Tackling Malnutrition Requires Multifaceted Approaches

Over the past few decades, there has been significant progress in several health indicators in Nepal. However, malnutrition remains a persistent and inadequately addressed public health challenge in Nepal. The country still faces a complex “double burden” of malnutrition; paradoxically, both undernutrition and overnutrition coexist. The root of the problem is mainly due to structural issues that range from poverty and food insecurity to cultural practices and gaps in the public health systems. 

In fact, the problem of malnutrition is not only due to food scarcity but also related to access to adequate nutrition, particularly in rural areas and among marginalised communities. Consuming enough calories is not sufficient to address malnutrition, but need dietary diversity. It is important to consume sufficient essential micronutrients such as iron, vitamin A, iodine, and zinc for normal growth and development. The deficiencies of those essential micronutrients remain unnoticed until the development of associated conditions, such as anemia, stunted growth, weakened immunity, and poor cognitive development. 

Long-term consequences 

Several studies have consistently reported a high prevalence of stunting among children under five years of age. Chronic undernutrition results in stunting, leading to long-term consequences on physical growth and brain development. A stunted child often struggles academically and consequently contributes less to the country’s development. Hence, malnutrition has been linked both to health and economic issues. 

Poverty is still a main reason for malnutrition. In remote and difficult terrains, families face seasonal food shortages and market access as their livelihoods are often dependent on subsistence agriculture. Poverty restricts their ability to purchase nutrient-rich items such as fruits, vegetables, dairy products, and protein sources such as meat and poultry products. 

Although economic factors significantly contribute to the existing problem of malnutrition, cultural beliefs and traditional practices exacerbate the problem. Food taboos also affect pregnant women and children considerably. Misconceptions about certain nutritious foods cause inadequate maternal nutrition during pregnancy, leading to low-birth-weight babies. Maternal health is closely associated with child nutrition. Malnourished mothers are more prone to diseases and more likely to give birth to low-weight infants. Similarly, early marriage and adolescent pregnancies are still prevalent in certain regions of the country, also contributing to the problem of malnutrition, mainly due to poor maternal health. Tackling malnutrition, therefore, should be focused on adolescent girls from pregnancy to infancy to early childhood. 

The lack of awareness about proper nutrition and feeding practices is another factor contributing to the problem. Although breastfeeding rates are relatively high in Nepal, exclusive breastfeeding for the first six months is not always practiced among certain families and communities. At the same time, complementary feeding is often inadequate in terms of both quantity and quality. 

The country's healthcare system is still developing, and several challenges must be addressed to effectively solve the problem of malnutrition. In a remote part of the country, infrastructure is limited, and access to health services is restricted. Nutrition programmes have been suffering from a lack of coordination among different agencies, and there is also a gap between policy and implementation at the grassroots level. 

In recent times, Nepal has launched initiatives to combat malnutrition through multi-sectoral approaches, such as the Multi-Sector Nutrition Plan (MSNP), which brings together various sectors. Health, agriculture, education, and sanitation sectors are integrated to fight the root cause of malnutrition, emphasising not only food security but also maternal care, hygiene, and behaviour change. Similarly, incorporating nutrition in school health education and community-based interventions has been commendable. 

Still, there are many challenges affecting the fight against malnutrition. A new threat to food security in Nepal is climate change. Unpredictable rainfall, floods, and landslides owing to climate change have been disrupting agricultural production, which has increased vulnerability to marginalised communities. Such erratic environmental conditions hamper food production, and access to nutritious food becomes even more difficult. 

Rapid urbanisation, at the same time, has introduced another aspect of malnutrition, i.e., overnutrition. Easy access to processed and calorie-dense foods in cities has added another dimension to the problem of malnutrition. Increased consumption of highly processed and high-calorie foods has led to a rise in obesity and non-communicable diseases such as diabetes, hypertension, and even cancer. The double burden of malnutrition, therefore, calls for a balanced and context-specific approach to nutrition in developing countries like Nepal. 

To tackle malnutrition in Nepal, a broad and context-specific effort is needed. It is important to improve food security along with the promotion of dietary diversity. The agriculture policies should focus on the production of nutrient-rich crops rather than staple grains. To effectively have a transformative impact on household nutrition, it is essential to empower women through education and economic opportunities. It has been seen that educated and empowered mothers are more likely to practice healthy feeding and seek healthcare. 

Approach

Strengthening the healthcare system is equally important and should include the training of healthcare workers. It should also ensure the availability of supplements and fortified foods and expand access to nutrition services in healthcare facilities. Similarly, female community health volunteers (FCHVs) should be mobilised for a nutrition awareness campaign and monitoring of child growth at the household level. 

A large-scale public awareness campaign should be designed for behavioural change focusing on cultural practices and misconceptions about food and nutrition. At the same time, appropriate practices such as exclusive breastfeeding, proper complementary feeding, adequate sanitation, and hygiene should be promoted at all levels. 

In conclusion, as a multifaceted problem, malnutrition requires a comprehensive and coordinated approach. It has to be acknowledged that fighting malnutrition is not only a moral responsibility but also a long-term investment for a well-nourished, healthier, and more productive population for the country. 

(Dr. Lohani is the clinical director at the Nepal Poison Information Centre. lohanis@gmail.com)