Nutrition As A Social Determinant of Health In Papua New Guinea.

In the urban and peri-urban areas of PNG, the household diet has shifted from a traditional diet of root crops to one that is composed of processed imported food. This observation was made by Saweri (2001) who wrote that as Papua New Guineans adopted a modern lifestyle, their food habits and choices are changing. Although PNG has abundant rainfall, fertile land and a long history of subsistence agriculture the changing socio-cultural, political and economic landscape has not taken advantage of these factors to ensure people in PNG have healthy food in adequate quantity in their homes. What are the factors preventing this from happening? How has the changing socio-cultural, political and economic landscape in PNG contributed to the problem of malnutrition, under nourishment and obesity?

National nutritional surveys in PNG have shown that nutritional status of children has not changed. Underweight, stunting and wasting continue to be prevalent in rural areas. Gibson (2000) showed that there is inequality and inequity in nutritional status between the rural and urban population. For example, 42% of the population surveyed did not meet the daily requirement of 2000 calories per person per day. Among children, 47% of rural children were stunted compared to 19.8% in urban areas. This observation had not changed when the nutritional survey was repeated in 2005 where rural children were more likely to be stunted compared to urban children (PNG NDoH 2011). Furthermore, there was also difference in the prevalence of stunting among the four regions where it was 52% in the Momase region, 46% in the Highlands region, 40% in the Islands region and 30% in the Southern region. Among adults, women in rural areas had a low body mass index (BMI) of 21.6 kg/m2 compared to urban women who had an average BMI of 25.3kg/m2 . Men in rural areas were also thinner compared to urban males. Urban population had 50% more protein available to them then rural people. These data indicate that the nutritional problem in PNG is unequally distributed and disproportionately affects the rural population and women. The unequal distribution is also noted among the four regions of the country.

The 2005 national nutritional survey also uncovered unequal distribution of micronutrient deficiency (PNG NDoH 2011). Although the urinary iodine level in non-pregnant women was above the recommended level of 100ug/L, it was highest amongst island women (290ug/dL) and lowest in highlands women (129.5ug/dL). This is most likely an environmental influence because women living in the coastal regions would have access to more seafood that has high iodine content compared to women in highlands areas where they have to depend on processed such as table salt for their iodine source. Between rural and urban women, rural women had a lower iodine level. Anaemia was prevalent among children followed by non-pregnant women and was low amongst men. As seen in other nutritional status, the distribution of anaemia was not the same for the four regions. Anaemia was highest amongst children in the Momase region (67.5%) and lowest in the Highlands children (24.3%). Vitamin A deficiency also was unequally distributed. There was a vitamin A deficiency gradient with the highest amongst children aged 6-11 months (37.8%) and progressively getting less with the lowest deficiency observed in children aged 48-59 months (21.8%). Furthermore, there was also a rural-urban difference as well as varying rates of vitamin A deficiency between the four regions of PNG. These data again show that micronutrient deficiency is also unequally distributed between the four regions and suggest influence of environmental factors. Anaemia and vitamin A deficiency appear to disproportionately affect women and children.

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