Today our world is targeted at rapid development in a variety of spheres. Many countries implement changes to increase their financial state and enhance the quality of life. Still, the majority of developing countries find it extremely difficult to cope with the issues they face. One of them is malnutrition, which is seen as problems with weight including both under- and overweight. It is considered in connection with children, as they are the most vulnerable part of the society, on which depends its future. Children cannot solve this problem themselves that is why the attention is to be paid by the individuals who are powerful enough to influence the situation. Today about 900 million people from all over the world are familiar with undernutrition and overweight. Moreover, almost 40% of more than 1 million deaths of children under five happen because of malnutrition (Chang, Trehan, Wang, Thakwalakwa, & Maleta, 2013). Such statistics prove that the issue is crucial and should be deeply investigated. It also supports our assumption that malnutrition is a global health issue and is a leading cause of death for children under five years of age. The providers of healthcare services are the ones who are expected to treat and prevent malnutrition. For the outcomes to be advantageous, they are to act according to the established plan, designed by the professionals and supported by the Global Health Policy. This paper aims to investigate malnutrition and discuss how Global Health Policy influences the decisions made by nursing leaders who work with child patients.
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When a person lacks nutrients, malnutrition occurs. Generally, it affects pregnant women and elderly individuals but the main problem can be seen while considering children. One-third of those who are under the age of five is commonly malnourished, as they are entirely dependent on those who take care of them and are not able to improve their health condition. Their organism develops actively at this time, so it requires lots of nutrients, and their lack influences the development adversely (Rodríguez, Cervantes, & Ortiz, 2011). Child malnutrition can be seen from three perspectives. The first one is stunting. It can be identified while assessing the correlation between the expected height of a child and the real one regarding age. The second one is wasting. It is seen when the child’s weight does not correlate with the height, as it is expected when a kid develops normally. The third perspective is underweight, which is found when the weight of a child does not correspond to one’s age (Kandala, Madungu, Emina, Nzita, & Cappuccio, 2011). However, generally many professionals presuppose undernutrition while speaking about this problem.
Malnutrition is one of the main public health issues, as it is widely spread in more than 36 countries. Most African and Asian children are reported to suffer from acute malnutrition. About 60 million have moderate problems, and more than 12 have severe ones. Every year 60% of the 11 million child deaths are caused by malnutrition. Developing countries are the main areas where malnutrition is faced because they are poor, and their population very often does not have enough money and products to supply the children with the required quantity of food of good quality. In countries where natural disasters happen regularly, people often lose everything they owned, live in bad conditions, and have no access to decent food. Thus, natural disasters are among the causes of malnutrition. Moreover, the citizens usually have large families, which presupposes that much money is to be earned and spent on nutrition, which is impossible in poor countries. Due to the low quality of life, the population receives a bad education so that future parents do not know enough regarding the process of taking care of the children. Moreover, in some cases, they are even not able to enhance their knowledge because of the lack of education (illiteracy, for example). It also indicates that they are not always able to utilize the resources they have in the right way and have wrong feeding practices (Rodríguez et al., 2011). Directly and indirectly, kids who are under five years old become innocent victims of this disorder (Jamro, Junejo, Lal, Bouk, & Jamro, 2012). Acute nutrition occurs when a child fails to gain needed nutrition. It is also often entailed by other diseases, as the weakened kid cannot resist them. Numerous researches showed that it increases potential risks of infections and lethal outcomes for children under five years old. Many suffer from repeated episodes of diarrhea and respiratory infection. However, the deaths caused by them are rarely officially connected with malnutrition, which proves that his issue is underestimated. Still, some professionals realized the necessity of coping with the trigger of the disease. They conducted several studies to underline the connection between malnutrition and other health issues. After that, the World Health Organization (WHO) created a group of specialists who investigated the issue and found out that almost 9 million children under 5 died from the diseases caused by malnutrition all over the world (including developed countries) in 2008 (Rodríguez et al., 2011).
When the incident of malnutrition happens, the child is taken to the hospital where one is expected to gain needed treatment and improve health conditions. Rather often, kids are brought to the hospitals for admission and the professionals notice that one has some problems with weight or height. As the hospitals cannot afford to have numerous physicians, the reduction of the causes of malnutrition is usually under the responsibilities of nurses. Moreover, they interact with the patients more, which allows them to influence the consumers and make those, who refuse to admit that their children have problems, yield and accept assistance. Except for that, if the malnutrition is not entailed by other diseases, the nurse can take care of a child with a little involvement of the physician.
Malnourished patients require special treatment, but often they receive poor hospital care, which increases the mortality instead of decreasing it. Having found this issue and realizing that these children require special treatment, WHO provided the guidelines the employees of healthcare delivery services are to follow. It allows them to improve the quality of care, streamline the treatment process and reduce the rates of mortality. As rural South Africa shows high indicators of malnutrition, the hospitals within this location were monitored to evaluate their work and find out why the rates fail to change even though the WHO implemented the plan of treatment and made it accessible worldwide. It turned out that some hospitals did not refer to the guidelines while others did and found out that the guidelines require improvement (Laillou, Prak, Groot, Whitney, & Conkle, 2014). Taking this information into account, we can claim that among the causes of such outcomes is the lack of nursing leadership. In the first case, leaders occurred to be not able to implement the plan and make the nurses follow it while, in the other case, the leaders failed to produce their plans, which would be of advantage for the patients and would be supported by other employees.
Risks of morbidity and mortality among children who are less than five years old are highly increased by problems connected with nutrition. Of course, malnutrition is successfully treated in many health facilities, but, as the study conducted by Chang et al. (2013) showed, less than 65% of recovered kids remained healthy. Unfortunately, almost 5% died while others faced this issue again. The fact that many children cannot recover from malnutrition completely proves that this topic should not be forgotten and is to be deeply considered, which is done by many researchers.
Normal nutritional status is extremely important for all children under five because it has an immense influence on the physical and cognitive development of a kid. It also defines how this individual will respond to illnesses, especially serious ones. Anthropometric measurements are conducted by health workers to make sure that a child faces discussed issues. It is accompanied by a physical examination managed by the physician or nurse. The lack or absence of a nutrient is the reason why malnutrition occurs. It can be of different severity depending on the cause and intensity of the issue as well as on the period it lasts. In a case when the weight of a child is 76-90% of the expected one, the mild form is observed. Moderate cases are faced when a kid has >60% of the average weight, and the severe ones when the weight is <60%. Rodríguez and his coworkers believe that the main cause of malnutrition is the wrong diet, which prevents the entry of needed nutrients into the organism. Other reasons are “deficiency in gastrointestinal absorption and/or increase in demand, or even, by an excessive excretion of nutrients” (Rodríguez et al., 2011, p. 1187). Children of the discussed age (<5) are said to suffer from protein-calorie malnutrition more often than from its other types. It all is derived from undernutrition faced by society and the injustices that entail and go along with this issue. According to the WHO, almost 30% of all children who live in developing countries located all over the world deal with this issue constantly and from time to time because they do not receive the food they need. Many people believe that African kids are the ones who suffer from this problem more the others, as their condition is discussed by numerous outstanding people and shown on the TV and Internet rather often. However, Rodríguez et al. (2011) prove that the individuals who live in such countries as Bangladesh, South Asia, and Pakistan are more affected by malnutrition. The problem is so crucial that it is evenly spread among the population of Mexico.
Food insecurity and malnutrition are issues discussed all over the world. Malnutrition can be seen from different perspectives, and it varies from the problem of being underweight to overweight. Patel (2012) underlines that this problem seems to be more crucial when it is considered as undernutrition and presupposes a child’s low weight. Vitamin A deficiency, anemia, diarrhea, and various infections are commonly seen as complications of malnutrition. Malnutrition affects the condition of individuals and the community in total negatively. Children under five years old die because of undernutrition. Being weak, they are often ill and require more medical care than normally developed kids, which turns into the overutilization of the resources. Malnutrition often has an adverse influence on the child’s development and cognitive abilities, which is later seen as poor educational achievements as well as economic and work productivity. In this way, the life of future generations also becomes impacted by the issue.
As it was mentioned earlier, the causes of malnutrition are found in different locations. For example, more than 50% of Pakistan children are undernourished, about 40% are stunted and almost 15% are wasted (Jamro et al., 2012). According to the data provided by the Sindh government, almost a million children who are less than 60 months old are malnourished. Because of the lack of nutrition, every year kids from deprived communities suffer about 5 episodes of diarrhea. The issue attracted the attention of the Nutrition Stabilization Center so the study was conducted to deepen into the subject. It was found that the children from rural areas whose mothers and fathers had a poor education, families included more than four kids, and had low income were the majority of all patients who had low weight. These factors were added to diarrhea and non-exclusive breastfeeding, which occurred to be the causes of the issue. Another study conducted in Bangladesh also proved that parental education plays an enormous role in the child’s possibility to suffer from malnutrition (Jamro et al., 2012).
The research made in the Democratic Republic of Congo showed that the reduction of food production in the country increased the number of undernourished children. In this way, Kandala et al. (2011) proved that there is a direct connection between the malnutrition and lack of implementation of national policy for food production and that the government is to consider the influence of different areas on the quality of the population’s life. Attention was also paid to the education of parents and the access to health facilities, which is rather low. As school education failed to teach the citizens how to make advantageous nutritional decisions, this is to be improved by other settings. It is believed that special programs accessible in the community can be beneficial.
A qualitative study in Bangladesh was focused on community-based management of acute malnutrition. It is claimed that Bangladesh is one of the locations where many children are reported to suffer from problems with nutrition. That is why the government of the republic developed guidelines to cope with this issue. The procedure was controlled by the representatives of the government, but for the health workers to be determined, the leaders in their facilities were ordered to take an active position. The national health and nutrition policy supported the implementation of malnutrition management guidelines believing it to be a relevant intervention, which is likely to enhance the situation in the republic. Health workers, including nurses, were said to be trained and provided with the educational items that would transfer the messages on malnutrition prevention. Such interventions can be implemented worldwide, as their advantage is already seen in Ghana, Kenya, Mozambique, Malawi, and Ethiopia. Almost 80% of children who participated in the study as they suffered from malnutrition recovered, which proves this idea (Kouam et al., 2014).
The fact that the government of Bangladesh designed its guidelines for malnutrition management is of advantage, as Laillou et al. (2014) found out that the WHO plan that was created to be utilized worldwide does not meet the expectations. The cut-off for screening turned into the failure to identify malnutrition in numbers of children. It proves that until the WHO guideline is updated, health facilities are to design their additional plans. Still, the guidelines prove that after the first Lancet Series on Maternal and Child Undernutrition, the issue attracted the attention of global organizations. Numbers of development agencies designed policy documents regarding problems with nutrition. The policymakers gained a set of interventions, which can be utilized in different countries (Gillespie, Haddad, Mannar, Menon, & Nisbett, 2013).
Malnutrition among children was always considered a critical issue, as it increased mortality rates among children all over the world. Our future generations turned out to be at risk of being malnourished, which is likely to increase the number of individuals who have problems with physical and cognitive development and cannot resist severe illnesses. Realizing that the issue is critical, global health organizations, as well as local ones, tend to do their best to solve the problem. Of course, the problem of nutrition depends on the family and their opportunities to provide children with decent food in required amounts, but the involvement of health facilities is also undeniable. They try to find the best plan of action and implement numerous changes aimed at the enhancement of the situation.
The shortage of personnel is a problem that is familiar to almost all countries worldwide. It is the challenge that should be overcome to implement the guidelines for malnutrition treatment. Of course, such things as better working conditions, increased salaries and other benefits can motivate the staff to change the way they work and undertake more responsibilities, but these are not the only triggers. Even though many countries that face problems with child nutrition are willing to take such steps, they often do not have enough finances to do this. That is why they should first consider other aspects of the change. Supervision and teamwork are the factors that enhance personnel performance in various spheres, and healthcare is not an exception. Needless to say that the staff is to be trained to work according to the guidelines. The creation of training modules is a step that simplifies and streamlines the process of development and education. Unfortunately, it is now not a part of the curriculum of medical schools (Kouam et al., 2014). That is why the training is to be provided at least for the senior nurses. Developed countries must save money, which can be done by training the leaders. Of course, it is better to educate the whole team; still, nursing leaders who are well-qualified and can successfully cope with training are expected to teach their teams how to work. They can organize their training for other nurses to learn new approaches. In this case, the position of a leader is crucial, as without it the staff is likely to be unmotivated and reluctant to implement any changes (Gardenier, 2012). Moreover, they may question the information received from the leader rather often, which will turn into complications in the patient’s condition.
Global political landscapes for nutrition underline the necessity of creating enabling environments, which require such shaping factors as “knowledge and evidence, politics and governance, and capacity and resources” (Gillespie et al., 2013). The reduction of children’s malnutrition is claimed to be achieved by better education for girls, control of fertility, accumulation of goods and products, and, of course, access to health care of high quality (Elia & Russell, 2010). Still, the existence of the policy is not enough because, as it was mentioned, many children who were successfully treated for malnutrition suffer from it again. In this way, nursing leaders are to pay their followers’ attention not only to the child’s condition but also to the necessity of pushing the family towards changes. They motivate nurses to get deeply involved in the treatment so that all possible gaps can be found and filled before adverse outcomes occur. As nurse administration organizes continuing nursing education, the leaders are to motivate their teams to participate in various conferences and seminars. It is crucial that they also explain the necessity of knowing all legal aspects and ways to treat and prevent malnutrition for the families and healthcare facilities to face fewer issues (Bagilkar & Savadatti, 2015). In this way, the nurse leader is to make new views regarding malnutrition shared among the others, and educating the parents about child’s nutrition is among the major ones (Joosten & Hulst, 2011).
Being a nurse leader, I would start with making my team realize that the health services we provide are not enough to make sure that the kid will remain healthy. I would persuade the nurses with the help of evidence so that they would not question this idea. Then I would provide some ideas of how we can influence this situation and encourage the team to share their views. In this way, they would be led by example, which is thought to be the most advantageous method. Together we would design a decent plan that would be accepted by everyone, which proves that it would be implemented. I would also ask the nurses to share their achievements and results during the meetings so that we would analyze them and make sure that our plan works. I would make sure that being in the hospital the child is fed appropriately, and the portion is increased slowly but also prevent malnutrition with the help of my team. I would communicate with families and encourage nurses to explain to them the peculiarities of appropriate feeding. We would pay attention not only to the health-related issues but also provide recommendations on how to supply a child with everything needed at home. Moreover, I would promote the involvement of the community in the reduction of malnutrition as it is also able to enhance the family’s state.
Thus, it can be concluded that malnutrition among children under five years is an issue familiar to the whole world, especially developing countries. It makes the child weak and sickly, which often leads to lethal outcomes. The problem occurs to be so crucial that global policies and guidelines were created to deal with it. Unfortunately, they fail to find a solution. Still, the reduction of cases of malnutrition and its successful treatment proves that we are on the right path. That is why local facilities also implement their plans aimed at improving child’s state. The involvement of nurses in this process is undeniable, as they are the ones who interact with patients and their families. Thus, the nurse leaders are to direct and control this process so that positive outcomes can be achieved.
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Chang, C., Trehan, I., Wang, R., Thakwalakwa, C., & Maleta, K. (2013). Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery. The Journal of Nutrition, 143(2), 215-220.
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Gillespie, S., Haddad, L., Mannar, V., Menon,, P., & Nisbett, N. (2013). The politics of reducing malnutrition: Building commitment and accelerating progress. The Lancet, 382(1), 552-569.
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