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Hunger does not merely relate to the lack of food availability but it has a broader aspect. Hunger has many faces: loss of energy, apathy, increased susceptibility to disease, shortfalls in nutritional status, disability, and premature death (Wiesmann 2004). It is of multidimensional nature.
The different uses of the word hunger are often confusing. "Hunger" is usually understood to refer to the discomfort associated with lack of food. FAO defines food deprivation, or "undernourishment," specifically as the consumption of fewer than about 1,800 kilocalories a day-the minimum that most people require to live a healthy and productive life. But this is a very narrow approach. The words hunger and undernourishment are often used interchangeably.
"Undernutrition" goes beyond calories and signifies deficiencies in any or all of the following: energy, protein, or essential vitamins and minerals. Undernutrition is the result of inadequate intake of food- in terms of either quantity or quality-poor utilization of nutrients due to infections or other illnesses, or a combination of these factors, which are in turn caused by household food insecurity; inadequate maternal health or child care practices; or inadequate access to health services, safe water, and sanitation.
Without combating hunger and undernutrition the betterment of the health status of people in the developing countries can never be achieved.
Basic determinants at the national level are the interacting fields of economy and technology use, policy and culture, as well as ecology and natural resource endowment. They interact with the underlying determinants at the household and community level: household food security, caring capacity and knowledge, and health environments (Smith and Haddad 2000).
DIAGRAM SHOWING DETERMINANTS, EFFECTS, AND OUTCOMES OF HUNGER AND UNDERNUTRITION
Inadequacies in all or part of these three areas can rapidly push an individual household member into a vicious cycle of insufficient dietary intake, weight loss and reduced immune system, infection, and concurrent physiological changes such as loss of appetite and energy-consuming fever. This vicious cycle may conclude with either full recovery or persistent impairment (such as blindness due to vitamin A deficiency or irreversible growth-retardation in children) or death (UNICEF 1990; Tomkins and Watson 1989).
"Best practices" to combat hunger and under nutrition have been available for a long time, but lack of political will on the part of leaders and lack of political power among the poor has hampered their implementation (Heidhues and von Braun 2004).
Developing countries account for 98 percent of the world's undernourished people and have a prevalence of undernourishment of 16 percent- down from 18 percent in 2009 but still well above the target set by the Millennium Development Goal (MDG) 1. The World Food Summit goal is to reduce, between 1990-92 and 2015, the number of undernourished people by half. Millennium Development Goal 1, target 1C, is to halve, between 1990 and 2015, the proportion of people who suffer from hunger.
GLOBAL HUNGER INDEX
Since indices have proven to be powerful tools for advocacy and are able to capture multifaceted phenomena, the Global Hunger Index (GHI) was developed to increase attention to the hunger problem and mobilize the political will to speed up urgently needed progress in the fight against hunger.
The lack of a commonly accepted, comprehensive measure for food security on an international scale has been identified as one of the roadblocks on the way to the eradication of hunger and malnutrition (Heidhues and von Braun 2004).
Global Hunger Index is such a measure which comprehensively reflects the situation of hunger and undernourishment.
The index combines the percentage of people who are food energy deficient, which refers to the entire population, with the two indicators that deal with children under five. This ensures that both the situation of the population as a whole and that of children, a particularly physiologically vulnerable subsection of the population, are captured (Wiesmann 2004).
Children's nutritional status deserves particular attention because malnutrition puts them at high risk of permanent physical and mental impairment and death (WHO 1997). Adults who were malnourished as children are less physically and intellectually productive, have lower educational attainment and lifetime earnings, and are affected by higher levels of chronic illness and disability (UNICEF 1998; Behrman, Alderman, and Hoddinott 2004; UNS SCN 2004). Clearly, the mortality data comprise other causes of death than malnutrition, and the actual contribution of child malnutrition to mortality is not easy to track because the proximate cause of death is frequently an infectious disease (Pelletier et al. 1994). However, about 53 percent of deaths among children under five worldwide are attributable to undernutrition (Caulfield et al. 2004).
To reflect the multidimensional nature of hunger, the GHI combines three equally weighted indicators in one index:
1. Undernourishment: the proportion of undernourished people as a percentage of the population (reflecting the share of the population with insufficient caloric intake).
2. Child underweight: the proportion of children younger than age five who are underweight (that is, have low weight for their age, reflecting wasting, stunted growth, or both), which is one indicator of child undernutrition.
3. Child mortality: the mortality rate of children younger than age five (partially reflecting the fatal synergy of inadequate caloric intake and unhealthy environments).
For aggregation into the Global Hunger Index, the three selected indicators are equally weighted.
The Global Hunger Index is calculated as follows:
GHI= (PUN+CUW+CM) / 3
GHI = Global Hunger Index,
PUN = proportion of the population undernourished (in percent),
CUW = prevalence of underweight in children under five (in percent), and
CM = proportion of children dying before age five (in percent).
The GHI varies between the best possible score of 0 and the worst possible score of 100. Higher scores indicate greater hunger - the lower the score, the better the country's situation. GHI
Scores above 10 are considered serious, scores greater than 20 are alarming, and scores exceeding 30 are extremely alarming.
The outcomes of insufficient quantity, quality, or safety of food as well as the consequences
of a failure to utilize nutrients biologically are encompassed in the above three dimensional definition.
In comparison to the three single indicators included in the GHI (the FAO estimates of the proportion of undernourished, the prevalence of underweight in children and child mortality), the GHI is a better measure. For India the scores calculated for the years 1990, 1996, 2001 and 2012 by International Food Policy Research Institute (IFPRI) are 30.3, 22.6, 24.2 and 22.9 respectively.
Problem Statement or Rationale for Research
From the above considerations it becomes obvious that how important is the assessment of Hunger Index for a country or sub-region is, for reflecting the magnitude of hunger and undernourishment. Better quantification leads to better consciousness of the problem and hence appropriate measures or plans can be made to tackle it for better health and life of the people.
It also leads to better awareness among the people in the community and helps to focus or locate the areas where nutritional status of population is very poor and hence targeted intervention can be done. It is also useful to monitor progress towards better nutrition in the long run.
To understand the problem of food insecurity in an urban slum in Maharashtra, its impact on people's health and quantification of "hunger and undernourishment" in terms of Global Hunger Index.
Objective of research
To assess the proportion of undernourished people as percentage of population in the selected urban slum.
To assess the proportion of children younger than age five who are underweight as percentage in the selected urban slum.
To find the mortality rate of children younger than age five in the selected urban slum.
To quantify the extent of "Hunger and Undernutrition" in the slum in terms of GHI (Global Hunger Index)
How undernourishment among the people in the area is detected and measured?
How prevalence of underweight in children is to be measured and quantified?
How the above two factors and under-5-mortality rate is taken and consolidated into Global Hunger Index to reflect "hunger and undernourishment" in the urban slum population.
Quantitative method is used. It will be a community based cross-sectional study.
Universe of Study
Individuals in the families having a child or children under 5 years of age. The children and adults in the family are included in the study.
Purposive sampling to include families having children under 5 years of age. The adults in the family are also included in the study.
Urban slum in the M-Ward area in Mumbai, Maharashtra. Families having children under 5 years of age are visited.
Appropriate number of families to provide a significant number of children under-5-years and individuals in other age groups will be taken into account. This will be decided after visiting the area.
Data Collection Method and Tool
Data needed for assessment of undernourishment in people will be collected by clinical examination of respondents in each family (Clinical Sign and Symptoms- Anaemia, clubbing, jaundice, cyanosis etc.).
Appropriate anthropometric measures for adults (Height, Weight, Mid-arm-circumference or MAC) and children (Height, Weight, Mid-arm-circumference or MAC, Head circumference, Chest circumference) can be taken.
Data regarding Birth-weight of babies and under-5-mortality rate can be gathered from the hospital records or from the Aanganwadi or Govt. health centers, if available.
For information regarding dietary intake, a short questionnaire can be used or interview with the correspondents can be done. (Questions concerning the type, quality, quantity of food they had including at least one weekday and one weekend).
Gomez's classification system will be used to classify the growth pattern of children.
The quantitative data regarding different parameters thus obtained can be analyzed and compared using SPSS 11.0.