Tackling malnutrition in all its forms

Ending hunger and malnutrition by 2030 will require approaches that go beyond targeting only stunting and wasting – agreed the participants of the Nutrition Seminar organised in March by the European Commission in Brussels.

Around the world, more than 800 million people continue to go hungry every day, with 3 million children dying each year of undernutrition-related conditions like stunting and wasting, according to Unicef.

At the same time, the growing rates of overweight and obesity are driving an increase in diseases like cancer, heart disease, stroke and diabetes – particularly in low-income countries.

With nearly one third of the world’s population suffering from some form of malnutrition, achieving the targets of the Agenda for Sustainable Change – and ending hunger and malnutrition by 2030 – will require far more comprehensive and interconnected approaches, said Francesco Branca, Director of Nutrition for Health and Development at the World Health Organization (WHO).

“Key here is the understanding that the different forms of malnutrition share common causes, like inadequate food systems,” he said. “These conditions can also coexist in the same countries, regions or even families – in what we call the double burden of malnutrition – so to tackle them we need much broader interventions.”

One solution, Branca said, could be programmes for increasing exclusive breastfeeding until the age of 2 or beyond.

According to WHO, optimal nutrition during this period plays a fundamental role in lowering morbidity and mortality – and can save more than 800,000 children each year – but babies who are breastfed for the first six months are also less likely to be overweight or obese later in life.

Engagement at all levels

One of the countries faced with the double burden of malnutrition is Kenya. At the national level, 26 percent of Kenyan children under five are stunted, 11 percent are underweight and 4 percent are wasted, according to the Ministry of Health data.

Nevertheless, the East African country is also struggling with high levels of overweight and obesity, affecting one in four women between 15 and 49 years old – with rates as high as 40% in urban areas.

“When it comes to the different forms of malnutrition, Kenya faces all of them,” said Gladys Mugambi, Director of Nutrition at the country’s Ministry of Health. “On the one hand, there are people who consume more than they require, on the other, there are those who don’t have enough to eat.”

Kenya is on track to meeting most of the nutrition targets set by the World Health Assembly for 2025 – having managed to significantly cut the rates of stunting and underweight, among others, according to Mugambi. The percentage of stunting in children, for instance, decreased from 35% in 2009 to 26% in 2014.

A lot of the progress, Mugambi said, comes back to the fact that Kenya has aligned itself with WHO’s global guidance on nutrition. The guidance framework serves as a benchmark for the country, “and we’re doing our best to emulate it at county levels,” she said.

“We’re also working with the Food and Agriculture Organization to finish our food composition tables; Unicef has provided us with guidance on maternal and child nutrition – the support of outside partners is absolutely indispensable.”

Regional cooperation is also important. “We’re looking at our neighbours who are facing similar issues,” Mugambi said. “Each of those countries has made progress in areas we’d like to follow. In Uganda, for example, the coordination is done from the prime minister’s office, while we’re still coordinating everything from the Ministry of Health. In Malawi, on the other hand, they have managed to scale up their agriculture programmes – and we’re looking into how they’ve done it.”

According to Mugambi, tackling malnutrition will require coordination among different sectors, but Kenya has not yet managed to coherently do so across all of them.

“There are areas we still need to improve,” Mugambi said, “but we now have an implementation framework that captures all the various sectors. The framework has defined the responsibilities of each sector, and this has helped us link more – what’s still needed is the actual implementation at county level.”

Mugambi is Kenya’s focal point for Scaling Up Nutrition – a global coalition of countries, civil society, businesses and donor networks. The movement, she said, has helped bring together the various ministries, raising the prospects of successful implementation of the new framework.

“The technical staff from each relevant Ministry are now engaged in planning of nutrition interventions – once we get the high-level leaders involved at the county levels, we will be able to implement more.”

Despite the marked reduction in undernutrition rates, however, the absolute numbers in Kenya have remained largely the same, with the number of stunted children projected to increase from 2.6 million to 2.96 million in 2025.

 “That’s because our population is increasing,” Mugambi said. “To address this, we have to scale up food distribution. But this means, we must also continue raising awareness about correct nutrition if we want to achieve significant results on all forms of malnutrition.”

Long-term commitments

The focus on all forms of malnutrition has led to concrete results in Kenya and elsewhere, but the successes, while important, must not overshadow the fact that progress has not been even across all countries, said Sarah Bernhardt, the nutrition expert at the EU Delegation to Chad.

Located in Central Africa, the landlocked country is facing an uphill struggle in the fight against malnutrition, with more than half of its children affected by the most severe forms of stunting and wasting.

“We haven’t seen much progress – yet,” said Bernhardt. “Whatever nutrition indicators we manage to improve, they quickly go back to very sad levels.”

In 2014, the European Commission set aside 3.5 billion euro to reduce the number of stunted children globally by 7 million over the next decade. The funds have helped jumpstart initiatives across Chad, Bernhardt said, “but there is still a lot of frustration, because we haven’t been able to move at the right pace”.

As one of the poorest countries in the world – and with climate change, armed conflicts and an ongoing economic crisis exacerbating the situation – many factors have impacted the lack of results in Chad.

“Some of them are out of our control,” Bernhardt said. “Others we could be doing a much better job on, like improving education, gender equality, but even vaccination and breastfeeding rates.”

More also needs to be done on awareness raising. “In many parts of the country, stunting is not really considered an issue – both by parents and health professionals – because when you’re focused on saving your child’s life, you’re much less concerned about what might happen to their health 20 years down the road,” Bernhardt said. “But we cannot forget that malnutrition comes in many different forms, so we have to improve how we educate the population about the long-term consequences.”

Despite the challenges, Bernhardt remains hopeful. “Recently, we’ve had some success with budget support in creating a leverage for political dialogue on determinants of malnutrition. I’m also sure that in the next five, 10 years the EU and others will come up with new and improved approaches for the general development of the country,” she said.

“But nutrition is an area where you focus on generational changes – and this requires long-term investment. One day, Chad will be able to have its very own nutrition budget and take the initiative into their own hands. We know that results will eventually come – we just have to be committed and patient.”

This article was written by Bartosz Brzezinski, Capacity4dev's Editorial Coordinator, with input from Unit B4 at DG DEVCO.