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Health Impact Framework/Research Paper

Malnutrition in the Sub-Saharan Region of Africa

Jason Keller

Delaware Technical Community College

NUR310

Dr. Jane Rosati

May 8, 2022
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Malnutrition in the Sub-Saharan Region of Africa

In today’s world, given how advanced countries and societies have become, we continue

to witness and even sometimes experience first-hand ongoing issues causing a decline in the

health of people. Even today, some of these issues still include violence (war), natural disasters,

diseases (communicable and non-communicable), and even environmental issues and have been

present for decades. Sometimes, these issues can be solved with proper education and

prevention. But even sometimes these easier solved issues are so deep-rooted in countries that

they seem almost impossible to solve given there is more to the picture than understood.

Through advancements in the realm of public health, the Health Impact Pyramid was

developed to help combat the problems associated with these issues. Dr. Thomas Frieden, who

was the director of the Center for Disease Control at the time, developed a framework to describe

the impact of different types of public health interventions to dramatically improve the health of

any issue plaguing a society. Within this pyramid, there’s six different tiers: from top to bottom

there is counseling and education, clinical improvement, long-lasting prevention interventions,

changing the context to make individuals’ default decisions healthy, and socioeconomic factors.

Starting from the top with the further down you go, the more of wider impact you’ll have on the

society as a whole. Running the opposite way, the more the increasing individual effort needed

by people to make a change. Theoretically, the top tiers could have a greater impact but they are

more challenging and require more effort to convince people to make the changes. Utilizing the

Health Impact Pyramid that Dr. Frieden developed, the issue of malnutrition in the Sub-Saharan

region of Africa will be analyzed.

At the bottom of the pyramid, socioeconomic factors, have one of the widest impacts of

people’s health. Socioeconomic factors can reach populations across an entire country and are
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comprised of basic solutions to issues. One drawback, is that these factors can be temporary as

they are dependent on the whole society to continue to implement the change. When the Sub-

Saharan region of Africa is viewed at a socioeconomic level, one can see why malnutrition issues

exist. This is mainly due to the country having the lowest income per capita. In other words,

these countries within this region are the world’s poorest. “It is therefore not surprising that the

burden of malnutrition is particularly heavy in [Sub-Saharan Africa], with 32.7 % of children

under five being stunted in 2019” (Delisle, 2021). Majority of the country’s population lives

below the international poverty line. “Poverty is unmistakably the driving factor in the lack of

resources to purchase or otherwise procure food, but the root causes of poverty are multifaceted”

(Bain, 2013). This factor poses an immediate risk for health for the population, and have been

reported as major causes of illness and mortality amongst children in Africa. “Contributing to

more than half of deaths in children worldwide; child malnutrition was associated with 54% of

deaths in children in developing countries in 2001” (Bain, 2013). Physical and mental

development becomes a serious threat to children’s lives when they start out at sub-optimal

nutrition levels as this can lead to permanent malabsorption issues and eventually to overall

malnutrition of the children for the rest of their lives. Lack of education is another

socioeconomic issue leading to malnutrition. The educational system of Sub-Saharan Africa

limits proper education to women in many communities. When mothers are to provide proper

nutrition for their children lack education to do so, malnutrition levels will remain an issue.

The second from the bottom tier of the pyramid involves making decisions towards

health easy within the individuals of a society. These interventions can involve many different

approaches from a governmental level with policies down to the individuals themselves.

Malnutrition must be approached from all levels in order for the change to be sustainable.
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Improving governmental policy would have the greatest overall impact. Eliminating the

corruption at this level can open up possibilities to end malnutrition and recognize that it’s not

only a public health issue but a basic human right to eat nutritious food. Changes in the

transportation industry has a direct influence on malnutrition. “Improvement of the transport

system to give access to locals to sell their local produce to raise incomes for their families is

important” (Bain, 2013). This can solve any food shortages in all the communities who are

struggling. The government can also step in and provide change to the educational system in

allowing more access to women. At the very least they can provide outreach programs to regions

that are severely impacted by the lack of education.

Long-lasting interventions provide help to the communities to keep them from regressing

back to the major issue at hand. For example, if a disease becomes rampant, a vaccination can be

developed as a one-time intervention to treat and eradicate it. The government can provide

resources directly to their affected communities. Resources like money to purchase seeds,

supplies, and equipment to farm the lands. This can not only be a fast way that farmers can

provide more nutritionally dense foods to these communities but can add additional jobs for

people to help combat poverty. Once this is established, the program can be used as an

emergency fail safe policy to keep malnutrition above a certain threshold.

Clinical interventions can be utilized in many different areas within malnutrition

prevention in the Sub-Saharan region of Africa. Breastfeeding promotion is the easiest

intervention to prevent growth stunting in infants. Breastfeeding provides the nutrients an infant

need to further develop their growth optimally. As seen in the United States already, there are

specific career paths nurses can take to facilitate breastfeeding learning to new mothers. Nurses

can organize health clinics to these areas and provide the knowledge and abilities to breastfeed
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their infants. Another direct clinical intervention would be to provide dietary supplements

directly to families with children. This can help curb the prevalence of malnutrition and start

getting to the individual level which will have a more prominent and lasting change.

Education is the most difficult section of the Health Impact Pyramid for this region but it

provides the greatest results once in full affect. Given the regions lack of education in many

areas, providing just even basic knowledge can be difficult but not impossible. In this region,

health and family planning services would provide a great education and service in the

prevention of malnutrition. Nurses can provide the education necessary for families to be to aid

in the prevention. Many different avenues can be discussed to provide a significant impact not

only to the immediate family by nurses, but to the regions where even cultures have specific

traditions and beliefs that can cause malnutrition. For example, “malaria is so common in much

of sub-Saharan Africa that many families see it as normal” (Skolnik, 2021). “Most of the

mothers avoid mentioning it because there is a cultural belief that it is a bad omen. They simply

refer to it as childhood disease” (Haruna, 2021). This belief is why malaria is still a top health

issue of these regions when there have been solutions to rid the disease for many years now. In

other regions, sociocultural beliefs have an impact of how the areas perceive sickness and illness.

They are viewed a little differently in which there is no relationship between human and

microorganism causing the sickness. “In some cases, the affliction may be said to spring from

the ill-will of an enemy witch, or the ire of the ancestors incurred by the sick person’s own

immoral actions” (Haruna, 2021). Another example that education can make an impact on beliefs

is that in some areas there are false beliefs about digestive abilities in children or the child’s

small size being normal so they don’t need as much food overall. In some African communities,

the culture itself can be associated with malnutrition towards specific genders. Women and girls
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are more vulnerable to die from malnutrition as boys and men are selected to eat more nutritional

dense foods. Women and young children are not allowed to eat certain foods due to cultural

beliefs. Unfortunately, many of these foods are very nutrient dense and can provide the nutrients

needed for development. As discussed in the clinical interventions providing supplements can

help curb this ongoing cultural issue continuing to make the problem worse. When looking at the

Stages of Change Model, it’s clear to see that a lot of these regions are stuck in the

precontemplation stage as the traditions of culture reigns supreme. “Precontemplation is the

stage at which there is no intention to change behavior in the foreseeable future” (Stages of

Change, n.d.). Many cultures in the regions are in this stage and are unaware of the problem of

malnutrition that their traditions have on their people.

There are many opportunities in which people can provide a significant role in the global

health field. One does not need to be trained in a health specific field like a physician or a nurse

in order to provide an impact. For example, if someone who is trained in the sanitation of water,

this person (or group) can provide their services on regions whose water quality is unsafe for its

population. This can have a dramatic impact alone on the health of these regions. Other areas

include, law, engineering, finance, economics, and ecology all can have a significant impact on

an underdeveloped region. There are many non-governmental organizational opportunities as

well. “The largest NGOs tend to recruit people with substantial experience and high-level skills

for their fieldwork in low- and middle-income countries. However, at their headquarters, these

organizations generally have a broader range of positions, and they recruit staff with a variety of

skill sets to carry out this work” (Skolnik, 2021). There are many types of non-governmental

organizations. These include humanitarian services, bilateral organizations, multilateral

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organizations, UN agencies, public-private partnerships, consulting firms, foundations,

academia, policy and advocacy organizations, and others in the private sector.

The overall general goal of all these organizations along with the healthcare field is to

provide the tools and resources to benefit areas of undeveloped regions. The more organizations

involved, the more of an impact on the regions health there will be. This is what global health is

all about. Maybe someday in the near future, malnutrition in the Sub-Saharan region of Africa,

and the issues of many other countries will be long forgotten.

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References

Bain, L. E., Awah, P. K., Geraldine, N., Kindong, N. P., Sigal, Y., Bernard, N., & Tanjeko, A. T.

(2013). Malnutrition in Sub-Saharan Africa: burden, causes and prospects. The Pan

African medical journal, 15, 120. https://doi.org/10.11604/pamj.2013.15.120.2535

Delisle, H., Faber, M., & Revault, P. (2021). Evidence-based strategies needed to combat

malnutrition in Sub-Saharan countries facing different stages of nutrition transition.

Public Health Nutrition, 24(12), 3577-3580. doi:10.1017/S1368980021001221

Haruna, Abdallah. (2021). Unveiling The Influence Of Culture On Healthcare Delivery In Sub-

Saharan Africa.

https://www.researchgate.net/publication/350850043_Unveiling_The_Influence_Of_Cu

lture_On_Healthcare_Delivery_In_Sub-_Saharan_Africa

Skolnik, R, (2021). Global Health 101 (4th edition). Jones and Bartlett Learning. Page 170.

ISBN- 13: 978-1284145280.

Stages of change. Cancer Prevention Research Center. (n.d.). Retrieved May 7, 2022, from

https://web.uri.edu/cprc/transtheoretical-model/stages-of-change/

Quamme, S. H., & Iversen, P. O. (2022, February 4). Prevalence of child stunting in Sub-

Saharan Africa and its risk factors. Clinical Nutrition Open Science.

https://www.sciencedirect.com/science/article/pii/S2667268522000092