Malnutrition Worldwide

Estimates indicate that 925 million people – more than one in every seven worldwide – are undernourished, and 98 percent live in the developing world. Malnutrition develops when the body does not have the correct amounts of certain key vitamins, minerals, and nutrients to maintain organ function and healthy tissues. In areas affected by drought or other natural disasters, food supplies may be extremely limited, and increases in the number of malnourished individuals may be seen. By exploring new farming techniques and working to ensure that aid is provided in the affected nations, it may be possible to reduce rates of malnutrition.

Two-thirds of malnourished individuals are concentrated in seven countries: Bangladesh, China, the Democratic Republic of Congo, Ethiopia, India, Indonesia, and Pakistan. Other nations, particularly those in regions affected by drought, are also facing massive food shortages and increasing rates of malnutrition. In the Horn of Africa, a reported 10 million people including children and people with disabilities have been affected by the recent drought in this region – the most severe drought in the area in the past 60 years, which has interrupted food production. UN reports show that those who currently do not have access to a reliable source of food include an estimated 3.2 million people in Ethiopia, 3.5 million in Kenya, 2.5 million in Somalia, 600,000 residents of north-eastern Uganda, and 120,000 individuals in Djibouti.

Children are at a particularly high risk of becoming malnourished. World Health Organization estimates indicate that malnutrition contributes to more than one-third of all child deaths worldwide and the United Nations Children’s Fund approximates that 480,000 children in Somalia, Kenya, and Ethiopia will be severely malnourished this year – a 50 percent increase over last year’s figure. Mark Bowden, the UN humanitarian coordinator for Somalia, notes that the nation is currently facing “the highest rate of malnutrition in the whole of Africa, [and] more than 30 percent of children are suffering from global acute malnutrition.” Many malnourished children can be treated through the administration of calorie-dense, nutrient-rich foods including Ready-to-use Therapeutic Food (RUTF). Though RUTF is still not available in some regions, it based on peanut butter and dried skimmed milk and provides sufficient nutrient intake for complete recovery from malnutrition, and can be stored for three to four months without refrigeration, even at tropical temperatures.

According to UN reports, world food production will need to increase by up to 100 percent by 2050 in order to sustain 9 billion people, the expected global population. In addition to utilizing sustainable farming techniques, some experts have suggested the introduction of “super wheat” – a crop that is more resistant to some types of fungus that can destroy crops. Further exploration of crop options and sustainable farming techniques could help to expand the food supply and help to reduce global rates of malnutrition.

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Healthcare Shortages in the U.S.

In remote areas worldwide, the availability of trained medical personnel continues to be problematic, but new research shows that there are also shortages of healthcare providers in the United States. Recent reports indicate that approximately 65 million Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), defined as regions with 2,000 or more residents per primary-care doctor. A recent study in the journal Academic Emergency Medicine found that three-quarters of U.S. emergency department directors indicated that they did not have adequate on-call trauma surgeon coverage. In addition to a lack of emergency department personnel, some regions of the U.S. are experiencing shortages of ophthalmologists, pediatricians, nurses, and dentists, all of which result in a lack of quality healthcare services. Treatment outcomes can be improved by finding alternative means of ensuring that patients have access to specialty healthcare.

Nearly a quarter of the U.S. hospital emergency departments that participated in a recent study reported an increase in the number of patients who left the facility before being seen by a specialist. According to the study’s lead author Dr. Mitesh Rao, 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Further, more than 70 percent of participating emergency departments noted staff shortages in neurosurgery and hand surgery, and for patients with traumatic brain or hand injuries, the resulting delays in care could significantly increase the risk of lifetime disability, and according to Dr. Rao, the study’s lead author, “Transferring patients significant distances to an available specialist is sometimes the only option.”

In regions with a dearth of a particular type of medical professionals, availability of general treatment may also be significantly limited. Reports indicate that 14 of 81 counties in Kansas have no dentists, leaving residents with few options. Without appropriate dental care, patients’ risk of developing infections detrimental to the heart and lungs can increase, as can the risk of other conditions. Pediatricians and family care physicians are also lacking in some areas of the U.S. According to a recent study, nearly one million children live in areas with no local doctor. Nurses are also in short supply in many areas, and according to experts, by 2020 the nation will have 29 percent fewer nurses than are needed to provide care.

To ensure the provision of care to patients in areas that lack clinical staff, some experts suggest the use of telemedicine and remote screening programs. Through these programs, specialists can provide clinical advice to clinicians remotely and improve the level of care provided without requiring transport of the patient. Remote screening and diagnosis have been proven effective for diabetic retinopathy in areas where expert ophthalmologists are not available. Using a special camera, clinical staff and technicians captured a picture of a patient’s eye and send it to a trained professional. Eighty-three percent of individuals with retinopathy were diagnosed correctly using this remote screening technique regardless of the level of medical training of the individual taking the photograph. Teleradiology programs have also been implemented in some areas, a number of which are now utilizing fourth-generation wireless networks to allow radiologists to transfer images more and make preliminary evaluations more quickly.

Comprehensive telemedicine programs can help to ensure the delivery of specialty healthcare in underserved areas of the U.S. and worldwide. The iCons in Medicine program is an global telehealth and humanitarian medicine volunteer alliance that serves to connect volunteer healthcare providers with individuals and clinics requesting assistance on challenging cases. Membership in the iCons in Medicine network includes nearly 400 individuals in 12 countries around the world. These individuals represent 35 academic and medical centers, and include renowned experts in telemedicine, e-health, and global health disparities. Over 130 physicians with expertise in 35 medical specialties are available to respond to teleconsultation requests from individuals representing over 20 organizations in 10 countries. Through the use of telemedicine and remote diagnosis and screening programs, the delivery of specialty care in remote areas and treatment outcomes can be improved.



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Food Shortage in Ethiopia

As a result of poor harvest yields and food shortages, food prices have increased 52 percent between 2007 and 2008, according to the Food and Agriculture Organization (FAO). Areas of Asia, the Pacific, and Sub-Saharan Africa are experiencing particularly large increases in food costs. The Humanitarian Practice Network reports that for individuals with limited means, these higher prices make it difficult or impossible to meet their food needs. The FAO indicates that the number of people classed as under-nourished worldwide increased by 75 million in 2007, reaching a total of 923 million individuals. Women-headed households, the urban poor, and those affected by conflict situations or natural disasters are among those most likely to be affected by food shortages.

The World Food Programme (WFP) has identified 30 countries and territories as being “in crisis” with regard to food shortage and other humanitarian concerns. Ethiopia, Africa’s second most populous country, is among the countries for which food shortages and rising prices are a pressing concern. 4.6 million Ethiopians are threatened by hunger and malnutrition, and 10 million have been affected by droughts. In addition to six major droughts in the last two decades, the region has been denied access to the ports of Eritrea following a border war. The BBC reports that following the United Nations’ food deliveries to Ethiopia this month, no further deliveries will be made until September or October. Because of worldwide food shortages, the UN has stated that it has “no option but to cut back” on the provisions, which have already been reduced by a third since July 2008.

In areas like Ethiopia where food and medications as well as medical services are often scarce, telemedicine initiatives may allow for the provision of better care to those suffering from illnesses related to malnutrition and/or poor quality food and drinking water. By utilizing the Internet, telemedicine programs like iConsult make it possible to provide humanitarian healthcare assistance without the cost and risk associated with traveling to conflict-affected areas.

Find out more about iConsult

Food and Agriculture Organization - United Nations World Food Programme - BBC News Report on Food Shortage

Jaspars, S. and Wiggins, ODI, S. (2009). “The global food crisis: an overview” Humanitarian Exchange. Humanitarian Practice Network, Number 42.

Image from a report on hunger in Ethiopia from The Economist