Child nutrition in Eswatini
Stunting, which is a sign of chronic malnutrition, is a serious problem in Eswatini, with the under-five population is estimated at 150,643 (13.3 per cent) of the total population, 25 per cent of children under the age of five being short for their age, estimated 60,257 children are stunted. Lubombo and Shiselweni region have the highest rates of stunting, with 28 per cent of children under 5 years stunted in Shiselweni. The highest rates being among children aged 18 to 23 months (35 per cent). However, stunting rates have been on a decline from 30.9 per cent in 2010 to 25.6 per cent in 2014 and 23 per cent in 2017.
As stunting rates show declining trends in three regions, the rates are rising in Manzini region (24.9 per cent in 2017) which could be linked to low excusive breastfeeding rates. The stunting rate also varied from 30.2 per cent in the poorest households to 9.2 per cent in the richest and is higher in rural areas than urban areas. Gender disparities are also evident as boys have higher stunting rates than girls (29.2 per cent and 21.2 per cent) (2014 MICS).
The country’s nutrition situation was significantly affected by a severe El Niño drought experienced in 2015/16 which impacted food security such that minimal dietary diversity was only 13 per cent, minimal meal frequency fell from 81.2 per cent to 76.3 per cent, and minimal acceptable diet fell from 39.2 per cent to 9.7 per cent. The regions with the highest projected proportion of people vulnerable to food insecurity were Lubombo (35 per cent) and Shiselweni (28 per cent).
Acute malnutrition is another challenge faced by the country. Wasting (low weight-for-height) prevalence was 2 per cent in 2014 but slightly increased to 2.5 per cent in 2017 (NDMA, 2017). Hhohho region is the most affected by wasting as the rate increased from 1.5 per cent to 3.2 per cnet during the same period. The country has rolled out the integrated management of acute malnutrition in all regions, to 41 health facilities. According to MICS 2014, and 2017 MoH administrative data, underweight prevalence has remained around 6 per cent (5.8 per cent MICS estimate and 6.3 per cent MoH estimate) showing no improvement over the past decade. This might be linked to the declining trends in exclusive breastfeeding observed from 63.8 per cent in 2014 to 58 per cent in 2018. Overweight and obesity for children under 5 years are reported slightly more prevalent in urban areas (11.6 per cent) than in rural areas (8.2 per cent), with Hhohho being the region with the highest prevalence.
Impact of Climate Change and Nutrition in Eswatini:
During the 2016/2017 rainfall season Eswatini Experience the worst drought in over 15 years influenced by The El Niño phenomenon. The Consequences of this drought have evident in the country over the past three years. The drought significantly decreased crop production killed livestock and devastated livelihoods throughout the country. An estimated 300,320 people were in need of immediate food assistance throughout the country. The hardest hit regions in the country were Lubombo and Shiselweni, where over 165,000 children are affected. Water shortages were widespread throughout the country, leaving vulnerable communities exposed to water-borne diseases. The drought further exacerbated levels of vulnerability among the population which are compounded by chronic food insecurity, high rates of HIV/AIDS, poverty and protection concerns, including gender-based violence (GBV).
Annually, an average of 2,640 children with SAM access treatment with 78 per cent recovery rates and less than 20 per cent fatality rates. It is highly likely that with the prolonged drought there will be increased malnutrition especially among children, pregnant and lactating women. The Multiple Indicator Cluster Survey (MICS) 2014, reported wasting level at 2 per cent and the April 2016 rapid nutrition assessment showed a 3.1 per cent wasting prevalence which is within the WHO 2000 threshold of 5 per cent for acceptable nutritional severity. At the same time, pockets of elevated malnutrition prevalence exist in Lowveld areas of Hhohho, Lubombo and Shiselweni (from Health and Nutrition Assessment, April 2016).
In the most affected regions of Lubombo and Shiselweni, thousands of children are at serious risk of malnutrition and diarrhoea, among other illnesses. An estimated 8,460 children 6-59 months are affected by acute malnutrition (Severe acute malnutrition 1,410 and moderate acute malnutrition 7,050.
Compared to the 2018 VAC, in 2019 chronic malnutrition seems to have increased by 5 percentage points, with stunting at 21 per cent and 26.3 per cent in the respective years. Within the prevailing conditions and poor rainfall harvest will be affected increasing the food insecurity signify a possible increase in stunting in early 2020.
More than 50 per cent of children 6-23 months do not meet the minimum acceptable diet (MICS 2014). In addition, two thirds of children 6-23 months old who are not breastfeeding do not receive the minimum acceptable diet. The rate for Exclusive Breast Feeding (EBF) is currently 63.8 per cent, from MICS 2014 data.
An assessment of nutrition supplies revealed a lack of Ready to Use Therapeutic Food (RUTF) at national central medical stores. In 2016 to 2018 UNCIF supported the procurement of Malnutrition Treatment feeds due to the fiscal space in the country which is observed to be on the decline.
Economic Impact of Malnutrition:
The Swaziland Hunger Study 2013 showed that stunted children have a higher school repetition rate, at 18.9 per cent, than well-nourished children at 14 per cent (NCCU 2013). This resulted in 5,550 additional cases of school grade repetition at a cost of E6.0 million. Stunting is estimated to have cost Swaziland E251 million in lost economic productivity.
The single biggest specific cause of DALYs in Eswatini according to the Cost of Inaction Child Health Study, 2017 was diarrheal diseases which are responsible for 15.2 per cent of all DALYs.
- Strengthening health system enabling environment for nutritional programming
Strengthening enabling environment for multi-sectoral coordination, planning, resources and delivery of nutrition services,
- Advocacy for increased budget for nutrition
- Support Government efforts to coordinate a multi-sectoral approach to scaling up nutrition, focusing on prevention of stunting during a child’s first 1,000 days
- Scaling-up of the Baby-Friendly Hospital Initiative
- Support capacity development and skill building among health workers to deliver quality nutrition services (including IMAM and SAM)
- Strengthening community systems for infant and young child feeding practices
Harnessing individuals, families, communities and civil society capacity to promote, enable and sustain behaviour change related to improved nutrition practices, infection prevention and Positive Sanitation and Hygiene Practices through community led total sanitation
- Scaling-up young child feeding practices interventions
- Support capacity development and skill building for community health workers to provide quality nutritional services
- Improving data management systems
Build a robust monitoring and evaluation system to inform and guide programme design and implementation and demonstrate impact on nutrition
- Enhance surveillance system for nutritional monitoring
- Strengthen community monitoring of nutrition
- Nutrition in Emergencies
Increase access and utilization by women and children of nutrition specific and sensitive interventions (including infection prevention) delivered across multiple sectors and platforms, and during times of emergencies
- Support national assessments, planning, and implementation during emergencies for nutritional cluster
- Advocate for allocation of adequate budget to enable procurement of essential equipment and tools for provision of MNCH and nutrition services
- Support recovery plans for nutritional interventions post emergencies