Name : Fransisca Stephanie WibisonoStudent id : 030 10 109

1. Three major determinants for maternal and child undernutrition

Theultimate manifestationof poor nutrition is malnutrition, due to basic, underlying and immediate factors that contribute to this condition.Theimmediate causeof 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 asunderlying 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.Thebasic causesof 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. StuntingStunting: Low height-for-age Children are classified as stunted if Z-scores of height-for-age 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 FoodWHO 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 communityNutritional 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.