Malnutrition a vast and persistent peril, says UNICEFTuesday, 16 December 1997: Malnutrition contributes to nearly seven million child deaths every year -- more than any infectious disease, war or natural disaster, according to the 1998 State of the World's Children report released by UNICEF today.
Where it does not kill, malnutrition can leave victims physically maimed, intellectually impaired and suffering from the consequences of a weakened immune system.
"The persistence of malnutrition has profound and frightening implications for children, society, and the future of humankind," said UNICEF Executive Director Carol Bellamy. "Yet this worldwide crisis has stirred little public alarm, despite substantial and growing scientific evidence of the danger."
While there have been dramatic reductions in malnutrition in some parts of the world, the overall number of malnourished children is on the rise. No less than half of all children under the age of five in South Asia and one-third of those in sub-Saharan Africa, as well as millions of children in industrialized countries, are malnourished.
Malnutrition is not only a "silent emergency" but a largely invisible one, the report found. Three-quarters of the children who die worldwide of causes related to malnutrition are what nutritionists describe as "mildly to moderately malnourished" and show no outward signs of problems.
Starvation of the kind arising from famines, war and other catastrophes, although much covered by world media, is responsible for only a tiny part of the worldwide nutrition crisis, the publications points out.
"Malnutrition is not a simple matter of whether a child can satisfy his or her appetite," Ms. Bellamy said. "A child who eats enough to avoid immediate hunger can still be malnourished. Good nutrition relies on a combination of adequate nutritious food, good health services and proper care for both pregnant women and children."
Malnutrition can take a variety of forms that contribute to each other, such as protein-energy malnutrition and deficiencies of micronutrients like iodine, iron and vitamin A. Malnutrition is chiefly a consequence of disease and inadequate dietary intake. But, according to the report, many more elements are involved, including discrimination against women, which results in women eating last and least, and in being denied the educational opportunities that would empower them to better care for themselves and for their children.
Malnourished women who become pregnant give birth to children who are already malnourished and whose ability to contribute to society as adults is diminished. Low-birthweight babies, for example, have IQs that average five points below that of healthy children. And women who are stunted -- the long-term result of their own low birthweight, a poor diet and repeated illness -- are more likely to die in childbirth, especially because of obstructed labour.
"While malnutrition has long been recognized as a consequence of poverty, it is increasingly clear that it is also a cause," Ms. Bellamy said.
But UNICEF says that recent breakthroughs in nutritional science could have yet undreamed-of benefits, not only for the general healthy development of children, but also in helping to limit and even prevent some major killer diseases.
"We now believe that good nutrition could be a key element in the fight against some of the world's greatest health challenges, including maternal mortality, malaria and even HIV/AIDS," Ms. Bellamy said. "And there is growing evidence that better nutrition in early childhood and during pregnancy may reduce the burden of heart disease, and other chronic and degenerative ailments, later in life."
One of the most exciting discoveries is of the power of vitamin A, which is found in such foods as eggs, butter, whole milk and liver. Studies show that deaths from diarrhoea can be reduced by 35 to 40 per cent if children are given vitamin A supplements. Other research shows that vitamin A could halve the number of deaths among children suffering from measles. A recent study in Nepal found that low-dose vitamin A supplements can reduce pregnancy related deaths dramatically - an average of 44 per cent among women in areas where vitamin A deficiency is widespread.
Although research is still inconclusive, it is believed that sufficient vitamin A intake may even be effective in reducing the spread of HIV/AIDS in countries where malnutrition is common. A study of HIV-infected women in Malawi concluded that vitamin A deficient women were four and a half times more likely to pass the virus on to their children than those with adequate vitamin A levels in their blood.
Supplements of vitamin A and zinc may boost children's resistance to malaria, which currently kills 600,000 young children each year. Moreover, zinc supplements seem to have a remarkable effect in reducing the toll of diarrhoea and pneumonia in poor countries.
"Like the breakthroughs in immunization in the 1980's, such simple, low-cost nutritional supplements could be one of the most significant new public health interventions for the late 1990's," Ms. Bellamy said.
Many such measures are already saving and improving lives. Sixty per cent of all edible salt in the world is now iodized, helping reduce the burden of iodine-deficiency disorders, which, until recently, was the world's leading cause of preventable mental retardation. Before 1990, approximately 40 million children were born each year at some risk of mental impairment due to iodine deficiency in their mothers' diets. By 1997 that figure was closer to 28 million.
In 1997, the lives of at least 300,000 young children were saved by vitamin A supplementation programmes in developing countries. Over 35 countries now routinely provide vitamin A supplements with immunizations or as part of health campaigns. UNICEF estimates that more than half of all young children, in countries where vitamin A deficiency is known to be common, received vitamin A capsules in 1996, compared to about one-third in 1994.
The report also offers many examples of dramatic improvements in overall malnutrition through community action. In Tanzania, severe malnutrition virtually disappeared and the lives of thousands of children were saved as the result of a community-based growth monitoring initiative which enabled parents to assess the nutritional well-being of their children and to take action for better child health. Common elements in all such success stories include committed political leadership and the involvement of communities themselves, especially women, in tackling their own problems.
But UNICEF is concerned that much more needs to be done to reduce the global toll of severe and moderate malnutrition.
Governments in poor and rich countries must show leadership and commitment and must provide funding to mount and support actions to combat malnutrition that can be implemented by communities themselves. The price of inaction is high, the report warns: Countless millions of children who are intellectually disabled, physically stunted and especially vulnerable to illness.
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