Nutrition in low- and middle-income countries

These 16 images highlight some of the problems in nutrition and food production faced by people living in low- and middle-income countries, and look at some potential solutions.

Image research and captions by Benjamin Thompson, adapted from Wellcome Images" target="_blank">Wellcome Images.

Rice transplanting

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Life in Bengal, India. A woman walks along a raised earth path through a paddy field. She carries young rice shoots for planting in rows in the water.

Credit: N Durrell McKenna.

Learning about nutrition

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Life and health in southern Thailand. A group of women are taught the nutritional values of foods on display by a health worker.

Credit: N Durrell McKenna.

Mossy foot

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Podoconiosis, locally known as mossy foot, is a condition that affects people that live and work in volcanic highlands. It is common in Ethiopia, where many people work on farmland and come into direct contact with the volcanic soil. Silicates in the soil get absorbed through the skin of the feet because workers are often barefoot. As a result, the foot swells and enlarges, causing the characteristic mossy appearance and sometimes making work impossible. Regular washing and bathing in antiseptic can treat this condition, but the only real treatment is to wear socks and shoes to prevent the skin coming into contact with the silicates in the soil.

Credit: Clive Chilvers.

Nutrition education through a theatre

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This image shows a theatre performance about growth monitoring and nutrition education in Zambia. This is an example of using an alternative medium to communicate health information to as many people as possible. A theatre performance is often more effective if the message conveyed is discussed by the audience after the play.

Credit: John and Penny Hubley.

Tippy tap for hand washing

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This ‘tippy tap’ in Zimbabwe is designed to dispense water for hand washing. A tippy tap is a simple device that can be used in rural areas where there is no running water. Operated by a foot pedal, the device is not touched by the hands, making it more hygienic.

Credit: John and Penny Hubley.

Nutritional education in India

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This image shows a health worker using flash cards to give health education on nutrition. Special skills are needed when communicating with adults. A good nutrition educator provides reliable, relevant information in an interesting and memorable way.

Credit: John and Penny Hubley.

Harvesting wheat

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These men are harvesting wheat in India. Wheat grains are a staple food used to make the flour that is the basis of many foods such as bread, pasta and noodles.

Credit: The Leprosy Mission International.

Planting rice

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These Indian women are transplanting rice in a flooded paddy field. Like wheat, rice is one of the staple foods for a large part of the world’s population. It has been cultivated in some parts of the world for thousands of years. Paddy fields provide an ideal environment for growing rice and preventing the growth of weeds. These fields require large amounts of both water and labour.

Credit: The Leprosy Mission International.

Drying rice

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This Indonesian woman is spreading out the rice harvest. Drying removes water from the grains, which prevents bacteria, moulds and yeasts from multiplying during storage. Drying also modifies the enzymes that age food, which means that the rice can be stored for longer periods. Dried rice is lighter in weight and easier to handle.

Credit: The Leprosy Mission International.

Woman carrying a basket of maize

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This Indonesian woman is carrying a basket of maize and tropical fruits to market. Maize is the major staple food in parts of South America and some regions of Africa. Yellow maize is the only cereal to contain carotene, which is used by the body to produce vitamin A.

Credit: Wellcome Images.

Measuring haemoglobin levels

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This technician is using a colorimetric method to measure the haemoglobin level in a sample of blood. The chart shows colour bands that equate to different haemoglobin levels.

Credit: Swiss Tropical Institute.

Food and nutrition surveillance

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This image shows a health worker measuring the mid-upper arm circumference of a boy in Tanzania during a nutrition survey. The proportion of malnourished children in different places at different times tells nutrition workers which communities have problems with nourishment so that appropriate resources can be targeted to them.

Credit: Swiss Tropical Institute courtesy of M Tanner.

Rehabilitation following severe malnutrition

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This Zimbabwean child is undergoing the rehabilitation phase of treatment for severe malnutrition. She is at a feeding centre attached to a rural hospital. Children with severe malnutrition should be treated in hospital, if possible, for stabilisation and early rehabilitation. When they are gaining weight and are free from oedema, diarrhoea, vomiting or fever, they can be transferred to a non-residential feeding centre where they can complete their nutritional rehabilitation.

Credit: Wellcome Images.

Cattle husbandry

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This herd of cattle is standing outside an Indian house. The cows provide milk for the family but the meat is not eaten, as cows are sacred to Hindu people. The cows’ dung is used as a cooking fuel.

Credit: Wellcome Images.

Health education meeting hut

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This image shows a health education meeting in a district hospital in Malanville, Benin. An effective way of improving health and nutrition is through local programmes in which community leaders and members, with help from trained health facilitators, assess problems and analyse the causes. Then they decide what actions and resources are needed to resolve the issues. Cost-effective results are more likely where a community is responsible for its own programme.

Credit: Swiss Tropical Institute courtesy of F Küchler.

Prevention of malnutrition - feeding enriched porridge

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This child is being fed enriched porridge in Benin. Porridge is made from cereal or root flours that contain high levels of starch. When cooked, the starch swells and absorbs water. Porridge is often mixed with lots of water to make it thin and easy to eat, but this can lead to a low concentration of nutrients. Adding oil or fat to porridge increases the amount of energy available without affecting the volume. Adding mashed beans or lentils, fish or eggs increases the protein and micronutrient content. This is helpful for children who are undernourished.

Credit: Swiss Tropical Institute courtesy of F Küchler.