Generally, nutrition status is affected by:
•Food intake,
•Health,
•Caring practices.
Food intake is determined by the amount and quality of food available. From birth to six months, exclusive breastfeeding is recommended. Data from recent demographic and
health surveys indicate that the percentage of babies under 6 months who are exclusively breastfed has been increasing, from 29% in 1996 to 32% in 1999 to 41% in 2004. However,exclusive breastfeeding is not common after a baby has reached two months of age; the practice tapers off quickly, and by the age of 4 to 5 months only 13.5% of babies are still being exclusively breastfed. Breastfeeding typically continues while infants are being weaned. For infants between 6 and 9 months, 91% are fed complementary foods along with breast milk (NBS, et al., 2005).
During the most critical nutritional period for children, i.e., under two years of age, the absolute amount of food in the household is unlikely to be the critical determinant of food intake. Children at this age consume little compared to older children and adults in the household. For such young children, food intake is more dependent upon the number of times per day they are able to eat – their small stomachs cannot absorb large quantities of food at one time – and the energy and nutrient density of their diets. The predominant diet in Tanzania is cereal-based with low energy and nutrient density. Food security, per se, is not the most critical determinant of the high prevalence of undernutrition in children in Tanzania.
In times of critical food shortages, children suffer along with other family members in affected households, but food shortages typically do not determine undernutrition in young children. The geographic pattern of malnutrition in Tanzania suggests that areas of the country which are the source of cereal surpluses, mainly in the south and west, are also the areas with relatively high rates of malnutrition. Food security, therefore, in the limited sense of cereal crop production, does not seem to be strongly associated with nutrition security.
Clearly, a broader perspective on food security is necessary, which is accepted in the Food Security Policy (Ministry of Agriculture and Food Security (MAFS) [Tanzania], 2004). Access to food and availability of food are the key determinants of food security, which, in turn, are strongly influenced by household income levels and food prices. Poverty is pervasive in Tanzania, and rural households are disproportionately poor. Not surprisingly, therefore,undernutrition in children is most prevalent among rural households and in the poorest households.
Thus the relationship between income and nutrition is a complex one, within and among
households, and nationally. It is only in the least poor 20% of households where the
percentage of children who are stunted falls substantially. According to the TDHS 2004/05, 15.7% of children in these households – which are predominantly urban – are stunted. In contrast, in households in the bottom four wealth quintiles, i.e., from the poorest to the less poor quintile, the percentage of children who are stunted is 45, 43, 41 and 38% respectively. There is a pattern of declining malnutrition with higher income, but several analysts have pointed out that increasing income accounts for only part of the decrease in malnutrition rates. Similar results have been found in analyses of the relation between higher national income (GDP) and rates of child malnutrition (Mkenda, 2004; Alderman, etal., 2005). Factors other than income alone are clearly at play.
Parents’ education affects children’s nutrition. The children of mothers with secondary education are much less likely to be stunted, but the difference in nutrition between the children of mothers with no education and children of mothers with only primary education is not significant (Research on Poverty Alleviation (REPOA), 2004). Currently, very few mothers have secondary education. Much greater investment in the education system will be required before higher levels of schooling are common Health factors are critical for nutrition. Fevers, diarrhoeal diseases and acute respiratory infections (ARIs) are all common among children in Tanzania, and they affect appetite –hence, food intake – as well as the body’s use of energy and other nutrients. During the two weeks prior to the TDHS 2004/05, 24% of all children under five years had fever, 13% had diarrhoea, and 8% had symptoms of acute respiratory infection (coughing accompanied by short rapid breathing). Children aged 6-23 months old were most affected. In this age bracket, 35% had a fever, one-quarter had diarrhoea, and 11% had symptoms of acute respiratory infection.
Recent improvements in prevention and treatment of malaria may explain in part the
reduction in child malnutrition. More effective drug treatment has been introduced, and more children are sleeping under mosquito nets.
Systems to deliver health and other services, especially for poor and rural children, are critical, especially for young children and pregnant women. The capacity of health workers and administrators who are responsible for service delivery need to be strengthened. Increased financial allocations to local authorities through basket funding and budget support are supporting improvements in healthcare. However, people in poor and rural households do not have the same access to health services as their less poor and urban peers, both in distance to service providers and in the costs of obtaining healthcare (NBS,et al. 2005). Moreover, while districts have prepared comprehensive health and
development plans, there is little mention of nutrition in these plans, even though malnutrition is recognised as a problem and some of the strategies in the district plans will indeed help to reduce rates of malnutrition.
Access to health services is one key aspect of care for children.
Caring practices also affect patterns of breastfeeding and the number of times a child is given anything to drink or eat during the day. Caregivers who must spend most of their time provisioning households –
farming, fetching water and fuel for cooking, washing, etc. – have little time to devote solely
to caring for young children. Care for the youngest children is, therefore, commonly
provided by older siblings, especially girls. And cooking is usually done only once per day.
Snack foods could provide additional intake to reduce malnutrition, but such foods are not
commonly given to young children, especially in rural communities and poor households.
In addition to feeding practices, care also includes hygiene practices and psychosocial
stimulation. Sound hygiene practices are hampered by shortages of water and soap,
unsanitary latrines, and inadequate waste disposal systems. As a result young children
suffer frequent bouts of diarrhoeal diseases. Psychosocial stimulation is limited by the
amount of time carers are able to devote to their children.
A particular group of children who need special care and feeding are those children who are
so severely malnourished that they have been admitted to hospital. Provision of food for
hospital patients is frequently inadequate, and is often left to the responsibility of families. In
cases of severely malnourished children, the circumstances of families are likely to have
contributed to the condition of the children who are in hospital. Hospitals, therefore, need to
be able to provide the food and healthcare to ensure that children are well nourished and
recover.
The effective communication of information plays a critical role in influencing caring and
feeding practices. Normally this information comes from families and communities through
informal means. However, health staff also have opportunities to provide information to
almost all mothers of young children during antenatal visits. The TDHS 2004/05 found that
97% of pregnant women visit a health facility for at least one antenatal check-up, and almost
all of them for two or more. In addition, at the time of the first visit to the health facility after
the birth of the baby, 91% of infants are immunised with BCG which is given at that time.
Community health days offer other possibilities for communicating sound nutrition practices.
Throughout Tanzania, health days are organised at least twice a year when children are
provided with vitamin A supplementation. These events are usually organised to coincide
with the Day of the African Child on June 16, and World AIDS Day on 1 December. Schools
are other venues for communication, both for siblings of young children who can share the
information with their families, and for older pupils, especially adolescent girls, to gain
greater understanding of nutrition.
Fundamental to all of the processes which influence nutritional outcomes is the importance
that society places on good nutrition and on supporting those who are most likely to suffer
from poor nutrition – children and pregnant women. Much more needs to be done to raise
the level of importance attached to policies and strategies affecting nutrition and vulnerable
groups, which, in turn, will significantly impact social and economic development more
generally.
The “silent” emergency of chronic malnutrition which so negatively affects the development
of nearly half the child population of Tanzania should command much greater attention, and
be accorded at the very least the same priority and resources which are provided to
emergency response to alleviate temporary food shortages caused by drought or flood
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