4 Reasons Malnutrition is About More than Food Security
POST AND PHOTOS BY BAILEY ADAMS // PUBLISHED MAY 2017
The world is in a nutrition crisis. Malnutrition directly affects one in three people, making it one of the most prominent issues affecting global health.
Of the 667 million children under the age of five, researchers estimate that 159 million are either chronically malnourished or stunted. That is almost a quarter of children globally. 
In Rwanda that number is even higher. On average, 37 percent of children under 5 are chronically malnourished. 
A common misconception is that malnutrition results from a lack of food to eat. However, the world produces more than enough to feed the entire global population. In fact, one third of all food produced (1.3 billion tons) is never consumed.  So why then is hunger so prevalent?
To truly understand and address this problem, we need to examine the root causes rather than continue to look to technical innovations that increase food production as the main solution.
In fact, a number of complex interrelated factors go beyond food production and may impact a family’s ability to feed their children. Some of these key factors include:
Poverty is unquestionably a driving factor in the lack of resources to purchase or otherwise obtain food. People living in poverty struggle to afford nutritious food for themselves and their families. Often, families also lack access to important agricultural inputs such as seeds and fertilizers, making it nearly impossible to cultivate the crops that could feed themselves and their children. Malnutrition and poverty also exist in a cycle – children who are malnourished face cognitive impairment and are less likely to perform well in school in addition to suboptimal functioning as productive adults. As a result, they will struggle to earn enough income to purchase nutritious foods or won’t have the productive capacity to grow the food needed to feed their families and advance their situation. Poverty, combined with other socioeconomic and political barriers, creates the bulk of food insecurity around the globe. 
2. Lack of Knowledge
Level of maternal education is one of the most important factors contributing to the nutritional status of women and children globally. Because decisions about food quality and quantity, household hygiene practices, and disease management are often made by the mother, maternal education is crucial for improving the health status of the family. However, in many resource-poor environments where educational attainment may be low, we also see a relative lack of knowledge around nutrition. For example, when knowledge about the importance of vitamins and nutrients is lacking, many families fail to consume even inexpensive and available foods that are rich in these same vitamins and nutrients.
Vestine Bayavuge, a GHI graduate from Shingiro Health Center, remarks “I was born a farmer, I would cultivate crops for two purposes, either for selling at markets or for home consumption. I never considered the nutritional benefits of crops before,” thus highlighting the importance of nutritional knowledge in addition to the resources themselves. Datvia Nyirarukumdo, from Busogo, echoes this statement, “We’ve had a good harvest of potatoes and beans and everything else. But we used to think that nutritious food was composed of potatoes and beans only… I didn't know the benefits of growing vegetables and I couldn't cook them.” The link between knowledge and improved health outcomes is well documented and plays a significant role in explaining why malnutrition is not simply an issue of food security.
3. Gender Imbalances
Social and economic inequalities between men and women often stand in the way of balanced nutrition. More often than not, malnutrition disproportionality affects women. In households that are vulnerable to food insecurity, women are at greater risk of experiencing malnutrition than men. Malnutrition in mothers, especially those who are pregnant or breastfeeding, can create a cycle of deprivation that increases the likelihood of a low birth weight child as well as childhood malnutrition.  Women are typically the primary caregivers for their children, and if they do not have the freedom to make household decisions their child’s health will be negatively impacted. Studies show that when women have the authority and ability to make decisions in the household, a higher proportion of family income will go to food, nutrition supplements, and health care.
Gender imbalances and the low status of women in the household may increase the likelihood of domestic and gender based violence. Domestic violence has been strongly associated with a woman’s inability to make decisions for herself and her family, including the choice of types and quantities of food she prepares. Additionally, the link between domestic violence and nutritional deficiencies may reflect the effects of physical manifestations of psychological stress. 
Furthermore, lack of decision-making power may also mean that women have less influence to make decisions regarding family planning. When women have fewer children they can invest more time and resources into each child. Increased birth spacing also allows mothers to harmonize childbirth and breastfeeding schedules, which has direct implications for nutritional status. Agnes Mukankuranga, mother of five from Rubungo, cites family planning as a critical intervention to improve malnutrition in her household. “As regarding birth spacing, I would stop breastfeeding when my child was only one year old because I was pregnant again. When you stop breastfeeding and you don’t have resources to provide food, your children can become malnourished. That is what happened in my family. My children are all one year apart. But since I started [family planning], they started to improve.”
4. Disease and Infection
Malnutrition and infection are strongly interdependent. While malnutrition can cause increased susceptibility to infection, infection also contributes to malnutrition - creating a vicious cycle. The consequences of an inadequate dietary intake include weight loss, damage to mucus membranes surrounding vital organs, impaired growth and development in children, and lowered immunity. This combination makes it much easier to become infected by various pathogens. Once infected, nutritional status is further aggravated by diarrhea, poor absorption of nutrients, loss of appetite and diversion of nutrients for the immune response, all of which lead to further nutrient loss and damage to defense mechanisms. This, in turn, causes reduced dietary intake. 
Chronic exposure to pathogens from contaminated environments can worsen health outcomes and damage the intestine, impairing long-term nutrient absorption. As a result, even if an individual were consuming enough food with the correct nutrients, the body wouldn’t be able to use and process those nutrients effectively. In addition to parasitic infections, such as malaria and worms, other infections like tuberculosis and HIV are intricately linked to nutritional status. Therefore, clean and safe water, hygienic living conditions, and access to health care are huge determinants in an individual’s overall health status. GHI’s Health Manager, Angeline Mumararungu, emphasizes this relationship, stating “early childhood illnesses can prevent children from thriving.”
At GHI, our program model is designed to address these interrelated factors that contribute to malnutrition in the home, as well as many more not included in this list. In addition to trainings on nutrition and agriculture we cover topics ranging from common illnesses, HIV/AIDS, gender-based violence, listening and communication, hygiene, traditional healing, family planning, mental health, and more. In doing so, we formally recognize that there is no straightforward link between agricultural yield and health outcomes, thus more accurately reflecting the lived realities of our partner families. By addressing these root causes head on - and making sure our partner families have the knowledge, skills, and inputs they need to thrive - we are taking real steps towards eradicating chronic childhood malnutrition in Rwanda.
Isi yose ifite ikibazo cyibyo kurya. Aho usanga ingaruka zimirire mibi igera kumwana umwe mubana batatu ari nabyo bituma ikibazo cyimirire mibi gifatwa nkikibazo cyibasira ubuzima bw’ umuntu. Muri miliyoni magana tandatu na mirongo itandatu by’ abana barimunsi y’ imyaka itanu, ubushakashatsi bwerekanako miliyoni ijana na mirongo itanu nicyenda byabana, baba bafite ikibazo cy’ imirire mibi cyangwa bafite ikibazo cyo kugwingira bitewe nimirire mibi.Kandi iki kigero cy’ abana bahuye nikibazo cyimirie mibi kijya kungana na kimwe cya kane cy’ abana bagize isi.
Murwanda usanga umubare urenga. Kukigereranyo cya 37% by’ abana barimunsi y’ imyaka itanu usanga bafite ikibazo gikabije cy’ imirire mibi.
Harabantu bagitekerezako ikibazo cyimirire mibi giterwa no kubura ibiryo bihagije byo kurya. Ariko iyo witegereje usanga isi itunganya ibyo kurya bishobora kuba birenze umubare wabayituye. Urugero, kimwe cyagatatu cy’ibiribwa (bigana na toni miliyoni imwe nibihumbi maganatatu 1.3 millions) usanga bitarariwe. Nonese n’ ikihe kibazo gituma inzara ikomeza kwiyongera?
Kugira ngo twumve kandi tunarandure iki kibazo cyimirire mibi, tugomba kuva imuzi aho iki kibazo gishobora guturuka aho gukomeza guhanga amaso inganda zongera ibyo kurya nkigisuobizo kirambye kuri iki kibazo.
Mubyukuri, haribindi bintu bigiye bigirana isano kandi ugasanga ibyo bintu birenze imyumvire yo gukomeza gutunganya ibyo kurya biva munganda. Kandi unasanga ibyo bintu bigira ingaruka kumuryango murirusange ndetse nabana. Reka turebere hamwe izo ngingo ukwo ari enye.
Bashobora kwihaza mubiribwa bo ubwabo ndetse nabana babo. Ikibazo cyimirire mibi gifitanye isano ihamabaye n’ imikorere yumwana mwishuri kandi kikagirana isano irihafi n’ imikorere y’ umuntu mubuzima busanzwe (hanze yishuri). Bishatse kuvugako niba badafite ubushobozi bwogukora, ntibazashobora no kubona amafaranga ashobora kubafasha guhaha indyo yuzuye. Ntanubwo bazabona imbaraga zo kuba bakwihingira ibyo kurya bitunga imiryango yabo. Ubukene hamwe nibibazo byubukungu, ibibazo bya politike, bitera ibibazo bikomeye biganisha kwibura ryibiryo kwisi hose.
2. Ubumenyi buke:
Uburere dukura kubabyeyi buri mubintu byerekana ubuzirange bwifunguro turya rya burimunsi kwisi hose. Kuberako usanga ko ubuziranenge, ingano,isuku yo murugo, ndetse no kwirinda indwara murugo ababyeyi babadamu babigiramo uruhare cyane. Ari nayo mpamvu ababyeyi bakwiye guhugurwa cyane kugirango hazamurwe ubuzima bwiza bw’ imiryango yabo. Usibyeko hari ahantu usanga ntamutungo kamere hafite ariko nanone biba ikibazo iyo abahaturiye ntabumenyi buhagije bafite kubijyanye no gutunganya ifunguro rigizwe nindyo yuzuye.Urugero, usanga abantu badosobanukiwe nakamaro kamavitamine. Aho usanga imiryango myishi inanirwa kurya ibiryo biciriritse bikungahaye kuri ayo mavitamine nizindi ntunga mubiri.
Vestine Bayavuge wahuguriwe kukigo nderabuzima cya Shyingiro yagize ati, “Navutse ndumihinzi, kandi mpinga imyaka yanjye kumpavu ebyiri: kugurisha mwisoko cyangwa gutunga urugo rwanjye. Ntabwo nigeze ntekereza akamaro kubuhinzi bwanjye mukurwanya ikibazo cy’ imirire mibi.” Ibi byerekana ko ikibazo kijyanye nogusobanukirwa ibjyanye nimirire cyiyongereye kukuba ntamutungo kamere uhagije yari afite. Dative Nyirarukundo, utuye i Busogo nawe yagize ati, “Tweza cyane ibijumba, ibishyimbo nibindi byinshi. Ariko twaterezagako indyo yuzuye igizwe nibijumba ndetse nibishyimbo gusa. Ntabwo nari inzi akamaro ko guhinga imboga kandi sinashoboraga nokuba nazihinga cyangwase ngo nziteke. Isano iri hagati yubumenyi nimibereho myiza byerekana neza cyane ko imirire mibi idaterwa no kugira ibiryo bidahagije gusa.
3. Ikibazo cyuburinganire buke nubwuzuzanye mu miryango:
Ubusumbane buri hagati yu mugabo numugore haba mubijyanye nubukungu cyangwa mubijyanye nubuzima busanzwe, bikomeje kuba imbogamizi mukurandura ikibazo cyimirire mibi. Icyo twavuga kukibaho ariko kidakunze kugaragara, nuko abagore bakunda kugerwaho nikibazo cyimirire mibi mungo zabo. Dufashe nkurugero, ushobora gusanga ingo zitishoboye, abagore bo muri izongo bakunda kugaragara ho ikibazo cy’ imirire mibi. Ikibazo cy’ imirire mibi cyanecyane kubabyeyi babagore batwite ingaruka zimirire mibi ishobora kugera kumwana urimunda nkokuvuka adashyitse (afite ibiro bike). Mubyukuri ababyeyi babadamu bagira uruhare runini mukwita kubana babo, kandi iyo badahawe uburenganzira buhagije bwo kwita kurugo rwabo neza, ibyo bigaragaza ihohoterwa rishingiye kugitsina. Ihohoterwa rishingiye kugitsina riri mubintu byagaragaye ko bikumira ababyeyi babadamu gufuta umwanzuro kungano yibiryo bategura murugo. Isano ririhagati yihohoterwa rishingiye kugitsina nikibazo cyimirire mibi bigira ingaruka kuburyo bugaragara kuguhungabana kw’ umubyeyi w’ umudamu.
Nanone, gukandamizwa kw’ umubyeyi w’ umudamu kugeza aho adashobora kwifatira imyanzuro biganisha kukuba yagira intege nke mugufata umwanzuro mugikorwa cyo kuringanyiza urubyaro. Iyo umubyeyi afite abana bake abona uburyo abitaho kandi gutandukanya imbyaro bituma umubyeyi yonsa abana be neza kandi kwonsa umwana neza biri mubintu biganisha kubuzima bwiza bw’umwana. Anyesi Mukankurangwa, umubyiyi wabana batanu, utuye Rubungo, yavuzeko kuringanyiza urubyaro biri mubintu byamufashije kurwanya ikibazo cyimirire mibi mumuryango we. “Kubijyanye no gucishamo imbyaro, umwana wanjye namukurikije afite umwaka umwe. Nukuvugako nahitaga mpagarika kwonsa wawundi kuberako ntwite, kandi ntabiryo narimfite bihagije byo kumugaburira. Ariko aho natangiye gahunda yo kuringanyiza urubyaro, ubu abana banjye bafite ubuzima bwiza cyane.”
Imirire mibi n’ indwara nibintu bifitanye isano ryahafi cyane. Nkuko imirire mibi ishobora kwerekeza kukibazo cyindwara, indwara nazo zishobora kwerekeza ku kibazo cyimirire mibi. Urugero, ingaruka ziterwa nokubura indyo yuzuye harimo gutakaza ibiro, kugabanyuka kwamatembabuzi aboneka mungingo zimwe na zimwe zumubiri, ikibazo cyimikurire mibi ndetse nikibazo cyimikorere yumwana mwishuri, nikibazo cyubudahangarwa bwumubiri (abasirikare bake bumubiri). Ibi byose bigaragazako iyo umuntu afite ikibazo cyimirie mibi agira nikibazo cyokurwaragurika. Usanga uwagize ikibazo cyimirire mibi agerwaho nindwara yo guhitwa, kutaakira intungamubiri neza, no gucika apeti, biganisha cyane no gutakaza abasirikare bumubiri.
Kuba ahantu hadasukuye bishobora kwangiriza ubuzima bwawe. Kwangirika kwamara bishobora gutuma umuntu adashobora kwakira intungamubiri ziri mufunguro yafashe. Ari naho usanga naho umuntu yarya ibyokurya bihagije, adashobora gushyira uturaso kumubiri. Icyiyongereyeho, indwara nka malariya ninzoka zo munda cyangwa igituntu nagakoko gatera sida nabyo biganisha kukibazo cyimirire mibi. Niyompavu, kwita kusuku, gukoresha amazi asukuye, no kubona ubuvuzi buhagije bishobora gutuma umuntu agira ubuzima bwiza. Umuyobozi mukuru ushinzwe ibyubuzima mumurima wubuzima (GHI’s Health Manager), yashyigikiyeko “Kurwaragurika kw’ umwana akiri muto bishobora gutuma atishima mubizima bwe bwose.” Indwara, agakoko gatera sida, ihohoterwa rishingiye kugitsina, ubumuga bwokuntumva, isuku, ubuvuzi bwagakondo, kuboneza urubyaro, ubuzima bwo mumutwe nibindi. Iyo dukora, tuzirikanako harisano ikomeye hagati yubuhinzi n’ ubuzima, arinayo mpamvu imiryango dukorana ibona ibintu uko biri (muburyo bugaragara).
Mukwibanda cyane kugitera ikibazo cyimirire mibi, twihatira kogenzura ko imiryango dukorana ifite ubumenyi buhagije bwabafasha kurandura ikibazo cyimirire mibi iwabo, ndetse no mu gihugu cyose cyu Rwanda.
 Report Finds Malnutrition Rates in Rwanda have Improved, But More Work is Still Needed, World Food Program. 2016
 Domestic violence associated with chronic malnutrition in women and children in India, Harvard School of Public Health. 2008