In spite of the fact that in Venezuela not only have electrical service failures not ceased but also have increased and the connection to the Internet is more and more complicated, here I am again. I must say that it is very painful for me to have to share this kind of news about my country, a land full of abundant natural resources and very gentle people.

Hunger threatens Venezuelan population

The socio-economic situation in which Venezuela currently finds itself has strongly compromised the diet of Venezuelans, both due to problems such as scarcity and difficulty in finding certain foods, and due to incessant inflation, which has led many people to reduce in great proportion the quantities they consume (mainly protein due to its high cost), and others to limit themselves to eating once or twice a day, many of them in a state of undernourishment, that is, with a consumption of dietary energy permanently lower than the minimum requirements they need to lead a healthy life.

All this context in which we are living directly affects vulnerable populations, among which we highlight: pregnant women, infants, children and adolescents. The result is reflected in the great increase in recent years of child malnutrition in all its forms and at different stages.

According to the WHO, the term malnutrition covers deficiencies, excesses and imbalances in a person's calorie and nutrient intake. Undernutrition, on the other hand, is a different concept that refers to poor supply and/or utilization of nutrients for the body, including emaciation (underweight in relation to height), stunting ( undersize in relation to age) and low weight (underweight in relation to age). Adequate nutrition, in quantity and quality, is necessary for good physical and intellectual development; this is why a malnourished child is affected not only in his immediate survival, but also in the growth and development of his body as well as in his intellectual capacities.

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Children are the most threatened

Child malnutrition is a serious public health problem in the country. According to a report by the United Nations Food and Agriculture Organization (FAO), hunger in Venezuela had almost tripled between 2010 and 2012, as well as in the triennium 2015-2017, reaching 3.7 million people. On the other hand, Caritas Venezuela, in January 2017 published its first report of the Saman project (System of Monitoring, Alert and Care in Nutrition and Health), focused on children under 5 years, which said that between October and December 2016, 52% of children monitored had some form of nutritional deficit, and that 25% also showed some form of acute malnutrition in four of the main states of the country: Capital District, Miranda, Vargas and Zulia, which include the states with the highest population density in Venezuela.

The J.M. de los Ríos Hospital is a sentinel institution (that is, one that seeks to obtain information on selected health events) of the SISVAN Food and Nutritional Surveillance System. This system is the one that must provide current and timely information on the nutritional situation of the population, and that is why they manage numbers and statistics in this regard. Between 2013 and 2015, between 30 and 34 severely malnourished children and adolescents were reported in the J.M. de los Ríos. Later in 2016, according to the pediatrician Ingrid Soto de Sanabria "the alarms were turned on in the hospital"; since only until September 2016, in the hospital they had already attended to 80 serious malnourished, of which 21 showed edematous forms, and 48 were breast-feeding.

For Sanabria the reasons for this were obvious: 83.75% of the patients came from families living in poverty; an indicator directly associated with risks of malnutrition due to deficits. It is clear that child malnutrition is the result of insufficient food intake (in quantity and quality), lack of adequate care and the emergence of infectious diseases; but all this goes hand in hand with poverty as a risk factor, mainly due to the difficulty in acquiring food, lack of health care, use of unhealthy water and sanitation systems, poor education of mothers, poor care and feeding practices, diets high in carbohydrates and low in protein, incorrect dilutions for "yielding" a formula, etc. "The diet of the patients was based mainly on tubers such as cassava, ocumo, yam and seasonal fruits such as mango. This was aggravated by the scarcity and very high costs of infant formulas, whole milk, meats and legumes. The teapots were being made with rice or banana flours," said Sanabria, which is a clear explanation of the increase in edematous forms of malnutrition, given by inadequate consumption of protein, different from the common case of marasmus, which has a total calorie deficit and a rickety appearance.

The vicious circle of Malnutrition

Malnutrition acts as a vicious circle: Malnourished women have low birth weight babies, which, together with other factors, increases their chances of malnutrition in childhood. Malnutrition, by affecting a child's intellectual and cognitive capacity, decreases his or her school performance and learning skills. It therefore limits a child's ability to become an adult who can contribute to his or her community and country, and makes him or her likely to repeat the mistakes made by his or her parents, raising malnourished children, and falling into a circle that follows and perpetuates malnutrition.

When you have a malnutrition that comes from generation to generation and also occurs in a situation like the one you live in the country today, breaking the circle is not easy. That is why intervention strategies must be well planned, concrete and directed at all levels (national, state, communal, family and even individual). In order to carry out these "interventions" it is first of all necessary, and should be demanded, the publication of official figures regarding the current nutritional situation in Venezuela, since they would be the bases and the reference to evaluate the success or failure of the proposals in this respect.

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Educate to raise awareness

Among the strategies that a nutritionist could address directly to support, at the collective level, in the management of this serious national situation, Nutritional Education stands out. Nutritional education in terms of breastfeeding; exclusive breastfeeding up to 6 months of age followed by adequate complementary feeding; in terms of healthy eating habits for children and their families; hygiene habits (such as handwashing, to reduce the risk of diarrhea and other diseases that go hand in hand with malnutrition); in terms of making the community aware of the need to check the growth of their children and to attend screening days; the use of local foods in preparations, teaching them that they can have a complete diet without major expenses, etc ...

Although it is clear that at the level of individual attention the strategies are different, and without taking into account the role that the State should play in all this, nutritional education is fundamental and extremely necessary to make a real change in the life not only of the patient at the moment of the emergency, but in the long term and in his family; trying, within their possibilities, to bring them closer to a healthy lifestyle.

The author of this article, the first in a series of post on Healthy eating, is Micaela Doubront González, the eldest of my nieces, who is Nutrition student at the Central University of Venezuela. She presents Diabetes type 1, which is a very critical condition in this country, given the irregular supply of insulin. The proceeds will be a contribution from the Steem Community to her.