A 3-year-old child is short for age but of proportionate weight for height. There is no recent weight loss. Which best describes this child's nutritional status? A. Acute malnutrition (wasting) B. Chronic malnutrition (stunting) C. Normal growth for age D. Severe acute malnutrition ANSWER: B — chronic malnutrition, i.e. stunting. Why: height-for-age is reduced while weight-for-height is preserved. Height cannot be lost, only failed to be gained, so a low height-for-age records a deficit accumulated over months to years. Weight-for-height is normal, so there is no current acute deficit. A: wasting would show a LOW weight-for-height. D: severe acute malnutrition is an acute picture, not this one.

Which single measure has been most effective in preventing iodine deficiency at population scale? A. Screening schoolchildren for goitre B. Iodine supplements for pregnant women C. Universal salt iodisation D. Health education about iodine-rich foods ANSWER: C — universal salt iodisation. Why: it is PASSIVE. People are protected by buying ordinary salt, with no appointment to keep, nothing to remember and no behaviour to change. Interventions requiring sustained individual effort reach the motivated; interventions built into something people already do reach everyone. B is valuable for a targeted group but does not protect a population. A detects the problem rather than preventing it.

Why do nutrition programmes that ignore sanitation often underperform? ANSWER: because undernutrition and infection are a single problem, each worsening the other. A malnourished child has weakened immunity, so infections are more frequent and more severe. An infected child eats less, absorbs less and consumes reserves faster, deepening the malnutrition. Repeated gut infection also impairs absorption directly, so nutrients delivered to an infected gut are substantially wasted. LEARNING POINT: nutrition, immunisation, clean water and sanitation are one programme, not four.

A national programme must correct widespread iron deficiency. Compare supplementation with fortification. ANSWER: they differ in speed, reach and durability. SUPPLEMENTATION Fast and targetable — the right tool for an identified at-risk group. Requires supply chain, staff and adherence. The benefit stops when the programme stops. FORTIFICATION Cheap per head and passive — reaches whoever buys the fortified food. Requires a regulated food industry and ongoing monitoring. Holds gains over years without individual effort. A real programme uses both: supplementation buys time now, fortification holds the gain, and dietary diversification is what eventually makes both unnecessary.

Define food security and name its dimensions. ANSWER: reliable access by all people at all times to sufficient, safe and nutritious food for an active and healthy life. AVAILABILITY Is the food physically present? ACCESS Can the household actually obtain it — income, distance? UTILISATION Can the body use it? Brings in health, sanitation and infection, since an infected gut absorbs poorly. STABILITY Is that true over time, or only after a good harvest? TRAP: do not confuse food security (access) with food safety (contamination — foodborne infection, adulteration, storage). UTILISATION is the dimension most often omitted, and it is where nutrition meets sanitation.

What is meant by the "double burden of malnutrition"? ANSWER: the coexistence of undernutrition and overnutrition in the same population — sometimes in the same household. A stunted child and an overweight, hypertensive adult may live under one roof. As diets shift from traditional staples toward energy-dense processed food and work becomes more sedentary, obesity and its consequences rise while micronutrient intake does not improve. LEARNING POINT: energy becomes abundant before nutrients do, so a national nutrition policy can no longer address scarcity alone.