by Lora Cracknell – BA International Development with French, University of Sussex.
If you were to be told that 5.9 million children under 5 died in 2015, you might attribute it to a number of things far removed from the control of policy makers. War. A global health epidemic. An unprecedented humanitarian crisis. But the main contributing factor, is in fact, far less glamorous. Malnutrition is responsible for almost half of these deaths, meaning that close to 3 million children are dying every year simply because they are unable to eat enough, or eat enough of what is nutritious. Predictably, developing countries are hit the hardest, with average malnutrition rates in low-income countries almost 11 times the average rate in high income countries.
Three forms of malnutrition can be identified. Perhaps most commonly linked with malnutrition is wasting, where a child is too thin for his or her height. Stunting, where a child does not reach the optimum height for their age range, hinders both physical and cognitive development, and those affected are at greater risk of infection, often leading to high infant mortality rates. Obesity, which refers to a child who is too heavy for his or her height, is also a widespread form of malnutrition, with children in this category at greater risk of non-communicable diseases later in life. Obesity is not just unique to developed countries – a significant number of developing countries struggle with the problems associated with over-eating.
A 2015 report by UNICEF shows that countries in Africa and Asia are those most affected by all forms of malnutrition. Currently more than half of all stunted children live in Asia, and more than one third live in Africa. Devastatingly, the number of children affected by stunting continues to rise in Africa; there were 4 million more stunted children in Western Africa in 2015 than there were in 2000. In addition to this, the wasting of children in Asia is on the verge of becoming a critical public health emergency. So despite numerous, targeted interventions, why does this part of the world continue to be so undernourished?
Crucial to the future, healthy development of a child is the nutrition received by the mother during pregnancy, as malnutrition during pregnancy is linked to both physical and cognitive impairment. However, in a number of developing countries, access to maternal healthcare can be limited or non-existent, and therefore relevant information on nutrient intake during pregnancy is often unavailable. Proper feeding of infants and young children is also essential for their growth and development, and the effects of chronic malnutrition beyond the age of 2-3 years are irreversible, making it critical to reach at risk children during the early stages. One recommendation from the WHO is for babies to be breastfed within the first hour of them being born, and then exclusively until 6 months old. This can prevent malnutrition, decrease the risk of infectious diseases, support’s infant’s immune systems and may protect them later in life against chronic diseases such as obesity and diabetes. But in many developing countries where mothers must continue to work throughout pregnancy and immediately after giving birth, the early weaning of children onto other foods can become a necessity, compromising the child’s nutrition.
There are many interventions that have had great success in raising the standard of infant and child nutrition in certain parts of the world, including educational programmes for caregivers in hard to reach areas, micronutrient supplementation for expectant mothers and school feeding programmes. But this is not happening on a large enough scale or with the urgency necessary in the case of this malnutrition crisis. Nutrition Exchange’s most recent publication, which summarises research and provides articles on nutrition programme experiences for those working to reduce malnutrition at the national and community level, speaks of four further ways in which future programmes and interventions should target malnutrition.
Firstly, the food system, through distribution, trade and advertising, can shape what kind of food consumers can access. Secondly, though many nutrition schemes have been successful in combating undernourishment, these are typically small in size and must be scaled up to reach a wider audience. It is key that this takes place at a parliamentary level, and governments must pledge to put nutrition top of their agenda. Thirdly, we must increase the funding for nutrition. This does not mean relying solely on humanitarian aid. Pressure must be put on governments to increase nutrition budget commitments. In the case of Senegal, an increased budget and release of funds for community-based action programmes, food fortification, de-worming and WASH interventions have seen a dramatic, positive effect on nutrition. Finally, we must work to eradicate knowledge gaps. Although there is increasing awareness of the importance of brain development in the early years of life on future health and development, it is imperative that this knowledge is more accessible across the board to policy makers, parents and teachers alike in developing countries.
Although considerable progress has been made in some developing countries, nutrition arguably remains too low on the global health agenda. If we are to meet the Sustainable Development Goal of ending hunger and all forms of malnutrition by 2030, we must find more ways to replicate successes achieved by nutrition programmes taking place on a smaller scale.