Sunday, May 18, 2014

Global Health Critical Reflection #3

One of my neighbor boys in Sierra Leone, Mohammed*, was always sick. I often saw his mother toting the two-year-old to the traditional healers in my town. I was intrigued by this because his father was earning two salaries from his job as a teacher at the secondary school and as an employee at the local mining company. The two incomes were a comfortable amount for a family of four to live and be healthy in Sierra Leone. (Although I’m sure he was supporting extended family and friends who did not live with him.) I was surprised that the family had enough money to take Mohammed to the hospital in the district capital, but chose not to.
Mohammed had many of the common physical features for undernourished children in West Africa – potbelly, “moon-face”, and slender limbs – characteristics of kwashiorkor as well as other nutrient deficiencies (World Food Programme, 2014). Mohammed ate from the same pot as his family, usually the traditional dish of rice with an oily leaf sauce. I never saw him eating any dried fish that is typically served in the sauce, which sustains many families with a relatively adequate source of protein. In Sierra Leone, it is culturally inappropriate to give a small child fish, because of local taboo. I hypothesize that this taboo stemmed from incidents of children choking on small fish bones. Either way, Mohammed was not getting all of the micro-nutrients necessary for physical and mental development. What was the association between Mohammed’s sickness and malnutrition? How does his family’s socio-economic status relate to his nutritional status?
In sub-Saharan Africa, high child mortality rates are attributed to acute respiratory infections, birth complications, diarrhea and malaria (World Health Organization, 2013). Undernutrition is an underlying risk factor between these illnesses as 45% of all childhood deaths are linked to undernutrition (World Health Organization, 2013). In “Maternal and child undernutrition: global and regional exposures and health consequences”, the researchers explore the connection between undernutrition and other preventable diseases. According to multi-national trials, “the pooled relative risk for morbidity associated with zinc deficiency is 1.09 for diarrhea, 1.25 for pneumonia, and 1.56 for malaria” (Black, 2008). In other words, there is a strong correlation between increasing nutrition deficiencies and increasing incidence of infectious disease. But why?
According to Peter Katona and Judit Katona-Apte, the interaction between nutrition and infection can be better understood through a cyclical pattern (2008). Due to the inadequate dietary intake, the immune system is damaged, which affects and subsequently increases the probability of disease incidence (Katona & Katona-Apte, 2008). A common symptom of many diseases is the loss of appetite, wherein the child will continue to experience undernourishment, thus repeating the cycle (Katona & Katona-Apte, 2008). Unfortunately this pattern is common amongst children in low-income countries, especially in sub-Saharan Africa, where 21.9% of children are underweight and 56.9% of children are stunted (Black, 2008).
Mohammed’s frequent visits to the witch-doctors can be explained through this vicious cycle of undernourishment and disease. Despite these physical constraints, there were cultural forces inhibiting Mohammed from living a healthy lifestyle. One day I saw the whole family packing their bags to spend the night at a relative’s house. The father told me that the traditional healer was going to sleep in their home to expel the evil spirits that were causing Mohammed’s sickness.
Evidently, culture plays a significant role in the health of children, but why did Mohammed’s mother not take him to the hospital if they had the money for it? Despite strong evidence that wealthier children are healthier children, I believe Mohammed’s parents were overwhelmed with societal norms and deep-rooted cultural beliefs, which led them to prepare imbalanced meals for Mohammed and to seek treatment from traditional healers rather than clinicians at the hospital.
Clearly, undernourishment is tangled into the complex system of social determinants of health and unfortunately, Mohammed was experiencing the adverse implications of that system.

*Name changed.


Black, R. E. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 243-260.
Katona, P., & Katona-Apte, J. (2008). The Interaction between Nutrition and Infection. Clinical Infectious Diseases, 1582-1588. Retrieved from
World Food Programme. (2014, March 8). Retrieved from Hunger:
World Health Organization. (2013, September). Retrieved from Children: reducing mortality:

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