For decades, UNICEF has utilized a multi-layered Conceptual Framework to explain that malnutrition stems from a cascade of interconnected causes, extending beyond immediate factors like diet and illness. The 'underlying determinants' represent the crucial second tier of this framework, situated below immediate causes (inadequate dietary intake and disease) and directly linked to household and community conditions.
The Three Main Underlying Determinants
UNICEF's framework groups the underlying determinants into three primary categories, emphasizing that simultaneous action in each area is necessary for sustainable nutritional improvement.
1. Inadequate Household Food Security
This determinant involves physical, social, and economic access to sufficient, safe, and nutritious food. Contributing factors include chronic lack of food access due to poverty, temporary shortages caused by events like droughts, and poor dietary variety leading to micronutrient deficiencies.
2. Inadequate Care Practices
Care encompasses providing time, attention, and support necessary for good nutrition. Key aspects include suboptimal infant and young child feeding practices (like insufficient breastfeeding), poor maternal nutrition, and lack of psychosocial support for caregivers.
3. Unhealthy Living Environment and Lack of Access to Health Services
A healthy living environment, including access to clean water, sanitation, and healthcare, is vital for preventing illness. Poor conditions contribute to the 'malnutrition-infection cycle'. Issues include inadequate WASH (Water, Sanitation, and Hygiene) leading to infectious diseases, limited access to healthcare due to distance or cost, and subpar housing.
Comparison of Determinant Tiers
| Feature | Immediate Determinants | Underlying Determinants | Basic Determinants |
|---|---|---|---|
| Focus | Individual physiological state | Household and community conditions | Societal structure and resources |
| Components | Inadequate dietary intake and disease | Food security, care practices, healthy environment, and access to services | Political stability, economic systems, resources, and ideologies |
| Causality | Directly leads to malnutrition | Drives the immediate causes | Influences the underlying determinants |
| Intervention Level | Short-term, clinical interventions (e.g., therapeutic feeding, medical treatment) | Mid-term, programmatic interventions (e.g., food aid, nutrition education, WASH programs) | Long-term, policy-level interventions (e.g., poverty reduction, governance, market regulation) |
A Broader Context of Basic Causes
These underlying determinants are shaped by the basic determinants – the macro-level factors like political and economic context and sociocultural structures. Systemic issues such as poverty and inequality create conditions for inadequate food security and poor access to services.
Conclusion
UNICEF's framework reveals malnutrition as a multifaceted issue rooted in a hierarchy of causes, not just food scarcity. The underlying determinants—household food insecurity, inadequate care practices, and an unhealthy living environment—link immediate health impacts to broader societal issues. Addressing these foundational layers through a multi-sectoral approach, from household practices to national policies, is crucial for effective and sustainable solutions.
