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close this bookPopulation and Nutrition (FAO)
View the document(introduction...)
View the documentAims/objectives
View the documentBasic concepts
View the documentActivity no. 1 - The group meal
View the documentActivity no. 2 - The nutrition doctor
View the documentActivity no. 3 - Building a drying rack for vegetables

Activity no. 2 - The nutrition doctor

The nutrition doctor

A role-playing activity to teach group members to recognize conditions related to nutrition deficiency, their causes and how they can be prevented.



Note: It is important that the leader and the other group members help the "doctor" to make the correct diagnosis. The other group members can participate as "consulting doctors".

  • The leader explains that the group is going to play a game of patient and nutrition doctor.
  • First the leader tells the group about the major nutrition-related conditions, copies the chart on the following pages onto a chalkboard or large piece of paper so all the group members can see it, and shows the pictures of malnutrition-related diseases on the following pages.
  • The leader asks for two volunteers, one to be the patient and one to be the doctor. The patient describes his imaginary symptoms (or those of a younger brother or sister).
  • The doctor asks the patient what he has been eating, how many people are in the family, whether they have enough food. With the help of the group members, the "doctor" identifies the condition and suggests what needs to be done to correct it.
  • The role-playing continues with a new doctor and a new patient.


So that group members will be able to:

  • Recognize the symptoms of common nutrition-related disorders.
  • Understand the importance of a balanced diet in preventing these disorders.
  • See the connection between population growth, family size and nutrition levels.



  • The chart on the following pages (copied onto a chalkboard or large piece of paper), and the illustrations to show the group members.
  • Guidance from the group leader to ensure that correct diagnoses are made.
  • Possible assistance from a health worker.
  • Participation and enthusiasm of the group.

Some background information for the group leader

What do we mean by malnutrition?

When the body doesn't get the supplies it needs from the food we eat, malnutrition is the result. That is, the body becomes unable to perform its basic functions properly. Malnutrition can be a vicious cycle for the subsistence farmer.

The problem of malnutrition is worst among children. Children who are malnourished grow poorly and even their mental capacity can be affected. In families with too many people and too few resources to provide adequate nutrition for all, the children suffer in many ways. If resources are not adequate, food, shelter, clothing and education all tend to be inadequate. In addition, children need love and attention but in families where nutrition levels are low, the parents are often too tired and overworked to give time and affection to their children.


Malnutrition is also a very serious problem for pregnant women and their babies. A pregnant woman (or one that is breast-feeding) needs more nourishment than usual. If she does not get this extra nutrition, both she and her baby are much more likely to be weak and/or sick


What happens when we don't get enough of the basic types of food? What are common nutrition-related conditions and means of prevention?

When food supplies are very low, people do not get enough protein-energy nutrients. Children are the first to be affected. The common causes of protein-energy malnutrition are:

Early or sudden ending of breast-feeding. Mothers should be encouraged to continue breast-feeding until the child is at least 18-24 months old. Often, however, the mother stops breast-feeding her baby much earlier, and if she becomes pregnant again, she often stops breast-feeding suddenly. If this happens, the baby may refuse to eat other forms of food and malnutrition can occur. Therefore, spacing of pregnancies is an important step in reducing malnutrition of both mother and child

Late introduction of solid foods. Even though the mother should continue breast-feeding her child, from the age of four to six months onward, the child needs other types of food in addition. This process of introducing solid foods is called weaning. If weaning is delayed, malnutrition may occur.

The food

Note: Diarrhœa is a serious problem causing weakness and even death especially in young children. The leaders guide on Population and Health discusses this in detail and describes a simple treatment - oral rehydration treatment or ORT

Poor eating habits. A child should eat at least four times each day.

Infections. Diarrhœa, internal parasites and fevers such as malaria can result in protein deficiency. Clean conditions for preparation of food are essential to help avoid disease.

If the lack of protein-energy foods is extreme, children may develop marasmus or kwashiorkor.

Marasmus is most common in children under one year of age and is characterized by inadequate body weight, wasted muscles, almost no body fat and general lack of energy.

Kwashiorkor usually occurs later than marasmus. The most obvious sign of kwashiorkor is swelling of the feet, lower legs and stomach. The child has a round 'moon face' and may look fat because of the swollen stomach. Hair often turns red or brown and starts to fall out and in very serious cases, the skin becomes blotehed and flaky. Kwashiorkor commonly occurs when children stop breast-feeding and are put onto diets with only energy foods (for example, cassava).



In summary, both marasmus and kwashiorkor are nutrition-related disorders resulting from not enough food being available (i.e., energy and nutrients). Kwashiorkor is generally more severe and occurs later than marasmus. Both of these conditions can be cured by a dramatic increase in the amount of protein-energy foods in a child's diet.

Other nutrition-related conditions, for example, goitre, anaemia and Vitamin A deficiency, are caused by a lack of specific nutrients. More information about these conditions, their causes, and means of prevention is given on the chart on the next page

Most Common Nutritional Deficiencies

Symptoms: Enlargement of the thyroid gland, leading to noticeable swelling of the neck and occasional difficulty in breathing.

Cause: Lack of iodine in the diet. Most common in mountain areas. Prevention/cure: Increased intake of fish, dark green leafy vegetables, or use of iodised salt.

Symptoms: Pale colour of tongue and inside of lower eyelids, general weakness.

Cause: Lack of iron in the diet. Common in pregnant women and parasite-affected individuals.

Prevention/cure: Increased intake of meat, eggs and dark green, leafy vegetables. Anaemia can also be controlled by taking iron tablets.

Vitamin A deficiency

Symptoms: Night blindness. The child cannot see in the dark or half darkness. In very serious cases, Vitamin A deficiency can lead to serious eye damage and eventual blindness.

Cause: Lack of Vitamin A in the diet. The condition is made worse in cases of general malnutrition, measles or diarrhœa.

Prevention/cure: Increased intake of dark green, leafy vegetables, or orange-coloured fruits and vegetables (paw paw, carrots, sweet potato, pumpkin), or fish oil. In extreme cases, Vitamin A capsules are needed.

Malnutrition is not only a factor causing sickness and death in children, it also makes it more likely they will get infections because they are weak. Infections of the stomach and intestines then make the matter worse because they cause diarrhœa and dehydration.


This cycle can be broken by good food and good hygiene together with regular visits to the local health centre.