Reduce stunting

Chronic malnutrition will result in stunting – an irreversible condition that literally stunts the physical and cognitive growth of children.

A mother breastfeeds her 4-month-old baby
UNICEF/UN0228416/Imbabazi

Challenge

While the number of stunted children worldwide has fallen from 255 million to 156 million over the past 25 years, the Eastern and Southern Africa region accounts for an increasing share of the global total.

Stunting can have a detrimental impact on a child’s development, and high levels over sustained periods of time can negatively impact a country’s economic outlook.

Stunting, or low height for age, is an indicator of chronic undernutrition. Stunting is caused by inadequate intake of nutritious food, frequent illnesses such as diarrhoea and intestinal worms, poor care practices, and lack of access to health and other essential services, especially in the first 1,000 days of a child’s life. In addition, a mother’s own health and nutrition have an impact on the baby’s nutrition.

Food insecurity among households living in poverty, especially in emergency-prone countries, contributes to high prevalence of severe acute malnutrition and higher risk of death and stunting in children. An estimated 1.8–2 million children aged 6–59 months need treatment for severe acute malnutrition in Eastern and Southern Africa every year. Ethiopia, Madagascar, Mozambique, Somalia, and the United Republic of Tanzania are among the countries with a high burden of both stunting and severe acute malnutrition.

Contrary to global trends where the number of stunted children has been declining over the last 25 years, in Eastern and Southern Africa the number of stunted children has risen from 23.6 million to 26.8 million in the same period, due to slow rates of stunting reduction and a quickly expanding child population.

A toddler has her mid-upper-arm circumference measured
UNICEF/UN022074/Ayene
28-month-old Nebila has her mid-upper-arm circumference measured by a Health Extension Worker in Ethiopia as she sits in the lap of her 12-year-old sister. Nebila was diagnosed with severe acute malnutrition and has been receiving treatment including ready-to-use-therapeutic food (RUTF).

Ten countries – Angola, Burundi, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, South Africa, Uganda, and the United Republic of Tanzania – account for more than 80 per cent of stunting in the region. In most countries, boys are more likely to be stunted than girls, and children from the poorest families are nearly twice as likely to be stunted as those from the richest. Children of adolescent mothers are also more likely to be malnourished and stunted.

The proportion of children aged 6–23 months receiving the minimum acceptable diet is low in the region, ranging from 3 per cent in Madagascar to 39 per cent in Kenya.  Micronutrient deficiencies – for Vitamin A, iodine, iron and zinc – particularly affect infants, young children and pregnant women in low-income households. 

While many countries have made progress in reducing stunting, the average annual rate of reduction is slower than population growth, and below the 3 per cent required to achieve a 40 per cent reduction in stunting by 2030.

It is estimated that 36 per cent of households in the region do not have access to adequate sanitation; 14 per cent practice open defecation; and 19 per cent do not have access to an improved water source, leading to a higher incidence of diarrhoea, and worms and other intestinal infestations, and contributing to high stunting prevalence. Improving basic service levels for drinking water and sanitation, reducing open defecation, ensuring the safe disposal of child faeces, and promoting good hygiene practices are critical steps to help reduce the risk of diarrhoeal and intestinal diseases.

In addition, the Water, Sanitation and Hygiene situation is particularly difficult for women and girls, who are frequently responsible for time-consuming, laborious and sometimes risky water collection, in addition to menstruation, caring for others, and cultural practices that restrict when and where they can access sanitation facilities. 

Solution

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Maternal, infant and young child nutrition, and micronutrient supplementation

UNICEF is scaling up quality community and health-facility-based interventions to improve maternal nutrition, and infant and young child feeding practices. Strong policy advocacy in support of frameworks to promote exclusive breastfeeding and laws protecting maternity and paternity leave can contribute to improved infant nutrition. Integrated approaches can facilitate uptake of multiple micronutrient powder and Vitamin A supplementation, which is why UNICEF uses occasions such as Child Health days to ensure that each child gets the complete package.
  

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Management of severe acute malnutrition and nutrition in emergencies

Identifying and treating cases of severe acute malnutrition in time are key to a child’s chances of recovery. UNICEF works around the clock to support partners in systematic screening and active case finding at community level, reinforcement of referral systems for complicated cases, quality of severe acute malnutrition management, and better linkages with management of infectious diseases. In emergencies, UNICEF acts fast to ensure systematic implementation of nutrition protocols in line with the Core Commitments for Children in Humanitarian Action.
  

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Water and sanitation in communities

UNICEF convenes nutrition and water and sanitation stakeholders around a common aim of significantly improving social and personal behaviour change for hygiene, as well as societal-level awareness raising and collective learning. UNICEF believes that strengthened coordination and collaboration among key partners will ensure maximum synergy in the delivery of interventions, targeting areas with high levels of acute malnutrition and/or stunting (including emergency situations).
  

A child receives ready-to-use therapeutic food (RUTF) from a UNICEF-supported Out-Patient Therapeutic (OTP) site near the town of Aweil in South Sudan.
UNICEF/UN034405/Rich
UNICEF is providing therapeutic food and medicine to treat children with severe acute malnutrition (SAM), as well as the training of health workers to identify, treat and manage SAM cases.