Preventing childhood malnutrition is the most cost-effective public health intervention for child survival and development.
Malnutrition in all its forms remains a major challenge in The Gambia. Many children, especially in rural areas, are poorly nourished. An analysis conducted in 2016 highlighted several issues, ranging from institutional arrangements, shortfall in domestic resources, to challenges related to the quality of service delivery. Some of the issues highlighted relate to inadequate staffing, insufficient and unpredictable funding, need for stronger coordination of nutrition activities, and the inadequate capacity and high attrition rates within the public sector partners impacting on both the coverage and quality of services.
In addition, caregivers have limited knowledge on nutrient-rich foods as recommended by the Infant and Young Child Feeding guidelines. Children are mainly fed with high carbohydrate foods such as millet or corn flour porridge. Often, foods that are rich in protein, vitamins and minerals are not included in the diet.
These statistics highlight a problem with malnutrition in The Gambia, for which serious efforts are required to reverse the trend.
Despite the wide gaps in nutrition, there has been considerable reduction in the number of malnourished children over the past decade. For example, stunting among children under 5 years has reduced over the past 10 years from 23.4 per cent in 2010 to 19.0 per cent in 2018 (MICS 2018). Stunting, however, remains relatively high in rural areas such as Kuntaur 26.6 per cent, Janjangbureh 24.3 per cent and Kerewan 20.8 per cent compared to 16.6 per cent in Banjul and 14.4 per cent in Kanifing Municipality. The statistics confirm the marked disparities between rural and urban areas. Similarly, while the prevalence of wasting has also reduced (from 9.5 per cent to 6 per cent between 2010 and 2018), rural children remain more wasted, 6.2 per cent, compared to 3.6 per cent in urban areas.
To ensure efficiency and sustainability, UNICEF is advocating for and supporting the Government of The Gambia to integrate nutrition in the provision of primary health care services across communities in The Gambia. When nutrition services are mainstreamed in the provision of basic health services, more parents will be reached with proper information and more children will eventually benefit from nutritious food.
Also, UNICEF supports the Government of The Gambia to strengthen capacities of service providers on Infant and Young Child Feeding Practices, as well as the treatment of Severe Acute Malnutrition. Our support cuts across various areas.
We support the development of equitable nutrition policies and strategies. We also support the strengthening of nutrition coordination mechanisms at the national and regional levels and continue to provide support to the National Nutrition Technical Advisory Committee, the Integrated Management of Acute Malnutrition (IMAM) Technical Working Group, the UN Nutrition Network, among others.
We also work with partners to strengthen the capacity of the Government and other partners in the delivery of nutrition services. This includes building the skills of health workers in nutrition, strengthening the supply chain management systems for Ready-to-Use Therapeutic Foods (RUTF) and other nutrition products, and strengthening the information and knowledge management systems. Our work also involves the promotion of social behavioural change communication as a critical component of community-level activities. This includes the training of facilitators, community social mobilizers, journalists, community champions, programme managers, health workers, CSOs, and researchers in community-based approaches.
Through our active work with government, we provide technical advice and support at the policy level to enhance institutional capacities, intersectoral coordination, nutrition financing and the development of various policies and plans on nutrition. We also support in promoting more innovation, knowledge management and evidence-generation to ensure that the needs of children and women are well researched and documented to adequately guide and inform programme and policy design.
We also work with partners to boost advocacy for and mobilisation of financial resources to support coordination and the provision of quality technical support to service delivery. Our work across the country and with diverse sets of partners also include fostering and leveraging partnership with different stakeholders, focusing on strengthening ongoing partnerships.
For more sustainable and long-term solution, UNICEF is supporting the integration of Nutrition specific activities into the Primary Health Care (PHC) Initiative and also the community level Integrated Community Case Management (ICCM) approach. Capacity of mothers and caregivers has been built to carry out MUAC assessment of their young children allowing early detection and treatment of malnutrition. This is part of support of resilience building of the communities.