The Sunday Mail
Dr Christine Peta Disability Issues —
The UN estimates that about one billion people are malnourished (FAO 2012), resulting in disease and disability. That is not to say over-nutrition is not an issue. Being overweight or obesity may also cause disease which results in disability, through conditions such as stroke (Groce et al).
Strokes may leave one partially paralysed, with slurred speech, loss of memory or mobility on one side or loss of hearing or sight. However, the focus of this article is on malnutrition which causes disability.
Malnutrition is the condition that occurs when the body is not getting enough nutrients to maintain healthy tissues and organ function, this could be due to several reasons that include an inability to eat, not eating the right things or consuming inadequate food (Medline Plus 2015).
Research has indicated that infants and young children within the critical age range of six months to 59 months (National Micronutrient Survey, 2012), who are underweight and whose ultimate growth is slower than that of children of the same age are more likely to screen positive for disability (Groce et al).
Unicef (2013) states that a huge number of children may become blind each year due to a lack of Vitamin A. Eating patterns differ from country to country but in Zimbabwe the best sources of Vitamin A foods are sweet potatoes, green leafy vegetables, pumpkins, butternuts, liver, milk, mangoes and fish (Mutingwende, 2016).
A lack of iodine may result in the development of a goitre and impaired cognitive development of younger children (University of Zimbabwe, 1990; Groce et al).
Cognitive development refers to the way a person sees things, thinks or gains understanding of his or her world, including aspects such as memory, language development, the processing of information, and the way the person reasons.
The sad fact is that negatively affected cognitive development may result in mental retardation. The belief that infants are unable to learn from their environments and to form ideas is untrue.
Babies become aware of their surroundings and are interested in exploring such surroundings from the time that they are born (Leider, 2006). In other words, babies start to learn from the time that they are born; they gather, sort and process information from around them, and use the data they draw to develop their own ways of seeing things and thinking skills.
Given the fact that studies have shown that babies do much more than sleep, eat and cry, malnutrition is, therefore, an enemy of child growth. Although people may try to give their children high iron foods at a later age, the damage may already have been done.
The reality is that malnourished children such as those with rickets or anaemia may be slow in language development and social development, because the child lacks the ability to engage with his/her parents and care-givers and to interact with the surrounding environment (WHO, 2012, Groce et al, Black et al, 2013).
Malnutrition may cause structural damage to the brain and may affect motor development (development of muscles to achieve, sitting, crawling and walking for example), thereby damaging the child’s ability to explore as well as his or her future mental growth and performance in school (Victora, 2008).
In addition, a malnourished child is likely to develop infections such as meningitis or cerebral malaria, such infections carry a high risk of causing permanent neurological damage and disability to a child (Katona & Katona 2008).
Social and Cultural Barriers
As noted by Groce et al, it is not common for some societies to believe that children who are born with disabilities will naturally not grow because of their impairment.
In some cultures mothers may be directed by traditional mid-wives and family members not to breast feed a child with congenital (from birth) disability, alongside a belief that children with such disabilities will die anyway or would not lead productive lives.
Such children may be given very small amounts of food or less nutritious food, alongside a belief that more nutritious food should not be “wasted” by giving to disabled children but it should be given to non-disabled children who stand a greater chance of making it in life and ultimately contributing towards uplifting the household.
The irony of the matter is that in some kind of self-fulfilling prophecy, children with disability may either starve to death or they may end up with more disabilities (Groce et al).
Feeding patterns within families may also contribute to the malnourishment of children with disabilities. The fallacious belief that disabled children are perpetual babies who do not grow, may see such children being fed with diets of liquids only, alongside a mistaken view that a disabled child is unable to eat solid food.
Sadly, this may lead to severe malnutrition or the death of the child in extreme cases (Groce et al). In some developing countries, cultural practices which relegate girls to a lower status demands that girls should help their mothers to prepare food and feed the boys and men first, and the girls and their mothers should eat last.
Such a traditional practice results in boys and men eating the best and most nutritious food at the expense of the nutrition of girls and women (Boylan 1991). In some societies in the developing world, girls whose mothers are seen as making little economic contribution to the running of the family are automatically assigned to a subordinate and inferior status.
Consequently, their brothers and fathers will eat the finest food first while the girls wait for left-overs or go hungry if there is no left-over food. Such traditional practices of gendered access to food adds many girls and women to disability statistics, as girls become more vulnerable to disabling conditions caused by malnutrition.
For the girl child who survives, she may step into mature womanhood with disability resulting from childhood malnutrition.
What should be done?
Government is making efforts to improve the micronutrient situation in Zimbabwe. WHO (2015) registered the country’s launch of the Zimbabwe National Food Fortification Strategy 2014-2018.
Food fortification is the process of adding minute levels of vitamins and minerals to foods during processing, and particularly in foods such as maize meal, cooking oil, sugar and wheat flour.
“It entails an addition of one or more micronutrients during processing regardless of whether the micronutrient is present or not in the said food to increase micronutrient intake in the population, and is one of the many ways to prevent and control micronutrient deficiency problems such as goitre, anaemia, impaired vision and mental retardation.” (WHO, 2015).
Both the World Health Organisation and the Health and Child Care Ministry commended the launch as a population wide intervention which seeks to address the burden of micronutrient deficiency, as a public health care issue (WHO, 2015).
It is clear that a malnourished child whether disabled or not, is at an increased risk of developing more disease, slow development and more disabilities.
Nutrition intervention programmes should pay special attention to children who are at a higher risk of becoming malnourished – such as those with existing disability or chronic disease, as well as reaching out to rehabilitation institutions where disabled children live.
Isolating disabled children from prevention interventions is futile, the reality is that children with disabilities may also need additional nutrition interventions that are associated with disability.
Nutrition intervention programmes should, therefore, seek to jointly address malnutrition and disability in daily living or emergency food crisis (Groce et al).
Such programmes should also raise awareness in both rural and urban areas to lessen the negative results of social and cultural beliefs that may worsen malnutrition, particularly among girls and children with disabilities.
Dr Christine Peta is a public healthcare practitioner, who, among other qualifications, holds a PhD in Disability Studies. Be part of the international debate on how best to nurture a society which is more accessible, supportive and inclusive of disabled people. Partner with Disability Centre for Africa (DCFA): WhatsApp +263773699229; www.dcfafrica.com; and e-mail [email protected]