Under-nutrition is not merely the result of poor food intake, in terms of quantity and quality, but also of illnesses. For the body to use nutritious food effectively also requires optimal health care, and access to safe water, hygiene and sanitation. This is particularly important for the most vulnerable groups, pregnant and breastfeeding women, children under two years of age and children under age of five who are suffering from infectious diseases such as HIV.
There is well established evidence that a lack of key vitamins and minerals in the diet such as iodine, iron, vitamin A, and folate, cause still births, miscarriages, mental and growth retardation, physical weakness, blindness, and increase the risk of diseases and ultimately death. When nutritional deprivations occur early in life, from conception up to two years of age, children will stop growing and become stunted (low height for age).
Stunting, also referred to as chronic malnutrition, has long term debilitating effects: Children who are stunted are at greater risk of illness and death, and those who survive are more likely to perform less well at school. If children experience weight loss or "wasting" (low weight for height), they are suffering from acute malnutrition. Underweight is a composite measure of both stunting and wasting. Unlike wasting and underweight, stunting past the age of two is irreversible. Plus, almost twice as many children are affected by stunting than by underweight.
In Eastern and Southern Africa, under-nutrition is a major underlying cause of the persistently high child mortality, contributing to more than a third of all deaths among children under five years of age. The figures are startling: 9.3 million children under five, or 15 percent of all children that age group are underweight, while 24 million, or 39 percent suffer from stunted growth.
Severe acute malnutrition (SAM) is the most advanced stage of malnutrition and the most threatening one to a child’s life. Studies have shown that mortality among children with severe acute malnutrition is five to 20 times higher than for well-nourished children. Without adequate treatment, between 30 to 50 percent of children with severe acute malnutrition will die. Four countries - Ethiopia, Madagascar, Kenya and Somalia - account for more than 60 percent of the region’s cases of severe acute malnutrition.
Ethiopia alone accounts for 35 percent of all cases in the region. Throughout Eastern and Southern Africa, children living in rural or from the poorest households are more susceptible to malnutrition. In Eritrea, for example, the prevalence of malnutrition for children under five years is 40 percent in rural areas and 23 percent in urban areas; while in Somalia the figure is 42 percent for children from the poorest 20 percent of the population, and 14 percent for the richest 20 percent.
Priority Nutrition ActionsThese are now widely accepted Priority Nutrition Actions, drawn from the recommendations made by Bhutta, et al. (2008) in the medical journal The Lancet (see graph). These correspond to the key interventions that are needed to prevent and treat under-nutrition.
Exclusive breastfeeding is the best start in life for every baby. According to a recent study published by The Lancet, exclusive breastfeeding is one of the single most effective interventions to combat child mortality. There is also evidence to suggest that early breastfeeding within the first hour of life can significantly reduce neonatal mortality.
Appropriate complementary feeding (timely introduction, safe and adequate amounts) with continued breastfeeding for up to two years is critical for children’s optimal growth and development. However, three countries in the region – South Africa, Somalia, and Angola - have breastfeeding rates of less than 20 percent. Across all the countries in the region, animal source foods, which have shown to be valuable in addressing micronutrient deficiency and stunting in young children in developing countries, and fruits and vegetables, contribute the least to complementary foods dietary intake of infants.
Another key intervention is vitamin A supplementation, which can help to strengthen children’s immune system and reduce child mortality by 23 percent. With a regional vitamin A supplementation (VAS) coverage of 80 percent, at any given time, some 14 million children in the region have not received enough vitamin A.
Apart from brain damage, iodine deficiency can cause learning disabilities and stunting, and significantly increases the risk for pregnant women of stillbirth and miscarriage. Salt iodization has proven to be most effective in reducing the risk of iodine deficiency. Five countries in Eastern and Southern Africa have achieved universal salt iodization, but still 159 million people including 6 million newborn children remain at risk of iodine deficiency.
UNICEF in Action
Proper nutrition is key to help children grow healthy and develop their full potential. In its programmes, UNICEF aims at scaling up and sustaining coverage of high-impact interventions in the three key areas:
Infant and Young Child Feeding, including in the context of HIV/AIDS
While infant feeding practices need to be strengthened overall, increasing the rates of early initiation of breastfeeding and of exclusive breastfeeding is critical to improving child survival and development. Virtually every mother can breastfeed, if given appropriate support, advice and encouragement. Across Eastern and Southern Africa, UNICEF supports mothers in promoting optimal breastfeeding and complementary feeding practices, including for HIV-positive mothers and for children who are exposed to or infected with the virus.
Essential Vitamins and Minerals
Many lives can be saved and improved through a range of cost-effective interventions, including micronutrient supplementation and fortification. To that end, UNICEF is supporting countries to deliver vitamin A supplementation to children 6-59 months through Child Health Days for twice a year, in partnership with Canadian International Development Agency (CIDA), Helen Keller International (HKI) and Micronutrient Initiative (MI). UNICEF is also fostering partnership with the International Council for Control of Iodine Deficiency Disorders, the Global Alliances on Improved Nutrition (GAIN), and Flour Fortification Initiative to support countries on Salt Iodization and the Flour Fortification Initiative, which leverage funding, commitment and innovations for the better essential vitamins and minerals intake of children.Exclusive breastfeeding rates (<6 months) in ESAR (2006-2010)
Integrated management of acute malnutrition
In partnership with the World Health Organization (WHO), UNICEF supports a community-based approach to diagnosing and treating severe acute malnutrition in the region. The Integrated Management of Acute Malnutrition (IMAM) approach involves training health workers and community members in a simple technique to detect malnutrition in children over the age of six months by measuring the circumference of a child’s upper arm. The aim is to identify malnourished children early and refer them to treatment before their health deteriorates dangerously.
For the treatment of severe acute malnourished children, UNICEF provides highly nutritious ready-to-use therapeutic foods to parents and caregivers, so that they can treat their children at home.
Results for children
The ground is being prepared to address under-nutrition with greater force in the region. UNICEF is working with the African Union’s Africa Task Force for Food and Nutrition Development (ATFFND) to raise broader awareness of the problem and leverage commitment and resources to combat the persistently high malnutrition rates in the continent, including Eastern and Southern Africa.
One key area of support is the implementation of the African Union’s regional nutrition strategy, which focuses on policy harmonization, advocacy and coordination; strengthening nutrition capacity; and enhancing nutrition information systems. Increasing number of countries are raising nutrition profile higher in their national agenda with commitment at the highest political level, such as Malawi, Rwanda and Namibia. This is proving instrumental to push the nutrition agenda forward and to use a comprehensive and multi-sectoral approach to effectively address the multiple causes of under-nutrition, an issue that falls under the domain of several sectors, such as health, water resources, social welfare, agriculture, and education.
Promoting and supporting optimal infant and young child feeding practices is taking place through several initiatives. Eight countries in the region have established national legislation or regulatory provisions to protect breastfeeding, based on the International Code of Marketing of Breast Milk Substitutes.
Exclusive breastfeeding rates in several countries in the region have improved by at least 10 percentage points over the last decade. In Zambia, for example, it increased from 10 percent in 1996 to 61 percent in 2009. Notable progress has also been achieved in Kenya, Malawi and Tanzania.
All countries in the region have held bi-annual mass vitamin A supplementation as part of the Child Health Day campaign. The intervention is integrated with other high impact outreach activities such as de-worming, immunization and distribution of insecticide-treated mosquito nets.
In February 2008, UNICEF selected eight priority countries for a campaign to wipe out iodine deficiency by ensuring universal salt iodization. Ethiopia, Tanzania, Angola, Mozambique, Somalia, Malawi, Madagascar and Zambia are home to 5.2 million of the region’s 6 million iodine-deficient infants.
Countries are increasingly recognizing Integrated Management of Acute Malnutrition as part of the minimum core package of nutrition interventions. Nineteen of the 20 countries in the region have begun to build national capacities to scale up this approach.
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