Untangling the web of malnutrition

Carly Hayes (University of Waterloo)

Malnutrition is a problem that spans multiple sectors: social, biological, environmental, and economic, just to name a few. What we have learned from interviews with community members, photos taken by school-aged children, speaking with experts, spending time with our family partners and gathering data from ministries, is that all of the causes are inherently connected and cannot be disentangled from the complex web of malnutrition.

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This pictures show the preparation of K’ispiño.  A typical dish made with alpaca blood, moraya flour, cilantro and salt. The meal was served with potatoes and uchucuta.

Malnutrition is the state of lacking adequate access to necessary macro and micronutrients in the daily diet that are required for the biological and cellular processes our bodies use to function. But malnutrition also encompasses a number of other factors, including sanitation, education, social structures, and culture. My colleague Kennedy recently wrote an article about it, and you can access it here.

The Peruvian government has sought to remedy malnutrition in the same way that it is structured – by providing programs that are multi-sectoral and address multiple problems. Through QaliWarma, the government has endeavoured to improve school attendance rates by providing school meals. Through CunaMas, mothers receive education on early childhood stimulation to improve cognitive development. In Chispitas, targeted families receive supplementation to combat anaemia in children aged from 6 to 36 months old. And finally, in Juntos, a cash transfer program, the Peruvian government has incentivized health care access and school attendance by providing conditional cash transfers of 100 soles per month.

While the Peruvian government has been praised for commitment and multi-sectoral approach to reducing malnutrition by the World Bank, this data masks regional inequalities. Last week we had an interview with the doctor of Lares Health Center (Lares was the poorest district in Peru until 2013), a centre who is in charge of 11 different communities. Cuncani is part of these communities, which are all between 40 minutes and five hours away from Lares. What came to light through this conversation is that despite this dedication to improving overall welfare, malnutrition has gotten worse in a number of ways. The statistics from this year, that were released few days ago, indicate that 37% of the children are malnourished, 22% more than a year ago.

Why is this happening? While we are still trying to answer this question, one possible answer is that no program exists to combat malnutrition, in its multiple forms, as an end goal in itself. These programs are often coupled with goals about achieving universal education, improving healthcare access, and increasing household incomes. Without a program to address malnutrition directly, the complexity of this problem gets lost among a number of other worthwhile goals. And without a direct focus on eliminating malnutrition in the most vulnerable communities, the malnutrition web will only become more tangled.

After finishing with this research, we will continue to improve our efforts and keep working on local solutions for local problems. With our work with the Lares Health Centre, and into the future, we are hoping to reinforce monitoring and evaluation efforts in order to prove that malnutrition and poverty can only be finished when reality, culture, and complexity are taken into account. We hope that the new government of Peru knows this and will take action with this in mind.

+3.5 m….2017


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[Versión en Español / English Version]

¡Sólo tenemos 3.5 meses más, antes de empezar el 2017! Como es usual, aún tenemos pendientes varias metas que queremos cumplir, actividades que realizar y MUCHO, MUCHO por aprender. Como les hemos contado antes, hemos dedicado el 2016 a aprender sobre desnutrición en los Andes, específicamente en Cuncani. 

Nos encontramos en la última etapa de nuestra investigación y antes que la terminemos, estaremos publicando artículos sobre  lo que estamos aprendiendo, los retos que encontramos y todo lo que estamos planeando para los siguientes años.

Esperamos que puedan disfrutar de nuestras publicaciones y acompañarnos en este proceso. Nos ENCANTA seguir aprendiendo para así, realizar un mejor trabajo y hacerlo de una manera más eficiente con nuestros socios en la comunidad.


We just have 3.5 more months before we start 2017! As usual, there are still so many goals to accomplish, activities to do and LOTS AND LOTS of things to learn! As we have told you before, we have dedicated 2016 to learn about malnutrition in the Andes, specifically in Cuncani.

We are in the last phase of our research and before we finish it, we will be posting different articles about all we are learning, the challenges we encounter and all we are planning for the future.

We hope you enjoy our posts and join us in this process! We LOVE to keep learning in order for us to do better work and work with our community partners in a more efficient way.


Malnutrition Facts

Kennedy Clark, Purdue University

(NC Intern)

To many people, malnutrition presents itself as an image of emaciated children with protruding bellies. However, malnutrition has many realities besides this one. It also includes the growing population of children suffering from obesity in western regions, and children in the Andes, who seem otherwise healthy, but are a bit short in nature. Malnutrition, to put it simply, is a deficiency of nutrients. This can be a deficiency of macronutrients such as carbohydrates, protein, or fats; or a deficiency of micronutrients which are vitamins and minerals such as vitamin A, iron, zinc, and iodine. In either situation, this deficiency can have devastating and sometimes lasting consequences for those affected.

Malnutrition mainly stems from issues falling under one of the two categories or primary and secondary malnutrition. Insufficient intake, for example, is considered primary malnutrition, in which adequate nutrients are not actually provided in the diet. On the other hand, diseases, such as diarrheal conditions, are an example of secondary malnutrition in which, though adequate nutrients may be provided in the diet, the body cannot correctly absorb them.

Malnutrition is extremely threatening to the body’s ability to maintain life. This is because nutrients provide the necessary fuel to drive metabolism, the collection of processes that keep us alive. Metabolism is divided in to two types of processes: catabolism and anabolism. In catabolism, the body breaks down matter in order to obtain energy. In anabolism, energy is consumed in order to synthesize material needed by the cells such as proteins and nucleic acids. Both of these aspects of metabolism involve complex systems of interaction between proteins already present in the body, and external nutrients introduced into the body through the diet. Thus, without adequate nutrients, the body cannot carry out these necessary processes.

Upon consumption, macronutrients are broken down from their more complex states of carbohydrates, lipids, and proteins, to create the small molecules of simple sugar, fatty acids, and amino acids, which serve as fuel or building blocks for various structures in the body. For example, the simple sugar, glucose is the brains sole source of energy. The phospholipid formed from fatty acids, makes up the outermost layer of most human cells, protecting it from being too permeable to outside pathogens. Furthermore, the amino acids come together to make proteins such as cortisol receptors that allow our bodies to react when faced with danger.

Micronutrients play a different, yet equally vital role in the process. They are often key players necessary for carrying out cellular processes. For example, iron serves as an important component in maintaining the structure of heme groups which are part of proteins found in the red blood cells that help with oxygen transport throughout the body. Iodine, another micronutrient, is similarly important in metabolic processes. It plays a role in the processes in the thyroid. Without the presence of iodine, the thyroid cannot produce its hormones, a number of which are responsible for growth and development throughout the body.

Be it insufficient intake of macronutrients, or of micronutrients, malnutrition can prove to be incredibly, and sometimes irreversibly harmful for those suffering from it. Adequate nutrition is essential for our existence, as without it, we do not have the ability to carry out the number of metabolic processes that take place in our bodies as efficiently as possible; and therefore, cannot function to our fullest potential. This is especially important when it comes to discussing developing regions, such as Andean communities like Cuncani. For them, the gravity of the effects of malnutrition is more complicated than it seems. With poor health outcomes in physical and mental development, the community can be set back in their ability to sustain themselves in their development process.