“Globally, 1 in 5 deaths among children under the age of 5 is attributed to severe wasting – also known as severe acute malnutrition – making it one of the top threats to child survival, robbing the lives of more than 1 million children each year.” (Child Health Alert 2022)
Wasting is when a child is too thin for their height. It is caused by a lack of nutritious food and repeated disease, including diarrhoea, malaria and measles. Severe wasting can result in death, but even for those children who survive there are lifelong effects on physical and mental development.
In East Asia and the Pacific, it is estimated that 1.7 million children were at risk of severe wasting with an estimated increase of 500,000 children in 2020. The Safeguarding Children’s Access to Good Diets, Services, and Practices in East Asia and the Pacific during the COVID-19 Pandemic: An Overview of UNICEF’s Nutrition Response report describes some of the impacts of the pandemic on malnutrition and some of the innovative responses put in place.
The full impact of COVID-19 on malnutrition is unknown and, more recently, UNICEF has issued a Child Health Alert: Severe Wasting, An Overlooked Child Survival Emergency, calling attention to the rapidly mounting cases of severe wasting and emphasizing the urgency of finding ways to address this alarming situation: “The global hunger crisis owing to COVID-19 and precipitated by the conflict Ukraine is pushing one child into severe malnutrition every minute in 15 crisis-hit countries." (UNICEF global press release, 2022)
Simplifying the management of child wasting
Early in the pandemic essential nutrition services were reduced by more than 30 per cent in the region. Management of child wasting involves health workers finding children in their homes, communities and clinics before they become too sick. Home visits and weekly visits to clinics by families to receive therapeutic foods were almost stopped following COVID-19 containment measures. To make sure these vulnerable children were reached, UNICEF and governments in the region accelerated the adoption of ‘simplified approaches’ for the detection and treatment of child wasting.
‘Simplified approaches’ refer to a range of modifications to wasting assessment and treatment protocols to improve coverage, particularly in highly vulnerable contexts, including shifting treatment to the community, where possible.
UNICEF East Asia and Pacific supported the development of guidance, operating procedures, online trainings and webinars. Two examples, include:
Mother or family MUAC (mid-upper arm circumference)
The MUAC tape is an easy way of assessing a child’s nutrition status by measuring the arm. Parents are trained to measure MUAC, leading to earlier detection of faltering growth and seeking treatment, more family involvement and, in the case of COVID-19, less direct contact and risk to health workers.
In Indonesia, UNICEF piloted ‘Mother MUAC’ in three districts, with some 65,000 out of 170,000 children under the age of five screened by their mothers. An online training and counselling tool (using a WhatsApp-based chatbot, videos and visuals for low literacy mothers) was piloted to demonstrate how to use the MUAC tapes.
Myanmar adopted MUAC-only screening and shifted this to the community, giving mothers a MUAC tape and simple training. In the Philippines, ‘Family MUAC’ was introduced in three provinces with more than 17,000 mothers and caregivers trained. In Timor-Leste, Family MUAC was scaled up nationally during the pandemic and UNICEF developed pictorial instructions for low literacy areas, distributing them with MUAC tapes. Mothers reported feeling empowered to monitor their children’s nutrition status.
Involving Community Health Workers
Another key change was to enable key tasks in caring for children with wasting to be undertaken by community workers who work directly in communities and are more accessible to families rather than health facility-based workers which involves families walking to their closest health centre. These changes were conducted in Indonesia, Philippines and Timor-Leste enabling many children to receive lifesaving therapeutic foods and medicines in a timely manner.
Many other changes were made using social media and popular figures* to pass messages about healthy eating, exercise and the importance to continue to breastfeed babies and give the right first foods.
These changes are essential to saving more and more children who are wasted and to preventing others becoming sick and losing weight. Lessons learned during COVID-19 can be refined and continued in the future. Making procedures and messages simpler and more practical to health workers and families alike, mean the lives of many more children can be saved and suffering averted.