Early deficits in childhood growth and development contribute to long-term problems that can persist into adulthood, including poor psychosocial wellbeing and reduced adult income. According to recent estimates, more than 200 million children worldwide fail to reach their full developmental potential. Underdevelopment is particularly widespread among children in Zambia; approximately 40% of Zambian children under five years of age are stunted due, in large part, to widespread malnutrition. It is a tremendous challenge for the public health care system in the country to address this burden. In this thesis, I investigate the capacity of rural health workers in Southern Province, Zambia to treat acute malnutrition among children under 5 years of age. Data presented in this thesis were collected from several sources. Information regarding current guidelines, trainings for treatment of acute malnutrition and supply chain for supplemental nutritious and ready-to-use therapeutic foods were collected during key informant interviews performed with nutritionists (n=4) and rural health workers (n=5) in Lusaka and Southern Province, Zambia. Nutritionists working within the health care system at the national, provincial and district levels were interviewed, as were rural health workers selected from a sample of health centers. Information on child nutrition was collected using 24-hour food recall questionnaires that were administered to mothers from a sample of households (n=215) in Southern Province. Data were analyzed with qualitative and quantitative methods. Outcomes of interest included the following: capability of rural health workers to address and treat acutely malnourished children; average daily consumption of carbohydrate, protein and fruit containing meals and snacks among infants; maternal perception of child growth and development as compared to other children of the same age; and mothers’ satisfaction with nutrition information and services provided by their local health centers. The first key finding of this study was that only 40% of rural health workers had been trained in the treatment of acute malnutrition within the last five years, while 100% of nutritionists had received training within the last two years. The second key finding was that infants six to 12 month old in the study sample were reported to have low protein and high carbohydrate consumption. On average, children consumed protein 0.75 times per day and carbohydrates 3.24 times per day. The third key finding was that mothers appeared to overestimate the development of their children. Despite the high rate of childhood stunting in the study sample (38%), 76% of mothers felt their child was the same height or taller than other children of the same age and sex, and close to 75% of mothers felt their child learned at the same speed as or quicker than other children of the same age and sex. These findings suggest that there are currently inadequate resources and capabilities within the Zambian health care system to properly manage the high rate of child malnutrition and stunting in the country. In order to have a greater effect on the reduction of stunting in children, efforts to better disseminate resources from the national level to the rural health centers for the treatment of chronic and acute malnutrition should be considered. Necessary resources include better access to trainings for rural health workers, anthropometric tools to measure levels of malnutrition and supplemental nutritious foods or ready-to-use therapeutic foods to treat children who are moderately or severely malnourished should be increased.

Maternal mental disorders may influence the adequacy of care that a mother should have with their children, affecting their growth and development, increasing the risk for malnutrition or other nutritional problems. This study aimed to investigate the existence of association between maternal common mental disorders (CMD) and child nutrition. Cross-sectional study was conducted with 596 children 6-60 months of age and their mothers in 39 quilombolas communities of Alagoas. The maternal mental health was assessed by the Self Report Questionnaire (SRQ-20). We collected data on anthropometric, socioeconomic, demographic, health, use of public services and presence of comorbidities. The nutritional status was determined by anthropometric standards of World Health Organization (WHO) and diagnosed with short stature when Z <-2 for index height for age (H/A), and overweight/obesity when Z &#8805; 2 for weight for height (W/H). To assess the nutritional status of mothers was used Body Mass Index (BMI) according parameter of the WHO. The findings found no association between maternal CMD and child nutritional status, but showed 65.3% of CMD among mothers of children under five years old, indicating a need for more studies that emphasize the role of maternal mental health as a possible risk to the child growth and development. However, we observed a high prevalence of nutritional deficiencies that persist as major public health problems in the state besides the strong presence of the nutritional transition, where malnutrition and obesity coexist with equal magnitude. Thus, interventions are needed in order to prevent, control and combat obesity and malnutrition, since both are health hazards. / Fundação de Amparo a Pesquisa do Estado de Alagoas / Os transtornos mentais maternos podem influenciar na adequação dos cuidados que uma mãe deve ter com seus filhos, afetando no seu crescimento e desenvolvimento, aumentando o risco para desnutrição ou outros agravos nutricionais. Este estudo teve como objetivo investigar a existência de associação entre o Transtorno Mental Comum (TMC) materno e o estado nutricional infantil. Realizou-se estudo transversal com 596 crianças de 6 a 60 meses de idade e suas respectivas mães em 39 comunidades quilombolas de Alagoas. A saúde mental materna foi avaliada pelo Self Report Questionnaire (SRQ-20). Foram coletados dados referentes às variáveis antropométricas, demográficas, socioeconômicas, de saúde, de utilização de serviços públicos e presença de morbidades. O estado nutricional infantil foi determinado pelo padrão antropométrico da World Health Organization (WHO) e diagnosticado com déficit estatural quando Z < -2 para o índice A/I e, sobrepeso/obesidade quando Z &#8805; 2 para o índice P/A. Para avaliação do estado nutricional das mães foi utilizado o Índice de Massa Corporal (IMC) segundo os parâmetros da WHO. Os achados não encontraram associação entre TMC materno e estado nutricional infantil, mas mostrou 65,3% de TMC em mães de crianças com até cinco anos de idade, indicando necessidade de mais estudos que enfatizem o papel da saúde mental materna como possível risco para o desenvolvimento e crescimento infantil. Contudo, observaram-se altas prevalências de agravos nutricionais que ainda persistem como problemas de saúde pública importantes no estado além da presença marcante da transição nutricional, onde desnutrição e obesidade coexistem com idêntica magnitude. Assim, intervenções são necessárias com a finalidade de prevenir, controlar e combater a obesidade e a desnutrição, já que ambas são agravos à saúde.

Thesis advisor: John Michalczyk / Why do we eat the foods that we do? This question is one that is not often considered by individuals as they go about their daily lives, but can have large implications on public health – for, there is a strong, physiological connection between food consumption and one’s health and wellbeing. Accordingly, when reflecting upon the health of a nation it is often important to consider its nutritional status. Ultimately, many determinants can contribute to how and why an individual eats certain foods, as can be seen in Ecuador. In this Latin American country, for instance, historical, socioeconomic, cultural, behavioral, socioeconomic, and environmental factors (among others) can be seen to influence the different diets – and by extension, the nutritional statuses – of different ethnic, regional, and geographic populations. Though common across Ecuador, discrepancies among these groups are particularly noticeable in the highland region, the Sierra. Overall, this paper examines the different forms of malnutrition, their implications on one’s health, and their prevalence across Ecuador. Additionally, it considers how the Ecuadorian diet was shaped, and how different subcuisines lend themselves to varying forms of malnutrition. Specifically, this paper focuses on the Sierra, given that levels of malnutrition are noticeably higher in this region, and that this highland area is home to large rural and indigenous communities who are most significantly impacted by the region’s nutritional conditions. / Thesis (BS) — Boston College, 2017. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Arts and Sciences Honors Program. / Discipline: .

OBJETIVOS: Determinar la desigualdad de la prevalencia de desnutrición crónica infantil en función a algunos determinantes sociales en países de América Latina y el Caribe (ALC)  MÉTODOS: Se realizó un estudio ecológico con los indicadores de desarrollo de la base de datos del Banco Mundial. Se analizaron los indicadores de 19 países (acceso a electricidad y servicios básicos de agua en población rural, PBI per cápita, gasto en salud per cápita). La desigualdad absoluta y relativa se determinó mediante el Índice de Kuznets absoluto, y relativo, la gradiente de la desigualdad a través de índice de las gradientes de la desigualdad, y para la desigualdad proporcional se usó el (índice de concentración de salud) ICS y la curva de concentración. RESULTADOS: la brecha de las desigualdades en la prevalencia de desnutrición crónica infantil entre los países de ALC se mantuvo prácticamente sin cambios significativos a lo largo del periodo estudiado. El 20% de los países con mayor desventaja concentran el 40% de la prevalencia de desnutrición crónica mientras que el 20% de los países con mayor ventaja solo el 7-8%, medido a través del ICS. CONCLUSIONES: A pesar de que en los Objetivos de Desarrollo del Milenio se encontraban eliminar la desnutrición, ésta permanece. La brecha de desigualdad ha disminuido respecto a la gradiente de desigualdad (desigualdad absoluta), sin embargo, la desigualdad proporcional se ha mantenido igual. Para eliminar esta brecha en ALC se deben generar políticas para distribuir de forma más eficiente y equitativa los recursos destinados al gasto en salud y los sectores relacionados, para de esa forma enfocarse en los determinantes sociales debidos. / OBJECTIVES: determinate the inequality of the prevalence of chronic childhood malnutrition according to some social stratifiers in the countries of Latin America and the Caribbean (LAC) METHODS: An ecological study was carried out at the country level with the development indicators of the World Bank database. The indicators of 19 countries will be analyzed (access to electricity and basic water services in rural areas, GDP per capita, health expenditure per capita). The absolute and relative inequality was determined by the absolute and relative Kuznets index, gradient of the inequality through the graduation index of the inequality, in addition, the proportional inequality was calculated through the index of concentration in health and the curve of concentration. RESULTS: the gap of inequalities in the prevalence of chronic child malnutrition in the LAC countries, remained practically without significant changes throughout the period studied. In addition, 20% of the countries with the greatest disadvantage accounted for 40% of the prevalence of chronic malnutrition compared to 20% of the countries with the greatest advantage, which presented 7-8% of the prevalence through the index of concentration on health. CONCLUSIONS: Although the Millennium Development Goals were to eliminate malnutrition, it was not possible to do so. However, the inequality gap has partially decreased. To eliminate it In LAC, wealth should be distributed more efficiently, and equitable resources allocated to health spending and related sectors. As well as generating Policies to address inequalities in and between countries. / Tesis