Undernutrition is one of the most serious but also most neglected problems in public health and development. It causes 45 per cent of all deaths among children under the age of 5 years in low and middle income countries. Undernutrition also increases the risk of infectious diseases and impairs mental and physical impairment among children.
In West and Central Africa (WCAR), each year an estimated one million children under the age of five years die from causes related to undernutrition. Among the 15 countries in the world with the worst under 5 mortality statistics, 11 are in WCAR. The prevalence of child stunting is also very high, and equals or exceeds 40% in 8 countries within the region.
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Forms of child undernutrition
There are different forms of child undernutrition. They include being too short for one’s age (stunting), dangerously thin for one’s height (wasting), and underweight for one’s age (composite form of undernutrition that includes elements of stunting and wasting). Deficiencies in vitamins and minerals (micronutrient deficiencies) are another form of undernutrition.
Stunting, or chronic malnutrition, indicates a failure to achieve one’s genetic potential for height. Once children are stunted, it is difficult for them to catch up in height later on. Stunting is an important predictor of poor child development and survival and may also lead to negative long-term negative consequences.
Wasting increases a child’s risk of dying; in its severe form it increases a child’s mortality risk by nine times as compared to children who are not undernourished. The presence of edema also marks a child’s heightened vulnerability of dying, and is commonly tracked alongside wasting through the indicator Global Acute Malnutrition (GAM).
Micronutrient deficiencies include deficiencies of vitamin A, iron, iodine, zinc and folic acid. These deficiencies can impair child health and lower the survival, growth and development of children.
WCAR has some of the highest prevalence estimates of these forms of undernutrition in the world:
Causes of child undernutrition
The immediate causes of undernutrition, inadequate intake and infections, are influenced by three broad factors: food, health and care. Optimal nutritional status results when children have access to affordable, diverse, nutrient-rich food; appropriate maternal and child-care practices; adequate health services; and a healthy environment including safe water, sanitation and good hygiene practices.
During the first six months of life, an infant who is not breastfed is more than 14 times more likely to die from all causes than an exclusively breastfed infant. Unfortunately, non-exclusive breastfeeding in the first 6 months of life is common in WCAR (figure 4).
With regard to stunting, the main causes include inadequate nutrition to support the rapid growth and development of infants and young children, and frequent infections during early life. Stunted mothers are in turn more likely to give birth to low birthweight babies, perpetuating an intergenerational cycle.
The main cause of anemia is iron deficiency. Parasitic infections like intestinal worms and malaria can also cause anemia or worsen it.
Beyond these underlying factors, basic causes of undernutrition are multiple: poverty, inequity, low maternal education, women’s social status and other social and cultural factors.
Reductions in stunting and other forms of undernutrition can be achieved through proven interventions. These include improving women’s nutrition; early and exclusive breastfeeding; timely, safe, appropriate and high-quality complementary food; appropriate micronutrient interventions; promotion of good sanitation practices and access to clean drinking water; prevention and treatment of severe acute malnutrition; promotion of healthy practices and appropriate use of health services. These interventions should focus on the critical 1,000-day window that spans from pregnancy to the first two years of life.
These nutrition-specific interventions are ideally complemented by contributions from the agriculture, social protection, early child development and education sectors to improve child nutrition. These so-called nutrition sensitive programs have enormous potential to enhance the scale and effectiveness of nutrition-specific interventions. The coordination of these nutrition interventions and nutrition-sensitive interventions are necessary to build the foundation for a healthy, more prosperous future and resilience in times of crisis.
Nutrition is undeniably central to the resilience agenda, particularly in regions such as the Sahel. There is a recognized need to build resilient systems to address the basic, underlying and immediate causes of undernutrition, to promote and protect good nutrition at all times, and to maintain nutritional status during periods of stress. In this regard, UNICEF supports the regional initiative AGIR (l’Alliance Globale pour l’Initiative Résilience au Sahel) and helps to mainstream nutrition in its agenda.
The global nutrition community is uniting around the Scaling Up Nutrition (SUN) movement, which supports nationally driven processes for the reduction of stunting and other forms of undernutrition. Countries participating to the SUN movement are putting the right policies in place, collaborating with partners to implement both specific nutrition interventions and nutrition-sensitive approaches, and mobilizing resources to effectively scale up nutrition. Among the 41 SUN countries worldwide, 15 are from WCAR.
As a further sign of commitment to nutrition in WCAR, the Assembly of Health Ministers of the Economic Community of West African States called on Member States and Partners in 2009 to accelerate efforts to address undernutrition in the region, with specific actions in the areas of capacity building, vitamin A supplementation for child survival, infant and young child nutrition and integrated management of acute undernutrition.