 |
Figure
12—The global prevalence of low female
body mass
index (BMI)
|
 |
Figure
13—Global prevalence of stunting in children
younger than five (red indicates
the greatest prevalence of
stunting and blue indicates the least prevalence of
stunting)
|
The
greatest struggle of developing nations is relieving deep-seated poverty. As a
result, a majority of the citizens, especially women and children, residing in
these countries are either undernourished or malnourished and have multiple
micronutrient deficiencies. It is estimated that 178 million children under the
age of five are stunted. This accounts for 32% of all children worldwide.
Furthermore, 19 million children face severe acute malnutrition (SAM). More
than 40% of the female population in countries like India, Pakistan,
Bangladesh, Ethiopia, and Somalia are underweight according to their BMI,
Figure 12. With developing nations, South Central Asia has the highest disease
burden due to stunting and wasting. India alone has around 61 million stunted and
or wasted children (accounting for 34% of the global estimate) with a
prevalence of 51%, Figure 13. As a result, India loses 600,000 individuals
annually from the direct and indirect physiological effects of stunting and
wasting.
 |
Figure
14—The relationship between poverty and
malnutrition
|
The
chief problems the people of the Satpuda Region face include: (1) poor hygienic
practices, (2) undernutrition and malnutrition, (3) inadequate and compromised
health, and (4) severely lacking education. All of these issues stem from one
main factor—poverty, Figure 14. Before the active involvement of Project ASHA
and to some extent the local government, the vision of good health and overall
prosperity within the surrounding region was deemed impossible. Until recently, the goal of giving the
villagers diverse opportunities for both an improved health status and a better
quality of life has slowly begun to become feasible. However, the people
inhabiting the villages surrounding Kevadiya Colony are not yet completely devoid
of their constant and daily life struggles.
The
villagers of the Satpuda Region live well below the poverty line—earning
approximately 1,000 rupees per month, which is roughly equivalent to 18 US
dollars per month. Their poverty is further compounded by their poor
geographical situation. A large percentage of the villages within the Narmada
District are located in unfavorable environments which worsens their
socioeconomic development and as a result their health status too. Some of the
villages are a mere cluster of scattered houses and huts that are located on
different hills as well as the slopes and peaks of mountains in the rural-most
areas of the Satpuda Mountain and Forest Range. As a result, commute to a nearest
city is achieved only by foot or a Jeep. Thus the villagers inhabiting these
types of areas are presented with very limited job opportunities.
A
majority of the villages lack infrastructure and proper internal development.
Many of the villages do not possess electricity, telephone, and transportation.
The villagers do not even have medical care centers or an ease of access to
health care facilities. The primary schools that are found in these villages
are ill-equipped and are not designed to provide children with a sufficient and
sound education or opportunities to help acquire what few jobs that may be made
available to them in their life time. Thus without any hopes of providing their
children with the tools necessary to create an optimistic future, the parents
enroll their children into physically taxing and meager work that ensures the
fate of another generation to live below the poverty line with the constant
lingering thought of when the next meal will come their way.
 |
Figure
15—The causative factors and determinants of
malnutrition, the gateway to
infectious diseases
|
Thus,
the combination of: (1) poor health care and educational facilities, (2)
unfavorable environment and lack of infrastructure, (3) food insecurity and
lack of nutritious foods, (4) poor hygienic practices, and (6) deeply-rooted
poverty and limited resources predisposes the villagers of the Satpuda Region
to a host of infectious diseases and illnesses, increased mortality, morbidity,
and disability rates, and an overall poor quality of life that has very little
room for improvement. A conceptual framework, (Figure 15), developed by UNICEF,
accurately models and portrays the proximal and distal factors and determinants
discussed above. Overall, the villagers’ way of life intrinsically increases
their susceptibility to disease which synergistically affects their economic
productivity further sustaining the deeply-seated poverty and the related
disease of poverty—undernutrition and malnutrition.
As
mentioned before in the Week 3 Narrative, both undernutrition and malnutrition
are gateways to infectious diseases and illnesses. The people and livestock
that inhabit the villages within Narmada District have long been victims of
food insecurity, especially during the summer season, when their land is so dry
that farming becomes an impossibility. During this time of year, the villagers
are at the highest risk for undernutrition and malnutrition. During the monsoon
and winter seasons, crops can be grown by the villagers; however these crops
are primarily grown to generate income and not for personal consumption. Lacking
a proper, nutritious, and well-balanced diet leads to various micronutrient
deficiencies that can lead to a host of adverse implications physiologically,
including but not limited to: impaired physical and mental development, lowered
immunity status, reduced cognitive function, stunted grow, increased mortality,
morbidity, and disability rates, etc. Figure 16 (below) illustrates how
undernutrition and malnutrition can physiologically affect individuals across
their life span. These physiological implications are greatly evident upon the
observation of the villagers residing within the Narmada District, especially
the women and children. The village’s women face various physiologic and social
stresses that predispose them to malnutrition throughout their lifetime. Such
stresses include: food insecurities and inadequate diets, recurrent infections,
poor health care, heavy work burdens, and gender inequalities. These factors are
further compounded by high fertility rates, repeat pregnancies, and short
intervals between pregnancies. As a result many women of the region display a
lower immunity status, obstructed pregnancies due to the disproportionate size between
the fetus’ head and the mother’s birth canal, and an increased risk of
mortality as a result of obstructed labor. As a consequence of maternal
undernutrition, the chances of delivering a low birth weight baby are high as
is a baby with birth defects, these in and of itself are major risk factors of
both neonatal and infant mortality and increases the infant’s chances of
stunted growth during adolescence. Undernutrition in the children residing
within the Satpuda Region has made them susceptible to low immune function and
has increased their risk of developing illnesses such as pneumonia and
diarrhea. In fact, approximately 50 to 70% of the diarrheal diseases, malaria,
measles, and lower respiratory tract infections during adolescence have been
attributable to undernutrition.
 |
| Figure
16—Physiological implications of undernutrition and malnutrition across an
individual’s life span |
Lastly,
poor water and sanitation practices within the tribal villages of the Narmada
District has made countless villagers fall victim to diarrheal diseases. In
fact, poor water quality and hygienic practices in developing nations is
responsible for 4 billion cases of diarrheal diseases worldwide (with most of
the victims being younger than five). Within the Satpuda Region and other
developing regions, diarrheal diseases have caused villagers to have: a
decreased dietary intake and nutrient absorption, malnutrition, reduced
resistance to infection, stunted growth and cognitive development.
Overall,
the life of a villager within the Satpuda Mountain and Forest Range is a
constant struggle; however with the aid of Project ASHA, these daily struggles
have begun to dwindle and the quality of life within the region has begun to
improve slowly but steadily.
The
following figures were adapted from the following websites:
