There is a popular theory behind the cause of global malnutrition, one that removes the burden of blame from lack of supply and drops it at the feet of behavior.
There is plenty of food in the world, the theory goes, even in areas where starvation and under-nutrition are everyday concerns; but it is poor parenting and feeding practices that allow the crisis to thrive, some say.
But Dr. Buddhima Lokuge, a medical practitioner with MSF/Doctors Without Borders in New York and the U.S. manager of the organization's Access to Essential Medicines Campaign, has been in the trenches of malnutrition devastation. He's seen what works and what doesn't, and he knows certainly that it is not a parenting issue.
"The real issues are food quality and the logistics of getting the right food to the right people at the right stages of their lives," Dr. Lokuge said in a lecture to Weill Cornell students on Feb. 10. His presentation "Starved for Attention: The Neglected Crisis of Childhood Malnutrition" elucidated the root causes of this epidemic and the role medical students could play in helping to fight it.
Under-nutrition is responsible for the deaths of 3.5 million to 5 million children under the age of 5 each year. There are as many as 178 million stunted children in the world at any given time.
"It is a political failure and a failure at many levels to allow a child to fall into malnutrition," Dr. Lokuge said. "At this stage, there is very little being done to address this crisis."
In India, for example, there has been double-digit growth of that country's economy, yet it is also home to the largest number of malnourished children in the world.
A possible reason behind the lack of attention paid to malnutrition and its effects, Dr. Lokuge said, is that rather than fatal starvation, the true effect of the crisis is the development of other serious health afflictions. Children that grow up without essential nutrients and sufficient diversity of diet are especially susceptible to developmental disorders and fatal diseases.
That is why Dr. Lokuge finds it particularly frustrating to hear the claim that there is no food shortage. While there may be plenty of rice to feed a child, the nutrients available in rice or other single staple foods are hardly sufficient to develop into a normal, healthy adult.
"A poorly nourished child becomes a stunted child who becomes a stunted mother who gives birth to another stunted child," Dr. Lokuge said.
Even if children are given the nutrients they need to develop properly, specifically type 2 nutrients like nitrogen, essential amino acids, sodium, potassium, zinc and magnesium, they must also be administered at the proper time. Dr. Lokuge said that after a child has reached 24 months, the developmental and immunological effects of malnutrition are largely irreversible.
In 2007, MSF provided 60,000 Nigerian children with a milk-based supplement to improve complementary diets during the lean season pre-harvest and saw a significant reduction in the seasonal severe malnutrition that occurs during those months.
Unfortunately, there is a reluctance to see the important role that food based strategies must play a role in the worst affected areas. They deny there is a malnutrition problem and instead focus on teaching better care practices like breast-feeding, an important component to battling the crisis, but hardly a cure-all.
An entire paradigm shift is needed, Dr. Lokuge said, and academic centers and researchers can play a role in that transformation.
"Malnutrition is an issue that is chronically under-addressed both in medical schools and in general, so it is wonderful to see so many students interested in learning more about this important issue from physicians like Dr. Lokuge," said Marilyn Michelow, '12, who helped organize the lecture. "He gave us a model for how to combine interests in medicine and global health."