Understanding Malnutrition and Treatments
Nutrition is Critical for Development
Despite progress achieved during the 1990s, rising food prices and the financial crisis have led to an increase in hunger and malnutrition. Children, particularly those younger than 2, are at special risk of hunger. The consequences of malnutrition during this critical window of development are long-term and irreversible. Poor fetal growth and/or persistent undernutrition early in life causes permanent damage including diminished intellectual capacity, impaired immune function and shorter height. In turn these problems lead to lower achievement in school and lower productivity on the job.
Malnutrition is also often intergenerational. An undernourished mother who gives birth to a small baby with poor fetal growth and a low birth weight guarantees her child an ominous start to life. If the baby is a girl, she may grow up underfed and continue the cycle -- giving birth to malnourished babies of her own. Many malnourished women don’t survive childbirth at all.
Well-nourished children, on the other hand, grow up to be stronger, healthier adults, more economically productive and better able to contribute to the development of their households, communities, and countries. A recent study that followed Guatemalan children into adulthood showed that those who received better nutrition as children earned higher wages later in life.[1] In countries like Guatemala where nearly half of all children are stunted, between 2 and 3 percent of GDP may be lost as a result of malnutrition.[2]
The scale of the world’s malnutrition problem is enormous. In 2007, 3.5 million children younger than five died as a direct or indirect consequence of malnutrition. But far more children live with rather than die from malnutrition. Today about 30 percent of all children younger than five are stunted, they are shorter than they should be because they are not receiving the nutrients needed to maintain healthy growth and development. Approximately 20 million children suffer from severe acute malnutrition. The most visible victims of undernutrition, these children are literally starving to death. Far more difficult to detect, hundreds of millions of children suffer from deficiencies in essential micronutrients such as vitamin A, iron, iodine, or zinc. This “hidden hunger” is often not recognized until it is too late to prevent long-term damage.[3]
Malnutrition is such a central issue that no fewer than three of the eight U.N. Millennium Development Goals depend on improving nutrition – eradicating hunger, improving maternal health, and reducing child mortality. Despite the well-documented human and economic toll malnutrition takes on women and young children, the issue has failed to capture attention and interest. In January 2008, the British medical journal The Lancet published a five-part series on nutrition, calling it “a desperately neglected aspect of maternal, newborn and child health… [that] has slipped through the gap.”[4]
We Can Improve Nutrition Now
There is plenty of evidence on what works to prevent or treat malnutrition. Sachets of powder containing key micronutrients are cheap to produce and easy to use. Mixed with food and given to children, their effect on cognitive development is well-documented. Nutrient and calorie rich foods that don’t require preparation or refrigeration have been developed and can be provided to mothers for home care of children suffering from severe acute malnutrition. (For more information on food aid, see here.)
In addition to documenting the human and economic costs and consequences of maternal and child malnutrition, the Lancet series identified proven interventions to improve health and nutrition.[5] These interventions include:
- Provision of micronutrients to pregnant women, new mothers, and young children;
- Promotion and support of improved feeding practices including exclusive breastfeeding for infants (0-6 months of age) and nutritionally appropriate complementary foods for older babies and toddlers;
- Improvement of sanitation and hygiene practices and facilities, including ensuring access to clean water.
- Treatment of infectious diseases, including diarrhea and malaria;
Ninty-percent of the world’s stunted children live in just 36 countries. Expanding the interventions singled out by The Lancet to reach children in these countries could lead to substantial improvements in the lives of millions. The wide use of these key interventions could reduce deaths of children under age two in these countries by nearly 25 percent.[6] Not only would more children survive infancy, but by preventing or aggressively treating malnutrition during the first two years of life, these children would grow up to be healthier, more productive adults. To find more information about countries with high rates of child malnutrition, see here.
Addressing Underlying Factors is Critical
Long-term success in improving nutrition requires addressing both immediate and underlying factors that allow malnutrition to persist. Underlying factors include care and social support of women and children, agriculture and access to critical public services such as health clinics, and water and sanitation facilities.[7]
Care of children and mothers
Mothers who are provided with knowledge and support are powerful advocates for the health and nutrition of their children. Too often however, women lack information about appropriate care and feeding practices. Knowledge alone is not enough, however, and women must be supported - physically, financially, socially - by family and community members to do what is best or what is needed.
Food security status of the household
The vast majority of malnutrition occurs in rural farming households. Poor farmers often lack the land or resources they need to grow enough or the right kind of food. A community’s traditional staple food (rice, cassava, corn) may be popular but lack nutrients. Foods such as milk, eggs, fruits and vegetables are important for nutrition but also often too expensive for poor families. All of these factors contribute to how well young children are fed.
Access to basic healthcare services
Many of the lives lost due to infectious diseases and malnutrition could be saved if mothers had access to basic health information and services. Trained health care workers can regularly check a woman’s nutritional status during pregnancy, encourage breastfeeding when the newborn arrives, and advise a pregnant mother about the nutrition needs of her growing baby. Sick mothers can be treated and babies can receive vaccinations. Children’s health and nutritional status can be monitored and appropriate advice and care can be provided to treat infectious diseases such as diarrhea.
The United States Can Be a Leader in the Fight Against Malnutrition
For too long, nutrition has been ignored in international efforts to promote development. One reason for this neglect is that malnutrition is caused by many factors in many different sectors. It needs to be everyone’s responsibility – but far too often, it is no one’s responsibility. This is true both for donors who have failed to invest money, time, and energy into effective nutrition programs and for developing country governments who have not made fighting maternal and child malnutrition a priority.
As the largest aid donor in the world the United States can play a leadership role in the fight to combat malnutrition. Workable programs can be scaled up and customized for diverse communities around the world. But taking the mantle of leadership requires defining a goal along with strategies and resources to back it up. The Obama administration has pledged to make fighting hunger a core issue in its development agenda. Improving nutrition of women and young children must be part of this fight as well.
Given the impact malnutrition has on economic and human development, it can be ignored no more. To meet the Millennium Development Goals and improve the lives of hundreds of millions of women and children around the world, concerted effort to reduce malnutrition is needed now.
[1] Hoddinott, J., et. al. (Feb. 2008) “Effects of a Nutrition Intervention During Early Childhood on Economic Productivity in Guatemalan Adults.” The Lancet.
[2] World Bank (2006) Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action.
[3] Black, R. et. al. (Jan. 2008) “Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences.” The Lancet.
[4] Horton R. (Jan. 2008) “Maternal and Child Undernutrition: An Urgent Opportunity.” The Lancet.
[5] Bhutta, Z., et. al. (Feb. 2008) “What Works? Interventions for Maternal and Child Undernutrition and Survival.” The Lancet.
[6] Ibid.
[7] UNICEF (1991) “Analytical Framework for Maternal and Child Health and Nutrition.”
