1. NUTRITION AND HEALTH
COMMUNITY HEALTH- THIRD EDITION CRIS WOOD
PREPARED BY
CHOL MACHOK AUGUSTINE MAGAK. STUDENT OF PH
REASONs
FOR THE PURPOSE OF GIVING THE HEALTHY INFORMATION TO PEOPLE IN NEED
OF IT.
EXPECTATIONS
TO HELP THE PEOPLE WHO NEED INFORMATION CONERNCING NUTRITON AND
HEALTH IN ORDER TO HELP THEMSELVES BY READING THIS MATERIAL, TO MAKE
USE OF THIS DATA AND EXTEND THE KNOWLEDGE ACQUIRE TO OTHER PEOPLE.
TOPICS TO BE COVER NUTRITON AND HEALTH
• INTRODUCTION
• BASIC NUTRITION
• NUTRIENTS
• COMMUNITY NUTRITON
• CHILD FEEDING AND NUTRITION
• NUTRITION IN SPECIAL GROUP
• ABNORMAL NUTRITION AND CLINICAL MALNUTRITION
• ASSESSING THE NUTRITIONAL STATUS OF AN INDIVIDUAL
• ASSESSING THE NUTRITIONAL STATUS OF THE COMMUNITY
• NUTRITIONAL INTERVENTIONS BY HEALTH WORKERS
INTRODUCTION
Nutrition is defined as the process by which food consumed by an organism is utilized via
digestion, absorption, transport, storage, metabolism and elimination. Good nutrition is basic to
good health.
Health is defined as a complete physical, social, spiritual and mental well-being of the person and
not merely the absent of disease or infirmity according to WHO.
The purpose of nutrition is

2. • To maintain life
• To grow or for the growth
• For normal functioning of organs and the production of energy
• The important of nutrition is for
1. Physical and mental development of children and adolescents
2. Healthy pregnancies and deliveries
3. Resistance to infection
4. The ability of the adults to work well
5. The prevention of deficiency diseases e.g. protein energy malnutrition (PEM), Iron deficiency
anemia, night blindness and goiter
MALNUTRITION
Malnutrition is bad nutrition in simple term. Bad nutrition can be due to under-nutrition or over-
nutrition. These two types of nutrition determine our health.
Under-nutrition is eating too little food or not eating enough healthy food. This type of nutrition
is the most common problem in the developing countries like South Sudan. The people most
affected are children and pregnant or lactating mothers. This type of malnutrition is bad for
children because their mental and physical growth and development can be affected. It is the major
cause of death in children.
Over-nutrition is eating too much of certain foods such as fats, sugars, and refined carbohydrates.
All these foods causes obesity and a number of degenerative diseases.
Over-nutrition
• This type of malnutrition has been in the western world but are now becoming widespread and
increasingly in developing countries like South Sudan.
BASIC NUTRITION ARE
1. Carbohydrates- energy giving foods
2. Proteins, oils and fats- body building foods (protein). Proteins are for growth and repair while
fats and oils for fuel energy and essential fatty acids.
3. Vitamins and minerals- are protective food
Functions of these basic nutrition
Group Functions
Carbohydrates As fuel energy for body heat and work
Fats As fuel energy and essential fatty
acids

3. Proteins For growth and repair
Minerals For developing body tissues and for
metabolic processes
Vitamins For metabolic (chemical reaction in
the body) processes
Water To provide body fluid and help
regulate body temperature
Spices and favoring's Add enjoyment to eating
Roughage (fiber), indigestible and
unobservable particles
Transport other nutrients, add bulk to
diet, provide habitat for bacterial flora
and assist in proper elimination
• Each group expect water contains a large number of different nutrients required by the body
but not identical, chemical structure.
• They are all broken down into simplest substances for the use by the body.
• Whatever food is eaten whether maize, cassava, cabbage, tomatoes or beans, it is converted
into a pool of mixed nutrients and this pool, the body draws it requirements. Some is
immediately use and some are stored in the body until it will be needed I.e... Iron, fat, and
vitamins A.
BALANCED DIET
• Balance diet refers to a meal or diet that has all nutrients required by the body in the right
amount.
• Carbohydrates, proteins and vitamins form part of balance diet, but the addition of minerals,
fats and water in right quantities complete the definition.
• Currently the term ‘balanced diversified diet’ is being promoted by nutritionists thus owing
the fact that one type of food taken on daily basis for too long may deny the body nutrients
available in different variety of food but in the same food group. For example eating vegetables
like Sukuma-wiki (Kale) daily will deny one other elements found in other locally available
vegetables like terere and manage. Therefore the family’s diet should comprise a variety of
the vegetables
The table showing quantity proportions of each food group i.e. preferable for one to have
consumed a right balanced diet.

4. Fats, Oils and sweets- use occasionally
Milk group. 2 serving Meat, or alternative group I.e... Fish, chicken.
2 serving
Vegetables group. 3-5 servings. Such carrots,
tomatoes, mushrooms, cabbages. Etc.
Fruit group. 6 or more servings. Such oranges,
.apples, bananas and mangoes, etc.
Breads and cereals group. 6 or more servings. Such as rice, slice breaks, maize flour
Energy requirements
• Energy is the ability to do work.
• Energy is needed in all aspects of life like walking and working.
• For vital functions such as;
1. Heart beat and respiration
2. For growth
3. For breakdown
4. Repair and maintenance of the body tissues
5. For maintenance of the body temperature
6. Large people, growing children, pregnant and lactating mothers, sick people, those doing
heavy work and those living in cold places need more energy than smaller, less active or
any other people.
However, the amount of energy require differ from one individual to the other and from day to
day.
Food
• Food is the body’s fuel.
• How does its work as a fuel?
• When fuel is burned, it supplies energy to the body.
• The burning of food is called metabolism.
• The amount of energy obtained from burning of food is measured in units. These are known
as Calories or joules. We use Calorie for simplicity
• One Calorie (Cal) = 4.12 kilojoules
• A food Calorie is always spelt with capital C, it is equivalent to 1000 basic Calories
Some approximate energy requirement are as below

5. • The average male office worker needs 2500 Cal/hours
• The average non-pregnant woman needs 2000 Cal/hours
• A lactating woman needs an extra of 500/600 Cal/hours
• A man or woman doing heavy work all day needs an extra of 1000 Cal/hours
• A woman who is pregnant and is also breastfeeding needs about 3000 Cal/hours and if she is
also doing heavy manual work in the farm, her total needs will be higher still.
Energy balance and energy deficiency
• There is a relationship between the amounts of food eaten, the energy spent and body weight.
• If the person eats more food than he or she uses then the extra energy is concerted and stored
as fat in the body and the person again weight.
• And if the person eats less food, than he or she needs energy, then the fat reserves will be used
up and the person will lose weight.
• The energy needed for the essential metabolic processes like heart beat and respiration,
maintenance of temperature is called basal metabolic rate (BMR). IT IS FOR THESE
FUNCTIONS ONLY.
• It varies from person to person due to differences in sex, age, body side, presence of
diseases like goiter, and others factors.
• The person burns energy at the basic rate only when at complete rest, all other activities
require extra energy.
Nutrients
• Carbohydrates- energy giving foods
• Proteins, fats and oils- proteins-body building, and fats- energy giving foods.
• Minerals and Vitamins- are protective foods
Carbohydrates are main sources of energy in our diet or meal.
• They contributed to 80% sometimes
• They are compounds which contain carbon, hydrogen and oxygen
• They are burned or metabolized to generate energy and in the process they produced (𝐶𝑂2 )
and (𝐻2O)
• 1g of carbohydrate gives 4 Calories of energy.
• We get most of our carbohydrates in form of starches and sugars
Classification of carbohydrates according to their complexities

6. • Monosaccharides
• Disaccharides
• Polysaccharides
Monosaccharides or simple sugars are simplest carbohydrates
• They are absorbed through the wall of intestines without being changed by digestion
• The main example of Monosaccharides are
• Glucose - are formed when some carbohydrates like starch are digested by enzymes.
• Fructose - are found in honey and fruit-juices.
Disaccharides are larger sugar units.
• They are made of two monosaccharides.
• The common examples of disaccharides are;
• Sucrose- are table sugars
• Galactose- are found in milk
• Maltose- are found in germinating seeds.
• They all dissolute in water
Polysaccharides are most complicated carbohydrates.
They do not dissolute in water but dissolute in solvent liquid like benzene
The major examples are starch, glycogen and cellulose
Conclusion- inadequate intake of carbohydrates resulted into under-nutrition and this leads to a
disease called Marasmus in children
Nutrients – fats (refers all fats and oils)
• Fats are a rich source of energy in the diet.
• They are made from carbon, hydrogen and oxygen
• They are insoluble in water but dissolve in some chemical solvents like benzene, chloroforms,
and ether.
• The term fat refers to all fats and oils and fat is used in things like butter, and margarine which
are solid at room temperature and Oils are those substances which have similar chemical
compositions with fats but are liquid at room temperature.
• Fats, when digested in the intestine, release glycerol and fatty acids.
Fatty acids are body building blocks and are divided into saturated and unsaturated groups.

7. What are saturated fats? From a chemical standpoint, saturated fats are simply fat molecules
that have no double bonds between carbon molecules because they are saturated with hydrogen
molecules. Saturated fats are typically solid at room temperature.
How do saturated fats affect my health? Replacing foods that are high in saturated fat with
healthier options can lower blood cholesterol levels and improve lipid profiles
What foods contain saturated fat? Saturated fats occur naturally in many foods. The majority
come mainly from animal sources, including meat and dairy products (butter).
Examples of foods with saturated fat are: fatty beef, lamb, pork, poultry with skin, beef fat
(tallow), lard and cream, butter, cheese and other dairy products made from whole or reduced-fat
(2 percent) milk.
In addition, many baked goods and fried foods can contain high levels of saturated fats. Some
plant-based oils, such as palm oil, palm kernel oil and coconut oil, also contain primarily saturated
fats, but do not contain cholesterol.
What are alternatives to replace saturated fats in the foods I eat?
• To get the nutrients you need, eat a dietary pattern that emphasizes: fruits vegetables, whole
grains, low-fat dairy products, poultry, fish and nuts,
• While limiting red meat and sugary foods and beverages.
• Choose lean meats and poultry without skin and prepare them without added saturated and
Trans fat.
• You should replace foods high in saturated fats with foods high in monounsaturated or
polyunsaturated fats. This means eating foods made with liquid vegetable oil but not tropical
oils. It also means eating fish and nuts. You also might try to replace some of the meat you eat
with beans or legumes.
There’s a lot of conflicting information about saturated fats. Should I eat them or not?
The American Heart Association recommends limiting saturated fats which are found in butter,
cheese, red meat and other animal-based foods. Decades of sound science has proven it can raise
your “bad” cholesterol and put you at higher risk for heart disease.
The more important thing to remember is the overall dietary picture.
Saturated fats are just one piece of the puzzle.
In general, you can’t go wrong eating more fruits, vegetables, whole grains and fewer calories.
When you hear about the latest “diet of the day” or a new or odd-sounding theory about food,
consider the source.
The American Heart Association makes dietary recommendations only after carefully
considering the latest scientific evidence.

8. An unsaturated fat is a fat or fatty acid in which there is one or more double bond in the fatty
acid chain
• They are liquid at room temperature
• What are examples of unsaturated fats?
1. Are all vegetables expect coconut oil and fish as below;
2. Avocados and avocado oil.
3. Olives and olive oil.
4. Peanut butter and peanut oil.
5. Vegetable oils, such as sunflower, corn, or canola.
6. Fatty fish, such as salmon and mackerel.
7. Nuts and seeds, such as almonds, peanuts, cashews, and sesame seeds.
Fats in the diet make food tastier and yield up to 9% calories per gram and due to reason is known
as an energy dense food
Fats can be used to increase the energy content of the a diet without increasing the bulk
Fats is also a useful vehicle for a fat soluble vitamins
Fats from the diet and fats converted in the body from excess carbohydrates are stored in the body
under skin, and around the organs as an energy reserve
The reserved energy is used when the energy in the diet is insufficient.
Too much saturated fatty acids causes degenerative diseases of the heart and blood vessels
Nutrients-proteins
• Protein is an essential part of all living cells.
• It is needed for growth and repair of the tissues
• Extra protein is needed for pregnancy, lactation, growing children and during sickness
• The proteins are found in both animals and plants differing thousands of proteins.
• The proteins are made up of 26 different amino acids. Some of these can be converted into
other amino acids by the body but essential amino acids cannot make it
• We can only obtain them from protein in our diet or meal
• Proteins from carbohydrates and fats are made from carbon, hydrogen and oxygen.
• They also contain nitrogen and sometimes Sulphur

9. • The nitrogenous component are for growth and repair of the body.
• The proteins we eat are broken into a pool of amino acids and this pool all types of protein
needed for our cells are then built up.
• Extra amino acids from diet are broken down and the nitrogenous component are separated
and eliminated from the body as urea and the rest of structure is converted into fat or glycogen
since the body does not stored protein as it does to carbohydrates and fats
• The main sources of protein in diet Sub-Saharan Africa like South Sudan is the staple food of
the particular area
• People who’s their staple foods are cereals such as maize, millet, sorghum, rice or wheat obtain
adequate protein from these sources.
• Other sources of proteins are relishes always eaten with staple food such soups, stews, sauces,
and vegetables
• The protein deficiency is closely associated with energy-deficiency. This can cause
energy/protein deficiency disease called Kwashiorkor
Minerals
Minerals are those elements on the earth and in foods that our bodies need to develop and function
normally. Those essential for health include calcium, phosphorus, potassium, sodium, chloride,
magnesium, iron, zinc, iodine, chromium, copper, fluoride, molybdenum, manganese, and
selenium
Minerals like sodium, potassium and chlorine are found in the body fluids and the minerals that
form the body part are calcium and phosphorous in bones.
And the minerals found in the human body are calcium, phosphorus, potassium, sodium, chloride,
magnesium, iron, zinc, iodine, copper, fluoride, manganese.
Major minerals
1. Calcium
2. Chloride
3. Magnesium
4. Phosphorus
5. Potassium
6. Sodium
7. Sulfur
Trace minerals
1. Chromium
2. Copper
3. Fluoride

10. 4. Iodine
5. Iron
6. Manganese
7. Molybdenum
8. Selenium
9. Zinc
Minerals Sources of
food or
foods rich
of
Functions deficiency Excess Toxicity
Calcium Dairy
products,
eggs, fish,
green leafy
vegetables,
legumes
and nuts
Bones and
teeth are
made from
protein and
calcium,
pregnant,
lactating and
growing
children
need
calcium,
bone and
teeth
formation,
general
metabolic
functions
including
blood
coagulation,
nerve
transmission
and muscles
contraction
and
relaxation
Lack of
calcium in
the body
results in
conditions
like tetany,
osteoporosis,
osteomalacia
and rickets
Too much
calcium can
cause an upset
stomach,
abdominal
pain, nausea,
vomiting, and
constipation.
Bone pain and
muscle
weakness.
Hypercalcemia
can cause the
bones to
release too
much calcium,
leaving them
deficient. This
abnormal
bone activity
can lead to
pain and
muscle
weakness.
Calcium toxicity is
rare, occurring in
those with
hyperparathyroidism
or high calcium
supplementation
levels. Like vitamin
D, toxicity can lead
to calcification of
soft tissues7
. In
addition, a very high
intake of calciumcan
lead to kidney stone
formation
Potassium Legumes,
whole
grains,
leafy
vegetables,
meats and
Healthy
functioning
of the cells,
it is an
eletolyte I,e,
is necessary
It cause
fatigue or
muscle
cramps,
severe
potassium

11. fruits like
ripe
bannas
for muscles
building,
organs and
tissues
repair,
carbohydrate
metabolism
and protein
synthesis
deficiency or
hypokalemia
can cause
serious
problems
like irregular
heart
function,
nervous
system
impairment
and even
death.
Phosphorous Fish, meat,
poultry
products,
dairy
products,
eggs, peas,
beans and
nuts
It is a
component
of bone,
teeth and
number of
enzymes in
the body.it
helps builds
strong and
teeth. It
involves in
release of
energy from
fat, protein
and
carbohydrate
during
metabolism,
formation of
cell
membranes
and many
enzymes
It is rare, but
can results to
weak, fragile
bone, loss of
appetite, less
energy and
susceptibility
to infections
Chlorine
Magnesium
Sulphur
Sodium
Vitamins
They are needed in small amount to acts as catalysts for metabolism in our body
Classification of vitamins: are fat-soluble and water-soluble vitamins

12. Fat-soluble vitamins are
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K

Water-soluble vitamins
1. B vitamins
a. Biotin (vitamin B7)
b. Folic acid (folate, vitamin B9)
c. Niacin (vitamin B3)
d. Pantothenic acid (vitamin B5
e. Riboflavin (vitamin B2)
f. Thiamin (vitamin B1)
g. Vitamin B6
h. Vitamin B12
2. Vitamin C
Vitamins Other names Functions Sources of foods Deficiencies
Community nutrition
Community nutrition is an approach which provides long-term solutions, promotes stability
and supplies communities with sustainable methods to reduce malnutrition, often referred t food
security.
A successful fight against global and local hunger must involve a community centered approach
to malnutrition. Establishing emergency aids is very important because it meets nutrition needs
for short-term and does not affect the long-term changes.
To develop a long-term changes, individual causes of malnutrition within the community must
be identified and dealt with. It is important to identify chronic and seasonal food shortages, diet
diversity and inadequate feeding practices that exist in that community.

13. Community approach to nutrition demands that the community answer these questions, with the
help of the trained individuals, and develop the long-term solutions to malnutrition problems.
Sustainable nutrition programmes must meet the real needs of the community, be relatively at
low-cost, protect the community’s resources and function with minimal external inputs. This
approach provides a greater ability to adjust to unexpected changes because the programmes are
rooted in the knowledge of the community.
The causes of malnutrition. The causes of malnutrition are divided into direct and underlying
causes.
The direct or immediate causes are due to deficient intake of a particular nutrient. For example,
deficiency of proteins result to kwashiorkor, iron deficiency leads to anaemia, deficiency of
vitamins A is xerophthalmia and iodine deficiency is goiter
The underlying causes of malnutrition in Sub-Saharan Africa are
a. Infections and diseases
b. Ignorance about nutrition
c. Seasonal changes leading to lack of production and
d. Unequal distribution of food and productivity.
Infection and disease
1. There is a very significant relationship between infection and nutrition that particularly
affects children.
2. Poor nutrition lowers the resistance of the whole body to infection and diseases.
3. Under-nourished children are more prone to infection, recover from illnesses more slowly
and frequently die from infection.
4. Malnutrition tends to be under-reported in disease and mortality statistics because a sick
child with malnutrition is likely to develop complications such as gastroenteritis that leads to
death but deaths are reported as due to diseases than malnutrition
5. Under-nutrition and malnutrition themselves are serious problems, they are mild and
moderate but they influence the onset and the outcome of the infections
6. Malnourished child gets infections more often than a well-nourished child
7. Infections causes fever, los of appetite, diarrheoa and vomiting, all interfere with intake and
absorption of food hence malnutrition
8. Fever and repair of the damaged cells also increase the need for food
9. Of all infections, diarrheoa is the significant cause of malnutrition. Diarrhea is common
during the weaning period-weanling diarrheoa

14. Ignorance about nutrition
1. In many parts of Africa, malnutrition is not only the lack of food but also ignorance about
nutrition due to lack of information and knowledge about nutrition.
2. Some parents believe that a child with big stomachs are well fed because they do not
understand that quality of foods is important
3. In many communities, nutritious foods like eggs and chicken are sold for money and that
money is used to buy sugars for making porridge for children.
4. Parents also lack understanding about the need of the frequent meals in the course of the day.
5. Children have small stomachs which are easily filled with bulky but nutrients-deficient foods
like ugali, matoke, and cassava.
6. To meet their nutritional requirements, children must be fed four or more times a day.
Seasonal changes and lack of food production
low-resistance
infections
low-food
intake
undernutrtion
Increased
need
Frequent
lysevere
Low-
resistanc
e
Death
Diarrhoea aQnd vomiting
Low food intake
Malnutrti
Malnutrition
Death

15. 1. Food shortages because of inadequate production still happen in many parts of Sub-Saharan
Africa countries due wars and civil strife disrupt food production,
2. Food shortages also occur during the rainy seasons. The work are intense and food become
low during this time of rainy periods. Rains also increases mosquitoes breeding hence more
malaria occur.
3. The worst food shortages is in before the next crops are ready to be harvested, this period is
called hungry or famine season.People become vulnerable to undernutrition and malnutrition
as well as malaria. Children suffered more from attacks of malaria
Unequal distribution of food
Unequal distribution of food within the family, region and even the countrywide as whole can
cause malnutrition
1. Within the family – the food distribution always favours the head of the family, (the man
when present,) hence nutritional risk groups’ esp. children and women become disadvantages.
It is a customs in some households in Africa for the males of the households to eat first the
most nutritious and tastiest part of the meals thus leaving little for women and children.
2. In urban areas where men often eat lunch away from house. They may have roast meat and
enjoy it with beer in the company of friends. Therefore, this practices leaves little or no money
for buying food for the homes, thus the family meals always have low quality and then the
vulnerable family members suffer the consequences.
3. Unequal distribution in a country results from low production of certain foods in some areas,
poor infrastructure, and lack of storage, preservation facilities and poverty. All these factors
lead to high incidence of malnutrition in some parts of the country.
Factors promoting good nutrition
Malnutrition occurs when people do not eat enough good food for their body requirements.
The factors promoting good nutrition and what can be done to improve the situation are
here below:
1. Good agriculture
2. Good economy
3. Healthy environment
4. Good education
5. Healthy social family life
6. Prevention and control of disease
Good agriculture
1. Clearing the land at the right time
2. Planting sufficient food crops
3. Use of irrigation and fertilizers if necessary and advice from agricultural instructors.

16. 4. Harvesting at right time, storage of food to avoid loss via pests or through having to sell at a
bad time.
5. A good transport and distribution system to ensure delivery of enough food to all regions.
Good economy
1. Sufficient money and resources widely allocated for priorities like agricultural improvement,
food and fuel, education and health
2. Enough cultivable land to grow sufficient food crops and cash crops for income.
3. Communal production and fair distribution, marketing and pricing e.g. through cooperative
societies
Healthy environment
1. Sufficient safe water located reasonable close to houses
2. Adequate fuel for cooking
3. Use of latrines and good general standards of sanitation
4. Vector and disease control important for nutrition and general health
Good education
1. Teaching about good nutrition and children health in schools, families, and communities.
Education for women must be encouraged
2. Showing ways of improving the present attitudes and practices. Especial emphasis should be
on good nutrition for the most vulnerable groups including the poor, mothers and children
3. Give advice about foods and practices that are practical for mothers locally
Healthy social and family
1. Family side- all children in the family are more likely to receive enough good food and
attention if the family is small compare to the large family. The younger children usually need
more care thus Encourage family planning.
2. If either or both parents are not home, it is important to ensure that the children are looked after
properly and that they have enough food, this may means having day care center.
3. Problems with alcohols and drugs are common in disrupted families
4. Appropriate distribution of money, work and food within the community and the family.
Support for mothers is important in keeping the children healthy. Priorities within the family
include seeing that children get their share of high quality energy and protein foods. Children
need small portions of food given several times during the day because they cannot digest the
quantities at once.
5. Care for children from broken or one parent families. Social integration and communal care
for these children and for underprivileged families is an important
Prevention and control of the disease
1. Most childhood illnesses are preventable by immunization- comprehensive vaccination of
children and good maternal care are important factors in good nutrition.

17. 2. Early detection and effective treatment of acute diseases such as diarrhoeal diseases and
respiratory tract infections.
Many of the factors mentioned above go together and some result to others. For example,
alcoholism result to farming practices that results to less income thus increasing poverty and
neglect of the family.
Poverty and disease go together
Improvement of undernutrition and malnutrition prevention require energetic and cooperative
efforts. Good preventive work in child health is one essential weapon in fighting malnutrition and
reducing malnutrition leads to lower morbidity and mortality in children who become healthier
than adults.
The that influencing nutrition in an individual and community are here below
Productivity- poor productivity has to be converted into high productivity in order to achieve the
goal of good nutrition.
Health- prevent diseases or treated them efficiently thus helping an individual who is susceptible
to infection and disease and improve health. Healthy people also provide food themselves compare
to those who are ill.
Education- poor education is connected to poor nutrition therefore, education should be improve
through creation of awareness and training in order to provide knowledge.
Other factors are socio-economic status, political stability and cultural factors. Putting them into
a consideration improve malnutrition and as well as solving the problems of malnutrition
productivity
educationhealth
Nutrition

18. The aim of nutrition programmes is to promote a healthy eating habits and to eradicate malnutrition
by making use of others fields such as marketing and economics, agriculture, and education via
inclusive action nationwide, communities and within families. Health workers to plays their roles
in promoting good nutritional habits.
Customs and beliefs affecting nutrition- most people especially in rural areas have a fixed
custom and beliefs about different foods and cooking practices. In areas, insects like termites and
grasshoppers which are rich of proteins and other nutrients are eaten which them survive during
the time of the hardship while some people like Jieng (Dinka) do not eat grasshoppers.
Also in some African communities, women and children are not allowed to eat chicken and eggs.
Another common practice is preventing children with measles not eat meat or taking salt. These
(traditions) customs and beliefs are harmful and should be discouraged but it is not by challenging
but with logical reasons that will help them understand the bad traditions they are do without their
notice hence help resistance and confrontation.
Child feeding and nutrition
Breast feeding is a common tradition practice. It is important to breast feed the babies by their
mothers especially by those in rural areas where poverty and poor living conditions make bottle
feeding dangerous.
The important of breast milk
1. It is always fresh
2. The mother’s breast milk is usually sufficient for a baby for first six months of life thus mothers
are encouraged to make exclusive breast feeding within this 6 months. By six months,
supplementary foods (weaning) should be introduced gradually
3. It safe from diarrhoea and other infections since it contains the mother’s antibodies
4. It is also easily available- clean and ready for the baby at all times.
5. It is easy to digest
6. It has the right temperature
7. It protects and brigs the mother and baby together.
Important of breast feeding
1. It is best because it cost mother nothing and milk is ready always
2. The baby’s suckling at the breast helps the postpartum uterus to contract
3. Breast feeding gives the mother the opportunities to care and love for her baby.
Breast feeding and HIV/AIDS
1. It is scientific fact that the baby born to a HIV positive mother may be HIV negative.
2. However, the child may acquire the virus from the mother through breast milk maybe when
the child’s gut lining is bruised. The bruising of the child gut happen when it’s given a solid

19. food at early age because the foods erode some protective membranes along the gastrointestinal
tract.
3. Protection of the baby- the mother who is positive should be advised at PMTCT station to
choose between either feeding the baby on breast milk exclusively for four months, then stop
the breast milk and substitute it with other milk (animals) and solid foods or to feed the baby
on formula feeds or milk from animals source without at any one time giving the baby her
breast milk. This is done to the mother who is HIV positive during counseling at the antenatal
Expressed milk
1. Not traditionally practice because mothers use to stay at home with their babies and care for
them
2. Today, several lactating mothers go for work after two months of maternity leave, and as they
resume their works, they need to learn how express breast milk for the safe of the baby and the
same is applied for a mother who si HIV positive who has chosen to breast feed exclusively
for 4 months but has to leave the baby for more than 6 hours
3. When expressing milk by the mother for the baby, maintenance of hygiene is importance for
the mother, baby, expressed milk and utensils because it prevent contamination that may lead
to diarrhoea.
4. Expressed milk should be stored in closed container and in the cool place away from direct
sunlight.
5. The child should be fed with expressed breast milk using cup and spoon but a bottle.
6. The health care workers should take time to educate mothers on these practice as they go a
long way in minimizing the childhood illnesses, related complications and deaths arising due
to malnutrition, infections and other diseases.
Weaning and under-nutrition
Weaning is the time during which a child’s diet changes from breast milk (or formula) alone to
family foods. It is useful to think of weaning in stages
Stage 1- the baby gets almost all nutrients from breast milk but starts other foods. These first foods
must be easy to eat and digest by the baby (exclusively breast feeding). These foods are called
weaning foods
Stage 2 – the baby continues to obtain the same amount of breast milk but eats increasing amounts
of other foods. The type of foods gradually change from weaning foods to regular family foods.
Stage 3- the child gradually takes less breast milk and eats more and more of the family foods.
The breast milk becomes a snack and for a comfort
Under-nutrition in sub-Saharan Africa occurs most frequently in children age 6 months to 3 years.
To prevent undernutrition, the most important single measure that can be taken besides continuing
breast feeding is to improve weaning foods and this is necessary to understand foods value.

20. Weaning foods
There are three factors that one must borne in mind when preparing a good weaning food for the
young children. These are;
1. To provide enough energy within the small amount that a young child can eatat one time.
There are two ways of ensuring an adequate intake of energy foods. The 1st is to feed young
children frequently from 4-5 times a day and the 2nd way is to mix foods with high energy
concentration into the basic staple food. For example, a teaspoon 5 g of oil gives 45 Calories
and 2 teaspoons 10 g of sugar give 40 calories. Feed young children at four times every day
2. To add protein to the staple food i.e. porridge given to the child.
Most cereals have a protein concentration of about 7%-8%, but this protein is of low biological
value. To improve the equality of the protein, small amounts of other animals or plant foods
containing protein must be added. Suitable proteins foods are cowpeas, beans, groundnuts,
fish powder, dried milk powder, flashed fish and minced meat or egg. Continue breast feeding
during weaning
3. To provide food in a form which is easily swallowed and digestedby young children. This
is done by mashing the food or grinding it into fine particles and adding liquid until it is soft.
It is also important to cook it well and teach mothers how to enrich weaning foods. This is an
important thing in children’s clinics. Use weaning mixtures
Weaning recipes
The main problems with weaning foods are how to prepare them in such a way that they are soft
and easily digested and how to reduce the bulk (volume) of the staple food energy. Weaning
recipes give different ways of mixing protein foods with thin porridge to give young children
protein-enrich food.
Examples are
a) Boil cowpeas and then mash
b) Roast groundnut and then grid to powder
c) Soak red beans overnight, remove the skin then cook and mask
d) Cook fish, remove bones and mash
e) Scrape meat with a knife to obtain small piece
f) Mix powdered milk to a paste with water and cook it the porridge.
A demonstration garden
To encourage mothers and others to grow a wide variety of foods for their children, a
demonstration garden at a health center is useful. Seek advice from the local agricultural extension
officers.
Day care centers
Many large communities now have a day care centers to look after their children when they go to
work. Therefore, the health workers can advise the mothers or community about the suitable foods

21. for their children at these centers which will supplement the home diet. Foods such as fruits grown
in the community can be added to the main meal and if the community or family has cows, they
can be advised to set aside some milk for the children
Nutrition in special groups
Nutrition during pregnancy and lactation
a) Women’s nutritional needs are greater than any other time in her life.
b) All the foetus needs to grow and the food needed for production of milk must come from
the mother.
c) A child born to a poorly nourished mother is likely to have a low birth weight below 2.5
kg, such babies are likely to die in the first few months of life.
d) During pregnancy, there is an increase in the weight of the woman and BMR also increases.
These increases require extra foods to provide extra energy, protein and other nutrients
e) Anaemia is a common problem in Africa esp amount pregnant women. A child born to
anaemic mother may have a very low reserve of the body iron and is likely to develop
anaemia in the 1st few weeks of life.so, it is adviseable to give iron supplement routinely
to pregnant women in the areas where iron-deficiency anaemia is common. This is usually
give in form of ferrous sulphate tablets to be taken 3 times a day. Folate, one of vitamin B
complex is also required for making blood cells and should be given together with iron to
pregnanat women.
f) Vitamin A deficiency in pregnancy is also bad for the baby , so multivitamin tablets should
be given during pregnancy in areas where Xerophthalmai is prevalent and also encourage
pregnant women to foods rich with vitamins A.
g) Lactation usually starts within 2 to 3 days after delivery and this the period when woman’s
body must replace the blood lost during delivery which might be litre or more. Here, the
mother who have just delivered need to eat more than usual amd those foods should include
foods rich with iron and vitamin A.
h) NUTRITIONAL cost of pregnancy and lactation is great, the woman’s store nutrients is
depleted and this is particularly so in in poor communities where women hardly ever get
enough food. Repeated pregnancy, combined with heavy work quickly make women weak
and sick
i) To prevent these problems, women must be well fed during their reproductive years. They
should be in a good nutritional health before and during pregnancy and lactation because a
woman who is malnourished has a greater risk of complications during pregnancy and is
likely to give birth to a low weight baby
Nutrition and HIV/AIDS
a) Malnutrition is one of the greatest complications of HIV infections

22. b) HIV/AIDS is associated with conditions which in reduced food intake. Decreased food
consumption may result from inability to shallow due to sores in the month and throat,
loss of appetite as result of fatigue or depression, side effects from the medication or
reduced quantity and quality of food in the household as a result of inability to work or
reduced income due to illnesses
c) HIV also interferes with the body’s ability to absorb nutrients due to effects occur of many
infections. Poor absorption maybe caused by an infection in the intestinal cell or increased
incidence of opportunistic infections like diarrhoea
d) The importance of good nutrition, hygiene and food safety to HIV/AIDS patients
1) Good nutrition strengthens immune system to fight opportunistic infections and delay the
progression of the disease,
2) Good nutrition reduces the severity of infections and the likelihood of weakening the
immune system at the onset of the symptoms.
3) It also contributes to weight gain, stops wasting and enables the host’s body to fight
opportunistic infections.
Nutrition and elderly people
The number of elderly people in Africa and especially South Sudan is increasing owing to improve
health care and quality of life. The care has changed with many of them being left on their own
while children emigrate in search for jobs and this has led to an increase nutritional challenges for
old people and these are due to
1) Various growth and developmental challenges
2) Illnesses
3) Poor appetite
4) Lack of teeth thus making it hard for them to eat any hard type of food.
5) Lack of support and carers who would provide the food and cook for them.
Therefore, the elderly people should not be left to become malnourished or worse still die of
malnutrition due to neglect.
Nutrition in people with diabetes
Diabetes is on the increase among many communities in Africa due to various factors such as;
 Sedentary lifestyles like smoking, drinking etc.
 Feeding and dietary habits that favours junk foods
 Inactive physical
 Family history and other factors
The effects of the disease can be minimized or reduced by the used of;
 Appropriate balanced diet. A patient is encouraged to eat diets rich in proteins such as fish,
poultry, nuts and beans, fruits and vegetables and whole grains
 Regular exercise

23.  Avoiding the use of drugs
 Regular checkup to avoid complications
Abnormal nutrition and clinical malnutrition
There are many types of malnutrition as below
The three syndrome of protein energy deficiencies
 Marasmus
 Kwashiorkor
 Marasmic kwashiorkor
Abnormal
nutrition
Micronutrients
deficiencies
Over nutrition
Undernutrition
Underweight
Vitamin deficiencies
Xerophthalmia,pellagra Overweight
Low birth
weight
Protein energy
deficiency, marasmus,
marasmic kwashiorkor
Minerals deficiencies,
iron. Anaemic, iodine
deficiencies
Nutrient excess
syndromes;
fluorosis,
hypertension,

24. The effects of underweight
 Children underweight grow more slow
 They are more likely to get infections as they have the weak body defenses and do not
develop antibodies easily
 They die more frequently when they get serious infection such as measles, whooping
cough, tuberculosis, and gastroenteritis
 They develop clinical forms of protein energy malnutrition very rapidly during these
episode of infectious diseases.
Management of underweight
Increase the intake Calories frequency of the meals in the diet by augmenting the amount of energy
foods. If this is not done, the limited amount of protein in diet will be used to provide the body
with energy and will therefore be wasted which means providing more Calories allow all the
available protein to be used for body building.
Protect the child from infection by immunization, prophylaxis against malaria, treatment of
intestinal parasites, and advice the mother on hygienic food preparation.
Weight the child regularly and encourage the mother by showing her the child’s growth curve
moving upwards along the normal weight for age path on the growth chart.
Recommend the mixed diet. Find out which additional foods the mother can easily obtain and
encourage her to mix any of these with the main staple. Do not tell mother the foods she cannot
get or afford
Prevention