The Nutrition Workshop Misnomer

Part of my itinerary while India was to participate in a South-Asia Sub-Regional Nutrition Workshop. The five-day workshop (February 25-29, 2008) aimed to develop a sub-regional nutrition strategy to improve capacity and strengthen partnerships to implement interventions to reduce malnutrition (stunting, underweight and anemia) in the region.

Based on recent studies, about 34 percent of world’s malnourished children are found in South Asia. Anemia which is one of the main indicators and precursors of mal/undernutrition is severe in the region affecting 79 percent of children and 58 percent of women in India alone. In addition, 30-60 percent of child mortality under the age of five in the sub-region is closely linked to malnutrition.

Approximately 25 participants composed of World Vision senior program/operations managers and technical staff from India, Nepal, Bangladesh, Myanmar and Sri Lanka will take part in the gathering.

Now, why I call it a workshop misnomer? Simply because the workshop was supposed to come up with nutrition strategies for South Asia and each of the participating countries. However, to my horror, during the workshop, the process used by the facilitators was operational planning! Apparently, the workshop team facilitators was composed of management and nutrition technical experts. The nutrition technical experts are extremely competent people but the putatively management “expert” turned out to have a very lame understanding of strategy development. Of course, the technical experts, who were engrossed with their own technical presentations did not realize it until my colleague pointed it out. Some changes were made along the way, but eventually, at the end of the workshop, the participants came up with operational plans rather than strategies.

I’ve learned a lot from the technical aspects of the workshop though. Although common sense tells us that nutrition is very important, I did not realize how essential it is for child survival and well-being and in preventing irreversible brain damage, chronic diseases and mortality. According to a study of brain scan results, an undernourished and sickly child’s brain has lesser gray matter essential for growth and development compared to that of well-nourished and healthy child. Applying economic analysis, an empty brain (otak kosong in Bahasa) results in loss of opportunity with the child eventually becoming society’s burden. In contrast, a smart child experiences life in all its fullness and eventually becomes a society’s resource.

Timing is very critical in addressing under nutrition. Health experts call this “-9 to + 24 mantra.” It means that any nutrition intervention should start from the onset of pregnancy right to delivery and at least until the child is two years old. Undernourished children before the age of two will have irreversible brain damage and will never be able to catch up with their health peers. In South Asia, 27 percent of children are already born undernourished.

To arrest malnutrition, the experts recommend what they call 3 + 6 packages. What are these packages?

- Pregnant women. During pregnancy, women should do the following three things: (1) Two additional meals, (2) Take Iron (Fe/folate) supplements, (3) Undergo deworming after 4 months of pregnancy.

- Under two (additional packages: Once the child is born, the following six things should be undertaken: (1) Exclusive Breast feeding, (2) Complementary feeding after 6 months, (3) Provision of Iron supplements to child, (4) Deworming after 6 months, (5) Taking of ORT, and (6) Vitamin A supplements.

The packages are simple to follow, yet, malnutrition persists due to poverty and ignorance!