General Nutrition
The diet must be composed of the macronutrients: proteins, carbohydrates, and fats, and the micronutrients: vitamins and minerals in an appropriate composition for balanced energy and optimal micronutrient intake. This can be achieved by consuming a variety of foods, thus assuring food diversity. For simplicity, food items can be divided into ten (table 1). Consumption of at least five of the ten food groups per day is considered as a proxy indicator for the possible intake of an adequate amount of micronutrients. Micronutrient adequacy is a determinant of dietary quality and is associated with dietary diversity. Thus it is recommended that the diet is composed of food items from the ten food groups. Failure to consume an appropriate amount of macro and micronutrients can lead to malnutrition.
Malnutrition is manifested in three forms: i) undernutrition, ii) overnutrition, and iii) micronutrient deficiency. These three forms of malnutrition have been referred to as the triple burden of malnutrition. Like many developing countries Eritrea is struggling against undernutrition and micronutrient deficiency at the same time as obesity and non-communicable diseases caused by over-nutrition are emerging. Thus, Eritrea too is dealing with the triple burden of malnutrition, which is a leading factor in morbidities and moralities due to communicable and non-communicable diseases.
As knowledge in nutrition expands nutrient classification is not just limited to macro (proteins, carbohydrates, and fats) and micro (vitamins and minerals) nutrients. Recent knowledge in nutrition includes the role of flavonoids, polyphenols, anti-inflammatory, anti-carcinogenic, anti anti-oxidants that play important roles in human nutrition. Since most of these groups of dietary components project color, the diversity of the natural color of the food consumed is important. The general recommendation is, therefore, to eat as many fruits and vegetables as possible of different colors. Thus, a simple rule of thumb is that to get as many nutrients as possible, half of the plate should consist of at least five fruits and vegetables of three colors.
For simplicity the pie model, food triangle, and in Eritrea, the Mesob model are developed to convey food recommendations in a simplified manner. The general recommendations for dietary composition are
1. First 1000 days in life
The time from conception until the age of 2 years (the first 1000 days in human life) plays a decisive role in a child's physical and mental development. Most of the 1000 days encompass pregnancy, and lactating; during which women are vulnerable to micronutrient deficiency as a result of increased physiological demand. Considering that the nutritional status of pregnant and lactating women affects the unborn and bread-fed child, women of reproductive age, adolescents and children during the first two years are important targets for effective nutrition intervention.
2. Intergenerational malnutrition
Malnutrition can affect future generations since a malnourished mother gives birth to a malnourished child, the low-birth infant will grow to be a malnourished adolescent and consequently, a malnourished pregnant giving birth to a malnourished infant thus completing an intergenerational vicious cycle of malnutrition. This vicious cycle of malnourishment can only be broken through well-designed sustainable intervention during the first 1000 days.
3. Causes of malnutrition
The causes of malnutrition can be classed as Root/Basic, underlying, and immediate causes of malnutrition.
The root causes of malnutrition are the main issues that affect the nutrition environment at the policy level. Basic causes involve social cultural, and political contexts, examples of such causes include inadequate resources: such as land, technology, infrastructure, and employment; financial deficiency: due to human physical, intellectual, and social capital shortage; and lack of or inadequate nutrition policy.
The underlying causes include household food insecurity, inadequate feeding practices, unhealthy household environment, and inadequate health services.
While the immediate causes are mostly at the personal level including inadequate dietary intake and or health conditions affecting food intake.
4. Interventions to improve nutrition
Nutrition programs should be evidence-based and multi-sectorial with a holistic approach mentality for effective and efficient interventions. The synergy between and within stockholders, through situation analysis to identify the causes at different levels and plan interventions according is curtail for meaningful impact on nutrition.
5. Reasons to why most interventions fail
Shortfalls such as failure to implement nutrition strategic plans, planned nutrition interventions and failure to follow and critically validate completed interventions, not up-scaling pilot projects that are rated to be effective and efficient, partnerships that cannot be sustained due to due to private and personal aspirations that are not inline with the expected nutrition impact for example aspirations to achieve or keep social prestige, lack of competence are some of the reasons why most interventions fail.