Name

: Fransisca Stephanie Wibisono

Student id : 030 10 109

1. Three major determinants for maternal and child undernutrition

The ultimate manifestation of poor nutrition is malnutrition, due to basic, underlying and
immediate factors that contribute to this condition.
The immediate cause of undernutrition is a result of a lack of dietary intake, or to disease.
This can be caused by consuming too few nutrients or to an infection, which can increase
requirements and prevent the body from absorbing those nutrients consumed.
At this level, infection and malnutrition are actually a vicious cycle where inadequate diet can
cause weight loss and growth faltering as well as lowered immunity. This in turn can lead to
increase incidence, severity and duration of disease. Disease, in turn leads to loss of appetite,
mal-absorption of nutrients and an increased need for nutritional requirements, leading back

to an inadequate diet. The primary diseases that contribute to this cycle in the developing
word are diarrhea, acute respiratory infections, measles and malaria. Both treating the disease
and efforts to improve their nutritional status can break the cycle.
At the next level are the underlying causes of malnutrition. Whether or not an individual
gets enough food to eat or whether s/he is at risk of infection is mainly the result of factors
operating at the household and community level.
Within the UNICEF framework described these are classified as underlying causes.
They can be grouped into three broad categories:
household food insecurity
inadequate care
unhealthy household environment and lack of health services.
Household food insecurity can be defined as the household having access to foods that are
needed to sustain life; or the inability to obtain enough affordable food for the nutritional
needs of the family and for the intake of food with the right balance of protein, fat and
carbohydrates. Inadequate care includes practices such as inadequate breast-feeding or poor
dietary intake. Sometimes cultural taboos play a negative role in food security, such as
withholding nutrition foods during pregnancy or illness. Lastly, lack of public health services,
poor sanitation and access to clean water can contribute to food insecurity.
Poverty is one of the underlying causes. If a family doesnt earn enough income through
consistent and sufficient work to buy food and other needs for a family, that resulting poverty
can lead to inadequate food security, and inability to access health care services.
The basic causes of malnutrition arise from a variety of complex social, economic and
political factors. These factors can defeat household food security: for instance, social and
food safety nets are not available for families who may suffer economic hardships; or women
and girls are not protected by countries laws and customs; and governments political and
ideological practices may impact income and resource distribution.

2. Stunting
Stunting: Low height-for-age Children are classified as stunted if Z-scores of height-forage are below minus two standard deviations (SD) from the median of the WHO Child
Growth Standards.
Stunted growth reflects a process of failure to reach linear growth potential as a result of
suboptimal health and/or nutritional conditions. On a population basis, high levels of
stunting are associated with poor socioeconomic conditions and increased risk of frequent
and early exposure to adverse conditions such as illness and/or inappropriate feeding
practices. Similarly, a decrease in the national stunting rate is usually indicative of
improvements in overall socioeconomic conditions of a country.
3. Complementary Feeding and Fortified Food
WHO recommends that infants start receiving complementary foods at 6 months of age in
addition to breast milk, initially 2-3 times a day between 6-8 months, increasing to 3-4
times daily between 9-11 months and 12-24 months with additional nutritious snacks
offered 1-2 times per day, as desired.
It can affect all age groups, but young children and women of reproductive age tend to be
among those most at risk of developing micronutrient deficiencies. Even moderate levels
of can have serious detrimental effects on human function Worldwide, the three most
common forms of MNM are iron, vitamin A and iodine deficiency. Young children
especially children under 5 really need this forfied food because they are in their golden
period of development.
4.Hepcidin

Iron supply for erythropoiesis enters the plasma via three different routes, binds to
transferrin and is transported to the bone marrow. The main iron supply is from re-cycled
red cells and this enters via the macrophages. A smaller supply comes from absorbed iron
which enters the plasma through the mucosal cell and, when needed, storage iron can be
provided from ferritin stored the hepatocytes. Entry into the plasma from all three cell
types is via the transport proteinferroportin.
Hepcidin is well known as ironregulatory hormone. Generally, it causes a decrease in
serum iron. The mechanism of hepcidin activity depends on hepcidin interactions with
ferroportin. Ferroportin is the only known mammalian cellular iron exporter, which is
expressed on the surface of reticuloendothelial macrophages, hepatocytes, duodenal
enterocytes and placenta cells. Hepcidin regulates posttranslationally ferroportin
expression. Hepcidin binds to ferroportin and causes its internalization and degradation in
endolysosomes, what in turn blocks the iron transport via ferroportin. When iron stores
are adequate or high, increased hepcidin expression inhibits intestinal iron absorption,
release of recycled iron from macrophages and its transport across the placenta. On the
other hand, when iron stores are low, hepcidin production is suppressed. By modulating
hepcidin expression, organism can control plasma iron level and maintain iron
metabolism homeostasis

5. survey of community
Nutritional status is influenced by a number of factors, such as age, sex, socio-economic
status, culture, household food security, dietary patterns, environmental sanitation etc.
Many of these factors have been studied in relation to energy-protein malnutrition They
may also be important determinants of overweight. When combined with dietary
assessment information, anthropometric data can help elucidate the nature of food and
nutrition problems identified within a population. For instance, it can guide decisions on
whether specific interventions are necessary, the types of intervention and which groups
should be targeted. The data can also be used to construct critical indicators in food and
nutrition monitoring and surveillance systems, which in turn can provide vital input into
policy and programme planning and management.