QUO Vadis Tigray

Latin meaning “where are you going” where is Tigray going? I watched a clip on Aiga forum about the recent conference of Tigrian professionals and the two points that I thought are very urgent for Tigarai/Ethiopia.

The two points that were mentioned were the stunting growth which was reported as 39% and the declining school performance. Since I was not present at the conference and not knowing the whole discussion, nevertheless I want to briefly comment on the two pertinent issues.

This brief writing is not by all means a thorough researched paper. It meat to highlight the urgency of the issues. There is a need of a multidiscipline study and guide lines.

Nutrition, environment, infection and brain development in early life.

Let me start with the following quotation

“We are guilty of many things, but our worst crime is abandoning the children, neglecting the foundation of life. Many of the things we need can wait. The child cannot. Right now, is the time his bones are being formed, his blood is being made and his senses are being developed. To him we cannot answer “Tomorrow”. His name is “Today:

Gabriela Mistral 1948

According to the new evidence 43% of children under 5 years of age, about 250 million in low and middle-income countries are at risk to reach their full potential of development-physical, socio emotional, cognition and motor development due to poverty and stunting. The percentage of child hood development at risk realizing their potential declined from 51% in2004 to 43% in 2010, considered a progress but in sub-Saharan Africa very little progress has been made, 70% in 2004 and 66% in 2010

Development is determined by Genetic(nature) as well as environment(nurture). Adequate nutrition is important in the critical years second trimester to 3-5 years for normal bran development. Inadequate of macronutrient (protein, carbohydrate, fat) which leads to protein- energy malnutrition, micronutrient (vitamins, mineral and electrolytes) leading to specific deficiency (discuss below).

 

Protein-energy malnutrition:

Definitions:

Underweight -When a child falls below 2 standard deviation of normal weight for age.

Stunting- when a child falls below 2 standard deviation height for age.

Wasting – 2 standard deviation for weight for height.

Stunting is a result of chronic malnutrition and by the WHO criteria 30-39% is considered high, where Tigrai children are currently which is unacceptable.

 

Micronutrient deficiencies:

In developing countries deficiencies of 4 vital micronutrients namely- Iron, iodine, vitamin and zinc are a major health problem. I will highlight one two of these

Iron: is due to poor diet, elevated requirement   e.g.  during pregnancy and early child hood, loss from parasite infection (e.g. hookworms, schistosomiasis, whipworm. Iron is required for an enzyme that regulate central nervous system cell division. Deficiency leads to impaired cognitive development, reduced growth and physical strength.

Management and prevention: iron rich foods in iron, iron-fortified foods, supplement in childhood and pregnancy.

Iodine: worldwide there is a significant deficiency of iodine intake.It is even more prevalent in northern Ethiopia Tigrai. Iodine is needed for the synthesis of thyroid hormone, which is essential for the development of central nervous system. Iodine deficiency can lead to congenital hypothyroidism growth retardation and irreversible mental retardation. Some studies showed that in areas with iodine deficiency children found to have 12-13 % lower IQ than children in sufficient areas.

Management and prevention: iodine supplement, iodine fortified salt.

Impaired Learning.

Approximately one third of children under 15 years of age in underdeveloped countries have or are at risk for learning impairment due to malnutrition and other hazard to brain development, specially malnutrition during the critical period of life second trimester to 3 -5years of age.

As discussed above malnutrition of both macronutrition (calories) and micronutrition leads to stunting and poor health-acute and chronic.

The need of urgent national policies.

There is nothing more urgent than that of making sure every child has a chance of survival and optimum development potential. Stunting is growth retardation as consequence of malnutrition with very serious outcome- physical and mental retardation. The cost of 39% of children at risk of not reaching their potential is enormous. I recognize up to know it has been a struggle for survival. We cannot predict where Tigrai is going unless as nation we are able to secure the wellbeing of the future generation. So if Tigrai and Ethiopia to compete with the rest of the world it is crucial that an urgent investment on the future generation of the country. The financial burden and cost is very high.

There is an urgent need to formulate policies that involve multi-sectors-health workers, the government, the community, family and  NGO’s.

The goal to achieve clean water to reduce bacterial and parasite infection which contributes for malnutrition.

Education and intervention to prevent malnutrition- food supplement in addition to breast feeding starting 6 months.

Universal child hood immunization which has the most effect on any countries health.

 

Gebrewahid Woldu

References

  1. Advancing early childhood development from since to scale- an executive summary for the Lancet series 2007-2011
  2. Olaf Muller, Michael Krwawinkel, malnutrition and health developing countries
  3. Elizabeth L Prado and Kathryn G Dewey, Nutrition and brain development in early life
  4. Nelson textbook of pediatrics, 17th edition
  5. Current Diagnosis and Treatment , pediatrics 24thedition

 

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