HIDDEN HUNGER:
Hidden hunger is also called deficiencies of micronutrients, afflicts more than two billion people, or globally 1 individual in three individuals (FAO 2013). Its effects can be destroying, leads to poor health, mental impairment, low productivity, or even death. The adverse effects on child survival and health are mostly acute, particularly in the first thousand (1,000 days) of the child's life, from conception to the age of two, resulting in cognitive consequences and serious physical. But the deficiencies from mild to moderate affect the development and well-being of a person. Additionally, to affecting human health, hidden hunger can curtail socio-economic development, especially in middle and low-income countries.
Hidden
hunger is the type of under-nutrition which occurs when absorption or intake of
vitamins and minerals such as iron, iodine, and zinc are very low in food to
maintain good health and development. Micronutrient deficiencies including the poor
diet, increased micronutrient needs during life stages e.g. lactation, and
pregnancy, also due to health problems such as infections, diseases, and
parasites. Hidden hunger occurs when the quality of
food people eat does not meet their nutrient requirements, so the food is
deficient in micronutrients such as the vitamins and minerals that they need
for their growth and development. 2 billion people suffer from vitamin and
mineral deficiencies. Women and children in families with low-income often
don’t get enough vitamin A, iodine and iron, and sometimes other essential
nutrients. This limits their growth, development, health and working capacity. Ensuring
people get vitamins, minerals and essential nutrients will helps prevent
malnutrition. Worldwide, about 800 million people are chronically hungry,
meaning that they are undernourished in terms of calories (FAO, 2017). About more than 2 billion people are affected by hidden
hunger, meaning that they suffer from micronutrient deficiencies (WHO, 2006). Although progress was made in reducing these
problems, ending hunger in all its forms – as stated in the Sustainable Development
Goals (SDGs) – remains a global challenge (Allen and de Brauw,
2018, Barrett, 2020). The goal of ending
hunger in all its forms involves a broad definition of hunger, including
calorie deficiencies (chronic hunger), micronutrient deficiencies (hidden
hunger), and related health problems.
Achieving
the SDGs requires the political knowledge and commitment about the actions that
can help in the reduction of different type of hunger effectively. While the
evidence for supporting the concrete nutrition interventions at the individual,
community, or household level is accumulating, lack of the reliable data
country-level makes it difficult to monitor and describe the magnitude of the
global hunger in all types over time (IFPRI, 2017). Given the
lack of data country level, the determinants of hunger on country-level cannot
sufficiently understood (Gillespie et al., 2013). From the few existing studies of cross countries
that investigated the hunger determinants relied on the data only covering few countries
and years (Headey, 2013). And nor did these existing studies
solving the issues that how to measure the “hunger” in different forms. Different
proxy measures were also used that only quantify the selected dimensions of
individual health or hunger outcomes, therefore, not capturing hunger in all the
types in the broader Sustainable Development Goals sense.
To overcome the shortcomings, the
Disability Adjusted Life Years (DALYs) were also suggested as a more comprehensive
and nuanced measure for analyzing the burden of the hunger (Black
et al., 2008). DALYs are a metric that quantify
the burden of the health problems in terms of healthy (disability-adjusted) life years lost. The common metric is
also useful to compare the magnitude of different types of the health problems.
In a context of hunger, DALYs calculated the factors of different risk, such as
the malnutrition of protein energy, childhood underweight, vitamin A
deficiency and iron deficiency. The DALYs metric also use to quantify the
burden of several forms of the hunger (Black et al., 2008). Therefore, no previous
study has been used the DALYs metric for explicitly comparison of the burden of
the chronic hunger and the hidden hunger burden over time and also analyzes the
determinants country-level of these burdens with cross-country regression
model.
SOLUTIONS FOR HIDDEN HUNGER
Diversifying
Diets
To sustainably
prevent the hidden hunger the increasing of dietary diversity is one of the
most effective ways (Thompson and Amoroso 2010). Dietary diversity is
associated with better child nutritional outcomes, and controlling for the socio-economic
factors (Arimond and Ruel 2004). In the long-term, diversification of diets
ensures a diet that are healthy and also contains a balanced, adequate
combination of the macronutrients (fats, carbohydrates, and protein); the essential
micro-nutrients; and other food-based substances like dietary fiber. Different
types of cereals, vegetables, legumes, fruits, and also the food from
animal-source provide ample nutrition for the most people, although certain
populations, like pregnant women, may also need the supplements (FAO 2013). The
Effective ways for the promotion of dietary diversity involved food-based
strategies, e.g. educating people to feeding their young once and infant’s
practices and home gardening, storage and preparation of food, methods of preservation
to prevent the loss of nutrient.
Fortification
of Commercial Foods
Commercial
food fortification is the addition of trace amounts of the micronutrients to the
staple foods during the processing, helps consumers to get the micronutrients
needed for the body. A cost effective ,scalable, and sustainable public health strategy,
fortification of diet is considered successful way to iodized salt, 71%
population of the world has access to the iodized salt and the iodine-deficient
countries has decreased from 54 to 32 since 2003 (Andersson, Karumbunathan, and
Zimmermann 2012).
Others commons
fortification examples includes the adding iron, zinc and vitamins B to wheat
flour and adding vitamin A to sugar and cooking oil. Fortification may be more effective
for the urban peoples, who consumed commercially fortified and processed food
products. On the other hand, it is less likely to reach the consumers live in
rural areas who have no proper access to the commercially fortified food
products. Fortification must be mandatory or subsidized to reach those peoples
who need more, fortification; otherwise the people will buy the cheaper and non-fortified
foods alternatives.
Shortcomings
of fortification:
There are also some peoples
who may resist or allergic to fortified foods. E.g. about 30% of Pakistanis
peoples avoid the iodized salt; due to mistaken they believe that iodized salt
causes the infertility in humans and rumors of a plot to limit the growth of
population (Leiby 2012).
People may also resist to
consuming fortified foods due to the flavor or cooking properties. And also it
can be difficult to determine the nutrients appropriate level. Fortificants
means the compounds used to fortify food may be lost during storage or
processing or may not be stable. Additionally, bioavailability, the rate or degree
at which the substance absorbed, may be limited. That said, the evidence of acceptability
and efficacy of fortification in home to grow continues (Adu-Afarwuah et al.
2008; Dewey, Yang, and Boy 2009; De-Regil et al. 2013).
Bio-fortification:
Bio-fortification
is the new intervention, involves food crops breeding, using transgenic or conventional
methods, for increasing their micronutrient content. Plant breeders are trying
to improve the yield and pest resistance, as well as consumption traits, such
as time of cooking and taste to match the conventional varieties. To date, only
conventionally bred bio-fortified crops have been delivered and released to the
farmers. Bio-fortified crops that have been released includes vitamin A orange (sweet
potato), vitamin A maize, vitamin A cassava, iron beans, iron pearl millet, zinc
wheat and zinc rice. While in the developing countries the bio-fortified crops
are not available, bio-fortification is expected to grow significantly in the
next five years (Saltzman et al. 2013). Bio-fortified foods provide the
safe and steady source of certain micronutrients for the people not reached by
other interventions. In contrast to large-scale fortification, which usually
reaches a greater share of urban than rural residents, the first target of bio-fortification
is rural areas where the crops are produced. Marketed surpluses of bio-fortified
crops may make their way into retail outlets, reaching the consumers first in
rural areas, then in urban ones. Given that bio-fortified foods staples cannot
deliver as high a level nor as the wide range of vitamins and minerals as
supplements or industrially fortified foods can, to clinical deficiencies, they
are not the best response. But they can help close the intake gap of
micronutrient and increase the daily minerals and vitamins intake throughout a
person life (Bouis et al. 2011). But the evidence on bio-fortification is not completed;
several crops such as maize, iron beans, maize, rice, sweet potatoes, pearl
millet, and vitamin A cassava showed the evidence of improved levels of
micronutrient (Pompano et al. 2013; Moura et al. 2014; Tanumihardjo 2013).
Interventions delivering the bio-fortified orange sweet potato that are significantly
improved vitamin A intake of mothers and young children (Hotz et al. 2012a;
Hotz et al. 2012b).
Supplementation
Vitamin
A supplementation is the most cost-effective interventions for improving
survival of child (Tan-Torres Edejer et al. 2005). From 1999 to 2005), coverage
increased in 2012, estimated rates of coverage globally were near 70% (UNICEF
2014b). Programs to supplement vitamin A are often integrated into the policies
of national health because they are associated with reduced the risk of
all-cause mortality and reduced the incidence of diarrhea (Imdad et al. 2010).
According to UNICEF, about 70% of young children ages 6 - 59 months need to
receive vitamin A supplements every 6 months to achieve the desired reductions
in the child mortality. However, because of fluctuations in the coverage, funding,
varies widely from year to year in different countries in the world. It should
also be noted that vitamin A supplements especially target the vulnerable
populations from 6 months to 5 years.
Supplementation for other micronutrient deficiencies is not very common. In some countries, iron-folate supplements are prescribed to pregnant women though coverage rates are often low and compliance rates even lower. For children, home fortification with micronutrient powders and lipid-based nutrient supplements can include multiple micronutrients, like iron and zinc, but they are harder to get into homes on a large scale than vitamin A supplements. In a trial in rural China, about half of parents or grandparents stopped giving children nutritional supplements containing soybeans, iron, zinc, calcium, and vitamins because they suspected the free supplements were unsafe or fake and not good for child. They also feared they would be charged later (Economist 2014). According to WHO Hidden hunger is a lack of vitamins and minerals.
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