EAPRO Meeting on Accelerating Progress to Manage Severe Wasting

Five million children in the East Asia and Pacific Region in 2019 are wasted; 80 per cent of them are under the age of two years. What can be done to address this?

Mueni Mutunga
Improving Policies, Programmes, and Partnerships for Maternal and Child Nutrition in Asia
UNICEF/Pirozzi

Five million children in the East Asia and Pacific Region in 2019 are wasted; 80 per cent of them are under the age of two years. What can be done to address this?

This was the central question that 50 participants from nine countries and UNICEF offices came together to answer in Bangkok in June 2019.

Government partners from Indonesia, Malaysia, Philippines, Vietnam, Myanmar, Cambodia, Lao PDR, Timor Leste, and Papua New Guinea gathered together with UNICEF nutrition experts to discuss  Accelerating Prevention and Treatment of Severe Acute Malnutrition (SAM) in East Asia and Pacific. 

Participants took stock of progress; explored programme strategies; defined priorities and identified gaps on the prevention and treatment of SAM. 

Wivina Belmonte, UNICEF East Asia and Pacific Deputy Regional Director, highlighted that the status quo on wasting in the region cannot remain, “The statistics are both sobering and stark”. Wasting in East Asia and Pacific is not just a problem in rural areas, for the poor and in humanitarian contexts. It affects everyone; the poor and rich in both rural and urban areas. 

Across the region, there are almost 5 million severely wasted children under the age of 5 years. Eighty per cent of whom are under two years old and 3 per cent of children are both wasted AND stunted. 

Mueni Mutunga, UNICEF East Asia and Pacific, Nutrition Specialist presented the current burden of severe wasting for the region and stressed that many of the risk factors are the same as those for stunting, as are the responses. The tragedy is further aggravated in that wasted children often become stunted perpetuating the cycle of chronic malnutrition and its dire consequences for individuals, communities and economies. It is thus imperative to not only scale up interventions to address severe wasting, but also to integrate the treatment of severe wasting commonly known as SAM into ongoing nutrition activities. 

The eight countries (Indonesia, Philippines, Vietnam, Myanmar, Cambodia, Lao PDR, Timor Leste,  and Papua New Guinea) that participated in the first discussion in 2015, have made progress by including the management of SAM as part of their national maternal and child health policies, a step in the right direction, yet much more remains to be done.

All the countries  that partipated in the meeting, including the newly joined Malaysia team, are falling short of the World Health Assembly/SDG target for wasting. The treatment for severe wasting remains low and is declining while the burden is increasing. Between 2017 and 2018, there was a 25 per cent decline in the total number of children receiving treatment. Only 1.5 per cent of children with SAM were treated.

wasting graph
unicef

Participant countries took stock of their current prevalence of wasting and presented their national targets towards meeting the World Health Assembly/SDG targets on wasting. Countries reviewed progress and set objectives to accelerate interventions to address wasting. 

meeting participants
UNICEF EAPRO

Country experiences in addressing severe wasting in East Asia and Pacific

The Philippines shared how they effectively used their experience in treating SAM during emergencies highlighting the need to integrate SAM treatment into mainstream health programmes. 

Representatives from Cambodia talked about the development of a locally produced ready-to-use therapeutic food (RUTF), made with fish powder, that was found to be effective and acceptable as imported RUTFs. 

Lao PDR shared their experience on developing and integrating pre-service training modules on SAM into the national nursing curriculum. 

Papua New Guinea talked about it’s journey in integrating measurement of Mid-Upper Arm Circumference into clinical consultation forms and management of SAM into health supervision and monitoring checklists.  

puzzle
unicef

Countries used a puzzle to spark ideas and discussions to take specific actions, ultimately providing a road map to reach their identified goal in expanding accesses to treatment services for SAM. Each participant then presented their central objective and key action to expand access to treatment services for SAM. 

Saul Guerrero, UNICEF Headquaters, Nutrition Specialist, shared suggested commitments with participants, these responded to the question “What can we do to accelerate progress towards Wasting Targets in the East Asia and Pacific Region?”. The commitments are based on key messages that emerged from discussions and will help provide a framework for accelerating progress towards the SDG goals on wasting.

Ten commitments on accelerating prevention and treatment of wasting in East Asia and Pacific

  1. We will develop national targets for wasting to drive progress in line with our national SDG targets on wasting.
  2. We will move the prevention and curative agendas for wasting as a single agenda.
  3. We will mobilize enough and sustainable financing to achieve wasting SDG goals; ensuring that our financing agenda is driven by our service targets, not the other way around.
  4. We will build and support decentralized capacity to detect and manage wasting for frontline health workers.
  5. We will strengthen the capacity of our health systems to tackle severe wasting for what it is: a pediatric disease.
  6. We will collect the essential data we need to drive programming for wasting.
  7. We will ensure the sustainable availability of supplies for treatment of severe wasting by integrating it into national essential (medicine/commodity) lists.
  8. We will build national humanitarian preparedness capacity to ensure services are prepared for, and can adapt to, disaster and climate change.
  9. We will mobilize national champions to help position wasting as a critical health and nutrition priority. 
  10. We will commit to documenting and sharing our country experiences and learn to prevent and treat wasting across the region.

Lastly, Christiane Rudert, UNICEF East Asia and Pacific, Regional Nutrition Adviser, reminded participants of the good progress in making prevention and treatment of severe wasting part of national child health policies. She challenged everyone to commit to demanding more from governments, donors and other stakeholders, to accelerate progress in addressing wasting in the region. 

Key Takeaways

  • East Asia can be a leader in integrating SAM treatment into health services.
  • Progress is being made but not enough, and for the most part, its not at scale. 
  • Stronger advocacy is needed to focus more attention on SAM and leverage investments and commitments on stunting reduction.
  • We need to go beyond “train and hope” approach to build skills and capacity to treat SAM for frontline health workers.
  • Humanitarian responses can provide the evidence needed to sustain and integrate SAM treatment after the recovery period.
  • The prevalence of wasting will not go down on its own. Stunting reduction does not equal wasting reduction, and increasing income does not equal improvements in wasting’.