Tanzania has made striking progress in many health indicators over the past decade, but not nutritional status.
Stunting currently affects 42 per cent of under five children, and is only a two percentage points lower than it was five years ago. The burden of stunting in Tanzania ranks third in Sub-Saharan Africa, after Ethiopia and the Democratic Republic of Congo.
Child underweight (16 percent) also remains at unacceptable levels, and the country is not on track to achieve the MDG 1 target to reduce underweight by one-half by the year 2015. There are pockets of very high acute malnutrition, including Zanzibar where 12 per cent of children are affected. About one third of children age 6-59 months are iron deficient and vitamin A deficient, 69 percent are anaemic, and over 18 million Tanzanians do not consume adequately iodized salt.
Inequities in child nutrition continue to persist. Children in the lowest household wealth quintile record the greatest stunting levels (48 percent) compared with children from the highest wealth quintile (26 percent).
The nutrition situation of adolescent girls and women in Tanzania is also alarming. About one third of women age 15-49 years are deficient in iron, vitamin A and iodine, two fifths of women are anaemic and one in ten women are undernourished. Malnourished adolescent girls and women are more likely to give birth to low birth weight infants, who are malnourished in childhood and later life, thus transferring undernutrition from one generation to the next.
The high levels of stunting in the country, affecting over three million children, constitute a silent emergency. Stunting does not generally receive the same attention as acute malnutrition or underweight because the effects are hidden and the threats to health and survival are not immediate.
However, the consequences of stunting are serious and long-lasting. In fact, height at the age of two years is the strongest predictor of future human capital.
The common assumption that increasing agriculture and food production will automatically lead to improvements in nutrition is therefore not valid. Iringa, Mbeya and Rukwa are among the five regions with the highest stunting and are all areas with high food production.
There are many causes of stunting and other forms of undernutrition, not just a lack of food. Children become malnourished if they suffer diseases that cause undernutrition or if they are unable to eat sufficient nutritious food. These two causes – diseases and inadequate dietary intake and – often occur together and are caused by multiple underlying factors including inadequate physical or economic access to food, poor health services, an unhealthy environment and inadequate caring practices for children and women. More basic causes include poverty, illiteracy, low status of women, social norms and behaviours.
Two of the most important caring practices for good nutrition in early life are breastfeeding and complementary feeding. Infants should be exclusively breastfed for the first six months of life. Breast milk provides all of the nutrients, vitamins and minerals an infant needs for growth for the first six months, and no other liquids or food are needed.
At 2-3 months, only 51 percent of infants are exclusively breastfed, and this falls to 23 percent by the age of 4-5 months. The duration of exclusively breastfeeding is on average only 2.5 months in mainland Tanzania and two weeks in Zanzibar. Complementary foods given to children are often carbohydrate-based and lack sufficient protein, minerals and vitamins. Many mothers lack the knowledge and support from other family members to exclusively breastfeed and feed their young children in the best way possible.
Why nutrition matters
In Tanzania malnutrition is a contributing factor in an estimated 130 child deaths every day. These children rarely starve to death, and their plight seldom makes headline news. They die because their immune systems are weakened through lack of essential nutrients, and so they easily succumb to common childhood diseases that they would otherwise be able to fight.
Beyond these daily tragedies, there are millions of children who fail to reach their potential because they have been deprived of essential nutrients for healthy growth and brain development. Children from communities that are iodine deficient can lose an average of 13.5 IQ points, and iron deficiency makes them tired and slow.
Undernourished children often miss and do less well at school, and are less productive in later life because short and weak adults cannot work as hard, making it very difficult for poor households to escape from poverty.
The threats of undernutrition to the economic growth of Tanzania are considerable. Recent analysis determined that vitamin and mineral deficiencies alone cost Tanzania TZS 650 billion (about US$ 390 million) in lost revenue each year, equivalent to 2.65 percent of GDP. Most of these losses are within the agriculture sector (almost TZS 400 billion), where physical stature and strength are critical to productivity.