked with the status, roles and responsibilities of women.

WFP 4. MALNUTRITION

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Among poor households there are likely to be severe constraints on caring behaviours. Some of these constraints may be the poor health and psychological state of the mother and other family members, the absence of key family members, or the break-up of the family. Others may be self-imposed, as when people decide to switch to a cheaper but less nutritious food.

In emergencies, displacement or forced migration is likely to cause severe social disruption and upheaval which may break links with extended family and wider social networks that would normally support the family in the care of its children and elderly. New social networks or groups - such as local NGO's or church relief groups - may then evolve to replace these structures. Another factor during emergencies which may diminish physical capacity, reduce energy intake and undermine caring capacity is the extra work demands on caregivers to secure food (e.g., foraging for wild food and poorly paid income-earning activities).

Critical to the design of programmes is an analysis of the care and social environment that:

• Takes into account the role and position of women in society in order to ensure that their particular needs are met in the most appropriate manner.

• Identifies the roles of caregivers and the demands placed upon them to ensure supportive interventions.

• Understands local attitudes to the most 'at-risk' groups in order to consider the feasibility of targeting resources at those most in need.

• Identifies viable leadership structures and community networks in order to ensure community participation and accountability.

Obviously, the success of a Programme hinges not only on resources given, but also on the ability to reach those most in need and to give caregivers the support they need to use resources effectively in the care of their families. It is also important to identify which caring practices are essential to a meaningful nutritional intervention - particularly in emergencies - and to ensure that appropriate steps are taken to support these caring practices. For example, the elderly may need assistance in getting to food distribution sites during an emergency, while staff for therapeutic feeding programmes may require training in order to provide appropriate psycho-social support for malnourished children.

Feeding practices - Optimal infant and young child feeding

Breastfeeding is the most important nutritional act in ensuring the adequate growth and development of the newborn child. It simultaneously addresses her/his food, health and care requirements. Breastfeeding should be exclusive for about the first six months of a child's life, after which time semi-solids should be progressively introduced to the diet to complement the continued breastfeeding. If a child less than six months old is not being breastfed, it is important to understand the reasons - and possible constraints - behind this.

Complementary feeding needs to be initiated at around six months of age in addition to sustained breastfeeding. By this age, the nutritional needs of the infant cannot be met by breast milk alone. Complementary foods should no longer be to as "weaning foods" as this incorrectly implies the cessation of breastfeeding. The quantity, quality and form of complementary foods are important as well as the frequency of their use. Complementary food should be safe, palatable, energy-dense, and micronutrient-rich.

The elements of care most critical for women during pregnancy and lactation are: extra quantities of good-quality food, release from onerous labour, adequate rest, and skilled, sensitive pre- and post-natal health care from trained practitioners.

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