Children as victims
According to recent estimates from the United Nations Food and Agriculture Organization (FAO), approximately 795 million people, or 1 in 9 people globally, experience chronic undernourishment1. The majority of those suffering live in developing nations. In sub-Saharan Africa alone – the region with the highest prevalence of hunger worldwide – 220 million people, or nearly 25% of the population, are undernourished2.
Children are often the most evident and vulnerable victims of malnutrition. Based on the most recent estimates from the United Nations Children’s Fund (UNICEF),approximately 45% of all deaths in children (under 5 years of age) can be attributed to undernutrition3. This statistic results in approximately 3.1 million child deaths each year3.
Malnutrition: a breakdown
Two primary types of malnutrition/under-nutrition are Protein-Energy Malnutrition (PEM) and micro nutrient deficiencies4. A third type – over nutrition (most commonly referred to as overweight/obesity) – has traditionally been considered a “developed world issue”; however, this trend of over nutrition is growing in developing regions of the world5.
Child malnutrition stems from insufficient food quantities, an inadequate balance of nutrient consumption, an inability to consume food, the improper digestion/absorption of nutrientsor medical conditions preventing the utilization of nutrients. The broader societal factors contributing to this type of malnutrition include: poverty, food insecurity (often the result of famine), inappropriate breastfeeding and weaning practices, diets low in energy/protein/fat, infrequent feeding and infections.
In addition to childhood mortality, malnutrition also works to exacerbate other illnesses in children such as malaria, measles and HIV/AIDS (as low nutritional status can deepen immunosuppression)6. Acute or short-term malnutrition can lead to wasting, a condition where an individual’s weight for their height/age is low(approximately 50 million children under five years of age suffer from wasting)3. In contrast, chronic malnutrition often results in stunting, a condition where an individual’s height for their age is low (as of 2014, nearly 25% of children under the age of five globally experience stunted growth)3.
An ever-expanding evidence base shows that malnutrition/under nutrition during a critical window of time (the 1,000 days between a child’s conception and the child’s second birthday) may delay physical growth/motor skill development, impair cognitive development and social skills and lower educational achievement7. Child malnutrition therefore carries long-term consequences into adulthood, negatively affecting an individual’s educational attainment, economic productivity and livelihood, continuing a cycle of inter generational inequality and poverty7.
Common strategies suggested to reduce child malnutrition encompass: improving household food security; improving the quality/safety of available food; protecting health (for example, seeking medical treatment for malnutrition, offering supplementary feeding programs and growth monitoring); and promoting appropriate diets. Studies have recognized simple and cost-effective interventions to preventing and treating malnutrition8.
The case of malnutrition in Ghana
Ghana, a West African nation, has experienced a decade of economic growth, social development and democratic governance, propelling its status to a “lower middle-income country”9. While child deaths in Ghana have decreased considerably, the reduction in child mortality rates is slowing and infant mortality rates are unimproved in the recent years.According to UNICEF estimates, 1 in 12 Ghanaian children under five years of age will die of a preventable childhood illness – with 40% of these childhood deaths attributable to malnutrition10.
Despite economic and social progress, Ghana continues to face serious food security and nutritional challenges, of which the greatest burden is borne by northern regions of the country. Over 1 million Ghanaians are food insecure, and approximately 25% of children under five experience chronic malnutrition9. While the national child stunting rate is approximately 28%, stunting rates in the northern regions of Ghana vary from 25-36%, a situation deemed “serious” by the World Health Organization (WHO)10,11. Although Ghana appears to be advancing rapidly, it is critical to maintain focus on children throughout the country who face poverty, insufficient healthcare access and inadequate nutrition.
Child malnutrition in the post-2015 development agenda
Global efforts have been put forth to reduce unnecessary and preventable child deaths around the world, most notably through the UN’s Millennium Development Goals, or MDGs as they are commonly referred. MDG 4 aimed to reduce the under-five child mortality rate by two-thirds, between 1990-201512. Great progress has been documented towards the achievement of this goal, with the under-five child mortality rate decreasing by more than 50% during this time period12. This translates into a global reduction – from 12.7 million child deaths in 1990, to approximately 6 million child deaths in 201512.
However, the global community recognizes that preventable child deaths (with under-nutrition as one of the leading causes) still pose great personal and societal costs, and exemplify a significant challenge to be addressed in this era. With the initiation of the post-2015 development agenda, the new Sustainable Development Goals (SDGs) represent a profound change from their predecessor, and have placed a renewed focus on combating child malnutrition.
The MDGs incorporated a hunger target under their first goal, with the lone indicator for malnutrition being the proportion of underweight children (moderately or severe) less than five years of age12.Unlike the MDGs previously, this new agenda dedicates an entire goal to “ending hunger, achieving food security, improving nutrition and promoting sustainable agriculture”13. Specifically, targets under SDG 2 intend to end hunger globally by 2030 (ensuring all people – especially the poor and vulnerable – have access to safe, nutritious and sufficient food all year), and end all forms of malnutrition by 2025 (by achieving internationally agreed upon targets on the reduction of stunting/wasting in children under five years of age)13.
However, the SDGs may miss an opportunity to fully address the issue of child malnutrition in their new agenda. It is important to note that while combatting malnutrition is incorporated under SDG2, it is in no way integrated within any other SDG goal or target, specifically SDG target 3.2, “ending preventable deaths of newborns and children under five years of age by 2030”13. This missing component is significant as malnutrition is a leading cause of preventable child deaths. A lack of integration within the SDGs may risk global efforts and action overlooking this critical connection.
Additionally, only 2 of the 6 global nutrition targets set in 2012 by the World Health Assembly (WHA) to address the problem of malnutrition have been incorporated into the SDGs14. This may lead global efforts tofocuson singular actions, rather than the full set of actions, required to improve child nutrition.
Nevertheless, as a successor to the MDGs, the post-2015 development agenda and its SDGs seem to be a leap forward in the fight to improve child nutrition globally.
1Hunger Statistics (2016). World Food Programme. Retrieved April 6, 2016 from https://www.wfp.org/hunger/stats
2 The State of Food Insecurity in the World (2015). Food and Agriculture Organization of the United Nations. Retrieved April 6, 2016 from http://www.fao.org/3/a-i4646e.pdf
3Nutrition: Malnutrition, Current Status and Progress (2015). UNICEF Data: Monitoring the Situation of Children and Women. Retrieved April 6, 2016 from http://data.unicef.org/nutrition/malnutrition.html
4Chapter 8 – Malnutrition and micro-nutrient deficiencies (Agriculture, food and nutrition for Africa: a resource book for teachers of…) (date unknown). FAO Corporate Document Repository. Retrieved April 6, 2016 from http://www.fao.org/docrep/w0078e/w0078e09.htm
5Nutrition: Controlling the global obesity epidemic (2016). World Health Organization. Retrieved April 6, 2016 from http://www.who.int/nutrition/topics/obesity/en/
6Knowledge Summary: Women’s and Children’s Health (2012). World Health Organization. Retrieved April 6, 2016 from http://www.who.int/pmnch/topics/part_publications/KS18-high.pdf
7Early Childhood Development: Nutrition (2011). The World Bank. Retrieved April 6, 2016 from http://go.worldbank.org/DL9AKYWQ70
8Bhutta, Z., Das, J., Rizvi, A. (2013). Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet, 382, 9890. http://dx.doi.org/10.1016/S0140-6736(13)60996-4
9Ghana: Nutrition Profile (2014). USAID. Retrieved April 6, 2016 from https://www.usaid.gov/sites/default/files/documents/1864/USAID-Ghana-Profile.pdf
10UNICEF Ghana (2015). UNICEF. Retrieved April 6. 2016 from http://www.unicef.org/wcaro/Countries_1743.html
1110 Facts About Hunger in Ghana (2015).World Food Programme. Retrieved April 6, 2016 from http://www.wfp.org/stories/10-facts-about-hunger-ghana
12The Millennium Development Goals Report (2015). United Nations. Retrieved April 6, 2016 from http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2015/English2015.pdf
13Sustainable Development Knowledge Platform (2015). United Nations. Retrieved April 6, 2016 from https://sustainabledevelopment.un.org
14Global Targets 2025: Poster (2016). World Health Organization. Retrieved April 6, 2016 from http://www.who.int/nutrition/topics/nutrition_globaltargets2025/en/