222.649.01 | AY 2012-2013 - 4th Term | 3 Credit(s)
TTh 3:30:00 PM
  • Contact Information
    Keith West
  • Course Learning Objectives

    Upon successfully completing this course, students will be able to:

    • Describe and be discussant on contemporary public health nutrition problems facing low-income countries
    • apply conventional epidemiologic, nutritional, demographic, and health economic concepts and indicators in characterizing nutrition problems and inerventions in low income populations
    • develop a profile of nutrition and health problems in a low-income country and evaluate national approaches to prevention
  • Course Description
    Presents major nutritional problems that influence the health, survival, and developmental capacity of populations in developing societies. Covers approaches implemented at the household, community, national, and international levels to improve nutritional status. Explores the degree to which malnutrition can be prevented or reduced prior to achieving full economic development through targeted public and private sector interventions that address the causes of malnutrition.

    Additional Faculty Notes:

    The purpose of this course is to motivate and engage the student to become familiar with (a) existing or emerging issues in international nutrition that influence the health, survival, and development capacity of people living in developing, low-income and underserved societies and, (b) various direct and indirect approaches to assessing and improving nutritional well-being of populations at-risk of malnutrition.  The malnourished live in two types of society:  (a) predominantly rural or agrarian or (b) rapidly burgeoning urban or periurban settings.  Where, until recently, nutritional concerns focused exclusively on undernutrition, a second “burden” exists, one of rising  obesity in populations transitioning to higher caloric diets and lower activity lifestyles, often with imbalances in dietary quality that can promote deficiencies.  Both forms of malnutrition are addressed in the course.  Both increasingly affect vast population segments of low income countries that are food insecure and nutritionally deprived with respect to dietary quality, quantity or both, often in chronically unhygienic settings.  In undernourished settings survival from conception and childhood through adulthood is constantly threatened and quality of life suffers because of undernutrition and micronutrient deficiencies, usually due to chronic food insecurity.  At times, convergence of severe stresses can lead to famine.  Infants, young children and women of reproductive age most at-risk, although adolescents and the aged in poor populations have to date received little attention.  Although advances in socio-economic and development status reduce undernutrition, the course explores interventions that seek to reduce food and nutritional insecurity, and that may also support goals of development.  The second burden of rising obesity is most apparent in certain regions (eg, Latin America, Northern Africa and East Asia), especially among urban poor, but is now apparent across urban areas of South Asia as well.  These populations are experiencing a “nutrition transition” that is giving rise to non-communicable diseases as major causes of death.  In an increasing number of societies both burdens of malnutrition exist.

    Where a population lies on a continuum of nutritional stress can be thought to evoke different individual, household, community, national, and international responses.  At each level, preventive action may be affected by extent and severity of dietary or nutritional stresses and by socio-economic, infrastructural, cultural, civil, and political factors.  Because nutritional problems are complex, adequate solutions intended to address their causes (a) often require action across sectors of society, (b) should be evidence-based and (c) should be pursued in the context of national policy and available resources.  This course seeks to introduce the student to pressing, contemporary nutritional problems afflicting low income societies, although it is not exhaustive in scope.  Rather, common themes and a need for basic skills and insights will emerge to encourage further study and skill acquisition in this important area of global health.   

  • Methods of Assessment

    Student evaluation based on term paper, mid-term exam, class participation, attendance and end of term presentation.

    Additional Faculty Notes:


    Grades will be based on two term papers, a mid term exam, consisting of 20 multiple choice questions and/or short answer questions, class participation, attendance and end of term presentation. There will be no final examination. 

    It is assumed that all students have signed up for the course because they are avid to learn and build a stronger understanding of public health nutrition into their career insights and skill sets.  However, grades must be assigned.  Numerical grades will be based on the following:


    Term papers (25% each)                                        50%

    Mid-term exam                                                           25%

    End of term presentation                                         15%

    Quality of class participation                                   05%

    Class attendance                                                      05%

    Total                                                                           100%


    Numerical grades will be calculated and, based on a curve of their distribution; a letter grade (A, B, C, D, or F) will be assigned.  Please Note:  Everyone starts off the course with an expectation of receiving a B.  Those who perform well (the expected norm at JHU!) will receive a B.  Students whose papers are outstanding will, with high score in midterm exam, excellent presentation, attendance and some quality participation, likely receive an A.  Those who work for a C will receive it.  We expect no one to get a D or F, though they have been earned in the past. 

  • Prerequisites

    Additional Faculty Notes:

    There are no formal prerequisites for taking the course.  However, students are expected to be familiar with basic principles of human nutrition, nutritional assessment and the types and causes of malnutrition, and in resource constraints faced by many low-income countries.  Students are strongly encouraged to use this opportunity to broaden their reading in these areas during the term in order to participate in an informed way in class discussions.  This will also help students to write two short but authoritative papers on nutritional problems, policies and programs in a selected country.

  • Required Text(s)

    Additional Faculty Notes:

    The primary reading for this course is:


    West KP Jr, Stewart CP, Caballero B, Black RE.  Nutrition.  In:  Merson MH, Black RE, Mills AJ (eds).  Global Health:  Diseases, Programs, Systems, and Policies, 3rd edition.  Burlington, MA:  Jones and Bartlett Learning, 2012;6:243-343.


    Maternal and Child Undernutrition:  The Lancet Series, January 2008.


    Other required and supplemental readings for classes are posted on CoursePlus.

  • Course Schedule

    Please see the course Session for a full list of dates and items for this course.

  • Academic Ethics Code

    Students enrolled in the Bloomberg School of Public Health of The Johns Hopkins University assume an obligation to conduct themselves in a manner appropriate to the University's mission as an institution of higher education. A student is obligated to refrain from acts which he or she knows, or under the circumstances has reason to know, impair the academic integrity of the University. Violations of academic integrity include, but are not limited to: cheating; plagiarism; knowingly furnishing false information to any agent of the University for inclusion in the academic record; violation of the rights and welfare of animal or human subjects in research; and misconduct as a member of either School or University committees or recognized groups or organizations.

  • Welcome Message

    Welcome to the 2012-13, 4th term, International Nutrition class.  The class will begin on Tuesday, March 26, 2013 and will be held on Tuesdays and Thursdays, 3:30-4:50 pm in BSPH room W4030. We hope you enjoy the class.

  • Course topics



    4th Quarter, 2013



    International Nutrition 222.649

    Course Instructor:  Dr. Keith West, Jr.

    Teaching Assistant:  Dr. Mohsin Yakub

    Tuesday & Thursday, 3:30-4:50, Room W4030


                      2013                                OUTLINE OF COURSE



    March   26


    Course Introduction and Overview

    Mohsin Yakub, PhD









    Undernutrition, Growth Faltering and Stunting

    Keith West, Jr, DrPH


    Friday, March 29 (5 pm) submission date for country preference


    April   2


    Micronutrient Deficiencies I:

    Vitamins A, E and Selenium

    Keith West, Jr., DrPH









    Micronutrient Deficiencies: II: 

    Iodine & Vitamin D

    Kerry Schulze, PhD









    Breast and Complementary Feeding

    Keith West, DrPH









    Interactions of Nutrition & Infection

    Christian Coles, PhD







    Monday, April 15 (5:00pm) is the deadline for submission of paper (part 1)




    Micronutrient Deficiencies III:

    Iron & Zinc

    Parul Christian, DrPH









    Mid-term Examination










    Obesity & the Nutrition Transition

    Jessica Jones-Smith, PhD









    Community Nutrition Programs

    Parul Christian, DrPH









    Lancet series on Maternal and Child Nutrition 2008 and 2013

    Robert E. Black, MD







    May   2


    Nutrition Surveillance and Program Monitoring

    Rolf Klemm, DrPH
















    Global Nutrition Initiatives

    Keith West, Jr, DrPH


    Friday, May 10 (5:00 pm) is the deadline for submission of final paper




    Epidemiology of Famine

    Keith West, Jr, DrPH









    Student Presentations

    Course Wrap-up


    Keith West, Jr, DrPH

                                                                                                                                                  26 March 2013

  • Course Format

    The course will focus on a discrete number of international nutrition issues.  A lecture will be given on each topic by a course instructor or guest speaker.  PowerPoint handouts will be available on the CoursePlus website.   Required readings will also be on CoursePlus, and may often serve as a focus for discussion.  Beyond the wealth of information on the web, supplementary readings (eg, textbooks) will be on reserve in room E2519, and can be signed out overnight.  Each lecture will be ~1 hour in length, leaving time (~20 minutes) for discussion of lecture content, required readings and experiences students bring into the course. 

  • Two Term Papers, Mid-Term Exam and Presentation



    Dates Due:  The first paper must be submitted to the CoursePlus site dropbox by 5:00 pm, Monday 15 April 2013.  The second paper must be submitted by 5:00 pm, Frifay 10 May 2013.  There will be no exceptions to extend beyond either of these deadlines.  Papers submitted after the above dates and times will not be accepted or read.


    Length:  Each paper should be 3 pages of text (1.5-spaced, 12 point font) in length, including a title, your name and 100 word, single space (10-point) abstract in the front, in addition to an adequate number of relevant references, specific (properly headed and formatted) tables or (properly composed and labeled) graphs, as needed to support arguments in each paper.  All work must be original.  No figure, table or text of any sort can be downloaded from the web or other sources. Please note that not less than 20 references per paper are expected, not less than 10 being culled from the peer review scientific literature for each paper.  They should reflect thought and originality, and be integrated into the text following ONLY the format as used in the American Journal of Clinical Nutrition.  For example,: 


    Popkin B.  Global nutritional dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases.  Am J Clin Nutr 2006;84:289-98.


    You are asked to hand in a list of 4 countries in which you are interested (not your home country) from which one will be assigned to you.


    Description:  Please prepare each term paper as if you were a nutrition consultant to the Ministry of Health.  In the first paper, you are expected to summarize, in a succinct, readable, expert, and highly informative cited way, nutritional conditions within the country, across age groups, locales, ethnicities, etc.  If you have done a good job, you will be contracted to return to the country at the Minister's request!  In the second paper,  summarize, inform and advise the Minister about one of his/her most pressing nutrition problems and what is being done to address it in the country.  You are expected to be familiar with the underlying mechanisms of the nutritional disorder(s) you address.  But as an expert, you realize that no minister (nor course instructor) will read more than 3 pages of text!  Most consultants would be pleased if they (the minister and instructor) would just read, understand and act on the abstract! This makes each 100 word, single spaced, 10-point abstract extremely important for packing the most salient points into them.  Because each paper is short, every sentence must count, placing reference numbers into the paper with a superscript in the order in which they FIRST appear.  No "ibid." please!


    Throughout each paper, as a Johns Hopkins consultant, you will be expected to apply sound epidemiologic constructs and language in characterizing the country’s problems.  Thus, after summarizing and distilling the nutritional problems in the country in the 1st paper, in the second you should address a problem of public health importance, describing more about its epidemiology (extent, severity, distribution, risk factors), and  nutrition programs that exist, or perhaps should exit, to address the problem.  Identify any gaps and offer suggestions for improvements.  Often, countries may have programs underway that are addressing the problem; find as much direct or indirect data/reports as possible that reflect the performance of the programs.  When reports are not available, you may need to refer to (and cite) similar programs in other countries to draw inference about likely impact or efficiencies of operation.  Web-based references are acceptable as long as they are accurately and fully referenced and access dated, but the nutritional condition MUST be discussed based on evidence from the peer-review, original scientific literature.


    Be creative, informative, but also conventional and balanced in content (as if you were going to publish each) in your own approach to organize, in the most efficient way possible, the issues and problems of the country.  NOTE:  It is not easy to "pack" information into three pages in a coherent way, so multiple edits will be needed. 


    References should support specific content of your paper, including tables and figures, which should be integrated numerically with other references used in the text. NEVER cite a paper that you have not read!  Also, DO NOT “fill” your reference section with irrelevant citations.  We must be able to discern that the reference is structural and informative to your paper.  


    Finally, every table and figure must be your own"work of art".  Making an informative, succinct, balanced, easy-to-read, stand-alone, referenced, logical and attractive table is indeed an art.  So, too, are figures challenging, that are clearly labeled with an adequate legend, with error margins noted where relevant, and data presented in a fair way.  These are the mediums by which we communicate in public health, and will help you to get your messages across to the busy minister (and busier course instructor!).


    Mid-Term Exam: Will be held on Thursday 18 April. Exam will be comprised of 20 multiple choice questions and/or short answer. Students are responsible for all materials covered in the lectures required readings. Students are advised to read all of chapter number 6 GLOBAL HEALTH Disease, Programs, Systems and Policies (3rd Edition), entitled “Nutrition” for the mid-term exams.

    End of term Presentation: Students have to present key findings from their term papers. Presentation should not be more than 3 minutes followed by 1-2 minutes for Q&A.


    NOTE:  It is absolutely essential that you be fully informed about, and adherent to, the School's Code of Ethics with respect to referencing the work of others.  Plagiarism in any way, in any small phrases, from any source, including web-based sources of information, for any portion of the term paper is strictly prohibited.  Thank you for making your paper 100% your own work (which will also be much more enjoyable to read!). 


  • Contact Information(from old syllabus)

    Keith West, Jr., Dr.P.H.
    Office: BSPH, room E2519
    Tel: 410-955-2061

    Mohsin Yakub, PhD (TA)
    Office: BSPH, room W2505
    Tel: 410-502-8957

    Rhonda Skinner (Admin Ass't)
    Office: BSPH, room E2519
    Tel: 410-955-2061

  • Disability Support Services
    If you are a student with a documented disability who requires an academic accommodation, please contact the Office of Student Life Services at 410-955-3034 or via email at