Nutrition education in the context of early childhood malnutrition in low-resource communities.

Malnutrition of early childhood is the outcome of a number of complex and related factors, insufficiency or imbalance of dietary intake being just one of many. It has been only fairly recently realized, for instance, just how considerable a part recurring infection plays in the stepwise progress of falter and inadequate rehabilitation by which the young child becomes malnourished. Furthermore, dietary intake is reduced or distorted by many other factors than lack of knowledge of what foods are appropriate for the growing child. Shortage of food, both seasonal and sporadic, loss of appetite, maternal deprivation and infection can all reduce intake. Ignorance, however, plays a large part in the malnutrition of the over-indulged children of the welfare states and in the commonest type of malnutrition, proteinenergy malnutrition of early childhood, in low-resource communities all over the world. I intend to concentrate in this paper on the principles of nutrition education as we attempted to deliver it to the mothers of malnourished or ‘at-risk’ children, and in general to mothers and community leaders in Uganda. In so doing I hope to point out possible points of application which I believe are common to the problems of both developing countries and the urban deprived in the developed countries. Finally, I hope there will be time to discuss some practical problems of evaluation of nutrition education. The cause of malnutrition to which education is directed is ignorance or lack of knowledge concerning the nature of food. It is only in the last hundred years or so that science has related what we eat to how we grow and develop, and even now we are only beginning to learn the importance of adequate nutrition for brain growth. In unschooled communities, where traditions and taboos still operate, highly complex conceptions of ‘food‘ exist which have nothing to do with growth and development. One of the basic reasons for proteinenergy malnutrition of early childhood in that part of Uganda where I worked for many years was the sudden weaning of the breast-fed infant onto an adult diet (two or three mealdd) of cooked banana (‘matoke’). The staple matoke is the food of the kings and is still regarded in rural families as the traditional food of the Baganda. The family meal centres on the steamed matoke, which is eaten with fingers which dip the matoke into the ‘sauce’, (groundnut, ‘dodo’, or other spinach, beans, etc.). Meat and fish are eaten at