Aiming for zero undernourished children

Monalinda Cadiz
About 3 million children worldwide die of undernutrition each year before they reach their 5th birthday. Can we end this pattern?

FEEDING. Feeding programs for children may not be sustainable in the long-term. EPA file photo

MANILA, Philippines – About 3 million children worldwide die of undernutrition each year before they reach their 5th birthday. 

Undernutrition occurs primarily because of hunger. 

Lancet, a medical journal, reported in 2013 that the death of 45.4% of children under 5 is attributable to nutritional disorders – specifically growth restriction, suboptimum breastfeeding, stunting, wasting, vitamin A and zinc deficiencies.    

Those lucky enough to survive would still have compromised cognitive development and physical abilities. 

Preventable

The United Nations Children’s Fund (Unicef) defines undernutrition as the outcome of insufficient food intake and repeated infectious diseases. (READ: Stunted, wasted children)

Undernutrition puts children at a greater risk of death from common infections, increases the frequency and severity of illnesses, and delays recovery. 

The interaction between undernutrition and infections can create a lethal cycle of worsening illness and deteriorating nutritional status. 

Factors affecting the nutrition of a child include household food insecurity, inadequate care and feeding practices, and unhealthy household environment and inadequate health services. (READ: Dimensions of food security)

The World Health Organization (WHO) suggested that actions should target the different causes of undernutrition to reach sustainable change. This requires a multisectoral approach.

The causes and solutions to undernutrition presents it as a preventable condition. Among these solutions are essential nutrition practices which are effective, feasible, available and affordable. These simple and available solutions include:

  • Exclusive breastfeeding for 6 months
  • Adequate complementary feeding starting at 6 months with continued breastfeeding for two years
  • Appropriate nutritional care of sick and malnourished children
  • Adequate intake of Vitamin A and iron for women and children
  • Adequate intake of iodine by all members of the household

Lack of commitment 

The Food and Agriculture Organization (FAO) has observed that hunger and undernutrition are among the most persistent global development challenges. 

Insufficient progress has been made towards achieving Millennium Development Goal 1 (MDG) –  the global commitment of nations to eradicate poverty and hunger by 2015, including the reduction of child undernutrition. 

For instance, the number of undernourished people has remained unchanged at 870 million for the past 5 years. FAO said that the lack of political will and political prioritization are among the reasons behind this slow progress. 

Such commitments are reflected by decisive public action, policies, programs, public spending, and legislation that tackle the twin problems of hunger and undernutrition. 

The Global Strategic Framework for Food Security and Nutrition identified the following causes of hunger and malnutrition:

  • Lack of good governance to ensure transparency, accountability and rule of law
  • Lack of high-level political commitment and prioritization of the fight against hunger and malnutrition
  • Lack of coherence in policymaking 
  • Lack of prioritization of policies, plans, programmes and funding to tackle hunger, malnutrition and food insecurity
  • War, conflict, lack of security, political instability and weak institutions
  • Weak international governance for food security and nutrition

MDGs

Of almost 200 nations around the world, 34 countries account for 90% of the global burden of malnutrition. The Philippines is one of them. (READ: PH Hunger in numbers)

The collaborative Hunger and Nutrition Commitment Index (HANCI) report ranked the Philippines 6th out of 45 developing countries based on political commitment to tackle hunger and undernutrition. 

Despite the high commitment, however, the stunting level among Filipino children is high, and hunger and undernutrition status in general is serious. 

To fulfill MDG 1, the prevalence of undernutrition should be reduced by 6.6% points in 2015, with an average annual reduction of 1.65%. 

Unicef reported that the Philippines has shown insufficient progress in reducing the number of underweight children since 1990. It identified 4 underlying drivers of undernutrition in the Philippines as: 

  • Poverty: 27% of Filipinos live below the ASEAN poverty line of roughly P55
  • Natural disasters and armed conflicts
  • Rapid urbanization: poverty driving people to cities and proliferation of squatter slums)
  • Mismatch between national and local policies and strategies: highly devolved supply and policies and services

Closely linked to MDG 1 is MDG 4 – reduction of child mortality by two-thirds – wherein Philippine commitment has had slow progress.

First 1,000 days

The Philippine Plan of Action for Nutrition (PPAN) is the government’s framework to achieve nutritional adequacy to improve the quality of life of Filipinos from 2011-2016. PPAN’s proposed strategies relate to governance – policy, plan and program formulation and coordination, monitoring and evaluation, research, and policy advocacy. 

The first 1,000 days in the life of a child is described as the window of opportunity to provide the best nutrition for optimum growth and development.  It is also the most crucial development stage of a child when undernutrition would have an irreversible impact on the child’s cognitive and physical development.  

Interventions for child nutrition does not appear too complicated. Foremost is optimum infant and young child feeding practices to reduce the prevalence of underweight and stunted under-5 children. 

PPAN promotes exclusive breastfeeding for the first 6 months of life, as well as the introduction and use of calorie, nutrient dense, and safe solid and semi-solid foods with continued breastfeeding in various settings – the home, rural health units, barangay health stations, birthing facilities, formal and informal workplaces.   

Lancet has stressed that breastfeeding can save up to 13% of children’s lives, and complementary feeding, up to 6%.      

Community-based management of malnutrition

PPAN also suggested the adoption and implementation of appropriate guidelines for the community-based management of acute malnutrition to reduce the prevalence of wasted under-5 children.  

This is particularly useful in disaster situations when the cases of acute malnutrition is on the rise because displacement affects the feeding habits of infants and young children.

In disaster situations, breastfeeding and complementary feeding practices are all the more necessary to prevent acute malnutrition. 

Pregnant women

According to PPAN, the integration and strengthening of nutrition services in ante-natal care services is important to reduce the prevalence of nutritionally-at-risk pregnant women.

Undernutrition is a cyclical problem – an undernourished mother may bring up an undernourished child who might one day become an undernourished mother herself. 

Educating pregnant mothers about their own nutrition, and preparing them for breastfeeding are important so that they will able to provide the best first nutritional source for their newborns. 

Other strategies include micronutrient supplementation of pregnant mothers and infants beyond 6 months old, increase of food supply at the community level, and economic access to the available food supply to decrease the percentage of Filipino households with inadequate calorie intake. (READ: Hunger and pregnancy)

Nutrition, a smart investment  

Unicef cited the multiple benefits of eliminating undernutrition in young children: 

  • Boosts Gross National Product (GDP) by 11%
  • Improves school attainment by at least 1 year
  • Increases wages by 5%-50%
  • Reduces poverty since well-nourished children are 3% more likely to escape poverty as adults
  • Empowers women to be 10% more likely to run their own business

In the long run, undernutrition reduces a nation’s economic advancement by at least 8% because of direct productivity losses, losses via poorer cognition and reduced schooling. – Rappler.com

Monalinda Cadiz is an advocate of children’s health. She is a development worker and communicator for the Child Health Now Campaign, World Vision’s first global campaign on a single issue: decrease child deaths from preventable causes.