In Her Lifetime Female Morbidity and Mortality in Sub-Saharan Africa (1996) / Chapter Skim
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3 Nutritional Status
3 Nutritional Status
Pages 54-79
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From page 54... ...
The third section of the chapter uses a life span perspective to examine the functional consequences of malnutrition among Sub-Saharan African females. The chapter concludes with some preliminary research recommendations.
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From page 55... ...
53) Standard models of determinants of the nutritional status of both children and women include quality and quantity of dietary intake, presence of infection, and energy expenditure as proximate determinants, which are themselves seen to be determined by a range of household, community, national, and global variables related to wealth, food production, education, and availability of health services, among other matters (see Kennedy et al., 1992; Leslie, 1991; Merchant and Kurz, 19935.
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From page 56... ...
Findings from the four African countries comparing child outcomes in households that participated in a cash-cropping scheme with otherwise similar, nonparticipating households found no evidence of a negative effect on child nutritional status from household participation in cash-cropping, but only very weak evidence of a positive effect. Comparison with the findings from the Guatemala study is illuminating: Guatemala was the only one of the six study sites where household participation in cash-cropping was significantly associated with better child health and nutrition outcomes, and this was attributed to the decision of the vegetable production and marketing cooperative to directly invest some of its profits in community health and social services.
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From page 57... ...
. Given that the energy demands of lactation are higher than those of pregnancy, however, it is essential to increase energy intake and/or reduce energy expenditure during breastfeeding in order to protect women's long-term nutritional status (Parker et al., 1990~.
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From page 58... ...
Nevertheless, a recent detailed study of the functional consequences of malnutrition among the Embu in Kenya found that reduction in energy expenditure during the third trimester was a major mechanism used by pregnant women to achieve reasonable infant birthweights in the face of inadequate dietary intake (Neumann et al., 19925. Evidence of the contribution of energy-sparing mechanisms to partially meet the additional energy demands of pregnancy has also emerged from a series of studies of women in three rural Gambian villages.
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From page 59... ...
Lawrence and colleagues interpreted their combined findings concerning changes in BMR, fat deposition, and energy expenditure as demonstrating that maternal nutritional status is si~nificantiv comnromise.~1 in rural Gambian women by pregnancy during the rainy season.
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From page 60... ...
Using BMI below 18.5 as the cutoff point, fewer than 20 percent of women in Middle America, South America, and China; slightly more than 20 percent of women in SubSaharan Africa; and about 40 percent of women in South and Southeast Asia were excessively thin. It is helpful to compare the regional information on child nutritional status from the Second Report on the World Nutrition Situation with the information on women's nutritional status, although unfortunately the ACC/ SCN does not report child nutritional status disaggregated by gender.
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From page 61... ...
When the other two indicators related to female nutritional status are examined, however, a somewhat different picture emerges. Based on percentage of low-birthweight infants and maternal mortality ratios, female malnutrition seems to be greatest in western Africa (this is consistent with the estimated subregional prevalences of anemia, as shown in Table 3-4~.
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From page 62... ...
Of the 13 countries for which there are data on low birthweight, 7 have percentages above 10; 3 are at 10 percent; 2 are below 10 percent; and 1, Zimbabwe, is difficult to classify because the rates given in the two sources, 15 percent and 6 percent, are so different. In maternal mortality ratios, only two countries in eastern Africa have a rate above 500 per 100,000 live births, 10 are in the 100 to 500 range, and 2 have rates below 100.
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From page 63... ...
1992a,b. Unlike daily per capita energy availability, both the percentage of infants born with low birthweights and maternal mortality ratios are specific to females.
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From page 64... ...
In western Africa, except for Cole d'Ivoire, where the mean BMI of women is similar to that found in the Kenya study, the BMI data support the conclusion of substantial female malnutrition suggested by the indirect indicators in Table 3-2. The data in Table 3-3 are consistent with the estimated regional average of 21 percent of women in Sub-Saharan Africa with a BMI below 18.5 (UN, 1992~.
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From page 65... ...
Middle Africa Zaire LESE: 21.7 LESE: 21.6 Significant seasonal variation in Bailey et al., 1992 EFE: 20.2 EFE: 20.2 weight loss, December to June Zaire TEMBO: 19.7 - Carael, 1978 NTOMBA: 21.1 HIGHLAND: 21.35 Western Africa Beninb 11.5% < 18.0 BMI 22.0% of women had BMI > 23.0; Fakambi, 1990 · · r.
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From page 66... ...
Table 3-4 suggests that although women in western Africa experience the highest prevalence of nutritional anemia, the prevalences in western Africa, middle Africa, and eastern Africa are quite similar, while women in southern Africa are definitely less anemic. The better situation of women in southern Africa has been attributed by some to the widespread use of iron cooking pots in this region (WHO, 1992)
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From page 67... ...
Within the Sub-Saharan African region, the areas most affected are eastern Africa, southern Africa, and the Sahelian parts of western Africa. Populations living where red palm oil is produced or distributed that is, along the coastal parts of western Africa and in some parts of central Africa are reasonably well protected against vitamin A deficiency.
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From page 68... ...
FUNCTIONAL CONSEQUENCES OF FEMALE NUTRITIONAL STATUS: TAKING A LIFE SPAN PERSPECTIVE Malnutrition is multifactorial in its etiology and cumulative in its manifestations. Merchant and Kurz (1993, p.
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69 _ C~ on Do Ct Cal ._ ~ .
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It has been estimated that maternal nutritional factors account for approximately half the influence of established determinants of intrauterine growth retardation in developing countries (Kramer, 1987, cited in Merchant and Kurz, 1993~. Current or past maternal malnutrition-as evidenced by short stature, low weight-for-height, poor quality dietary intake, and excessive energy expenditure is a significant risk factor for bearing infants of low birthweight, a relationship that shows a direct intergenerational transmission of malnutrition.
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From page 71... ...
_ _ ~ J ~_ _ = ~ ~ ~ ~ ~at_ _ ~ ~ _ ~ V ~ ~ ~ ~V ~ ~ ~ ~ ~at_ ~ ~I ~ ~ ~ ~ Morbidity rates among Embu women were significantly higher among pregnant women than among nonpregnant women of reproductive age (Neumann et al., 1992~. In addition to the well-established negative effects of pregnancy on the immune system, the researchers attributed the greater morbidity among pregnant women to their lower food intake.
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From page 72... ...
There are pockets of severe iodine deficiency in the majority of Sub-Saharan African countries; in the region as a whole, there are estimated to be at least 500,000 overt cretins whose condition is ascribed to maternal iodine deficiency during pregnancy (UN, 19923. In addition to congenital cretinism, children who suffer from iodine deficiency during their preschool or school years also show delayed mental development although unlike cretinism, these cognitive impairments can be reduced with appropriate nutritional intervention.
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From page 73... ...
The Kenya research also reports surprisingly good infant birthweight outcomes, in spite of low energy intake during pregnancy and a weight gain only half that recommended. In contrast with the reported findings from The Gambia, however, the Kenya study found no compensatory lowering of resting energy expenditure among pregnant women.
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Irondeficiency anemia is most commonly observed in women ages 15 to 40 years, and is itself a risk factor for maternal mortality. PEM and iron-deficiency anemia during the childbearing years are also major risk factors for low birthweight.
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From page 75... ...
In addition, the high proportion of low-birthweight infants in many Sub-Saharan African countries is substantially attributable to maternal malnutrition, both prior to and during pregnancy. Although some researchers have suggested that Sub-Saharan African females seem to "accommodate" remarkably well to inadequate food intakes, multiple pregnancies, long duration of breastfeeding, and long hours of energy-intensive domestic and market work, appearances can be deceiving.
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From page 76... ...
Although it is useful to compare the regional information on child nutritional status from the Second Report on the World Nutrition Situation with the information on women's nutritional status, the ACC/SCN does not report child nutritional status disaggregated by gender. Similarly, although a substantial amount of research has been carried out to investigate the nutritional situation in Sub-Saharan Africa during the postcolonial period, the number, scope, and quality of nutrition studies varies substantially from one country to another, and many otherwise excellent studies (particularly of child malnutrition)
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5. Cutoffs used by WHO were less than 120g/L hemoglobin for nonpregnant adult women and less than 110g/L for pregnant women.
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1970. The ecology of malnutrition in Eastern Africa and four countries of Western Africa.
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From page 79... ...
1991. Gender Differences in Household Resource Allocations.
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