For the Love of Neighbor

Catholics held a Day of Action for Migrant Children on Wednesday.  We wrote prayers for the children on strips of fabric and tied them to a metal fence representing the cages that kids are being kept in at the immigrant detention centers. Jean Stokan from the Sisters of Mercy spoke about the hypocrisy of the U.S. government, funding and fueling so much of the violence outbreaking in Central America, meanwhile we won’t even let migrants escaping the violence to find refuge in the U.S. without putting them in cages, without proper hygiene, food or water, and keeping them separated from their parents.  “Child detention is illegal under international law and causes serious mental, physical, and emotional health complications.”

The American Academy of Pediatrics and many other public health organizations have declared the policies towards immigrants a public health crisis. Immigrant policing has been found to negatively impact trust of government health information including vaccination of children.  The children are experiencing psychological trauma and may experience long-term mental health effects due to the detention and separation.  “The experiences may also exacerbate prior exposure to traumas in the home country (eg, violence) and during migration (eg, extortion).”  The children are not getting appropriate medical care; are forced to be in situations of poor sanitation and living conditions, and sit through long detention periods without the stimulation necessary to promote healthy child development. AAP past-president, Dr. Colleen Kraft, said “Separating parents from their kids at the border contradicts everything we know about children's welfare.”   

Indeed, any human rights crisis is a public health crisis, when people are not provided with the means by which they need to live dignified lives with nourishing food, clean water, clean air, shelter, clothing, bodily autonomy, and anything else they need to maintain hygiene and safety. 

Meanwhile, the public health community is also fighting for Child Nutrition Reauthorization, and ensuring the future of school wellness in New York State.  Almost 90% of school districts in New York State are missing at least one element of a comprehensive school wellness policy, as measured by the WELLSAT tool from the Rudd Center for Food Policy and Obesity.  New York City school wellness advocates are trying to tackle support for school wellness, better school food and nutrition education at the city, state, and federal levels right now.   At the state level through the WELL Campaign, we want to see a model state school wellness policy that incorporates mental health and social and emotional learning alongside standards for school food, nutrition education, physical activity and physical education.   

And yet, the battle against inhumane immigration policies towards children seems totally disconnected from the battle for child health and well-being in schools.  Why can’t we see these efforts for the dignity & well-being of children as all connected, and work on them together?  Surely the faith community knows that public health advocates working on child nutrition also don’t want to see kids in cages, right?

Perhaps you think that nutrition education is not as important as immigration policies and ending child detention. (I for one have not seen many Catholic organizations promoting nutrition education, with exceptions including Altagracia Faith & Justice works in Northern Manhattan and the Mercy Center in the South Bronx - organizations serving immigrant communities while also protesting the root causes that cause people to have to flee their countries in the first place.) 

We cannot forget that everything is connected.  The Amazon and other rainforest areas are being destroyed to clear land for cattle that is used to produce fast food, palm trees to create an unhealthy oil which is used as a stabilizer for processed foods, and other consumer products such as paper, furniture and clothing which our consumeristic society is so dependent on.  If we do not each take a serious look at our lifestyles and examine how they are contributing to the destruction of human livelihoods and lives, and teach children to do the same, we will continue to perpetuate the crises in front of us. We live in an interconnected world and all our actions have consequences. We are called to co-create with our Creator, not destroy.  Youth are striking for the climate, some every Friday through the Fridays for Future movement, and some are just gearing up specifically for September 20.  

There are ways these youth can take action in their own schools though; we need to be proactive in our actions, not just resistant.  The Tisch Center for Food, Education and Policy at Teachers College, Columbia University has created a handout about what youth can do to demand more sustainability solutions in their schools. This could take the form of starting a school garden, participating in Meatless Mondays, campaigning for a Green Team, advocating for food and nutrition education, or decreasing food waste from school lunch. 

At the end of a “Climate Emergency and the Green New Deal” event at Riverside Church, a Fridays for Future climate strike march video was played with a backdrop of music from the song Bella Ciao which was used to protest the Nazis (re-written with lyrics to protest climate change), followed by the audience singing along. This was a chilling reminder of the connection between genocide and environmental destruction, which is all too close to home in the United States, with the founding of this country being at the expense of so many Native American lives, and too timely, with the killing of indigenous peoples in the Amazon and in other rainforests where the native peoples rely on the rainforests for their livelihoods.  

I have been encouraged to see youth leadership in promoting peace and living in harmony with creation, such as the Interfaith Youth Forum for Environment & Peace organized by JPIC Franciscans Africa.  However, the work of JPIC Franciscans Africa and the work of many other religious groups across the world are doing to promote this harmony is deeply underfunded.  For now, I have created a Go Fund Me page for JPIC Franciscans Africa, with hope and prayers that sufficient funds can be raised by the time of their 2019 youth forum which will be held during the Global Climate Strike on 20 September and World Peace Day on 21 September. The report about my trip to Kenya for the Laudato Si Generation conference, which I wrote about recently, has been translated into Spanish, French and Italian by the International Council of the Secular Franciscan Order.   

Recognizing the divide and silos between the public health community and faith-rooted social justice advocates, who seem to rarely work together for the same causes, several colleagues and I have decided to start the Interfaith Public Health Network, which seeks to engage and mobilize faith communities to improve population health, by addressing the underlying determinants of health (social, commercial, environmental, and political) through connecting, convening, cultivating, and catalyzing.  We want to bring the voices of healthcare advocates and the faith community together to advocate for things such as reduced emissions which lead to child asthma, promote agroecology projects and appreciation of plant-based meals which support the health of environment and people, support mental health services for people in need, and improve gun violence prevention measures.  

During a visit to New York by Olivier van Beeman from the Netherlands, author of the book “Heineken in Africa” the Interfaith Public Health Network organized an event with Olivier van Beeman along with Minister Onleilove Alston and Dr. Nicholas Freudenberg at the CUNY School of Public Health. We brought together the faith and public health communities to learn about the insidious practices of a multinational corporation that takes advantage of government tax loopholes in order to make its profits at the expense of the African community.  Some governments are even intertwined with the company, such as in Burundi.  This is the type of issue the Interfaith Public Health Network wants to raise awareness about: as Minister Onleilove Alston pointed out, in her religious tradition, it’s not a sin to drink, but it’s a sin to commit injustice.  And these injustices, involving government collusion with multinational companies, is what’s contributing to poverty, violence, despair and migration of our neighbors in many countries throughout the world, our common home. 

Food Security and HIV/AIDS in Kenya

Ellen Gustafson, the co-founder of FEED Projects, launched the "30 Project" on TEDxEast this past Friday. In light of reading the statistics on the new 30 Project website (namely, "The U.S. now spends 20 times more on food aid to Africa than it does helping Africans develop ways to feed themselves," I've decided to post a paper I wrote last semester for my International Nutrition class (where Ellen actually was a guest lecturer). Ellen is a fantastic speaker, but more on that later. For now here's my paper.

Food Security and HIV/AIDS in Kenya (by Kelly Moltzen)

In Kenya, as well as many other places around the world particularly in sub-Saharan Africa, human immunodeficiency virus (HIV) is still a huge epidemiological issue despite access to antiretroviral medications. One of the reasons for the high rates of HIV in Kenya is because people do not have access to adequate food, thereby compounding the effects of the disease on the immune system. Rates of food insecurity in Kenya are very high, particularly in rural areas.[1] There are many contributing factors to the problem of food insecurity, not excluding political corruption, which led the World Bank and the IMF to delay giving loans to the government in 2006.[2] In addition, Kenya suffers from severe droughts which reduce agricultural output, and low investment in the country’s economic growth.² There is still no funding specifically dedicated to food security for the HIV population.¹

In any country in which it occurs, the coexistence of HIV, poverty, and food insecurity has devastating impacts on people’s health.¹ HIV worsens nutritional status, further leading to the decline in health of people living with HIV/AIDS (PLWHA).[3] When HIV-infected people do not receive sufficient food to nourish them and help them recover, this leads to the perpetuation of the disease and increased numbers of PLWHA.[4] This happens through several mechanisms, occurring through biological as well as social and economic pathways.⁴ HIV can be transmitted horizontally when food insecure women – who are responsible for the health of their families – engage in transactional sex to make money to buy food for their families. It can also be transmitted vertically, as pregnant malnourished women with HIV have a greater chance of transmitting the disease to an unborn infant than well-nourished pregnant women. In particular, factors associated with higher mother-to-child transmission are low iron and Vitamin A stores, low BMI, and maternal weight loss.⁴

Food insecurity also impacts access to treatment and care services.⁴ While the Kenyan Ministry of Health has worked with Doctors Without Borders to provide free access to ARV treatments in the Nairobi slums of Kibera, a considerable number of eligible individuals have not accepted the offer for medications.[5] Oftentimes, even when receiving free ARV medications, parents need to choose between paying for transportation to attend health care appointments, and using the money to adequately feed themselves and their children.⁴ This problem seems like it would be even larger in rural areas than urban areas, where traveling is less convenient. Also, in the study of Kibera, one of the main reasons for not accepting the offer for medications was because of a fear of taking the medication on an empty stomach.⁵

Lack of food has shown to negatively impact the efficacy of antiretroviral (ARV) medications. Food insecurity has been associated with a decrease in the effectiveness of protease-inhibitor based regimens, and specifically a 30% decrease in drug plasma concentrations.⁴ Very high viral loads have been found among those receiving highly active antiretroviral treatment (HAART).⁴ Taking ARV regimens with food has been shown to increase the bioavailability of medications by as much as 700%.⁴ The ability of the human body to suppress the virus has shown to be 70% lower in people reporting food insecurity, even after levels of adherence to the medication regimen were taken into account.⁴ Thus, it is of paramount importance that patients receive adequate nutrition, if there is any chance of halting the spread of HIV in sub-Saharan Africa and elsewhere.

HIV prevalence in Kenya is more concentrated in the west of the country⁶ and where there are higher poverty rates, small plots of land, and poor soil quality.¹ There are over 1.5 million people in Kenya currently living with HIV, and there are approximately 100,000 deaths from AIDS per year in this country.[6] Up to 700 people reportedly die on a daily basis in Kenya from infections related to their HIV status.[7] One study found that PLWHA were more likely to be malnourished than people whose status was not established.⁷

The study found that the majority of foods eaten by PLWHA were low in nutrients that help build up the immune system and maintain adequate weight, and that there was not a lot of variety in the foods consumed.⁷ High protein foods such as meats and legumes were found to be consumed by less than a quarter of the sampled households.⁷ Interestingly, those surveyed showed a lack of nutrition knowledge in terms of which foods were appropriate for PLWHA to eat to support a healthy immune system.⁷ This is likely related to the literacy rates, as many people cannot understand educational brochures which are handed out if they are illiterate. The literacy rates in Kenya are approximately 80% for females and 90% for males, as estimated in 2003.²

Additionally, there are high numbers of widows, orphans, and falling school attendance rates in Kenya.¹ Many children must care for their ailing parents who have HIV/AIDS, and this adversely affects their ability to participate fully in obtaining their education. Mishra et al found that “orphans, fostered children, and children of HIV–infected parents are significantly less likely to attend school than non–orphaned/non-fostered children of HIV–negative parents.”[8]

The Academic Model Providing Access to Healthcare (AMPATH) identified over 67,000 individuals from 17 clinics in Kenya as food insecure in 2007, which amounts to 33.5% of the total number of people assessed.¹ AMPATH began as a collaboration between a consortium of universities in Indiana and the Moi Teaching and Referral Hospital and Moi University School of Medicine. When the extent of the problem of HIV and food insecurity was realized, AMPATH established partnerships with the World Health Organization’s World Food Program (WFP) and the United States Agency for International Development (USAID), and began producing food on farms in Kenya to complement food donations.¹

Essentially, these international aid organizations are working with clinical staff and community groups to provide resources and support to HIV patients and their families. Nutritionists assess all patients in the AMPATH clinics with the Household Food Insecurity Access Scale used by USAID.¹ The nutritionists were given criteria to use to decide who would qualify for the program, which included meeting one or more of the following: “a) having insufficient access to food to support patient recovery; b) Body Mass Index (BMI) below 19; c) Household income less than 3,000 Ksh per month; d) CD4 count less than 200.”³ In general, however, the nutritionists subjectively decide eligibility status, giving food insecurity the most weight.³ Those who qualify for the program are provided 6 months of nutrition support, as this is the amount of time thought necessary to recover and be able to carry out activities of daily living; however, there is some flexibility in the length of time a patient could receive the food support.^1,3

The amount of food allotted to patients is determined based on the number of people in the household.^1,3 Monthly follow-ups are used so that patients renew their “food prescription” on a regular basis¹; patients are also weighed and receive nutrition counseling during these monthly follow-ups.³ Patients are enrolled either through the WFP or through the “HAART and Harvest Initiative” (HHI), and fill their food prescriptions at distribution sites on a regular basis, depending on how far the site is from their residence.³ When patients are weaned off food support, they are enrolled in the “Family Preservation Initiative” which provides education on income generating activities or food production.^1,3 They could also choose to attend patient-led support group meetings.³

To provide necessary food to the patients, a combination of production, purchase, and donation of food is used; as stated, food production is “a key component of the AMPATH nutrition program.” ¹ Six farms were started, 4 of which are used for high production of food (3 rural, 1 urban), and two of which are used for educating patients on how to increase the yield of small plots they may own.^1,3 A continuous source of water is provided, which allows the farms to produce a year-round supply of fresh vegetables.¹ Over 20 tons of vegetables are produced per month, and an expected 4 tons of fruits are also expected to be produced as the farms become more productive.¹

In addition to food production, the WFP provides food donations of legumes, corn, corn-soy blends, and cooking oil, for up to 30,000 recipients and 1500 orphans and vulnerable children; an additional 2,000 people receive corn-soy blends from USAID. AMPATH also coordinates the distribution of eggs and milk which are produced by patients within the program,¹ as well as local and exotic herbs.³

Industrial engineers from Purdue University worked with AMPATH to design a computerized nutritional information system that could be used to coordinate the distribution of food to patients throughout western Kenya. The foods available, as well as patients needing that food, are entered into the system, which then helps coordinate who will pick up, transport, and deliver the food to the proper places. Altogether, food and fixed costs of the program cost $0.27 per patient per day. ¹

The AMPATH model and collaboration with the WFP and USAID provides a remarkable opportunity to improve the nutritional status of Kenyans, especially those living with HIV/AIDS. It uses an academic partnership, teaches native Kenyans how to farm the land and uses the crops they produce as part of the food support package given to the HIV/AIDS patients and their families. It also provides the patients with nutrition education, and an opportunity to learn skills on income-generating activities through the Family Preservation Initiative.

However, as noted by Mamlin et al, the current system still relies heavily on food donations and is unsustainable in the long run.¹ It is necessary to teach more Kenyans how to till the land and increase the number of farms and gardens producing crops. There should be more diversity of crops grown on these farms, as this would help not only decrease dependence on foreign food aid, but also to improve the nutritional status of Kenyans – both PLWHA and those currently without the disease. By improving the nutrition of all Kenyans, this will strengthen people’s immune systems and make them less susceptible to acquiring and transmitting HIV to others.

Currently the country is still receiving a significant amount of corn-soy blend through the WFP and USAID. ¹ Alternatively, people could learn to grow a variety of crops that are diverse, have a high nutrient density, and are native to the land in Africa, such as amaranth, millet and sorghum[9]. Research is beginning to show a tendency towards increased food security in Kenya when traditional crops are grown.[10] In rural areas, people should be provided with support needed to start new farms with a variety of crops. This can provide a source of nutrition as well as become an income-generating activity if a sufficient number of crops are grown. If these farms aim to produce large numbers of crops on a scale which could feed the nation of Kenya (either directly or through increased trade), it may be necessary to invest in resources to help farmers cope with the effects of climate change. Climate change has a greater negative impact on developing countries such as those in Africa, and has led to droughts and desertification across the continent. Work should be done to expand Navdana, the program Dr. Vandana Shiva has started in India which is a women-centered movement focused on biodiversity and food sovereignty in the face of climate change.[11]

On a smaller scale, in both rural and urban areas, gardens can be built alongside hospitals to provide patients with both nutritious food and the educational and physical exercise of harvesting the crops. In urban areas, support should be provided to allow people to start their own gardens at home.

There are already non-profit organizations helping to start these types of gardens to support PLWHA in Kenya, such as Development in Gardening (DIG)[12]. DIG has a partnership with USAID, so this relationship should be fostered further in order to provide more individuals with the opportunity to garden.

For the multitude of reasons outlined above, ensuring the food security of HIV/AIDS patients and their families is critical in improving the health of the patients and helping to limit the spread of HIV. This should be done by training Kenyans to increase the food productivity of their land in a sustainable manner.

References

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[1] Mamlin J, Kimaiyo S, Lewis S, et al. Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya. American Journal of Public Health. 2009;99(2):215-221.

[2] The World Factbook. Kenya. Central Intelligence Agency. https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html. Accessed December 14, 2009.

[3] Byron E, Gillespie S, Nangami M. Integrating nutrition security with treatment of people living with HIV: lessons from Kenya. Food Nutr Bull. 2008; 29:87–97. http://programs.ifpri.org/renewal/pdf/KenyaAMPATH.pdf. Accessed December 14, 2009.

[4] Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD. Food Insecurity and HIV/AIDS: Current Knowledge, Gaps, and Research Priorities. Current HIV/AIDS Reports 2009;6:224–231.

[5] Unge C, Johansson A, Zachariah R, et al. Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. AIDS Care 2008, 20:146–149.

[6] Kenya. Epidemiological Country Profile on HIV/AIDS. WHO. 2008. http://apps.who.int/globalatlas/predefinedReports/EFS2008/short/EFSCountryProfiles2008_KE.pdf. Accessed December 14, 2009.

[7] Kuria, EN. Food consumption and nutritional status of people living with HIV/AIDS (PLWHA): a case of Thika and Bungoma Districts, Kenya. Public Health Nutrition. 15 June 2009; 1-5. Published online: doi:10.1017/S1368980009990826.

[8] Mishra V, Arnold F, Otieno F, Cross A, Hong R. Education and Nutritional Status of Orphans and Children of HIV-Infected Parents in Kenya. AIDS Education and Prevention. 2007;19(5):383–395.

[9] Board on Science and Technology for International Development. The Lost Crops of Africa. Volume I: Grains. National Research Council. Washington, D.C.: National Academy Press; 1996.

[10] Figueroa Gomez de Salazar B, Tittonell P, Ohiokpehai O, Giller K. The Contribution of Traditional Vegetables to Household Food Security in Two Communities of Vihiga and Migori Districts, Kenya. Wageningen University. 2008. http://www.icuc-iwmi.org/Symposium2008/Theme%201/T1.3-Blanca%20Figuero.pdf. Accessed December 14, 2009.

[11] Navdana. Available at: http://navdanya.org/. Accessed December 14, 2009.

[12] Development in Gardening. Available at: http://www.developmentingardening.org/ . Accessed December 14, 2009.

The End of Poverty?

The End Of Poverty? from Philippe Diaz on Vimeo.

This Saturday I went to Radical Living for a New York Faith & Justice house gathering/film screening to watch The End of Poverty? This film doesn't just give us the sobering statistics about global poverty, but also tells us how economic disparities came about and many ideas for what needs to be done to fix the situation. I won't bore you with too many statistics, but just some overall things to think about. Poverty as the world knows it today comes from structural injustices that allow big, multinational corporations to exert an unfair influence on developing countries. As the film points out the Global South is actually financing the North "to the tune of about $200 billion every year." Crops and resources are grown and taken from developing countries (the growers being paid way under the cost of production for these goods), brought to developed countries like the US for processing, and then shipped back out to other countries. When the product gets back to developing countries that import goods from the US, it is still cheaper to buy than from growers who try to make a living off of selling crops directly to their countrymen. This is exactly what had led to developing countries becoming dependent on imports from places like the US, and is exactly what happened in Haiti with the rice crop (here's a video).

Why don't governments say no to these trade agreements? I've heard from several people who have worked and lived in Africa that there is no government accountability and regulations are not enforced. However, as I learned today representatives from large multinational corporations (of course, Monsanto comes to mind) insidiously make deals with politicians, promising them money and threatening them to not carry out their campaign platforms. This leads to poor accountability for everyone in the country and lets the big corporations privatize and monopolize the country and its resources.

Additionally, as pointed out in the film, many agricultural practices today are the same as slavery used to be – except today, the workers haven't rebelled, and their employers aren't responsible for them. "Back then, the boss was the slave's owner. He had to take care of the slave's health and food. He had to take care of shelter, even if it was the slave's quarters. Today the boss has no such concerns."

The End of Poverty? focused a lot on the history of colonialism and capitalism as a central cause of poverty, and explains how in order to have wealth in capitalist societies, we have to create poverty in the south. "There is no other way." And unfortunately in the past 25 years or so economic disparities have been getting wider. Not only that, but the countries with the biggest income disparities are also the ones with the highest rates of violence. We do not see this violence in the poorest of the poor countries.

The existence of the poor, underserved workers means that we can buy products for 10% of the cost of production – an issue which has far-reaching implications for the health of consumers and the environment. We are currently using 30% more than what the earth can regenerate; in order for everyone to live like we do in America, we would need six planets; while if everyone were living like people in Burkina Faso, we would only need 1/10 of the planet. As an example of what goes on with the food industry in America, watch The True Cost of Food.

Some other discussion which came about from watching the film included a discussion about the term "developing." Did the film glorify indigenous peoples? I thought this was similar to Avatar. How much should we really be encouraging "developing" countries to become more industrialized? What third world countries need is a means to have their needs met: clean water, public health measures, adaptation to climate change, and ownership of land so they can grow food for themselves. Yes, some countries need roads and education and sustainable technology, but we need to make sure we don't push the development of industrialization in the same way the "developed" countries of the Global North came about. Poor use of resources is exactly what has led to the social injustices and climate change issues we worry about today. Perhaps we need a new term to clarify meeting the needs of poor countries. And of course, these needs need to be identified by the community in question. Telling people what they need without understanding their situation doesn't help anyone and is disrespectful.

With that said, there are some changes to be made which can indeed help bring many people out of poverty. Some solutions for ending poverty pointed out in the film (listed out clearly in a space where you can sign a petition to mobilize support for change) include ending the monopoly over natural resources and at least 51% local communal ownership in corporations, redistribution of land to farmers, a cap on exports, a worldwide subsidy for organic agriculture, and cancellation of third world debt (such as that vowed by the G7 in cancelling Haiti's debt). Others include ending child labor under the age of 16 with a creation of a subsidy for scholarship, getting rid of the tax on basic consumption and labor and instead having a 2% worldwide tax on property ownership (except basic habitation for the poor), ensuring an equal voting system in international organizations such as IMF, World Bank, WTO, and of course a commitment by industrialized countries to decrease carbon emission by 50% over a ten-year period.

How can this all be funded? I vote for everyone chipping in to the first non-for-profit global lottery dedicated to sustainability – multinational corporations included.

I also vote for new accountability for multinational corporations – such as limiting the reach of Monsanto, the global fishing industry (which has overstepped its boundaries so much that many of the world's fish are in danger of extinction – no more fish by 2048), fast food and junk food companies (which have already contributed to the nutrition transition – obesity occurring in the hungry even in third world countries), and infant formula companies (the last thing third world countries need is to be told their breastmilk isn't good enough. Breastmilk has so many more benefits than infant formula it's unbelievable. In Ghana they have a saying that goes something like "bottle fed babies are stupid, breastfed babies are smart." Instead money could be given to mothers so they can grow and buy food for themselves – the only reason breastfed infants would be malnourished is because the mother is malnourished. And money could be given to mothers in the form of conditional cash transfers which would ensure children were educated and kept healthy, in exchange for money for food).

charity:water in NY Times!

I am very happy to see international traveler and global health writer Nicholas Kristof has written an article about charity:water in the Sunday edition of the NY Times! I first heard about charity:water last year right before my birthday, when the Facebook Causes application asked me to fundraise by having family and friends donate $22 for my 22nd birthday, as charity:water's founder Scott Harrison had donors give $33 for his 33rd birthday. This organization is partnering with non-profits in developing countries to build wells with hand-pumps for thousands of communities in Haiti, Honduras, India, and many African countries. You can get involved with volunteering for charity:water by emailing nicky.yates@charitywater.org.

You can learn a lot more about Kristof's topics by reading the comments people post about his articles on his blog. In reading the comments on his charity:water article, I found articles and research on whether or not water projects in developing countries are sustainable, by the International Institute for Environment and Development and the World Bank (Comment 7) (lesson: don't abandon the wells after building them!). I also found people from other countries who would like to partner with charity:water (Comments 10, 15, 18) and information about a dangerous plan in place regarding the NYS Watershed and the Delaware River Basin Commission (Comment 13).

I really liked Comment 14, about how Mr. Kristof breezes right over the fact that it was the spiritual crisis Scott Harrison underwent and how he became a follower of Christ after his time volunteering with Mercy Ships. Also Comment 11, criticizing Nick Kristof for paying too much attention to the act of giving, and not highlighting the fact that self-sacrifice is what's important. Sacrificing one's time for others, and building community, so that the people you are helping are actually being empowered to make changes for themselves, not simply enabled by being given handouts.

Or put another way, having the moral courage to stand up for what's right, every day of your life. I've posted three comments on Irshad Manji's Moral Courage Project webpage so far, explaining how to stand up for our fellow global citizens and how to get others motivated, too. We can't expect to partake in activities once and that solve all the problems in the world. We need to keep at it, and dedicate our entire lives to the causes, making sure to follow up with those we help and not abandon them. There are plenty of people already taking up this cross, as Shane Claiborne shows with his movie "The Ordinary Radicals." We can do it too, and social media can help. Scott Harrison's successful marketing campaign demonstrates the power of social networking; I think this can be taken a step further if teachers would think outside the box, and incorporate blogs, twitter, and Facebook into everyday homework assignments. More and more non-profit organizations are creating these social networking accounts, and the sky's the limit with the charitable organizations one can find out about and get involved in, merely by spending some time on the Internet. Let's wake up and use the tools God has given us to use here in the 21st century.

Kelly Moltzen has invited you to join Kiva!

Hello!

I just made a loan to someone in Nigeria using a revolutionary new website called Kiva (www.kiva.org).

You can go to Kiva's website and lend to someone across the globe who needs a loan for their business - like raising goats, selling vegetables at market or making bricks. Each loan has a picture of the entrepreneur, a description of their business and how they plan to use the loan so you know exactly how your money is being spent - and you get updates letting you know how the entrepreneur is going.

The best part is, when the entrepreneur pays back their loan you get your money back - and Kiva's loans are managed by microfinance institutions on the ground who have a lot of experience doing this, so you can trust that your money is being handled responsibly.

I just made a loan to an entrepreneur named Ogbonna Edith in Nigeria. They still need another $625.00 to complete their loan request of $975.00 (you can loan as little as $25.00!). Help me get this entrepreneur off the ground by clicking on the link below to make a loan to Ogbonna Edith too:

http://www.kiva.org/app.php?page=businesses&action=about&id=115592

It's finally easy to actually do something about poverty - using Kiva I know exactly who my money is loaned to and what they're using it for. And most of all, I know that I'm helping them build a sustainable business that will provide income to feed, clothe, house and educate their family long after my loan is paid back.

Join me in changing the world - one loan at a time.

Thanks!

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What others are saying about www.Kiva.org:

'Revolutionising how donors and lenders in the US are connecting with small entrepreneurs in developing countries.'
-- BBC

'If you've got 25 bucks, a PC and a PayPal account, you've now got the wherewithal to be an international financier.'
-- CNN Money

'Smaller investors can make loans of as little as $25 to specific individual entrepreneurs through a service launched last fall by Kiva.org.'
-- The Wall Street Journal

'An inexpensive feel-good investment opportunity...All loaned funds go directly to the applicants, and most loans are repaid in full.'
-- Entrepreneur Magazine

Check it out!
https://www.kiva.org/app.php?page=register&_isc=f218cb6c-5a0f-11de-911c-dc6669dc15d3&_te=inu

The Home Project

This is by far the most clear, comprehensive, and easily accessible video on the state of our world and the impact that human beings are having on it. It's an hour and a half long; please watch it, and share it with everyone you know - not for my sake, but for your sake, everyone else's that lives on Planet Earth, and future generations. Oh yeah, and the sake of our Planet.

The Home Project

P.S. It's on YouTube, so it's free!

You were blessed with a voice, so use it!

For all the revolutionary things I come across in my experiences, I don’t blog nearly enough – which just makes the posts I do get around to writing that many times more heavy and laden with lots of information. Sorry about that.

It bothers me that all the really fascinating things I learn about – moral courage and social entrepreneurship, Paul Farmer and liberation theology, taking the core of your “religious” beliefs seriously and public service – I learn about outside the classroom, church, and mainstream media. That some of the best public health measures could actually be things like what Scott Harrison is doing with charity:water – gathering support and raising money to install wells in Africa so that people can have easily accessible, clean water. Development in Gardening, which helps people in developing countries start their own gardens so they can improve nutrition for AIDS patients and community members in general. Or Oxfam America, which not only works on international development projects, but also advocates for Congress to put money towards helping women in developing countries adapt to climate change. And the hospital and public health infrastructure Paul Farmer has built in Cange, Haiti, that I am reading about in the book Mountains Beyond Mountains. And then Irshad Manji, professor in the NYU Wagner School of Public Service and Director of the Moral Courage Project, who invited me to a private viewing of The Stoning of Soraya M.

The last time I cried as much as I did while watching The Stoning of Soraya M. was when I watched The Passion of the Christ. Except, it was worse this time, and not because my hands were tied with rope. The Passion…well, most people have heard about the story of Jesus…He died for our sins on a cross, He was ridiculed for calling Himself God. He was a great person. But Soraya was also a great person, and yet she was killed too, for no good reason. Not just by her community, but some of her own family members, as well. Leading up to the event, people in Soraya's community had uneasy feelings about the accusations and following through with the stoning. They knew that there was something wrong with the situation, and yet…the stoning still happened.

This story is about more than “stoning.” It’s not saying that the stoners should be punished, or the Islam faith rejected. Firstoff, the takeaway from tonight’s film screening and discussion is that we need to stand up for things that we find wrong in society, as Zahra did. She is the reason the book was written, and the reason this film exists. She used her moral courage to take advantage of a journalist in town to bring to light a horrible situation, that of suppressed women’s rights and an unconscionable practice that still exists today called stoning. Two thousand years ago, Jesus said “let him who is without sin throw the first stone.” Nobody could throw the stone because nobody was without sin. Too bad people still haven't learned this lesson.

Yet there is a moral fiber that runs through virtually every religion, and Islam is no exception. Irshad Manji has made that clear with her book The Trouble with Islam Today. What happened here (and that I believe has happened with many Catholics and other Christians) is that people strayed from the fundamental truths of their religion. Religion fosters groupthink, which is bad. Belief in God and spirituality should be a personal endeavor. Just as Muslims should know the truth about the Quran, Christians should know that the Nag Hammadi texts exist, and that there are gospels which may be just as valid as the four gospels that made it into the Bible (which only cover the Outer Mysteries).

In Mountains Beyond Mountains (a book that describes the work of Dr. Paul Farmer, who started the non-profit Partners in Health in Haiti and potentially may be in charge of USAID's Foreign Assistance Efforts), there are many memorable quotes by Farmer but one of my favorites is, “You want to talk crucifixion? I’ll show you crucifixion, you bastards.” The way I understand this is, we shouldn’t merely be worshiping Jesus for dying for us. Yeah, that’s great, we can give all our selfish thoughts over to him and know that we don’t have to be damned for eternity. But the main point we should get from Jesus’s life is how to treat others. The stories in the Bible aren’t one-time deals that we should just read over and over again. They are really happening, today and every day of our lives. The destitute – the people of Cange, Haiti, living in poverty and misery – that Paul Farmer found to be of great faith, they are the people we should be looking to help. Women all over the world who are considered to be of lesser importance than men, and innocent, righteous, loving women who are stoned to death for no reason – they are the ones we should be paying attention to. Not just living here in our comfortable lives, going to church every weekend and having fun with friends. How can you live with yourself in good conscience, knowing awful, horrible things are happening to people in this world because people have a skewed view of who God is?

I'd like to leave you with these lyrics, from a Follower-of-Christ perspective:

But if we are the body
Why aren't His arms reaching?
Why aren't His hands healing?
Why aren't His words teaching?
And if we are the body
Why aren't His feet going?
Why is His love not showing them there is a way?
There is a way
-Casting Crowns

"The single greatest cause of atheism in the world today is Christians who acknowledge Jesus with their lips, then walk out the door and deny Him by their lifestyles. That is what an unbelieving world simply finds unbelievable." -DC Talk

Stunting in Uganda

Here's another term paper I just wrote:

Kelly Moltzen
Final Paper
E33.2314: International Health and Development
December 17, 2008

Political, Social, and Economic Contributors to Stunting in Uganda

The prevalence of stunted growth in Eastern Africa due to undernutrition is the highest in the world and has serious implications for maternal and child health (Black et al., 2008). In Uganda, where nearly half (49%) of the population is under the age of 15 (Bachou & Labadarios, 2002), the national average of stunting in children younger than five years old is 32% (UNICEF, 2008). Prevalence of stunting is generally highest for the poorest segments of the population (Black et al., 2008), with this number reaching up to 54% in the war-torn northeastern region of Karamoja (Africa News, 2007a). Stunting is associated with higher mortality and lower cognitive development. It therefore has widespread implications not just for an individual’s development, but also for the development of entire regions (Jilcott, Masso, Ickes, Myhre, & Myhre, 2007). Stunting has been found to be the best predictor of human capital, as “there is compelling evidence that malnourished children are unproductive as adults” (Africa News, 2008). Therefore, the prevention of stunting has the potential to bring about “important health, educational, and economic benefits” (Victora et al., 2008). The underlying causes of maternal and child mortality include poorly resourced health and nutrition services, food insecurity, and inadequate feeding practices, inadequate access to safe water and sanitation (UNICEF, 2008). However, there are even more basic social, economic, and political causes that contribute to the lack of capital necessary to prevent these underlying causes (Black et al., 2008). In Uganda, these include poverty, political unrest, misplaced policy decisions and interventions, and the discrimination and exclusion of mothers and children.

Stunting is defined as height-for-age less than -2 z-scores (Jilcott et al., 2007); the average Ugandan child falls one standard deviation below the international norms (Alderman, 2007). This restriction of a child’s potential growth is evidence of chronic undernutrition, leads to irreversible impairment, is associated with increased risk of death, and could potentially affect future generations. For instance, maternal short stature adversely affects pregnancy outcomes (Black et al., 2008). Research shows that it is much more efficient to prevent chronic undernutrition and its devastating effects than to attempt interventions later on in the lifecourse (Africa News, 2008), as the critical period of development occurs during the first two years of life. However, the Ministry of Health in Uganda has historically focused its childhood nutrition programs on children who are already underweight (Africa News, 2008), a misdirected intervention that has had serious consequences.

Northern Uganda is burdened with great deals of civil strife. Political instability in Uganda is associated with increased contributory factors to malnutrition, poor economic growth, worse health service delivery by government, local, and international agencies, and higher child mortality rates, as compared to times in the country’s history that saw more political stability. In a study of the Bundibugyo District of Uganda, where the stunting rate in children is 44.8%, students ranked last in recent secondary school standardized leaving exams (Jilcott et al., 2007). This rural, marginalized population is still recovering from Allied Democratic Force rebel attacks that occurred in the late 1990’s, during which people had to live in Internally Displaced People (IDP) camps. Malnutrition, malaria, tuberculosis, and sickle cell disease are common among children in Bundibugyo (Jilcott et al., 2007).

Social aspects such as gender inequality play a large role in health and stunting rates in Uganda. In a country where many families already struggle to get a meal on the table, women and children traditionally eat last in the household, after men (Nadakavukaren, 2006). “To reverse the trend of gender inequality, the United Nations Children’s Fund (UNICEF) recommends the empowering of women in politics, arguing this has the potential to change society” (Africa News, 2007c; UNICEF, 2008). UNICEF’s State of the World’s Children 2007 report said “women who have greater influence in decision-making can promote better healthcare practices for the family. Women's participation in household decisions decreases stunting among children and reduces child mortality” (Africa News, 2007c).

The impact of poverty in Uganda is profoundly felt through a lack of funds and resources to buy livestock. “Animal-source foods…are an important component of children’s diets, as a major source of protein and micronutrients” (Black et al., 2008). Yet in Uganda, many families can only afford meat once a year, if that (Tuller, 2007). This excludes them from access to adequate sources of protein and iron in the diet – key nutrients in preventing maternal and child mortality. Low intake of meat, fish, and/or poultry is associated with iron-deficiency anemia in mothers, which is an important contributor to maternal mortality as it increases the risk of dying with blood loss during delivery (Black et al., 2008). Mothers who die while the child is still an infant poses additional risks for newborns, as they no longer have their mothers to breastfeed them. Grandparents, particularly grandmothers, are left to care for 50% of orphans in Uganda (Africa News, 2007c); however, milk production of grandmothers is not nearly as sufficient as would be necessary for the child to thrive. If women were empowered within the household and within the government, they could push for better access to livestock which could drastically improve the nutritional and economic situations of many Ugandans.

The importance of farming and agriculture to nutritional status, as well as the social and economic development of Uganda, cannot be overstated. Farming is a critical aspect of the economy of Uganda; one women professed that “African business is agriculture” (Stuart, 2007). However, the current cropping systems in Uganda are leading to nutritional deficiencies and are also threatened by climate change. Uganda would do well to consider alternative agricultural strategies; over the past few years, the National Academies released a series of books entitled “The Lost Crops of Africa,” which enforces the promise of many crops that are native to Africa, but are not currently widely harvested (The National Academies Press, 2006).

There are currently two main cropping systems in Uganda: a grain-based system in the northern and western regions, and a banana-based one in the central, southern, and eastern regions (McIntyre, Bouldin, Urey, & Kizito, 2001). Since livestock farming is not a large contributor to nutrient intake in Uganda, this leads to low protein intake in the banana farming areas, as the banana-based system has been found to be associated with nutritional deficits of protein in addition to calcium, iron, and zinc. Zinc deficiency is associated with stunting prevalence, and both iron and zinc deficiencies have both been shown to be associated with increased cognitive impairment among children (Black et al., 2008). A different study found that the local variety of bananas is low in iron, iodine, and Vitamin A (Eliot, 2008) – the three micronutrients that are most deficient in Ugandans’ diets (Bachou & Labadarios, 2002).

In addition, diminished crop yields due to seasonal variation and crop infestation compromises the nutritional quality of bananas (Stuart, 2007). Addressing banana stem infestations is one solution, as weevil and nematode infestations in the roots of banana plants lead to a decreased absorbance of vitamins, minerals, and water by the plant (Stuart, 2007). Drought and soil degradation may compound the effects of the diseased stems, leading to lower yields and quality of bananas. Using tissue-cultured banana plants with endophytes (good microbes) reintroduced to the plant at an early stage would help to increase the plant’s natural defenses before it is planted in the field. A sensitization campaign was supposedly started in 2008 to educate Ugandans on the adoption of growing tissue-cultured banana plants – something that has already been started in Kenya (Stuart, 2007). Another potential solution is genetically modified bananas, which have been developed in Australia and are currently undergoing field testing in Uganda (Eliot, 2008).

Strategies have also been proposed to alter the land area’s crop selection. Initiatives which set out to introduce new crops to farmers and broaden the range of crops planted may hold promise in improving the diet quality of Ugandans; the Uganda Bean Program is one such example of success (McIntyre et al., 2001). The Vice President of Uganda discusses the role of maize flour in the diet as contributing to stunting, as its high phytate content contributes to zinc malabsorption, and “zinc deficiency contributes significantly to stunting and impaired cognitive development” (Africa News, 2007b). He offers the suggestion of providing children with more “millet, soya, and sorghum, which are easily available in Uganda” (Africa News, 2007b). The Ugandan government could be instrumental in providing aid to the development and implementation of alternative agricultural strategies, as well as facilitating the distribution of higher nutritional quality food.

Agriculture is inextricably linked with the HIV/AIDS epidemic, as the practice makes available food and nutrition that are of critical importance in fighting the disease (Africa News, 2008; Tuller, 2007). David Tuller, a graduate student from the University of California, San Francisco, spent five months in Uganda investigating whether “food insecurity…undermines the effectiveness of HIV treatment” (Tuller, 2007). Far too often, parents must choose between feeding their children and selling their crops to make the money needed for the “monthly clinic trip for the medication that keeps them alive” – a trip that also means a missed opportunity for gardening or other work (Tuller, 2007). Compounding the issue of food insecurity among people with HIV/AIDS is the issue of power struggles between men and women. Hunger and food insecurity put women at the mercy of their husbands, who will oftentimes demand unprotected sex in exchange for bringing food home (Tuller, 2007). In this way poverty, food insecurity, and gender disparities interact to prolong the HIV epidemic and continue the plight of the disenfranchised.

The government has a role to play in improving food security in urbanized areas as well. Although stunting is twice as prevalent in rural areas as urban ones, people are moving to urban slums in greater numbers, leading to higher rates of stunting in urban areas (Bachou & Labadarios, 2002). Malnutrition in urban areas is a very real issue, but strategies such as urban agriculture could help curb food insecurity. Urban agriculture has traditionally formed an informal safety net for buffering the impact of economic hardship and the cutbacks of urban subsidies and formal safety nets. However, urban farming is currently not endorsed by the government and is actually illegal, despite its positive association with decreased rates of stunting (Maxwell, Levin, & Csete, 1998). Officials of local and national governments do not recognize benefits that urban farming could have on health; they actually consider it a threat to public health and generally overlook or even discourage it (Maxwell et al., 1998). There is plenty of idle land available in cities that could easily be used for urban farming if policymakers recognized its importance in enhancing food security and made the legal framework more conducive to informal livelihood strategies.

Perhaps the most important thing the government could do to increase food security and improve its country’s maternal and child health is to form community partnerships (UNICEF, 2008). Engaging the community in the promotion of its own health is critical to the success of any intervention, as it builds capacity and empowers its members. Governments should engage in intersectoral collaboration and work cooperatively on community, district, and national levels to include all members of a community in policy and decision-making processes, particularly women. By including women in policy and decision-making, this may help change the ethos of gender discrimination and ultimately lead to improved diets and access to healthy environments for women and children. As UNICEF posits, “the ultimate responsibility for ensuring children’s rights to health and nutrition lies with national governments in partnership with civil society” (UNICEF, 2008).

Local authorities, research establishments, and development agencies should “work with the urban poor to understand and develop other urban food and livelihood security strategies” (Maxwell et al., 1998). A key facet of community partnerships involves community growth promotion, or the recruitment of community health workers to bring health education to the communities door-to-door. This may include educating caregivers on the importance of exclusive breastfeeding, health, nutrition, numeracy, and literacy, and improving the capacity of women in a community to recognize malnutrition (Alderman, 2007). Rates of exclusive breastfeeding are declining throughout the world, which is problematic because there is a higher risk of morbidity and mortality from suboptimum breastfeeding (Black et al., 2008). Similarly, “suboptimum complementary feeding is clearly a determinant of stunting” (Black et al., 2008). Infectious diseases, particularly those that result in diarrhea, reduce intestinal absorption of nutrients and thereby are large contributors to stunting (Black et al., 2008). Educating women on these health issues could not only lead to lower stunting rates and improved health outcomes for children, but could also improve capacity, decrease dependence, and even improve the economy.

Farming and community growth promotion are both associated with decreased prevalence of stunting in children. One study found significantly less stunting in children from farming households than children from non-farming households (Maxwell et al., 1998). Also, there are more moderately and severely undernourished children in non-farming households than in farming households among lower socio-economic households (Maxwell et al., 1998). Farming has been proposed as a good female income-generating activity, and allows mothers to spend more time caring for their children (Maxwell et al., 1998). Evidence shows that community growth promotion, including education and skills training on early childhood development, can have an impact on children’s diets in Uganda. In a longitudinal intervention study, training focused on breastfeeding, complementary feeding at time of weaning, and diet diversification (Alderman, 2007). Improvements were seen in children’s diets in their first year or two of life with long-term intervention exposure, which is significant because the first two years of life are the most critical in a child’s physical and cognitive development (Africa News, 2008).

In the north, political upheaval compromises the social capital and economic potential of certain populations residing in Uganda, making self-sufficiency more difficult. Rebel groups in northern Uganda pose a serious threat to the health and well-being of the population. Northern Uganda is plagued by the Lord’s Resistance Army’s terrorist activities, which makes access to food difficult and takes children out of school. This is especially true in Karamoja, where fewer than twenty percent of children attend school because they must help out with the farming at home (Grainger, 2007). To make matters worse, droughts are drastically reducing the amount of crops to harvest, and two-thirds of the region is dependent on foreign food aid such as from the World Food Programme (Africa News, 2007a; Grainger, 2007).

In addition, northern Uganda is home to a significant number of refugees relocating to Uganda from neighboring countries. In 2005, there were nearly 188,000 refugees in Uganda from Sudan alone (Kaiser, 2005). Although the majority of refugees currently in Uganda have been there since the 1980’s and 1990’s, the government of Uganda has outright rejected the notion for permanent integration of refugees into the Ugandan population (Kaiser, 2005). Yet refugees are not even granted the right to freedom of movement, and experience insecurity, deprivation, and political repression in the north (Kaiser, 2005).

Refugees in Uganda have consistently been the victims of social exclusion, defined by Manuel Castells as “the process by which certain individuals and groups are systemically barred from access to positions that would enable them to an autonomous livelihood within the social standards framed by institutions and values in a given context” (Castells, 2000). The Ugandan government has attempted to implement the “Self-Reliance Strategy” (SRS) to provide services to refugees in such a way that it would improve the socioeconomic development of both the refugees and their Ugandan hosts. The idea was for services for refugees to be integrated into regular government structures and policies. It was envisioned that refugees would be able to grow or buy their own food, access and pay for basic services, and maintain self-sustaining community structures (Kaiser, 2005). While the SRS program was successful in one region that had considerable political stability, in most other areas refugees were often relocated from one unsafe area to another, not informed of what was going on, and regularly denied access to a range of economic activities. In attempting to fulfill the material needs of the refugee population, their legal and political rights have not been maintained. As a result of this social exclusion, the building of capacity, self-esteem, and social resources has been hindered, consequently undermining the goals of the program (Kaiser, 2005). This has implications for nutrition outcomes in that the crux of a successful, sustainable public health intervention relies on a community’s social capital and solidarity.

There is much evidence of the negative impact of political activities on nutritional status. Granaries have been abandoned in the north due to increased political insecurity, which adds to the problem of recurrent drought and seasonal variation that threaten household food security (Bachou & Labadarios, 2002). Political insecurity has also made the delivery of health-promotion services in these areas more difficult (Bachou & Labadarios, 2002). There was a statistical difference in stunting prevalence in sub-counties depending on distance to the health center, with populations who lived further away experiencing greater rates of stunting (Jilcott et al., 2007). This underlines the significance of lack of access to health-promoting resources, as management of malnutrition is primarily facility-based in Uganda (Jilcott et al., 2007). In addition, for those in the areas with the worst malnutrition, such as Karamoja, the health and therapeutic feeding centers are regularly overcrowded, which raises the risk of cross-infections and hypothermia from sleeping on the floor (Africa News, 2007a). Indeed, as UNICEF puts it, “cultural and climatic factors as well as endemic conflict combine to create cyclic humanitarian crises of a disastrous scale and complexity” (Africa News, 2007a).

While the intentions of programs such as the SRS are noteworthy, their implementation and outcomes have not been quite as stellar. The government must be sure to be sensitive to the realities of life when developing intervention programs. It must balance its own interests with its citizens, and those of the refugees in the north, in order to mitigate the detrimental effects of conflict on both populations. Chen and Berlinguer state that “good health is the cornerstone of economic progress, a multiplier of society’s human resources, and, indeed, the primary objective of development” (Chen & Berlinguer, 2001). Therefore, vesting more interest in the rights of refugees in terms of the SRS would allow these individuals more autonomy and access to health-promoting resources, ultimately benefitting the country of Uganda as a whole.

One intervention that has been moderately successful but has encountered some difficulties is the distribution of Vitamin A supplements. Vitamin A deficiencies have been common in Uganda, and while the vitamin is fat-soluble, Ugandans’ main source of Vitamin A is green leafy vegetables (Bachou & Labadarios, 2002). Ugandans’ diets are low in fat, especially as a result of the insufficient contribution of animal sources to their diet. Inadequate quantities of Vitamin A in mothers’ diets lead to Vitamin A deficient breastmilk (Black et al., 2008). The Ministry of Health’s national protocol for Vitamin A supplementation for postpartum mothers has been moderately successful at reducing Vitamin A deficiencies in Uganda, with a current coverage rate of 78% in children 6-59 months old (UNICEF, 2008). However, there are many barriers to the success of supplement distribution in Uganda. The country lacks a well-defined system for the distribution of the capsules, as they are only readily accessible to mothers who use health facilities (Bachou & Labadarios, 2002). In addition, capsule supplementation may not be ideal in the north due to the political instability, and in many of the isolated, rural areas of the country, as serious barriers may be encountered in attempting to distribute supplements to both of these populations. Additionally, supplementation is not a sustainable solution, but a downstream intervention that does not get to the root of the problem of inadequate Vitamin A in the food that is consumed. Micronutrient supplementation may be successful in improving child health outcomes in the short term, but in order to “eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment” (Bhutta et al., 2008).

Community partnerships have proven successful in decreasing rates of stunting in India (UNICEF, 2008), and will likewise be critical to successful public health interventions as Uganda moves forward. The government’s first priority should be inclusion of women in decision and policymaking, and building intersectoral collaboration. These collaborations should then prioritize nutrition issues, improving food security in Uganda such as through supporting alternative cropping strategies and changing its stance on urban agriculture. At the same time, it should support education on breastfeeding and complementary feeding practices through community growth promotion. In the Lancet’s 2008 series on Maternal and Child Undernutrition, Bhutta et. al concluded that “in populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25…, whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41” (Bhutta et al., 2008). Stunting is inextricably tied to social, economic and political issues, so in order to decrease its prevalence, improve maternal and child health, and improve the future development of Uganda, the role of policy and community partnerships should be seriously considered.

References

Africa News. (2007a, September 27). Uganda: Malnutrition the Main Challenge in Karamoja's Chronic Emergency. Africa News: UN Integrated Regional Information Networks.
Africa News. (2007b, February 3). Uganda: The Hidden Brain Hunger. Africa News: The Monitor.
Africa News. (2007c, March 8). Women and Gender: UN - Women Still Play Second Fiddle. Africa News: The East African Standard.
Africa News. (2008, April 30). Uganda: Early Prevention is Best, Says Child Malnutrition Study. Africa News: The Monitor.
Alderman, H. (2007). Improving Nutrition Through Community Growth Promotion: Longitudinal Study of the Nutrition and Early Child Development Program in Uganda. World Development, 35(8), 1376-1389.
Bachou, H., & Labadarios, D. (2002). The Nutrition Situation in Uganda. Nutrition, 18(4), 356-358.
Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S., Dewey, K., Giugliani, E., et al. (2008). What Works: Interventions for Maternal and Child Undernutrition and Survival. The Lancet, 371(9610), 417-440.
Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., et al. (2008). Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. The Lancet, 371(9608), 243-260.
Castells, M. (2000). The Rise of the Fourth World. In D. Held, & A. McGrew (Eds.), The Global Transformations Reader: An Introduction to the Globalization Debate (pp. 348). Cambridge: Polity Press.
Chen, L., & Berlinguer, G. (2001). Health Equity in a Globalizing World. In T. e. a. Evans (Ed.), Challenging Inequities in Health: From Ethics to Action (pp. 34). Oxford: Oxford University Press.
Eliot, J. (2008, March 5). Uganda Health Gets Hand. The Cairns Post (Australia), pp. 31.
Grainger, S. (2007, 19 January). Surviving Uganda's Cattle Wars. BBC News.
Jilcott, S. B., Masso, K. L., Ickes, S. B., Myhre, S. D., & Myhre, J. A. (2007). Surviving But Not Quite Thriving: Anthropometric Survey of Children Aged 6 to 59 Months in a Rural Western Uganda District. Journal of the American Dietetic Association, 107(11), 1983-1988.
Kaiser, T. (2005). Participating in Development? Refugee Protection, Politics and Developmental Approaches to Refugee Management in Uganda. Third World Quarterly, 26(2), 351-367.
Maxwell, D., Levin, C., & Csete, J. (1998). Does Urban Agriculture Help Prevent Malnutrition? Evidence from Kampala. Food Policy, 23(5), 411-424.
McIntyre, B. D., Bouldin, D. R., Urey, G. H., & Kizito, F. (2001). Modeling Cropping Strategies to Improve Human Nutrition in Uganda. Agricultural Systems, 67(2), 105-120.
Nadakavukaren, A. (2006). Our Global Environment, A Health Perspective (6th ed.). Long Grove, IL: Waveland Press, Inc.
Stuart, P. (2007, Bananas--Science Comes to the Rescue. African Business, 332, 58.
The National Academies Press. (2006). Lost Crops of Africa: Volume II: Vegetables. Washington, D.C.: The National Academies Press.
Tuller, D. (2007, December 25). Food Scarcity and H.I.V. Interwoven in Uganda. The New York Times, pp. 6.
UNICEF. (2008). The State of the World's Children.
Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., et al. (2008). Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital. The Lancet, 371(9609), 340-357.